Part 2 — PART II. (continued 10)

When vertigo affects people about fifty years of age, their sight has generally been suddenly impaired; and from their less accurate vision they do not soon enough perceive the apparent motions of objects; like a person in a room, the walls of which are stained with the uniform figures of lozenges, explained in Sect. XX. 1. This is generally ascribed to indigestion; but it ceases spontaneously, as the patient acquires the habit of balancing himself by less distinct objects.

A gentleman about 50 was seized with an uncommon degree of vertigo, so as to fall on the ground, and not to be able to turn his head, as he sat up either in his chair or in his bed, and this continued eight or ten weeks. As he had many decayed teeth in his mouth, and the vertigo was preceded and sometimes accompanied by pains on one side of his head, the disease of a tooth was suspected to be the cause. And as his timidity was too great to admit the extraction of those which were decayed; after the trial of cupping repeatedly, fomentations on his head, repeated blisters, with valerian, Peruvian bark, musk, opium, and variety of other medicines; mercurials were used, both externally and internally, with design to inflame the membranes of the teeth, and by that means to prevent the torpor of the action of the membranes about the temple, and parietal bone; which are catenated with the membranes of the teeth by irritative association, but not by sensitive association. The event was, that as soon as the gums became sore with a slight ptyalism, the pains about the head and vertigo gradually diminished, and during the soreness of his gums entirely ceased; but I believe recurred afterwards, though in less degree.

The idea of inflaming the membranes of the teeth to produce increased sensation in them, and thus to prevent their irritative connection with those of the cranium, was taken from the treatment of trismus, or locked jaw, by endeavouring to inflame the injured tendon; which is said to prevent or to remove the spasm of the muscles of the jaw. See Class III. 1. 1. 13. and 15.

M. M. Emetics. Blisters. Issues about the head. Extraction of decayed teeth. Slight salivation. Sorbentia. Incitantia.

12. Vertigo ebriosa. Vertigo from intoxication is owing to the association of the irritative ideas of vision with the irritative motions of the stomach. Whence when these latter become much increased by the immoderate stimulus of wine, the irritative motions of the retina are produced with less energy by reverse sympathy, and become at the same time succeeded by sensation in consequence of their decreased action. See Sect. XXI. 3. and XXXV. 1. 2. So conversely when the irritative motions of vision are increased by turning round, or by our unaccustomed agitation at sea, those of the stomach become inverted by reverse sympathy, and are attended in consequence with disagreeable sensation. Which decreased action of the stomach is in consequence of the increased expenditure of the sensorial power on the irritative ideas of vision, as explained in Vertigo rotatoria.

Whence though a certain quantity of vinous spirit stimulates the whole system into increased action, and perhaps even increases the secretion of sensorial power in the brain; yet as soon as any degree of vertigo is produced, it is a proof, that by the too great expenditure of sensorial power by the stomach, and its nearest associated motions, the more distant ones, as those of vision, become imperfectly exerted. From hence may be deduced the necessity of exhibiting wine in fevers with weak pulse in only appropriated quantity; because if the least intoxication be induced, some part of the system must act more feebly from the unnecessary expenditure of sensorial power.

13. Vertigo febriculosa. Vertigo in fevers either proceeds from the general deficiency of sensorial power belonging to the irritative associations, or to a greater expenditure of it on some links of the trains and tribes of associated irritative motions. There is however a slighter vertigo attending all people, who have been long confined in bed, on their first rising; owing to their having been so long unused to the apparent motions of objects in their erect posture, or as they pass by them, that they have lost in part the habit of balancing themselves by them.

14. Vertigo cerebrosa. Vertigo from injuries of the brain, either from external violence, or which attend paralytic attacks, are owing to the general deficiency of sensorial power. In these distressful situations the vital motions, or those immediately necessary to life, claim their share of sensorial power in the first place, otherwise the patient must die; and those motions, which are less necessary, feel a deficiency of it, as these of the organs of sense and muscles; which constitute vertigo; and lastly the voluntary motions, which are still less immediately necessary to life, are frequently partially destroyed, as in palsy; or totally, as in apoplexy.

15. Murmur aurium vertiginosum. The vertiginous murmur in the ears, or noise in the head, is compared to the undulations of the sound of bells, or to the humming of bees. It frequently attends people about 60 years of age; and like the visual vertigo described above is owing to our hearing less perfectly from the gradual inirritability of the organ on the approach of age; and the disagreeable sensation of noise attending it is owing to the less energetic action of these irritative motions; which not being sufficiently distinct to excite their usual associations become succeeded by our attention, like the indistinct view of the apparent motions of objects mentioned in vertigo visualis. This may be better understood from considering the use, which blind men make of these irritative sounds, which they have taught themselves to attend to, but which escape the notice of others. The late blind Justice Fielding walked for the first time into my room, when he once visited me, and after speaking a few words said, "this room is about 22 feet long, 18 wide, and 12 high;" all which he guessed by the ear with great accuracy. Now if these irritative sounds from the partial loss of hearing do not correspond with the size or usual echoes of the places, where we are; their catenation with other irritative ideas, as those of vision, becomes dissevered or disturbed; and we attend to them in consequence, which I think unravels this intricate circumstance of noises being always heard in the head, when the sense of hearing begins to be impaired, from whatever cause it occurs.

This ringing in the ears also attends the vertigo from intoxication; for the irritative ideas of sound are then more weakly excited in consequence of the deficiency of the sensorial power of association. As is known by this also being attended with disagreeable sensation, and by its accompanying other diseases of debility, as strokes on the head, fainting fits, and paralytic seizures. For in this vertigo from intoxication so much sensorial power in general is expended on the increased actions of the stomach, and its nearest connections, as the capillaries of the skin; that there is a deficiency for the purposes of the other irritative associations of motions usually connected with it. This auditory vertigo attends both the rotatory and the visual vertigo above mentioned; in the former it is introduced by reverse sympathy, that is, by the diminution of sensorial power; too great a quantity of it being expended on the increased irritative motions of vision; in the latter it is produced either by the same causes which produce the visual vertigo, or by direct sympathy with it. See Sect. XX. 7.

M. M. Stimulate the internal ear by ether, or with essential oil diluted with expressed oil, or with a solution of opium in wine, or in water. Or with salt and water.

16. Tactus, gustus, olfactius vertiginosi. Vertiginous touch, taste, and smell. In the vertigo of intoxication, when the patient lies down in bed, it sometimes happens even in the dark, that the bed seems to librate under him, and he is afraid of falling out of it. The same occurs to people, who are sea-sick, even when they lie down in the dark. In these the irritative motions of the nerves of touch, or irritative tangible ideas, are performed with less energy, in one case by reverse sympathy with the stomach, in the other by reverse sympathy with the nerves of vision, and in consequence become attended with sensation, and produce the fear of falling by other associations.

A vertigo of the sense of touch may be produced, if any one turns round for a time with his eyes shut, and suddenly stops without opening them; for he will for a time seem to be still going forwards; which is difficult to explain. See the notes at the end of the first and second volume belonging to Sect. XX. 6.

In the beginning of some fevers, along with incessant vomiting, the patients complain of disagreeable tastes in their mouth, and disagreeable odours; which are to be ascribed to the general debility of the great trains and tribes of associated irritative motions, and to be explained from their direct sympathy with the decreased action of a sick stomach; or from the less secretion of sensorial power in the brain. These organs of sense are constantly stimulated into action by the saliva or by the air; hence, like the sense of hunger, when they are torpid from want of stimulus, or from want of sensorial power, pain or disagreeable sensation ensues, as of hunger, or faintness, or sickness in one case; and the ideas of bad tastes or odours in the other. This accords with the laws of causation, Sect. IV. 5.

17. Pulsus mollis in vomitione. The softness of the pulse in the act of vomiting is caused by direct association between the heart and the stomach; as explained in Sect. XXV. 17. A great slowness of the pulsation of the heart sometimes attends sickness, and even with intermissions of it, as in the exhibition of too great a dose of digitalis.

18. Pulsus intermittens a ventriculo. When the pulse first begins to intermit, it is common for the patient to bring up a little air from his stomach; which if he accomplishes before the intermission occurs, always prevents it; whence that this debility of the heart is owing to the direct association of its motions with those of the stomach is well evinced. See Sect. XXV. 17.

I this morning saw Mr. ——, who has long had at times an unequal pulse, with indigestion and flatulency, and occasional asthma; he was seized two days ago with diarrhœa, and this morning with sickness, and his pulse was every way unequal. After an emetic his pulse still continued very intermittent and unequal. He then took some breakfast of toast and butter, and tea, and to my great surprise his pulse became immediately perfectly regular, about 100 in a minute, and not weak, by this stimulus on his stomach.

A person, who for many years had had a frequent intermission of his pulse, and occasional palpitation of his heart, was relieved from them both for a time by taking about four drops of a saturated solution of arsenic three or four times a day for three or four days. As this intermission of the pulse is occasioned by the direct association of the motions of the heart with those of the stomach, the indication of cure must be to strengthen the action of the stomach by the bark. Spice. Moderate quantities of wine. A blister. Half a grain of opium twice a day. Solution of arsenic?

19. Febris inirritativa. Inirritative fever described in Class I. 2. 1. 1. belongs to this place, as it consists of disordered trains and tribes of associated irritative motions, with lessened actions of the associated organs. In this fever the pulsations of the heart and arteries are weakened or lessened, not only in the cold paroxysm, as in the irritative fever, but also in the hot paroxysm. The capillary arteries or glands have their actions nevertheless increased after the first cold fit, as appears by the greater production of heat, and the glow of arterial blood, in the cutaneous vessels; and lastly, the action of the stomach is much impaired or destroyed, as appears by the total want of appetite to solid food. Whence it would seem, that the torpid motions of the stomach, whatever may occasion them, are a very frequent cause of continued fever with weak pulse; and that these torpid motions of the stomach do not sufficiently excite the sensorial power of association, which contributes in health to actuate the heart and arteries along with the irritation produced by the stimulus of the blood; and hence the actions of these organs are weaker. And lastly, that the accumulation of the sensorial power of association, which ought to be expended on the motions of the heart and arteries, becomes now exerted on the cutaneous and pulmonary capillaries. See Supplement I. 8. and Sect. XXXV. 1. 1. and XXXIII. 2. 10.

I have dwelt longer on the vertiginous diseases in this genus, both because of their great intricacy, and because they seem to open a road to the knowledge of fever, which consists of associated trains and tribes of irritative or sensitive motions, which are sometimes mixed with the vertiginous ones, and sometimes separate from them.

ORDO II.

Decreased Associate Motions.

GENUS II.

Catenated with Sensitive Motions.

In this genus the sensorial power of association is exerted with less energy, and thence the actions produced by it are less than natural; and pain is produced in consequence, according to the fifth law of animal causation, Sect. IV. This pain is generally attended with coldness of the affected part, and is seldom succeeded by inflammation of it. This decreased action of the secondary link of the associated motions, belonging to this genus, is owing to the previous exhaustion of sensorial power either in the increased actions of the primary link of the associated motions, or by the pain which attends them; both which are frequently the consequence of the stimulus of something external to the affected fibres.

As pain is produced either by excess or defect of the natural exertions of the fibres, it is not, considered separately, a criterion of the presence of either. In the associations belonging to this genus the sensation of pain or pleasure produces or attends the primary link of the associated motions, and very often gives name to the disease.

When great pain exists without causing any fibrous motions, I conjecture that it contributes to exhaust or expend the general quantity of sensorial power; because people are fatigued by enduring pain, till at length they sleep. Which is contrary to what I had perhaps erroneously supposed in Sect. XXXV. 2. 3. If it causes fibrous motions, it then takes the name of sensation, according to the definition of sensation in Sect. II. 2. 9.; and increased fibrous action or inflammation is the consequence. This circumstance of the general exhaustion of sensorial power by the existence of pain will assist in explaining many of the diseases of this genus.

Many of the canals of the body, as the urethra, the bile-duct, the throat, have the motions of their two extremities associated by having been accustomed to feel pleasurable or painful sensations at the same time or in succession. This is termed sensitive association, though those painful or pleasurable sensations do not cause the motions, but only attend them; and are thus perhaps, strictly speaking, only catenated with them.

SPECIES.

1. Torpor genæ a dolore dentis. In tooth-ach there is generally a coldness of the cheek, which is sensible to the hand, and is attended in some degree with the pain of cold. The cheek and tooth have frequently been engaged in pleasurable action at the same time during the masticating of our food; whence they have acquired sensitive associations. The torpor of the cheek may have for its cause the too great expenditure of sensorial power by the painful sensation of the membranes of the diseased tooth; whence the membranes of the cheek associated with those of the alveolar process are deprived of their natural share of it, and become torpid; thus they produce less secretions, and less heat, and the pain of cold is the consequence. This torpor of the vessels of the cheek cannot be produced by the activity of the sensorial power of sensation; for then they would act more violently than natural, or become inflamed. And though the pain by exhausting so much sensorial power may be a remote cause, it is the defeat of the power of association, which is the immediate cause of the torpor of the cheek.

After some hours this pain occasioned by the torpor of the vessels of the cheek either gradually ceases along with the pain of the diseased tooth; or, by the accumulation of sensorial power during their state of torpor, the capillaries of the cheek act with greater violence, and produce more secretions, and heat, and consequent tumour, and inflammation. In this state the pain of the diseased tooth ceases; as the sensorial power of sensation is now expended on the inflamed vessels of the cheek. It is probable that most other internal membranous inflammations begin in a similar manner; whence there may seem to be a double kind of sensitive association; first, with decreased action of the associated organ, and then with increased action of it; but the latter is in this case simply the consequence of the former; that is, the tumor or inflammation of the cheek is in consequence of its previous quiescence or torpor.

2. Stranguria a dolore vesicæ. The strangury, which has its origin from pain at the neck of the bladder, consists of a pain in the external extremity of the urethra or of the glans penis of men, and probably in the external termination of the urethra or of the clitoris of women; and is owing to the sympathy of these with some distant parts, generally with the other end of the urethra; an endeavour and difficulty of making water attends this pain.

Its remote cause is from the internal or external use of cantharides, which stimulate the neck of the bladder; or from a stone, which whenever it is pushed into the neck of the bladder, gives this pain of strangury, but not at other times; and hence it is felt most severely in this case after having made water.

The sensations or sensitive motions of the glans penis, and of the sphincter of the bladder, have been accustomed to exist together during the discharge of the urine; and hence the two ends of the urethra sympathize by association. When there is a stone at the neck of the bladder, which is not so large or rough as to inflame the part, the sphincter of the bladder becomes stimulated into pain; but as the glans penis is for the purposes of copulation more sensitive than the sphincter of the bladder, as soon as it becomes affected with pain by the association above mentioned, the sensation at the neck of the bladder ceases; and then the pain of the glans penis would seem to be associated with the irritative motions only of the sphincter of the bladder, and not with the sensitive ones of it. But a circumstance similar to this occurs in epileptic fits, which at first are induced by disagreeable sensation, and afterwards seem to occur without previous pain, from the suddenness in which they follow and relieve the pain, which occasioned them. From this analogy I imagine the pain of the glans penis is associated with the pain of the sphincter of the bladder; but that as soon as the greater pain in a more sensible part is produced; the lesser one, which occasioned it, ceases; and that this is one of the laws of sensitive association. See Sect. XXXV. 2. 1.

A young man had by an accident swallowed a large spoonful or more of tincture of cantharides; as soon as he began to feel the pain of strangury, he was advised to drink large quantities of warmish water; to which, as soon as it could be got, some gum arabic was added. In an hour or two he drank by intervals of a few minutes about two gallons of water, and discharged his urine every four or five minutes. A little blood was voided towards the end, but he suffered no ill consequence.

M. M. Warm water internally. Clysters of warm water. Fomentation. Opium. Solution of fixed alkali supersaturated with carbonic acid. A bougie may be used to push back a stone into the bladder. See Class I. 1. 3. 10.

3. Stranguria convulsiva. The convulsive strangury, like that before described, is probably occasioned by the torpor or defective action of the painful part in consequence of the too great expenditure of sensorial power on the primary link of the associated motions, as no heat or inflammation attends this violent pain. This kind of strangury recurs by stated periods, and sometimes arises to so great a degree, that convulsion or temporary madness terminates each period of it. It affects women oftener than men, is attended with cold extremities without fever, and is distinguished from the stone of the bladder by the regularity of its periods, and by the pain being not increased after making water.

On introducing the catheter sometimes part of the urine will come away and not the whole, which is difficult to explain; but may arise from the weakness of the muscular fibres of the bladder; which are not liable suddenly to contract themselves so far as to exclude the whole of the urine. In some old people, who have experienced a long retention of urine, the bladder never regains the power of completely emptying itself; and many who are beginning to be weak from age can make water a second time, a few minutes after they supposed they had emptied the bladder.

I have believed this pain to originate from sympathy with some distant part, as from ascarides in the rectum, or from piles in women; or from caruncles in the urethra about the caput gallinaginis in men; and that the pain has been in the glans or clitoris by reverse sympathy of these more sensible parts with those above mentioned.

M. M. Venesection. Opium in large quantities. Warm bath. Balsams. Bark. Tincture of cantharides. Bougie, and the treatment for hæmorrhoids. Leeches applied to the sphincter ani. Aerated alcaline water. Soap and sal soda. Opium in clysters given an hour before the expected return. Smoke of tobacco in clysters. Arsenic?

4. Dolor termini intestinalis ductûs choledochi. Pain at the intestinal end of the gall-duct. When a gall-stone is protruded from the gall-bladder a little way into the end of the gall-duct, the pain is felt at the other end of the gall-duct, which terminates in the duodenum. For the actions of the two terminations of this canal are associated together from the same streams of bile passing through them in succession, exactly as the two terminations of the urethra have their actions associated, as described in Species 2 and 3 of this genus. But as the intestinal termination of the bile-duct is made more sensible for the purpose of bringing down more bile, when it is stimulated by new supplies of food from the stomach, it falls into violent pain from association; and then the pain on the region of the gall-bladder ceases, exactly as above explained in the account of the pain of the glans penis from a stone in the sphincter of the bladder.

The common bile-duct opens into the intestine exactly at what is called the pit of the stomach; and hence it has sometimes happened, that this pain from association with the sensation of a gall-stone at the other end of the bile-duct has been mistaken for a pain of the stomach.

For the method of cure see Class I. 1. 3. 8. to which should be added the use of strong electric shocks passed through the bile-duct from the pit of the stomach to the back, and from one side to the other. A case of the good effect of electricity in the jaundice is related in Sect. XXX. 2. And another case, where it promoted the passage of a painful gall-stone, is described by Dr. Hall, experienced on himself. Trans. of the College at Philadelphia, Vol. I. p. 192.

Half a pint of warm water two or three times a day is much recommended to dilute the inspissated bile.

5. Dolor pharyngis ab acido gastrico. The two ends of the throat sympathize by sensitive association in the same manner as the other canals above mentioned, namely, the urethra and the bile-duct; hence when too great acidity of undigested aliment, or the carbonic acid air, which escapes in fermentation, stimulates the cardia ventriculi, or lower end of the gula, into pain; the pharinx, or upper end of it, is affected with greater pain, or a disagreeable sensation of heat.

6. Pruritus narium a vermibus. The itching of the nose from worms in the intestines is another curious instance of the sensitive associations of the motions of membranes; especially of those which constitute the canals of the body. Previous to the deglutition of agreeable food, as milk in our earliest infancy, an agreeable odour affects the membrane, which lines the nostrils; and hence an association seems to take place between the agreeable sensations produced by food in the stomach and bowels, and the agreeable sensations of the nostrils. The existence of ascarides in the rectum I believe produces this itching of the nostrils more than the worms in other parts of the intestines; as we have already seen, that the terminations of canals sympathize more than their other parts, as in the urethra and gall-ducts. See Class I. 1. 5. 9. IV. 1. 2. 9.

7. Cephalæa. Head-ach. In cold fits of the ague, the head-ach arises from consent with some torpid viscus, like the pain of the loins. After drunkenness the head-ach is very common, owing to direct sympathy of the membranes of the head with those of the stomach; which is become torpid after the too violent stimulus of the preceding intoxication; and is hence removeable by spirit of wine, or opium, exhibited in smaller quantities. In some constitutions these head-achs are induced, when the feet are exposed to much external cold; in this case the feet should be covered with oiled silk, which prevents the evaporation of the perspirable matter, and thence diminishes one cause of external cold.

M. M. Valerian in powder two drams three or four times a day is recommended. The bark. Chalybeates. A grain of opium twice a day for a long time. From five to ten drops of the saturated solution of arsenic two or three times a day. See Class I. 2. 4. 11. A lady once assured me, that when her head-ach was coming on, she drank three pints (pounds) of hot water, as hastily as she could; which prevented the progress of the disease. A solution of arsenic is recommended by Dr. Fowler of York. Very strong errhines are said sometimes to cure head-achs taken at the times the pain recurs, till a few drops of blood issue from the nostrils. As one grain of turpeth mineral (vitriolic calx of mercury) mixed with ten grains of fine sugar. Euphorbium or cayan pepper mixed with sugar, and used with caution as an errhine. See the M. M. of the next Species.

8. Hemicrania. Pain on one side of the head. This disease is attended with cold skin, and hence whatever may be the remote cause, the immediate one seems to be want of stimulus, either of heat or distention, or of some other unknown stimulus in the painful part; or in those, with which it is associated. The membranes in their natural state are only irritable by distention; in their diseased state, they are sensible like muscular fibres. Hence a diseased tooth may render the neighbouring membranes sensible, and is frequently the cause of this disease.

Sometimes the stomach is torpid along with the pained membrane of the head; and then sickness and inappetency attends either as a cause or consequence. The natural cure of hemicrania is the accumulation of sensorial power during the rest or sickness of the patient. Mrs. —— is frequently liable to hemicrania with sickness, which is probably owing to a diseased tooth; the paroxysm occurs irregularly, but always after some previous fatigue, or other cause of debility. She lies in bed, sick, and without taking any solid food, and very little of fluids, and those of the aqueous kind, and, after about 48 or 50 hours, rises free from complaint. Similar to this is the recovery from cold paroxysms of fever, from the torpor occasioned by fear, and from syncope; which are all owing to the accumulation of sensorial power during the inactivity of the system. Hence it appears, that, though when the sensorial power of volition is much exhausted by fatigue, it can be restored by eight or ten hours of sleep; yet, when the sensorial power of irritation is exhausted by fatigue, that it requires two whole solar or lunar days of rest, before it can be restored.

The late Dr. Monro asserted in his lectures, that he cured the hemicrania, or megrim, by a strong vomit, and a brisk purge immediately after it. This method succeeds best if opium and the bark are given in due quantity after the operation of the cathartic; and with still more certainty, if bleeding in small quantity is premised, where the pulse will admit of it. See Sect. XXXV. 2. 1.

The pain generally affects one eye, and spreads a little way on that side of the nose, and may sometimes be relieved by pressing or cutting the nerve, where it passes into the bone of the orbit above the eye. When it affects a small defined part on the parietal bone on one side, it is generally termed Clavus hystericus, and is always I believe owing to a diseased dens molaris. The tendons of the muscles, which serve the office of mastication, have been extended into pain at the same time, that the membranous coverings of the roots of the teeth have been compressed into pain, during the biting or mastication of hard bodies. Hence when the membranes, which cover the roots of the teeth, become affected with pain by a beginning decay, or perhaps by the torpor or coldness of the dying part of the tooth, the tendons and membranous fascia of the muscles about the same side of the head become affected with violent pain by their sensitive associations: and as soon as this associated pain takes place, the pain of the tooth entirely ceases, as explained in the second species of this genus.

A remarkable circumstance attends this kind of hemicrania, viz. that it recurs by periods like those of intermittent fevers, as explained in the Section on Catenation of Motions; these periods sometimes correspond with alternate lunar or solar days like tertian agues, and that even when a decaying tooth is evidently the cause; which has been evinced by the cure of the disease by extracting the tooth. At other times they observe the monthly lunations, and seem to be induced by the debility, which attends menstruation.

The dens sapientiæ, or last tooth of the upper jaw, frequently decays first, and gives hemicrania over the eye on the same side. The first or second grinder in the under-jaw is liable to give violent pain about the middle of the parietal bone, or side of the head, on the same side, which is generally called the Clavus hystericus, of which an instructive case is related in Sect. XXXV. 2. 1.

M. M. Detect and extract the diseased tooth. Cut the affected nerve, or stimulate the diseased membrane by acu-puncture. Venesection to six ounces by the lancet or by leeches. A strong emetic and a subsequent cathartic; and then an opiate and the bark. Pass small electric shocks through the pained membrane, and through the teeth on the same side. Apply vitriolic ether externally, and a grain of opium with camphor internally, to the cheek on the affected side, where a diseased tooth may be suspected. Foment the head with warm vinegar. Drink two large spoonfuls of vinegar. Stimulate the gums of the suspected teeth by oil of cloves, by opium. See Class I. 1. 4. 4. Snuff volatile spirit of vinegar up the nostrils. Lastly, in permanent head-achs, as in permanent vertigo, I have seen good effect by the use of mercurial ointment rubbed on the shaved head or about the throat, till a mild salivation commences, which by inflaming the membranes of the teeth may prevent their irritative sympathy with those of the cranium. Thus by inflaming the tendon, which is the cause of locked jaw, and probably by inflaming the wound, which is the cause of hydrophobia, those diseases may be cured, by disuniting the irritative sympathy between those parts, which may not possess any sensitive sympathy. This idea is well worth our attention.

Otalgia. Ear-ach is another disease occasioned by the sympathy of the membranes of the ear with those which invest or surround a decaying tooth, as I have had frequent reason to believe; and is frequently relieved by filling the ear with tincture of opium. See Class I. 2. 4.

9. Dolor humeri in hepatitide. In the efforts of excluding the fæces and urine the muscles of the shoulders are exerted to compress the air in the lungs, that the diaphragm may be pressed down. Hence the distention of the tendons or fibres of these muscles is associated with the distention of the tendons or fibres of the diaphragm; and when the latter are pained by the enlargement or heat of the inflamed liver, the former sympathize with them. Sometimes but one shoulder is affected, sometimes both; it is probable that many other pains, which are termed rheumatic, have a similar origin, viz. from sensitive associations.

As no inflammation is produced in consequence of this pain of the shoulder, it seems to be owing to inaction of the membranous part from defect of the sensorial power of association, of which the primary link is the inflamed membrane of the liver; which now expends so much of the sensorial power in general by its increased action, that the membranes about the shoulder, which are links of association with it, become deprived of their usual share, and consequently fall into torpor.

10. Torpor pedum in eruptione variolarum. At the commencement of the eruption of the small-pox, when the face and breast of children are very hot, their extremities are frequently cold. This I ascribe to sensitive association between the different parts of the skin; whence when a part acts too violently, the other part is liable to act too weakly; and the skin of the face being affected first in the eruption of the small-pox, the skin of the feet becomes cold in consequence by reverse sympathy.

M. M. Cover the feet with flannel, and expose the face and bosom to cool air, which in a very short time both warms the feet and cools the face; and hence what is erroneously called a rash, but which is probably a too hasty eruption of the small-pox, disappears; and afterwards fewer and more distinct eruptions of the small-pox supervene.

11. Testium dolor nephriticus. The pain and retraction of the testicle on the same side, when there is a stone in the ureter, is to be ascribed to sensitive association; whether the connecting cause be a branch of the same nerve, or from membranes, which have been frequently affected at the same time.

12. Dolor digiti minimi sympatheticus. When any one accidentally strikes his elbow against any hard body, a tingling pain runs down to the little finger end. This is owing to sensitive association of motions by means of the same branch of a nerve, as in hemicrania from a decaying tooth the pain is owing to the sensitive association of tendons or membranes.

13. Dolor brachii in hydrope pectoris. The pain in the left arm which attends some dropsies of the chest, is explained in Sect. XXIX. 5. 2. 10. which resembles the pain of the little finger from a percussion of the nerve at the elbow in the preceding article. A numbness of this kind is produced over the whole leg, when the crural nerve is much compressed by sitting for a time with one leg crossed over the other.

Mr. ——, about sixty, had for two years been affected with difficulty of respiration on any exertion, with pain about the sternum, and of his left arm; which last was more considerable than is usual in dropsy of the chest; some months ago the pain of his arm, after walking a mile or two, became excessive, with coldness and numbness; and on the next day the back of the hand, and a part of the arm swelled, and became inflamed, which relieved the pain; and was taken for the gout, and continued several days. He after some months became dropsical both in respect to his chest and limbs, and was six or seven times perfectly relieved by one dram of saturated tincture of digitalis, taken two or three times a day for a few days in a glass of peppermint water. He afterwards breathed oxygen gas undiluted, in the quantity of six or eight gallons a day for three or four weeks without any effect, and sunk at length from general debility.

In this instructive case I imagine the pressure or stimulus of one part of the nerve within the chest caused the other part, which serves the arm, to become torpid, and consequently cold by sympathy; and that the inflammation was the consequence of the previous torpor and coldness of the arm, in the same manner as the swelling and inflammation of the cheek in tooth-ach, in the first species of this genus; and that many rheumatic inflammations are thus produced by sympathy with some distant part.

14. Diarrhœa a dentitione. The diarrhœa, which frequently attends dentition, is the consequence of indigestion; the aliment acquires chemical changes, and by its acidity acts as a cathartic; and changes the yellow bile into green, which is evacuated along with indigested parts of the coagulum of milk. The indigestion is owing to the torpor of the stomach and intestines caused by their association with the membranes of the gums, which are now stimulated into great exertion with pain; both which contribute to expend the general quantity of sensorial power, which belongs to this membranous association; and thus the stomach and intestines act with less than their natural energy. This is generally esteemed a favourable symptom in difficult dentition, as the pain of the alveolar membranes exhausts the sensorial power without producing convulsions for its relief. See Class I. 1. 4. 5. And the diarrhœa ceases, as the tooth advances.

ORDO II.

Decreased Associate Motions.

GENUS III.

Catenated with Voluntary Motions.

SPECIES.

1. Titubatio linguæ. Impediment of speech is owing to the associations of the motions of the organs of speech being interrupted or dissevered by ill-employed sensation or sensitive motions, as by awe, bashfulness, ambition of shining, or fear of not succeeding, and the person uses voluntary efforts in vain to regain the broken associations, as explained in Sect. XVII. 1. 10. and XVII. 2. 10.

The broken association is generally between the first consonant and the succeeding vowel; as in endeavouring to pronounce the word parable, the p is voluntarily repeated again and again, but the remainder of the word does not follow, because the association between it and the next vowel is dissevered.

M. M. The art of curing this defect is to cause the stammerer to repeat the word, which he finds difficult to speak, eight or ten times without the initial letter, in a strong voice, or with an aspirate before it, as arable, or harable; and at length to speak it very softly with the initial letter p, parable. This should be practised for weeks or months upon every word, which the stammerer hesitates in pronouncing. To this should be added much commerce with mankind, in order to acquire a carelessness about the opinions of others.

2. Chorea St. Viti. In the St. Vitus's dance the patient can at any time lie still in bed, which shews the motions not to be convulsive; and he can at different times voluntarily exert every muscle of his body; which evinces, that they are not paralytic. In this disease the principal muscle in any designed motion obeys the will; but those muscles, whose motions were associated with the principal one, do not act; as their association is dissevered, and thus the arm or leg is drawn outward, or inward, or backward, instead of upward or forward, with various gesticulations exactly resembling the impediment of speech.

This disease is frequently left after the itch has been too hastily cured. See Convulsio dolorifica, Class III. 1. 1. 6. A girl about eighteen, after wearing a mercurial girdle to cure the itch, acquired the Chorea St. Viti in so universal a manner, that her speech became affected as well as her limbs; and there was evidently a disunion of the common trains of ideas; as the itch was still among the younger children of the family, she was advised to take her sister as a bedfellow, and thus received the itch again; and the dance of St. Vitus gradually ceased. See Class II. 1. 5. 6.

M. M. Give the patient the itch again. Calomel a grain every night, or sublimate a quarter of a grain twice a day for a fortnight. Steel. Bark. Warm-bath. Cold-bath. Opium. Venesection once at the beginning of the disease. Electricity. Perpetual slow and repeated efforts to move each limb in the designed direction, as in the titubatio linguæ above described.

3. Risus. Laughter is a perpetual interruption of voluntary exertion by the interposition of pleasurable sensation; which not being checked by any important consequences rises into pain, and requires to be relieved or moderated by the frequent repetition of voluntary exertion. See Sect. XXXIV. 1. 4. and Class III. 1. 1. 4. and IV. 1. 3. 3.

4. Tremor ex irâ. The trembling of the limbs from anger. The interruption of the voluntary associations of motions by anger, originates from too great a part of the sensorial power being exerted on the organs of sense; whence the muscles, which ought to support the body upright, are deprived of their due quantity, and tremble from debility. See Class III. 2. 1. 1.

5. Rubor ex irâ. Redness from anger. Anger is an excess of aversion, that is of voluntarity not yet employed. It is excited by the pain of offended pride; when it is employed it becomes outrage, cruelty, insanity. The cutaneous capillaries, especially those of the face, are more mobile, that is, more easily excited into increased action, or more easily become torpid, from less variation of sensorial power, than any other parts of the system, which is owing to their being perpetually subject to the vicissitudes of heat and cold, and of extension and corrugation. Hence, when an excess of voluntarity exists without being immediately expended in the actions of the large muscles, the capillary arteries and glands acquire more energetic action, and a flushed skin is produced, with increased secretion of perspirable matter, and consequent heat, owing to the pause or interruption of voluntary action; and thus the actions of these cutaneous vessels become associated between the irascent ideas and irascent muscular actions, which are thus for a time interrupted.

6. Rubor criminati. The blushing of accused people, whether guilty or not, appears to be owing to circumstances similar to that of anger; for in these situations there is always a sudden voluntarity, or wish, of clearing their characters arises in the mind of the accused person; which, before an opportunity is given for it to be expended on the large muscles, influences the capillary arteries and glands, as in the preceding article. Whence the increased actions of the capillaries, and the consequent redness and heat, become exerted between the voluntary ideas of self-defence, and the muscular actions necessary for that purpose; which last are thus for a time interrupted or delayed.

Even in the blush of modesty or bashfulness there is a self-condemnation for some supposed defect or indecorum, and a sudden voluntarity, or wish, of self-defence; which not being expended in actions of the larger muscles excites the capillaries into action; which in these subjects are more mobile than in others.

The blush of young girls on coming into an assembly room, where they expect their dress, and steps, and manner to be examined, as in dancing a minuet, may have another origin; and may be considered as a hot fit of returning confidence, after a previous cold fit of fear.

7. Tarditas paralytica. By a stroke of the palsy or apoplexy it frequently happens, that those ideas, which were associated in trains, whose first link was a voluntary idea, have their connection dissevered; and the patient is under the necessity by repeated efforts slowly to renew their associations. In this situation those words, which have the fewest other words associated with them, as the proper names of persons or places, are the most difficult to recollect. And in those efforts of recollection the word opposite to the word required is often produced, as hot for cold, winter for summer, which is owing to our associating our ideas of things by their opposites as well as by their similitudes, and in some instances perhaps more frequently, or more forcibly. Other paralytic patients are liable to give wrong names to external objects, as using the word pigs for sheep, or cows for horses; in this case the association between the idea of the animal and the name of it is dissevered; but the idea of the class or genus of the thing remains; and he takes a name from the first of the species, which presents itself, and sometimes can correct himself, till he finds the true one.

8. Tarditas senilis. Slowness of age. The difficulty of associating ideas increases with our age; as may be observed from old people forgetting the business of the last hour, unless they impress it strongly, or by frequent repetition, though they can well recollect the transactions of their youth. I saw an elderly man, who could reason with great clearness and precision and in accurate language on subjects, which he had been accustomed to think upon; and yet did not know, that he had rang the bell by his fire-side in one minute afterwards; nor could then recollect the object he had wanted, when his servant came.

Similar to this is the difficulty which old people experience in learning new bodily movements, that is, in associating new muscular actions, as in learning a new trade or manufactury. The trains of movements, which obey volition, are the last which we acquire; and the first, which are disassociated.

ORDO II.

Decreased Associate Motions.

GENUS IV.

Catenated with External Influences.

As the diseases, which obey solar or lunar periods, commence with torpor or inactivity, such as the cold paroxysms of fevers, the torpor and consequent pain of hemicrania, and the pains which precede the fits of epilepsy and convulsion, it would seem, that these diseases are more generally owing to the diminution than to the excess of solar or lunar gravitation; as the diseases, which originate from the influence of the matter of heat, are much more generally in this country produced by the defect than by the excess of that fluid.

The periodic returns of so many diseases coincide with the diurnal, monthly, and annual rounds of time; that any one, who would deny the influence of the sun and moon on the periods of quotidian, tertian, and quartan fevers, must deny their effect on the tides, and on the seasons. It has generally been believed, that solar and lunar effect was exerted on the blood; which was thus rendered more or less stimulant to the system, as described in Sect. XXXII. 6. But as the fluid matter of gravitation permeates and covers all things, like the fluid matter of heat; I am induced to believe, that gravitation acts in its medium state rather as a causa sine quâ non of animal motion, like heat; which may disorder the system chemically or mechanically, when it is diminished; but may nevertheless stimulate it, when increased, into animal exertion.

Without heat and motion, which some philosophers still believe to be the same thing, as they so perpetually appear together, the particles of matter would attract and move towards each other, and the whole universe freeze or coalesce into one solid mass. These therefore counteract the gravitation of bodies to one center; and not only prevent the planets from falling into the sun, but become either the efficient causes of vegetable and animal life, or the causes without which life cannot exist; as by their means the component particles of matter are enabled to slide over each other with all the various degrees of fluidity and repulsion.

As the attraction of the moon countervails or diminishes the terrene gravitation of bodies on the surface of the earth; a tide rises on that side of the earth, which is turned towards the moon; and follows it, as the earth revolves. Another tide is raised at the same time on the opposite side of the revolving earth; which is owing to the greater centrifugal motion of that side of the earth, which counteracts the gravitation of bodies near its surface. For the earth and moon may be considered as two cannon balls of different sizes held together by a chain, and revolving once a month round a common center of gravity between them, near the earth's surface; at the same time that they perform their annual orbits round the sun. Whence the centrifugal force of that side of the earth, which is farthest from this center of motion, round which the earth and moon monthly revolve, is considerably greater, than the centrifugal force of that side of the earth, which is nearest it; to which should be added, that this centrifugal force not only contributes to diminish the terrene gravitation of bodies on the earth's surface on that side furthest from this center of motion, but also to increase it on that side, which is nearest it.

Another circumstance, which tends to raise the tide on the part of the earth's surface, which is most distant from the moon, is, that the attraction of the moon is less on that part of the ocean, than it is on the other parts of the earth. Thus the moon may be supposed to attract the water on the side of the earth nearest it with a power equal to three; and to attract the central parts of the earth with a power equal to two; and the water on the part of the earth most distant from the moon with a power only equal to one. Hence on the side of the earth most distant from the moon, the moon's attraction is less, and the centrifugal force round their common center of motion is greater; both which contribute to raise the tides on that side of the earth. On the side of the earth nearest the moon, the moon's attraction is so much greater as to raise the tides; though the centrifugal force of the surface of the earth round their common center of motion in some degree opposes this effect.

On these accounts, when the moon is in the zenith or nadir, the gravitation of bodies on the earth's surface will be greatest at the two opposite quadratures; that is, the greatest gravitation of bodies on the earth's surface towards her center during the lunar day is about six hours and an half after the southing, or after the northing of the moon.

Circumstances similar to these, but in a less degree, must occur in respect to the solar influence on terrestrial bodies; that is, there must be a diminution of the gravity of bodies, near the earth's surface at noon, when the sun is over them; and also at midnight from the greater centrifugal force of that side of the earth, which is most distant from the center, round which the earth moves in her annual orbit, than on the side nearest that center. Whence it likewise follows, that the gravitation of bodies towards the earth is greatest about six hours after noon, and after midnight.

Now when the sun and moon have their united gravitation on the same side of the earth, as at the new moon; or when the solar attraction coincides with the greater centrifugal motion of that side of the earth, which is furthest distant from the moon, as at the full moon; and when this happens about noon or midnight, the gravitation of terrene bodies towards the earth will be greater about six hours after noon, and after midnight, than at any other part of the lunar period; because the attraction of both these luminaries is then exerted on those sides of the earth over which they hang, which at other times of the month are more or less exerted on other parts of it.

Lastly, as heat and motion counteract the gravitation of the particles of bodies to each other, and hence become either the efficient causes of vegetable and animal life, or the causes without which life cannot exist, it seems to follow, that when our gravitation towards the earth's center is greatest, the powers of life should be the least; and hence that those diseases, which begin with torpor, should occur about six hours after the solar or lunar noon, or about six hours after the solar or lunar midnight; and this most frequently about six hours after or before the new or full moon; and especially when these happen at noon or at midnight; or lastly, according to the combination of these powers in diminishing or increasing the earth's attraction to bodies on its surface.

The returns or exacerbations of many fevers, both irritative and inflammatory, about six in the evening, and of the periodic cough described in Sect. XXXVI. 3. 9. countenance this theory. Tables might be made out to shew the combined powers of the sun and moon in diminishing the gravitation of bodies on the earth's surface, at every part of their diurnal, monthly, and annual periods; and which might facilitate the elucidation of this subject. But I am well aware of the difficulty of its application to diseases, and hope these conjectures may induce others to publish more numerous observations, and more conclusive reasonings.

SPECIES.

1. Somni periodus. The periods of sleeping and of waking are shortened or prolonged by so many other circumstances in animal life, besides the minute difference between diurnal and nocturnal solar gravitation, that it can scarcely be ascribed to this influence. At the same time it is curious to observe, that vegetables in respect to their times of sleeping more regularly observe the hour of the day, than the presence or absence of light, or of heat, as may be seen by consulting the calendar of Flora. Botanic Garden, Part II. Canto 2. l. 165. note.

Some diseases, which at first sight might be supposed to be influenced by solar periods, seem to be induced by the increasing sensibility of the system to pain during our sleeping hours; as explained in Sect. XVIII. 15. Of these are the fits of asthma, of some epilepsies, and of some hæmoptoes; all which disturb the patient after some hours sleep, and are therefore to be ascribed to the increase of our dormant sensibility. There may likewise be some doubt, whether the commencement of the pain of gout in the foot, as it generally makes its attack after sleep, should be ascribed to the increased sensibility in sleep, or to solar influence?

M. M. When asthmatic or epileptic fits or hæmoptoe occur after a certain number of hours of sleep, the patient should be forcibly awakened before the expected time by an alarm clock, and drink a cup of chocolate or lemonade.—Or a grain of opium should be given at going to bed.—In one case to prevent the too great increase of sensibility by shortening the time of sleep; and in the other by increasing the irritative motions, and expending by that means a part of the sensorial power.

2. Studii inanis periodus. Class III. 1. 2. 2. The cataleptic spasm which preceded the reverie and somnambulation in the patient, whose case is related in Sect. XIX. 2. occurred at exactly the same hour, which was about eleven in the morning for many weeks; till those periods were disturbed by large doses of opium; and must therefore be referred to some effect of solar gravitation. In the case of Master A. Sect. XXXIV. 3. as the reverie began early in the morning during sleep, there may be a doubt, whether this commenced with torpor of some organ catenated with solar gravitation; or was caused by the existence of a previous torpid part, which only became so painful as to excite the exertions of reverie by the perpetual increase of sensibility during the continuance of sleep, as in some fits of epilepsy, asthma, and hæmoptoe mentioned in the preceding article.

3. Hemicraniæ periodus. Periods of hemicrania. Class IV. 2. 2. 8. The torpor and consequent pain of some membranes on one side of the head, as over one eye, is frequently occasioned by a decaying tooth, and is liable to return every day, or on alternate days at solar or lunar periods. In this case large quantities of the bark will frequently cure the disease, and especially if preceded by venesection and a brisk cathartic; but if the offending tooth can be detected, the most certain cure is its extraction. These partial head-achs are also liable to return at the greater lunar periods, as about once a month. Five drops from a two-ounce phial of a saturated solution of arsenic twice a day for a week or two have been said to prevent the returns of this disease. See a Treatise on Arsenic by Dr. Fowler, of York. Strong errhines have also been recommended.

4. Epilepsiæ dolorificæ periodus. Class III. 1. 1. 8. The pain which induces after about an hour the violent convulsions or insanity, which constitute the painful epilepsy, generally observe solar diurnal periods for four or five weeks, and are probably governed by solar and lunar times in respect to their greater periods; for I have observed that the daily paroxysms, unless disturbed by large doses of opium, recur at very nearly the same hour, and after a few weeks the patients have recovered to relapse again at the interval of a few months. But more observations are wanted upon this subject, which might be of great advantage in preventing the attacks of this disease; as much less opium given an hour before its expected daily return will prevent the paroxysm, than is necessary to cure it, after it has commenced.

5. Convulsionis dolorificæ periodus. Class III. 1. 1. 6. The pains, which produce these convulsions, are generally left after rheumatism, and come on when the patients are become warm in bed, or have been for a short time asleep, and are therefore perhaps rather to be ascribed to the increasing sensibility of the system during sleep, than to solar diurnal periods, as in Species first and second of this Genus.

6. Tussis periodicæ periodus. Periodic cough, Class IV. 2. 1. 9. returns at exact solar periods; that described in Sect. XXXVI. 3. 9. recurred about seven in the afternoon for several weeks, till its periods were disturbed by opium, and then it recurred at eleven at night for about a week, and was then totally destroyed by opium given in very large quantities, after having been previously for a few days omitted.

7. Catameniæ periodus. Periods of menstruation. The correspondence of the periods of the catamenia with those of the moon was treated of in Sect. XXXII. 6. and can admit of no more doubt, than that the returns of the tides are governed by lunar influence. But the manner in which this is produced, is less evident; it has commonly been ascribed to some effect of the lunar gravitation on the circulating blood, as mentioned in Sect. XXXII. 6. But it is more analogous to other animal phenomena to suppose that the lunar gravitation immediately affects the solids by its influx or stimulus. Which we believe of the fluid element of heat, in which we are equally immersed; and of the electric fluid, which also surrounds and pervades us. See Sect. XXXVI. 2. 3.

If the torpor of the uterine veins, which induces the monthly periods of the catamenia, be governed by the increase of terrene gravitation; that is, by the deficiency of the counter-influence of solar and lunar gravitation; why does not it occur most frequently when the terrene gravitation is the greatest, as about six hours after the new moon, and next to that at about six hours after the full moon? This question has its difficulty; first, if the terrene gravitation be greatest about six hours after the new moon, it must become less and less about the same time every lunar day, till the end of the first quarter, when it will be the least; it must then increase daily till the full. After the full the terrene gravitation must again decrease till the end of the third quarter, when it will again be the least, and must increase again till the new moon; that is, the solar and lunar counter-gravitation is greatest, when those luminaries are vertical, at the new moon, and full moon, and least about six hours afterwards. If it was known, whether more menstruations occur about six hours after the moon is in the zenith or nadir; and in the second and fourth quarters of the moon, than in the first and third; some light would be thrown on this subject; which must in that respect wait for future observations.

Secondly, if the lunar influence produces a very small degree of quiescence, suppose of the uterine veins, at first; and if that recurs at certain periods, as of lunar days, or about 25 hours, even with less power to produce quiescence than at first; yet the quiescence will daily increase by the acquired habit acting at the same time, as explained in Sect. XII. 3. 3. till at length so great a degree of quiescence will be induced as to cause the inaction of the veins of the uterus, and consequent venous hæmorrhage. See Sect. XXXII. 6. Class I. 2. 1. 11. IV. 1. 4. 4. See the introduction to this Genus.

8. Hæmorrhoidis periodus. The periods of the piles depend on the torpor of the veins of the rectum, and are believed to recur nearly at monthly intervals. See Sect. XXVII. 2. and Class I. 2. 1. 6.

9. Podagræ periodus. The periods of gout in some patients recur at annual intervals, as in the case related above in Class IV. 1. 2. 15. in which the gouty paroxysm returned for three successive years on nearly the same day of the month. The commencement of the pain of each paroxysm is generally a few hours after midnight, and may thence either be induced by diurnal solar periods, or by the increasing sensibility during sleep, as mentioned in the first species of this genus.

10. Erysipelatis periodus. Some kinds of erysipelas which probably originate from the association of the cutaneous vessels with a diseased liver, occur at monthly periods, like the hæmorrhois or piles; and others at annual periods like the gout; as a torpor of some part I suppose always precedes the erysipelatous inflammation, the periods should accord with the increasing influence of terrene gravitation, as described in the introduction to this Genus, and in Species the seventh of it. Other periods of diseases referable to solar and lunar influence are mentioned in Sect XXXVI. and many others will probably be discovered by future observation.

11. Febrium periodus. Periods of fevers. The commencement of the cold fits of intermittent fevers, and the daily exacerbations of other fevers, so regularly recur at diurnal solar or lunar periods, that it is impossible to deny their connection with gravitation; as explained in Sect. XXXVI. 3. Not only these exacerbations of fever, and their remissions, obey the diurnal solar and lunar periods; but the preparatory circumstances, which introduce fevers, or which determine their crisises, appear to be governed by the parts of monthly lunar periods, and of solar annual ones. Thus the variolous fever in the natural small-pox commences on the 14th day, and in the inoculated small-pox on the seventh day. The fever and eruption in the distinct kind take up another quarter of a lunation, and the maturation another quarter.

The fever, which is termed canine madness, or hydrophobia, is believed to commence near the new or full moon; and, if the cause is not then great enough to bring on the disease, it seems to acquire some strength, or to lie dormant, till another, or perhaps more powerful lunation calls it into action. In the spring, about three or four years ago, a mad dog very much worried one swine confined in a sty, and bit another in the same sty in a less degree; the former became mad, refused his meat, was much convulsed, and died in about four days; this disease commenced about a month after the bite. The other swine began to be ill about a month after the first, and died in the same manner.

ORDO III.

Retrograde Associate Motions.

GENUS I.

Catenated with Irritative Motions.

Those retrograde associate motions, the first links of which are catenated with irritative motions, belong to this genus. All the retrograde motions are consequent to debility, or inactivity, of the organ; and therefore properly belong to the genera of decreased actions both in this and the former classes.

SPECIES.

1. Diabætes irritata. When the absorbents of the intestines are stimulated too strongly by spirit of wine, as in the beginning of drunkenness, the urinary absorbents invert their motions. The same happens from worms in the intestines. In other kinds of diabetes may not the remote cause be the too strong action of the cutaneous absorbents, or of the pulmonary ones? May not in such cases oil externally or internally be of service? or warm bathing for an hour at a time? In hysteric inversions of motion is some other part too much stimulated? or pained from the want of stimulus?

2. Sudor frigidus in asthmate. The cause of the paroxysms of humoral asthma is not well understood; I suppose it to be owing to a torpidity or inaction of the absorbents belonging to the pulmonary vessels, as happens probably to other viscera at the commencement of intermittent fevers, and to a consequent accumulation of fluids in them; which at length producing great irritation or uneasy sensation causes the violent efforts to produce the absorption of it. The motions of the cutaneous absorbent vessels by their association with those of the pulmonary ones become retrograde, and effuse upon the skin a fluid, which is said to be viscid, and which adheres in drops.

A few days ago I saw a young man of delicate constitution in what was called a fit of the asthma; he had about two months before had a peripneumony, and had been ever since subject to difficult respiration on exertion, with occasional palpitation of his heart. He was now seized about eight at night after some exertion of mind in his business with cold extremities, and difficulty of breathing. He gradually became worse, and in about half an hour, the palpitation of his heart and difficult respiration were very alarming; his whole skin was cold and pale, yet he did not shudder as in cold paroxysm of fever; his tongue from the point to the middle became as cold as his other extremities, with cold breath. He seemed to be in the act of dying, except that his pulse continued equal in time, though very quick. He lost three ounces of blood, and took ten drops of laudanum with musk and salt of hartshorn, and recovered in an hour or two without any cold sweat.

There being no cold sweat seems to indicate, that there was no accumulation of serous fluid in the lungs; and that their inactivity, and the coldness of the breath, was owing to the sympathy of the air-cells with some distant part. There was no shuddering produced, because the lungs are not sensible to heat and cold; as any one may observe by going from a warm room into a frosty air, and the contrary. So the steam of hot tea, which scalds the mouth, does not affect the lungs with the sensation of heat. I was induced to believe, that the whole cold fit might be owing to suppuration in some part of the chest; as the general difficulty of breathing seemed to be increased after a few days with pulse of 120, and other signs of empyema. Does the cold sweat, and the occurrence of the fits of asthma after sleep, distinguish the humoral asthma from the cold paroxysm of intermittents, or which attends suppuration, or which precedes inflammation?—I heard a few weeks afterwards, that he spit up much matter at the time he died.

3. Diabætes a timore. The motions of the absorbent vessels of the neck of the bladder become inverted by their consent with those of the skin; which are become torpid by their reverse sympathy with the painful ideas of fear, as in Sect. XVI. 8. 1. whence there is a great discharge of pale urine, as in hysteric diseases.

The same happens from anxiety, where the painful suspense is continued, even when the degree of fear is small; as in young men about to be examined for a degree at the universities the frequency of making water is very observable. When this anxiety is attended with a sleepless night, the quantity of pale urine is amazingly great in some people, and the micturition very frequent.

M. M. Opium. Joy. Consolations of friendship.

4. Diarrhœa a timore. The absorbent vessels of the intestines invert their motions by direct consent with the skin; hence many liquid stools as well as much pale urine are liable to accompany continued fear, along with coldness of the skin. The immediate cause of this is the decreased sensorial power of association, which intervenes between the actions of the absorbents of the cold skin, and those of the intestinal absorbents; the motions of the latter become on that account weakened and at length retrograde. The remote cause is the torpor of the vessels of the skin catenated with the pain of fear, as explained in Sect. XVI. 8. 1.

The capillaries of the skin consent more generally by direct sympathy with those of the lower intestines, and of the bladder; but by reverse sympathy more generally with those of the stomach and upper intestines. As appears in fevers, where the hot skin accompanies indigestion of the stomach; and in diarrhœas attended with cold extremities.

The remote cause is the torpor of the skin owing to its reverse sympathy with the painful sensual motions, or ideas, of fear; which are now actuated with great energy, so as to deprive the second link of associated motions of their due share of sensorial power. It is also probable, that the pain of fear itself may contribute to exhaust the sensorial power, even when it produces no muscular action. See Class IV. 2. 2.

5. Pallor et tremor a timore. A retrograde action of the capillaries of the skin producing paleness, and a torpor of the muscular fibres of the limbs occasioning trembling, are caused by their reverse associations with the ideas or imaginations of fear; which are now actuated with violent energy, and accompanied with great pain. The cause of these associations are explained in Sect XVI. 8. 1.

These torpid actions of the capillaries and muscles of the limbs are not caused immediately by the painful sensation of fear; as in that case they would have been increased and not decreased actions, as occurs in anger; where the painful volition increases the actions of the capillaries, exciting a blush and heat of the skin. Whence we may gain some knowledge of what is meant by depressing and exciting passions; the former confiding of ideas attended with pain, which pain occasions no muscular actions, like the pain of cold head-ach; the latter being attended with volitions, and consequent muscular exertions.

That is, the pain of fear, and the pain of anger, are produced by the exertion of certain ideas, or motions of certain nerves of sense; in the former case, the painful sensation of fear produces no muscular actions, yet it exhausts or employs so much sensorial power, that the whole system acts more feebly, or becomes retrograde; but some parts of it more so than others, according to their early associations described in Sect. XVI. 8. 1. hence the tremor of the limbs, palpitation of heart, and even syncope. In anger the painful volition produces violent muscular actions; but if previous to these any deliberation occurs, a flushed countenance sometimes, and a red skin, are produced by this superabundance of volition exerted on the arterial system; but at other times the skin becomes pale, and the legs tremble, from the exhaustion or expenditure of the sensorial power by the painful volitions of anger on the organs of sense, as by the painful sensations of fear above mentioned.

Where the passion of fear exists in a great degree, it exhausts or expends so much sensorial power, either simply by the pain which attends it, or by the violent and perpetual excitement of the terrific imaginations or ideas, that not only a cold and pale skin, but a retrograde motion of the cutaneous absorbents occurs, and a cold sweat appears upon the whole surface of the body, which probably sometimes increases pulmonary absorption; as in Class II. 1. 6. 4. and as in the cold sweats, which attend the paroxysms of humoral asthma. Hence anxiety, which is a continued pain of fear, so universally debilitates the constitution as to occasion a lingering death; which happens much more frequently than is usually supposed; and these victims of continued anxiety are said to die of a broken heart. Other kinds of paleness are described in Class I. 2. 2. 2.

M. M. Opium. Wine. Food. Joy.

6. Palpitatio cordis a timore. The palpitation of the heart from fear is owing to the weak action of it, and perhaps sometimes to the retrograde exertion of the ventricules and auricles; because it seems to be affected by its association with the capillaries, the actions of which, with those of the arteries and veins, constitute one great circle of associate motions. Now when the capillaries of the skin become torpid, coldness and paleness succeed; and with these are associated the capillaries of the lungs, whence difficult respiration; and with these the weak and retrograde actions of the heart. At the same time the absorbents of the skin, and of the bladder, and of the intestines, sometimes become retrograde, and regurgitate their contents; as appears by the pale urine in large quantities, which attends hysteric complaints along with this palpitation of the heart; and from the cold sweats, and diarrhœa; all which, as well as the hysteric complaints, are liable to be induced or attended by fear.

When fear has still more violently affected the system, there have been instances where syncope, and sudden death, or a total stoppage of the circulation, have succeeded: in these last cases, the pain of fear has employed or exhausted the whole of the sensorial power, so that not only those muscular fibres generally exerted by volition cease to act, whence the patient falls down; and those, which constitute the organs of sense, whence syncope; but lastly those, which perform the vital motions, become deprived of sensorial power, and death ensues. See Class. I. 2. 1. 4. and I. 2. 1. 10. Similar to this in some epileptic fits the patient first suddenly falls down, without even endeavouring to save himself by his hands before the convulsive motions come on. In this case the great exertion of some small part in consequence of great irritation or sensation exhausts the whole sensorial power, which was lodged in the extremities of the locomotive nerves, for a short time, as in syncope; and as soon as these muscles are again supplied, convulsions supervene to relieve the painful sensation. See Class III. 1. 1. 7.

7. Abortio a timore. Women miscarry much more frequently from a fright, than from bodily injury. A torpor or retrograde motion of the capillary arteries of the internal uterus is probably the immediate cause of these miscarriages, owing to the association of the actions of those vessels with the capillaries of the skin, which are rendered torpid or retrograde by fear. By this contraction of the uterine arteries, the fine vessels of the placenta, which are inserted into them, are detruded, or otherwise so affected, that the placenta separates at this time from the uterus, and the fetus dies from want of oxygenation. A strong young woman, in the fifth or sixth month of her pregnancy, who has since borne many children, went into her cellar to draw beer; one of the servant boys was hid behind a barrel, and started out to surprise her, believing her to be the maid-servant; she began to flood immediately, and miscarried in a few hours. See Sect. XXXIX. 6. 5. and Class I. 2. 1. 14.

8. Hysteria a timore. Some delicate ladies are liable to fall into hysteric fits from sudden fright. The peristaltic motions of the bowels and stomach, and those of the œsophagus, make a part of the great circle of irritative motions with those of the skin, and many other membranes. Hence when the cutaneous vessels become torpid from their reverse sympathy with the painful ideas of fear; these of the bowels, and stomach, and œsophagus, become first torpid by direct sympathy with those of the skin, and then feebly and ineffectually invert the order of their motions, which constitutes a paroxysm of the hysteric disease. See Class I. 3. 1. 10. These hysteric paroxysms are sometimes followed by convulsions, which belong to Class III. as they are exertions to relieve pain; and sometimes by death. See Species 9 of this Genus, and Class I. 2. 1. 4.

Indigestion from fear is to be ascribed in the same manner to the torpor of the stomach, owing to its association with the skin. As in Class IV. 1. 2. 5. IV. 2. 1.

ORDO III.

Retrograde Associate Motions.

GENUS II.

Catenated with Sensitive Motions.

SPECIES.

1. Nausea idealis. Nausea from disgustful ideas, as from nauseous stories, or disgustful sights, or smells, or tastes, as well as vomiting from the same causes, consists in the retrograde actions of the lymphatics of the throat, and of the œsophagus, and stomach; which are associated with the disgustful ideas, or sensual motions of sight, or hearing, or smell, or taste; for as these are decreased motions of the lymphatics, or of the œsophagus, or stomach, they cannot immediately be excited by the sensorial power of painful sensation, as in that case they ought to be increased motions. So much sensorial power is employed for a time on the disgustful idea, or expended in the production of inactive pain, which attends it, that the other parts of the associated chain of action, of which this disgustful idea is now become a link, is deprived of their accustomed share; and therefore first stop, and then invert their motions. Owing to deficiency of sensorial power, as explained more at large in Sect. XXXV. 1. 3.

2. Nausea a conceptu. The nausea, which pregnant women are so subject to during the first part of gestation, is owing to the reverse sympathy between the uterus and stomach, so that the increased action of the former, excited by the stimulus of the growing embryon, which I believe is sometimes attended with sensation, produces decreased actions of the latter with the disagreeable sensation of sickness with indigestion and consequent acidity. When the fetus acquires so much muscular power as to move its limbs, or to turn itself, which is called quickening, this sickness of pregnancy generally ceases.

M. M. Calcined magnesia. Rhubarb. Half a grain of opium twice a day. Recumbent posture on a sofa.

3. Vomitio vertiginosa. Sea-sickness, the irritative motions of vision, by which we balance ourselves, and preserve our perpendicularity, are disturbed by the indistinctness of their objects; which is either owing to the similarity of them, or to their distance, or to their apparent or unusual motions. Hence these irritative motions of vision are exerted with greater energy, and are in consequence attended with sensation; which, at first is agreeable, as when children swing on a rope; afterwards the irritative motions of the stomach, and of the absorbent vessels, which open their mouths into it, become inverted by their associations with them by reverse sympathy.

For the action of vomiting, as well as the disagreeable sensation of sickness, are shewn to be occasioned by defect of the sensorial power; which in this case is owing to the greater expenditure of it by the sense of vision. On the same account the vomiting, which attends the passage of a stone through the ureter, or from an inflammation of the bowels, or in the commencement of some fevers, is caused by the increased expenditure of the sensorial power by the too great action of some links of the associations of irritative motions; and there being in consequence a deficiency of the quantity required for other links of this great catenation.

It must be observed, that the expenditure of sensorial power by the retinas of the eyes is very great; which may be estimated by the perpetual use of those organs during our waking hours, and during most of our sleeping ones; and by the large diameters of the two optic nerves, which are nearly the size of a quill, or equal to some of the principal nerves, which serve the limbs.

4. Vomitio a calculo in uretere. The action of vomiting in consequence of the increased or decreased actions of the ureter, when a stone lodges in it. The natural actions of the stomach, which consist of motions subject to intermitted irritations from the fluids, which pass through it, are associated with those of the ureter; and become torpid, and consequently retrograde, by intervals, when the actions of the ureter becomes torpid owing to previous great stimulus from the stone it contains; as appears from the vomiting existing when the pain is least. When the motions of the ureter are thus lessened, the sensorial power of association, which ought to actuate the stomach along with the sensorial power of irritation, ceases to be excited into action; and in consequence the actions of the stomach become less energetic, and in consequence retrograde.

For as vomiting is a decreased action of the stomach, as explained in Sect. XXXV. 1. 3. it cannot be supposed to be produced by the pain of gravel in the ureter alone, as it should then be an increased action, not a decreased one.

The perpetual vomiting in ileus is caused in like manner by the defective excitement of the sensorial power of association by the bowel, which is torpid during the intervals of pain; and the stomach sympathizes with it. See Enteritis, Class II. 1. 2. 11. Does this symptom of vomiting indicate, whether the disease be above or below the valve of the colon? Does not the softer pulse in some kinds of enteritis depend on the sympathy of the heart and arteries with the sickness of the stomach? See Ileus and Cholera.

Hence this sickness, as well as the sickness in some fevers, cannot be esteemed an effort of nature to dislodge any offensive material; but like the sea-sickness described above, and in Sect. XX. 4. is the consequence of the associations of irritative or sensitive motions. See Class I. 1. 3. 9.

5. Vomitio ab insultu paralytico. Paralytic affections generally commence with vomiting, the same frequently happens from a violent blow with a stick on the head; this curious connection of the brain and stomach has not been explained; as it resembles the sickness in consequence of vertigo at sea, it would seem to arise from a similar cause, viz. from disturbed irritative or sensitive associations.

6. Vomitio a titillatione faucium. If the throat be slightly tickled with a feather, a nausea is produced, that is, an inverted action of the mouths of the lymphatics of the fauces, and by direct sympathy an inverted action of the stomach ensues. As these parts have frequently been stimulated at the same time into pleasurable action by the deglutition of our daily aliment, their actions become strongly associated. And as all the food, we swallow, is either moist originally, or mixed with our moist saliva in the mouth; a feather, which is originally dry, and which in some measure repels the moist saliva, is disagreeable to the touch of the fauces; at the same time this nausea and vomiting cannot be caused by the disagreeable sensation simply, as then they ought to have been increased exertions, and not decreased ones, as shewn in Section XXXV. 1. 3. But the mouths of the lymphatics of the fauces are stimulated by the dry feather into too great action for a time, and become retrograde afterwards by the debility consequent to too great previous stimulus.

7. Vomitio cute sympathetica. Vomiting is successfully stopped by the application of a blister on the back in some fevers, where the extremities are cold, and the skin pale. It was stopped by Sydenham by producing a sweat on the skin by covering the head with the bed-clothes. See Class IV. 1. 1. 3. and Suppl. I. 11. 6.

ORDO III.

Retrograde Associate Motions.

GENUS III.

Catenated with Voluntary Motions.

SPECIES.

1. Ruminatio. In the rumination of horned cattle the food is brought up from the first stomach by the retrograde motions of the stomach and œsophagus, which are catenated with the voluntary motions of the abdominal muscles.

2. Vomitio voluntaria. Voluntary vomiting. Some human subjects have been said to have obtained this power of voluntary action over the retrograde motions of the stomach and œsophagus, and thus to have been able to empty their stomach at pleasure. See Sect. XXV. 6. This voluntary act of emptying the stomach is possessed by some birds, as the pigeon; who has an organ for secreting milk in its stomach, as Mr. Hunter observed; and softens the food for its young by previously swallowing it; and afterwards putting its bill into theirs returns it into their mouths. See Sect. XXXIX. 4. 8. The pelicans use a stomach, or throat bag, for the purpose of bringing the fish, which they catch in the sea to shore, and then eject them, and eat them at their leisure. See Sect. XVI. 11. And I am well informed of a bitch, who having puppies in a stable at a distance from the house, swallowed the flesh-meat, which was given her, in large pieces, and carrying it immediately to her whelps, brought it up out of her stomach, and laid it down before them.

3. Eructatio voluntaria. Voluntary eructation. Some, who have weak digestions, and thence have frequently been induced to eruct the quantity of air discharged from the fermenting aliment in their stomachs, have gradually obtained a power of voluntary eructation, and have been able thus to bring up hogsheads of air from their stomachs, whenever they pleased. This great quantity of air is to be ascribed to the increase of the fermentation of the aliment by drawing off the gas as soon as it is produced. See Sect. XXIII. 4.

ORDO III.

Retrograde Associate Motions.

GENUS. IV.

Catenated with External Influences.

SPECIES.

1. Catarrhus periodicus. Periodical catarrh is not a very uncommon disease; there is a great discharge of a thin saline mucous material from the membranes of the nostrils, and probably from the maxillary and frontal sinuses, which recur once a day at exact solar periods; unless it be disturbed by the exhibition of opium; and resembles the periodic cough mentioned below. See Class I. 3. 2. 1. It is probably owing to the retrograde action of the lymphatics of the membranes affected, and produced immediately by solar influence.

2. Tussis periodica. Periodic cough, called nervous cough, and tussis serina. It seems to arise from a periodic retrograde action of the lymphatics of the membrane, which lines the air-cells of the lungs. And the action of coughing, which is violently for an hour or longer, is probably excited by the stimulus of the thin fluid thus produced, as well as by the disagreeable sensation attending membranous inactivity; and resembles periodic catarrh not only in its situation on a mucous membrane, but in the discharge of a thin fluid. As it is partly restrainable, it does not come under the name of convulsion; and as it is not attended with difficult respiration, it cannot be called asthma; it is cured by very large doses of opium, see a case and cure in Sect. XXXVI. 3. 9. see Class IV. 2. 4. 6. and seems immediately to be induced by solar influence.

3. Histeria a frigore. Hysteric paroxysms are occasioned by whatever suddenly debilitates the system, as fear, or cold, and perhaps sometimes by external moisture of the air, as all delicate people have their days of greater or less debility, see Class IV. 3. 1. 8.

4. Nausea pluvialis. Sickness at the commencement of a rainy season is very common among dogs, who assist themselves by eating the agrostris canina, or dog's grass, and thus empty their stomachs. The same occurs with less frequency to cats, who make use of the same expedient. See Sect. XVI. 11. I have known one person, who from his early years has always been sick at the beginning of wet weather, and still continues so. Is this owing to a sympathy of the mucous membrane of the stomach with the mechanical relaxation of the external cuticle by a moister atmosphere, as is seen in the corrugated cuticle of the hands of washing-women? or does it sympathize with the mucous membrane of the lungs, which must be affected along with the mucus on its surface by the respiration of a moister atmosphere?