cheek either gradually ceases along with the pain of the diseased tooth;
or, by the accumulation of sensorial power during their state of torpor,
the capillaries of the cheek act with greater violence, and produce more
secretions, and heat, and consequent tumour, and inflammation. In this
state the pain of the diseased tooth ceases; as the sensorial power of
sensation is now expended on the inflamed vessels of the cheek. It is
probable that most other internal membranous inflammations begin in a
similar manner; whence there may seem to be a double kind of sensitive
association; first, with decreased action of the associated organ, and then
with increased action of it; but the latter is in this case simply the
consequence of the former; that is, the tumor or inflammation of the cheek
is in consequence of its previous quiescence or torpor.
2. _Stranguria a dolore vesicae._ The strangury, which has its origin from
pain at the neck of the bladder, consists of a pain in the external
extremity of the urethra or of the glans penis of men, and probably in the
external termination of the urethra or of the clitoris of women; and is
owing to the sympathy of these with some distant parts, generally with the
other end of the urethra; an endeavour and difficulty of making water
attends this pain.
Its remote cause is from the internal or external use of cantharides, which
stimulate the neck of the bladder; or from a stone, which whenever it is
pushed into the neck of the bladder, gives this pain of strangury, but not
at other times; and hence it is felt most severely in this case after
having made water.
The sensations or sensitive motions of the glans penis, and of the
sphincter of the bladder, have been accustomed to exist together during the
discharge of the urine; and hence the two ends of the urethra sympathize by
association. When there is a stone at the neck of the bladder, which is not
so large or rough as to inflame the part, the sphincter of the bladder
becomes stimulated into pain; but as the glans penis is for the purposes of
copulation more sensitive than the sphincter of the bladder, as soon as it
becomes affected with pain by the association above mentioned, the
sensation at the neck of the bladder ceases; and then the pain of the glans
penis would seem to be associated with the irritative motions only of the
sphincter of the bladder, and not with the sensitive ones of it. But a
circumstance similar to this occurs in epileptic fits, which at first are
induced by disagreeable sensation, and afterwards seem to occur without
previous pain, from the suddenness in which they follow and relieve the
pain, which occasioned them. From this analogy I imagine the pain of the
glans penis is associated with the pain of the sphincter of the bladder;
but that _as soon as the greater pain in a more sensible part is produced;
the lesser one, which occasioned it, ceases_; and that this is one of the
laws of sensitive association. See Sect. XXXV. 2. 1.
A young man had by an accident swallowed a large spoonful or more of
tincture of cantharides; as soon as he began to feel the pain of strangury,
he was advised to drink large quantities of warmish water; to which, as
soon as it could be got, some gum arabic was added. In an hour or two he
drank by intervals of a few minutes about two gallons of water, and
discharged his urine every four or five minutes. A little blood was voided
towards the end, but he suffered no ill consequence.
M. M. Warm water internally. Clysters of warm water. Fomentation. Opium.
Solution of fixed alkali supersaturated with carbonic acid. A bougie may be
used to push back a stone into the bladder. See Class I. 1. 3. 10.
3. _Stranguria convulsiva._ The convulsive strangury, like that before
described, is probably occasioned by the torpor or defective action of the
painful part in consequence of the too great expenditure of sensorial power
on the primary link of the associated motions, as no heat or inflammation
attends this violent pain. This kind of strangury recurs by stated periods,
and sometimes arises to so great a degree, that convulsion or temporary
madness terminates each period of it. It affects women oftener than men, is
attended with cold extremities without fever, and is distinguished from the
stone of the bladder by the regularity of its periods, and by the pain
being not increased after making water.
On introducing the catheter sometimes part of the urine will come away and
not the whole, which is difficult to explain; but may arise from the
weakness of the muscular fibres of the bladder; which are not liable
suddenly to contract themselves so far as to exclude the whole of the
urine. In some old people, who have experienced a long retention of urine,
the bladder never regains the power of completely emptying itself; and many
who are beginning to be weak from age can make water a second time, a few
minutes after they supposed they had emptied the bladder.
I have believed this pain to originate from sympathy with some distant
part, as from ascarides in the rectum, or from piles in women; or from
caruncles in the urethra about the caput gallinaginis in men; and that the
pain has been in the glans or clitoris by reverse sympathy of these more
sensible parts with those above mentioned.
M. M. Venesection. Opium in large quantities. Warm bath. Balsams. Bark.
Tincture of cantharides. Bougie, and the treatment for haemorrhoids.
Leeches applied to the sphincter ani. Aerated alcaline water. Soap and sal
soda. Opium in clysters given an hour before the expected return. Smoke of
tobacco in clysters. Arsenic?
4. _Dolor termini intestinalis ductus choledochi._ Pain at the intestinal
end of the gall-duct. When a gall-stone is protruded from the gall-bladder
a little way into the end of the gall-duct, the pain is felt at the other
end of the gall-duct, which terminates in the duodenum. For the actions of
the two terminations of this canal are associated together from the same
streams of bile passing through them in succession, exactly as the two
terminations of the urethra have their actions associated, as described in
Species 2 and 3 of this genus. But as the intestinal termination of the
bile-duct is made more sensible for the purpose of bringing down more bile,
when it is stimulated by new supplies of food from the stomach, it falls
into violent pain from association; and then the pain on the region of the
gall-bladder ceases, exactly as above explained in the account of the pain
of the glans penis from a stone in the sphincter of the bladder.
The common bile-duct opens into the intestine exactly at what is called the
pit of the stomach; and hence it has sometimes happened, that this pain
from association with the sensation of a gall-stone at the other end of the
bile-duct has been mistaken for a pain of the stomach.
For the method of cure see Class I. 1. 3. 8. to which should be added the
use of strong electric shocks passed through the bile-duct from the pit of
the stomach to the back, and from one side to the other. A case of the good
effect of electricity in the jaundice is related in Sect. XXX. 2. And
another case, where it promoted the passage of a painful gall-stone, is
described by Dr. Hall, experienced on himself. Trans. of the College at
Philadelphia, Vol. I. p. 192.
Half a pint of warm water two or three times a day is much recommended to
dilute the inspissated bile.
5. _Dolor pharyngis ab acido gastrico._ The two ends of the throat
sympathize by sensitive association in the same manner as the other canals
above mentioned, namely, the urethra and the bile-duct; hence when too
great acidity of undigested aliment, or the carbonic acid air, which
escapes in fermentation, stimulates the cardia ventriculi, or lower end of
the gula, into pain; the pharinx, or upper end of it, is affected with
greater pain, or a disagreeable sensation of heat.
6. _Pruritus narium a vermibus._ The itching of the nose from worms in the
intestines is another curious instance of the sensitive associations of the
motions of membranes; especially of those which constitute the canals of
the body. Previous to the deglutition of agreeable food, as milk in our
earliest infancy, an agreeable odour affects the membrane, which lines the
nostrils; and hence an association seems to take place between the
agreeable sensations produced by food in the stomach and bowels, and the
agreeable sensations of the nostrils. The existence of ascarides in the
rectum I believe produces this itching of the nostrils more than the worms
in other parts of the intestines; as we have already seen, that the
terminations of canals sympathize more than their other parts, as in the
urethra and gall-ducts. See Class I. 1. 5. 9. IV. 1. 2. 9.
7. _Cephalaea._ Head-ach. In cold fits of the ague, the head-ach arises
from consent with some torpid viscus, like the pain of the loins. After
drunkenness the head-ach is very common, owing to direct sympathy of the
membranes of the head with those of the stomach; which is become torpid
after the too violent stimulus of the preceding intoxication; and is hence
removeable by spirit of wine, or opium, exhibited in smaller quantities. In
some constitutions these head-achs are induced, when the feet are exposed
to much external cold; in this case the feet should be covered with oiled
silk, which prevents the evaporation of the perspirable matter, and thence
diminishes one cause of external cold.
M. M. Valerian in powder two drams three or four times a day is
recommended. The bark. Chalybeates. A grain of opium twice a day for a long
time. From five to ten drops of the saturated solution of arsenic two or
three times a day. See Class I. 2. 4. 11. A lady once assured me, that when
her head-ach was coming on, she drank three pints (pounds) of hot water, as
hastily as she could; which prevented the progress of the disease. A
solution of arsenic is recommended by Dr. Fowler of York. Very strong
errhines are said sometimes to cure head-achs taken at the times the pain
recurs, till a few drops of blood issue from the nostrils. As one grain of
turpeth mineral (vitriolic calx of mercury) mixed with ten grains of fine
sugar. Euphorbium or cayan pepper mixed with sugar, and used with caution
as an errhine. See the M. M. of the next Species.
8. _Hemicrania._ Pain on one side of the head. This disease is attended
with cold skin, and hence whatever may be the remote cause, the immediate
one seems to be want of stimulus, either of heat or distention, or of some
other unknown stimulus in the painful part; or in those, with which it is
associated. The membranes in their natural state are only irritable by
distention; in their diseased state, they are sensible like muscular
fibres. Hence a diseased tooth may render the neighbouring membranes
sensible, and is frequently the cause of this disease.
Sometimes the stomach is torpid along with the pained membrane of the head;
and then sickness and inappetency attends either as a cause or consequence.
The natural cure of hemicrania is the accumulation of sensorial power
during the rest or sickness of the patient. Mrs. ---- is frequently liable
to hemicrania with sickness, which is probably owing to a diseased tooth;
the paroxysm occurs irregularly, but always after some previous fatigue, or
other cause of debility. She lies in bed, sick, and without taking any
solid food, and very little of fluids, and those of the aqueous kind, and,
after about 48 or 50 hours, rises free from complaint. Similar to this is
the recovery from cold paroxysms of fever, from the torpor occasioned by
fear, and from syncope; which are all owing to the accumulation of
sensorial power during the inactivity of the system. Hence it appears,
that, though when the sensorial power of volition is much exhausted by
fatigue, it can be restored by eight or ten hours of sleep; yet, when the
sensorial power of irritation is exhausted by fatigue, that it requires two
whole solar or lunar days of rest, before it can be restored.
The late Dr. Monro asserted in his lectures, that he cured the hemicrania,
or megrim, by a strong vomit, and a brisk purge immediately after it. This
method succeeds best if opium and the bark are given in due quantity after
the operation of the cathartic; and with still more certainty, if bleeding
in small quantity is premised, where the pulse will admit of it. See Sect.
XXXV. 2. 1.
The pain generally affects one eye, and spreads a little way on that side
of the nose, and may sometimes be relieved by pressing or cutting the
nerve, where it passes into the bone of the orbit above the eye. When it
affects a small defined part on the parietal bone on one side, it is
generally termed Clavus hystericus, and is always I believe owing to a
diseased dens molaris. The tendons of the muscles, which serve the office
of mastication, have been extended into pain at the same time, that the
membranous coverings of the roots of the teeth have been compressed into
pain, during the biting or mastication of hard bodies. Hence when the
membranes, which cover the roots of the teeth, become affected with pain by
a beginning decay, or perhaps by the torpor or coldness of the dying part
of the tooth, the tendons and membranous fascia of the muscles about the
same side of the head become affected with violent pain by their sensitive
associations: and as soon as this associated pain takes place, the pain of
the tooth entirely ceases, as explained in the second species of this
genus.
A remarkable circumstance attends this kind of hemicrania, viz. that it
recurs by periods like those of intermittent fevers, as explained in the
Section on Catenation of Motions; these periods sometimes correspond with
alternate lunar or solar days like tertian agues, and that even when a
decaying tooth is evidently the cause; which has been evinced by the cure
of the disease by extracting the tooth. At other times they observe the
monthly lunations, and seem to be induced by the debility, which attends
menstruation.
The dens sapientiae, or last tooth of the upper jaw, frequently decays
first, and gives hemicrania over the eye on the same side. The first or
second grinder in the under-jaw is liable to give violent pain about the
middle of the parietal bone, or side of the head, on the same side, which
is generally called the Clavus hystericus, of which an instructive case is
related in Sect. XXXV. 2. 1.
M. M. Detect and extract the diseased tooth. Cut the affected nerve, or
stimulate the diseased membrane by acu-puncture. Venesection to six ounces
by the lancet or by leeches. A strong emetic and a subsequent cathartic;
and then an opiate and the bark. Pass small electric shocks through the
pained membrane, and through the teeth on the same side. Apply vitriolic
ether externally, and a grain of opium with camphor internally, to the
cheek on the affected side, where a diseased tooth may be suspected. Foment
the head with warm vinegar. Drink two large spoonfuls of vinegar. Stimulate
the gums of the suspected teeth by oil of cloves, by opium. See Class I. 1.
4. 4. Snuff volatile spirit of vinegar up the nostrils. Lastly, in
permanent head-achs, as in permanent vertigo, I have seen good effect by
the use of mercurial ointment rubbed on the shaved head or about the
throat, till a mild salivation commences, which by inflaming the membranes
of the teeth may prevent their irritative sympathy with those of the
cranium. Thus by inflaming the tendon, which is the cause of locked jaw,
and probably by inflaming the wound, which is the cause of hydrophobia,
those diseases may be cured, by disuniting the irritative sympathy between
those parts, which may not possess any sensitive sympathy. This idea is
well worth our attention.
_Otalgia._ Ear-ach is another disease occasioned by the sympathy of the
membranes of the ear with those which invest or surround a decaying tooth,
as I have had frequent reason to believe; and is frequently relieved by
filling the ear with tincture of opium. See Class I. 2. 4.
9. _Dolor humeri in hepatitide._ In the efforts of excluding the faeces and
urine the muscles of the shoulders are exerted to compress the air in the
lungs, that the diaphragm may be pressed down. Hence the distention of the
tendons or fibres of these muscles is associated with the distention of the
tendons or fibres of the diaphragm; and when the latter are pained by the
enlargement or heat of the inflamed liver, the former sympathize with them.
Sometimes but one shoulder is affected, sometimes both; it is probable that
many other pains, which are termed rheumatic, have a similar origin, viz.
from sensitive associations.
As no inflammation is produced in consequence of this pain of the shoulder,
it seems to be owing to inaction of the membranous part from defect of the
sensorial power of association, of which the primary link is the inflamed
membrane of the liver; which now expends so much of the sensorial power in
general by its increased action, that the membranes about the shoulder,
which are links of association with it, become deprived of their usual
share, and consequently fall into torpor.
10. _Torpor pedum in eruptione variolarum._ At the commencement of the
eruption of the small-pox, when the face and breast of children are very
hot, their extremities are frequently cold. This I ascribe to sensitive
association between the different parts of the skin; whence when a part
acts too violently, the other part is liable to act too weakly; and the
skin of the face being affected first in the eruption of the small-pox, the
skin of the feet becomes cold in consequence by reverse sympathy.
M. M. Cover the feet with flannel, and expose the face and bosom to cool
air, which in a very short time both warms the feet and cools the face; and
hence what is erroneously called a rash, but which is probably a too hasty
eruption of the small-pox, disappears; and afterwards fewer and more
distinct eruptions of the small-pox supervene.
11. _Testium dolor nephriticus._ The pain and retraction of the testicle on
the same side, when there is a stone in the ureter, is to be ascribed to
sensitive association; whether the connecting cause be a branch of the same
nerve, or from membranes, which have been frequently affected at the same
time.
12. _Dolor digiti minimi sympatheticus._ When any one accidentally strikes
his elbow against any hard body, a tingling pain runs down to the little
finger end. This is owing to sensitive association of motions by means of
the same branch of a nerve, as in hemicrania from a decaying tooth the pain
is owing to the sensitive association of tendons or membranes.
13. _Dolor brachii in hydrope pectoris._ The pain in the left arm which
attends some dropsies of the chest, is explained in Sect. XXIX. 5. 2. 10.
which resembles the pain of the little finger from a percussion of the
nerve at the elbow in the preceding article. A numbness of this kind is
produced over the whole leg, when the crural nerve is much compressed by
sitting for a time with one leg crossed over the other.
Mr. ----, about sixty, had for two years been affected with difficulty of
respiration on any exertion, with pain about the sternum, and of his left
arm; which last was more considerable than is usual in dropsy of the chest;
some months ago the pain of his arm, after walking a mile or two, became
excessive, with coldness and numbness; and on the next day the back of the
hand, and a part of the arm swelled, and became inflamed, which relieved
the pain; and was taken for the gout, and continued several days. He after
some months became dropsical both in respect to his chest and limbs, and
was six or seven times perfectly relieved by one dram of saturated tincture
of digitalis, taken two or three times a day for a few days in a glass of
peppermint water. He afterwards breathed oxygen gas undiluted, in the
quantity of six or eight gallons a day for three or four weeks without any
effect, and sunk at length from general debility.
In this instructive case I imagine the pressure or stimulus of one part of
the nerve within the chest caused the other part, which serves the arm, to
become torpid, and consequently cold by sympathy; and that the inflammation
was the consequence of the previous torpor and coldness of the arm, in the
same manner as the swelling and inflammation of the cheek in tooth-ach, in
the first species of this genus; and that many rheumatic inflammations are
thus produced by sympathy with some distant part.
14. _Diarrhoea a dentitione._ The diarrhoea, which frequently attends
dentition, is the consequence of indigestion; the aliment acquires chemical
changes, and by its acidity acts as a cathartic; and changes the yellow
bile into green, which is evacuated along with indigested parts of the
coagulum of milk. The indigestion is owing to the torpor of the stomach and
intestines caused by their association with the membranes of the gums,
which are now stimulated into great exertion with pain; both which
contribute to expend the general quantity of sensorial power, which belongs
to this membranous association; and thus the stomach and intestines act
with less than their natural energy. This is generally esteemed a
favourable symptom in difficult dentition, as the pain of the alveolar
membranes exhausts the sensorial power without producing convulsions for
its relief. See Class I. 1. 4. 5. And the diarrhoea ceases, as the tooth
advances.
* * * * *
ORDO II.
_Decreased Associate Motions._
GENUS III.
_Catenated with Voluntary Motions._
SPECIES.
1. _Titubatio linguae._ Impediment of speech is owing to the associations
of the motions of the organs of speech being interrupted or dissevered by
ill-employed sensation or sensitive motions, as by awe, bashfulness,
ambition of shining, or fear of not succeeding, and the person uses
voluntary efforts in vain to regain the broken associations, as explained
in Sect. XVII. 1. 10. and XVII. 2. 10.
The broken association is generally between the first consonant and the
succeeding vowel; as in endeavouring to pronounce the word parable, the p
is voluntarily repeated again and again, but the remainder of the word does
not follow, because the association between it and the next vowel is
dissevered.
M. M. The art of curing this defect is to cause the stammerer to repeat the
word, which he finds difficult to speak, eight or ten times without the
initial letter, in a strong voice, or with an aspirate before it, as
arable, or harable; and at length to speak it very softly with the initial
letter p, parable. This should be practised for weeks or months upon every
word, which the stammerer hesitates in pronouncing. To this should be added
much commerce with mankind, in order to acquire a carelessness about the
opinions of others.
2. _Chorea St. Viti._ In the St. Vitus's dance the patient can at any time
lie still in bed, which shews the motions not to be convulsive; and he can
at different times voluntarily exert every muscle of his body; which
evinces, that they are not paralytic. In this disease the principal muscle
in any designed motion obeys the will; but those muscles, whose motions
were associated with the principal one, do not act; as their association is
dissevered, and thus the arm or leg is drawn outward, or inward, or
backward, instead of upward or forward, with various gesticulations exactly
resembling the impediment of speech.
This disease is frequently left after the itch has been too hastily cured.
See Convulsio dolorifica, Class III. 1. 1. 6. A girl about eighteen, after
wearing a mercurial girdle to cure the itch, acquired the Chorea St. Viti
in so universal a manner, that her speech became affected as well as her
limbs; and there was evidently a disunion of the common trains of ideas; as
the itch was still among the younger children of the family, she was
advised to take her sister as a bedfellow, and thus received the itch
again; and the dance of St. Vitus gradually ceased. See Class II. 1. 5. 6.
M. M. Give the patient the itch again. Calomel a grain every night, or
sublimate a quarter of a grain twice a day for a fortnight. Steel. Bark.
Warm-bath. Cold-bath. Opium. Venesection once at the beginning of the
disease. Electricity. Perpetual slow and repeated efforts to move each limb
in the designed direction, as in the titubatio linguae above described.
3. _Risus._ Laughter is a perpetual interruption of voluntary exertion by
the interposition of pleasurable sensation; which not being checked by any
important consequences rises into pain, and requires to be relieved or
moderated by the frequent repetition of voluntary exertion. See Sect.
XXXIV. 1. 4. and Class III. 1. 1. 4. and IV. 1. 3. 3.
4. _Tremor ex ira._ The trembling of the limbs from anger. The interruption
of the voluntary associations of motions by anger, originates from too
great a part of the sensorial power being exerted on the organs of sense;
whence the muscles, which ought to support the body upright, are deprived
of their due quantity, and tremble from debility. See Class III. 2. 1. 1.
5. _Rubor ex ira._ Redness from anger. Anger is an excess of aversion, that
is of voluntarity not yet employed. It is excited by the pain of offended
pride; when it is employed it becomes outrage, cruelty, insanity. The
cutaneous capillaries, especially those of the face, are more mobile, that
is, more easily excited into increased action, or more easily become
torpid, from less variation of sensorial power, than any other parts of the
system, which is owing to their being perpetually subject to the
vicissitudes of heat and cold, and of extension and corrugation. Hence,
when an excess of voluntarity exists without being immediately expended in
the actions of the large muscles, the capillary arteries and glands acquire
more energetic action, and a flushed skin is produced, with increased
secretion of perspirable matter, and consequent heat, owing to the pause or
interruption of voluntary action; and thus the actions of these cutaneous
vessels become associated between the irascent ideas and irascent muscular
actions, which are thus for a time interrupted.
6. _Rubor criminati._ The blushing of accused people, whether guilty or
not, appears to be owing to circumstances similar to that of anger; for in
these situations there is always a sudden voluntarity, or wish, of clearing
their characters arises in the mind of the accused person; which, before an
opportunity is given for it to be expended on the large muscles, influences
the capillary arteries and glands, as in the preceding article. Whence the
increased actions of the capillaries, and the consequent redness and heat,
become exerted between the voluntary ideas of self-defence, and the
muscular actions necessary for that purpose; which last are thus for a time
interrupted or delayed.
Even in the blush of modesty or bashfulness there is a self-condemnation
for some supposed defect or indecorum, and a sudden voluntarity, or wish,
of self-defence; which not being expended in actions of the larger muscles
excites the capillaries into action; which in these subjects are more
mobile than in others.
The blush of young girls on coming into an assembly room, where they expect
their dress, and steps, and manner to be examined, as in dancing a minuet,
may have another origin; and may be considered as a hot fit of returning
confidence, after a previous cold fit of fear.
7. _Tarditas paralytica._ By a stroke of the palsy or apoplexy it
frequently happens, that those ideas, which were associated in trains,
whose first link was a voluntary idea, have their connection dissevered;
and the patient is under the necessity by repeated efforts slowly to renew
their associations. In this situation those words, which have the fewest
other words associated with them, as the proper names of persons or places,
are the most difficult to recollect. And in those efforts of recollection
the word opposite to the word required is often produced, as hot for cold,
winter for summer, which is owing to our associating our ideas of things by
their opposites as well as by their similitudes, and in some instances
perhaps more frequently, or more forcibly. Other paralytic patients are
liable to give wrong names to external objects, as using the word pigs for
sheep, or cows for horses; in this case the association between the idea of
the animal and the name of it is dissevered; but the idea of the class or
genus of the thing remains; and he takes a name from the first of the
species, which presents itself, and sometimes can correct himself, till he
finds the true one.
8. _Tarditas senilis._ Slowness of age. The difficulty of associating ideas
increases with our age; as may be observed from old people forgetting the
business of the last hour, unless they impress it strongly, or by frequent
repetition, though they can well recollect the transactions of their youth.
I saw an elderly man, who could reason with great clearness and precision
and in accurate language on subjects, which he had been accustomed to think
upon; and yet did not know, that he had rang the bell by his fire-side in
one minute afterwards; nor could then recollect the object he had wanted,
when his servant came.
Similar to this is the difficulty which old people experience in learning
new bodily movements, that is, in associating new muscular actions, as in
learning a new trade or manufactury. The trains of movements, which obey
volition, are the last which we acquire; and the first, which are
disassociated.
* * * * *
ORDO II.
_Decreased Associate Motions._
GENUS IV.
_Catenated with External Influences._
As the diseases, which obey solar or lunar periods, commence with torpor or
inactivity, such as the cold paroxysms of fevers, the torpor and consequent
pain of hemicrania, and the pains which precede the fits of epilepsy and
convulsion, it would seem, that these diseases are more generally owing to
the diminution than to the excess of solar or lunar gravitation; as the
diseases, which originate from the influence of the matter of heat, are
much more generally in this country produced by the defect than by the
excess of that fluid.
The periodic returns of so many diseases coincide with the diurnal,
monthly, and annual rounds of time; that any one, who would deny the
influence of the sun and moon on the periods of quotidian, tertian, and
quartan fevers, must deny their effect on the tides, and on the seasons. It
has generally been believed, that solar and lunar effect was exerted on the
blood; which was thus rendered more or less stimulant to the system, as
described in Sect. XXXII. 6. But as the fluid matter of gravitation
permeates and covers all things, like the fluid matter of heat; I am
induced to believe, that gravitation acts in its medium state rather as a
causa sine qua non of animal motion, like heat; which may disorder the
system chemically or mechanically, when it is diminished; but may
nevertheless stimulate it, when increased, into animal exertion.
Without heat and motion, which some philosophers still believe to be the
same thing, as they so perpetually appear together, the particles of matter
would attract and move towards each other, and the whole universe freeze or
coalesce into one solid mass. These therefore counteract the gravitation of
bodies to one center; and not only prevent the planets from falling into
the sun, but become either the efficient causes of vegetable and animal
life, or the causes without which life cannot exist; as by their means the
component particles of matter are enabled to slide over each other with all
the various degrees of fluidity and repulsion.
As the attraction of the moon countervails or diminishes the terrene
gravitation of bodies on the surface of the earth; a tide rises on that
side of the earth, which is turned towards the moon; and follows it, as the
earth revolves. Another tide is raised at the same time on the opposite
side of the revolving earth; which is owing to the greater centrifugal
motion of that side of the earth, which counteracts the gravitation of
bodies near its surface. For the earth and moon may be considered as two
cannon balls of different sizes held together by a chain, and revolving
once a month round a common center of gravity between them, near the
earth's surface; at the same time that they perform their annual orbits
round the sun. Whence the centrifugal force of that side of the earth,
which is farthest from this center of motion, round which the earth and
moon monthly revolve, is considerably greater, than the centrifugal force
of that side of the earth, which is nearest it; to which should be added,
that this centrifugal force not only contributes to diminish the terrene
gravitation of bodies on the earth's surface on that side furthest from
this center of motion, but also to increase it on that side, which is
nearest it.
Another circumstance, which tends to raise the tide on the part of the
earth's surface, which is most distant from the moon, is, that the
attraction of the moon is less on that part of the ocean, than it is on the
other parts of the earth. Thus the moon may be supposed to attract the
water on the side of the earth nearest it with a power equal to three; and
to attract the central parts of the earth with a power equal to two; and
the water on the part of the earth most distant from the moon with a power
only equal to one. Hence on the side of the earth most distant from the
moon, the moon's attraction is less, and the centrifugal force round their
common center of motion is greater; both which contribute to raise the
tides on that side of the earth. On the side of the earth nearest the moon,
the moon's attraction is so much greater as to raise the tides; though the
centrifugal force of the surface of the earth round their common center of
motion in some degree opposes this effect.
On these accounts, when the moon is in the zenith or nadir, the gravitation
of bodies on the earth's surface will be greatest at the two opposite
quadratures; that is, the greatest gravitation of bodies on the earth's
surface towards her center during the lunar day is about six hours and an
half after the southing, or after the northing of the moon.
Circumstances similar to these, but in a less degree, must occur in respect
to the solar influence on terrestrial bodies; that is, there must be a
diminution of the gravity of bodies, near the earth's surface at noon, when
the sun is over them; and also at midnight from the greater centrifugal
force of that side of the earth, which is most distant from the center,
round which the earth moves in her annual orbit, than on the side nearest
that center. Whence it likewise follows, that the gravitation of bodies
towards the earth is greatest about six hours after noon, and after
midnight.
Now when the sun and moon have their united gravitation on the same side of
the earth, as at the new moon; or when the solar attraction coincides with
the greater centrifugal motion of that side of the earth, which is furthest
distant from the moon, as at the full moon; and when this happens about
noon or midnight, the gravitation of terrene bodies towards the earth will
be greater about six hours after noon, and after midnight, than at any
other part of the lunar period; because the attraction of both these
luminaries is then exerted on those sides of the earth over which they
hang, which at other times of the month are more or less exerted on other
parts of it.
Lastly, as heat and motion counteract the gravitation of the particles of
bodies to each other, and hence become either the efficient causes of
vegetable and animal life, or the causes without which life cannot exist,
it seems to follow, that when our gravitation towards the earth's center is
greatest, the powers of life should be the least; and hence that those
diseases, which begin with torpor, should occur about six hours after the
solar or lunar noon, or about six hours after the solar or lunar midnight;
and this most frequently about six hours after or before the new or full
moon; and especially when these happen at noon or at midnight; or lastly,
according to the combination of these powers in diminishing or increasing
the earth's attraction to bodies on its surface.
The returns or exacerbations of many fevers, both irritative and
inflammatory, about six in the evening, and of the periodic cough described
in Sect. XXXVI. 3. 9. countenance this theory. Tables might be made out to
shew the combined powers of the sun and moon in diminishing the gravitation
of bodies on the earth's surface, at every part of their diurnal, monthly,
and annual periods; and which might facilitate the elucidation of this
subject. But I am well aware of the difficulty of its application to
diseases, and hope these conjectures may induce others to publish more
numerous observations, and more conclusive reasonings.
SPECIES.
1. _Somni periodus._ The periods of sleeping and of waking are shortened or
prolonged by so many other circumstances in animal life, besides the minute
difference between diurnal and nocturnal solar gravitation, that it can
scarcely be ascribed to this influence. At the same time it is curious to
observe, that vegetables in respect to their times of sleeping more
regularly observe the hour of the day, than the presence or absence of
light, or of heat, as may be seen by consulting the calendar of Flora.
Botanic Garden, Part II. Canto 2. l. 165. note.
Some diseases, which at first sight might be supposed to be influenced by
solar periods, seem to be induced by the increasing sensibility of the
system to pain during our sleeping hours; as explained in Sect. XVIII. 15.
Of these are the fits of asthma, of some epilepsies, and of some
haemoptoes; all which disturb the patient after some hours sleep, and are
therefore to be ascribed to the increase of our dormant sensibility. There
may likewise be some doubt, whether the commencement of the pain of gout in
the foot, as it generally makes its attack after sleep, should be ascribed
to the increased sensibility in sleep, or to solar influence?
M. M. When asthmatic or epileptic fits or haemoptoe occur after a certain
number of hours of sleep, the patient should be forcibly awakened before
the expected time by an alarm clock, and drink a cup of chocolate or
lemonade.--Or a grain of opium should be given at going to bed.--In one
case to prevent the too great increase of sensibility by shortening the
time of sleep; and in the other by increasing the irritative motions, and
expending by that means a part of the sensorial power.
2. _Studii inanis periodus._ Class III. 1. 2. 2. The cataleptic spasm which
preceded the reverie and somnambulation in the patient, whose case is
related in Sect. XIX. 2. occurred at exactly the same hour, which was about
eleven in the morning for many weeks; till those periods were disturbed by
large doses of opium; and must therefore be referred to some effect of
solar gravitation. In the case of Master A. Sect. XXXIV. 3. as the reverie
began early in the morning during sleep, there may be a doubt, whether this
commenced with torpor of some organ catenated with solar gravitation; or
was caused by the existence of a previous torpid part, which only became so
painful as to excite the exertions of reverie by the perpetual increase of
sensibility during the continuance of sleep, as in some fits of epilepsy,
asthma, and haemoptoe mentioned in the preceding article.
3. _Hemicraniae periodus._ Periods of hemicrania. Class IV. 2. 2. 8. The
torpor and consequent pain of some membranes on one side of the head, as
over one eye, is frequently occasioned by a decaying tooth, and is liable
to return every day, or on alternate days at solar or lunar periods. In
this case large quantities of the bark will frequently cure the disease,
and especially if preceded by venesection and a brisk cathartic; but if the
offending tooth can be detected, the most certain cure is its extraction.
These partial head-achs are also liable to return at the greater lunar
periods, as about once a month. Five drops from a two-ounce phial of a
saturated solution of arsenic twice a day for a week or two have been said
to prevent the returns of this disease. See a Treatise on Arsenic by Dr.
Fowler, of York. Strong errhines have also been recommended.
4. _Epilepsiae dolorificae periodus._ Class III. 1. 1. 8. The pain which
induces after about an hour the violent convulsions or insanity, which
constitute the painful epilepsy, generally observe solar diurnal periods
for four or five weeks, and are probably governed by solar and lunar times
in respect to their greater periods; for I have observed that the daily
paroxysms, unless disturbed by large doses of opium, recur at very nearly
the same hour, and after a few weeks the patients have recovered to relapse
again at the interval of a few months. But more observations are wanted
upon this subject, which might be of great advantage in preventing the
attacks of this disease; as much less opium given an hour before its
expected daily return will prevent the paroxysm, than is necessary to cure
it, after it has commenced.
5. _Convulsionis dolorificae periodus._ Class III. 1. 1. 6. The pains,
which produce these convulsions, are generally left after rheumatism, and
come on when the patients are become warm in bed, or have been for a short
time asleep, and are therefore perhaps rather to be ascribed to the
increasing sensibility of the system during sleep, than to solar diurnal
periods, as in Species first and second of this Genus.
6. _Tussis periodicae periodus._ Periodic cough, Class IV. 2. 1. 9. returns
at exact solar periods; that described in Sect. XXXVI. 3. 9. recurred about
seven in the afternoon for several weeks, till its periods were disturbed
by opium, and then it recurred at eleven at night for about a week, and was
then totally destroyed by opium given in very large quantities, after
having been previously for a few days omitted.
7. _Catameniae periodus._ Periods of menstruation. The correspondence of
the periods of the catamenia with those of the moon was treated of in Sect.
XXXII. 6. and can admit of no more doubt, than that the returns of the
tides are governed by lunar influence. But the manner in which this is
produced, is less evident; it has commonly been ascribed to some effect of
the lunar gravitation on the circulating blood, as mentioned in Sect.
XXXII. 6. But it is more analogous to other animal phenomena to suppose
that the lunar gravitation immediately affects the solids by its influx or
stimulus. Which we believe of the fluid element of heat, in which we are
equally immersed; and of the electric fluid, which also surrounds and
pervades us. See Sect. XXXVI. 2. 3.
If the torpor of the uterine veins, which induces the monthly periods of
the catamenia, be governed by the increase of terrene gravitation; that is,
by the deficiency of the counter-influence of solar and lunar gravitation;
why does not it occur most frequently when the terrene gravitation is the
greatest, as about six hours after the new moon, and next to that at about
six hours after the full moon? This question has its difficulty; first, if
the terrene gravitation be greatest about six hours after the new moon, it
must become less and less about the same time every lunar day, till the end
of the first quarter, when it will be the least; it must then increase
daily till the full. After the full the terrene gravitation must again
decrease till the end of the third quarter, when it will again be the
least, and must increase again till the new moon; that is, the solar and
lunar counter-gravitation is greatest, when those luminaries are vertical,
at the new moon, and full moon, and least about six hours afterwards. If it
was known, whether more menstruations occur about six hours after the moon
is in the zenith or nadir; and in the second and fourth quarters of the
moon, than in the first and third; some light would be thrown on this
subject; which must in that respect wait for future observations.
Secondly, if the lunar influence produces a very small degree of
quiescence, suppose of the uterine veins, at first; and if that recurs at
certain periods, as of lunar days, or about 25 hours, even with less power
to produce quiescence than at first; yet the quiescence will daily increase
by the acquired habit acting at the same time, as explained in Sect. XII.
3. 3. till at length so great a degree of quiescence will be induced as to
cause the inaction of the veins of the uterus, and consequent venous
haemorrhage. See Sect. XXXII. 6. Class I. 2. 1. 11. IV. 1. 4. 4. See the
introduction to this Genus.
8. _Haemorrhoidis periodus._ The periods of the piles depend on the torpor
of the veins of the rectum, and are believed to recur nearly at monthly
intervals. See Sect. XXVII. 2. and Class I. 2. 1. 6.
9. _Podagrae periodus._ The periods of gout in some patients recur at
annual intervals, as in the case related above in Class IV. 1. 2. 15. in
which the gouty paroxysm returned for three successive years on nearly the
same day of the month. The commencement of the pain of each paroxysm is
generally a few hours after midnight, and may thence either be induced by
diurnal solar periods, or by the increasing sensibility during sleep, as
mentioned in the first species of this genus.
10. _Erysipelatis periodus._ Some kinds of erysipelas which probably
originate from the association of the cutaneous vessels with a diseased
liver, occur at monthly periods, like the haemorrhois or piles; and others
at annual periods like the gout; as a torpor of some part I suppose always
precedes the erysipelatous inflammation, the periods should accord with the
increasing influence of terrene gravitation, as described in the
introduction to this Genus, and in Species the seventh of it. Other periods
of diseases referable to solar and lunar influence are mentioned in Sect
XXXVI. and many others will probably be discovered by future observation.
11. _Febrium periodus._ Periods of fevers. The commencement of the cold
fits of intermittent fevers, and the daily exacerbations of other fevers,
so regularly recur at diurnal solar or lunar periods, that it is impossible
to deny their connection with gravitation; as explained in Sect. XXXVI. 3.
Not only these exacerbations of fever, and their remissions, obey the
diurnal solar and lunar periods; but the preparatory circumstances, which
introduce fevers, or which determine their crisises, appear to be governed
by the parts of monthly lunar periods, and of solar annual ones. Thus the
variolous fever in the natural small-pox commences on the 14th day, and in
the inoculated small-pox on the seventh day. The fever and eruption in the
distinct kind take up another quarter of a lunation, and the maturation
another quarter.
The fever, which is termed canine madness, or hydrophobia, is believed to
commence near the new or full moon; and, if the cause is not then great
enough to bring on the disease, it seems to acquire some strength, or to
lie dormant, till another, or perhaps more powerful lunation calls it into
action. In the spring, about three or four years ago, a mad dog very much
worried one swine confined in a sty, and bit another in the same sty in a
less degree; the former became mad, refused his meat, was much convulsed,
and died in about four days; this disease commenced about a month after the
bite. The other swine began to be ill about a month after the first, and
died in the same manner.
* * * * *
ORDO III.
_Retrograde Associate Motions._
GENUS I.
_Catenated with Irritative Motions._
Those retrograde associate motions, the first links of which are catenated
with irritative motions, belong to this genus. All the retrograde motions
are consequent to debility, or inactivity, of the organ; and therefore
properly belong to the genera of decreased actions both in this and the
former classes.
SPECIES.
1. _Diabaetes irritata._ When the absorbents of the intestines are
stimulated too strongly by spirit of wine, as in the beginning of
drunkenness, the urinary absorbents invert their motions. The same happens
from worms in the intestines. In other kinds of diabetes may not the remote
cause be the too strong action of the cutaneous absorbents, or of the
pulmonary ones? May not in such cases oil externally or internally be of
service? or warm bathing for an hour at a time? In hysteric inversions of
motion is some other part too much stimulated? or pained from the want of
stimulus?
2. _Sudor frigidus in asthmate._ The cause of the paroxysms of humoral
asthma is not well understood; I suppose it to be owing to a torpidity or
inaction of the absorbents belonging to the pulmonary vessels, as happens
probably to other viscera at the commencement of intermittent fevers, and
to a consequent accumulation of fluids in them; which at length producing
great irritation or uneasy sensation causes the violent efforts to produce
the absorption of it. The motions of the cutaneous absorbent vessels by
their association with those of the pulmonary ones become retrograde, and
effuse upon the skin a fluid, which is said to be viscid, and which adheres
in drops.
A few days ago I saw a young man of delicate constitution in what was
called a fit of the asthma; he had about two months before had a
peripneumony, and had been ever since subject to difficult respiration on
exertion, with occasional palpitation of his heart. He was now seized about
eight at night after some exertion of mind in his business with cold
extremities, and difficulty of breathing. He gradually became worse, and in
about half an hour, the palpitation of his heart and difficult respiration
were very alarming; his whole skin was cold and pale, yet he did not
shudder as in cold paroxysm of fever; his tongue from the point to the
middle became as cold as his other extremities, with cold breath. He seemed
to be in the act of dying, except that his pulse continued equal in time,
though very quick. He lost three ounces of blood, and took ten drops of
laudanum with musk and salt of hartshorn, and recovered in an hour or two
without any cold sweat.
There being no cold sweat seems to indicate, that there was no accumulation
of serous fluid in the lungs; and that their inactivity, and the coldness
of the breath, was owing to the sympathy of the air-cells with some distant
part. There was no shuddering produced, because the lungs are not sensible
to heat and cold; as any one may observe by going from a warm room into a
frosty air, and the contrary. So the steam of hot tea, which scalds the
mouth, does not affect the lungs with the sensation of heat. I was induced
to believe, that the whole cold fit might be owing to suppuration in some
part of the chest; as the general difficulty of breathing seemed to be
increased after a few days with pulse of 120, and other signs of empyema.
Does the cold sweat, and the occurrence of the fits of asthma after sleep,
distinguish the humoral asthma from the cold paroxysm of intermittents, or
which attends suppuration, or which precedes inflammation?--I heard a few
weeks afterwards, that he spit up much matter at the time he died.
3. _Diabaetes a timore._ The motions of the absorbent vessels of the neck
of the bladder become inverted by their consent with those of the skin;
which are become torpid by their reverse sympathy with the painful ideas of
fear, as in Sect. XVI. 8. 1. whence there is a great discharge of pale
urine, as in hysteric diseases.
The same happens from anxiety, where the painful suspense is continued,
even when the degree of fear is small; as in young men about to be examined
for a degree at the universities the frequency of making water is very
observable. When this anxiety is attended with a sleepless night, the
quantity of pale urine is amazingly great in some people, and the
micturition very frequent.
M. M. Opium. Joy. Consolations of friendship.
4. _Diarrhoea a timore._ The absorbent vessels of the intestines invert
their motions by direct consent with the skin; hence many liquid stools as
well as much pale urine are liable to accompany continued fear, along with
coldness of the skin. The immediate cause of this is the decreased
sensorial power of association, which intervenes between the actions of the
absorbents of the cold skin, and those of the intestinal absorbents; the
motions of the latter become on that account weakened and at length
retrograde. The remote cause is the torpor of the vessels of the skin
catenated with the pain of fear, as explained in Sect. XVI. 8. 1.
The capillaries of the skin consent more generally by direct sympathy with
those of the lower intestines, and of the bladder; but by reverse sympathy
more generally with those of the stomach and upper intestines. As appears
in fevers, where the hot skin accompanies indigestion of the stomach; and
in diarrhoeas attended with cold extremities.
The remote cause is the torpor of the skin owing to its reverse sympathy
with the painful sensual motions, or ideas, of fear; which are now actuated
with great energy, so as to deprive the second link of associated motions
of their due share of sensorial power. It is also probable, that the pain
of fear itself may contribute to exhaust the sensorial power, even when it
produces no muscular action. See Class IV. 2. 2.
5. _Pallor et tremor a timore._ A retrograde action of the capillaries of
the skin producing paleness, and a torpor of the muscular fibres of the
limbs occasioning trembling, are caused by their reverse associations with
the ideas or imaginations of fear; which are now actuated with violent
energy, and accompanied with great pain. The cause of these associations
are explained in Sect XVI. 8. 1.
These torpid actions of the capillaries and muscles of the limbs are not
caused immediately by the painful sensation of fear; as in that case they
would have been increased and not decreased actions, as occurs in anger;
where the painful volition increases the actions of the capillaries,
exciting a blush and heat of the skin. Whence we may gain some knowledge of
what is meant by depressing and exciting passions; the former confiding of
ideas attended with pain, which pain occasions no muscular actions, like
the pain of cold head-ach; the latter being attended with volitions, and
consequent muscular exertions.
That is, the pain of fear, and the pain of anger, are produced by the
exertion of certain ideas, or motions of certain nerves of sense; in the
former case, the painful sensation of fear produces no muscular actions,
yet it exhausts or employs so much sensorial power, that the whole system
acts more feebly, or becomes retrograde; but some parts of it more so than
others, according to their early associations described in Sect. XVI. 8. 1.
hence the tremor of the limbs, palpitation of heart, and even syncope. In
anger the painful volition produces violent muscular actions; but if
previous to these any deliberation occurs, a flushed countenance sometimes,
and a red skin, are produced by this superabundance of volition exerted on
the arterial system; but at other times the skin becomes pale, and the legs
tremble, from the exhaustion or expenditure of the sensorial power by the
painful volitions of anger on the organs of sense, as by the painful
sensations of fear above mentioned.
Where the passion of fear exists in a great degree, it exhausts or expends
so much sensorial power, either simply by the pain which attends it, or by
the violent and perpetual excitement of the terrific imaginations or ideas,
that not only a cold and pale skin, but a retrograde motion of the
cutaneous absorbents occurs, and a cold sweat appears upon the whole
surface of the body, which probably sometimes increases pulmonary
absorption; as in Class II. 1. 6. 4. and as in the cold sweats, which
attend the paroxysms of humoral asthma. Hence anxiety, which is a continued
pain of fear, so universally debilitates the constitution as to occasion a
lingering death; which happens much more frequently than is usually
supposed; and these victims of continued anxiety are said to die of a
broken heart. Other kinds of paleness are described in Class I. 2. 2. 2.
M. M. Opium. Wine. Food. Joy.
6. _Palpitatio cordis a timore._ The palpitation of the heart from fear is
owing to the weak action of it, and perhaps sometimes to the retrograde
exertion of the ventricules and auricles; because it seems to be affected
by its association with the capillaries, the actions of which, with those
of the arteries and veins, constitute one great circle of associate
motions. Now when the capillaries of the skin become torpid, coldness and
paleness succeed; and with these are associated the capillaries of the
lungs, whence difficult respiration; and with these the weak and retrograde
actions of the heart. At the same time the absorbents of the skin, and of
the bladder, and of the intestines, sometimes become retrograde, and
regurgitate their contents; as appears by the pale urine in large
quantities, which attends hysteric complaints along with this palpitation
of the heart; and from the cold sweats, and diarrhoea; all which, as well
as the hysteric complaints, are liable to be induced or attended by fear.
When fear has still more violently affected the system, there have been
instances where syncope, and sudden death, or a total stoppage of the
circulation, have succeeded: in these last cases, the pain of fear has
employed or exhausted the whole of the sensorial power, so that not only
those muscular fibres generally exerted by volition cease to act, whence
the patient falls down; and those, which constitute the organs of sense,
whence syncope; but lastly those, which perform the vital motions, become
deprived of sensorial power, and death ensues. See Class. I. 2. 1. 4. and
I. 2. 1. 10. Similar to this in some epileptic fits the patient first
suddenly falls down, without even endeavouring to save himself by his hands
before the convulsive motions come on. In this case the great exertion of
some small part in consequence of great irritation or sensation exhausts
the whole sensorial power, which was lodged in the extremities of the
locomotive nerves, for a short time, as in syncope; and as soon as these
muscles are again supplied, convulsions supervene to relieve the painful
sensation. See Class III. 1. 1. 7.
7. _Abortio a timore._ Women miscarry much more frequently from a fright,
than from bodily injury. A torpor or retrograde motion of the capillary
arteries of the internal uterus is probably the immediate cause of these
miscarriages, owing to the association of the actions of those vessels with
the capillaries of the skin, which are rendered torpid or retrograde by
fear. By this contraction of the uterine arteries, the fine vessels of the
placenta, which are inserted into them, are detruded, or otherwise so
affected, that the placenta separates at this time from the uterus, and the
fetus dies from want of oxygenation. A strong young woman, in the fifth or
sixth month of her pregnancy, who has since borne many children, went into
her cellar to draw beer; one of the servant boys was hid behind a barrel,
and started out to surprise her, believing her to be the maid-servant; she
began to flood immediately, and miscarried in a few hours. See Sect. XXXIX.
6. 5. and Class I. 2. 1. 14.
8. _Hysteria a timore._ Some delicate ladies are liable to fall into
hysteric fits from sudden fright. The peristaltic motions of the bowels and
stomach, and those of the oesophagus, make a part of the great circle of
irritative motions with those of the skin, and many other membranes. Hence
when the cutaneous vessels become torpid from their reverse sympathy with
the painful ideas of fear; these of the bowels, and stomach, and
oesophagus, become first torpid by direct sympathy with those of the skin,
and then feebly and ineffectually invert the order of their motions, which
constitutes a paroxysm of the hysteric disease. See Class I. 3. 1. 10.
These hysteric paroxysms are sometimes followed by convulsions, which
belong to Class III. as they are exertions to relieve pain; and sometimes
by death. See Species 9 of this Genus, and Class I. 2. 1. 4.
Indigestion from fear is to be ascribed in the same manner to the torpor of
the stomach, owing to its association with the skin. As in Class IV. 1. 2.
5. IV. 2. 1.
* * * * *
ORDO III.
_Retrograde Associate Motions._
GENUS II.
_Catenated with Sensitive Motions._
SPECIES.
1. _Nausea idealis._ Nausea from disgustful ideas, as from nauseous
stories, or disgustful sights, or smells, or tastes, as well as vomiting
from the same causes, consists in the retrograde actions of the lymphatics
of the throat, and of the oesophagus, and stomach; which are associated
with the disgustful ideas, or sensual motions of sight, or hearing, or
smell, or taste; for as these are decreased motions of the lymphatics, or
of the oesophagus, or stomach, they cannot immediately be excited by the
sensorial power of painful sensation, as in that case they ought to be
increased motions. So much sensorial power is employed for a time on the
disgustful idea, or expended in the production of inactive pain, which
attends it, that the other parts of the associated chain of action, of
which this disgustful idea is now become a link, is deprived of their
accustomed share; and therefore first stop, and then invert their motions.
Owing to deficiency of sensorial power, as explained more at large in Sect.
XXXV. 1. 3.
2. _Nausea a conceptu._ The nausea, which pregnant women are so subject to
during the first part of gestation, is owing to the reverse sympathy
between the uterus and stomach, so that the increased action of the former,
excited by the stimulus of the growing embryon, which I believe is
sometimes attended with sensation, produces decreased actions of the latter
with the disagreeable sensation of sickness with indigestion and consequent
acidity. When the fetus acquires so much muscular power as to move its
limbs, or to turn itself, which is called quickening, this sickness of
pregnancy generally ceases.
M. M. Calcined magnesia. Rhubarb. Half a grain of opium twice a day.
Recumbent posture on a sofa.
3. _Vomitio vertiginosa._ Sea-sickness, the irritative motions of vision,
by which we balance ourselves, and preserve our perpendicularity, are
disturbed by the indistinctness of their objects; which is either owing to
the similarity of them, or to their distance, or to their apparent or
unusual motions. Hence these irritative motions of vision are exerted with
greater energy, and are in consequence attended with sensation; which, at
first is agreeable, as when children swing on a rope; afterwards the
irritative motions of the stomach, and of the absorbent vessels, which open
their mouths into it, become inverted by their associations with them by
reverse sympathy.
For the action of vomiting, as well as the disagreeable sensation of
sickness, are shewn to be occasioned by defect of the sensorial power;
which in this case is owing to the greater expenditure of it by the sense
of vision. On the same account the vomiting, which attends the passage of a
stone through the ureter, or from an inflammation of the bowels, or in the
commencement of some fevers, is caused by the increased expenditure of the
sensorial power by the too great action of some links of the associations
of irritative motions; and there being in consequence a deficiency of the
quantity required for other links of this great catenation.
It must be observed, that the expenditure of sensorial power by the retinas
of the eyes is very great; which may be estimated by the perpetual use of
those organs during our waking hours, and during most of our sleeping ones;
and by the large diameters of the two optic nerves, which are nearly the
size of a quill, or equal to some of the principal nerves, which serve the
limbs.
4. _Vomitio a calculo in uretere._ The action of vomiting in consequence of
the increased or decreased actions of the ureter, when a stone lodges in
it. The natural actions of the stomach, which consist of motions subject to
intermitted irritations from the fluids, which pass through it, are
associated with those of the ureter; and become torpid, and consequently
retrograde, by intervals, when the actions of the ureter becomes torpid
owing to previous great stimulus from the stone it contains; as appears
from the vomiting existing when the pain is least. When the motions of the
ureter are thus lessened, the sensorial power of association, which ought
to actuate the stomach along with the sensorial power of irritation, ceases
to be excited into action; and in consequence the actions of the stomach
become less energetic, and in consequence retrograde.
For as vomiting is a decreased action of the stomach, as explained in Sect.
XXXV. 1. 3. it cannot be supposed to be produced by the pain of gravel in
the ureter alone, as it should then be an increased action, not a decreased
one.
The perpetual vomiting in ileus is caused in like manner by the defective
excitement of the sensorial power of association by the bowel, which is
torpid during the intervals of pain; and the stomach sympathizes with it.
See Enteritis, Class II. 1. 2. 11. Does this symptom of vomiting indicate,
whether the disease be above or below the valve of the colon? Does not the
softer pulse in some kinds of enteritis depend on the sympathy of the heart
and arteries with the sickness of the stomach? See Ileus and Cholera.
Hence this sickness, as well as the sickness in some fevers, cannot be
esteemed an effort of nature to dislodge any offensive material; but like
the sea-sickness described above, and in Sect. XX. 4. is the consequence of
the associations of irritative or sensitive motions. See Class I. 1. 3. 9.
5. _Vomitio ab insultu paralytico._ Paralytic affections generally commence
with vomiting, the same frequently happens from a violent blow with a stick
on the head; this curious connection of the brain and stomach has not been
explained; as it resembles the sickness in consequence of vertigo at sea,
it would seem to arise from a similar cause, viz. from disturbed irritative
or sensitive associations.
6. _Vomitio a titillatione faucium._ If the throat be slightly tickled with
a feather, a nausea is produced, that is, an inverted action of the mouths
of the lymphatics of the fauces, and by direct sympathy an inverted action
of the stomach ensues. As these parts have frequently been stimulated at
the same time into pleasurable action by the deglutition of our daily
aliment, their actions become strongly associated. And as all the food, we
swallow, is either moist originally, or mixed with our moist saliva in the
mouth; a feather, which is originally dry, and which in some measure repels
the moist saliva, is disagreeable to the touch of the fauces; at the same
time this nausea and vomiting cannot be caused by the disagreeable
sensation simply, as then they ought to have been increased exertions, and
not decreased ones, as shewn in Section XXXV. 1. 3. But the mouths of the
lymphatics of the fauces are stimulated by the dry feather into too great
action for a time, and become retrograde afterwards by the debility
consequent to too great previous stimulus.
7. _Vomitio cute sympathetica._ Vomiting is successfully stopped by the
application of a blister on the back in some fevers, where the extremities
are cold, and the skin pale. It was stopped by Sydenham by producing a
sweat on the skin by covering the head with the bed-clothes. See Class IV.
1. 1. 3. and Suppl. I. 11. 6.
* * * * *
ORDO III.
_Retrograde Associate Motions._
GENUS III.
_Catenated with Voluntary Motions._
SPECIES.
1. _Ruminatio._ In the rumination of horned cattle the food is brought up
from the first stomach by the retrograde motions of the stomach and
oesophagus, which are catenated with the voluntary motions of the abdominal
muscles.
2. _Vomitio voluntaria._ Voluntary vomiting. Some human subjects have been
said to have obtained this power of voluntary action over the retrograde
motions of the stomach and oesophagus, and thus to have been able to empty
their stomach at pleasure. See Sect. XXV. 6. This voluntary act of emptying
the stomach is possessed by some birds, as the pigeon; who has an organ for
secreting milk in its stomach, as Mr. Hunter observed; and softens the food
for its young by previously swallowing it; and afterwards putting its bill
into theirs returns it into their mouths. See Sect. XXXIX. 4. 8. The
pelicans use a stomach, or throat bag, for the purpose of bringing the
fish, which they catch in the sea to shore, and then eject them, and eat
them at their leisure. See Sect. XVI. 11. And I am well informed of a
bitch, who having puppies in a stable at a distance from the house,
swallowed the flesh-meat, which was given her, in large pieces, and
carrying it immediately to her whelps, brought it up out of her stomach,
and laid it down before them.
3. _Eructatio voluntaria._ Voluntary eructation. Some, who have weak
digestions, and thence have frequently been induced to eruct the quantity
of air discharged from the fermenting aliment in their stomachs, have
gradually obtained a power of voluntary eructation, and have been able thus
to bring up hogsheads of air from their stomachs, whenever they pleased.
This great quantity of air is to be ascribed to the increase of the
fermentation of the aliment by drawing off the gas as soon as it is
produced. See Sect. XXIII. 4.
* * * * *
ORDO III.
_Retrograde Associate Motions._
GENUS. IV.
_Catenated with External Influences._
SPECIES.
1. _Catarrhus periodicus._ Periodical catarrh is not a very uncommon
disease; there is a great discharge of a thin saline mucous material from
the membranes of the nostrils, and probably from the maxillary and frontal
sinuses, which recur once a day at exact solar periods; unless it be
disturbed by the exhibition of opium; and resembles the periodic cough
mentioned below. See Class I. 3. 2. 1. It is probably owing to the
retrograde action of the lymphatics of the membranes affected, and produced
immediately by solar influence.
2. _Tussis periodica._ Periodic cough, called nervous cough, and tussis
serina. It seems to arise from a periodic retrograde action of the
lymphatics of the membrane, which lines the air-cells of the lungs. And the
action of coughing, which is violently for an hour or longer, is probably
excited by the stimulus of the thin fluid thus produced, as well as by the
disagreeable sensation attending membranous inactivity; and resembles
periodic catarrh not only in its situation on a mucous membrane, but in the
discharge of a thin fluid. As it is partly restrainable, it does not come
under the name of convulsion; and as it is not attended with difficult
respiration, it cannot be called asthma; it is cured by very large doses of
opium, see a case and cure in Sect. XXXVI. 3. 9. see Class IV. 2. 4. 6. and
seems immediately to be induced by solar influence.
3. _Histeria a frigore._ Hysteric paroxysms are occasioned by whatever
suddenly debilitates the system, as fear, or cold, and perhaps sometimes by
external moisture of the air, as all delicate people have their days of
greater or less debility, see Class IV. 3. 1. 8.
4. _Nausea pluvialis._ Sickness at the commencement of a rainy season is
very common among dogs, who assist themselves by eating the agrostris
canina, or dog's grass, and thus empty their stomachs. The same occurs with
less frequency to cats, who make use of the same expedient. See Sect. XVI.
11. I have known one person, who from his early years has always been sick
at the beginning of wet weather, and still continues so. Is this owing to a
sympathy of the mucous membrane of the stomach with the mechanical
relaxation of the external cuticle by a moister atmosphere, as is seen in
the corrugated cuticle of the hands of washing-women? or does it sympathize
with the mucous membrane of the lungs, which must be affected along with
the mucus on its surface by the respiration of a moister atmosphere?
* * * * *
SUPPLEMENT TO CLASS IV.
_Sympathetic Theory of Fever._
As fever consists in the increase or diminution of direct or reverse
associated motions, whatever may have been the remote cause of them, it
properly belongs to the fourth class of diseases; and is introduced at the
end of the class, that its great difficulties might receive elucidation
from the preceding parts of it. These I shall endeavour to enumerate under
the following heads, trusting that the candid reader will discover in these
rudiments of the theory of fever a nascent embryon, an infant Hercules,
which Time may rear to maturity, and render serviceable to mankind.
I. Simple fever of two kinds.
II. Compound fever.
III. Termination of the cold fit.
IV. Return of the cold fit.
V. Sensation excited in fever.
VI. Circles of associated motions.
VII. Alternations of cold and hot fits.
VIII. Orgasm of the capillaries.
IX. Torpor of the lungs.
X. Torpor of the brain.
XI. Torpor of the heart and arteries.
XII. Torpor of the stomach and intestines.
XIII. Case of continued fever explained.
XIV. Termination of continued fever.
XV. Inflammation excited in fever.
XVI. Recapitulation.
I. _Simple fever._
1. When a small part of the cutaneous capillaries with their mucous or
perspirative glands are for a short time exposed to a colder medium, as
when the hands are immersed in iced water for a minute, these capillary
vessels and their glands become torpid or quiescent, owing to the eduction
of the stimulus of heat. The skin then becomes pale, because no blood
passes through the external capillaries; and appears shrunk, because their
sides are collapsed from inactivity, not contracted by spasm; the roots of
the hair are left prominent from the seceding or subsiding of the skin
around them; and the pain of coldness is produced.
In this situation, if the usual degree of warmth be applied, these vessels
regain their activity; and having now become more irritable from an
accumulation of the sensorial power of irritation during their quiescence,
a greater exertion of them follows, with an increased glow of the skin, and
another kind of pain, which is called the hot-ach; but no fever, properly
so called, is yet produced; as this effect is not universal, nor permanent,
nor recurrent.
2. If a greater part of the cutaneous capillaries with their mucous and
perspirative glands be exposed for a longer time to cold, the torpor or
quiescence becomes extended by direct sympathy to the heart and arteries;
which is known by the weakness, and consequent frequency of the pulse in
cold fits of fever.
This requires to be further explained. The movements of the heart and
arteries, and the whole of the circulatory vessels, are in general excited
into action by the two sensorial powers of irritation, and of association.
The former is excited by stimulus, the latter by the previous actions of a
part of the vital circle of motions. In the above situation the capillaries
act weakly from defect of irritation, which is caused by deficient stimulus
of heat; but the heart and arteries act weakly from defect of association,
which is owing to the weak action of the capillaries; which does not now
excite the sensorial power of association into action with sufficient
energy.
After a time, either by the application of warmth, or by the increase of
their irritability owing to the accumulation of the sensorial power of
irritation during their previous quiescence, the capillary vessels and
glands act with greater energy than natural; whence the red colour and heat
of the skin. The heart and arteries acquire a greater strength of
pulsation, and continue the frequency of it, owing to the accumulation of
the sensorial power of association during their previous torpor, and their
consequent greater associability; which is now also more strongly excited
by the increased actions of the capillaries. And thus a fit of simple fever
is produced, which is termed Febris irritativa; and consists of a torpor of
the cutaneous capillaries with their mucous and perspirative glands,
accompanied with a torpor of the heart and arteries; and afterwards of an
increased action of all these vessels, by what is termed direct sympathy.
This fever, with strong pulse without inflammation, or febris irritativa,
described in Class I. 1. 1. 1. is frequently seen in vernal intermittents,
as the orgasm of the heart and arteries is then occasioned by their
previous state of torpor; but more rarely I believe exists in the type of
continued fever, except there be an evident remission, or approximation to
a cold fit; at which time a new accumulation of the sensorial power of
association is produced; which afterwards actuates the heart and arteries
with unnatural vigour; or unless there be some stimulus perpetually acting
on the system so as to induce an increased secretion of sensorial power in
the brain, as occurs in slight degrees of intoxication. Since without one
or other of these circumstances in continued fevers without inflammation,
that is, without the additional sensorial power of sensation being
introduced, it seems difficult to account for the production of so great a
quantity of sensorial power, as must be necessary to give perpetual
increase of action to the whole sanguiferous system.
3. On the contrary, while the cutaneous capillaries with their mucous and
perspirative glands acquire an increased irritability, as above, by the
accumulation of that sensorial power during their previous quiescence, and
thus constitute the hot fit of fever; if the heart and arteries do not
acquire any increase of associability, but continue in their state of
torpor, another kind of simple fever is produced; which is generally of the
continued kind, and is termed Febris inirritativa; which consists of a
previous torpor of the capillaries of the skin, and of the heart and
arteries by direct sympathy with them; and afterwards of an orgasm or
increased action of the capillaries of the skin, with a decreased action,
or continued torpor, of the heart and arteries by reverse sympathy with
them. This orgasm of the cutaneous capillaries, which appears by the blush
and heat of the skin, is at first owing to the accumulation of the
sensorial power of irritation during their previous torpid state, as in the
febris irritata above described; but which is afterwards supported or
continued by the reverse sympathy of these capillaries with the torpid
state of the heart and arteries, as will be further explained in article 8
of this Supplement.
4. The renovated activity of the capillaries commences as soon or sooner
than that of the heart and arteries after the cold fit of irritative fever;
and is not owing to their being forced open by the blood being impelled
into them mechanically, by the renovated action of the heart and arteries;
for these capillaries of the skin have greater mobility than the heart and
arteries, as appears in the sudden blush of shame; which may be owing to
their being more liable to perpetual varieties of activity from their
exposure to the vicissitudes of atmospheric heat. And because in
inirritative fevers, or those with arterial debility, the capillaries
acquire increased strength, as is evinced by the heat of the skin, while
the pulsations of the heart and arteries remain feeble.
5. It was said above, that the cutaneous capillaries, when they were
rendered torpid by exposure to cold, either recovered their activity by the
reapplication of external warmth; or by their increased irritability, which
is caused by the accumulation of that sensorial power during their
quiescence. An example of the former of these may be seen on emerging from
a very cold bath; which produces a fit of simple fever; the cold fit, and
consequent hot fit, of which may be prolonged by continuing in the bath;
which has indeed proved fatal to some weak and delicate people, and to
others after having been much exhausted by heat and exercise. See Sect.
XXXII. 3. 2. An example of the latter may be taken from going into a bath
of about eighty degrees of heat, as into the bath at Buxton, where the
bather first feels a chill, and after a minute becomes warm, though he
remains in the same medium, owing to the increase of irritability from the
accumulation of that sensorial power during the short time, which the
chilness continued.
6. Hence simple fevers are of two kinds; first, the febris irritativa, or
fever with strong pulse; which consists of a previous torpor of the heart,
arteries, and capillaries, and a succeeding orgasm of those vessels.
Secondly, the febris inirritativa, or fever with weak pulse, which consists
of a previous torpor of the heart, arteries, and capillaries; and of a
succeeding orgasm of the capillaries, the torpor of the heart and arteries
continuing. But as the frequency of the pulse occurs both in the state of
torpor, and in that of orgasm, of the heart and arteries; this constitutes
a criterion to distinguish fever from other diseases, which are owing to
the torpor of some parts of the system, as paresis, and hemicrania.
7. The reader will please to observe, that where the cutaneous or pulmonary
capillaries are mentioned, their mucous and perspirative glands are to be
understood as included; but that the absorbents belonging to those systems
of vessels, and the commencement of the veins, are not always included; as
these are liable to torpor separately, as in anasarca, and petechiae; or to
orgasm, or increased action, as in the exhibition of strong emetics, or in
the application of vinegar to the lips; yet he will also please to observe,
that an increased or decreased action of these absorbents and veins
generally occurs along with that of the capillaries, as appears by the dry
skin in hot fits of fever; and from there being generally at the same time
no accumulation of venous blood in the cutaneous vessels, which would
appear by its purple colour.
II. _Compound fever._
1. When other parts of the system sympathize with this torpor and orgasm of
the cutaneous capillaries, and of the heart and arteries; the fever-fit
becomes more complicated and dangerous; and this in proportion to the
number and consequence of such affected parts. Thus if the lungs become
affected, as in going into very cold water, a shortness of breath occurs;
which is owing to the collapse or inactivity (not to the active
contraction, or spasm), of the pulmonary capillaries; which, as the lungs
are not sensible to cold, are not subject to painful sensation, and
consequent shuddering, like the skin. In this case after a time the
pulmonary capillaries, like the cutaneous ones, act with increased energy;
the breathing, which was before quick, and the air thrown out at each
respiration in less quantity, and cool to the back of the hand opposed to
it, now becomes larger in quantity, and warmer than natural; which however
is not accompanied with the sensation of heat in the membrane, which lines
the air-vessels of the lungs, as in the skin.
2. One consequence of this increased heat of the breath is the increased
evaporation of the mucus on the tongue and nostrils. A viscid material is
secreted by these membranes to preserve them moist and supple, for the
purposes of the senses of taste and of smell, which are extended beneath
their surfaces; this viscid mucus, when the aqueous part of it is
evaporated by the increased heat of the respired air, or is absorbed by the
too great action of the mucous absorbents, adheres closely on those
membranes, and is not without difficulty to be separated from them. This
dryness of the tongue and nostrils is a circumstance therefore worthy to be
attended to; as it shews the increased action of the pulmonary capillaries,
and the consequent increased heat of the expired air; and may thus
indicate, when colder air should be admitted to the patient. See Class I.
1. 3. 1. The middle part of the tongue becomes dry sooner, and recovers its
moisture later, than the edges of it; because the currents of respired air
pass most over the middle part of it. This however is not the case, when
the dryness of the tongue is owing only to the increased mucous absorption.
When however a frequent cough attends pulmonary inflammation, the edges of
the tongue are liable to be as much furred as the middle of it; as during
the action of coughing the middle of the tongue is depressed, so as to form
half a cylinder, to give a greater aperture for the emission of air from
the larynx; and the edges of it become thus as much exposed to the currents
of air, as the middle parts of it.
3. When the internal capillaries or glands sympathize with the cutaneous
capillaries; or when any of them are previously affected with torpor, and
the external or cutaneous capillaries are affected secondarily; other
symptoms are produced, which render the paroxysms of fever still more
complicate. Thus if the spleen or pancreas are primarily or secondarily
affected, so as to be rendered torpid or quiescent, they are liable to
become enlarged, and to remain so even after the extinction of the
fever-fit. These in some intermittent fevers are perceptible to the hand,
and are called ague-cakes; their tumour seems to be owing to the permanent
torpor of the absorbent system, the secerning vessels continuing to act
some time afterwards. If the secretory vessels of the liver are affected
first with torpor, and afterwards with orgasm, a greater secretion of bile
is produced, which sometimes causes a diarrhoea. If a torpor of the
kidneys, and of the absorbents of the bladder occurs, either primarily, or
by sympathy with the cutaneous capillaries, the urine is in small quantity
and pale, as explained in Class I. 2. 2. 5.; and if these secretory vessels
of the kidneys, and the absorbents of the bladder act more strongly than
natural afterwards by their increased irritability or associability, the
urine becomes in larger quantity, and deeper coloured, or deposits its
earthy parts, as in Class I. 1. 2. 4. which has been esteemed a favourable
circumstance. But if the urine be in small quantity, and no sediment
appears in it, after the hot fit is over; it shews, that the secerning
vessels of the kidneys and the absorbent vessels of the bladder have not
regained the whole of their activity, and thence indicates a greater
tendency to a return of the cold fit.
4. When the stomach is affected with torpor either primarily; or
secondarily by its sympathy with the cutaneous capillaries; or with some
internal viscus; sickness occurs, with a total want of appetite to any
thing solid; vomiting then supervenes, which may often be relieved by a
blister on the skin, if the skin be cool and pale; but not if it be hot and
flushed. The intestines cease to perform their office of absorption from a
similar torpor; and a diarrhoea supervenes owing to the acrimony of their
putrid, or of their acid contents. The loose undigested or fetid stools
indicate the inability of the intestines to perform their proper office; as
the mucus and gastric acid, which are vomited up, does that of the stomach;
this torpor of the stomach is liable to continue after the cold paroxysm
ceases, and to convert intermittent fevers into continued ones by its
direct sympathy with the heart and arteries. See article 10 of this
Supplement.
5. If the meninges of the brain sympathize with other torpid parts, or are
primarily affected, delirium, stupor, and perhaps hydrocephalus internus
occur, see Class II. 1. 7. 1. and I. 2. 5. 10; and sometimes the pulse
becomes slow, producing paresis instead of fever. But if the membranes,
which cover the muscles about the head, or of the pericranium, become
torpid by their sympathy with other torpid parts, or are primarily
affected, a head-ach supervenes; which however generally ceases with the
cold paroxysm of fever. For as when the sensorial power of volition is
exhausted by labour, a few hours, or half a solar day, passed in sleep
recruits the system by accumulation of this sensorial power; so when the
sensorial power of irritation is exhausted, one or two solar or lunar days
of rest or quiescence of the affected part will generally restore its
action by accumulation of irritability, and consequent increase of
association, as in hemicrania, Class IV. 2. 2. 8. But when the heart and
arteries become torpid, either primarily, or by their sympathy with the
stomach, this accumulation of the sensorial power of irritation can take
place but slowly; _as to rest is death_! This explains the cause of the
duration of fevers with weak pulse, which continue a quarter, or half, or
three quarters, or a whole lunation, or still longer, before sufficient
accumulation of irritability can be produced to restore their natural
strength of action.
6. If the absorbent vessels, which are spread around the neck of the
bladder, become torpid by their direct sympathy with the absorbents of the
skin in cold fits of fever; the urine, which is poured into the bladder in
but small quantity from the torpid kidneys, has nevertheless none of its
aqueous saline part reabsorbed; and this saline part stimulates the bladder
to empty itself frequently, though the urine is in small quantity. Which is
not therefore owing to any supposed spasm of the bladder, for the action of
it in excluding the urine is weak, and as much controlable by the will as
in ordinary micturition.
7. If the beginnings or absorbent mouths of the venous system remain
torpid, petechiae or vibices are produced in fevers, similar to those which
are seen in scurvy without fever. If the skin was frequently moistened for
an hour, and at the same time exposed to the common air, or to oxygen gas,
it might contribute to turn the black colour of these points of
extravasated blood into scarlet, and thus by increasing its stimulus
facilitate its reabsorption? For oxygen gas penetrates moist animal
membranes though not dry ones, as in the lungs during respiration.
8. When the sensorial power of sensation is introduced into the arterial
system, other kinds of compound fevers are produced, which will be spoken
of in their place.
III. _Termination of the cold Fit._
1. If all the parts, which were affected with torpor, regain their
irritability, and associability, the cold paroxysm of fever ceases; but as
some of the parts affected were previously accustomed to incessant action,
as the heart and arteries, and others only to intermitted action, as the
stomach and intestines; and as those, which are subjected during health to
perpetual action, accumulate sensorial power faster, when their motions are
impeded, than those which are subjected to intermitted action; it happens,
that some of the parts, which were affected with torpor during the cold
fit, recover their irritability or associability sooner than others, and
more perfectly, or acquire a greater quantity of them than natural; as
appears by the partial heat and flushings previous to the general hot fit.
Hence if all the parts, which were previously torpid, regain their due
degree of irritability, or of associability, the disease is removed, and
health restored. If some or all of them acquire more than their natural
degree of these sensorial powers; increased actions, and consequent
increased secretions, and greater heat occur, and constitute the hot fit of
fever. If after this hot fit of fever all the parts, which had acquired too
great irritability, or associability, regain their natural degree of it;
the disease is removed, and health restored. But if some of these parts do
not regain their natural degree of these sensorial powers, the actions of
those parts remain imperfect, and are more or less injurious to the system,
according to the importance of their functions.
2. Thus if a torpor of the heart and arteries remains; the quick pulse
without strength, which began in the cold fit, persists; and a continued
fever is produced. If the torpor of the stomach and intestines remains,
which are known by sickness and undigested stools, the fever is liable to
be of considerable length and danger; the same if the kidnies and absorbent
system retain some degree of torpor, as is shewn by the pale urine in not
unusual quantity. If part of the absorbent system remains torpid, as the
absorbent vessels of the spleen, a tumour of that viscus occurs, which may
be felt by the hand; the same sometimes happens to the liver; and these
from their tendency to more complete torpor are afterwards liable to give
occasion to a return of the cold fit. If the cellular absorbents do not
completely recover their activity, a pale and bloated countenance with
swelled legs mark their want of action.
3. As the termination of the cold fit is owing to the accumulation of the
sensorial power of irritation and of association during the previous
quiescence of the system; and as those parts, which are in perpetual action
during health, are more subject to this accumulation during their torpor,
or quiescence; one should have imagined, that the heart and arteries would
acquire this accumulation of sensorial power sooner or in greater degree
than other parts. This indeed so happens, where the pulse is previously
strong, as in febris irritativa; or where another sensorial power, as that
of sensation, is exerted on the arterial system, as in inflammations. The
heart and arteries in these cases soon recover from their torpor, and are
exerted with great violence.
Many other parts of the system subject to perpetual motion in health may
rest for a time without much inconvenience to the whole; as when the
fingers of some people become cold and pale; and during this complete rest
great accumulation of irritability may be produced, But where the heart and
arteries are previously feeble, they cannot much diminish their actions,
and certainly cannot rest entirely, for that would be death; and therefore
in this case their accumulation of the sensorial power of irritation or of
association is slowly produced, and a long fever supervenes in consequence;
or sudden death, as frequently happens, terminates the cold fit.
Whence it appears, that in fevers with weak pulse, if the action of the
heart, arteries, and capillaries could be diminished, or stopped for a
short time without occasioning the death of the patient, as happens in cold
bathing, or to persons apparently drowned, that a great accumulation of the
sensorial powers of irritation or of association might soon be produced,
and the pulse become stronger, and consequently slower, and the fever
cease. Hence cold ablution may be of service in fevers with weak pulse, by
preventing the expenditure and producing accumulation of the sensorial
power of irritation or association. Stupor may be useful on the same
account. Could a centrifugal swing be serviceable for this purpose, either
by placing the head or the feet in the outward part of the circle, as
described in Art. 15. 7. of this Supplement?
IV. _Return of the cold Fit._
1. If the increased action of the cutaneous and pulmonary capillaries, and
of the heart and arteries, in febris irritativa continues long and with
violence, a proportional expenditure or exhaustion of sensorial power
occurs; which by its tendency to induce torpor of some part, or of the
whole, brings on a return of the cold fit.
2. Another cause which contributes to induce torpor of the whole system by
the sympathy of its parts with each other, is the remaining torpor of some
viscus; which after the last cold paroxysm had not recovered itself, as of
the spleen, liver, kidnies, or of the stomach and intestines, or absorbent
vessels, as above mentioned.
3. Other causes are the deficiency of the natural stimuli, as hunger,
thirst, and want of fresh air. Other causes are great fatigue, want of
rest, fear, grief, or anxiety of mind. And lastly, the influence of
external ethereal fluids, as the defect of external heat, and of solar or
lunar gravitation. Of the latter the return of the paroxysms of continued
fevers about six o'clock in the evening, when the solar gravitation is the
least, affords an example of the influence of it; and the usual periods of
intermittents, whether quotidian, tertian, or quartan, which so regularly
obey solar or lunar days, afford instances of the influence of those
luminaries on these kinds of fevers.
4. If the tendency to torpor of some viscus is considerable, this will be
increased at the time, when the terrene gravitation is greatest, as
explained in the introduction to Class IV. 2. 4. and may either produce a
cold paroxysm of quotidian fever; or it may not yet be sufficient in
quantity for that purpose, but may nevertheless become greater, and
continue so till the next period of the greatest terrene gravitation, and
may then either produce a paroxysm of tertian fever; or may still become
greater, and continue so till the next period of greatest terrene
gravitation, and then produce a paroxysm of quartan ague. And lastly, the
periodical times of these paroxysms may exceed, or fall short of, the time
of greatest diurnal terrene gravitation according to the time of day, or
period of the moon, in which the first fit began; that is, whether the
diurnal terrene gravitation was then in an increasing or decreasing state.
V. _Sensation excited in Fever._
1. A curious observation is related by Dr. Fordyce in his Tract on Simple
fever, page 168. He asserts, that those people, who have been confined some
time in a very warm atmosphere, as of 120 or 130 degrees of heat, do not
feel cold, nor are subject to paleness of their skins, on coming into a
temperature of 30 or 40 degrees; which would produce great paleness and
painful sensation of coldness in those, who had been some time confined in
an atmosphere of only 86 or 90 degrees. Analogous to this, an observing
friend of mine assured me, that once having sat up to a very late hour with
three or four very ingenious and humorous companions, and drank a
considerable quantity of wine; both contrary to his usual habits of life;
and being obliged to rise early, and to ride a long journey on the next
day; he expected to have found himself weak and soon fatigued; but on the
contrary he performed his journey with unusual ease and alacrity; and
frequently laughed, as he rode, at the wit of the preceding evening. In
both these cases a degree of pain or pleasure actuated the system; and thus
a sensorial power, that of sensation, was superadded to that of irritation,
or volition. See Sect. XXXIV. 2. 6.
2. Similar to this, when the energetic exertions of some parts of the
system in the hot fit of fever arise to a certain excess, a degree of
sensation is produced; as of heat, which particularly increases the actions
of the cutaneous vessels, which are more liable to be excited by this
stimulus. When this additional sensorial power of sensation exists to a
greater degree, the pulse, which was before full, now becomes hard, owing
to the inflammation of the vasa vasorum, or coats of the arteries. In these
cases, whether there is any topical inflammation or not, the fever ceases
to intermit; but nevertheless there are daily remissions and exacerbations
of it; which recur for the most part about six in the evening, when the
solar gravitation is the least, as mentioned in Sect. XXXVI. 3. 7.
3. Thus the introduction of another sensorial power, that of sensation,
converts an intermittent fever into a continued one. If it be attended with
strong pulse, it is termed febris sensitiva irritata, or pyrexia, or
inflammation; if with a weak pulse, it is termed febris sensitiva
inirritata, or typhus gravior, or malignant fever. The seat of the
inflammation is in the glandular or capillary system, as it consists in the
secretion of new fluids, or new fibres, which form new vessels, as they
harden, like the silk of the silk-worm. See Art. 15. of this Supplement.
VI. _Circles of irritative Associate Motions._
1. There are some associate motions, which are perpetually proceeding in
our waking hours, and are catenated by their first link, or in some
subsequent parts of the chain, with the stimuli or the influence of
external things; which we shall here enumerate, as they contribute to the
knowledge of fever. Of these are the irritative ideas, or sensual motions
of the organs of sense, and the muscular motions associated with them;
which, when the chain is disturbed or interrupted, excite the sensorial
power of sensation, and proceed in confusion. Thus if the irritative ideas
of sight are disturbed, the paralactic motions of objects, which in general
are unperceived, become sensible to us; and the locomotive muscles
associated with them, which ought to preserve the body erect, stagger from
this decrease or interruption of the sensorial power of association; and
vertigo is produced.
When the irritative sensual motions, or ideas, belonging to one sense are
increased or diminished, the irritative sensual motions, or ideas, of the
other senses are liable to become disturbed by their general catenations;
whence occur noises in the ears, bad tastes in the mouth, bad odours, and
numbness or tingling of the limbs, as a greater or less number of senses
are affected. These constitute concomitant circles of disturbed irritative
ideas; or make a part of the great circle of irritative ideas, or motions
of the organs of sense; and when thus disturbed occasion many kinds of
hallucination of our other senses, or attend on the vertigo of vision.
2. Another great circle of irritative associated motions consists of those
of the alimentary canal; which are catenated with stimuli or with
influences external to the system, but continue to be exerted in our
sleeping as well as in our waking hours. When these associations of motion
are disturbed by the too great or too small stimulus of the food taken into
the stomach, or by the too great excess or deprivation of heat, or by
indigestible substances, or by torpor or orgasm occasioned by their
association with other parts, various diseases are induced under the names
of apepsia, hypochondriasis, hysteria, diarrhoea, cholera, ileus,
nephritis, fever.
3. A third circle of irritative associate motions consists of those of the
absorbent system; which may be divided into two, the lacteals, and the
lymphatics. When the stomach and intestines are recently filled with food
and fluid, the lacteal system is stimulated into great action; at the same
time the cellular, cutaneous, and pulmonary lymphatics act with less
energy; because less fluid is then wanted from those branches, and because
more sensorial power is expended by the lacteal branch. On this account
these two systems of absorbents are liable to act by reverse sympathy;
hence pale urine is made after a full dinner, as less of the aqueous part
of it is imbibed by the urinary lymphatics; and hence the water in anasarca
of the lungs and limbs is speedily absorbed, when the actions of the
lacteals of the stomach or intestines are weakened or inverted by the
exhibition of those drugs, which produce nausea, or by violent vomiting, or
violent cathartics.
Hence in diabetes the lacteal system acts strongly, at the same time that
the urinary lymphatics invert their motions, and transmit the chyle into
the bladder; and in diarrhoea from crapula, or too great a quantity of food
and fluid taken at a time, the lacteals act strongly, and absorb chyle or
fluids from the stomach and upper intestines; while the lymphatics of the
lower intestines revert their motions, and transmit this over-repletion
into the lower intestines, and thus produce diarrhoea; which accounts for
the speedy operation of some cathartic drugs, when much fluid is taken
along with them.
4. Other circles of irritative associate motions of great importance are
those of the secerning system; of these are the motions of the larger
congeries of glands, which form the liver, spleen, pancreas, gastric
glands, kidneys, salivary glands, and many others; some of which act by
direct and others by reverse sympathy with each other. Thus when the
gastric glands act most powerfully, as when the stomach is filled with
food, the kidneys act with less energy; as is shewn by the small secretion
of urine for the first hour or two after dinner; which reverse sympathy is
occasioned by the greater expenditure of sensorial power on the gastric
glands, and to the newly absorbed fluids not yet being sufficiently
animalized, or otherwise prepared, to stimulate the secretory vessels of
the kidneys.
But those very extensive glands, which secrete the perspirable matter of
the skin and lungs, with the mucus, which lubricates all the internal cells
and cavities of the body, claim our particular attention. These glands, as
well as all the others, proceed from the capillary vessels, which unite the
arteries with the veins, and are not properly a part of them; the mucous
and perspirative glands, which arise from the cutaneous and pulmonary
capillaries, are associated by direct sympathy; as appears from immersion
in the cold bath, which is therefore attended with a temporary difficult
respiration; while those from the capillaries of the stomach and heart and
arteries are more generally associated by reverse sympathy with those of
the cutaneous capillaries; as appears in fevers with weak pulse and
indigestion, and at the same time with a hot and dry skin.
The disturbed actions of this circle of the associate motions of the
secerning system, when the sensorial power of sensation is added to that of
irritation, frequently produces inflammation, which consists in the
secretion of new fluids or new vessels. Nevertheless, if these disturbed
actions be of the torpid kind, the pain, which attends them, is seldom
productive of inflammation, as in hemicrania; but is liable to excite
voluntary actions, and thus to expend much sensorial power, as in the
shuddering in cold fits of fever, or in convulsions; or lastly the pain
itself, which attends torpid actions, is liable to expend or exhaust much
sensorial power without producing any increased actions; whence the low
pulse, and cold extremities, which usually attend hemicrania; and hence
when inert, or inactive sensation attends one link of associated action,
the succeeding link is generally rendered torpid, as a coldness of the
cheek attends tooth-ach.
5. A fifth important circle of irritative motions is that of the
sanguiferous system, in which the capillary vessels are to be included,
which unite the arterial and venous systems, both pulmonary and aortal. The
disturbed action of this system of the heart and arteries, and capillaries,
constitute simple fever; to which may be added, that the secerning and
absorbent vessels appending to the capillaries, and the bibulous mouths of
the veins, are in some measure at the same time generally affected.
6. Now, though the links of each of these circles of irritative motions are
more strictly associated together, yet are they in greater or less degree
associated or catenated with each other by direct or reverse sympathy. Thus
the sickness, or inverted irritative motions of the stomach, are associated
or catenated with the disturbed irritative ideas, or sensual motions, in
vertigo; as in sea-sickness. This sickness of the stomach is also
associated or catenated with the torpor of the heart and arteries by direct
sympathy, and with the capillaries and absorbents by reverse sympathy; and
are thus all of them liable occasionally to be disturbed, when one of them
is diseased; and constitute the great variety of the kinds or symptoms of
fevers.
VII. _Alternation of the cold and hot Fits._
1. When any cause occurs, which diminishes to a certain degree the supply
of sensorial power in respect to the whole system; as suppose a temporary
inexertion of the brain; what happens? First, those motions are exerted
with less energy, which are not immediately necessary to life, as the
locomotive muscles; and those ideas, which are generally excited by
volition; at the same time this deficiency of voluntary motion is different
from that which occurs in sleep; as in that the movements of the arterial
system are increased in energy though not in frequency. Next, the motions
of the alimentary canal become performed with less energy, or cease
altogether; and a total want of appetite to solid food occurs, or sickness,
or a diarrhoea occasioned by the indigested aliment. Then the absorbent
vessels cease to act with their due energy; whence thirst, and pale urine,
though in small quantities. Fourthly, the secerning vessels become affected
by the general diminution of sensorial power; whence all the secreted
fluids are produced in less quantity. And lastly, the sanguiferous canals
feel the general torpor; the pulsations of the heart and arteries become
feeble, and consequently quick; and the capillaries of the skin become
inactive, acquire less blood from the arteries, and are consequently paler
and shrunk.
In this last circumstance of the torpor of the sanguiferous system consists
inirritative fever; as all the others are rather accidental or concomitant
symptoms, and not essential ones; as fewer or more of them may be present,
or may exist with a greater or less degree of inactivity.
2. Now as the capillaries of the skin are exposed to greater varieties of
heat and cold, than the heart and arteries, they are supposed to be more
mobile, that is, more susceptible of torpor or exertion, or to
inflammation, by external stimuli or influences, than the other parts of
the sanguiferous system; and as the skin is more sensible to the presence
of heat, than the internal parts of the body, the commencement of the cold
paroxysms of fever generally either first exists in, or is first perceived
by, the coldness and paleness of the skin; and the commencement of the hot
fits by the heat and redness of it.