Chapter XIX: Part I: c. i (1)

But this opinion wants the support of analogy, as there is no known process in animal bodies, which is purely chemical, not even digestion; nor can any of these matters be produced by chemical processes. Add to this, that it is probable, that the insects, observed in the pustules of the itch, and in the stools of dysenteric patients, are the consequences, and not the causes of these diseases. And that the specific medicines, which cure the itch and lues venerea, as brimstone and mercury, act only by increasing the absorption of the matter in the ulcuscles of those diseases, and thence disposing them to heal; which would otherwise continue to spread.

Why the venereal disease, and itch, and tenia, or scald head, are repeatedly contagious, while those contagions attended with fever can be received but once, seems to depend on their being rather local diseases than universal ones, and are hence not attended with fever, except the purulent fever in their last stages, when the patient is destroyed by them. On this account the whole of the system does not become habituated to these morbid actions, so as to cease to be affected with sensation by a repetition of the contagion. Thus the contagious matter of the venereal disease, and of the tenia, affects the lymphatic glands, as the inquinal glands, and those about the roots of the hair and neck, where it is arrested, but does not seem to affect the blood-vessels, since no fever ensues.

Hence it would appear, that these kinds of contagion are propagated not by means of the circulation, but by sympathy of distant parts with each other; since if a distant part, as the palate, should be excited by sensitive association into the same kind of motions, as the parts originally affected by the contact of infectious matter; that distant part will produce the same kind of infectious matter; for every secretion from the blood is formed from it by the peculiar motions of the fine extremities of the gland, which secretes it; the various secreted fluids, as the bile, saliva, gastric juice, not previously existing, as such, in the blood-vessels.

And this peculiar sympathy between the genitals and the throat, owing to sensitive association, appears not only in the production of venereal ulcers in the throat, but in variety of other instances, as in the mumps, in the hydrophobia, some coughs, strangulation, the production of the beard, change of voice at puberty. Which are further described in Class IV. 1. 2. 7.

To evince that the production of such large quantities of contagious matter, as are seen in some variolous patients, so as to cover the whole skin almost with pustules, does not arise from any chemical fermentation in the blood, but that it is owing to morbid motions of the fine extremities of the capillaries, or glands, whether these be ruptured or not, appears from the quantity of this matter always corresponding with the quantity of the fever; that is, with the violent exertions of those glands and capillaries, which are the terminations of the arterial system.

The truth of this theory is evinced further by a circumstance observed by Mr. J. Hunter, in his Treatise on Venereal Disease; that in a patient, who was inoculated for the small-pox, and who appeared afterwards to have been previously infested with the measles, the progress of the small-pox was delayed till the measles had run their course, and that then the small-pox went through its usual periods.

Two similar cases fell under my care, which I shall here relate, as it confirms that of Mr. Hunter, and contributes to illustrate this part of the theory of contagious diseases. I have transcribed the particulars from a letter of Mr. Lightwood of Yoxal, the surgeon who daily attended them, and at my request, after I had seen them, kept a kind of journal of their cases.

Miss H. and Miss L. two sisters, the one about four and the other about three years old, were inoculated Feb. 7, 1791. On the 10th there was a redness on both arms discernible by a glass. On the 11th their arms were so much inflamed as to leave no doubt of the infection having taken place. On the 12th less appearance of inflammation on their arms. In the evening Miss L. had an eruption, which resembled the measles. On the 12th the eruption on Miss L. was very full on the face and breast, like the measles, with considerable fever. It was now known, that the measles were in a farm house in the neighbourhood. Miss H.'s arm less inflamed than yesterday. On the 14th Miss L.'s fever great, and the eruption universal. The arm appears to be healed. Miss H.'s arm somewhat redder. They were now put into separate rooms. On the 15th Miss L.'s arms as yesterday. Eruption continues. Miss H.'s arms have varied but little. 16th, the eruptions on Miss L. are dying away, her fever gone. Begins to have a little redness in one arm at the place of inoculation. Miss H.'s arms get redder, but she has no appearance of complaint. 20th, Miss L.'s arms have advanced slowly till this day, and now a few pustules appear. Miss H.'s arm has made little progress from the 16th to this day, and now she has some fever. 21st, Miss L. as yesterday. Miss H. has much inflammation, and an increase of the red circle on one arm to the size of half a crown, and had much fever at night, with fetid breath. 22d, Miss L.'s pustules continue advancing. Miss H.'s inflammation of her arm and red circle increases. A few red spots appear in different parts with some degree of fever this morning, 23d. Miss L. has a larger crop of pustules. Miss H. has small pustules and great inflammation of her arms, with but one pustule likely to suppurate. After this day they gradually got well, and the pustules disappeared.

In one of these cases the measles went through their common course with milder symptoms than usual, and in the other the measly contagion seemed just sufficient to stop the progress of variolous contagion, but without itself throwing the constitution into any disorder. At the same time both the measles and small-pox seem to have been rendered milder. Does not this give an idea, that if they were both inoculated at the same time, that neither of them might affect the patient?

From these cases I contend, that the contagious matter of these diseases does not affect the constitution by a fermentation, or chemical change of the blood, because then they must have proceeded together, and have produced a third something, not exactly similar to either of them: but that they produce new motions of the cutaneous terminations of the blood-vessels, which for a time proceed daily with increasing activity, like some paroxysms of fever, till they at length secrete or form a similar poison by these unnatural actions.

Now as in the measles one kind of unnatural motion takes place, and in the small-pox another kind, it is easy to conceive, that these different kinds of morbid motions cannot exist together; and therefore, that that which has first begun will continue till the system becomes habituated to the stimulus which occasions it, and has ceased to be thrown into action by it; and then the other kind of stimulus will in its turn produce fever, and new kinds of motions peculiar to itself.

10. On further considering the action of contagious matter, since the former part of this work was sent to the press; where I have asserted, in Sect. XXII. 3. 3. that it is probable, that the variolous matter is diffused through the blood; I prevailed on my friend Mr. Power, surgeon at Bosworth in Leicestershire to try, whether the small-pox could be inoculated by using the blood of a variolous patient instead of the matter from the pustules; as I thought such an experiment might throw some light at least on this interesting subject. The following is an extract from his letter:--

"March 11, 1793. I inoculated two children, who had not had the small-pox, with blood; which was taken from a patient on the second day after the eruption commenced, and before it was completed. And at the same time I inoculated myself with blood from the same person, in order to compare the appearances, which might arise in a person liable to receive the infection, and in one not liable to receive it. On the same day I inoculated four other children liable to receive the infection with blood taken from another person on the fourth day after the commencement of the eruption. The patients from whom the blood was taken had the disease mildly, but had the most pustules of any I could select from twenty inoculated patients; and as much of the blood was insinuated under the cuticle as I could introduce by elevating the skin without drawing blood; and three or four such punctures were made in each of their arms, and the blood was used in its fluid state.

"As the appearances in all these patients, as well as in myself, were similar, I shall only mention them in general terms. March 13. A slight subcuticular discoloration, with rather a livid appearance, without soreness or pain, was visible in them all, as well as in my own hand. 15. The discoloration somewhat less, without pain or soreness. Some patients inoculated on the same day with variolous matter have considerable inflammation. 17. The discoloration is quite gone in them all, and from my own hand, a dry mark only remaining. And they were all inoculated on the 18th, with variolous matter, which produced the disease in them all."

Mr. Power afterwards observes, that, as the patients from whom the blood was taken had the disease mildly, it may be supposed, that though the contagious matter might be mixed with the blood, it might still be in too dilute a state to convey the infection; but adds at the same time, that he has diluted recent matter with at least five times its quantity of water, and which has still given the infection; though he has sometimes diluted it so far as to fail.

The following experiments were instituted at my request by my friend Mr. Hadley, surgeon in Derby, to ascertain whether the blood of a person in the small-pox be capable of communicating the disease. "Experiment 1st. October 18th, 1793. I took some blood from a vein in the arm of a person who had the small-pox, on the second day of the eruption, and introduced a small quantity of it immediately with the point of a lancet between the scars and true skin of the right arm of a boy nine years old in two or three different places; the other arm was inoculated with variolous matter at the same time.

"19th. The punctured parts of the right arm were surrounded with some degree of subcuticular inflammation. 20th. The inflammation more considerable, with a slight degree of itching, but no pain upon pressure. 21st. Upon examining the arm this day with a lens I found the inflammation less extensive, and the redness changing to a deep yellow or orange-colour, 22d. Inflammation nearly gone. 23d. Nothing remained, except a slight discoloration and a little scurfy appearance on the punctures. At the same time the inflammation of the arm inoculated with variolous matter was increasing fast, and he had the disease mildly at the usual time.

"Experiment 2d. I inoculated another child at the same time and in the same manner, with blood taken on the first day of the eruption; but as the appearance and effects were similar to those in the preceding experiment, I shall not relate them minutely.

"Experiment 3d. October 20th. Blood was taken from a person who had the small-pox, on the third day of the eruption, and on the sixth from the commencement of the eruptive fever. I introduced some of it in its fluid state into both arms of a boy seven years old.

21st. There appeared to be some inflammation under the cuticle, where the punctures were made. 22d. Inflammation more considerable. 23d. On this day the inflammation was somewhat greater, and the cuticle rather elevated.

"24th. Inflammation much less, and only a brown or orange-colour remained. 25th. Scarcely any discoloration left. On this day he was inoculated with variolous matter, the progress of the infection went on in the usual way, and he had the small-pox very favourably.

"At this time I was requested to inoculate a young person, who was thought to have had the small-pox, but his parents were not quite certain; in one arm I introduced variolous matter, and in the other blood, taken as in experiment 3d. On the second day after the operation, the punctured parts were inflamed, though I think the arm in which I had inserted variolous matter was rather more so than the other. On the third the inflammation was increased, and looked much the same as in the preceding experiment. 4th. The inflammation was much diminished, and on the 5th almost gone. He was exposed at the same time to the natural infection, but has continued perfectly well.

"I have frequently observed (and believe most practitioners have done the same), that if variolous matter be inserted in the arm of a person who has previously had the small-pox, that the inflammation on the second or third days is much greater, than if they had not had the disease, but on the fourth or fifth it disappears.

"On the 23d I introduced blood into the arms of three more children, taken on the third and fourth days of the eruption. The appearances were much the same as mentioned in experiments first and third. They were afterwards inoculated with variolous matter, and had the disease in the regular way.

"The above experiments were made with blood taken from a small vein in the hand or foot of three or four different patients, whom I had at that time under inoculation. They were selected from 160, as having the greatest number of pustules. The part was washed with warm water before the blood was taken, to prevent the possibility of any matter being mixed with it from the surface."

Shall we conclude from hence, that the variolous matter never enters the blood-vessels? but that the morbid motions of the vessels of the skin around the insertion of it continue to increase in a larger and larger circle for six or seven days; that then their quantity of morbid action becomes great enough to produce a fever-fit, and to affect the stomach by association of motions? and finally, that a second association of motions is produced between the stomach and the other parts of the skin, inducing them into morbid actions similar to those of the circle round the insertion of the variolous matter? Many more experiments and observations are required before this important question can be satisfactorily answered.

It may be adduced, that as the matter inserted into the skin of the arm frequently swells the lymphatic in the axilla, that in that circumstance it seems to be there arrested in its progress, and cannot be imagined to enter the blood by that lymphatic gland till the swelling of it subsides. Some other phænomena of the disease are more easily reconcileable to this theory of sympathetic motions than to that of absorption; as the time taken up between the insertion of the matter, and the operation of it on the system, as mentioned above. For the circle around the insertion is seen to increase, and to inflame; and I believe, undergoes a kind of diurnal paroxysm of torpor and paleness with a succeeding increase of action and colour, like a topical fever-fit. Whereas if the matter is conceived to circulate for six or seven days with the blood, without producing disorder, it ought to be rendered milder, or the blood-vessels more familiarized to its acrimony.

It is much easier to conceive from this doctrine of associated or sympathetic motions of distant parts of the system, how it happens, that the variolous infection can be received but once, as before explained; than by supposing, that a change is effected in the mass of blood by any kind of fermentative process.

The curious circumstance of the two contagions of small-pox and measles not acting at the same time, but one of them resting or suspending its action till that of the other ceases, may be much easier explained from sympathetic or associated actions of the infected part with other parts of the system, than it can from supposing the two contagions to enter the circulation.

The skin of the face is subject to more frequent vicissitudes of heat and cold, from its exposure to the open air, and is in consequence more liable to sensitive association with the stomach than any other part of the surface of the body, because their actions have been more frequently thus associated. Thus in a surfeit from drinking cold water, when a person is very hot and fatigued, an eruption is liable to appear on the face in consequence of this sympathy. In the same manner the rosy eruption on the faces of drunkards more probably arises from the sympathy of the face with the stomach, rather than between the face and the liver, as is generally supposed.

This sympathy between the stomach and the skin of the face is apparent in the eruption of the small-pox; since, where the disease is in considerable quantity, the eruption on the face first succeeds the sickness of the stomach. In the natural disease the stomach seems to be frequently primarily affected, either alone or along with the tonsils, as the matter seems to be only diffused in the air, and by being mixed with the saliva, or mucus of the tonsils, to be swallowed into the stomach.

After some days the irritative circles of motions become disordered by this new stimulus, which acts upon the mucus lining of the stomach; and sickness, vertigo, and a diurnal fever succeed. These disordered irritative motions become daily increased for two or three days, and then by their increased action certain sensitive motions, or inflammation, is produced, and at the next cold fit of fever, when the stomach recovers from its torpor, an inflammation of the external skin is formed in points (which afterwards suppurate), by sensitive association, in the same manner as a cough is produced in consequence of exposing the feet to cold, as described in Sect. XXV. 17. and Class IV. 2. I. 7. If the inoculated skin of the arm, as far as it appears inflamed, was to be cut out, or destroyed by caustic, before the fever commenced, as suppose on the fourth day after inoculation, would this prevent the disease? as it is supposed to prevent the hydrophobia.

III. 1. Where the new vessels, and enlarged old ones, which constitute inflammation, are not so hastily distended as to burst, and form a new kind of gland for the secretion of matter, as above mentioned; if such circumstances happen as diminish the painful sensation, the tendency to growth ceases, and by and by an absorption commences, not only of the superabundant quantity of fluids deposited in the inflamed part, but of the solids likewise, and this even of the hardest kind.

Thus during the growth of the second set of teeth in children, the roots of the first set are totally absorbed, till at length nothing of them remains but the crown; though a few weeks before, if they are drawn immaturely, their roots are found complete. Similar to this Mr. Hunter has observed, that where a dead piece of bone is to exfoliate, or to separate from a living one, that the dead part does not putrify, but remains perfectly sound, while the surface of the living part of the bone, which is in contact with the dead part, becomes absorbed, and thus effects its separation. Med. Comment. Edinb. V. 1. 425. In the same manner the calcareous matter of gouty concretions, the coagulable lymph deposited on inflamed membranes in rheumatism and extravasated blood become absorbed; which are all as solid and as indissoluble materials as the new vessels produced in inflammation.

This absorption of the new vessels and deposited fluids of inflamed parts is called resolution: it is produced by first using such internal means as decrease the pain of the part, and in consequence its new motions, as repeated bleeding, cathartics, diluent potations, and warm bath.

After the vessels are thus emptied, and the absorption of the new vessels and deposited fluids is evidently begun, it is much promoted by stimulating the part externally by solutions of lead, or other metals, and internally by the bark, and small doses of opium. Hence when an ophthalmy begins to become paler, any acrid eye-water, as a solution of six grains of white vitriol in an ounce of water, hastens the absorption, and clears the eye in a very short time. But the same application used a few days sooner would have increased the inflammation. Hence after evacuation opium in small doses may contribute to promote the absorption of fluids deposited on the brain, as observed by Mr. Bromfield in his treatise of surgery.

2. Where an abscess is formed by the rupture of these new vessels, the violence of inflammation ceases, and a new gland separates a material called pus: at the same time a less degree of inflammation produces new vessels called vulgarly proud flesh; which, if no bandage confines its growth, nor any other circumstance promotes absorption in the wound, would rise to a great height above the usual size of the part.

Hence the art of healing ulcers consists in producing a tendency to absorption in the wound greater than the deposition. Thus when an ill-conditioned ulcer separates a copious and thin discharge, by the use of any stimulus, as of salts of lead, or mercury, or copper externally applied, the discharge becomes diminished in quantity, and becomes thicker, as the thinner parts are first absorbed.

But nothing so much contributes to increase the absorption in a wound as covering the whole limb above the sore with a bandage, which should be spread with some plaster, as with emplastrum de minio, to prevent it from slipping. By this artificial tightness of the skin, the arterial pulsations act with double their usual power in promoting the ascending current of the fluid in the valvular lymphatics.

Internally the absorption from ulcers should be promoted first by evacuation, then by opium, bark, mercury, steel.

3. Where the inflammation proceeds with greater violence or rapidity, that is, when by the painful sensation a more inordinate activity of the organ is produced, and by this great activity an additional quantity of painful sensation follows in an increasing ratio, till the whole of the sensorial power, or spirit of animation, in the part becomes exhausted, a mortification ensues, as in a carbuncle, in inflammations of the bowels, in the extremities of old people, or in the limbs of those who are brought near a fire after having been much benumbed with cold. And from hence it appears, why weak people are more subject to mortification than strong ones, and why in weak persons less pain will produce mortification, namely, because the sensorial power is sooner exhausted by any excess of activity. I remember seeing a gentleman who had the preceding day travelled two stages in a chaise with what he termed a bearable pain in his bowels; which when I saw him had ceased rather suddenly, and without a passage through him; his pulse was then weak, though not very quick; but as nothing which he swallowed would continue in his stomach many minutes, I concluded that the bowel was mortified; he died on the next day. It is usual for patients sinking under the small-pox with mortified pustules, and with purple spots intermixed, to complain of no pain, but to say they are pretty well to the last moment.

_Recapitulation._

IV. When the motions of any part of the system, in consequence of previous torpor, are performed with more energy than in the irritative fevers, a disagreeable sensation is produced, and new actions of some part of the system commence in consequence of this sensation conjointly with the irritation: which motions constitute inflammation. If the fever be attended with a strong pulse, as in pleurisy, or rheumatism, it is termed synocha sensitiva, or sensitive fever with strong pulse; which is usually termed inflammatory fever. If it be attended with weak pulse, it is termed typhus sensitivus, or sensitive fever with weak pulse, or typhus gravior, or putrid malignant fever.

The synocha sensitiva, or sensitive fever with strong pulse, is generally attended with some topical inflammation, as in peripneumony, hepatitis, and is accompanied with much coagulable lymph, or size; which rises to the surface of the blood, when taken into a bason, as it cools; and which is believed to be the increased mucous secretion from the coats of the arteries, inspissated by a greater absorption of its aqueous and saline part, and perhaps changed by its delay in the circulation.

The typhus sensitivus, or sensitive fever with weak pulse, is frequently attended with delirium, which is caused by the deficiency of the quantity of sensorial power, and with variety of cutaneous eruptions.

Inflammation is caused by the pains occasioned by excess of action, and not by those pains which are occasioned by defect of action. These morbid actions, which are thus produced by two sensorial powers, viz. by irritation and sensation, secrete new living fibres, which elongate the old vessels, or form new ones, and at the same time much heat is evolved from these combinations. By the rupture of these vessels, or by a new construction of their apertures, purulent matters are secreted of various kinds; which are infectious the first time they are applied to the skin beneath the cuticle, or swallowed with the saliva into the stomach. This contagion acts not by its being absorbed into the circulation, but by the sympathies, or associated actions, between the part first stimulated by the contagious matter and the other parts of the system. Thus in the natural small-pox the contagion is swallowed with the saliva, and by its stimulus inflames the stomach; this variolous inflammation of the stomach increases every day, like the circle round the puncture of an inoculated arm, till it becomes great enough to disorder the circles of irritative and sensitive motions, and thus produces fever-fits, with sickness and vomiting. Lastly, after the cold paroxysm, or fit of torpor, of the stomach has increased for two or three successive days, an inflammation of the skin commences in points; which generally first appear upon the face, as the associated actions between the skin of the face and that of the stomach have been more frequently exerted together than those of any other parts of the external surface.

Contagious matters, as those of the measles and small-pox, do not act upon the system at the same time; but the progress of that which was last received is delayed, till the action of the former infection ceases. All kinds of matter, even that from common ulcers, are probably contagious the first time they are inserted beneath the cuticle or swallowed into the stomach; that is, as they were formed by certain morbid actions of the extremities of the vessels, they have the power to excite similar morbid actions in the extremities of other vessels, to which they are applied; and these by sympathy, or associations of motion, excite similar morbid actions in distant parts of the system, without entering the circulation; and hence the blood of a patient in the small-pox will not give that disease by inoculation to others.

When the new fibres or vessels become again absorbed into the circulation, the inflammation ceases; which is promoted, after sufficient evacuations, by external stimulants and bandages: but where the action of the vessels is very great, a mortification of the part is liable to ensue, owing to the exhaustion of sensorial power; which however occurs in weak people without much pain, and without very violent previous inflammation; and, like partial paralysis, may be esteemed one mode of natural death of old people, a part dying before the whole.

* * * * *

SECT. XXXIV.

DISEASES OF VOLITION.

I. 1. _Volition defined. Motions termed involuntary are caused by
volition. Desires opposed to each other. Deliberation. Ass between two
hay-cocks. Saliva swallowed against one's desire. Voluntary motions
distinguished from those associated with sensitive motions._ 2. _Pains
from excess, and from defect of motion. No pain is felt during vehement
voluntary exertion; as in cold fits of ague, labour-pains, strangury,
tenesmus, vomiting, restlessness in fevers, convulsion of a wounded
muscle._ 3. _Of holding the breath and screaming in pain; why swine and
dogs cry out in pain, and not sheep and horses. Of grinning and biting
in pain; why mad animals bite others._ 4. _Epileptic convulsions
explained, why the fits begin with quivering of the under jaw, biting
the tongue, and setting the teeth; why the convulsive motions are
alternately relaxed. The phenomenon of laughter explained. Why children
cannot tickle themselves. How some have died from immoderate laughter._
5. _Of cataleptic spasms, of the locked jaw, of painful cramps._ 6.
_Syncope explained. Why no external objects are perceived in syncope._
7. _Of palsy and apoplexy from violent exertions. Case of Mrs. Scot.
From dancing, scating, swimming. Case of Mr. Nairn. Why palsies are not
always immediately preceded by violent exertions. Palsy and epilepsy
from diseased livers. Why the right arm more frequently paralytic than
the left. How paralytic limbs regain their motions._ II. _Diseases of
the sensual motions from excess or defect of voluntary exertion._ 1.
_Madness._ 2. _Distinguished from delirium._ 3. _Why mankind more
liable to insanity than brutes._ 4. _Suspicion. Want of shame, and of
cleanliness._ 5. _They bear cold, hunger, and fatigue. Charles XII. of
Sweden._ 6. _Pleasureable delirium, and insanity. Child riding on a
stick. Pains of martyrdom not felt._ 7. _Dropsy._ 8. _Inflammation
cured by insanity._ III. 1. _Pain relieved by reverie. Reverie is an
exertion of voluntary and sensitive motions._ 2. _Case of reverie._ 3.
_Lady supposed to have two souls._ 4. _Methods of relieving pain._

I. 1. Before we commence this Section on Diseased Voluntary Motions, it may be necessary to premise, that the word volition is not used in this work exactly in its common acceptation. Volition is said in Section V. to bear the same analogy to desire and aversion, which sensation does to pleasure and pain. And hence that, when desire or aversion produces any action of the muscular fibres, or of the organs of sense, they are termed volition; and the actions produced in consequence are termed voluntary actions. Whence it appears, that motions of our muscles or ideas may be produced in consequence of desire or aversion without our having the power to prevent them, and yet these motions may be termed voluntary, according to our definition of the word; though in common language they would be called involuntary.

The objects of desire and aversion are generally at a distance, whereas those of pleasure and pain are immediately acting upon our organs. Hence, before desire or aversion are exerted, so as to cause any actions, there is generally time for deliberation; which consists in discovering the means to obtain the object of desire, or to avoid the object of aversion; or in examining the good or bad consequences, which may result from them. In this case it is evident, that we have a power to delay the proposed action, or to perform it; and this power of choosing, whether we shall act or not, is in common language expressed by the word volition, or will. Whereas in this work the word volition means simply the active state of the sensorial faculty in producing motion in consequence of desire or aversion: whether we have the power of restraining that action, or not; that is, whether we exert any actions in consequence of opposite desires or aversions, or not.

For if the objects of desire or aversion are present, there is no necessity to investigate or compare the _means_ of obtaining them, nor do we always deliberate about their consequences; that is, no deliberation necessarily intervenes, and in consequence the power of choosing to act or not is not exerted. It is probable, that this twofold use of the word volition in all languages has confounded the metaphysicians, who have disputed about free will and necessity. Whereas from the above analysis it would appear, that during our sleep, we use no voluntary exertions at all; and in our waking hours, that they are the consequence of desire or aversion.

To will is to act in consequence of desire; but to desire means to desire something, even if that something be only to become free from the pain, which causes the desire; for to desire nothing is not to desire; the word desire, therefore, includes both the action and the object or motive; for the object and motive of desire are the same thing. Hence to desire without an object, that is, without a motive, is a solecism in language. As if one should ask, if you could eat without food, or breathe without air.

From this account of volition it appears, that convulsions of the muscles, as in epileptic fits, may in the common sense of that word be termed involuntary; because no deliberation is interposed between the desire or aversion and the consequent action; but in the sense of the word, as above defined, they belong to the class of voluntary motions, as delivered in Vol. II. Class III. If this use of the word be discordant to the ear of the reader, the term morbid voluntary motions, or motions in consequence of aversion, may be substituted in its stead.

If a person has a desire to be cured of the ague, and has at the same time an aversion (or contrary desire) to swallowing an ounce of Peruvian bark; he balances desire against desire, or aversion against aversion; and thus he acquires the power of choosing, which is the common acceptation of the word _willing_. But in the cold fit of ague, after having discovered that the act of shuddering, or exerting the subcutaneous muscles, relieves the pain of cold; he immediately exerts this act of volition, and shudders, as soon as the pain and consequent aversion return, without any deliberation intervening; yet is this act, as well as that of swallowing an ounce of the bark, caused by volition; and that even though he endeavours in vain to prevent it by a weaker contrary volition. This recalls to our minds the story of the hungry ass between two hay-stacks, where the two desires are supposed so exactly to counteract each other, that he goes to neither of the stacks, but perishes by want. Now as two equal and opposite desires are thus supposed to balance each other, and prevent all action, it follows, that if one of these hay-stacks was suddenly removed, that the ass would irresistibly be hurried to the other, which in the common use of the word might be called an involuntary act; but which, in our acceptation of it, would be classed amongst voluntary actions, as above explained.

Hence to deliberate is to compare opposing desires or aversions, and that which is the most interesting at length prevails, and produces action. Similar to this, where two pains oppose each other, the stronger or more interesting one produces action; as in pleurisy the pain from suffocation would produce expansion of the lungs, but the pain occasioned by extending the inflamed membrane, which lines the chest, opposes this expansion, and one or the other alternately prevails.

When any one moves his hand quickly near another person's eyes, the eye-lids instantly close; this act in common language is termed involuntary, as we have not time to deliberate or to exert any contrary desire or aversion, but in this work it would be termed a voluntary act, because it is caused by the faculty of volition, and after a few trials the nictitation can be prevented by a contrary or opposing volition.

The power of opposing volitions is best exemplified in the story of Mutius Scævola, who is said to have thrust his hand into the fire before Porcenna, and to have suffered it to be consumed for having failed him in his attempt on the life of that general. Here the aversion for the loss of same, or the unsatisfied desire to serve his country, the two prevalent enthusiasms at that time, were more powerful than the desire of withdrawing his hand, which must be occasioned by the pain of combustion; of these opposing volitions

Vincit amor patriæ, laudumque immensa cupido.

If any one is told not to swallow his saliva for a minute, he soon swallows it contrary to his will, in the common sense of that word; but this also is a voluntary action, as it is performed by the faculty of volition, and is thus to be understood. When the power of volition is exerted on any of our senses, they become more acute, as in our attempts to hear small noises in the night. As explained in Section XIX. 6. Hence by our attention to the fauces from our desire not to swallow our saliva; the fauces become more sensible; and the stimulus of the saliva is followed by greater sensation, and consequent desire of swallowing it. So that the desire or volition in consequence of the increased sensation of the saliva is more powerful, than the previous desire not to swallow it. See Vol. II. Deglutitio invita. In the same manner if a modest man wishes not to want to make water, when he is confined with ladies in a coach or an assembly-room; that very act of volition induces the circumstance, which he wishes to avoid, as above explained; insomuch that I once saw a partial insanity, which might be called a voluntary diabetes, which was occasioned by the fear (and consequent aversion) of not being able to make water at all.

It is further necessary to observe here, to prevent any confusion of voluntary, with sensitive, or associate motions, that in all the instances of violent efforts to relieve pain, those efforts are at first voluntary exertions; but after they have been frequently repeated for the purpose of relieving certain pains, they become associated with those pains, and cease at those times to be subservient to the will; as in coughing, sneezing, and strangury. Of these motions those which contribute to remove or dislodge the offending cause, as the actions of the abdominal muscles in parturition or in vomiting, though they were originally excited by volition, are in this work termed sensitive motions; but those actions of the muscles or organs of sense, which do not contribute to remove the offending cause, as in general convulsions or in madness, are in this work termed voluntary motions, or motions in consequence of aversion, though in common language they are called involuntary ones. Those sensitive unrestrainable actions, which contribute to remove the cause of pain are uniformly and invariably exerted, as in coughing or sneezing; but those motions which are exerted in consequence of aversion without contributing to remove the painful cause, but only to prevent the sensation of it, as in epileptic, or cataleptic fits, are not uniformly and invariably exerted, but change from one set of muscles to another, as will be further explained; and may by this criterion also be distinguished from the former.

At the same time those motions, which are excited by perpetual stimulus, or by association with each other, or immediately by pleasureable or painful sensation, may properly be termed involuntary motions, as those of the heart and arteries; as the faculty of volition seldom affects those, except when it exists in unnatural quantity, as in maniacal people.

2. It was observed in Section XIV. on the Production of Ideas, that those parts of the system, which are usually termed the organs of sense, are liable to be excited into pain by the excess of the stimulus of those objects, which are by nature adapted to affect them; as of too great light, sound, or pressure. But that these organs receive no pain from the defect or absence of these stimuli, as in darkness or silence. But that our other organs of perception, which have generally been called appetites, as of hunger, thirst, want of heat, want of fresh air, are liable to be affected with pain by the defect, as well as by the excess of their appropriated stimuli.

This excess or defect of stimulus is however to be considered only as the remote cause of the pain, the immediate cause being the excess or defect of the natural action of the affected part, according to Sect. IV. 5. Hence all the pains of the body may be divided into those from excess of motion, and those from defect of motion; which distinction is of great importance in the knowledge and the cure of many diseases. For as the pains from excess of motion either gradually subside, or are in general succeeded by inflammation; so those from defect of motion either gradually subside, or are in general succeeded by convulsion, or madness. These pains are easily distinguishable from each other by this circumstance, that the former are attended with heat of the pained part, or of the whole body; whereas the latter exists without increase of heat in the pained part, and is generally attended with coldness of the extremities of the body; which is the true criterion of what have been called nervous pains.

Thus when any acrid material, as snuff or lime, falls into the eye, pain and inflammation and heat are produced from the excess of stimulus; but violent hunger, hemicrania, or the clavus hystericus, are attended with coldness of the extremities, and defect of circulation. When we are exposed to great cold, the pain we experience from the deficiency of heat is attended with a quiescence of the motions of the vascular system; so that no inflammation is produced, but a great desire of heat, and a tremulous motion of the subcutaneous muscles, which is properly a convulsion in consequence of this pain from defect of the stimulus of heat.

It was before mentioned, that as sensation consists in certain movements of the sensorium, beginning at some of the extremities of it, and propagated to the central parts of it; so volition consists of certain other movements of the sensorium, commencing in the central parts of it, and propagated to some of its extremities. This idea of these two great powers of motion in the animal machine is confirmed from observing, that they never exist in a great degree or universally at the same time; for while we strongly exert our voluntary motions, we cease to feel the pains or uneasinesses, which occasioned us to exert them.

Hence during the time of fighting with fists or swords no pain is felt by the combatants, till they cease to exert themselves. Thus in the beginning of ague-fits the painful sensation of cold is diminished, while the patient exerts himself in the shivering and gnashing of his teeth. He then ceases to exert himself, and the pain of cold returns; and he is thus perpetually induced to reiterate these exertions, from which he experiences a temporary relief. The same occurs in labour-pains, the exertion of the parturient woman relieves the violence of the pains for a time, which recur again soon after she has ceased to use those exertions. The same is true in many other painful diseases, as in the strangury, tenesmus, and the efforts of vomiting; all these disagreeable sensations are diminished or removed for a time by the various exertions they occasion, and recur alternately with those exertions.

The restlessness in some fevers is an almost perpetual exertion of this kind, excited to relieve some disagreeable sensations; the reciprocal opposite exertions of a wounded worm, the alternate emprosthotonos and opisthotonos of some spasmodic diseases, and the intervals of all convulsions, from whatever cause, seem to be owing to this circumstance of the laws of animation; that great or universal exertion cannot exist at the same time with great or universal sensation, though they can exist reciprocally; which is probably resolvable into the more general law, that the whole sensorial power being expended in one mode of exertion, there is none to spare for any other. Whence syncope, or temporary apoplexy, succeeds to epileptic convulsions.

3. Hence when any violent pain afflicts us, of which we can neither avoid nor remove the cause, we soon learn to endeavour to alleviate it, by exerting some violent voluntary effort, as mentioned above; and are naturally induced to use those muscles for this purpose, which have been in the early periods of our lives most frequently or most powerfully exerted.

Now the first muscles, which infants use most frequently, are those of respiration; and on this account we gain a habit of holding our breath, at the same time that we use great efforts to exclude it, for this purpose of alleviating unavoidable pain; or we press out our breath through a small aperture of the larynx, and scream violently, when the pain is greater than is relievable by the former mode of exertion. Thus children scream to relieve any pain either of body or mind, as from anger, or fear of being beaten.

Hence it is curious to observe, that those animals, who have more frequently exerted their muscles of respiration violently, as in talking, barking, or grunting, as children, dogs, hogs, scream much more, when they are in pain, than those other animals, who use little or no language in their common modes of life; as horses, sheep, and cows.

The next most frequent or most powerful efforts, which infants are first tempted to produce, are those with the muscles in biting hard substances; indeed the exertion of these muscles is very powerful in common mastication, as appears from the pain we receive, if a bit of bone is unexpectedly found amongst our softer food; and further appears from their acting to so great mechanical disadvantage, particularly when we bite with the incisores, or canine teeth; which are first formed, and thence are first used to violent exertion.

Hence when a person is in great pain, the cause of which he cannot remove, he sets his teeth firmly together, or bites some substance between them with great vehemence, as another mode of violent exertion to produce a temporary relief. Thus we have a proverb where no help can be had in pain, "to grin and abide;" and the tortures of hell are said to be attended with "gnashing of teeth."

Hence in violent spasmodic pains I have seen people bite not only their tongues, but their arms or fingers, or those of the attendants, or any object which was near them; and also strike, pinch, or tear, others or themselves, particularly the part of their own body, which is painful at the time. Soldiers, who die of painful wounds in battle, are said in Homer to bite the ground. Thus also in the bellon, or colica saturnina, the patients are said to bite their own flesh, and dogs in this disease to bite up the ground they lie upon. It is probable that the great endeavours to bite in mad dogs, and the violence of other mad animals, is owing to the same cause.

4. If the efforts of our voluntary motions are exerted with still greater energy for the relief of some disagreeable sensation, convulsions are produced; as the various kinds of epilepsy, and in some hysteric paroxysms. In all these diseases a pain, or disagreeable sensation is produced, frequently by worms, or acidity in the bowels, or by a diseased nerve in the side, or head, or by the pain of a diseased liver.

In some constitutions a more intolerable degree of pain is produced in some part at a distance from the cause by sensitive association, as before explained; these pains in such constitutions arise to so great a degree, that I verily believe no artificial tortures could equal some, which I have witnessed; and am confident life would not have long been preserved, unless they had been soon diminished or removed by the universal convulsion of the voluntary motions, or by temporary madness.

In some of the unfortunate patients I have observed, the pain has risen to an inexpressible degree, as above described, before the convulsions have supervened; and which were preceded by screaming, and grinning; in others, as in the common epilepsy, the convulsion has immediately succeeded the commencement of the disagreeable sensations; and as a stupor frequently succeeds the convulsions, they only seemed to remember that a pain at the stomach preceded the fit, or some other uneasy feel; or more frequently retained no memory at all of the immediate cause of the paroxysm. But even in this kind of epilepsy, where the patient does not recollect any preceding pain, the paroxysms generally are preceded by a quivering motion of the under jaw, with a biting of the tongue; the teeth afterwards become pressed together with vehemence, and the eyes are then convulsed, before the commencement of the universal convulsion; which are all efforts to relieve pain.

The reason why these convulsive motions are alternately exerted and remitted was mentioned above, and in Sect. XII. 1. 3. when the exertions are such as give a temporary relief to the pain, which excites them, they cease for a time, till the pain is again perceived; and then new exertions are produced for its relief. We see daily examples of this in the loud reiterated laughter of some people; the pleasureable sensation, which excites this laughter, arises for a time so high as to change its name and become painful: the convulsive motions of the respiratory muscles relieve the pain for a time; we are, however, unwilling to lose the pleasure, and presently put a stop to this exertion, and immediately the pleasure recurs, and again as instantly rises into pain. All of us have felt the pain of immoderate laughter; children have been tickled into convulsions of the whole body; and others have died in the act of laughing; probably from a paralysis succeeding the long continued actions of the muscles of respiration.

Hence we learn the reason, why children, who are so easily excited to laugh by the tickling of other people's fingers, cannot tickle themselves into laughter. The exertion of their hands in the endeavour to tickle themselves prevents the necessity of any exertion of the respiratory muscles to relieve the excess of pleasurable affection. See Sect. XVII. 3. 5.

Chrysippus is recorded to have died laughing, when an ass was invited to sup with him. The same is related of one of the popes, who, when he was ill, saw a tame monkey at his bedside put on the holy thiara. Hall. Phys. T. III. p. 306.

There are instances of epilepsy being produced by laughing recorded by Van Swieten, T. III. 402 and 308. And it is well known, that many people have died instantaneously from the painful excess of joy, which probably might have been prevented by the exertions of laughter.

Every combination of ideas, which we attend to, occasions pain or pleasure; those which occasion pleasure, furnish either social or selfish pleasure, either malicious or friendly, or lascivious, or sublime pleasure; that is, they give us pleasure mixed with other emotions, or they give us unmixed pleasure, without occasioning any other emotions or exertions at the same time. This unmixed pleasure, if it be great, becomes painful, like all other animal motions from stimuli of every kind; and if no other exertions are occasioned at the same time, we use the exertion of laughter to relieve this pain. Hence laughter is occasioned by such wit as excites simple pleasure without any other emotion, such as pity, love, reverence. For sublime ideas are mixed with admiration, beautiful ones with love, new ones with surprise; and these exertions of our ideas prevent the action of laughter from being necessary to relieve the painful pleasure above described. Whence laughable wit consists of frivolous ideas, without connections of any consequence, such as puns on words, or on phrases, incongruous junctions of ideas; on which account laughter is so frequent in children.

Unmixed pleasure less than that, which causes laughter, causes sleep, as in singing children to sleep, or in slight intoxication from wine or food. See Sect. XVIII. 12.

5. If the pains, or disagreeable sensations, above described do not obtain a temporary relief from these convulsive exertions of the muscles, those convulsive exertions continue without remission, and one kind of catalepsy is produced. Thus when a nerve or tendon produces great pain by its being inflamed or wounded, the patient sets his teeth firmly together, and grins violently, to diminish the pain; and if the pain is not relieved by this exertion, no relaxation of the maxillary muscles takes place, as in the convulsions above described, but the jaws remain firmly fixed together. This locked jaw is the most frequent instance of cataleptic spasm, because we are more inclined to exert the muscles subservient to mastication from their early obedience to violent efforts of volition.