Chapter XIII: Section XXXIII: 2. 9. In this disease the actions of these vessels (1)

producing ulcers on the throat and skin are imperfect imitations of those producing chanker, or gonorrhoea; since the matter produced by them is not infectious, while the imitative actions in the hydrophobia appear to be perfect resemblances, as they produce a material equally infectious with the original one, which induced them.

The contagion from the bite of a mad dog differs from other contagious materials, from its being communicable from other animals to mankind, and from many animals to each other; the phenomena attending the hydrophobia are in some degree explicable on the foregoing theory. The infectious matter does not appear to enter the circulation, as it cannot be traced along the course of the lymphatics from the wound, nor is there any swelling of the lymphatic glands, nor does any fever attend, as occurs in the small-pox, and in many other contagious diseases; yet by some unknown process the disease is communicated from the wound to the throat, and that many months after the injury, so as to produce pain and hydrophobia, with a secretion of infectious saliva of the same kind, as that of the mad dog, which inflicted the wound.

This subject is very intricate.--It would appear, that by certain morbid actions of the salivary glands of the mad dog, a peculiar kind of saliva is produced; which being instilled into a wound of another animal stimulates the cutaneous or mucous glands into morbid actions, but which are ineffectual in respect to the production of a similar contagious material; but the salivary glands by irritative sympathy are thrown into similar action, and produce an infectious saliva similar to that instilled into the wound.

Though in many contagious fevers a material similar to that which produced the disease, is thus generated by imitation; yet there are other infectious materials, which do not thus propagate themselves, but which seem to act like slow poisons. Of this kind was the contagious matter, which produced the jail-fever at the assizes at Oxford about a century ago. Which, though fatal to so many, was not communicated to their nurses or attendants. In these cases, the imitations of the fine vessels, as above described, appear to be imperfect, and do not therefore produce a matter similar to that, which stimulates them; in this circumstance resembling the venereal matter in ulcers of the throat or skin, according to the curious discovery of Mr. Hunter above related, who found, by repeated inoculations, that it would not infect. Hunter on Venereal Disease, Part vi. ch. 1.

Another example of morbid imitation is in the production of a great quantity of contagious matter, as in the inoculated small-pox, from a small quantity of it inserted into the arm, and probably diffused in the blood. These particles of contagious matter stimulate the extremities of the fine arteries of the skin, and cause them to imitate some properties of those particles of contagious matter, so as to produce a thousandfold of a similar material. See Sect. XXXIII. 2. 6. Other instances are mentioned in the Section on Generation, which shew the probability that the extremities of the seminal glands may imitate certain ideas of the mind, or actions of the organs of sense, and thus occasion the male or female sex of the embryon. See Sect. XXXIX. 6.

4. We come now to those imitations, which are not attended with sensation. Of these are all the irritative ideas already explained, as when the retina of the eye imitates by its action or configuration the tree or the bench, which I shun in walking past without attending to them. Other examples of these irritative imitations are daily observable in common life; thus one yawning person shall set a whole company a yawning; and some have acquired winking of the eyes or impediments of speech by imitating their companions without being conscious of it.

5. Besides the three species of imitations above described there may be some associate motions, which may imitate each other in the kind as well as in the quantity of their action; but it is difficult to distinguish them from the associations of motions treated of in Section XXXV. Where the actions of other persons are imitated there can be no doubt, or where we imitate a preconceived idea by exertion of our locomotive muscles, as in painting a dragon; all these imitations may aptly be referred to the sources above described of the propensity to activity, and the facility of repetition; at the same time I do not affirm, that all those other apparent sensitive and irritative imitations may not be resolvable into associations of a peculiar kind, in which certain distant parts of similar irritability or sensibility, and which have habitually acted together, may affect each other exactly with the same kinds of motion; as many parts are known to sympathise in the quantity of their motions. And that therefore they may be ultimately resolvable into associations of action, as described in Sect. XXXV.

* * * * *

SECT. XXIII.

OF THE CIRCULATORY SYSTEM.

I. _The heart and arteries have no antagonist muscles. Veins absorb the
blood, propel it forwards, and distend the heart; contraction of the
heart distends the arteries. Vena portarum._ II. _Glands which take
their fluids from the blood. With long necks, with short necks._ III.
_Absorbent system._ IV. _Heat given out from glandular secretions.
Blood changes colour in the lungs and in the glands and capillaries._
V. _Blood is absorbed by veins, as chyle by lacteal vessels, otherwise
they could not join their streams._ VI. _Two kinds of stimulus,
agreeable and disagreeable. Glandular appetency. Glands originally
possessed sensation._

I. We now step forwards to illustrate some of the phenomena of diseases, and to trace out their most efficacious methods of cure; and shall commence this subject with a short description of the circulatory system.

As the nerves, whose extremities form our various organs of sense and muscles, are all joined, or communicate, by means of the brain, for the convenience perhaps of the distribution of a subtile ethereal fluid for the purpose of motion; so all those vessels of the body, which carry the grosser fluids for the purposes of nutrition, communicate with each other by the heart.

The heart and arteries are hollow muscles, and are therefore indued with power of contraction in consequence of stimulus, like all other muscular fibres; but, as they have no antagonist muscles, the cavities of the vessels, which they form, would remain for ever closed, after they have contracted themselves, unless some extraneous power be applied to again distend them. This extraneous power in respect to the heart is the current of blood, which is perpetually absorbed by the veins from the various glands and capillaries, and pushed into the heart by a power probably very similar to that, which raises the sap in vegetables in the spring, which, according to Dr. Hale's experiment on the stump of a vine, exerted a force equal to a column of water above twenty feet high. This force of the current of blood in the veins is partly produced by their absorbent power, exerted at the beginning of every fine ramification; which may be conceived to be a mouth absorbing blood, as the mouths of the lacteals and lymphatics absorb chyle and lymph. And partly by their intermitted compression by the pulsations of their generally concomitant arteries; by which the blood is perpetually propelled towards the heart, as the valves in many veins, and the absorbent mouths in them all, will not suffer it to return.

The blood, thus forcibly injected into the chambers of the heart, distends this combination of hollow muscles; till by the stimulus of distention they contract themselves; and, pushing forwards the blood into the arteries, exert sufficient force to overcome in less than a second of time the vis inertiæ, and perhaps some elasticity, of the very extensive ramifications of the two great systems of the aortal and pulmonary arteries. The power necessary to do this in so short a time must be considerable, and has been variously estimated by different physiologists.

The muscular coats of the arterial system are then brought into action by the stimulus of distention, and propel the blood to the mouths, or through the convolutions, which precede the secretory apertures of the various glands and capillaries.

In the vessels of the liver there is no intervention of the heart; but the vena portarum, which does the office of an artery, is distended by the blood poured into it from the mesenteric veins, and is by this distention stimulated to contract itself, and propel the blood to the mouths of the numerous glands, which compose that viscus.

II. The glandular system of vessels may be divided into those, which take some fluid from the circulation; and those, which give something to it. Those, which take their fluid from the circulation are the various glands, by which the tears, bile, urine, perspiration, and many other secretions are produced; these glands probably consist of a mouth to select, a belly to digest, and an excretory aperture to emit their appropriated fluids; the blood is conveyed by the power of the heart and arteries to the mouths of these glands, it is there taken up by the living power of the gland, and carried forwards to its belly, and excretory aperture, where a part is separated, and the remainder absorbed by the veins for further purposes.

Some of these glands are furnished with long convoluted necks or tubes, as the seminal ones, which are curiously seen when injected with quicksilver. Others seem to consist of shorter tubes, as that great congeries of glands, which constitute the liver, and those of the kidneys. Some have their excretory apertures opening into reservoirs, as the urinary and gall-bladders. And others on the external body, as those which secrete the tears, and perspirable matter.

Another great system of glands, which have very short necks, are the capillary vessels; by which the insensible perspiration is secreted on the skin; and the mucus of various consistences, which lubricates the interstices of the cellular membrane, of the muscular fibres, and of all the larger cavities of the body. From the want of a long convolution of vessels some have doubted, whether these capillaries should be considered as glands, and have been led to conclude, that the perspirable matter rather exuded than was secreted. But the fluid of perspiration is not simple water, though that part of it, which exhales into the air may be such; for there is another part of it, which in a state of health is absorbed again; but which, when the absorbents are diseased, remains on the surface of the skin, in the form of scurf, or indurated mucus. Another thing, which shews their similitude to other glands, is their sensibility to certain affections of the mind; as is seen in the deeper colour of the skin in the blush of shame, or the greater paleness of it from fear.

III. Another series of glandular vessels is called the absorbent system; these open their mouths into all the cavities, and upon all those surfaces of the body, where the excretory apertures of the other glands pour out their fluids. The mouths of the absorbent system drink up a part or the whole of these fluids, and carry them forwards by their living power to their respective glands, which are called conglobate glands. There these fluids undergo some change, before they pass on into the circulation; but if they are very acrid, the conglobate gland swells, and sometimes suppurates, as in inoculation of the small-pox, in the plague, and in venereal absorptions; at other times the fluid may perhaps continue there, till it undergoes some chemical change, that renders it less noxious; or, what is more likely, till it is regurgitated by the retrograde motion of the gland in spontaneous sweats or diarrhoeas, as disagreeing food is vomited from the stomach.

IV. As all the fluids, that pass through these glands, and capillary vessels, undergo a chemical change, acquiring new combinations, the matter of heat is at the same time given out; this is apparent, since whatever increases insensible perspiration, increases the heat of the skin; and when the action of these vessels is much increased but for a moment, as in blushing, a vivid heat on the skin is the immediate consequence. So when great bilious secretions, or those of any other gland, are produced, heat is generated in the part in proportion to the quantity of the secretion.

The heat produced on the skin by blushing may be thought by some too sudden to be pronounced a chemical effect, as the fermentations or new combinations taking place in a fluid is in general a slower process. Yet are there many chemical mixtures in which heat is given out as instantaneously; as in solutions of metals in acids, or in mixtures of essential oils and acids, as of oil of cloves and acid of nitre. So the bruised parts of an unripe apple become almost instantaneously sweet; and if the chemico-animal process of digestion be stopped for but a moment, as by fear, or even by voluntary eructation, a great quantity of air is generated, by the fermentation, which instantly succeeds the stop of digestion. By the experiments of Dr. Hales it appears, that an apple during fermentation gave up above six hundred times its bulk of air; and the materials in the stomach are such, and in such a situation, as immediately to run into fermentation, when digestion is impeded.

As the blood passes through the small vessels of the lungs, which connect the pulmonary artery and vein, it undergoes a change of colour from a dark to a light red; which may be termed a chemical change, as it is known to be effected by an admixture of oxygene, or vital air; which, according to a discovery of Dr. Priestley, passes through the moist membranes, which constitute the sides of these vessels. As the blood passes through the capillary vessels, and glands, which connect the aorta and its various branches with their correspondent veins in the extremities of the body, it again loses the bright red colour, and undergoes some new combinations in the glands or capillaries, in which the matter of heat is given out from the secreted fluids. This process therefore, as well as the process of respiration, has some analogy to combustion, as the vital air or oxygene seems to become united to some inflammable base, and the matter of heat escapes from the new acid, which is thus produced.

V. After the blood has passed these glands and capillaries, and parted with whatever they chose to take from it, the remainder is received by the veins, which are a set of blood-absorbing vessels in general corresponding with the ramifications of the arterial system. At the extremity of the fine convolutions of the glands the arterial force ceases; this in respect to the capillary vessels, which unite the extremities of the arteries with the commencement of the veins, is evident to the eye, on viewing the tail of a tadpole by means of a solar, or even by a common microscope, for globules of blood are seen to endeavour to pass, and to return again and again, before they become absorbed by the mouths of the veins; which returning of these globules evinces, that the arterial force behind them has ceased. The veins are furnished with valves like the lymphatic absorbents; and the great trunks of the veins, and of the lacteals and lymphatics, join together before the ingress of their fluids into the left chamber of the heart; both which evince, that the blood in the veins, and the lymph and chyle in the lacteals and lymphatics, are carried on by a similar force; otherwise the stream, which was propelled with a less power, could not enter the vessels, which contained the stream propelled with a greater power. From whence it appears, that the veins are a system of vessels absorbing blood, as the lacteals and lymphatics are a system of vessels absorbing chyle and lymph. See Sect. XXVII. 1.

VI. The movements of their adapted fluids in the various vessels of the body are carried forwards by the actions of those vessels in consequence of two kinds of stimulus, one of which may be compared to a pleasurable sensation or desire inducing the vessel to seize, and, as it were, to swallow the particles thus selected from the blood; as is done by the mouths of the various glands, veins, and other absorbents, which may be called glandular appetency. The other kind of stimulus may be compared to disagreeable sensation, or aversion, as when the heart has received the blood, and is stimulated by it to push it forwards into the arteries; the same again stimulates the arteries to contract, and carry forwards the blood to their extremities, the glands and capillaries. Thus the mesenteric veins absorb the blood from the intestines by glandular appetency, and carry it forward to the vena portarum; which acting as an artery contracts itself by disagreeable stimulus, and pushes it to its ramified extremities, the various glands, which constitute the liver.

It seems probable, that at the beginning of the formation of these vessels in the embryon, an agreeable sensation was in reality felt by the glands during secretion, as is now felt in the act of swallowing palatable food; and that a disagreeable sensation was originally felt by the heart from the distention occasioned by the blood, or by its chemical stimulus; but that by habit these are all become irritative motions; that is, such motions as do not affect the whole system, except when the vessels are diseased by inflammation.

* * * * *

SECT. XXIV.

OF THE SECRETIONS OF SALIVA, AND OF TEARS, AND OF THE LACRYMAL SACK.

I. _Secretion of saliva increased by mercury in the blood._ 1. _By the
food in the mouth. Dryness of the mouth not from a deficiency of
saliva._ 2. _By Sensitive ideas._ 3. _By volition._ 4. _By distasteful
substances. It is secreted in a dilute and saline state. It then
becomes more viscid._ 5. _By ideas of distasteful substances._ 6. _By
nausea._ 7. _By aversion._ 8. _By catenation with stimulating
substances in the ear._ II. 1. _Secretion of tears less in sleep. From
stimulation of their excretory duct._ 2. _Lacrymal sack is a gland._ 3.
_Its uses._ 4. _Tears are secreted, when the nasal duct is stimulated._
5. _Or when it is excited by sensation._ 6. _Or by volition._ 7. _The
lacrymal sack can regurgitate its contents into the eye._ 8. _More
tears are secreted by association with the irritation of the nasal duct
of the lacrymal sack, than the puncta lacrymalia can imbibe. Of the
gout in the liver and stomach._

I. The salival glands drink up a certain fluid from the circumfluent blood, and pour it into the mouth. They are sometimes stimulated into action by the blood, that surrounds their origin, or by some part of that heterogeneous fluid: for when mercurial salts, or oxydes, are mixed with the blood, they stimulate these glands into unnatural exertions; and then an unusual quantity of saliva is separated.

1. As the saliva secreted by these glands is most wanted during the mastication of our food, it happens, when the terminations of their ducts in the mouth are stimulated into action, the salival glands themselves are brought into increased action at the same time by association, and separate a greater quantity of their juices from the blood; in the same manner as tears are produced in greater abundance during the stimulus of the vapour of onions, or of any other acrid material in the eye.

The saliva is thus naturally poured into the mouth only during the stimulus of our food in mastication; for when there is too great an exhalation of the mucilaginous secretion from the membranes, which line the mouth, or too great an absorption of it, the mouth becomes dry, though there is no deficiency in the quantity of saliva; as in those who sleep with their mouths open, and in some fevers.

2. Though during the mastication of our natural food the salival glands are excited into action by the stimulus on their excretory ducts, and a due quantity of saliva is separated from the blood, and poured into the mouth; yet as this mastication of our food is always attended with a degree of pleasure; and that pleasurable sensation is also connected with our ideas of certain kinds of aliment; it follows, that when these ideas are reproduced, the pleasurable sensation arises along with them, and the salival glands are excited into action, and fill the mouth with saliva from this sensitive association, as is frequently seen in dogs, who slaver at the sight of food.

3. We have also a voluntary power over the action of these salival glands, for we can at any time produce a flow of saliva into our mouth, and spit out, or swallow it at will.

4. If any very acrid material be held in the mouth, as the root of pyrethrum, or the leaves of tobacco, the salival glands are stimulated into stronger action than is natural, and thence secrete a much larger quantity of saliva; which is at the same time more viscid than in its natural state; because the lymphatics, that open their mouths into the ducts of the salival glands, and on the membranes, which line the mouth, are likewise stimulated into stronger action, and absorb the more liquid parts of the saliva with greater avidity; and the remainder is left both in greater quantity and more viscid.

The increased absorption in the mouth by some stimulating substances, which are called astringents, as crab juice, is evident from the instant dryness produced in the mouth by a small quantity of them.

As the extremities of the glands are of exquisite tenuity, as appears by their difficulty of injection, it was necessary for them to secrete their fluids in a very dilute state; and, probably for the purpose of stimulating them into action, a quantity of neutral salt is likewise secreted or formed by the gland. This aqueous and saline part of all secreted fluids is again reabsorbed into the habit. More than half of some secreted fluids is thus imbibed from the reservoirs, into which they are poured; as in the urinary bladder much more than half of what is secreted by the kidneys becomes reabsorbed by the lymphatics, which are thickly dispersed around the neck of the bladder. This seems to be the purpose of the urinary bladders of fish, as otherwise such a receptacle for the urine could have been of no use to an animal immersed in water.

5. The idea of substances disagreeably acrid will also produce a quantity of saliva in the mouth; as when we smell very putrid vapours, we are induced to spit out our saliva, as if something disagreeable was actually upon our palates.

6. When disagreeable food in the stomach produces nausea, a flow of saliva is excited in the mouth by association; as efforts to vomit are frequently produced by disagreeable drugs in the mouth by the same kind of association.

7. A preternatural flow of saliva is likewise sometimes occasioned by a disease of the voluntary power; for if we think about our saliva, and determine not to swallow it, or not to spit it out, an exertion is produced by the will, and more saliva is secreted against our wish; that is, by our aversion, which bears the same analogy to desire, as pain does to pleasure; as they are only modifications of the same disposition of the sensorium. See Class IV. 3. 2. 1.

8. The quantity of saliva may also be increased beyond what is natural, by the catenation of the motions of these glands with other motions, or sensations, as by an extraneous body in the ear; of which I have known an instance; or by the application of stizolobium, siliqua hirsuta, cowhage, to the seat of the parotis, as some writers have affirmed.

II. 1. The lacrymal gland drinks up a certain fluid from the circumfluent blood, and pours it on the ball of the eye, on the upper part of the external corner of the eyelids. Though it may perhaps be stimulated into the performance of its natural action by the blood, which surrounds its origin, or by some part of that heterogeneous fluid; yet as the tears secreted by this gland are more wanted at some times than at others, its secretion is variable, like that of the saliva above mentioned, and is chiefly produced when its excretory duct is stimulated; for in our common sleep there seems to be little or no secretion of tears; though they are occasionally produced by our sensations in dreams.

Thus when any extraneous material on the eye-ball, or the dryness of the external covering of it, or the coldness of the air, or the acrimony of some vapours, as of onions, stimulates the excretory duct of the lacrymal gland, it discharges its contents upon the ball; a quicker secretion takes place in the gland, and abundant tears succeed, to moisten, clean, and lubricate the eye. These by frequent nictitation are diffused over the whole ball, and as the external angle of the eye in winking is closed sooner than the internal angle, the tears are gradually driven forwards, and downwards from the lacrymal gland to the puncta lacrymalia.

2. The lacrymal sack, with its puncta lacrymalia, and its nasal duct, is a complete gland; and is singular in this respect, that it neither derives its fluid from, nor disgorges it into the circulation. The simplicity of the structure of this gland, and both the extremities of it being on the surface of the body, makes it well worthy our minuter observation; as the actions of more intricate and concealed glands may be better understood from their analogy to this.

3. This simple gland consists of two absorbing mouths, a belly, and an excretory duct. As the tears are brought to the internal angle of the eye, these two mouths drink them up, being stimulated into action by this fluid, which they absorb. The belly of the gland, or lacrymal sack, is thus filled, in which the saline part of the tears is absorbed, and when the other end of the gland, or nasal duct, is stimulated by the dryness, or pained by the coldness of the air, or affected by any acrimonious dust or vapour in the nostrils, it is excited into action together with the sack, and the tears are disgorged upon the membrane, which lines the nostrils; where they serve a second purpose to moisten, clean, and lubricate, the organ of smell.

4. When the nasal duct of this gland is stimulated by any very acrid material, as the powder of tobacco, or volatile spirits, it not only disgorges the contents of its belly or receptacle (the lacrymal sack), and absorbs hastily all the fluid, that is ready for it in the corner of the eye; but by the association of its motions with those of the lacrymal gland, it excites that also into increased action, and a large flow of tears is poured into the eye.

5. This nasal duct is likewise excited into strong action by sensitive ideas, as in grief, or joy, and then also by its associations with the lacrymal gland it produces a great flow of tears without any external stimulus; as is more fully explained in Sect. XVI. 8. on Instinct.

6. There are some, famous in the arts of exciting compassion, who are said to have acquired a voluntary power of producing a flow of tears in the eye; which, from what has been said in the section on Instinct above mentioned, I should suspect, is performed by acquiring a voluntary power over the action of this nasal duct.

7. There is another circumstance well worthy our attention, that when by any accident this nasal duct is obstructed, the lacrymal sack, which is the belly or receptacle of this gland, by slight pressure of the finger is enabled to disgorge its contents again into the eye; perhaps the bile in the same manner, when the biliary ducts are obstructed, is returned into the blood by the vessels which secrete it?

8. A very important though minute occurrence must here be observed, that though the lacrymal gland is only excited into action, when we weep at a distressful tale, by its association with this nasal duct, as is more fully explained in Sect. XVI. 8; yet the quantity of tears secreted at once is more than the puncta lacrymalia can readily absorb; which shews _that the motions occasioned by associations are frequently more energetic than the original motions, by which they were occasioned_. Which we shall have occasion to mention hereafter, to illustrate, why pains frequently exist in a part distant from the cause of them, as in the other end of the urethra, when a stone stimulates the neck of the bladder. And why inflammations frequently arise in parts distant from their cause, as the gutta rosea of drinking people, from an inflamed liver.

The inflammation of a part is generally preceded by a torpor or quiescence of it; if this exists in any large congeries of glands, as in the liver, or any membranous part, as the stomach, pain is produced and chilliness in consequence of the torpor of the vessels. In this situation sometimes an inflammation of the parts succeeds the torpor; at other times a distant more sensible part becomes inflamed; whose actions have previously been associated with it; and the torpor of the first part ceases. This I apprehend happens, when the gout of the foot succeeds a pain of the biliary duct, or of the stomach. Lastly, it sometimes happens, that the pain of torpor exists without any consequent inflammation of the affected part, or of any distant part associated with it, as in the membranes about the temple and eye-brows in hemicrania, and in those pains, which occasion convulsions; if this happens to gouty people, when it affects the liver, I suppose epileptic fits are produced; and, when it affects the stomach, death is the consequence. In these cases the pulse is weak, and the extremities cold, and such medicines as stimulate the quiescent parts into action, or which induce inflammation in them, or in any distant part, which is associated with them, cures the present pain of torpor, and saves the patient.

I have twice seen a gouty inflammation of the liver, attended with jaundice; the patients after a few days were both of them affected with cold fits, like ague-fits, and their feet became affected with gout, and the inflammation of their livers ceased. It is probable, that the uneasy sensations about the stomach, and indigestion, which precedes gouty paroxysms, are generally owing to torpor or slight inflammation of the liver, and biliary ducts; but where great pain with continued sickness, with feeble pulse, and sensation of cold, affect the stomach in patients debilitated by the gout, that it is a torpor of the stomach itself, and destroys the patient from the great connexion of that viscus with the vital organs. See Sect. XXV. 17.

* * * * *

SECT. XXV.

OF THE STOMACH AND INTESTINES.

1. _Of swallowing our food. Ruminating animals._ 2. _Action of the
stomach._ 3. _Action of the intestines. Irritative motions connected
with these._ 4. _Effects of repletion._ 5. _Stronger action of the
stomach and intestines from more stimulating food._ 6. _Their action
inverted by still greater stimuli. Or by disgustful ideas. Or by
volition._ 7. _Other glands strengthen or invert their motions by
sympathy._ 8. _Vomiting performed by intervals._ 9. _Inversion of the
cutaneous absorbents._ 10. _Increased secretion of bile and pancreatic
juice._ 11. _Inversion of the lacteals._ 12. _And of the bile-ducts._
13. _Case of a cholera._ 14. _Further account of the inversion of
lacteals._ 15. _Iliac passions. Valve of the colon._ 16. _Cure of the
iliac passion._ 17. _Pain of gall-stone distinguished from pain of the
stomach. Gout of the stomach from torpor, from inflammation.
Intermitting pulse owing to indigestion. To overdose of foxglove. Weak
pulse from emetics. Death from a blow on the stomach. From gout of the
stomach._

1. The throat, stomach, and intestines, may be considered as one great gland; which like the lacrymal sack above mentioned, neither begins nor ends in the circulation. Though the act of masticating our aliment belongs to the sensitive class of motions, for the pleasure of its taste induces the muscles of the jaw into action; yet the deglutition of it when masticated is generally, if not always, an irritative motion, occasioned by the application of the food already masticated to the origin of the pharinx; in the same manner as we often swallow our spittle without attending to it.

The ruminating class of animals have the power to invert the motion of their gullet, and of their first stomach, from the stimulus of this aliment, when it is a little further prepared; as is their daily practice in chewing the cud; and appears to the eye of any one, who attends to them, whilst they are employed in this second mastication of their food.

2. When our natural aliment arrives into the stomach, this organ is simulated into its proper vermicular action; which beginning at the upper orifice of it, and terminating at the lower one, gradually mixes together and pushes forwards the digesting materials into the intestine beneath it.

At the same time the glands, that supply the gastric juices, which are necessary to promote the chemical part of the process of digestion, are stimulated to discharge their contained fluids, and to separate a further supply from the blood-vessels: and the lacteals or lymphatics, which open their mouths into the stomach, are stimulated into action, and take up some part of the digesting materials.

3. The remainder of these digesting materials is carried forwards into the upper intestines, and stimulates them into their peristaltic motion similar to that of the stomach; which continues gradually to mix the changing materials, and pass them along through the valve of the colon to the excretory end of this great gland, the sphincter ani.

The digesting materials produce a flow of bile, and of pancreatic juice, as they pass along the duodenum, by stimulating the excretory ducts of the liver and pancreas, which terminate in that intestine: and other branches of the absorbent or lymphatic system, called lacteals, are excited to drink up, as it passes, those parts of the digesting materials, that are proper for their purpose, by its stimulus on their mouths.

4. When the stomach and intestines are thus filled with their proper food, not only the motions of the gastric glands, the pancreas, liver, and lacteal vessels, are excited into action; but at the same time the whole tribe of irritative motions are exerted with greater energy, a greater degree of warmth, colour, plumpness, and moisture, is given to the skin from the increased action of those glands called capillary vessels; pleasurable sensation is excited, the voluntary motions are less easily exerted, and at length suspended; and sleep succeeds, unless it be prevented by the stimulus of surrounding objects, or by voluntary exertion, or by an acquired habit, which was originally produced by one or other of these circumstances, as is explained in Sect. XXI. on Drunkenness.

At this time also, as the blood-vessels become replete with chyle, more urine is separated into the bladder, and less of it is reabsorbed; more mucus poured into the cellular membranes, and less of it reabsorbed; the pulse becomes fuller, and softer, and in general quicker. The reason why less urine and cellular mucus is absorbed after a full meal with sufficient drink is owing to the blood-vessels being fuller: hence one means to promote absorption is to decrease the resistance by emptying the vessels by venesection. From this decreased absorption the urine becomes pale as well as copious, and the skin appears plump as well as florid.

By daily repetition of these movements they all become connected together, and make a diurnal circle of irritative action, and if one of this chain be disturbed, the whole is liable to be put into disorder. See Sect. XX. on Vertigo.

5. When the stomach and intestines receive a quantity of food, whose stimulus is greater than usual, all their motions, and those of the glands and lymphatics, are stimulated into stronger action than usual, and perform their offices with greater vigour and in less time: such are the effects of certain quantities of spice or of vinous spirit.

6. But if the quantity or duration of these stimuli are still further increased, the stomach and throat are stimulated into a motion, whose direction is contrary to the natural one above described; and they regurgitate the materials, which they contain, instead of carrying them forwards. This retrograde motion of the stomach may be compared to the stretchings of wearied limbs the contrary way, and is well elucidated by the following experiment. Look earnestly for a minute or two on an area an inch square of pink silk, placed in a strong light, the eye becomes fatigued, the colour becomes faint, and at length vanishes, for the fatigued eye can no longer be stimulated into direct motions; then on closing the eye a green spectrum will appear in it, which is a colour directly contrary to pink, and which will appear and disappear repeatedly, like the efforts in vomiting. See Section XXIX. 11.

Hence all those drugs, which by their bitter or astringent stimulus increase the action of the stomach, as camomile and white vitriol, if their quantity is increased above a certain dose become emetics.

These inverted motions of the stomach and throat are generally produced from the stimulus of unnatural food, and are attended with the sensation of nausea or sickness: but as this sensation is again connected with an idea of the distasteful food, which induced it; so an idea of nauseous food will also sometimes excite the action of nausea; and that give rise by association to the inversion of the motions of the stomach and throat. As some, who have had horse-flesh or dogs-flesh given them for beef or mutton, are said to have vomited many hours afterwards, when they have been told of the imposition.

I have been told of a person, who had gained a voluntary command over these inverted motions of the stomach and throat, and supported himself by exhibiting this curiosity to the public. At these exhibitions he swallowed a pint of red rough gooseberries, and a pint of white smooth ones, brought them up in small parcels into his mouth, and restored them separately to the spectators, who called for red or white as they pleased, till the whole were redelivered.

7. At the same time that these motions of the stomach and throat are stimulated into inversion, some of the other irritative motions, that had acquired more immediate connexions with the stomach, as those of the gastric glands, are excited into stronger action by this association; and some other of these motions, which are more easily excited, as those of the gastric lymphatics, are inverted by their association with the retrograde motions of the stomach, and regurgitate their contents, and thus a greater quantity of mucus, and of lymph, or chyle, is poured into the stomach, and thrown up along with its contents.

8. These inversions of the motion of the stomach in vomiting are performed by intervals, for the same reason that many other motions are reciprocally exerted and relaxed; for during the time of exertion the stimulus, or sensation, which caused this exertion, is not perceived; but begins to be perceived again, as soon as the exertion ceases, and is some time in again producing its effect. As explained in Sect. XXXIV. on Volition, where it is shewn, that the contractions of the fibres, and the sensation of pain, which occasioned that exertion, cannot exist at the same time. The exertion ceases from another cause also, which is the exhaustion of the sensorial power of the part, and these two causes frequently operate together.

9. At the times of these inverted efforts of the stomach not only the lymphatics, which open their mouths into the stomach, but those of the skin also, are for a time inverted; for sweats are sometimes pushed out during the efforts of vomiting without an increase of heat.

10. But if by a greater stimulus the motions of the stomach are inverted still more violently or more permanently, the duodenum has its peristaltic motions inverted at the same time by their association with those of the stomach; and the bile and pancreatic juice, which it contains, are by the inverted motions brought up into the stomach, and discharged along with its contents; while a greater quantity of bile and pancreatic juice is poured into this intestine; as the glands, that secrete them, are by their association with the motions of the intestine excited into stronger action than usual.

11. The other intestines are by association excited into more powerful action, while the lymphatics, that open their mouths into them, suffer an inversion of their motions corresponding with the lymphatics of the stomach, and duodenum; which with a part of the abundant secretion of bile is carried downwards, and contributes both to stimulate the bowels, and to increase the quantity of the evacuations. This inversion of the motion of the lymphatics appears from the quantity of chyle, which comes away by stools; which is otherwise absorbed as soon as produced, and by the immense quantity of thin fluid, which is evacuated along with it.

12. But if the stimulus, which inverts the stomach, be still more powerful, or more permanent, it sometimes happens, that the motions of the biliary glands, and of their excretory ducts, are at the same time inverted, and regurgitate their contained bile into the blood-vessels, as appears by the yellow colour of the skin, and of the urine; and it is probable the pancreatic secretion may suffer an inversion at the same time, though we have yet no mark by which this can be ascertained.

13. Mr. ---- eat two putrid pigeons out of a cold pigeon-pye, and drank about a pint of beer and ale along with them, and immediately rode about five miles. He was then seized with vomiting, which was after a few periods succeeded by purging; these continued alternately for two hours; and the purging continued by intervals for six or eight hours longer. During this time he could not force himself to drink more than one pint in the whole; this great inability to drink was owing to the nausea, or inverted motions of the stomach, which the voluntary exertion of swallowing could seldom and with difficulty overcome; yet he discharged in the whole at least six quarts; whence came this quantity of liquid? First, the contents of the stomach were emitted, then of the duodenum, gall-bladder, and pancreas, by vomiting. After this the contents of the lower bowels, then the chyle, that was in the lacteal vessels, and in the receptacle of chyle, was regurgitated into the intestines by a retrograde motion of these vessels. And afterwards the mucus deposited in the cellular membrane, and on the surface of all the other membranes, seems to have been absorbed; and with the fluid absorbed from the air to have been carried up their respective lymphatic branches by the increased energy of their natural motions, and down the visceral lymphatics, or lacteals, by the inversion of their motions.

14. It may be difficult to invent experiments to demonstrate the truth of this inversion of some branches of the absorbent system, and increased absorption of others, but the analogy of these vessels to the intestinal canal, and the symptoms of many diseases, render this opinion more probable than many other received opinions of the animal oeconomy.

In the above instance, after the yellow excrement was voided, the fluid ceased to have any smell, and appeared like curdled milk, and then a thinner fluid, and some mucus, were evacuated; did not these seem to partake of the chyle, of the mucous fluid from all the cells of the body, and lastly, of the atmospheric moisture? All these facts may be easily observed by any one, who takes a brisk purge.

15. Where the stimulus on the stomach, or on some other part of the intestinal canal, is still more permanent, not only the lacteal vessels, but the whole canal itself, becomes inverted from its associations: this is the iliac passion, in which all the fluids mentioned above are thrown up by the mouth. At this time the valve in the colon, from the inverted motions of that bowel, and the inverted action of this living valve, does not prevent the regurgitation of its contents.

The structure of this valve may be represented by a flexile leathern pipe standing up from the bottom of a vessel of water: its sides collapse by the pressure of the ambient fluid, as a small part of that fluid passes through it; but if it has a living power, and by its inverted action keeps itself open, it becomes like a rigid pipe, and will admit the whole liquid to pass. See Sect. XXIX. 2. 5.

In this case the patient is averse to drink, from the constant inversion of the motions of the stomach, and yet many quarts are daily ejected from the stomach, which at length smell of excrement, and at last seem to be only a thin mucilaginous or aqueous liquor.

From whence is it possible, that this great quantity of fluid for many successive days can be supplied, after the cells of the body have given up their fluids, but from the atmosphere? When the cutaneous branch of absorbents acts with unnatural strength, it is probable the intestinal branch has its motions inverted, and thus a fluid is supplied without entering the arterial system. Could oiling or painting the skin give a check to this disease?

So when the stomach has its motions inverted, the lymphatics of the stomach, which are most strictly associated with it, invert their motions at the same time. But the more distant branches of lymphatics, which are less strictly associated with it, act with increased energy; as the cutaneous lymphatics in the cholera, or iliac passion, above described. And other irritative motions become decreased, as the pulsations of the arteries, from the extra-derivation or exhaustion of the sensorial power.

Sometimes when stronger vomiting takes place the more distant branches of the lymphatic system invert their motions with those of the stomach, and loose stools are produced, and cold sweats.

So when the lacteals have their motions inverted, as during the operation of strong purges, the urinary and cutaneous absorbents have their motions increased to supply the want of fluid in the blood, as in great thirst; but after a meal with sufficient potation the urine is pale, that is, the urinary absorbents act weakly, no supply of water being wanted for the blood. And when the intestinal absorbents act too violently, as when too great quantities of fluid have been drank, the urinary absorbents invert their motions to carry off the superfluity, which is a new circumstance of association, and a temporary diabetes supervenes.

16. I have had the opportunity of seeing four patients in the iliac passion, where the ejected material smelled and looked like excrement. Two of these were so exhausted at the time I saw them, that more blood could not be taken from them, and as their pain had ceased, and they continued to vomit up every thing which they drank, I suspected that a mortification of the bowel had already taken place, and as they were both women advanced in life, and a mortification is produced with less preceding pain in old and weak people, these both died. The other two, who were both young men, had still pain and strength sufficient for further venesection, and they neither of them had any appearance of hernia, both recovered by repeated bleeding, and a scruple of calomel given to one, and half a dram to the other, in very small pills: the usual means of clysters, and purges joined with opiates, had been in vain attempted. I have thought an ounce or two of crude mercury in less violent diseases of this kind has been of use, by contributing to restore its natural motion to some part of the intestinal canal, either by its weight or stimulus; and that hence the whole tube recovered its usual associations of progressive peristaltic motion. I have in three cases seen crude mercury given in small doses, as one or two ounces twice a day, have great effect in stopping pertinacious vomitings.

17. Besides the affections above described, the stomach is liable, like many other membranes of the body, to torpor without consequent inflammation: as happens to the membranes about the head in some cases of hemicrania, or in general head-ach. This torpor of the stomach is attended with indigestion, and consequent flatulency, and with pain, which is usually called the cramp of the stomach, and is relievable by aromatics, essential oils, alcohol, or opium.

The intrusion of a gall-stone into the common bile-duct from the gall-bladder is sometimes mistaken for a pain of the stomach, as neither of them are attended with fever; but in the passage of a gall-stone, the pain is confined to a less space, which is exactly where the common bile-duct enters the duodenum, as explained in Section XXX. 1. 3. Whereas in this gastrodynia the pain is diffused over the whole stomach; and, like other diseases from torpor, the pulse is weaker, and the extremities colder, and the general debility greater, than in the passage of a gall-stone; for in the former the debility is the consequence of the pain, in the latter it is the cause of it.

Though the first fits of the gout, I believe, commence with a torpor of the liver; and the ball of the toe becomes inflamed instead of the membranes of the liver in consequence of this torpor, as a coryza or catarrh frequently succeeds a long exposure of the feet to cold, as in snow, or on a moist brick-floor; yet in old or exhausted constitutions, which have been long habituated to its attacks, it sometimes commences with a torpor of the stomach, and is transferable to every membrane of the body. When the gout begins with torpor of the stomach, a painful sensation of cold occurs, which the patient compares to ice, with weak pulse, cold extremities, and sickness; this in its slighter degree is relievable by spice, wine, or opium; in its greater degree it is succeeded by sudden death, which is owing to the sympathy of the stomach with the heart, as explained below.

If the stomach becomes inflamed in consequence of this gouty torpor of it, or in consequence of its sympathy with some other part, the danger is less. A sickness and vomiting continues many days, or even weeks, the stomach rejecting every thing stimulant, even opium or alcohol, together with much viscid mucus; till the inflammation at length ceases, as happens when other membranes, as those of the joints, are the seat of gouty inflammation; as observed in Sect. XXIV. 2. 8.

The sympathy, or association of motions, between those of the stomach and those of the heart, are evinced in many diseases. First, many people are occasionally affected with an intermission of their pulse for a few days, which then ceases again. In this case there is a stop of the motion of the heart, and at the same time a tendency to eructation from the stomach. As soon as the patient feels a tendency to the intermission of the motion of his heart, if he voluntarily brings up wind from his stomach, the stop of the heart does not occur. From hence I conclude that the stop of digestion is the primary disease; and that air is instantly generated from the aliment, which begins to ferment, if the digestive process is impeded for a moment, (see Sect. XXIII. 4.); and that the stop of the heart is in consequence of the association of the motions of these viscera, as explained in Sect. XXXV. 1. 4.; but if the little air, which is instantly generated during the temporary torpor of the stomach, be evacuated, the digestion recommences, and the temporary torpor of the heart does not follow. One patient, whom I lately saw, and who had been five or six days much troubled with this intermission of a pulsation of his heart, and who had hemicrania with some fever, was immediately relieved from them all by losing ten ounces of blood, which had what is termed an inflammatory crust on it.