Chapter XVI: Section XXXVI: 2. 3 (4)

On waking, this increased sensibility and irritability of the system ceases by the renewed exertions of volition; in the same manner as more violent exertions of volition destroy greater pains; and the pulse in consequence subsides along with the increase of heat; if more violent efforts of volition are exerted, the system becomes still less affected by sensation or irritation. Hence the fever and vertigo of intoxication are lessened by intense thinking, Sect. XXI. 8; and insane people are known to bear the pain of cold and hunger better than others, Sect. XXXIV. 2. 5; and lastly, if greater voluntary efforts exist, as in violent anger or violent exercise, the whole system is thrown into more energetic action, and a voluntary fever is induced, as appears by the red skin, quickened pulse, and increase of heat; whence dropsies and fevers with debility are not unfrequently removed by insanity.

Hence the exertion of the voluntary power in its natural degree diminishes the increased sensibility, and irritability, and probably the increased associability, which occurs during sleep; and thus reduces the frequency of the pulse in the feverish sleep after a full meal. In its more powerful state of exertion, it diminishes or destroys sensations and irritations, which are stronger than natural, as in intoxication, or which precede convulsions, or insanity. In its still more powerful degree, the superabundance of this sensorial power actuates and invigorates the whole moving system, giving strength and frequency to the pulse, and an universal glow both of colour and of heat, as in violent anger, or outrageous insanities.

If, in the feverish sleep above described, the skin becomes cooled by the evaporation of much perspirable matter, or by the application of cooler air, or thinner clothes, the actions of the cutaneous capillaries are lessened by defect of the stimulus of heat, which counteracts the increase of sensibility during sleep, and the pulsations of the heart and arteries become slower from the lessened stimulus of the particles of blood thus cooled in the cutaneous and pulmonary vessels. Hence the admission of cold air, or ablution with subtepid or with cold water, in fevers with hot skin, whether they be attended with arterial strength, or arterial debility, renders the pulse slower; in the former case by diminishing the stimulus of the blood, and in the latter by lessening the expenditure of sensorial power. See Suppl. I. 8. and 15.

13. _Incubus._ The night-mare is an imperfect sleep, where the desire of locomotion is vehement, but the muscles do not obey the will; it is attended with great uneasiness, a sense of suffocation, and frequently with fear. It is caused by violent fatigue, or drunkenness, or indigestible food, or lying on the back, or perhaps from many other kinds of uneasiness in our sleep, which may originate either from the body or mind.

Now as the action of respiration is partly voluntary, this complaint may be owing to the irritability of the system being too small to carry on the circulation of the blood through the lungs during sleep, when the voluntary power is suspended. Whence the blood may accumulate in them, and a painful oppression supervene; as in some haemorrhages of the lungs, which occur during sleep; and in patients much debilitated by fevers. See Somnus interruptus, Class I. 2. 1. 3. and I. 2. 1. 9.

Great fatigue with a full supper and much wine, I have been well informed by one patient, always produced this disease in himself to a great degree. Now the general irritability of the system is much decreased by fatigue, as it exhausts the sensorial power; and secondly, too much wine and stimulating food will again diminish the irritability of some parts of the system, by employing a part of the sensorial power, which is already too small, in digesting a great quantity of aliment; and in increasing the motions of the organs of sense in consequence of some degree of intoxication, whence difficulty of breathing may occur from the inirritability of the lungs, as in Class I. 2. 1. 3.

M. M. To sleep on a hard bed with the head raised. Moderate supper. The bark. By sleeping on a harder bed the patient will turn himself more frequently, and not be liable to sleep too profoundly, or lie too long in one posture. To be awakened frequently by an alarm clock.

14. _Lethargus._ The lethargy is a slighter apoplexy. It is supposed to originate from universal pressure on the brain, and is said to be produced by compressing the spinal marrow, where there is a deficiency of the bone in the spina bifida. See Sect. XVIII. 20. Whereas in the hydrocephalus there is only a partial pressure of the brain; and probably in nervous fevers with stupor the pressure on the brain may affect only the nerves of the senses, which lie within the skull, and not those nerves of the medulla oblongata, which principally contribute to move the heart and arteries; whence in the lethargic or apoplectic stupor the pulse is slow as in sleep, whereas in nervous fever the pulse is very quick and feeble, and generally so in hydrocephalus.

In cases of obstructed kidneys, whether owing to the tubuli uriniferi being totally obstructed by calculous matter, or by their paralysis, a kind of drowsiness or lethargy comes on about the eighth or ninth day, and the patient gradually sinks. See Class I. 1. 3. 9.

15. _Syncope epileptica_, is a temporary apoplexy, the pulse continuing in its natural state, and the voluntary power suspended. This terminates the paroxysms of epilepsy.

When the animal power is much exhausted by the preceding convulsions, so that the motions from sensation as well as those from volition are suspended; in a quarter or half an hour the sensorial power becomes restored, and if no pain, or irritation producing pain, recurs, the fit of epilepsy ceases; if the pain recurs, or the irritation, which used to produce it, a new fit of convulsion takes place, and is succeeded again by a syncope. See Epilepsy, Class III. 1. 1. 7.

16. _Apoplexia._ Apoplexy may be termed an universal palsy, or a permanent sleep. In which, where the pulse is weak, copious bleeding must be injurious; as is well observed by Dr. Heberden, Trans. of the College.

Mr. ----, about 70 years of age, had an apoplectic seizure. His pulse was strong and full. One of the temporal arteries was opened, and about ten ounces of blood suddenly taken from it. He seemed to receive no benefit from this operation; but gradually sunk, and lived but a day or two.

If apoplexy arises from the pressure of blood extravasated on the brain, one moderate venesection may be of service to prevent the further effusion of blood; but copious venesection must be injurious by weakening the patient; since the effused blood must have time, as in common vibices or bruises, to undergo a chemico-animal process, so to change its nature as to fit it for absorption; which may take two or three weeks, which time a patient weakened by repeated venesection or arteriotomy may not survive.

Mrs. ----, about 40 years old, had an apoplectic seizure after great exertion from fear; she had lain about 24 hours without speech, or having swallowed any liquid. She was then forcibly raised in bed, and a spoonful of solution of aloes in wine put into her mouth, and the end of the spoon withdrawn, that she might more easily swallow the liquid.--This was done every hour, with broth, and wine and water intervening, till evacuations were procured; which with other means had good effect, and she recovered, except that a considerable degree of hemiplegia remained, and some imperfection of her speech.

Many people, who have taken so much vinous spirit as to acquire the temporary apoplexy of intoxication, and are not improperly said to be dead-drunk, have died after copious venesection, I suppose in consequence of it. I once saw at a public meeting two gentlemen in the drunken apoplexy; they were totally insensible with low pulse, on this account they were directed not to lose blood, but to be laid on a bed with their heads high, and to be turned every half hour; as soon as they could swallow, warm tea was given them, which evacuated their stomachs, and they gradually recovered, as people do from less degrees of intoxication.

M. M. Cupping on the occiput. Venesection once in moderate quantity. Warm fomentations long continued and frequently repeated on the shaved head. Solution of aloes. Clysters with solution of aloe and oil of amber. A blister on the spine. An emetic. Afterwards the bark, and small doses of chalybeates. Small electric shocks through the head. Errhines. If small doses of opium?

17. _Mors a frigore._ Death from cold. The unfortunate travellers, who almost every winter perish in the snow, are much exhausted by their efforts to proceed on their journey, as well as benumbed by cold. And as much greater exercise can be borne without fatigue in cold weather than in warm; because the excessive motions of the cutaneous vessels are thus prevented, and the consequent waste of sensorial power; it may be inferred, that the fatigued traveller becomes paralytic from violent exertion as well as by the application of cold.

Great degrees of cold affect the motions of those vessels most, which have been generally excited into action by irritation; for when the feet are much benumbed by cold, and painful, and at the same time almost insensible to the touch of external objects, the voluntary muscles retain their motions, and we continue to walk on; the same happens to the fingers of children in throwing snow-balls, the voluntary motions of the muscles continue, though those of the cutaneous vessels are benumbed into inactivity.

Mr. Thompson, an elderly gentleman of Shrewsbury, was seized with hemiplegia in the cold bath; which I suppose might be owing to some great energy of exertion, as much as to the coldness of the water. As in the instance given of Mr. Nairn, who, by the exertion to save his relation, perished himself. See Sect. XXXIV. 1. 7.

Whence I conclude, that though heat is a fluid necessary to muscular motion, both perhaps by its stimulus, and by its keeping the minute component parts of the ultimate fibrils of the muscles or organs of sense at a proper distance from each other; yet that paralysis, properly so called, is the consequence of exhaustion of sensorial power by exertion. And that the accumulations of it during the torpor of the cutaneous vessels by exposure to cold, or of some internal viscus in the cold fits of agues, are frequently instrumental in recovering the use of paralytic limbs, or of the motions of other paralytic parts of the system. See Spec. 4. of this genus.

Animal bodies resist the power of cold probably by their exertions in consequence of the pain of cold, see Botan. Gard. V. 1. additional note xii. But if these increased exertions be too violent, so as to exhaust the sensorial power in producing unnecessary motions, the animal will probably sooner perish. Thus a moderate quantity of wine or spirit repeated at proper intervals of time might be of service to those, who are long exposed to excessive cold, both by increasing the action of the capillary vessels, and thus producing heat, and perhaps by increasing in some degree the secretion of sensorial power in the brain. But the contrary must happen when taken immoderately, and not at due intervals. A well attested history was once related to me of two men, who set out on foot to travel in the snow, one of whom drank two or three glasses of brandy before they began their journey, the other contented himself with his usual diet and potation; the former of whom perished in spite of any assistance his companion could afford him; and the other performed his journey with safety. In this case the sensorial power was exhausted by the unnecessary motions of incipient intoxication by the stimulus of the brandy, as well as by the exertions of walking; which so weakened the dram-drinker, that the cold sooner destroyed him; that is, he had not power to produce sufficient muscular or arterial action, and in consequence sufficient heat, to supply the great expenditure of it. Hence the capillaries of the skin first cease to act, and become pale and empty; next those which are immediately associated with them, as the extremities of the pulmonary artery, as happens on going into the cold bath. By the continued inaction of these parts of the vascular system the blood becomes accumulated in the internal arteries, and the brain is supposed to be affected by its compression; because these patients are said to sleep, or to become apoplectic, before they die. I overtook a fishman asleep on his panniers on a very cold frosty night, but on waking him he did not appear to be in any degree of stupor. See Class I. 2. 2. 1.

When travellers are benighted in deep snow, they might frequently be saved by covering themselves in it, except a small aperture for air; in which situation the lives of hares, sheep, and other animals, are so often preserved. The snow, both in respect to its component parts, and to the air contained in its pores, is a bad conductor of heat, and will therefore well keep out the external cold; and as the water, when part of it dissolves, is attracted into the pores of the remainder of it, the situation of an animal beneath it is perfectly dry; and, if he is in contact with the earth, he is in a degree of heat between 48, the medium heat of the earth, and 32, the freezing point; that is, in 40 degrees of heat, in which a man thus covered will be as warm as in bed. See Botan. Garden, V. II. notes on Anemone, Barometz, and Muschus. If these facts were more generally understood, it might annually save the lives of many.

After any part of the vascular system of the body has been long exposed to cold, the sensorial power is so much accumulated in it, that on coming into a warm room the pain of hotach is produced, and inflammation, and consequent mortification, owing to the great exertion of those vessels, when again exposed to a moderate degree of warmth. See Sect. XII. 5. Whence the propriety of applying but very low degrees of heat to limbs benumbed with cold at first, as of snow in its state of dissolving, which is at 32 degrees of heat, or of very cold water. A French writer has observed, that if frozen apples be thawed gradually by covering them with thawing snow, or immersing them in very cold water, that they do not lose their taste; if this fact was well ascertained, it might teach us how to preserve other ripe fruits in ice-houses for winter consumption.

* * * * *

ORDO II.

_Decreased Volition._

GENUS II.

_With decreased Actions of the Organs of Sense._

SPECIES.

1. _Recollectionis jactura._ Loss of recollection. This is the defect of memory in old people, who forget the actions of yesterday, being incapable of voluntary recollection, and yet remember those of their youth, which by frequent repetition are introduced by association or suggestion. This is properly the paralysis of the mind; the organs of sense do not obey the voluntary power; that is, our ideas cannot be recollected, or acted over again by the will.

After an apoplectic attack the patients, on beginning to recover, find themselves most at a loss in recollecting proper names of persons or places; as those words have not been so frequently associated with the ideas they stand for, as the common words of a language. Mr. ----, a man of strong mind, of a short necked family, many of whom had suffered by apoplexy, after an apoplectic fit on his recovering the use of speech, after repeated trials to remember the name of a person or place, applauded himself, when he succeeded, with such a childish smile on the partial return of his sagacity, as very much affected me.--Not long, alas! to return; for another attack in a few weeks destroyed the whole.

I saw a child after the small-pox, which was left in this situation; it was lively, active, and even vigorous; but shewed that kind of surprise, which novelty excites, at every object it viewed; and that as often as it viewed it. I never heard the termination of the case.

2. _Stultitia voluntaria._ Voluntary folly. The absence of voluntary power and consequent incapacity to compare the ideas of present and future good. Brute animals may be said to be in this situation, as they are in general excited into action only by their present painful or pleasurable sensations. Hence though they are liable to surprise, when their passing trains of ideas are dissevered by violent stimuli; yet are they not affected with wonder or astonishment at the novelty of objects; as they possess but in a very inferior degree, that voluntary power of comparing the present ideas with those previously acquired, which distinguishes mankind; and is termed analogical reasoning, when deliberatively exerted; and intuitive analogy, when used without our attention to it, and which always preserves our hourly trains of ideas consistent with truth and nature. See Sect. XVII. 3. 7.

3. _Credulitas._ Credulity. Life is short, opportunities of knowledge rare; our senses are fallacious, our reasonings uncertain, mankind therefore struggles with perpetual error from the cradle to the coffin. He is necessitated to correct experiment by analogy, and analogy by experiment; and not always to rest satisfied in the belief of facts even with this two-fold testimony, till future opportunities, or the observations of others, concur in their support.

Ignorance and credulity have ever been companions, and have misled and enslaved mankind; philosophy has in all ages endeavoured to oppose their progress, and to loosen the shackles they had imposed; philosophers have on this account been called unbelievers: unbelievers of what? of the fictions of fancy, of witchcraft, hobgobblins, apparitions, vampires, fairies; of the influence of stars on human actions, miracles wrought by the bones of saints, the flights of ominous birds, the predictions from the bowels of dying animals, expounders of dreams, fortune-tellers, conjurors, modern prophets, necromancy, cheiromancy, animal magnetism, with endless variety of folly? These they have disbelieved and despised, but have ever bowed their hoary heads to Truth and Nature.

Mankind may be divided in respect to the facility of their belief or conviction into two classes; those, who are ready to assent to single facts from the evidence of their senses, or from the serious assertions of others; and those, who require analogy to corroborate or authenticate them.

Our first knowledge is acquired by our senses; but these are liable to deceive us, and we learn to detect these deceptions by comparing the ideas presented to us by one sense with those presented by another. Thus when we first view a cylinder, it appears to the eye as a flat surface with different shades on it, till we correct this idea by the sense of touch, and find its surface to be circular; that is, having some parts gradually receding further from the eye than others. So when a child, or a cat, or a bird, first sees its own image in a looking-glass, it believes that another animal exists before it, and detects this fallacy by going behind the glass to examine, if another tangible animal really exists there.

Another exuberant source of error consists in the false notions, which we receive in our early years from the design or ignorance of our instructors, which affect all our future reasoning by their perpetual intrusions; as those habits of muscular actions of the face or limbs, which are called tricks, when contracted in infancy continue to the end of our lives.

A third great source of error is the vivacity of our ideas of imagination, which perpetually intrude themselves by various associations, and compose the farrago of our dreams; in which, by the suspension of volition, we are precluded from comparing the ideas of one sense with those of another, or the incongruity of their successions with the usual course of nature, and thus to detect their fallacy. Which we do in our waking hours by a perpetual voluntary exertion, a process of the mind above mentioned, which we have termed intuitive analogy. Sect. XVII. 3. 7.

This analogy presupposes an acquired knowledge of things, hence children and ignorant people are the most credulous, as not possessing much knowledge of the usual course of nature; and secondly, those are most credulous, whose faculty of comparing ideas, or the voluntary exertion of it, is slow or imperfect. Thus if the power of the magnetic needle of turning towards the north, or the shock given by touching both sides of an electrized coated jar, was related for the first time to a philosopher, and to an ignorant person; the former would be less ready to believe them, than the latter; as he would find nothing similar in nature to compare them to, he would again and again repeat the experiment, before he would give it his entire credence; till by these repetitions it would cease to be a single fact, and would therefore gain the evidence of analogy. But the latter, as having less knowledge of nature, and less facility of voluntary exertion, would more readily believe the assertions of others, or a single fact, as presented to his own observation. Of this kind are the bulk of mankind; they continue throughout their lives in a state of childhood, and have thus been the dupes of priests and politicians in all countries and in all ages of the world.

In regard to religious matters, there is an intellectual cowardice instilled into the minds of the people from their infancy; which prevents their inquiry: credulity is made an indispensable virtue; to inquire or exert their reason in religious matters is denounced as sinful; and in the catholic church is punished with more severe penances than moral crimes. But in respect to our belief of the supposed medical facts, which are published by variety of authors; many of whom are ignorant, and therefore credulous; the golden rule of David Hume may be applied with great advantage. "When two miraculous assertions oppose each other, believe the less miraculous." Thus if a person is said to have received the small-pox a second time, and to have gone through all the stages of it, one may thus reason: twenty thousand people have been exposed to the variolous contagion a second time without receiving the variolous fever, to every one who has been said to have thus received it; it appears therefore less miraculous, that the assertor of this supposed fact has been deceived, or wishes to deceive, than that it has so happened contrary to the long experienced order of nature.

M. M. The method of cure is to increase our knowledge of the laws of nature, and our habit of comparing whatever ideas are presented to us with those known laws, and thus to counteract the fallacies of our senses, to emancipate ourselves from the false impressions which we have imbibed in our infancy, and to set the faculty of reason above that of imagination.

* * * * *

_The Orders and Genera of the Fourth Class of Diseases._

CLASS IV.

DISEASES OF ASSOCIATION.

ORDO I.

_Increased Associate Motions._

GENERA.

1. Catenated with irritative motions.
2. Catenated with sensitive motions.
3. Catenated with voluntary motions.
4. Catenated with external influences.

ORDO II.

_Decreased Associate Motions._

GENERA.

1. Catenated with irritative motions.
2. Catenated with sensitive motions.
3. Catenated with voluntary motions.
4. Catenated with external influences.

ORDO III.

_Retrograde Associate Motions._

GENERA.

1. Catenated with irritative motions.
2. Catenated with sensitive motions.
3. Catenated with voluntary motions.
4. Catenated with external influences.

* * * * *

_The Orders, Genera, and Species, of the Fourth Class of Diseases._

* * * * *

CLASS IV.

DISEASES OF ASSOCIATION.

ORDO I.

_Increased Associate Motions._

GENUS I.

_Catenated with Irritative Motions._

SPECIES.

1. _Rubor vultus pransorum._ Flushing of the face after dinner.
2. _Sudor stragulis immersorum._ Sweat from covering the face
in bed.
3. _Cessatio aegritudinis cute_ Cure of sickness by stimulating
_excitata._ the skin.
4. _Digestio aucta frigore cutaneo._ Digestion increased by coldness of
the skin.
5. _Catarrhus a frigore cutaneo._ Catarrh from cold skin.
6. _Absorptio cellularis aucta_ Cellular absorption increased by
_vomitu._ vomiting.
7. _Syngultus nephriticus._ Nephritic hiccough.
8. _Febris irritativa._ Irritative fever.

GENUS II.

_Catenated with Sensitive Motions._

SPECIES.

1. _Lacrymarum fluxus_ Sympathetic tears.
_sympatheticus._
2. _Sternutatio a lumine._ Sneezing from light.
3. _Dolor dentium a Stridore._ Tooth-edge from grating sounds.
4. _Risus sardonicus._ Sardonic smile.
5. _Salivae fluxus cibo viso._ Flux of saliva at sight of food.
6. _Tensio mamularum viso puerulo._ Tension of the nipples of lactescent
women at sight of the child.
7. _Tensio penis in hydrophobia._ Tension of the penis in hydrophobia.
8. _Tenesmus calculosus._ Tenesmus from stone.
9. _Polypus narium ex ascaride._ Polypus of the nose from ascarides.
10. _Crampus surarum in diarrhoea._ Cramp from diarrhoea.
11. _Zona ignea nephritica._ Nephritic shingles.
12. _Eruptio variolarum._ Eruption of small-pox.
13. _Gutta rosea stomatica._ Stomatic rosy drop.
14. ---- _hepatica._ Hepatic rosy drop.
15. _Podagra._ Gout.
16. _Rheumatismus._ Rheumatism.
17. _Erysipelas._ Erysipelas.
18. _Testium tumor in gonorrhoea._ Swelled testis in gonorrhoea.
19. ---- _in parotitide._ ---- in mumps.

GENUS III.

_Catenated with Voluntary Motions._

SPECIES.

1. _Deglutitio invita._ Involuntary deglutition.
2. _Nictitatio invita._ ---- nictitation.
3. _Risus invitus._ ---- laughter.
4. _Lusus digitorum invitus._ ---- actions with the fingers.
5. _Unguium morsiuncula invita._ ---- biting the nails.
6. _Vigilia invita._ ---- watchfulness.

GENUS IV.

_Catenated with External Influences._

SPECIES.

1. _Vita ovi._ Life of an egg.
2. _Vita hiemi-dormientium._ Life of winter-sleepers.
3. _Pullulatio arborum._ Budding of trees.
4. _Orgasmatis venerei periodus._ Periods of venereal desire.
5. _Brachii concussio electrica._ Electric shock through the arm.
6. _Oxygenatio sanguinis._ Oxygenation of the blood.
7. _Humectatio corporis._ Humectation of the body.

ORDO II.

_Decreased Associate Motions._

GENUS I.

_Catenated with Irritative Motions._

SPECIES.

1. _Cutis frigida pransorum._ Chillness after dinner.
2. _Pallor urinae pransorum._ Pale urine after dinner.
3. ---- _a frigore cutaneo._ ---- from cold skin.
4. _Pallor ex aegritudine._ Paleness from sickness.
5. _Dyspnoea a balneo frigido._ Shortness of breath from cold
bathing.
6. _Dyspepsia a pedibus frigidis._ Indigestion from cold feet.
7. _Tussis a pedibus frigidis._ Cough from cold feet.
8. ---- _hepatica._ Liver-cough.
9. ---- _arthritica._ Gout-cough.
10. _Vertigo rotatoria._ Vertigo rotatory.
11. ---- _visualis._ ---- visual.
12. ---- _ebriosa._ ---- inebriate.
13. ---- _febriculosa._ ---- feverish.
14. ---- _cerebrosa._ ---- from the brain.
15. _Murmur aurium vertiginosum._ Noise in the ears.
16. _Tactus, gustus, olfactus_ Vertiginous touch, taste, smell.
_vertiginosi._
17. _Pulsus mollis a vomitione._ Soft pulse in vomiting.
18. ---- _intermittens a ventriculo._ Intermittent pulse from the
stomach.
19. _Febris inirritativa._ Inirritative fever.

GENUS II.

_Catenated with Sensitive Motions._

SPECIES.

1. _Torpor genae a dolore dentis._ Coldness of the cheek from tooth-ach.
2. _Stranguria a dolore vesicae._ Strangury from pain of the bladder.
3. ---- _convulsiva._ Convulsive strangury.
4. _Dolor termini ductus_ Pain of the end of the bile-duct.
_choledochi._
5. _Dolor pharyngis ab acido_ Pain of the throat from gastric acid.
_gastrico._
6. _Pruritus narium a vermibus._ Itching of the nose from worms.
7. _Cephalaea._ Head-ach.
8. _Hemicrania et otalgia._ Partial head-ach, and ear-ach.
9. _Dolor humeri in hepatitide._ Pain of shoulder in hepatitis.
10. _Torpor pedum variola_ Cold feet in eruption of small-pox.
_erumpente._
11. _Testium dolor nephriticus._ Nephritic pain of testis.
12. _Dolor digiti minimi_ Pain of little finger from sympathy.
_sympatheticus._
13. _Dolor brachii in hydrope_ Pain of the arm in dropsy of the
_pectoris._ chest.
14. _Diarrhoea a dentitione._ Diarrhoea from toothing.

GENUS III.

_Catenated with Voluntary Motions._

SPECIES.

1. _Titubatio linguae._ Impediment of speech.
2. _Chorea sancti viti._ St. Vitus' dance.
3. _Risus._ Laughter.
4. _Tremor ex ira._ Trembling from anger.
5. _Rubor ex ira._ Redness from anger.
6. ---- _criminati._ Blush of guilt.
7. _Tarditas paralytica._ Slowness from palsy.
8. ---- _senilis._ ---- of age.

GENUS IV.

_Catenated with External Influences._

SPECIES.

1. _Somni periodus._ Periods of sleep.
2. _Studii inanis periodus._ ---- of reverie.
3. _Hemicraniae periodus._ ---- of head-ach.
4. _Epilepsiae dolorificae periodus._ ---- of painful epilepsy.
5. _Convulsionis dolorificae periodus._ ---- of painful convulsion.
6. _Tussis periodicae periodus._ ---- of periodic cough.
7. _Catameniae periodus._ ---- of catamenia.
8. _Haemorrhoidis periodus._ ---- of the piles.
9. _Podagrae periodus._ ---- of the gout.
10. _Erysipelatis periodus._ ---- of erysipelas.
11. _Febrium periodus._ ---- of fevers.

ORDO III.

_Retrograde Associate Motions._

GENUS I.

_Catenated with Irritative Motions._

SPECIES.

1. _Diabaetes irritata._ Diabetes from irritation.
2. _Sudor frigidus in asthmate._ Cold sweat in asthma.
3. _Diabaetes a timore._ Diabetes from fear.
4. _Diarrhoea a timore._ Diarrhoea from fear.
5. _Pallor et tremor a timore._ Paleness and trembling from fear.
6. _Palpitatio cordis a timore._ Palpitation of the heart from fear.
7. _Abortio a timore._ Abortion from fear.
8. _Hysteria a timore._ Hysterics from fear.

GENUS II.

_Catenated with Sensitive Motions._

SPECIES.

1. _Nausea idealis._ Nausea from ideas.
2. ---- _a conceptu._ Nausea from conception.
3. _Vomitio vertiginosa._ Vomiting from vertigo.
4. ---- _a calculo in uretere._ ---- from stone in the ureter.
5. ---- _ab insultu paralytico._ ---- from stroke of palsy.
6. ---- _a titilatione faucium._ ---- from tickling the throat.
7. ---- _cute sympathetica._ ---- from sympathy with the skin.

GENUS III.

_Catenated with Voluntary Motions._

SPECIES.

1. _Ruminatio._ Rumination.
2. _Vomitio voluntaria._ Voluntary vomiting.
3. _Eructatio voluntaria._ ---- eructation.

GENUS IV.

_Catenated with External Influences._

SPECIES.

1. _Catarrhus periodicus._ Periodical catarrh.
2. _Tussis periodica._ Periodic cough.
3. _Histeria a frigore._ Hysterics from cold.
4. _Nausea pluvialis._ Sickness against rain.

* * * * *

CLASS IV.

DISEASES OF ASSOCIATION.

ORDO I.

_Increased Associate Motions._

GENUS I.

_Catenated with Irritative Motion._

The importance of the subsequent class not only consists in its elucidating all the sympathetic diseases, but in its opening _a road to the knowledge of fever_. The difficulty and novelty of the subject must plead in excuse for the present imperfect state of it. The reader is entreated previously to attend to the following circumstances for the greater facility of investigating their intricate connections; which I shall enumerate under the following heads.

A. Associate motions distinguished from catenations.
B. Associate motions of three kinds.
C. Associations affected by external influences.
D. Associations affected by other sensorial motions.
E. Associations catenated with sensation.
F. Direct and reverse sympathy.
G. Associations affected four ways.
H. Origin of associations.
I. Of the action of vomiting.
K. Tertian associations.

A. _Associate Motions distinguished from Catenations._

Associate motions properly mean only those, which are caused by the sensorial power of association. Whence it appears, that those fibrous motions, which constitute the introductory link of an associate train of motions, are excluded from this definition, as not being themselves caused by the sensorial power of association, but by irritation, or sensation, or volition. I shall give for example the flushing of the face after dinner; the capillary vessels of the face increase their actions in consequence of their catenation, not their association, with those of the stomach; which latter are caused to act with greater energy by the irritation excited by the stimulus of food. These capillaries of the face are associated with each other reciprocally, as being all of them excited by the sensorial power of association; but they are only catenated with those of the stomach, which are not in this case associate motions but irritative ones. The common use of the word association for almost every kind of connection has rendered this subject difficult; from which inaccuracy I fear some parts of this work are not exempt.

B. _Associate Motions of three Kinds._

Those trains or tribes of associate motions, whose introductory link consists of an irritative motion, are termed irritative associations; as when the muscles of the eyelids close the eye in common nictitation. Those, whose introductory link consists of a sensitive motion, are termed sensitive associations; as when the pectoral and intercostal muscles act in sneezing. And lastly, those, whose introductory link consists of a voluntary motion, are termed voluntary associations; as when the muscles of the lower limbs act in concert with those of the arm in fencing.

C. _Associations affected by external Influences._

Circles of associate motions, as well as trains and tribes of them, are liable to be affected by external influences, which consist of etherial fluids, and which, by penetrating the system, act upon it perhaps rather as a causa sine qua non of its movements, than directly as a stimulus; except when they are accumulated in unusual quantity. We have a sense adapted to the perception of the excess or defect of one of these fluids; I mean that of elementary heat; in which all things are immersed. See Class IV. 1. 4. 7. But there are others of them, which as we have no power to evade their influence, so we have no sense to perceive it; these are the solar, and lunar, and terrestrial gravitation, in which also all things are immersed; the electric aura, which pervades us, and is perpetually varying, See Class IV. 1. 4. 5; the magnetic fluid, Class IV. 1. 4. 5; and lastly, the great life-preserver oxygen gas, and the aqueous vapour of the atmosphere, see Class IV. 1. 4. 6. and 7. and 2.

Of these external influences those of heat, and of gravity, have diurnal periods of increase and decrease; besides their greater periods of monthly or annual variation. The manner in which they act by periodical increments on the system, till some effect is produced, is spoken of in Sect. XXXII. 3. and 6.

D. _Associations affected by other Sensorial Motions._

Circles and trains of associate motions are also liable to be affected by their catenations with other sensorial powers, as of irritation, or sensation, or volition; which other sensorial powers either thus simply form some of the links of the catenation, or add to the energy of the associated motions. Thus when vomiting is caused by the stimulus of a stone in the ureter, the sensation of pain seems to be a link of the catenation rather than an efficient cause of the vomiting. But when the capillary vessels of the skin increase their action from the influence of external heat, they are excited both by the stimulus of unusual heat, as well as by the stimulus of the blood, and by their accustomed association with the actions of the heart and arteries. And lastly, in the blush of anger the sensorial power of volition is added to that of association, and irritation, to excite the capillaries of the face with increased action. See Class IV. 2. 3. 5.

E. _Associations catenated with Sensation._

Pain frequently accompanies associate trains or circles of motion without its being a cause, or a link, of them, but simply an attendant symptom; though it frequently gives name to the disease, as head-ach. Thus in the cramp of the calves of the legs in diarrhoea, the increased sensorial power of association is the proximate cause; the preceding increased action of the bowels is the remote cause; and the proximate effect is the violent contractions of the musculi gastrocnemii; but the pain of these muscles is only an attendant symptom, or a remote effect. See Sect. XVIII. 15. Other sensitive associations are mentioned in Class IV. 1. 2. and IV. 1. 2. 15.

Thus, if the flushing of the face above mentioned after dinner be called a disease, the immediate or proximate cause is the increased power of association, the remote cause is the increased irritative motions of the stomach in consequence of the stimulus of food and wine. The disease or proximate effect consists in the increased actions of the cutaneous vessels of the face; and the sensation of heat, the existence of heat, and the red colour, are attendants or symptoms, or remote effects, of the increased actions of these cutaneous vessels.

F. _Direct and reverse Sympathy._

The increased actions of the primary part of the trains of associated motions are sometimes succeeded by increased actions of the secondary part of the train; and sometimes by decreased actions of it. So likewise the decreased actions of the primary part of a train of associate motions are sometimes succeeded by decreased actions of the secondary part, and sometimes by increased actions of it. The former of these situations is called direct sympathy, and the latter reverse sympathy. In general I believe, where the primary part of the train of associated motions is exerted more than natural, it produces direct sympathy in strong people, and reverse sympathy in weak ones, as a full meal makes some people hot, and others chill. And where the primary part of the train is exerted less than natural, it produces direct sympathy in weak people, and reverse sympathy in strong ones, as on being exposed for a certain length of time on horseback in a cold day gives indigestion and consequent heart-burn to weak people, and strengthens the digestion, and induces consequent hunger in strong ones. See Sect. XXXV. 1.

This may perhaps be more easily understood, by considering strength and weakness, when applied to animal bodies, as consisting in the quantity of sensorial power residing in the contracting fibres, and the quantity of stimulus applied, as shewn in Sect. XII. 2. 1. Now when defective stimulus, within certain limits, is partially applied to parts subject to perpetual motion, the expenditure of sensorial power is for a while lessened, but not its general production in the brain, nor its derivation into the weakly-stimulated part. Hence in strong people, or such whose fibres abound with sensorial power, if the first tribe of an associate train of motions be deprived in part of its accustomed stimulus, its action becomes diminished; and the sensorial power becomes accumulated, and by its superabundance, or overflowing as it were, increases the action of the second tribe of the associate actions by reverse sympathy. As exposing the warm skin for a moderate time to cold air increases the action of the stomach, and thus strengthens the power of digestion.

On the reverse, when additional stimulus within certain limits is partially applied to parts, which are deficient in respect to the natural quantity of sensorial power, the expenditure of sensorial power is increased, but in a less degree than the increased production of it in the brain, or its increased derivation into the strongly-stimulated organ. Hence in weak people, or such whose fibres are deficient of sensorial power, if the first tribe of an associate train of motions be subjected for a while to greater stimulus than usual, a greater production of sensorial power, or a greater derivation of it into the stimulated parts occurs; which by its excess, or overflowing as it were, increases the actions of the second tribe of the associate motions by direct sympathy. Thus when vomiting occurs with cold extremities, a blister on the back in a few hours occasions universal warmth of the skin, and stops the vomiting. And when a diarrhoea occurs with pale skin and cold extremities, the pricking of the points of a flannel shirt, worn next the skin, occasions universal warmth of it, and checks or cures the diarrhoea.

In some associate trains of action nevertheless reverse sympathies more frequently occur than direct ones, and in others direct ones more frequently than reverse ones. Thus in continued fever with debility there appears to be a reverse sympathy between the capillary vessels of the stomach and those of the skin; because there exists a total aversion to solid food, and constant heat on the surface of the body. Yet these two systems of vessels are at other times actuated by direct sympathy, as when paleness attends sickness, or cold feet induces indigestion. This subject requires to be further investigated, as it probably depends not only on the present or previous plus or minus of the sensorial power of association, but also on the introduction of other kinds of sensorial power, as in Class IV. 1. 1. D; or the increased production of it in the brain, or the greater mobility of one part of a train of actions than another.

Thus when much food or wine is taken into the stomach, if there be no superfluity of sensorial power in the system, that is, none to be spared from the continual actions of it, a paleness and chillness succeeds for a time; because now the expenditure of it by the increased actions of the stomach is greater than the present production of it. In a little time however the stimulus of the food and wine increases the production of sensorial power in the brain, and this produces a superfluity of it in the system; in consequence of which the skin now becomes warm and florid, which was at first cold and pale; and thus the reverse sympathy is shortly converted into a direct one; which is probably owing to the introduction of a second sensorial power, that of pleasurable sensation.

On the contrary, when an emetic drug produces sickness, the skin is at first pale for a time by direct sympathy with the capillaries of the stomach; but in a few minutes, by the accumulation of sensorial power in the stomach during its less active state in sickness, the capillaries of the skin, which are associated with those of the stomach, act with greater energy by reverse sympathy, and a florid colour returns. Where the quantity of action is diminished in the first part of a train of motions, whether by previous diminution of sensorial power, or present diminution of stimulus, the second part of the train becomes torpid by direct sympathy. And when the quantity of action of the first part becomes increased by the accumulation of sensorial power during its previous torpor, or by increase of stimulus, the actions of the second part of it likewise become increased by direct sympathy.

In moderate hunger the skin is pale, as before dinner, and in moderate sickness, as no great accumulation of sensorial power has commenced; but in violent hunger, and in greater torpor of the stomach, as from contagious matter, the accumulation of sensorial power becomes so great as to affect the arterial and capillary system, and fever is produced in both cases.

In contagious fevers with arterial debilities commencing with torpor of the stomach, why is the action of the heart weakened, and that of the capillaries increased? Is it because the mobility of the heart is less than that of the stomach, and the mobility of the capillaries greater? Or is it because the association between the muscular fibres of the stomach and those of the heart have been uniformly associated by direct sympathy; and the capillaries of the stomach and those of the skin have been more frequently associated by reverse sympathy?

Where the actions of the stomach have been previously exhausted by long stimulus, as on the day after intoxication, little or no accumulation of sensorial power occurs, during the torpor of the organ, beyond what is required to replace the deficiency of it, and hence fever seldom follows intoxication. And a repetition of the stimulus sometimes becomes necessary even to induce its natural action, as in dram-drinkers.

Where there has been no previous exhaustion of sensorial power, and the primary link of associate motions is violently actuated by the sensorial power of sensation, the secondary link is also violently actuated by direct sympathy, as in inflammatory fevers. Where however the sensorial power of the system is less than natural, the secondary link of associated motions becomes torpid by reverse sympathy, as in the inoculated small-pox during the eruption on the face the feet are frequently cold.

G. _Associations affected four Ways._

Hence associated trains or circles of motions may be affected four different ways. 1. By the greater or less energy of action of the first link with which they are catenated, and from which they take their names; as irritative, sensitive, or voluntary associations. 2. By being excited by two or more sensorial powers at the same time, as by irritation and association, as in the instance of the application of the stimulus of increased external heat to the cutaneous capillaries. 3. By catenation with other sensorial powers, as with pain or pleasure, which are in this case not the proximate cause of motion, but which, by becoming a link of catenation, excites the sensorial power of association into action; as the pain at the neck of the gall-bladder occasioned by a gall-stone is transferred to the other end of that canal, and becomes a link of catenation between the action of the two extremities of it. 4. The influence of ethereal fluids, as of heat and gravitation. To which last perhaps might be added moisture and oxygen gas as constituting necessary parts of the system, rather than stimuli to excite it into action.

H. _The Origin of Associations._

Some trains or circles of associate motions must have been formed before our nativity, as those of the heart, arteries, and capillaries; others have been associated, as occasion required them, as the muscles of the diaphragm and abdomen in vomiting; and others by perpetual habit, as those of the stomach with the heart and arteries directly, as in weak pulse during sickness; with the capillaries directly, as in the flushed skin after dinner; and lastly, with the cellular absorbents reversely, as in the increased absorption in anasarca during sickness; and with the irritative motions of the organs of sense reversely, as in vertigo, or sea-sickness. Some of these associations shall be here shortly described to facilitate the investigation of others.

First, other congeries of glands occupy but a particular part of the system, or constitute a particular organ, as the liver, or kidneys; but those glands, which secrete the mucus, and perspirable matter, which are called capillaries, are of very great extent; they receive the blood from the arteries, separate from it the mucus, which lines every cell, and covers every cavity of body; and the perspirable matter, which softens and lubricates the whole surface of the skin, and the more extensive surface of the air-vessels, which compose the lungs. These are supplied with blood by the perpetual action of the heart and arteries, and have therefore their motions associated with the former, and with each other, by sympathy, which is sometimes direct, and sometimes reverse.

One branch of this association, the capillaries of the skin, are very irritable by the increased quantities of cold and heat, another branch, that of the lungs, has not the perception of cold and heat, but is liable by direct sympathy to act in concert with the former, as in going into the cold bath. And it is probable the capillaries of the internal membranes are likewise directly affected by their sympathy with those of the skin, as appears from the defect of secretion in ulcers during the cold fits of agues.

The motions of this extensive system of capillaries, thus associated by direct sympathy, are also associated with those of the heart and arteries, sometimes by reverse and sometimes by direct sympathy; and thus constitute simple fever. The cold paroxysm of which consists in their torpor, and the hot one in their orgasm, or increased activity.

I. _Of the Action of Vomiting._

The manner, in which the stomach and the diaphragm and abdominal muscles acquire their associate action in vomiting, requires some attention. It is not probable, that this action of vomiting occurs before nativity; as the uniform application of the nutritive liquor amnii to the mouth of the foetus, and the uniform expenditure of its nourishment, would not seem to give occasion to too great temporary repletion of the stomach; and would preclude the deglutition of any improper material. After nativity the stomach of the child may be occasionally too much distended with milk; as previous hunger may induce it to overgorge itself; and by repeated efforts the act of vomiting is learned, as a means of getting free from a disagreeable sensation. Thus when any disgustful material, as a bitter drug, is taken into the mouth; certain retrograde motions of the tongue and lips are produced, for the purpose of putting the disagreeable material out of the mouth again.

When the stomach is disagreeably stimulated by the distention or acrimony of the aliment, a similar effort to regurgitate it must occur; and by repeated trials the action of the diaphragm and abdominal muscles by squeezing the stomach assists its retrograde exertion to disgorge its contents. In the same manner when a piece of gravel is pushed into the urethra, or a piece of indurated bile into the neck of the gall-bladder, after they have been in vain pressed forward by the usual motions of those ducts, they return into the bladders of gall and urine by the retrograde motions of them.

That this is one mode, in which vomiting is induced, appears from the instantaneous rejection from the stomach occasioned by some nauseous drug, or from some nauseous idea; and lastly, from the voluntary power, which some people have been said to have acquired, of emptying their stomachs, much in the same manner as ruminating animals bring up the grass from their first stomach.

There are nevertheless many modes by which these inverted motions of the stomach and oesophagus are induced, and which it is of consequence to distinguish from each other. The first is the mode above described, where an effort is made to dislodge something, which stimulates the stomach into disagreeable sensation; and which is returned by repeated exertions; as when a nauseous drug is taken into the mouth, or a bit of sand falls into the eye, or a drop of water into the wind-pipe. In this the peristaltic motions of the stomach are first stopped, and then reverted by painful sensation; and the abdominal muscles and diaphragm by repeated efforts become associated with them. Now as less sensorial power is expended on the retrograde actions of the stomach, and of the lymphatics, which open their mouths on its surface, than by their natural motions, an accumulation of sensorial power in the fibres of the stomach follows the exhibition of an emetic, and on that account an emetic will sometimes stop a spontaneous vomiting which was owing to sensorial deficiency. See Sect. XXXV. 1. 3. and Art. V. 2. 1.

As bitters and metallic salts, exhibited in small doses, stimulate the stomach into greater action, as appears by their increasing the power of digestion, and yet become emetic, when given in larger doses; one might suspect, that they became emetic by inducing debility, and consequent retrograde actions of the stomach, by their previously exhausting the sensorial power by their great stimulus; which might be effected in a moment without producing pain, and in consequence without our perceiving it. But on the contrary, there does not in general appear on the exhibition of emetics to be any previous exhaustion of sensorial power; because there is evidently an accumulation of it during the sickness, as appears from the digestion being stronger afterwards; and from the increased action of the cellular and cutaneous absorbents during its operation. See Art. V. 2. 1.

Another mode, by which vomiting is induced, is owing to debility or deficiency of sensorial power, from the previous exhaustion of it; as on the day after intoxication, or which occurs in people enfeebled with the gout, and in dropsy, and in some fevers with debility. In these, when the vomiting ceases, there is no appearance of accumulation of sensorial power, as the digestion still remains weak and imperfect.

Another mode by which sickness or vomiting is induced, is by defect of stimulus, as in great hunger; and in those, who have been habituated to spice and spirit with their meals, who are liable to be sick after taking food without these additional stimuli. Other means of inducing sickness by vertigo, or by nauseous ideas, will be mentioned below.

We shall only add, that the motions of the muscular fibres of the stomach are associated with those of the heart and arteries by direct sympathy, as appears by the weakness of the pulse during the exhibition of an emetic; and that the absorbents of the stomach are associated with the cellular and cutaneous absorbents by reverse sympathy, as is shewn by the great absorption of the mucus of the cells in anasarca during sickness; at the same time that the absorbents of the stomach invert their actions, and pour the mucus and water thus absorbed into that viscus.

In cold paroxysms of fever the stomach partakes of the general torpor, and vomiting is induced by its debility, either by its association with the torpid capillaries, or other torpid parts, or by its own torpor commencing first, and causing the cold fit. The disordered motions of the stomach frequently seem to be the cause or primary seat of fever, as where contagious miasmata are swallowed with the saliva, and where fever is produced by sea-sickness, which I once saw. Nevertheless a disorder of the stomach does not always induce fever, as in that case it should constantly attend indigestion, and vertigo, and sea-sickness; but is itself frequently induced by association with the disordered movements of other parts of the system, as when it arises from gravel in the ureter, or from a percussion on the head.