in greatest quantity, during their quiescence, which were most perpetually
in action during health; hence those parts of the system soonest recover
from torpor in intermittent fever, and soonest fall into the contrary
extreme of increased activity; as the sanguiferous system of the heart and
arteries and capillaries. But of these the capillaries seem first to
acquire a renovation of their action, as the heat of the skin becomes first
renewed, as well as increased beyond its natural quantity, and this in some
parts sooner than in others; which quantity of heat is however not to be
estimated simply by the rise of the mercury in the thermometer, but also by
the quantity carried away into the atmosphere, or diffused amongst other
bodies in a given time; as more heat passes through water, which boils
vehemently, than when it boils gently, though the rise of the thermometer
in both cases continues the same. This fact may be known by boiling an egg
in water, the white of which coagulates in much less time, if the water
boils vehemently, than if it boils moderately, though the sensible heat of
the water is the same in both cases.
Another cause, which induces the cutaneous capillaries to renew their
actions sooner than the heart and arteries after immersion in the cold
bath, is, that their torpor was occasioned by defect of irritation; whereas
that of the heart and arteries was occasioned by defect of association;
which defect of association was owing to the decreased actions of the
capillaries, and is now again excited by their renewed action; which
excitement must therefore be subsequent to that increased action of the
capillaries; and in consequence the increased action of the heart and
arteries at the commencement of the hot fit of some fevers is subsequent to
the increased action of the cutaneous capillaries. There is, however, in
this case an accumulation of the sensorial power of association in the
heart and arteries, which must contribute to increase their orgasm in the
hot fit, as well as the increased excitement of it by the increased action
of the capillaries.
4. Now this increased action of the system, during the hot fit, by
exhausting the sensorial powers of irritation and association, contributes
to induce a renewal of the cold paroxysm; as the accumulation of those
sensorial powers in the cold fit produces the increased actions of the hot
fit; which two states of the system reciprocally induce each other by a
kind of libration, or a plus and minus, of the sensorial powers of
irritation and association.
If the exhaustion of sensorial power during the hot fit of fever only
reduces the quantity of irritability and associability to its natural
standard, the fever is cured, not being liable to return. If the quantity
of these sensorial powers be reduced only so much, as not to produce a
second cold fit during the present quantity of external stimuli or
influences; yet it may be so far reduced, that a very small subtraction of
stimulus, or of influence, may again induce a cold fit; such as the
coldness of the night-air, or the diminution of solar or lunar gravitation,
as in intermittent fevers.
5. Another cause of the renovation of the cold fits of fever is from some
parts of the system not having completely recovered from the former cold
paroxysm; as happens to the spleen, liver, or other internal viscus; which
sometimes remains tumid, and either occasions a return of the cold fit by
direct sympathy with other parts of the body, or by its own want of action
causes a diminution of the general quantity of heat, and thus facilitates
the renovation of the torpor of the whole system, and gives cause to
intermittent fevers catenated with lunar or solar influence.
VIII. _Orgasm of the Capillaries._
As the remaining torpor of some less essential part of the system, as of
the spleen, when the hot fit ceases, produces after one, two, or three days
a return of cold fit by direct sympathy with the cutaneous capillaries,
when joined with some other cause of torpor, as the defect of solar or
lunar influences, or the exposure to cold or hunger, and thus gives origin
to intermittent fever; so the remaining torpor of some more essential parts
of the system, as of the stomach and intestines, is probably the cause of
the immediate recurrence of the cold paroxysm, at the time the hot one
ceases, by their direct sympathy with the cutaneous capillaries, without
the assistance of any other cause of torpor; and thus produces remittent
fever. And lastly the remaining torpor of some still more essential parts
of the system, as the heart and arteries, after the hot fit ought to cease,
is liable by reverse sympathy with the cutaneous capillaries to continue
their orgasm, and thus to render a fever continual, which would otherwise
remit or intermit.
Many difficulties here occur, which we shall endeavour to throw some light
upon, and leave to future investigation; observing only that difficulties
were to be expected, otherwise fevers would long since have been
understood, as they have employed the unremitted attention of the
physicians of all ages of the world.
1. Why do the same parts of successive trains of action sometimes affect
each other by direct, and sometimes by reverse sympathy?--1st, When any
irritative motion ceases, or becomes torpid, which was before in perpetual
action; it is either deprived of its usual stimulus, and thence the
sensorial power of irritation is not excited; or it has been previously too
much stimulated, and the sensorial power has been thus exhausted.
In the former case an accumulation of sensorial power soon occurs, which is
excitable by a renewal of the stimulus; as when the fingers, which have
been immersed some time in snow, are again exposed to the usual warmth of a
room. Or, secondly, the sensorial power of irritation becomes so much
accumulated, that the motions, which were torpid, are now performed by less
stimulus than natural; as appears by the warmth, which soon occurs after
the first chill in going into frosty air, or into the bath at Buxton, which
is about eighty degrees of heat. Or, lastly, this accumulation of the
sensorial power of irritation so far abounds, that it increases the action
of the next link of the associated train or tribe of motions; thus on
exposing the skin to cold air, as in walking out in a frosty morning, the
actions of the stomach are increased, and digestion strengthened.
But where the torpor of some irritative motion is owing to the previous
exhaustion of the sensorial power of irritation by too great stimulus, the
restoration of it occurs either not at all, or much more slowly than in the
former instances; thus after intoxication the stomach is very slow in
recovering its due quantity of the sensorial power of irritation, and never
shews any accumulation of it.
2. When an associate motion, as described in the introduction to Class IV.
1. 1. acts with less energy, the sensorial power of association is either
not sufficiently excited by the preceding fibrous motions; or it has been
expended or exhausted by the too violent actions of the preceding fibrous
motions. In the former case there occurs an accumulation of the sensorial
power of association; exactly as, where the usual stimulus is withdrawn,
there occurs an accumulation of the sensorial power of irritation. Thus
when the actions of the capillaries of the skin are diminished by immersion
in cold water, the capillaries of the lungs are rendered torpid by the want
of the excitement of the sensorial power of association, owing to the
lessened actions of the previous fibrous motions, namely, of those of the
skin. Nevertheless as soon as the capillaries of the skin regain their
increased activity by the accumulation of the sensorial power of
irritation, these capillaries of the lungs act with greater energy also
owing to their accumulated sensorial power of association. These are
instances of direct sympathy, and constitute the cold and hot paroxysms of
intermittent fever; or the first paroxysm of a continued one.
3. When the first link of a train of associated motions, which is subject
to perpetual action, becomes a considerable time torpid for want of being
excited by the previous exertions of the irritative motions, with which it
is catenated; the sensorial power of association becomes accumulated in so
great a degree as to affect the second link of the train of associated
motions, and to excite it into stronger action. Thus when the stomach is
rendered torpid by contagious matter swallowed into it mixed with the
saliva, the heart and arteries act more feebly; because the sensorial power
of association, which used to be excited by the fibrous motions of the
stomach, is not now excited; and in consequence the motions of the heart
and arteries act only by the sensorial power of irritation, which is
excited by the stimulus of the blood.
But during this torpor of the stomach, and less action of the heart and
arteries, so great an accumulation of the sensorial powers of irritation
and of association occurs, that it adds to the action of the next link of
this vital circle of actions, that is, to that of the cutaneous
capillaries. Whence in this situation the torpor of the stomach occasions a
diminished action of the heart and arteries by direct sympathy, and may be
said to occasion an increased one of the cutaneous capillaries by reverse
sympathy; which constitute continued fever with weak pulse.
Nor is this increased action of the capillaries in consequence of the
decreased action of the heart and arteries, as in fevers with weak pulse, a
single fact in the animal economy; though it exists in this case in the
greatest degree or duration, because the heart and arteries are perpetually
in greater action than any other part of the system. But a similar
circumstance occurs, when the stomach is rendered inactive by defective
excitement of the sensorial power of association, as in sea-sickness, or in
nephritis. In these cases the sensorial power of association becomes much
accumulated in the stomach, and seems by its superabundance to excite the
absorbent system, which is so nearly connected with it, into great increase
of action; as is known by the great quantity frequently in these situations
rejected by vomit, which could not otherways be supplied. It is probable
the increase of digestion by walking in frosty air, with many other animal
facts, may by future observations be found to be dependent on this
principle, as well as the increased action of the capillaries in continued
fevers with weak pulse.
Whereas in continued fever with strong pulse, which may perhaps occur
sometimes on the first day even of the plague, the stomach with the heart
and arteries and the capillaries act by direct sympathy; that is, the
stomach is excited into stronger action by increased irritation owing to
the stimulus of contagious matter; these stronger irritative motions of the
stomach excite a greater quantity of the sensorial power of association,
which then actuates the heart and arteries with greater energy, as these
are catenated with the stomach; and in the same manner the increased
actions of the heart and arteries excite a greater quantity of the
sensorial power of association, which actuates the cutaneous capillaries
with increase of energy. See Class IV. 1. 1.
4. I shall dwell a little longer on this intricate subject. The
commencement of fever-fits is known by the inactivity of the cutaneous
capillaries, which inactivity is observable by the paleness and coldness of
the skin, and also by the pain of coldness, which attends it. There is
nevertheless in most cases, except those which are owing to exposure to
external cold, a torpor of the capillaries of some internal viscus
preceding this inactivity of the cutaneous capillaries; which is known, by
the tumour or hardness of the viscus, or by an aching pain of it. The
capillaries of the lungs are at the same time rendered inactive or torpid,
as appears by the difficulty of breathing, and coldness of the breath in
cold fits of fever, and in going into the cold bath; but the lungs are not
affected with the pain either of coldness or of torpor.
One cause of this synchronous or successive inactivity of the cutaneous
capillaries, in consequence of the previous torpor of some internal viscus,
may be owing to the deficiency of heat; which must occur, when any part
becomes inactive; because the secretions of that part cease or are
lessened, and the quantity of heat of it in consequence. But the principal
cause of it I suppose to be owing to the defect of the sensorial power of
association; which power of association is excited by some previous or
concomitant motions of the parts of every great circle of actions. This
appears on going into the cold bath, because the shortness of breath
instantly occurs, sooner than one can conceive the diminution of the heat
of the skin could affect the lungs by the want of its stimulus; but not
sooner than the defect of the sensorial power of association could affect
them; because this must cease to be excited into action on the instant that
the cutaneous capillaries cease to act; whence in the first moment of
contact of the cold water the cutaneous capillaries cease to act from
defect of irritation; which is caused by defect of the stimulus of heat;
and in the second moment the capillaries of the lungs cease to act from the
defect of association; which is caused by the defect of the motions of the
cutaneous capillaries. Thus the universal torpor in the cold paroxysm of
fever is an example of direct sympathy, though occasioned in part by defect
of irritation, and in part by defect of association.
5. Thus in walking out in a frosty morning the skin is cooled by the
contact of the cold air, whence the actions of its capillaries are
diminished for want of their usual stimulus of heat to excite a sufficient
quantity of the sensorial power of irritation. Hence there is at first a
saving of sensorial power of irritation for the purpose of actuating the
other parts of the system with greater energy. Secondly the sensorial power
of association, which used to be excited by the motions of the cutaneous
capillaries, is now not so powerfully excited; and in consequence the
parts, which constitute the next links of the circles of associated
motions, are for a time actuated with less energy, and a temporary general
chillness succeeds; which is so far similar to the cold fit of intermittent
fever.
In this situation there is a curious circumstance occurs, which merits
peculiar attention: after a short time, though the external skin continues
cool by its exposure to the cold air, and the actions of its capillaries
are consequently diminished, yet the capillaries of the stomach act with
greater energy; as is known by increased digestion and consequent hunger.
This is to be ascribed to the accumulation of the sensorial power of
irritation, which now excites by its superabundance, or overflowing, as it
were, the stomach into increased action; though it is at the same time
excited less powerfully than usual by the sensorial power of association.
Thus the accumulation of the sensorial power of irritation in the vessels
of the skin increases in this case the action of the stomach, in the same
manner as an accumulation of the sensorial power of association in the
heart and arteries in fevers with weak pulse increases the action of the
capillaries.
If nevertheless the coldness of the skin be too long continued, or exists
in too great a degree, so as in some measure to impair the life of the
part, no further accumulation of the sensorial power of irritation occurs;
and in consequence the actions of the stomach become less than natural by
the defect of the sensorial power of association; which has ceased to be
excited by the want of action of the cutaneous capillaries. Whence
continued coldness of the feet is accompanied with indigestion and
heartburn. See Class IV. 2. 1. 6.
6. Similar to this when the actions of the stomach are rendered torpid by
the previous stimulus of a violent emetic, and its motions become
retrograde in consequence, a great quantity of sensorial power is exerted
on the lymphatics of the lungs, and other parts of the body; which excites
them into greater direct action, as is evinced by the exhibition of
digitalis in anasarca. In this situation I suppose the emetic drug
stimulates the muscular fibres of the stomach into too great action; and
that in consequence a great torpor soon succeeds; and that this inaction of
the muscular parts of the stomach is not followed by much accumulation of
the sensorial power of irritation; because that sensorial power is in great
measure exhausted by the previous excessive stimulus. But the lymphatics of
the stomach have their actions lessened by defect of the sensorial power of
association, which is not now excited into action, owing to the lessened
motions of the muscular parts of it, with which the lymphatics are
associated. The sensorial power of association becomes therefore
accumulated in these lymphatics of the stomach, because it is not excited
into action; exactly as the power of irritation becomes accumulated in the
hand, when immersed in snow; and this accumulated sensorial power of
association excites the lymphatic of the lungs and of other parts, which
are most nearly associated with those of the stomach, into more energetic
actions. Thus the muscular fibres of the stomach act with the lymphatics of
that organ in direct sympathy; and the lymphatics of the stomach act in
reverse sympathy with those of the lungs and of other parts of the body;
the former of which is caused by defect of the excitement of the sensorial
power of association, and the latter by the accumulation of it.
Besides the efficient cause, as above explained, the final cause, or
convenience, of these organic actions are worthy our attention. In this
case of an acrid drug swallowed into the stomach the reverted actions of
the muscular fibres of the stomach tend to eject its enemy; the reverted
actions of its lymphatics pour a great quantity of fluids into the stomach
for the purpose of diluting or washing off the noxious drug; and the
increased actions of the other lymphatics supply these retrograde ones of
the stomach with an inconceivable supply of fluids, as is seen in Ileus and
Cholera.
7. The inquisitive reader will excuse my continuing this subject, though
perhaps with some repetitions, as it envelopes the very essence of fever.
When the first link of a train of actions is excited by excessive stimulus,
or excessive irritability, and thus acts with unusual energy by the
increased quantity of irritation, these increased motions excite a greater
quantity of the sensorial power of association, which causes increased
motions in the second link, which is catenated with the first; and then the
excessive action of this second link excites also a greater quantity of the
sensorial power of association, which increases the motions of the third
link of this chain of association, and thus the increase of the stimulus on
the irritative motions, to which the chain of association is catenated,
increases the action of the whole chain or circle of associated motions.
After a time the irritative motions become torpid by expenditure of the
sensorial power of irritation, and then the power of association also
becomes less exerted, both because it has been in part exhausted by too
great action, and is now less excited by the lessened action of the
irritative motions, which used to excite it. These are both instances of
direct sympathy, and frequently constitute the cold and hot fit of
intermittents.
But though the accumulation of the sensorial power of irritation during the
quiescence of some motion owing to want of stimulus generally induces
torpor in the first link of the train of associated motions catenated with
it; as the capillaries of the lungs become torpid immediately on immersion
of the skin into cold water; yet in some situations an orgasm or excess of
action is produced in the first link of the associated motions thus
catenated with irritative ones; as in the increased action of the stomach,
when the skin is for a time exposed to cold air; which may in part be
ascribed to the general increase of action of the whole system, owing to
the diminished expenditure of sensorial power, but particularly of the
parts, which have habitually acted together; as when one arm is paralytic
the other is liable to more frequent or almost continual motion; and when
one eye becomes blind the other frequently becomes stronger; which is well
known to farriers, who are said sometimes to destroy the sight of one eye
to strengthen that of the other in diseased horses.
Hence there is sometimes a direct sympathy, and sometimes a reverse one
succeeds the torpor occasioned by defect of stimulus, the latter of which
is perhaps owing to a certain time being required for the production of an
accumulation of the sensorial power of irritation by the nervous branches
of the torpid organ; which accumulation is now in part or entirely derived
to the next link of the association. Thus in going into a coldish bath, as
into a river in the summer months, we at first experience a difficulty of
breathing from the torpid action of the pulmonary capillaries, owing to the
deficient excitement of the sensorial power of association in consequence
of the torpor of the cutaneous capillaries. But in a very short time, as in
one minute, the sensorial power of irritation becomes accumulated by the
inactivity of the cutaneous capillaries; and as its superabundance becomes
now expended on the pulmonary capillaries, the difficult respiration
ceases; though the cutaneous capillaries continue torpid by their contact
with the cold water, and consequently the sensorial power of association,
which used to contribute to actuate the pulmonary capillaries, is less
excited.
8. In like manner when there exists an accumulation of the sensorial power
of association, owing to defect of its excitement by some previous
irritative or associate motions, it is generally accompanied for a certain
time by a torpor not only of the link first affected, but of the subsequent
parts, or of the whole train of associated motions, as in the cold fits of
intermittent fevers. Yet after a time an increased action of the next links
of associated motions succeeds the torpor of the first, as the absorbent
vessels of the lungs act more violently in consequence of the deficient
action of those of the stomach; and the skin at the commencement of
sickness is pale and cold, but in a little time becomes flushed and warm.
Thus we see in associate motions, which are rendered torpid by defect of
excitement, that sometimes a direct, and sometimes a reverse sympathy
succeeds in the subsequent links of the chain. But I believe where a torpor
of irritative or of the associate motions is caused by a previous too great
expenditure or exhaustion of the sensorial powers of irritation or
association, no increase of action in the subsequent link ever occurs, or
not till after a very long time.
Thus when the stomach becomes torpid by previous violent exertion, and
consequent exhaustion of the sensorial power of irritation, as after
intoxication with wine or opium, or after the exhibition of some violent
emetic drug, the torpor is communicated to the heart and arteries, as in
continued fevers with weak pulse. But where the torpor of the stomach is
produced from defective association, as in sea-sickness; or in the sickness
which occurs, when a stone stimulates the ureter; no torpor is then
communicated to the heart and arteries. For in the former case there is no
accumulation of sensorial power in the stomach, which was previously
exhausted by too great stimulus; but in the latter case the accumulation of
sensorial power in the stomach during its torpor is evinced by this
circumstance; that in sea-sickness the patients eat and drink voraciously
at intervals; and the pulse is generally not affected by the sickness
occasioned by a stone in the ureter. For the action of the stomach is then
lessened, and in consequence becomes retrograde, not owing to the
exhaustion of the sensorial power of irritation, but to the want of
excitement of the sensorial power of association; which is caused by the
defective action of the ureter, which becomes occasionally torpid by the
great stimulus of the stone it contains; or which is caused by the great
exhaustion of sensorial power by the pain; which affects the ureter without
exciting inflammation, or increased action of it.
9. Thus though the stomach after the great stimulus of intoxication from
excess of wine or opium will continue many hours without accumulation of
sensorial power, as appears from the patient's experiencing no appetite at
the intervals of sickness; yet after long abstinence from food, at length
not only the exhausted quantity of sensorial power is renewed, but an
accumulation of it at length occurs, and hunger returns. In this situation
the stomach is generally about a whole day before it regains its usual
powers of digestion; but if it has been still more violently stimulated,
and its actions further impaired, a still more permanent torpor along with
a continued fever with weak pulse is liable to occur; and a fourth part, or
a half, or three fourths, or a whole lunar period passes, before it
recovers its due irritability and consequent action.
In similar manner, after a person has been confined in a very warm room for
some hours, the cutaneous capillaries, with their secretory and absorbent
vessels, become exhausted of their sensorial power of irritation by the too
great violent exertions occasioned by the unusual stimulus of heat; and in
coming into a colder atmosphere an inactivity of the cutaneous vessels
exists at first for some time without accumulation of sensorial power; as
is shewn by the continuance of the pain of cold and the paleness; but after
a time both the pain of cold and paleness vanish, which now indicates an
accumulation of the sensorial power of irritation, as less degrees of heat
stimulate the system into due action.
In the same manner, after any one has been some time in the summer
sunshine, on coming into a dark cell he continues much longer before he can
clearly distinguish objects, than if his eyes had only been previously
exposed to the light of a cloudy day in winter; because the sensorial power
of irritation, and consequent sensation, had in the first case been
previously much expended or exhausted; and therefore required a much longer
time before it could be produced in the brain, or derived to the optic
nerves, in such quantity as to restore the deficiency, and to cause an
accumulation of it; whereas in the latter case no deficiency had occurred.
10. Thus the accumulation or deficiency of sensorial power in a torpid
organ, which had previously been accustomed to perpetual action, depends on
the manner in which it becomes torpid; that is, whether by great previous
stimulus, or great previous excitement of the power of association; or by
defect of its accustomed stimulus, or of its accustomed excitement of the
power of association. In the former case the sensorial power is in an
exhausted state, and therefore is not likely to become so soon accumulated,
as after drunkenness, or exposure to great heat, or to great light; in the
latter a great accumulation of sensorial power occurs, as after exposure to
cold, or hunger, or darkness.
Hence when the stomach continues torpid by previous violent stimulus, as in
the exhibition of digitalis, no accumulation of sensorial power of
irritation supervenes; and in consequence the motions of the heart and
arteries, which are associated with those of the stomach, become weak, and
slow, and intermittent, from the defect of the excitement of the sensorial
power of association. But what follows? as the actions of the heart and
arteries are lessened by the deficient action of the sensorial power of
association, and not by previous increased excitement of it; a great
accumulation of the sensorial power of association occurs, which is exerted
on the pulmonary and cutaneous absorbents by reverse sympathy, and produces
a great absorption of the fluid effused into the cellular membrane in
anasarca, with dry skin; constituting one kind of atrophy.
But if at the same time the secerning vessels of the stomach are stimulated
into so violent activity as to induce great consequent torpor, as probably
happens when contagious matter is swallowed into the stomach with our
saliva, those of the heart and arteries act feebly from the deficient
excitement of the power of association; and then the cutaneous and
pulmonary secerning vessels act with greater force than natural, owing to
the accumulation of the sensorial power of association; and unnatural heat
of the skin, and of the breath succeed; but without frequency of pulse,
constituting the paresis irritativa of Class I. 2. 1. 2. And lastly, if a
paucity of blood attends this paresis, or some other cause inducing a
frequency of pulse, the febris inirritativa, or fever with weak pulse, is
produced.
But on the contrary when the stomach has previously been rendered torpid by
defect of stimulus, as by hunger, if food be too hastily supplied, not only
great exertion of the stomach itself succeeds, but fever with strong pulse
is induced in consequence; that is, the heart and arteries are excited into
more energetic action by the excess of the power of association, which
catenates their motions with those of the stomach. For the redundancy of
sensorial power of irritation, which was accumulated during the inactivity
of the stomach, and is now called into action by stimulus, actuates that
organ with increased energy, and excites by these increased motions the
sensorial power of association; which has also been accumulated during the
inactivity of the heart and arteries; and thus these organs also are now
excited into greater action.
So after the skin has been exposed some hours to greater heat than natural
in the warm room, other parts, as the membranes of the nostrils, or of the
lungs, or of the stomach, are liable to become torpid from direct sympathy
with it, when we come into air of a moderate temperature; whence catarrhs,
coughs, and fevers. But if this torpor be occasioned by defect of stimulus,
as after being exposed to frosty air, the accumulation of sensorial power
is exerted, and a glow of the skin follows, with increased digestion, full
respiration, and more vigorous circulation.
11. It may be asked, Why is there a great and constant accumulation of the
sensorial power of association, owing to the torpor of the stomach and
heart and arteries, in continued fever with weak pulse; which is exerted on
the cutaneous and pulmonary capillaries, so as to excite them into
increased action for many weeks, and yet no such exuberance of sensorial
power produces fever in winter-sleeping animals, or in chlorosis, or
apepsia, or hysteria?
In winter-sleeping animals I suppose the whole nervous system is torpid, or
paralysed, as in the sleep of frozen people; and that the stomach is torpid
in consequence of the inactivity or quiescence of the brain; and that all
other parts of the body, and the cutaneous capillaries with the rest,
labour under a similar torpor.
In chlorosis, I imagine, the actions of the heart and arteries, as well as
those of the cutaneous and pulmonary capillaries, suffer along with those
of the stomach from the deficient stimulus of the pale blood; and that
though the liver is probably the seat of the original torpor in this
disease, with which all other parts sympathize from defect of the
excitation of the sensorial power of association; yet as this torpor occurs
in so small a degree as not to excite a shuddering or cold fit, no
observable consequences are in general occasioned by the consequent
accumulation of sensorial power. Sometimes indeed in chlorosis there does
occur a frequent pulse and hot skin; in which circumstances I suppose the
heart and arteries are become in some degree torpid by direct sympathy with
the torpid liver; and that hence not only the pulse becomes frequent, but
the capillaries of the skin act more violently by reverse sympathy with the
heart and arteries, owing to the accumulation of the sensorial power of
association in them during their torpid state, as occurs in irritative
fever. See Article 11 of this Supplement.
In apepsia chronica the actions of the stomach are not so far impaired or
destroyed as totally to prevent the excitation of the sensorial power of
association, which therefore contributes something towards the actions of
the heart and arteries, though less than natural, as a weak pulse always I
believe attends this disease.
There is a torpor of the stomach, and of the upper part of the alimentary
canal in hysteria, as is evident from the retrograde actions of the
duodenum, stomach, and oesophagus, which constitute the globus hystericus,
or sensation of a globe rising into the throat. But as these retrograde
actions are less than those, which induce sickness or vomiting, and are not
occasioned by previous exhaustion of the sensorial power of irritation,
they do not so totally prevent the excitement of the sensorial power of
association, as to lessen the motion of the heart and arteries so much as
to induce fever; yet in this case, as in apepsia, and in chlorosis, the
pulsations of the heart and arteries are weaker than natural, and are
sometimes attended with occasionally increased action of the capillaries;
as appears from the flushings of the face, and hot skin, which generally
form an evening febricula in diseases attended with weak digestion.
12. The increased action, or orgasm, of the cutaneous, pulmonary, and
cellular capillaries, with their secerning and absorbent vessels, in those
fevers which are attended with deficiency of vital action, exhausts the
patient both by the additional expenditure of sensorial power on those
organs of secretion, and by the too great absorption of the mucus and fat
of the body; whence great debility and great emaciation. Hence one great
indication of cure of continued fever with arterial debility is to diminish
the too great action of the capillaries; which is to be done by frequent
ablutions, or bathing the whole skin in tepid or in cold water, as
recommended by Dr. Currie of Liverpool (Philos. Trans. for 1792), for half
an hour, twice a day, or at those times when the skin feels dryest and
hottest. Much cool air should also be admitted, when the breath of the
patient feels hot to one's hand; or when the tongue, especially its middle
part, is dry, and covered with a crust of indurated mucus; as these
indicate the increased action of the pulmonary capillaries; in the same
manner as the dry and hot skin indicates the orgasm of the cutaneous
capillaries; and the emaciation of the body that of the cellular ones.
For this purpose of abating the action of the capillaries by frequent
ablution or fomentation, water of any degree of heat beneath that of the
body will be of service, and ought in accurate language to be called a cold
bath; but the degree of coldness, where the patient is sensible, should in
some measure be governed by his sensations; as it is probable, that the
degree of coldness, which is most grateful to him, will also be of the
greatest benefit to him. See Class III. 2. 1. 12. and Article 15 of this
Supplement.
Another great use of frequent ablutions, or fomentations, or baths, in
fevers, where the stomach is in some degree torpid, is to supply the system
with aqueous fluid by means of the cutaneous absorbents; which is
dissipated faster by the increased action of the secerning capillaries,
than the stomach can furnish, and occasions great thirst at the intervals
of the sickness.
IX. _Torpor of the Lungs._
1. The lungs in many cases of contagion may first be affected with torpor,
and the skin become cold by sympathy; in the same manner as a cold skin on
going into the cold bath induces difficulty of breathing. Or the stomach
may become affected with torpor by its sympathy with the lungs, as in the
experiments of Mr. Watt with hydro-carbonate gas; a few respirations of
which induced sickness, and even syncope. When the stomach or skin is thus
affected secondarily by association, an accumulation of sensorial power
occurs much sooner, than when these parts become torpid in consequence of
previous excess of stimulus; and hence they sooner recover their accustomed
action, and the fever ceases. The particles of contagious matter thus
received by respiration somewhat resemble in their effects the acid gases
from burning sulphur, or from charcoal; which, if they do not instantly
destroy, induce a fever, and the patient slowly recovers.
2. I was some years ago stooping down to look, which way the water oozed
from a morass, as a labourer opened it with a spade, to detect the source
of the spring, and inhaled a vapour, which occasioned an instant sense of
suffocation. Immediately recoiling I believe I inhaled it but once; yet a
few hours afterwards in the cool of the evening, when I returned home
rather fatigued and hungry, a shivering and cold fit occurred, which was
followed by a hot one; and the whole disease began and terminated in about
twelve hours without return. In this case the power of fear, or of
imagination, was not concerned; as I neither thought of the bad air of a
morass before I perceived it; nor expected a fever-fit, till it occurred.
In this case the torpor commenced in the lungs, and after a few hours, by
the addition of fatigue, and cold, and hunger, was propagated by direct
sympathy to the rest of the system. An orgasm or increased action of the
whole system was then induced by the accumulation of sensorial power of
irritation in the lungs, and of association in the other organs; and when
these subsided, the disease ceased. It may be asked, could a torpor of the
capillaries of the air-vessels of the lungs be so suddenly produced by
great stimulation?--It appears probable, that it might, because great
exertion of irritative motions may be instantly produced without our
perceiving them; that is, without their being attended by sensation, both
in the lungs and stomach; and the organs may become torpid by the great
expenditure of the sensorial power of irritation in an instant of time; as
paralysis frequently instantly follows too great an exertion of voluntary
power.
3. When the capillaries of the lungs act too violently, as in some
continued fevers; which is known by the heat of the breath, and by the
dryness of the tongue, especially of the middle part of it; not only cooler
air might be admitted more freely into a sick room to counteract this
orgasm of the pulmonary capillaries; but perhaps the patient might breathe
with advantage a mixture of carbonic acid gas, or of hydrogene gas, or of
azote with atmospheric air. And on the contrary, when there exists an
evident torpor of the pulmonary capillaries, which may be known by the
correspondent chilness of the skin; and by a tickling cough, which
sometimes attends cold paroxysms of fever, and is then owing to the
deficient absorption of the pulmonary mucus, the saline parts of which
stimulate the bronchiae, or air-vessels; a mixture of one part of oxygen
gas with 10 or 20 parts of atmospheric air might probably be breathed with
great advantage.
X. _Torpor of the Brain._
As the inactivity or torpor of the absorbent vessels of the brain is the
cause of hydrocephalus internus; and as the deficiency of venous absorption
in the brain, or torpor of the extremities of its veins, is believed
frequently to be the cause of apoplexies; so there is reason to conclude,
that the torpor of the secerning vessels of the brain, which are supposed
to produce the sensorial power, may constitute the immediate cause of some
fevers with arterial debility. And also that the increased action of these
secerning vessels may sometimes constitute the immediate cause of fevers
with arterial strength.
It is nevertheless probable, that the torpor or orgasm of the sanguiferous,
absorbent, or secerning vessels of the brain may frequently exist as a
secondary effect, owing to their association with other organs, as the
stomach or lungs; and may thus be produced like the torpor of the heart and
arteries in inirritative fevers, or like the orgasm of those organs in
irritative fevers, or inflammatory ones.
Where there exists a torpor of the brain, might not very slight electric
shocks passed frequently through it in all directions be used with
advantage? Might not fomentations of 94 or 96 degrees of heat on the head
for an hour at a time, and frequently repeated, stimulate the brain into
action; as in the revival of winter-sleeping animals by warmth? Ether
externally might be frequently applied, and a blister on the shaved head.
Where the secerning vessels of the brain act with too great energy, as in
some inflammatory fevers, might it not be diminished by laying the patient
horizontally on a mill-stone, and whirling him, till sleep should be
produced, as the brain becomes compressed by the centrifugal force? See
Article 15 of this Supplement.
XI. _Torpor of the Heart and Arteries._
1. It was shewn in Class IV. 1. 1. 6. in IV. 2. 1. 2. and in Suppl. I. 6.
3. that a reverse sympathy generally exists between the lacteal and
lymphatic branches of the absorbent system. Hence, when the motions of the
absorbents of the stomach are rendered torpid or retrograde in fevers with
arterial debility, those of the skin, lungs, and cellular membrane, act
with increased energy. But the actions of the muscular fibres of the heart
and arteries are at the same time associated with those of the muscular
fibres of the stomach by direct sympathy. Both these actions occur during
the operation of powerful emetics, as squill, or digitalis; while the
motions of the stomach continue torpid or retrograde, the cellular and
cutaneous absorbents act with greater energy, and the pulsations of the
heart and arteries become weaker, and sometimes slower.
2. The increased action of the stomach after a meal, and of the heart and
arteries at the same time from the stimulus of the new supply of chyle,
seems originally to have produced, and to have established, this direct
sympathy between them. As the increased action of the absorbents of the
stomach after a meal has been usually attended with diminished action of
the other branches of the absorbent system, as mentioned in Class IV. 1. 1.
6. and has thus established a reverse sympathy between them.
2. Besides the reverse sympathy of the absorbent vessels and the muscles of
the stomach, and of the heart and arteries, with those of the skin, lungs,
and cellular membrane; there exists a similar reverse sympathy between the
secerning vessels or glands of the former of these organs with those of the
latter; that is the mucous glands of the heart and arteries act generally
by direct sympathy with those of the stomach; and the mucous glands of the
cellular membrane of the lungs, and of the skin, act by reverse sympathy
with them both.
Hence when the stomach is torpid, as in sickness, this torpor sometimes
only affects the absorbent vessels of it; and then the absorbents of the
cellular membrane and the skin only act with increased energy by reverse
sympathy. If the torpor affects the muscular fibres of the stomach, those
of the heart and arteries act by direct sympathy with it, and a weak pulse
is produced, as in the exhibition of digitalis, but without increase of
heat. But if the torpor also affects the glands of the stomach, the
cutaneous and pulmonary glands act with greater energy by their reverse
sympathy with those of the stomach, and of the heart and arteries; and
great heat is produced along with increased perspiration both from the skin
and lungs.
3. There is some difficulty in explaining, why the actions of the extensive
system of capillary glands, which exist on every other membrane and cell in
the body for the purpose of secreting mucus and perspirable matter, should
so generally act by reverse sympathy with those of the stomach and upper
part of the intestines. It was shewn in Class IV. 1. 1. 6. that when the
stomach was filled with solid and fluid aliment, the absorbents of the
cellular membrane, and of the bladder, and of the skin acted with less
energy; as the fluids they were used to absorb and transmit into the
circulation, were now less wanted; and that hence by habit a reverse
sympathy obtained between these branches of the absorbents of the
alimentary canal, and those of the other parts of the body.
Now, as at this time less fluid was absorbed by the cutaneous and cellular
lymphatics, it would happen, that less would be secreted by their
correspondent secerning vessels, or capillary glands; and that hence by
habit, these secerning vessels would acquire a reverse sympathy of action
with the secerning vessels of the alimentary canal.
Thus when the absorption of the tears by the puncta lacrymalia is much
increased by the stimulus of snuff; or of an affecting idea, on the nasal
dusts, as explained in Sect. XVI. 8. 2. a great increase of the secretion
of tears from the lacrymal glands is produced by the direct sympathy of the
action of these glands with those of their correspondent absorbents; and
that though in this case they are placed at so great a distance from each
other.
4. A difficult question here occurs; why does it happen, that in fevers
with weak pulse the contractions of the heart and arteries become at the
same time more frequent; which also sometimes occurs in chlorosis, and in
some hysteric and hypochondriac diseases, and in some insanities; yet at
other times the weak pulse becomes at the same time slow, as in the
exhibition of digitalis, and in paresis irritativa, described in Class I.
2. 1. 2. which may be termed a fever with slow pulse? this frequency of
pulse can not depend on heat, because it sometimes exists without heat, as
towards the end of some fevers with debility.
Now as apoplexies, which are sometimes ascribed to fulness of blood, are
attended with slow pulse; and as in animals dying in the slaughter house
from deficiency of blood the pulse becomes frequent in extreme; may not the
frequency of pulse in fevers with arterial debility be in general owing to
paucity of blood? as explained in Sect. XXXII. 2. 3. and its slowness in
paresis irritativa be caused by the debility being accompanied with due
quantity of blood? or may not the former circumstance sometimes depend on a
concomitant affection of the brain approaching to sleep? or to the unusual
facility of the passage of the blood through the pulmonary and aortal
capillaries? in which circumstance the heart may completely empty itself at
each pulsation, though its contractions may be weak. While the latter
depends on the difficulty of the passage of the blood through the pulmonary
or aortal capillaries, as in the cold fits of intermittents, and in some
palpitations of the heart, and in some kinds of haemoptoe? in these cases
the increased resistance prevents the heart from emptying itself, and in
consequence a new diastole sooner occurs, and thus the number of pulsations
becomes greater in a given time.
5. In respect to the sympathies of action, which produce or constitute
fever with debility, the system may be divided into certain provinces,
which are assentient or opposite to each other. First, the lacteals or
absorbent vessels of the stomach, and upper part of the intestines;
secondly, the lymphatics or all the other branches of the absorbent
vessels, which arise from the skin, mucous membranes, cellular membranes,
and the various glands. These two divisions act by reverse sympathy with
each other in the hot fits of fever with debility, though by direct
sympathy in the cold ones. The third division consists of the secerning
vessels of the stomach and upper intestines; and the fourth of the
secerning vessels of all the other parts of the body, as the capillary
glands of the skin, lungs, and cellular membrane, and the various other
glands belonging to the sanguiferous system. Many of these frequently, but
the capillaries always, act by reverse sympathy with those of the third
division above mentioned in the hot fits of fever with debility, though by
direct sympathy with them in the cold fits. Fifthly, the muscular fibres of
the stomach, and upper intestines; and sixthly, the muscular fibres of the
heart and arteries. The actions of these two last divisions of moving
fibres act by direct sympathy with each other, both in the cold and hot
fits of fevers with debility.
The efficient cause of those apparent sympathies in fevers with weak pulse
may be thus understood. In the cold paroxysm of fever with weak pulse the
part first affected I believe to be the stomach, and that it has become
torpid by previous violent exertion, as by swallowing contagious matter
mixed with saliva, and not by defect of stimulus, as from cold or hunger.
The actions of this important organ, which sympathizes with almost every
part of the body, being thus much diminished or nearly destroyed, the
sensorial power of association is not excited; which in health contributes
to move the heart and arteries, and all the rest of the system; whence an
universal torpor occurs.
When the hot fit approaches, the stomach in fevers with strong pulse
regains its activity by the accumulation of the sensorial power of either
irritation, if it was the part first affected, or of association if it was
affected in sympathy with some other torpid part, as the spleen or liver;
which accumulation is produced during its torpor. At the same time all the
other parts of the system acquire greater energy of action by the
accumulation of the sensorial power of association, which was produced,
during their inactivity in the cold fit.
But in fevers with weak pulse the stomach, whose sensorial power of
irritation had been previously exhausted by violent action, acquires no
such quick accumulation of sensorial power, but remains in a state of
torpor after the hot fit commences. The heart and arteries remain also in a
state of torpor, because there continues to be no excitement of their power
of association owing to the torpid motions of the stomach; but hence it
happens, that there exists at this time a great accumulation of the power
of association in the less active fibres of the heart and arteries; which,
as it is not excited and expended by them, increases the associability of
the next link of the associated chain of motions, which consists of the
capillaries or other glands; and that in so great a degree as to actuate
them with unnatural energy, and thus to produce a perpetual hot fit of
fever. Because the associability of the capillaries is so much increased by
the accumulation of this power, owing to the lessened activity of the heart
and arteries, as to over-balance the lessened excitement of it by the
weaker movements of the heart and arteries.
6. When the accumulation of the sensorial power of irritation caused by
defect of stimulus is greater in the first link of a train of actions, to
which associated motions are catenated, than the deficiency of the
excitement of the sensorial power of association in the next link, what
happens?--the superabundance of the unemployed sensorial power of the first
link is derived to the second; the associability of which thus becomes so
greatly increased, that it acts more violently than natural, though the
excitement of its power of association by the lessened action of the first
link is less than natural. So that in this situation the withdrawing of an
accustomed stimulus in some parts of the system will decrease the
irritative motions of that part, and at the same time occasion an increase
of the associate motion of another part, which is catenated with it.
This circumstance nevertheless can only occur in those parts of the system,
whose natural actions are perpetual, and the accumulation of sensorial
power on that account very great, when their activity is much lessened by
the deduction of their usual stimulus; and are therefore only to be found
in the sanguiferous system, or in the alimentary canal, or in the glands
and capillaries. Of the first of which the following is an instance.
The respiration of a reduced atmosphere, that is of air mixed with
hydrogene or azote, quickens the pulse, as observed in the case of Mrs.
Eaton by Dr. Reynolds and Dr. Thornton; to which Dr. Beddoes adds in a
note, that "he never saw an instance in which a lowered atmosphere did not
at the moment quicken the pulse, while it weakened the action of the heart
and arteries." Considerations on Factitious Airs, by Thomas Beddoes and
James Watt, Part III. p. 67. Johnson, London. By the assistance of this new
fact the curious circumstance of the quick production of warmth of the skin
on covering the head under the bed-clothes, which every one must at some
time have experienced, receives a more satisfactory explanation, than that
which is given in Class IV. 1. 1. 2. which was printed before this part of
Dr. Beddoes's Considerations was published.
For if the blood be deprived of its accustomed quantity of oxygen, as in
covering the head in bed, and thus breathing an air rendered impure by
repeated respiration, or by breathing a factitious air with less proportion
of oxygen, which in common respiration passes through the moist membranes
of the lungs, and mixes with the blood, the pulsations of the heart and
arteries become weaker, and consequently quicker, by the defect of the
stimulus of oxygen. And as these vessels are subject to perpetual motion,
the accumulation of the sensorial power of irritation becomes so great by
their lessened activity, that it excites the vessels next connected, the
cutaneous capillaries for instance, into more energetic actions, so as to
produce increased heat of the skin, and greater perspiration.
How exactly this resembles a continued fever with weak and quick pulse!--in
the latter the action of the heart and arteries are lessened by defect of
the excitement of the sensorial power of association, owing to the torpor
or lessened actions of the stomach; hence the accumulation of the sensorial
power of association in this case, as the accumulation of that of
irritation in the former, becomes so abundant as to excite into increased
action the parts most nearly connected, as the cutaneous capillaries.
In respect to the circumstance mentioned by Sydenham, that covering the
head in bed in a short time relieved the pertinacious sickness of the
patient, it must be observed, that when the action of the heart and
arteries become weakened by the want of the due stimulus of the proper
quantity of oxygen in the blood, that an accumulation of the sensorial
power of irritation occurs in the fibres of the heart and arteries, which
then is expended on those of the capillary glands, increasing their actions
and consequent secretions and heat. And then the stomach is thrown into
stronger action, both by the greater excitement of its natural quantity of
the sensorial power of association by the increased actions of the
capillaries, and also by some increase of associability, as it had been
previously a long time in a state of torpor, or less activity than natural,
as evinced by its perpetual sickness.
In a manner somewhat similar to this, is the redness of the skin produced
in angry people by the superabundance of the unemployed sensorial power of
volition, as explained in Class IV. 2. 3. 5. Rubor ex ira. From hence we
learn how, when people in fevers with weak pulse, or in dropsies, become
insane, the abundance of the unemployed sensorial power of volition
increases the actions of the whole moving system, and cures those diseases.
7. As the orgasm of the capillaries in fevers with weak pulse is
immediately caused by the torpid actions of the heart and arteries, as
above explained, this supplies us with another indication of cure in such
fevers, and that is to stimulate these organs. This may probably be done by
some kind of medicines, which are known to pass into the blood unchanged in
some of their properties. It is possible that nitre, or its acid, may pass
into the blood and increase the colour of it, and thus increase its
stimulus, and the same may be supposed of other salts, neutral or metallic?
As rubia tinctoria, madder, colours the bones of young animals, it must
pass into the blood with its colouring matter at least unchanged, and
perhaps many other medicines may likewise affect the blood, and thus act by
stimulating the heart and arteries, as well as by stimulating the stomach;
which circumstance deserves further attention.
Another way of immediately stimulating the heart and arteries would be by
transfusing new blood into them. Is it possible that any other fluid
besides blood, as chyle, or milk, or water, could, if managed with great
art, be introduced safely or advantageously into the vein of a living
animal?
A third method of exciting the heart and arteries immediately is by
increasing the natural stimulus of the blood, and is well worthy experiment
in all fevers with weak pulse; and that consists in supplying the blood
with a greater proportion of oxygen; which may be done by respiration, if
the patient was to breathe either oxygen gas pure, or diluted with
atmospheric air, which might be given to many gallons frequently in a day,
and by passing through the moist membranes of the lungs, according to the
experiments of Dr. Priestley, and uniting with the blood, might render it
more stimulant, and thus excite the heart and arteries into greater action!
May not some easier method of exhibiting oxygen gas by respiration be
discovered, as by using very small quantities of hyper-oxygenated marine
acid gas very much diluted with atmospheric air?
XII. _Torpor of the Stomach and upper Intestines._
1. The principal circumstance, which supports the increased action of the
capillaries in continued fever with weak pulse, is their reverse sympathy
with those of the stomach and upper intestines, or with those of the heart
and arteries. The torpor of the stomach and upper intestines is apparent in
continued fevers from the total want of appetite for solid food, besides
the sickness with which fevers generally commence, and the frequent
diarrhoea with indigested stools, at the same time the thirst of the
patient is sometimes urgent at the intervals of the sickness. Why the
stomach can at this time take fluids by intervals, and not solids, is
difficult to explain; except it be supposed, as some have affirmed, that
the lacteal absorbents are a different branch from the lymphatic
absorbents, and that in this case the former only are in a state of
permanent torpor.
2. The torpor of the heart and arteries is known by the weakness of the
pulse. When the actions of the absorbents of the stomach are diminished by
the exhibition of small doses of digitalis, or become retrograde by larger
ones, the heart and arteries act more feebly by direct sympathy; but the
cellular, cutaneous, and pulmonary absorbents are excited into greater
action. Whence in anasarca the fluids in the cellular membrane throughout
the whole body are absorbed during the sickness, and frequently a great
quantity of atmospheric moisture at the same time; as appears by the very
great discharge of urine, which sometimes happens in these cases; and in
ileus the prodigious evacuations by vomiting, which are often a hundred
fold greater than the quantity swallowed, evince the great action of all
the other absorbents during the sickness of the stomach.
3. But when the stomach is rendered permanently sick by an emetic drug, as
by digitalis, it is not probable, that much accumulation of sensorial power
is soon produced in this organ; because its usual quantity of sensorial
power is previously exhausted by the great stimulus of the foxglove; and
hence it seems probable, that the great accumulation of sensorial power,
which now causes the increased action of the absorbents, is produced in
consequence of the inactivity of the heart and arteries; which inactivity
is induced by deficient excitement of the sensorial power of association
between those organs and the stomach, and not by any previous exhaustion of
their natural quantity of sensorial power; whereas in ileus, where the
torpor of the stomach, and consequent sickness, is induced by reverse
sympathy with an inflamed intestine, that is, by dissevered or defective
association; the accumulation of sensorial power, which in that disease so
violently actuates the cellular, pulmonary, and cutaneous absorbents, is
apparently produced by the torpor of the stomach and lacteals, and the
consequent accumulation of the sensorial power of association in them owing
to their lessened action in sickness.
4. This accounts for the dry skin in fevers with weak pulse, where the
stomach and the heart and arteries are in a torpid state, and for the
sudden emaciation of the body; because the actions of the cellular and
cutaneous absorbents are increased by reverse sympathy with those of the
stomach, or with those of the heart and arteries; that is by the
expenditure of that sensorial power of association, which is accumulated in
consequence of the torpor of the stomach and heart and arteries, or of
either of them; this also explains the sudden absorption of the milk in
puerperal fevers; and contributes along with the heat of the respired air
to the dryness of the mucous membrane of the tongue and nostrils.
5. Besides the reverse sympathy, with which the absorbent vessels of the
stomach and upper intestines act in respect to all the other absorbent
vessels, as in the exhibition of digitalis, and in ileus; there is another
reverse sympathy exists between the capillaries, or secretory vessels of
the stomach, and those of the skin. Which may nevertheless be occasioned by
the accumulation of sensorial power by the torpor of the heart and
arteries, which is induced by direct sympathy with the stomach; thus when
the torpor of the stomach remains in a fever-fit which might otherwise have
intermitted, the torpor of the heart and arteries remains also by direct
sympathy, and the increased cutaneous capillary action, and consequent
heat, are produced by reverse sympathy; and the fever is thus rendered
continual, owing primarily to the torpor of the stomach.
6. The reverse sympathy, which exists between the capillaries of the
stomach and the cutaneous capillaries, appears by the chillness of some
people after dinner; and contrary-wise by the digestion being strengthened,
when the skin is exposed to cold air for a short time; as mentioned in
Class IV. 1. 1. 4. and IV. 2. 1. 1. and from the heat and glow on the skin,
which attends the action of vomiting; for though when sickness first
commences, the skin is pale and cold; as it then partakes of the general
torpor, which induces the sickness; yet after the vomiting has continued
some minutes, so that an accumulation of sensorial power exists in the
capillaries of the stomach, and of the skin, owing to their diminished
action; a glow of the skin succeeds, with sweat, as well as with increased
absorption.
7. Nevertheless in some circumstances the stomach and the heart and
arteries seem to act by direct sympathy with the cutaneous capillaries, as
in the flushing of the face and glow of the skin of some people after
dinner; and as in fevers with strong pulse. In these cases there appears to
be an increased production of sensorial power, either of sensation, as in
the blush of shame; or of volition, as in the blush of anger; or of
irritation, as in the flushed face after dinner above mentioned.
This increased action of the capillaries of the skin along with the
increased actions of the stomach and heart is perhaps to be esteemed a
synchronous increase of action, rather than a sympathy between those
organs. Thus the flushing of the face after dinner may be owing to the
secretion of sensorial power in the brain being increased by the
association of that organ with the stomach, in a greater proportion than
the increased expenditure of it, or may be owing also to the stimulus of
new chyle received into the blood.
8. When the stomach and the heart and arteries are rendered torpid in
fevers, not only the cutaneous, cellular, and pulmonary absorbents are
excited to act with greater energy; but also their correspondent
capillaries and secerning vessels or glands, especially perhaps those of
the skin, are induced into more energetic action. Whence greater heat, a
greater secretion of perspirable matter, and of mucus; and a greater
absorption of them both, and of aerial moisture. These reverse sympathies
coincide with other animal facts, as in eruption of small pox on the face
and neck the feet become cold, while the face and neck are much flushed;
and in the hemiplagia, when one arm and leg become disobedient to volition,
the patient is perpetually moving the other. Which are well accounted for
by the accumulation of sensorial power in one part of an associated series
of actions, when less of it is expended by another part of it; and by a
deficiency of sensorial power in the second link of association, when too
much of it is expended by the first.
9. This doctrine of reverse sympathy enables us to account for that
difficult problem, why in continued fevers the increased action of the
cutaneous, cellular, and pulmonary capillaries proceeds without
interruption or return of cold fit; though perhaps with some exacerbations
and remissions; and that during a quarter, or half, or three quarters, or a
whole lunation; while at the same time the pulsations of the heart and
arteries are weaker than natural.
To this should be added the direct sympathy, which exists between the
peristaltic motions of the fibres of the stomach, and the pulsations of the
heart. And that the stomach has become torpid by the too great stimulus of
some poisonous or contagious matter; and this very intricate idea of
continued fever with feeble pulse is reduced to curious simplicity.
The direct sympathy of the stomach and heart and arteries not only appears
from the stronger and slower pulse of persons exhausted by fatigue, after
they have drank a glass of wine, and eaten a few mouthfuls; but appears
also from the exhibition of large doses of digitalis; when the patient
labours under great and incessant efforts to vomit, at the same time that
the actions of the absorbent system are known to be much increased by the
hasty absorption of the serous fluid in anasarca, the pulsations of the
heart become slow and intermittent to an alarming degree. See Class IV. 2.
1. 17. and 18.
10. It would assist us much in the knowledge and cure of fevers, if we
could always determine, which part of the system was primarily affected;
and whether the torpor of it was from previous excess or defect of
stimulus; which the industry of future observers must discover. Thus if the
stomach be affected primarily, and that by previous excess of stimulus, as
when certain quantities of opium, or wine, or blue vitriol, or arsenic, are
swallowed, it is some time in recovering the quantity of sensorial power
previously exhausted by excess of stimulus, before any accumulation of it
can occur. But if it be affected with torpor secondarily, by sympathy with
some distant part; as with the torpid capillaries of the skin, that is by
defective excitement of the sensorial power of association; or if it be
affected by defect of stimulus of food or of heat; it sooner acquires so
much accumulation of sensorial power, as to be enabled to accommodate
itself to its lessened stimulus by increase of its irritability.
Thus in the hemicrania the torpor generally commences in a diseased tooth,
and the membranes about the temple, and also those of the stomach become
torpid by direct synchronous sympathy; and pain of the head, and sickness
supervene; but no fever or quickness of pulse. In this case the torpor of
the stomach is owing to defect of the sensorial power of association, which
is caused by the too feeble actions of the membranes surrounding the
diseased tooth, and thus the train of sympathy ceases here without
affecting the motions of the heart and arteries; but where contagious
matter is swallowed into the stomach, the stomach after a time becomes
torpid from exhaustion of the sensorial power of irritation, and the heart
and arteries act feebly from defect of the excitement of the power of
association. In the former case the torpor of the stomach is conquered by
accumulation of the power of association in one or two whole days; in the
latter it recovers by accumulation of the power of irritation in three or
four weeks.
In intermittent fevers the stomach is generally I believe affected
secondarily by sympathy with the torpid cutaneous capillaries, or with some
internal torpid viscus, and on this account an accumulation of sensorial
power arises in a few hours sufficient to restore the natural irritability
of this organ; and hence the hot fit succeeds, and the fever intermits. Or
if this accumulation of sensorial power becomes excessive and permanent,
the continued fever with strong pulse is produced, or febris irritativa.
In continued fevers the stomach is frequently I suppose affected with
torpor by previous excess of stimulus, and consequent exhaustion of
sensorial power, as when contagious matter is swallowed with the saliva,
and it is then much slower in producing an accumulation of sensorial power
sufficient to restore its healthy irritability; which is a frequent cause
of continued fever with weak pulse or febris inirritativa. Which consists,
after the cold fit is over, in a more frequent and more feeble action of
the heart and arteries, owing to their direct sympathy with the muscular
fibres of the torpid stomach; together with an increased action of the
capillaries, glands, and absorbents of the skin, and cellular membrane,
owing to their reverse sympathy with the torpid capillaries, glands, and
absorbents of the stomach, or with those of the heart and arteries.
Or in more accurate language. 1. The febris inirritativa, or fever with
weak pulse, commences with torpor of the stomach, occasioned by previous
exhaustion of sensorial power of irritation by the stimulus of contagious
matter swallowed with the saliva. 2. The whole system becomes torpid from
defect of the excitement or the sensorial power of association owing to the
too feeble actions of the stomach, this is the cold fit. 3. The whole
system, except the stomach with the upper intestines, and the heart and
arteries, falls into increased action, or orgasm, owing to accumulation of
sensorial power of association during their previous torpor, this is the
hot fit. 4. The stomach and upper intestines have not acquired their
natural quantity of sensorial power of irritation, which was previously
exhausted by violent action in consequence of the stimulus of contagious
matter, and the heart and arteries remain torpid from deficient excitement
of the sensorial power of association owing to the too feeble actions of
the stomach. 5. The accumulation of sensorial power of association in
consequence of the torpor of the heart and arteries occasions a perpetual
orgasm, or increased action of the capillaries.
11. From hence it may be deducted first, that when the torpor of the
stomach first occurs, either as a primary effect, or as a secondary link of
some associate train or circle of motions, a general torpor of the system
sometimes accompanies it, which constitutes the cold fit of fever; at other
times no such general torpor occurs, as during the operation of a weak
emetic, or during sea-sickness.
Secondly. After a time it generally happens, that a torpor of the stomach
ceases, and its actions are renewed with increase of vigour by accumulation
of sensorial power during its quiescence; as after the operation of a weak
emetic, or at the intervals of sea-sickness, or after the paroxysm of an
intermittent fever.
Thirdly. The stomach is sometimes much slower in recovering from a previous
torpor, and is then the remote cause of continued fever with weak pulse;
which is owing to a torpor of the heart and arteries, produced in
consequence of the deficient excitement of the power of association by the
too weak actions of the stomach; and to an orgasm of the capillaries of the
other parts of the system, in consequence of the accumulation of sensorial
power occasioned by the inactivity of the heart and arteries.
Fourthly. The torpor of the stomach is sometimes so complete, that probably
the origin of its nerves is likewise affected, and then no accumulation of
sensorial power occurs. In this case the patient dies for want of
nourishment; either in three or four weeks, of the inirritative fever; or
without quick pulse, by what we have called paresis irritativa. Or he
continues many years in a state of total debility. When this torpor
suddenly commences, the patient generally suffers epileptic fits or
temporary insanity from the disagreeable sensation of so great a torpor of
the stomach; which also happens sometimes at the eruption of the distinct
small pox; whence we have termed this disease anorexia epileptica. See
Class II. 2. 2. 1. and III. 1. 1. 7. and Suppl. I. 14. 3.
Fifthly. When this torpor of the stomach is less in degree or extent, and
yet without recovering its natural irritability by accumulation of
sensorial power, as it does after the cold fit of intermittent fever, or
after the operation of mild emetics, or during syncope; a permanent defect
of its activity, and of that of the upper intestines, remains, which
constitutes apepsia, cardialgia, hypochondriasis, and hysteria. See Class
I. 3. 1. 3. and I. 2. 4. 5.
Sixthly. If the torpor of the stomach be induced by direct sympathy, as in
consequence of a previous torpor of the liver, or spleen, or skin, an
accumulation of sensorial power will sooner be produced in the stomach;
because there has been no previous expenditure of it, the present torpor of
the stomach arising from defect of association. Hence some fevers perfectly
intermit, the stomach recovering its complete action after the torpor and
consequent orgasm, which constitute the paroxysm of fever, are terminated.
Seventhly. If the torpor of the stomach be owing to defect of irritation,
as to the want of food, an accumulation of sensorial power soon occurs with
an increase of digestion, if food be timely applied; or with violent
inflammation, if food be given in too great quantity after very long
abstinence.
Eighthly. If the torpor of the stomach be induced by defect of pleasurable
sensation, as when sickness is caused by the suggestion of nauseous ideas;
an accumulation of sensorial power soon occurs, and the sickness ceases
with the return of hunger; for in this case the inactivity of the stomach
is occasioned by the subduction of agreeable sensation, which acts as a
subduction of stimulus, and not by exhausting the natural quantity of
sensorial power in the fibres or nerves of the stomach.
Ninthly. If the torpor of the stomach be induced by a twofold cause, as in
sea-sickness. See Vertigo rotatoria. Class IV. 2. 1. 10. in which the first
link of association acts too strongly, and in consequence expends more than
usual of the sensorial power of irritation; and secondly in which sensation
is produced between the links of association, and dissevers or enfeebles
them; the accumulation of sensorial power soon occurs in the stomach; as no
previous expenditure of it in that organ has occurred. Whence in
sea-sickness the persons take food with eagerness at times, when the
vertigo eases for a few minutes.
Tenthly. If the gastric torpor be induced by previous violent exertion, as
after intoxication, or after contagious matter has been swallowed, or some
poisons, as digitalis, or arsenic; an accumulation of sensorial power very
slowly succeeds; whence long sickness, or continued fever, because the
quantity of sensorial power already wasted must first be renewed, before an
accumulation of it can be produced.
12. This leads us to a second indication of cure in continued fevers, which
consists in strengthening the actions of the stomach; as the first
indication consisted in decreasing the actions of the cutaneous capillaries
and absorbents. The actions of the stomach may sometimes be increased by
exhibiting a mild emetic; as an accumulation of sensorial power in the
fibres of the stomach is produced during their retrograde actions. Besides
the evacuation of any noxious material from the stomach and duodenum, and
from the absorbents, which open their mouths on their internal surfaces, by
their retrograde motion.
It is probable, that when mild emetics are given, as ipecacuanha, or
antimonium tartarizatum, or infusion of chamomile, they are rejected by an
inverted motion of the stomach and oesophagus in consequence of
disagreeable sensation, as dust is excluded from the eye; and these actions
having by previous habit been found effectual, and that hence there is no
exhaustion of the sensorial power of irritation. But where strong emetics
are administered, as digitalis, or contagious matter, the previous
exhaustion of the sensorial power of irritation seems to be a cause of the
continued retrograde actions and sickness of the stomach. An emetic of the
former kind may therefore strengthen the power of the stomach immediately
after its operation by the accumulation of sensorial power of irritation
during its action. See Class IV. 1. 1.
Another method of decreasing the action of the stomach for a time, and
thence of increasing it afterwards, is by the accumulation of the sensorial
power of irritation during its torpor; is by giving ice, iced water, iced
creams, or iced wine. This accounts for the pleasure, which many people in
fevers with weak pulse express on drinking cold beverage of any kind.
A second method of exciting the stomach into action, and of decreasing that
of the capillaries in consequence, is by the stimulus of wine, opium, bark,
metallic salts of antimony, steel, copper, arsenic, given in small repeated
quantities; which so long as they render the pulse slower are certainly of
service, and may be given warm or cold, as most agreeable to the patient.
For it is possible, that the capillaries of the stomach may act too
violently, and produce heat, at the same time that the large muscles of it
may be in a torpid state; which curious circumstance future observations
must determine.
Thirdly. Hot fomentation on the region of the stomach might be of most
essential service by its stimulus, as heat penetrates the system not by the
absorbent vessels, but by external influence; whence the use of hot
fomentation to the head in torpor of the brain; and the use of hot bath in
cases of general debility, which has been much too frequently neglected
from a popular error occasioned by the unmeaning application of the word
relaxation to animal power. If the fluid of heat could be directed to pass
through particular parts of the body with as little diffusion of its
influence, as that of electricity in the shocks from the coated jar, it
might be employed with still greater advantage.
Fourthly. The use of repeated small electric shocks through the region of
the stomach might be of service in fevers with weak pulse, and well
deserves a trial; twenty or thirty small shocks twice a day for a week or
two would be a promising experiment.
Fifthly. A blister on the back, or sides, or on the pit of the stomach,
repeated in succession, by stimulating the skin frequently strengthens the
action of the stomach by exciting the sensorial power of association; this
especially in those fevers where the skin of the extremities, as of the
hands or nose or ears, sooner becomes cold, when exposed to the air, than
usual.
Sixthly. The action of the stomach may be increased by preventing too great
expenditure of sensorial power in the link of previous motion with which it
is catenated, especially if the action of that link be greater than
natural. Thus as the capillaries of the skin act too violently in fevers
with weak pulse, if these are exposed to cold air or cold water, the
sensorial power, which previously occasioned their orgasm, becomes
accumulated, and tends to increase the action of the stomach; thus in those
fevers with weak pulse and hot skin, if the stomach be stimulated by
repeated small doses of bark and wine or opium, and be further excited at
the same time by accumulation of sensorial power occasioned by rendering
the capillaries torpid by cold air or water, this twofold application is
frequently attended with visible good effect.
By thus stimulating the torpid stomach into greater action, the motions of
the heart and arteries will likewise be increased by the greater excitement
of the power of association. And the capillaries of the skin will cease to
act so violently, from their not possessing so great a superfluity of
sensorial power as during the greater quiescence of the stomach and of the
heart and arteries. Which is in some circumstances similar to the curious
phenomenon mentioned in Class IV. 2. 2. 10; where, by covering the chill
feet with flannel at the eruption of the small-pox, the points of the
flannel stimulate the skin of the feet into greater action, and the
quantity of heat, which they possess, is also confined, or insulated, and
further increases by its stimulus the activity of the cutaneous vessels of
the feet; and by that circumstance abates the too great action of the
capillaries of the face, and the consequent heat of it.
XIII. _Case of continued fever._
The following case of continued fever which I frequently saw during its
progress, as it is less complicate than usual, may illustrate this
doctrine. Master S. D. an active boy about eight years of age, had been
much in the snow for many days, and sat in the classical school with wet
feet; he had also about a fortnight attended a writing school, where many
children of the lower order were instructed. He was seized on February the
8th, 1795, with great languor, and pain in his forehead, with vomiting and
perpetual sickness; his pulse weak, but not very frequent. He took an
emetic, and on the next day, had a blister, which checked the sickness only
for a few hours; his skin became perpetually hot, and dry; and his tongue
white and furred; his pulse when asleep about 104 in a minute, and when
awake about 112.
Fourth day of the disease. He has had another blister, the pain of his head
is gone, but the sickness continues by intervals; he refuses to take any
solid food, and will drink nothing but milk, or milk and water, cold. He
has two or three very liquid stools every day, which are somtimes green,
but generally of a darkish yellow, with great flatulency both upwards and
downwards at those times. An antimonial powder was once given, but
instantly rejected; a spoonful of decoction of bark was also exhibited with
the same event. His legs are bathed, and his hands and face are moistened
twice a day for half an hour in warmish water, which is nevertheless much
colder than his skin.
Eighth day. His skin continues hot and dry without any observable
remissions, with liquid stools and much flatulency and sickness; his water
when observed was of a straw colour. He has asked for cyder, and drinks
nearly a bottle a day mixed with cold water, and takes three drops of
laudanum twice a day.
Twelfth day. He continues much the same, takes no milk, drinks only cyder
and water, skin hot and dry, tongue hot and furred, with liquid stools, and
sickness always at the same time; sleeps much.
Sixteenth day. Was apparently more torpid, and once rather delirious; pulse
112. Takes only capillaire and water; sleeps much.
Twentieth day. Pulse 100, skin dry but less hot, liquid stools not so
frequent, he is emaciated to a great degree, he has eaten half a tea-cup
full of custard to day, drinks only capillaire and water, has thrice taken
two large spoonfuls of decoction of bark with three drops of laudanum,
refuses to have his legs bathed, and will now take nothing but three drops
of laudanum twice a day.
Twenty-fourth day. He has gradually taken more custard every day, and began
to attend to some new play things, and takes wine syllabub.
Twenty-eighth day. He daily grows stronger, eats eggs, and and butter, and
sleeps immediately after his food, can creep on his hands and knees, but
cannot stand erect.
Thirty-second day. He cannot yet stand alone safely, but seems hourly to
improve in strength of body, and activity of mind.
In this case the remote cause of his fever could not be well ascertained,
as it might be from having his feet cold for many successive days, or from
contagion; but the latter seems more probable, because his younger brother
became ill of a similar fever about three weeks afterwards, and probably
received the infection from him. The disease commenced with great torpor of
the stomach, which was shewn by his total aversion to solid food, and
perpetual sickness; the watery stools, which were sometimes green, or of a
darkish yellow, were owing to the acrimony, or acidity, of the contents of
the bowels; which as well as the flatulency were occasioned by indigestion.
This torpor of the stomach continued throughout the whole fever, and when
it ceased, the fever ceased along with it.
The contagious material of this fever I suppose to have been mixed with the
saliva, and swallowed into the stomach; that it excited the vessels, which
constitute the stomach, into the greatest irritative motion like arsenic;
_which might not be perceived, and yet might render that organ paralytic or
inirritable in a moment of time_; as animals sometimes die by one single
exertion, and consequent paralysis, without a second struggle; as by
lightning, or being shot through the back part of the brain; of both which
I have seen instances. I had once an opportunity of inspecting two oxen, a
few minutes after they were killed by lightning under a crab-tree on moist
ground in long grass; and observed, that they could not have struggled, as
the grass was not pressed or bent near them; I have also seen two horses
shot through the cerebellum, who never once drew in their legs after they
first stretched them out, but died instantaneously; in a similar manner the
lungs seem to be rendered instantly inanimate by the fumes of burning
sulphur.
The lungs may be sometimes primarily affected with contagious matter
floating in the atmosphere as well as the stomach, as mentioned in article
9. of this Supplement. But probably this may occur much less frequently,
because the oxygene of the atmosphere does not appear to be taken into the
blood by animal absorption, as the saliva in the stomach, but passes
through the moist membranes into the blood, like the ethereal fluids of
electricity or heat, or by chemical attraction, and in consequence the
contagious matter may be left behind; except it may sometimes be absorbed
along with the mucus; of which however in this case there appeared no
symptoms.
The tonsils are other organs liable to receive contagious matter, as in the
small-pox, scarlet-fever, and in other sensitive inirritated fevers; but no
symptom of this appeared here, as the tonsils were at no time of the fever
inflamed, though they were in this child previously uncommonly large.
The pain of the forehead does not seem to have been of the internal parts
of the head, because the nerves, which serve the stomach, are not derived
from the anterior part of the brain; but it seems to have been owing to a
torpor of the external membranes about the forehead from their direct
sympathy with those of the stomach; that is, from the deficient excitement
of the sensorial power of association; and seemed in some measure to be
relieved by the emetics and blisters.
The pulsations of the heart were weaker and in consequence quicker than
natural, owing to their direct sympathy with the torpid peristaltic motions
of the stomach; that is to the deficient excitement of the sensorial power
of association.
The action of the cutaneous capillaries and absorbents were stronger than
natural, as appeared by the perpetual heat and dryness of the skin; which
was owing to their reverse sympathy with the heart and arteries. This
weaker and quicker action of the heart and arteries, and the stronger
action of the cutaneous capillaries and absorbents, continued throughout
the disease, and may be said to have constituted the fever, of which the
torpor of the stomach was the remote cause.
His tongue was not very much furred or very dry, nor his breath very hot;
which shewed, that there was no great increase of the action of the mucous
absorbents, nor of the pulmonary capillaries, and yet sufficient to produce
great emaciation. His urine was nearly natural both in quantity and colour;
which shewed, that there was no increase of action either of the kidnies,
or of the urinary absorbents.
The bathing his legs and hands and face for half an hour twice a day seemed
to refresh him, and sometimes made his pulse slower, and thence I suppose
stronger. This seems to have been caused by the water, though subtepid,
being much below the heat of his skin, and consequently contributing to
cool the capillaries, and by satiating the absorbents to relieve the uneasy
sensation from the dryness of the skin.
He continued the use of three drops of tincture of opium from about the
eighth day to the twenty-fourth, and for the three preceding days took
along with if two large spoonfuls of an infusion of bark in equal parts of
wine and water. The former of these by its stimulus seemed to decrease his
languor for a time, and the latter to strengthen his returning power of
digestion.
The daily exacerbations or remissions were obscure, and not well attended
to; but he appeared to be worse on the fourteenth or fifteenth days, as his
pulse was then quickest, and his inattention greatest; and he began to get
better on the twentieth or twenty-first days of his disease; for the pulse
then became less frequent, and his skin cooler, and he took rather more
food: these circumstances seemed to observe the quarter periods of
lunation.
XIV. _Termination of continued fever._
1. When the stomach is primarily affected with torpor not by defect of
stimulus, but in consequence of the previous exhaustion of its sensorial
power; and not secondarily by its association with other torpid parts; it
seems to be the general cause of the weak pulsations of the heart and
arteries, and the consequent increased action of the capillaries, which
constitute continued fever with weak pulse. In this situation if the
patient recovers, it is owing to the renovation of life in the torpid
stomach, as happens to the whole system in winter-sleeping animals. If he
perishes, it is owing to the exhaustion of the body for want of nourishment
occasioned by indigestion; which is hastened by the increased actions of
the capillaries and absorbents.
2. When the stomach is primarily affected by defect of stimulus, as by cold
or hunger; or secondarily by defect of the power of association, as in
intermittent fevers; or lastly in consequence of the introduction of the
sensorial power of sensation, as in inflammatory diseases; the actions of
the heart and arteries are not diminished, as when the stomach is primarily
affected with torpor by its previous exhaustion of sensorial power, but
become greatly increased, producing irritative or inflammatory fever. Where
this fever is continued, though with some remissions and exacerbations, the
excessive action is at length so much lessened by expenditure of sensorial
power, as to gradually terminate in health; or it becomes totally
exhausted, and death succeeds the destruction of the irritability and
associability of the system.
3. There is also another termination of the diseases in consequence of
great torpor of the stomach, which are not always termed fevers; one of
these is attended with so great and universal torpor, that the patient dies
in the first cold fit; that is, within twelve hours or less of the first
seizure; this is commonly termed sudden death. But the quickness of the
pulse, and the coldness with shuddering, and with sick stomach,
distinguished a case, which I lately saw, from the sudden deaths occasioned
by apoplexy, or ruptured blood-vessels.
In hemicrania I believe the stomach is always affected secondarily, as no
quickness of pulse generally attends it, and as the stomach recovers its
activity in about two whole days. But in the following case, which I saw
last week, I suppose the stomach suddenly became paralytic, and caused in
about a week the death of the patient. Miss ----, a fine young lady about
nineteen, had bathed a few times, about a month before, in a cold spring,
and was always much indisposed after it; she was seized with sickness, and
cold shuddering, with very quick pulse, which was succeeded by a violent
hot fit; during the next cold paroxysm she had a convulsion fit; and after
that symptoms of insanity, so as to strike and bite the attendants, and to
speak furious language; the same circumstances occurred during a third fit,
in which I believe a strait waistcoat was put on, and some blood taken from
her; during all this time her stomach would receive no nutriment, except
once or twice a little wine and water. On the seventh day of the disease,
when I saw her, the extremities were cold, the pulse not to be counted and
she was unable to swallow, or to speak; a clyster was used with turpentine
and musk and opium, with warm fomentations, but she did not recover from
that cold fit.
In this case the convulsion fit and the insanity seem to have been violent
efforts to relieve the disagreeable sensation of the paralytic stomach; and
the quick pulse, and returning fits of torpor and of orgasm, evinced the
disease to be attended with fever, though it might have been called
anorexia maniacalis, or epileptica.
4. Might not many be saved in these fevers with weak pulse for a few weeks
by the introduction of blood into a vein, once in two or three days; which
might thus give further time for the recovery of the torpid stomach? Which
seems to require some weeks to acquire its former habits of action, like
the muscles of paralytic patients, who have all their habits of voluntary
associations to form afresh, as in infancy.
If this experiment be again tried on the human subject, it should be so
contrived, that the blood in passing from the well person to the sick one
should not be exposed to the air; it should not be cooled or heated; and it
should be measured; all which may be done in the following manner. Procure
two silver pipes, each about an inch long, in the form of funnels, wide at
top, with a tail beneath, the former something wider than a swan-quill, and
the latter less than a small crow-quill. Fix one of these silver funnels by
its wide end to one end of the gut of a chicken fresh killed about four or
six inches long, and the other to the other end of the gut; then introduce
the small end of one funnel into the vein of the arm of a well person
downwards towards the hand; and laying the gut with the other end on a
water-plate heated to 98 degrees in a very warm room; let the blood run
through it. Then pressing the finger on the gut near the arm of the well
person, slide it along so as to press out one gutful into a cup, in order
to ascertain the quantity by weight. Then introduce the other end of the
other funnel into a similar vein in the arm of the sick person upwards
towards the shoulder; and by sliding one finger, and then another
reciprocally, along the chicken's gut, so as to compress it, from the arm
of the well person to the arm of the sick one, the blood may be measured,
and thus the exact quantity known which is given and received. See Class I.
2. 3. 25.
XV. _Inflammation excited in fever._
1. When the actions of any part of the system of capillaries are excited to
a certain degree, sensation is produced, along with a greater quantity of
heat, as mentioned in the fifth article of this supplement. When this
increased capillary action becomes still more energetic, by the combined
sensorial powers of sensation with irritation, new fibres are secreted, or
new fluids, (which harden into fibres like the mucus secreted by the
silk-worm, or spider, or pinna,) from which new vessels are constructed; it
is then termed inflammation: if this exists in the capillary vessels of the
cellular membrane or skin only, with feeble pulsations of the heart and
arteries, the febris sensitiva inirritata, or malignant fever, occurs; if
the coats of the arteries are also inflamed, the febris sensitiva irritata,
or inflammatory fever, exists.
In all these fevers the part inflamed is called a phlegmon, and by its
violent actions excites so much pain, that is, so much of the sensorial
power of sensation, as to produce more violent actions, and inflammation,
throughout the whole system. Whence great heat from the excited capillaries
of the skin, large and quick pulsations of the heart, full and hard
arteries, with great universal secretions and absorptions. These
perpetually continue, though with exacerbations and remissions; which seem
to be governed by solar or lunar influence.
2. In this situation there generally, I suppose, exists an increased
activity of the secerning vessels of the brain, and consequently an
increased production of sensorial power; in less violent quantity of this
disease however the increase of the action of the heart and arteries may be
owing simply to the accumulation of sensorial power of association in the
stomach, when that organ is affected by sympathy with some inflamed part.
In the same manner as the capillaries are violently and permanently
actuated by the accumulation of the sensorial power of association in the
heart and arteries, when the stomach is affected primarily by contagious
matter, and the heart and arteries secondarily. Thus I suspect, that in the
distinct small-pox the stomach is affected secondarily by sympathy with the
infected tonsils or inoculated arm; but that in the confluent small-pox the
stomach is affected primarily, as well as the tonsils, by contagious matter
mixed with the saliva, and swallowed.
3. In inflammatory fevers with great arterial action, as the stomach is not
always affected with torpor, and as there is a direct sympathy between the
stomach and heart, some people have believed, that nauseating doses of some
emetic drug, as of antimonium tartarizatum, have been administered with
advantage, abating by direct sympathy the actions of the heart. This theory
is not ill founded, and the use of digitalis, given in small doses, as from
half a dram to a dram of the saturated tincture, two or three times a day,
as well as other less violent emetic drugs, would be worth the attention of
hospital physicians.
Sickness might also be produced probably with advantage by whirling the
patient in a chair suspended from the cieling by two parallel cords; which
after being revolved fifty or one hundred times in one direction, would
return with great circular velocity, and produce vertigo, similar I suppose
to sea-sickness. And lastly the sickness produced by respiring an
atmosphere mixed with one tenth of carbonated hydrogen, discovered by Mr.
Watt, and published by Dr. Beddoes, would be well worthy exact and repeated
experiment.
4. Cool air, cool fomentations, or ablutions, are also useful in this
inflammatory fever; as by cooling the particles of blood in the cutaneous
and pulmonary vessels, they must return to the heart with less stimulus,
than when they are heated above the natural degree of ninety-eight. For
this purpose snow and ice have been scattered on the patients in Italy; and
cold bathing has been used at the eruption of the small pox in China, and
both, it is said, with advantage. See Class III. 2. 1. 12. and Suppl. I. 8.
5. The lancet however with repeated mild cathartics is the great agent in
destroying this enormous excitement of the system, so long as the strength
of the patient will admit of evacuations. Blisters over the painful part,
where the phlegmon or topical inflammation is situated, after great
evacuation, is of evident service, as in pleurisy. Warm bathing for half an
hour twice a day, when the patient becomes enfeebled, is of great benefit,
as in peripneumony and rheumatism.
6. When other means fail of success in abating the violent excitement of
the system in inflammatory diseases, might not the shaved head be covered
with large bladders of cold water, in which ice or salt had been recently
dissolved; and changed as often as necessary, till the brain is rendered in
some degree torpid by cold?--Might not a greater degree of cold, as iced
water, or snow, be applied to the cutaneous capillaries?
7. Another experiment I have frequently wished to try, which cannot be done
in private practice, and which I therefore recommend to some hospital
physician; and that is, to endeavour to still the violent actions of the
heart and arteries, after due evacuations by venesection and cathartics, by
gently compressing the brain. This might be done by suspending a bed, so as
to whirl the patient round with his head most distant from the center of
motion, as if he lay across a millstone, as described in Sect. XVIII. 20.
For this purpose a perpendicular shaft armed with iron gudgeons might have
one end pass into the floor, and the other into a beam in the cieling, with
an horizontal arm, to which a small bed might be readily suspended.
By thus whirling the patient with increasing velocity sleep might be
produced, and probably the violence of the actions of the heart and
arteries might be diminished in inflammatory fevers; and, as it is
believed, that no accumulation of sensorial power would succeed a torpor of
the origin of the nerves, either thus procured by mechanical compression,
or by the bladder-cap of cold water above described, the lives of thousands
might probably be saved by thus extinguishing the exacerbations of febrile
paroxysms, or preventing the returns of them.
In fevers with weak pulse sleep, or a degree of stupor, thus produced,
might prevent the too great expenditure of sensorial power, and thus
contribute to preserve the patient. See Class I. 2. 5. 10. on stupor. What
might be the consequence of whirling a person with his head next the center
of motion, so as to force the blood from the brain into the other parts of
the body, might be discovered by cautious experiment without danger, and
might probably add to our ability of curing fever.
XVI. _Recapitulation._
1. The sensorial power causes the contraction of the fibres, and is excited
into action by four different circumstances, by the stimulus of external
bodies, by pain or pleasure, by desire or aversion, or by the previous
motions of other contracting fibres. In the first situation it is called
the sensorial power of irritation, in the second the sensorial power of
sensation, in the third the sensorial power of volition, and in the fourth
the sensorial power of association.
Many parts of the body are excited into perpetual action, as the
sanguiferous vessels consisting of the heart, arteries, and veins; others
into nearly perpetual action, as the conglomerate and capillary glands; and
others into actions still somewhat less frequent, as the alimentary canal,
and the lacteal and lymphatic absorbents with their conglobate glands: all
these are principally actuated by the sensorial powers of irritation, and
of association; but in some degree or at some times by those of sensation,
and even of volition. There are three kinds of stimulus, which may easily
be occasionally diminished, that of heat on the skin, of food in the
stomach, and of the oxygenous part of the atmosphere, which mixes with the
blood in respiration, and stimulates the heart and arteries.
2. When any parts, which are naturally excited into perpetual action by
stimulus, become torpid or less active from decrease of that stimulus;
there first occurs a decrease of the activity of the parts next catenated
with them; thus going into cold water produces a torpor of the capillary
vessels of the lungs, as is known by the difficult respiration, which
immediately occurs; for the sensorial power of association, which naturally
contributes to actuate the lungs, is now less excited by the decreased
actions of the cutaneous vessels, with which they are catenated. This
constitutes the cold fit of fever.
There next occurs an accumulation of the sensorial power of irritation in
the parts, which were torpid from defect of stimulus, as the cutaneous
vessels for instance when exposed to cold air; and a similar accumulation
of the sensorial power of association occurs in the parts which were
catenated with the former, as the vessels of the lungs in the example above
mentioned. Whence, if the subduction of stimulus has not been too great, so
as to impair the health of the part, the activity of the irritative motions
returns, even though the stimulus continues less than usual; and those of
the associate motions become considerably increased, because these latter
are now excited by the previous fibrous motions, which now act as strong or
stronger than formerly, and have also acquired an accumulation of the
sensorial power of association. This accounts for the curious event of our
becoming warm in a minute or two after remaining in water of about 80
degrees of heat, as in the bath at Buxton; or in the cold air of a frosty
morning of about 30 degrees of heat.
But if the parts thus possessed of the accumulated sensorial powers of
irritation and of association be exposed again to their natural quantity of
stimulus, a great excess of activity supervenes; because the fibres, which
possess accumulated irritation, are now excited by their usual quantity of
stimulus; and those which possess accumulated association, are now excited
by double or treble the quantity of the preceding irritative fibrous
motions, with which they are catenated; this constitutes the hot fit of
fever.
Another important circumstance occurs, when the parts, which are torpid
from decreased stimulus, do not accumulate a quantity of sensorial power
sufficient for the purpose of renewing their own natural quantity of
action; but are nevertheless not so torpid, as to have the life of the part
impaired. In this situation the superabundance of the accumulated power of
irritation contributes to actuate the associate motions next catenated with
them. Thus, when a person breathes air with less oxygene than natural, as
by covering his head in bed, and thus respiring the same atmosphere
repeatedly, the heart and arteries become less active by defect of the
stimulus of oxygene; and then the accumulation of sensorial power of
irritation becomes instantly very great, as these organs are subject to
perpetual and energetic action. This accumulation nevertheless is not so
great as to renew their own activity under this defect of stimulus, but yet
is in sufficient abundance to increase the associability of the next link
of catenation, that is, to actuate the capillaries of the skin with great
and perpetual increase of energy. This resembles continued fever with weak
pulse; in which the accumulation of the sensorial power caused by the
lessened motions of the heart and arteries, actuates the capillaries with
increase of energy.
3. When the accumulation of the sensorial power of association, which is
caused as above explained by deficient excitement owing to the lessened
quantity of action of the irritative fibrous motions, with which the
associate train is catenated, is not in quantity sufficient to renew the
natural actions of the first link of an associate train of motions; it is
nevertheless frequently so abundant as to actuate the next link of the
associated train with unnatural energy by increasing its associability; and
that in a still greater degree if that second link of the associated train
was previously in a torpid state, that is, had previously acquired some
accumulation of the sensorial power of association. This important
circumstance of the animal economy is worthy our most accurate attention.
Thus if the heart and arteries are deprived of their due quantity of the
stimulus of oxygene in the blood, a weak and quick pulse ensues, with an
accumulation of the sensorial power of irritation; next follows an increase
of the action of the capillaries by the superabundance of this accumulated
power of irritation; but there also exists an accumulation of the power of
association in these acting capillaries, which is not now excited by the
deficient actions of the heart and arteries; but which by its abundance
contributes to actuate the next link of association, which is the sick
stomach in the case related from Sydenham in Class IV. 1. 1. 2. and
explained in this Supplement I. 4. And as this sick stomach was in a
previous state of torpor, it might at the same time possess an accumulation
of some sensorial power, which, if it was of association, would be thus
more powerfully excited by the increased actions of the capillaries; which
existed in consequence of the weak action of the heart and arteries. This
also resembles in some respects the continued fevers with weak pulse, and
with increased activity of the capillaries.
4. When a torpor of some irritative motions occurs from a previous
exhaustion of the sensorial power of irritation by the action of some very
great stimulus, it is long before any accumulation of the sensorial power
of irritation is produced; as is experienced in the sickness and languor,
which continues a whole day after a fit of drunkenness. But nevertheless
there occurs an accumulation of the sensorial power of association in the
first link of the associate train of motions, which is catenated with these
torpid irritative ones; which accumulation is owing to deficient excitement
of that sensorial power in the first link of the associate train. This
first link therefore exists also in a less active or torpid state, but the
accumulation of the sensorial power of association by its superabundance
contributes to actuate the second link of the associate train with
unnatural quantity of motion; and that though its own natural quantity of
the power of association is not excited by the deficient action of
preceding fibrous motions.
When this happens to the stomach, as after its irritative motions have been
much exerted from the unnatural stimulus of wine, or opium, or of
contagious matter mixed with the saliva, a torpor or inactivity of it
succeeds for a greater or less length of time; as no accumulation of the
sensorial power of irritation can occur, till the natural quantity, which
has been previously expended, is first restored. Then the heart and
arteries which are next in catenation, become less active from the want of
sufficient excitement of the sensorial power of association, which
previously contributed to actuate them. This sensorial power of association
therefore becomes accumulated, and by its superabundance contributes to
actuate the link next in association, which has thus acquired so great a
degree of associability, as to overbalance the less quantity of the
excitement of it by the torpid action of the previous or first associate
link. This happens to the capillaries, when the heart and arteries are
affected as above by the torpor of the stomach, when it is occasioned by
previous great expenditure of its sensorial power, and thus constitutes
fever with weak pulse, which is here termed inirritative fever, typhus
mitior.
5. When a deficiency of stimulus is too great or too long continued, so as
to impair the life of the part, no further accumulation of sensorial power
occurs; as when the skin is long exposed to cold and damp air. In that case
the link in catenation, that is, the first of the associate train, is
rendered torpid by defect of excitement of its usual quantity of the
sensorial power of association, and from there being no accumulation of the
sensorial power of irritation to increase its associability, and thus to
contribute to actuate it by overbalancing the defect of the excitement of
its association.
Thus on riding long and slowly on a cold and damp day, the exhalation of
the vapour, which is impinged on the skin, as the traveller proceeds,
carries away his warmth faster, than it is generated within the system; and
thus the capillaries of the skin have their actions so much impaired after
a time, that no accumulation of the sensorial power of irritation occurs;
and then the stomach, whose motions are catenated with those of the
capillaries, ceases to act from the deficient excitement of the power of
association; and indigestion and flatulency succeed, instead of the
increased digestion and hunger, which occur, when the cutaneous capillaries
are exposed to a less degree of cold, and for a shorter time. In which
latter situation the accumulation of the sensorial power of irritation
increases by its superabundance the associability of the fibres of the
stomach, so as to overbalance the defect of the excitement of their
association.
6. The stomach is affected secondarily in fevers with strong pulse, as in
those with weak pulse it is affected primarily. To illustrate this doctrine
I shall relate the following case of Mr. Y----. He was a young man rather
intemperate in the use of wine or beer, and was seized with a cold fit, and
with a consequent hot one with strong pulse; on examining his hypochondrium
an oblong tumour was distinctly felt on the left side of the stomach, which
extended six or eight inches downward, and was believed to be a tumour of
the spleen, which thus occasioned by its torpor the cold fit and consequent
hot fit of fever with strong pulse. This fever continued, though with
remissions, for two or three weeks; and the patient repeatedly lost blood,
used cathartics with calomel and sena, and had frequent antimonial and
saline medicines. And after he was much weakened by evacuations, the
peruvian bark and small doses of steel removed the fever, but the tumour
remained many years during the remainder of his life.
In this case the tumour of the spleen was occasioned by the torpor of the
absorbent vessels; while the secerning vessels continued somewhat longer to
pour their fluids into the cells of it. Then the inactivity of this viscus
affected the whole system with torpor by the deficient excitement of the
sensorial power of association, which contributes along with the irritation
caused by their specific stimuli to actuate the whole sanguiferous,
secerning, and absorbent vessels; and along with these the stomach, which
possesses perhaps greater mobility, or promptitude to torpor or to orgasm,
than any other part. And after a time all these parts recover their actions
by the accumulation of their sensorial power of association. But the spleen
not recovering its action from the accumulation of its power of irritation,
as appeared from the continuance of the tumor, still affects the stomach by
its defective irritative motions ceasing to excite the association, which
ought to contribute to actuate it.
Hence the stomach continues torpid in respect to its motions, but
accumulates its power of association; which is not excited into action by
the defective motions of the spleen; this accumulation of the sensorial
power of association now by its superabundance actuates the next link of
associate motions, which consists of the heart and arteries, into greater
energy of action than natural, and thus causes fever with strong pulse;
which, as it was supposed to be most frequently excited by increase of
irritation, is called irritative fever or synocha.
Similar to this in the small pox, which is given by inoculation, the
stomach is affected secondarily, when the fever commences; and hence in
this small-pox the pulsations of the heart and arteries are frequently
stronger than natural, but never weaker, for the reasons above given.
Whereas in that small-pox, which is caused by the stomach being primarily
affected, by the contagious matter being swallowed with the saliva, whether
the tonsils are at the same time affected or not, the pulsations of the
heart and arteries become weak, and the inirritative fever is produced, as
explained above, along with the confluent small-pox. This unfolds the cause
of the mildness of the inoculated small-pox; because in this disease the
stomach is affected secondarily, whereas in the natural small-pox it is
frequently affected primarily by swallowing the contagious matter mixed
with saliva.