Chapter XII: Part II (11)

During the journey he did not find the improvement he expected, but the
nightly perspirations began to diminish; and the extraordinary fatigue
he experienced proceeded evidently from his travelling in a
post-chaise, where he could not indulge in a recumbent position. The
weather at Bristol had been hot, and the earth arid and dusty. At
Matlock, during the month of June 1784, there was almost a perpetual
drizzle, the soil was wet, and the air moist and cold. Here, however,
the patient's cough began to abate, and at intervals he found an
opportunity of riding more or less on horseback. From two or three
hundred yards at a time, he got to ride a mile without stopping; and at
length he was able to sit on horseback during a ride from Mason's Bath
to the village of Matlock along the Derwent, and round on the opposite
banks, by the works of Mr. Arkwright, back to the house whence he
started, a distance of five miles. On dismounting, however, he was
seized with diliquium, and soon after the strength he had recovered was
lost by an attack of the haemorrhoids of the most painful kind, and
requiring much loss of blood from the parts affected.

On reflection, it appeared that the only benefit received by the
patient was during motion, and continued motion could better be
obtained in the course of a journey than during his residence at any
particular place. This, and other circumstances of a private but
painful nature, determined him to set out from Matlock on a journey to
Scotland. The weather was now much improved, and during the journey he
recruited his strength. Though as yet he could not sit upright at rest
for half an hour together without a disposition to giddiness, dimness
of sight, and deliquium, he was able to sit upright under the motion of
a post-chaise during a journey of from 40 to 70 miles daily, and his
appetite began to improve. Still his cough continued, and his hectic
flushings, though the chills were much abated and very irregular.

The salutary effects of motion being now more striking than ever, he
purchased a horse admirably adapted to a valetudinarian in
Dumfriesshire, and being now able to sit on horseback for an hour
together, he rode out several times a day. He fixed his residence for a
few weeks at Moffat, a village at the foot of the mountains whence the
Tweed, the Clyde, and the Annan, descend in different directions; a
situation inland, dry, and healthy, and elevated about three hundred
feet above the surface of the sea. Here his strength recovered daily,
and he began to eat animal food, which for several months before he had
not tasted. Persevering in exercise on horseback, he gradually
increased the length of his rides, according to his strength, from four
to twenty miles a day; and returning on horseback to Lancashire by the
lakes of Cumberland, he arrived at Liverpool on the first of September,
having rode the last day of his journey forty miles.

The two inferences of most importance to be drawn from this narrative,
are, first, the extraordinary benefit derived from gestation in a
carriage, and still more the mixture of gestation and exercise on
horseback, in arresting or mitigating the hectic paroxysm; and
secondly, that in the florid consumption, as Dr. Beddoes terms it, an
elevated and inland air is in certain circumstances peculiarly
salutary; while an atmosphere loaded with the spray of the sea is
irritating and noxious. The benefit derived in this case from exercise
on horseback, may lead us to doubt whether Sydenham's praise of this
remedy be as much exaggerated as it has of late been supposed. Since
the publication of Dr. C. Smyth on the effects of swinging in lowering
the pulse in the hectic paroxysm, the subject of this narrative has
repeated his experiments in a great variety of cases, and has confirmed
them. He has also repeatedly seen the hectic paroxysm prevented, or cut
short, by external ablution of the naked body with tepid water.

So much was his power of digestion impaired or vitiated by the immense
evacuations, and the long continued debility he underwent, that after
the cough was removed, and indeed for several years after the period
mentioned, he never could eat animal food without heat and flushing,
with frequent pulse and extreme drowsiness. If this drowsiness was
encouraged, the fever ran high, and he awoke from disturbed sleep,
wearied and depressed. If it was resolutely resisted by gentle
exercise, it went off in about an hour, as well as the increased
frequency of the pulse. This agitation was however such as to
incapacitate him during the afternoon for study of any kind. The same
effects did not follow a meal of milk and vegetables, but under this
diet his strength did not recruit; whereas after the use of animal food
it recovered rapidly, notwithstanding the inconvenience already
mentioned. For this inconvenience he at last found a remedy in the use
of coffee immediately after dinner, recommended to him by his friend
Dr. Percival. At first this remedy operated like a charm, but by
frequent use, and indeed by abuse, it no longer possesses its original
efficacy.

Dr. Falconer, in his Dissertation on the Influence of the Passions and
Affections of the Mind on Health and Disease, supposes that the
cheerfulness which attends hectic fever, the ever-springing hope, which
brightens the gloom of the consumptive patient, increases the diseased
actions, and hastens his doom. And hence he is led to enquire, whether
the influence of fear might not be substituted in such cases to that of
hope with advantage to the patient? This question I shall not presume
to answer, but it leads me to say something of the state of the mind in
the case just related.

The patient, being a physician, was not ignorant of his danger, which,
some melancholy circumstances served to impress on his mind. It has
already been mentioned, that his mother and grandfather died of this
disease. It may be added, that in the year preceding that on which he
himself was attacked, a sister of his was carried off by consumption in
her 17th year; that in the same winter in which he fell ill, two other
sisters were seized with the same fatal disorder, to which one of them
fell a victim during his residence at Bristol, and that the hope of
bidding a last adieu to the other was the immediate cause of his
journey to Scotland, a hope which, alas! was indulged in vain. The day
on which he reached the end of his journey, her remains were committed
to the dust! It may be conjectured from these circumstances, that
whatever benefit may be derived from the apprehension of death, must in
this case have been obtained. The expectation of this issue was indeed
for some time so fixed that it ceased to produce much agitation; in
conformity to that general law of our nature, by which almost all men
submit with composure to a fate that is foreseen, and that appears
inevitable. As however the progress of disease and debility seemed to
be arrested, the hope and the love of life revived, and produced, from
time to time, the observations and the exertions already mentioned.

Wine and beer were rigorously abstained from during six months of the
above history; and all the blood which was taken was even to the last
buffy." Feb. 3, 1795.

8. _Febris scrophulosa._ The hectic fever occasioned by ulcers of the lymphatic glands, when exposed to the air, does not differ from that attending pulmonary consumption, being accompanied with night-sweats and occasional diarrhoea.

M. M. The bark. Opium internally. Externally cerussa and bark in fine powder. Bandage. Sea-bathing. See Class I. 2. 3. 21. and II. 1. 4. 13.

9. _Febris ischiadica._ A hectic fever from an open ulcer between the muscles of the pelvis, which differs not from the preceding. If the matter in this situation lodges till part of it, I suppose, becomes putrid, and aerates the other part; or till it becomes absorbed from some other circumstance; a similar hectic fever is produced, with night-sweats, or diarrhoea.

Mrs. ----, after a lying in, had pain on one side of her loins, which extended to the internal part of the thigh on the same side. No fluctuation of matter could be felt; she became hectic with copious night-sweats, and occasional diarrhoea, for four or five weeks; and recovered by, I suppose, the total absorption of the matter, and the reunion of the walls of the abscess. See Class II. 1. 2. 18.

10. _Febris Arthropuodica._ Fever from the matter of diseased joints. Does the matter from suppurating bones, which generally has a very putrid smell, produce hectic fever, or typhus? See Class II. 1. 4. 16.

11. _Febris a pure contagioso._ Fever from contagious pus. When the contagious matters have been produced on the external habit, and in process of time become absorbed, a fever is produced in consequence of this reabsorption; which differs with the previous irritability or inirritability, as well as with the sensibility of the patient.

12. _Febris variolosa secundaria._ Secondary fever of small-pox. In the distinct small-pox the fever is of the sensitive irritated or inflammatory kind; in the confluent small-pox it is of the sensitive inirritated kind, or typhus gravior. In both of them the swelling of the face, when the matter there begins to be absorbed, and of the hands, when the matter there begins to be absorbed, shew, that it stimulates the capillary vessels or glands, occasioning an increased secretion greater than the absorbents can take up, like the action of the cantharides in a blister; now as the application of a blister on the skin frequently occasions the strangury, which shews, that some part of the cantharides is absorbed; there is reason to conclude, that a part of the matter of small-pox is absorbed, and thus produces the secondary fever. See Class II. 1. 3. 9. And not simply by its stimulus on the surface of the ulcers beneath the scabs. The exsudation of a yellow fluid from beneath the confluent eruptions on the face before the height is spoken of in Class II. 1. 3. 2.

The material thus absorbed in the secondary fever of small-pox differs from that of open ulcers, as it is only aerated through the elevated cuticle; and secondly, because there is not a constant supply of fresh matter, when that already in the pustules is exhausted, either by absorption, or by evaporation, or by its induration into a scab. Might not the covering the face assiduously and exactly with plasters, as with cerate of calamy, or with minium plaster, by precluding the air from the pustules, prevent their contracting a contagious, or acescent, or fever-producing power? and the secondary fever be thus prevented entirely. If the matter in those pustules on the face in the confluent small-pox were thus prevented from oxygenation, it is highly probable, both from this theory, and from the facts before mentioned, that the matter would not erode the skin beneath them, and by these means no marks or scars would succeed.

13. _Febris carcinomatosa._ Fever from the matter of cancer. In a late publication the pain is said to be relieved, and the fever cured, and the cancer eradicated, by the application of carbonic acid gas, or fixed air. See Class II. 1. 4. 16.

14. _Febris venerea._ From the absorption of the matter from venereal ulcers and suppurating bones. See Syphilis, II. 1. 5. 2.

M. M. Any mercurial calx. Sarsaparilla? Mezereon?

15. _Febris a sanie putrida._ Fever from putrid sanies. When parts of the body are destroyed by external violence, as a bruise, or by mortification, a putrefaction soon succeeds; as they are kept in that degree of warmth and moisture by their adhesion to the living parts of the body, which most forwards that process. Thus the sloughs of mortified parts of the tonsils give fetor to the breath in some fevers; the matter from putrefying teeth, or other suppurating bones, is particularly offensive; and even the scurf, which adheres to the tongue, frequently acquires a bitter taste from its incipient putridity. This material differs from those before mentioned, as its deleterious property depends on a chemical rather than an animal process.

16. _Febris puerpera._ Puerperal fever. It appears from some late dissections, which have been published, of those women who have died of the puerperal fever, that matter has been formed in the omentum, and found in the cavity of the abdomen, with some blood or sanies. These parts are supposed to have been injured by the exertions accompanying labour; and as matter in this viscus may have been produced without much pain, this disease is not attended with arterial strength and hard full pulse like the inflammation of the uterus; and as the fever is of the inirritative or typhus kind, there is reason to believe, that the previous exhaustion of the patient during labour may contribute to its production; as well as the absorption of a material not purulent but putrid; which is formed by the delay of extravasated or dead matter produced by the bruises of the omentum, or other viscera, in the efforts of parturition, rather than by purulent matter, the consequence of suppuration. The pulse is generally about 120 when in bed and in the morning; and is increased to 134, or more, when the patient sits up, or in the evening paroxysm. The pulse of all very weak patients increases in frequency when they sit up; because the expenditure of sensorial power necessary to preserve an erect posture deducts so much from their general strength; and hence the pulse becomes weaker, and in consequence quicker. See Sect. XII. 1. 4.

In this fever time must be allowed for the absorption of the matter. Very large and repeated quantities of the bark, by preventing sufficient food from being taken, as bread, and wine, and water, I have thought has much injured the patient; for the bark is not here given as in intermittent fevers to prevent the paroxysm, but simply to strengthen the patient by increasing the power of digestion. About two ounces of decoction of bark, with four drops of laudanum, and a dram of sweet spirit of vitriol, once in six hours, and a glass of wine between those times, with panada, or other food, I have thought of most advantage, with a small blister occasionally.

Where not only the stomach but also the bowels are much distended with air, so as to sound on striking them with the fingers, the case is always dangerous, generally hopeless; which is more so in proportion to the quickness of the pulse. Where the bowels are distended two drops of oil of cinnamon should be given in the panada three or four times a day.

17. _Febris a sphacelo._ Fever from mortification. This fever from absorption of putrid matter is of the inirritative or typhus kind. See the preceding article.

M. M. Opium and the bark are frequently given in too great quantity, so as to induce consequent debility, and to oppress the power of digestion.

* * * * *

ORDO I.

_Increased Sensation._

GENUS VII.

_With increased Action of the Organs of Sense._

SPECIES.

1. _Delirium febrile._ Paraphrosyne. The ideas in delirium consist of those excited by the sensation of pleasure or pain, which precedes them, and the trains of other ideas associated with these, and not of those excited by external irritations or by voluntary exertion. Hence the patients do not know the room which they inhabit, or the people who surround them; nor have they any voluntary exertion, where the delirium is complete; so that their efforts in walking about a room or rising from their bed are unsteady, and produced by their catenations with the immediate affections of pleasure or pain. See Section XXXIII. 1. 4.

By the above circumstances it is distinguished from madness, in which the patients well know the persons of their acquaintance, and the place where they are; and perform all the voluntary actions with steadiness and determination. See Sect. XXXIV. 2. 2.

Delirium is sometimes less complete, and then a new face and louder voice stimulate the patient to attend to them for a few moments; and then they relapse again into perfect delirium. At other times a delirium affects but one sense, and the person thinks he sees things which do not exist; and is at the same time sensible to the questions which are asked him, and to the taste of the food which is offered to him.

This partial delirium is termed an hallucination of the disordered organ; and may probably arise from the origin of one nerve of sense being more liable to inflammation than the others; that is, an exuberance of the sensorial power of sensation may affect it; which is therefore thrown into action by slighter sensitive catenations, without being obedient to external stimulus, or to the power of volition.

The perpetual flow of ideas in delirium is owing to the same circumstance, as of those in our dreams; namely, to the defect or paralysis of the voluntary power; as in hemiplagia, when one side of the body is paralytic, and thus expends less of the sensorial power, the limbs on the other side are in constant motion from the exuberance of it. Whence less sensorial power is exhausted in delirium, than at other times, as well as in sleep; and hence in fevers with great debility, it is perhaps, as well as the stupor, rather a favourable circumstance; and when removed by numerous blisters, the death of the patient often follows the recovery of his understanding. See Class I. 2. 5. 6. and I. 2. 5. 10.

Delirium in diseases from inirritability is sometimes preceded by a propensity to surprise. See Class I. 1. 5. 11.

M. M. Fomentations of the shaved head for an hour repeatedly. A blister on the head. Rising from bed. Wine and opium, and sometimes venesection in small quantity by cupping, if the strength of the arterial system will allow it.

2. _Delirium maniacale._ Maniacal delirium. There is another kind of delirium, described in Sect. XXXIII. 1. 4. which has the increase of pleasureable or painful sensation for its cause, without any diminution of the other sensorial powers; but as this excites the patient to the exertion of voluntary actions, for the purpose of obtaining the object of his pleasureable ideas, or avoiding the object of his painful ones, such as perpetual prayer, when it is of the religious kind, it belongs to the insanities described in Class III. 1. 2. 1, and is more properly termed hallucinatio maniacalis.

3. _Dilirium ebrietatis._ The drunken delirium is in nothing different from the delirium attending fevers except in its cause, as from alcohol, or other poisons. When it is attended with an apoplectic stupor, the pulse is generally low; and venesection I believe sometimes destroys those, who would otherwise have recovered in a few hours.

M. M. Diluting liquids. An emetic.

4. _Somnium._ Dreams constitute the most complete kind of delirium. As in these no external irritations are attended to, and the power of volition is entirely suspended; so that the sensations of pleasure and pain, with their associations, alone excite the endless trains of our sleeping ideas; as explained in Sect. XVIII. on Sleep.

5. _Hallucinatio visus._ Deception of sight. These visual hallucinations are perpetual in our dreams; and sometimes precede general delirium in fevers; and sometimes belong to reverie, and to insanity. See Class III. 1. 2. 1. and 2. and must be treated accordingly.

Other kinds of visual hallucinations occur by moon-light; when objects are not seen so distinctly as to produce the usual ideas associated with them, but appear to us exactly as they are seen. Thus the trunk of a tree appears a flat surface, instead of a cylinder as by day, and we are deceived and alarmed by seeing things as they really are seen. See Berkley on Vision.

6. _Hallucinatio auditus._ Auricular deception frequently occurs in dreams, and sometimes precedes general delirium in fevers; and sometimes belongs to vertigo, and to reverie, and to insanity. See Sect. XX. 7. and Class III. 1. 2. 1. and 2.

7. _Rubor a calore._ The blush from heat is occasioned by the increased action of the cutaneous vessels in consequence of the increased sensation of heat. See Class I. 1. 2. 1. and 3.

8. _Rubor jucunditatis._ The blush of joy is owing to the increased action of the capillary arteries, along with that of every moving vessel in the body, from the increase of pleasurable sensation.

9. _Priapismus amatorius._ Amatorial priapism. The blood is poured into the cells of the corpora cavernosa much faster than it can be reabsorbed by the vena penis, owing in this case to the pleasurable sensation of love increasing the arterial action. See Class I. 1. 4. 6.

10. _Distentio mamularum._ The teats of female animals, when they give suck, become rigid and erected, in the same manner as in the last article, from the pleasurable sensation of the love of the mother to her offspring. Whence the teat may properly be called an organ of sense. The nipples of men do the same when rubbed with the hand. See Class I. 1. 4. 7.

* * * * *

ORDO II.

_Decreased Sensation._

GENUS I.

_Of the General System._

SPECIES.

1. _Stultitia insensibilis._ Folly from insensibility. The pleasure or pain generated in the system is not sufficient to promote the usual activity either of the sensual or muscular fibres.

2. _Taedium vitae._ Ennui. Irksomeness of life. The pain of laziness has been thought by some philosophers to be that principle of action, which has excited all our industry, and distinguished mankind from the brutes of the field. It is certain that, where the ennui exists, it is relieved by the exertions of our minds or bodies, as all other painful sensations are relieved; but it depends much upon our early habits, whether we become patient of laziness, or inclined to activity, during the remainder of our lives, as other animals do not appear to be affected with this malady; which is perhaps left owing to deficiency of pleasurable sensation, than to the superabundancy of voluntary power, which occasions pain in the muscles by its accumulation; as appears from the perpetual motions of a squirrel confined in a cage.

3. _Paresis sensitiva._ Weakness of the whole system from insensibility.

* * * * *

ORDO II.

_Decreased Sensation._

GENUS II.

_Of Particular Organs._

SPECIES.

1. _Anorexia._ Want of appetite. Some elderly people, and those debilitated by fermented liquors, are liable to lose their appetite for animal food; which is probably in part owing to the deficiency of gastric acid, as well as to the general decay of the system: elderly people will go on years without animal food; but inebriates soon sink, when their digestion becomes so far impaired. Want of appetite is sometimes produced by the putrid matter from many decaying teeth being perpetually mixed with the saliva, and thence affecting the organ of taste, and greatly injuring the digestion.

M. M. Fine charcoal powder diffused in warm water held in the mouth frequently in a day, as in Class I. 2. 4. 12. or solution of alum in water. Extract the decayed teeth. An emetic. A blister. Chalybeates. Vitriolic acid. Bile of an ox inspissated, and made into pills; 20 grains to be taken before dinner and supper. Opium half a grain twice a day.

All the strength we possess is ultimately derived from the food, which we are able to digest; whence a total debility of the system frequently follows the want of appetite, and of the power of digestion. Some young ladies I have observed to fall into this general debility, so as but just to be able to walk about; which I have sometimes ascribed to their voluntary fasting, when they believed themselves too plump; and who have thus lost both their health and beauty by too great abstinence, which could never be restored.

I have seen other cases of what may be termed anorexia epileptica, in which a total loss of appetite, and of the power of digestion, suddenly occurred along with epileptic fits. Miss B. a girl about eighteen, apparently very healthy, and rather plump, was seized with fits, which were at first called hysterical; they occurred at the end of menstruation, and returned very frequently with total loss of appetite. She was relieved by venesection, blisters, and opiates; her strength diminished, and after some returns of the fits, she took to her bed, and has survived 15 or 20 years; she has in general eaten half a potato a day, and seldom speaks, but retains her senses, and had many years occasional returns of convulsion. I have seen two similar cases, where the anorexia, or want of appetite, was in less degree; and but just so much food could be digested, as supplied them with sufficient strength to keep from the bed or sofa for half the day. As well as I can recollect, all these patients were attended with weak pulse, and cold pale skin; and received benefit by opium, from a quarter of a grain to a grain four times a day. See Class III. 1. 1. 7. and III. 1. 2. 1. and III. 1. 2. 20.

2. _Adipsia._ Want of thirst. Several of the inferior people, as farmers wives, have a habit of not drinking with their dinner at all, or only take a spoonful or two of ale after it. I have frequently observed these to labour under bad digestion, and debility in consequence; which I have ascribed to the too great stimulus of solid food undiluted, destroying in process of time the irritability of the stomach.

3. _Impotentia_ (agenesia). Impotency much seldomer happens to the male sex than sterility to the female sex. Sometimes a temporary impotence occurs from bashfulness, or the interference of some voluntary exertion in the production of an effect, which should be performed alone by pleasurable sensation.

One, who was soon to be married to a lady of superior condition to his own, expressed fear of not succeeding on the wedding night; he was advised to take a grain of opium before he went to bed, and to accustom himself to sleep with a woman previously, but not to enjoy her, to take off his bashfulness; which succeeded to his wish.

M. M. Chalybeates. Opium. Bark. Tincture of cantharides.

4. _Sterilitas._ Barrenness. One of the ancient medical writers asserts, that the female sex become pregnant with most certainty at or near the time of menstruation. This is not improbable, since these monthly periods seem to referable the monthly venereal orgasm of some female quadrupeds, which become pregnant at those times only; and hence the computation of pregnancy is not often erroneous, though taken from the last menstruation. See