Part 2 — PART II. (continued 9)

There are nevertheless many modes by which these inverted motions of the stomach and œsophagus 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.

The connexion of the motions of the stomach with irritative ideas, or motions of the organs of sense, in vertigo, is shewn in Sect. XX. and thus it appears, that many circles of association are either directly or reversely associated, or catenated, with this viscus; which will much contribute to unfold some of the symptoms of fever.

K. Tertian Associations.

The third link of associate trains of motion is sometimes actuated by reverse sympathy, with the second link, and that by reverse sympathy with the first link; so that the first and third link may act by direct sympathy, and the intermediate one by reverse sympathy. Of this instances are given in the syngultus nephriticus, Class IV. 1. 1. 7. and IV. 2. 1. At other times the tertian or quartan links of associate motions are actuated by direct sympathy; and that sometimes forwards and sometimes backwards in respect to the usual order of those trains of associate motions, as in Class IV. 1. 2. 1.

SPECIES.

1. Rubor vultûs prandorum. Flushing of the face after dinner is explained in Sect. XXXV. 1. In the beginning of intoxication the whole skin becomes florid from the association of the actions of the cutaneous arteries with those of the stomach, because vinous spirit excites the fibres of the stomach into more violent action than the stimulus of common food; and the cutaneous capillaries of the face, from their more frequent exposure to the vicissitudes of cold and heat, possess more mobility or irritability than those of other parts of the skin, as further explained in Sect. XXXIII. 2. 10. Vinegar is liable to produce this flushing of the face, which probably is owing to the quantity of vinous spirit it contains, as I believe the unfermented vegetable acids do not produce this effect. In every kind of blush the arterial blood is propelled into the capillaries faster than the venous absorption can carry it forwards into the veins, in this respect resembling the tensio phalli.

Can the beginning vinous or acetous fermentation of the aliment in weak stomachs contribute to this effect? or is it to be ascribed to the greater power of association between the arteries of the face and the fibres of the stomach in some people than in others?

M. M. Eat and drink less at a time, and more frequently. Put 20 drops of weak acid of vitriol into water to be drank at meals. Let the dress over the stomach and bowels be loose. Use no fermented liquors, or vinegar, or spice.

2. Sudor stragulis immersorum. Sweat from being covered in bed. In the commencement of an epidemic fever, in which the perpetual efforts to vomit was a distressing symptom, Dr. Sydenham discovered, that if the patient's head was for a short time covered over with the bed clothes, warmth was produced, and a sweat broke out upon the skin, and the tendency to vomit ceased. In this curious fact two trains of associated motions are excited into increased action. First, the vessels of the lungs are known to have their motion associated with those of the skin by the difficulty of breathing on going into the cold bath, as described in Sect. XXXII. 3. 2. Hence, when the vessels of the lungs become excited into stronger action, by the bad air under the bed clothes, warmed and adulterated by frequent breathing, those of the external skin soon become excited by their association into more energetic action, and generate more heat along with a greater secretion of perspirable matter. Secondly, the sympathy between the stomach and skin is evident in variety of circumstances; thus the cold air of frosty days applied to the skin for a short time increases the action of the stomach by reverse sympathy, but decreases it if continued too long by direct sympathy; so in the circumstance above mentioned the action of the stomach is increased by direct sympathy with that of the skin; and the tendency to vomit, which was owing to its diminished action, ceases.

3. Cessatio ægritudinis cute excitatâ. The cure of sickness by stimulating the skin. This is explained in the preceding article; and further noticed in IV. 2. 2. 4. and in IV. 1. 1. f.

Similar to these is the effect of a blister on the back in relieving sickness, indigestion, and heart-burn; and, on the contrary, by these symptoms being frequently induced by coldness of the extremities. The blister stimulates the cutaneous vessels into greater action; whence warmth and pain are produced at the same time, and the fibres of the stomach are excited into greater action by their association with those of the skin. It does not appear, that the concomitant pain of the blister causes the increased energy of the stomach, because the motions of it are not greater than natural; though it is sometimes difficult to determine, whether the primary part of some associated trains be connected with irritative or sensitive motions.

In the same manner a flannel shirt, to one who has not been in the habit of wearing one, stimulates the skin by its points, and thus stops vomiting in some cases; and is particularly efficacious in checking some chronical diarrhœas, which are not attended with fever; for the absorbents of the skin are thus stimulated into greater action, with which those of the intestines consent by direct sympathy.

This effect cannot be ascribed to the warmth alone of the flannel shirt, as being a covering of loose texture, and confining air in its pores, like a sponge, which air is known to be a bad conductor of heat, since in that case its use should be equally efficacious, if it were worn over a linen shirt; and an increased warmth of the room of the patient would be equally serviceable.

4. Digestio aucta frigore cutaneo. Digestion increased by coldness of the skin. Every one has experienced the increase of his appetite after walking in the cool air in frosty days; for there is at this time not only a saving of sensorial power by the less exertion of the cutaneous vessels; but, as these consent with those of the stomach and bowels, this saving of sensorial power is transferred by reverse sympathy from the cutaneous capillaries and absorbents to those of the stomach and intestines.

Hence weak people should use the cold air of winter as a cold bath; that is, they should stay in it but a short time at once, but should immerse themselves in it many times a day.

5. Catarrhus a frigore cutaneo. Catarrh from cold skin. This has been already explained in Class I. 1. 2. 7. and is further described in Sect. XXXV. 1. 3. In this disease the vessels of the membrane, which lines the nostrils, are excited into greater action; when those of the skin, with which they are associated, are excited into less action by the deficiency of external heat, by reverse sympathy; and though the pain of cold attends the torpor of the primary link of this association, yet the increased motions of the membrane of the nostrils are associated with those of the cutaneous vessels, and not with the pain of them, because no inflammation follows.

6. Absorptio cellularis aucta vomitu. In the act of vomiting the irritative motions of the stomach are inverted, and of the absorbents, which open their mouths into it; while the cutaneous, cellular, and pulmonary absorbents are induced, by reverse sympathy with them, to act with greater energy. This is seen in cases of anasarca, when long sickness and vomiting are caused by squills, or antimonial salts, or most of all by the decoction of digitalis purpurea, foxglove; and Mr. J. Hunter mentions a case, in which a large bubo, which was just ready to break, was absorbed in a few days by sickness at sea. Treatise on the Blood, p. 501, which is thus accounted for; less sensorial power is expended during sickness by the decreased action of the fibres of the stomach, and of its absorbents; as shewn in Sect. XXXV. 1. 3. whence an accumulation of it is produced, and there is in consequence a greater quantity of sensorial power for the exertion of those motions, which are associated with the absorbents of the stomach by reverse sympathy.

The reverse sympathy between the lacteal and lymphatic branches of the absorbent system have been produced by the one branch being less excited to act, when the other supplies sufficient fluid or nutriment to the sanguiferous vessels. Thus when the stomach is full, and the supply of chyle and mucus and water is in sufficient quantity; the pulmonary, cellular, and cutaneous lymphatics are not excited into action; whence the urine is pale, and the skin moist, from the defect of absorption on those surfaces.

7. Syngultus nephriticus. When a stone irritates the ureter, and that even without its being attended with pain or fever, sometimes a chronical hiccough occurs, and continues for days and weeks, instead of sickness or vomiting; which are the common symptoms. In this case the motions of the stomach are decreased by their sympathy with those of the ureter, which are increased by the stimulus of the stone in it; and the increased motions of the diaphragm seem to exist in consequence of their association with the stomach by a second reverse sympathy. This hiccough may nevertheless admit of another explanation, and be supposed to be a convulsive exertion of the diaphragm to relieve the disagreeable sensation of the stomach in consequence of its disordered irritative associations; and in that case it would belong to Class III. 1. 1. See Class IV. 2. 1. for another example of tertiary association.

M. M. Venesection. Emetic. Calomel. Cathartic, opium, oil of cinnamon from two to ten drops. Aerated alcaline water. Peruvian bark.

8. Febris irritativa. Irritative fever, described in Class I. 1. 1. 1. The diseases above explained in this genus are chiefly concerning the sympathies of the absorbent system, or the alimentary canal, which are not so much associated with the arterial system, as to throw it into disorder, when they are slightly deranged; but when any great congeries of conglomerate glands, which may be considered as the extremities of the arterial system, are affected with torpor, the whole arterial system and the heart sympathize with the torpid glands, and act with less energy; which constitutes the cold fit of fever; which is therefore at first a decreased action of the associate organ; but as this decrease of action is only a temporary effect, and an increase of exertion both of the torpid glands, and of the whole arterial system, soon follows; the hot fit of irritative fever, or fever with strong pulse, properly belongs to this class and genus of diseases.

ORDO I.

Increased Associate Motions.

GENUS II.

Catenated with Sensitive Motions.

The primary links of the associated actions of this genus are either produced or attended by painful or pleasurable sensation. The secondary links of the first ten species are attended with increased motions without inflammation, those of the remainder are attended with inflammation. All inflammations, which do not arise in the part which was previously torpid, belong to this genus; as the gout, rheumatism, erysipelas. It is probable many other inflammations may, by future observation, require to be transplanted into this class.

The circles of sensitive associate motions consist chiefly of the excretory ducts of the capillaries and of the mouths of the absorbent vessels, which constitute the membranes; and which have been induced into action at the same time; or they consist of the terminations of canals; or of parts which are endued with greater sensibility than those which form the first link of the association. An instance of the first of those is the sympathy between the membranes of the alveolar processes of the jaws, and the membranes above or beneath the muscles about the temples in hemicrania. An instance of the second is in the sympathy between the excretory duct of the lacrymal gland, and the nasal duct of the lacrymal sack. And an instance of the third is the sympathy between the membranes of the liver, and the skin of the face in the gutta rosea of inebriates.

SPECIES.

1. Lacrymarum fluxus sympatheticus. A flow of tears from grief or joy. When the termination of the duct of the lacrymal sac in the nostrils becomes affected either by painful or pleasurable sensations, in consequence of external stimulus, or by its association with agreeable or disagreeable ideas, the motions of the lacrymal gland are at the same time exerted with greater energy, and a profusion of tears succeeds by sensitive association, as explained in Sect. XVI. 8. 2.

In this case there exists a chain of associated actions, the secretion of the lacrymal gland is increased by whatever stimulates the surface of the eye, at the same time the increased abundance of tears stimulates the puncta lacrymalia into greater action; and the fluid thus absorbed stimulates the lacrymal sac, and its nasal duct in the nose into greater action. In a contrary direction of this chain of association the present increase of action is induced. First, the nasal duct of the lacrymal sac is excited into increased action by some pleasurable or painful idea, as described in Sect. XVI. 8. 2. 2d. The puncta lacrymalia or other extremity of the lacrymal sac sympathizes with it (as the two ends of all other canals sympathize with each other). 3d. With these increased motions of the puncta lacrymalia those of the excretory duct of the lacrymal gland are associated from their having so perpetually acted together. And, lastly, with the increased actions of the excretory duct of this gland are associated those of the other end of it by their frequently acting together; in the same manner as the extremities of other canals are associated; and thus a greater flow of tears is poured into the eye.

When a flow of tears is produced in grief, it is believed to relieve the violence of it, which is worthy a further inquiry. Painful sensations, when great, excite the faculty of volition; and the person continues voluntarily to call up or perform those ideas, which occasion the painful sensation; that is, the afflicted person becomes so far insane or melancholy; but tears are produced by the sensorial faculty of association, and shew that the pain is so far relieved as not to excite the excessive power of volition, or insanity, and are therefore a sign of the abatement of the painful state of grief, rather than a cause of that abatement. See Class III. 1. 2. 10.

2. Sternutatio a lumine. Some persons sneeze from looking up at the light sky in a morning after coming out of a dark bedroom. The olfactory nerves are brought into too great action by their sympathy with the optic nerves, or by their respective sympathies with some intervening parts, as probably with the two extremities of the lacrymal sac; that is, with the puncta lacrymalia and the nasal duct. See Class II. 1. 1. 3.

3. Dolor dentium Stridore. Tooth-edge from grating sounds, and from the touch of certain substances, and even from imagination alone, is described and explained in Sect. XVI. 10. The increased actions of the alveolar vessels or membranes are associated with the ideas, or sensual motions of the auditory nerves in the first case; and of those of the sense of touch, in the second case; and by imagination, or ideas exerted of painful sensation alone, in the last.

4. Risus sardonicus. A disagreeable smile attends inflammations of the diaphragm arising from the associations of the reiterated exertions of that muscle with those of the lips and cheeks in laughing. See Diaphragmitis, Class II. 1. 2. 6.

5. Salivæ fluxus cibo viso. The flow of saliva into the mouths of hungry animals at the sight or smell of food is seen in dogs standing round a dinner-table. The increased actions of the salivary glands have been usually produced by the stimulus of agreeable food on their excretory ducts during the mastication of it; and with this increased action of their excretory ducts the other terminations of those glands in the capillary arteries have been excited into increased action by the mutual association of the ends of canals; and at the same time the pleasurable ideas, or sensual motions, of the sense of smell and of sight have accompanied this increased secretion of saliva. Hence this chain of motions becomes associated with those visual or olfactory ideas, or with the pleasure, which produces or attends them.

6. Tensio mamularum viso puerulo. The nipples of lactescent women are liable to become turgid at the sight of their young offspring. The nipple has generally been rendered turgid by the titillation of the lips or gums of the child in giving suck; the visible idea of the child has thus frequently accompanied this pleasurable sensation of parting with the milk, and turgescence of the tubes, which constitute the nipple. Hence the visual idea of the child, and the pleasure which attends it, become associated with those increased arterial actions, which swell the cells of the mamula, and extend its tubes; which is very similar to the tensio phalli visâ muliere nudâ etiam in insomnio.

7. Tensio penis in hydrophobia. An erection of the penis occurs in the hydrophobia, and is a troublesome symptom, as observed by Cœlius Aurelianus, Fothergill, and Vaughn, and would seem to be produced by an unexplained sympathy between the sensations about the fauces and the penis. In men the hair grows about both these parts, the voice changes, and the neck thickens at puberty. In the mumps, when the swellings about the throat subsides, the testicles are liable to swell. Venereal infection received by the penis is very liable to affect the throat with ulcers. Violent coughs, with soreness or rawness about the fauces are often attended with erection of the penis; which is also said to happen to male animals, that are hanged; which last circumstance has generally been ascribed to the obstruction of the circulation of the blood, but is more probably occasioned by the stimulus of the cord in compressing the throat; since if it was owing to impeded circulation it ought equally to occur in drowning animals.

In men the throat becomes so thickened at the time of puberty, that a measure of this is used to ascertain the payment of a poll-tax on males in some of the islands of the Mediterranean, which commences at puberty; a string is wrapped twice round the thinnest part of the neck, the ends of it are then put into each corner of the mouth; and if, when thus held in the teeth, it passes readily over the head, the subject is taxable.

It is difficult to point out by what circumstance the sensitive motions of the penis and of the throat and nose become associated; I can only observe, that these parts are subjected to greater pleasurable sensations than any other parts of the body; one being designed to preserve ourselves by the pleasure attending the smell and deglutition of food, and the other to ensure the propagation of our species; and may thus gain an association of their sensitive motion by their being eminently sensible to pleasure. See Class I. 3. 1. 11. and III. 1. 1. 15. and Sect. XVI. 5.

In the female sex this association between the face, throat, nose, and pubis does not exist; whence no hair grows on their chins at the time of puberty, nor does their voices change, or their necks thicken. This happens probably from there being in them a more exquisite sensitive sympathy between the pubis and the breasts. Hence their breasts swell at the time of puberty, and secrete milk at the time of parturition. And in the parotitis, or mumps, the breasts of women swell, when the tumor of the parotitis subsides. See Class I. 1. 2. 15. Whence it would appear, that their breasts possess an intermediate sympathy between the pubis and the throat; as they are the seat of a passion, which men do not possess, that of suckling children.

8. Tenesmus calculosus. The sphincter of the rectum becomes painful or inflamed from the association of its sensitive motions with those of the sphincter of the bladder, when the latter is stimulated into violent pain or inflammation by a stone.

9. Polypus narium ex ascaridibus? The stimulation of ascarides in the rectum produces by sensitive sympathy an itching of the nose, as explained in IV. 2. 2. 6; and in three children I have seen a polypus in the nose, who were all affected with ascarides; to the perpetual stimulation of which, and the consequent sensitive association, I was led to ascribe the inflammation and thickening of the membrane of the nostrils.

10. Crampus surarum in cholera. A cramp of the muscles of the legs occurs in violent diarrhœa, or cholera, and from the use of too much acid diet in gouty habits. This seems to sympathize with uneasy sensation in the bowels. See Class III. 1. 1. 14. This association is not easily accounted for, but is analogous in some degree to the paralysis of the muscles of the arms in colica saturnina. It would seem, that the muscles of the legs in walking get a sympathy with the lower parts of the intestines, and those of the arms in variety of employment obtain a sympathy with the higher parts of them. See Cholera and Ileus.

11. Zona ignea nephritica. Nephritic shingles. The external skin about the loins and sides of the belly I suppose to have greater mobility in respect to sensitive association, than the external membrane of the kidney; and that their motions are by some unknown means thus associated. When the torpor or beginning inflammation of this membrane ceases, the external skin becomes inflamed, in its stead, and a kind of herpes, called the shingles, covers the loins and sides of the belly. See Class II. 1. 5. 9.

12. Eruptio variolarum. After the inflammation of the inoculated arm has spread for a quarter of a lunation, it affects the stomach by reverse sympathy; that is, the actions of the stomach are associated with those of the skin; and as much sensorial power is now exerted on the inflamed skin, the other part of this sensitive association is deprived of its natural share, and becomes torpid, or inverts its motions. After this torpor of the stomach has continued a time, and much sensorial power is thus accumulated; other parts of the skin, which are also associated with it, as that of the face first, are thrown into partial inflammation; that is, the eruptions of the small-pox appear on the face.

For that the variolous matter affects the stomach previous to its eruption on the skin appears from the sickness at the commencement of the fever; and because, when the morbid motions affect the skin, those of the stomach cease; as in the gout and erysipelas, mentioned below. The consent between the stomach and the skin appears in variety of other diseases; and as they both consist of surfaces, which absorb and secrete a quantity of moisture, their motions must frequently be produced together or in succession; which is the foundation of all the sympathies of animal motions, whether of the irritative, sensitive, or voluntary kinds.

Now as the skin, which covers the face, is exposed to greater variations of heat and cold than any other part of the body; it probably possesses more mobility to sensitive associations, not only than the stomach, but than any other part of the skin; and is thence affected at the eruption of the small-pox with violent action and consequent inflammation, by the association of its motions with those of the stomach, a day before the other parts of the skin; and becomes fuller of pustules, than any other part of the body. See Class II. 1. 3. 9.

It might be supposed, that the successive swelling of the hands, when the face subsides, at the height of the small-pox, and of the feet, when the hands subside, were governed by some unknown associations of those parts of the system; but these successions of tumor and subsidence more evidently depend on the times of the eruption of the pustules on those parts, as they appear a day sooner on the face than on the hands, and a day sooner on the hands than on the feet, owing to the greater comparative mobility of those parts of the skin.

13. Gutta rosea stomatica. Stomatic red face. On drinking cold water, or cold milk, when heated with exercise, or on eating cold vegetables, as raw turnips, many people in harvest-time have been afflicted with what has been called a surfeit. The stomach becomes painful, with indigestion and flatulency, and after a few days an eruption of the face appears, and continues with some relief, but not with entire relief; as both the pimpled face and indigestion are liable to continue even to old age.

M. M. Venesection. A cathartic with calomel. Then half a grain of opium twice a day for many weeks. If saturated solution of arsenic three or five drops twice or thrice a day for a week?

14. Gutta rosea hepatica. The rosy drop of the face of some drinking people is produced like the gout described below, in consequence of an inflamed liver. In these constitutions the skin of the face being exposed to greater variation of heat and cold than the membranes of the liver, possesses more mobility than those hepatic membranes; and hence by whatever means these membranes are induced to sympathize, when this sensitive association occurs, the cutaneous vessels of the face run into greater degrees of those motions, which constitute inflammation, than previously existed in the membranes of the liver; and then those motions of the liver cease. See Class II. 1. 4. 6.

An inflammation of the liver so frequently attends the great potation of vinous spirit, there is reason to suspect, that this viscus itself becomes inflamed by sensitive association with the stomach; or that, when one termination of the bile-duct, which enters the duodenum is stimulated violently, the other end may become inflamed by sensitive association.

15. Podagra. The gout, except when it affects the liver or stomach, seems always to be a secondary disease, and, like the rheumatism and erysipelas mentioned below, begins with the torpor of some distant part of the system.

The most frequent primary seat of the gout I suppose to be the liver, which is probably affected with torpor not only previous to the annual paroxysms of the gout, but to every change of its situation from one limb to another. The reasons, which induce me to suspect the liver to be first affected, are not only because the jaundice sometimes attends the commencement of gout, as described in Sect. XXIV. 2. 8. but a pain also over the pit of the stomach, which I suppose to be of the termination of the bile-duct in the duodenum, and which is erroneously supposed to be the gout of the stomach, with indigestion and flatulency, generally attends the commencement of the inflammation of each limb. See Arthritis ventriculi, Class I. 2. 4. 6. In the two cases, which I saw, of the gout in the limbs being preceded by jaundice, there was a cold shivering fit attended the inflammation of the foot, and a pain at the pit of the stomach; which ceased along with the jaundice, as soon as the foot became inflamed. This led me to suspect, that there was a torpor of the liver, and perhaps of the foot also, but nevertheless the liver might also in this case be previously inflamed, as observed in Sect. XXIV. 2. 8.

Now as the membranes of the joints of the feet suffer greater variations of heat and cold than the membranes of the liver, and are more habituated to extension and contraction than other parts of the skin in their vicinity; I suppose them to be more mobile, that is, more liable to run into extremes of exertion or quiescence; and are thence more susceptible of inflammation, than such parts as are less exposed to great variations of heat and cold, or of extension and contraction.

When a stone presses into the sphincter of the bladder, the glans penis is affected with greater pain by sympathy, owing to its greater sensibility, than the sphincter of the bladder; and when this pain commences, that of the sphincter ceases, when the stone is not too large, or pushed too far into the urethra. Thus when the membrane, which covers the ball of the great toe, sympathizes with some membranous part of a torpid or inflamed liver; this membrane of the toe falls into that kind of action, whether of torpor or inflammation, with greater energy, than those actions excited in the diseased liver; and when this new torpor or inflammation commences, that with which it sympathises ceases; which I believe to be a general law of associated inflammations.

The paroxysms of the gout would seem to be catenated with solar influence, both in respect to their larger annual periods, and to their diurnal periods—See Sect. XXXVI. 3. 6.—as the former occur about the same season of the year, and the latter commence about an hour before sun-rise; nevertheless the annual periods may depend on the succession of great vicissitudes of cold and heat, and the diurnal ones on our increased sensibility to internal sensations during sleep, as in the fits of asthma, and of some epilepsies. See Sect. XVIII. 15.

In respect to the pre-remote cause or disposition to the gout, there can be no doubt of its individually arising from the potation of fermented or spirituous liquors in this country; whether opium produces the same effect in the countries, where it is in daily use, I have never been well informed. See Sect. XXI. 10, where this subject is treated of; to which I have to add, that I have seen some, and heard of others, who have moderated their paroxysms of gout, by diminishing the quantity of fermented liquors, which they had been accustomed to; and others who, by a total abstinence from fermented liquors, have entirely freed themselves from this excruciating malady; which otherwise grows with our years, and curtails or renders miserable the latter half, or third, of the lives of those, who are subject to it. The remote cause is whatever induces temporary torpor or weakness of the system; and the proximate cause is the inirritability, or defective irritation, of some part of the system; whence torpor and consequent inflammation. The great Sydenham saw the beneficial effects of the abstinence from fermented liquors in preventing the gout, and adds, "if an empiric could give small-beer only to gouty patients as a nostrum, and persuade them not to drink any other spirituous fluids, that he might rescue thousands from this disease, and acquire a fortune for his ingenuity." Yet it is to be lamented, that this accurate observer of diseases had not resolution to practise his own prescription, and thus to have set an example to the world of the truth of his doctrine; but, on the contrary, recommends Madeira, the strongest wine in common use, to be taken in the fits of the gout, to the detriment of thousands; and is said himself to have perished a martyr to the disease, which he knew how to subdue!

As example has more forcible effect: than simple assertion, I shall now concisely relate my own case, and that of one of my most respected friends. E. D. was about forty years of age, when he was first seized with a fit of the gout. The ball of his right great toe was very painful, and much swelled and inflamed, which continued five or six days in spite of venesection, a brisk cathartic with ten grains of calomel, and the application of cold air and cold water to his foot. He then ceased to drink ale or wine alone; confining himself to small beer, or wine diluted with about thrice its quantity of water. In about a year he suffered two other fits of the gout, in less violent degree. He then totally abstained from all fermented liquors, not even tasting small-beer, or a drop of any kind of wine; but eat plentifully of flesh-meat, and all kinds of vegetables, and fruit, using for his drink at meals chiefly water alone, or lemonade, or cream and water; with tea and coffee between them as usual.

By this abstinence from fermented liquors he kept quite free from the gout for fifteen or sixteen years; and then began to take small-beer mixed with water occasionally, or wine and water, or perry and water, or cyder and water; by which indulgence after a few months he had again a paroxysm of gout, which continued about three days in the ball of his toe; which occasioned him to return to his habit of drinking water, and has now for above twenty years kept in perpetual health, except accidental colds from the changes of the seasons. Before he abstained from fermented or spirituous liquors, he was frequently subject to the piles, and to the gravel, neither of which he has since experienced.

In the following case the gout was established by longer habit and greater violence, and therefore required more cautious treatment. The Rev. R. W. was seized with the gout about the age of thirty-two, which increased so rapidly that at the age of forty-one he was confined to his room seven months in that year; he had some degree of lameness during the intervals, with chalky swellings of his heels and elbows. As the disease had continued so long and so violently, and the powers of his digestion were somewhat weakened, he was advised not entirely to leave off all fermented liquors; and as small-beer is of such various strength, he was advised to drink exactly two wine glasses, about four ounces, of wine mixed with three or four times its quantity of water, with or without lemon and sugar, for his daily potation at dinner, and no other fermented liquor of any kind; and was advised to eat flesh-meat with any kind of boiled vegetables, and fruit, with or without spice. He has now scrupulously continued this regimen for above five years, and has had an annual moderate gouty paroxysm of a few weeks, instead of the confinement of so many months, with great health and good spirits during the intervals.

The following is a more particular account of the history of this case; being part of a letter which Mr. Wilmot wrote on that subject at my entreaty.

"I entered into the army with an excellent constitution at the age of fifteen. The corps I served in was distinguished by its regularity, that is, the regular allowance of the mess was only one pint of wine per man each day; unless we had company to dine with us; then, as was the general custom of the time, the bottle circulated without limit. This mode of living, though by no means considered as excess for men, was certainly too great for a youth of my age. This style of living I continued, when with the regiment, till the latter end of the year 1769, when I had the misfortune to sleep in a damp bed at Sheffield on a journey to York, but arrived there before I felt the ill effects of it. I was then seized with a violent inflammatory rheumatism with great inflammation of my eyes, and was attended by Dr. Dealtry; so violent was the disorder, that I was bled for it eight times in less than a fortnight; and was three months, before I could consider my health perfectly re-established. Dr. Dealtry told me, that I should be subject to similar attacks for many years; and that he had no doubt, from the tendency he found in my habit to inflammation, that, when I was farther advanced in life, I should change that complaint for the gout. He predicted truly; for the three succeeding winters I had the same complaint, but not so violently; the fourth winter I escaped, and imputed my escape to the continuance of cold bathing during the whole of that winter; after that I never escaped it, till I had a regular and severe fit of the gout: after the first attack of rheumatic fever I was more abstemious in my manner of living, though when in company I never subjected myself to any great restraint. In the year 1774 I had quitted the army, and being in a more retired situation, was seldom led into any excess; in 1776 and 1777 I was in the habit of drinking a good deal of wine very frequently, though not constantly. After that period till the year 1781, I drank a larger quantity of wine regularly, but very seldom to any degree of intoxication. I lived much at that time in the society of some gentlemen, who usually drank nearly a bottle of wine daily after dinner. I must here however observe, that at no part of my life was I accustomed to drink wine in an evening, and very seldom drank any thing more than a single half-pint glass of some sort of spirits diluted with much water. Till the year 1781 I had always been accustomed to use very violent and continued exercise on horseback; in the winter months I pursued all field diversions, and in the summer months I rode frequent and long journeys; and with this exercise was liable to perspire to great excess; besides which I was subject to very profuse night-sweats, and had frequently boils break out all over me, especially in the spring and autumn; for which I took no medicine, except a little flour of sulphur with cream of tartar in honey.

"You will observe I bring every thing down to the date of 1781. In the month of October in that year, when I was just entered into the thirty-second year of my age, I had the first attack of gout; that fit was very severe, and of many weeks continuance. I now determined upon a more abstemious method of living, in respect to wine; and indeed the society, in which I had before been accustomed to live, being considerably changed, I had less frequent temptations to excess. From this time I enjoyed the most perfect good state of health till August 1784, when I had my second attack of gout. I never perfectly recovered from this attack through the succeeding winter, and in March 1785 was advised to try the Bath waters, and drank them under the direction of one of the faculty of that place. I was there soon seized with a fever, and a slight attack of gout in one knee. I should observe, that when I set out from home, I was in a weak and low state, and unequal to much fatigue; as appeared by my having a fainting fit one day on the road, after having travelled only about fifty miles; in the course of the summer I had two or three more slight attacks of gout of less consequence, till the month of October; when I was afflicted with it all over me in such a manner, as to be without the possibility of the least degree of removal for some days; and was about two months without being able to get into the air. This was the severest attack I had then experienced; though I have since had several equally severe. In the course of this summer I had a fall with my horse; and soon after it, having discovered an enlargement on one elbow, I concluded I had hurt it at that time; but in the course of this last attack having a similar enlargement on the other elbow, I found my mistake, and that they were collections of gouty matter; these increased to the size of pullet's eggs, and continue in that state. I had soon after similar enlargements on my heels; the right heel being severely bruised, I was under the necessity of having it lanced, and a large quantity of chalky matter was discharged from it; and have since that time frequently had chalky matter taken from it, and sometimes small bits of apparently perfect chalk. My right hand soon was afflicted in the same way, and I have scarcely a joint on those fingers now in a natural state. My left hand has escaped tolerably well. After this last attack (viz. October 1785), I had two or three slight attacks before the month of June 1787, when I had a very severe intermittent fever; from that time I continued very well till the latter end of the year, when I began to feel the gout about me very much, but was not confined by it. I was in this state advised to try what is called the American Recipe (gum guaiacum and nitre dissolved in spirits); it had apparently been of essential service to a friend of mine, who from the inability to walk a mile for some years, was believed to be restored by the use of this medicine to a good state of health, so as to walk ten miles a day. In addition to this medicine I drank, as my common beverage with my meals, spruce beer. I had so high an opinion of this medicine in the gout, and of spruce beer as an antiscorbutic, that I contemplated with much satisfaction, and with very little doubt, the perfect restoration of my health and strength; but I was miserably deceived; for in September 1788 I was seized with the gout in a degree that none but arthritics, and indeed but few of those, can easily conceive. From this time till August 1789 I scarcely ever passed a comfortable day; seven months of this time I had been confined, my health seemed much impaired, my strength was diminished, and my appetite almost gone. In this state my friends pressed me to consult you. I was unwilling for some time to do it, as I had lost all hope of relief; however, when I had determined to apply to you, I likewise determined to give up every prejudice of my own respecting my case, and to adhere most strictly to your advice. On the 20th of August 1789 I consulted you, on the 25th I entered upon the regimen, which you prescribed, and which was as follows.

"Drink no malt liquor on any account. Let your beverage at dinner consist of two glasses of wine diluted with three half-pints of water. On no account drink any more wine or spirituous liquors in the course of the day; but, if you want more liquid, take cream and water, or milk and water, or lemonade, with tea, coffee, chocolate. Use the warm bath twice a week for half an hour before going to bed, at the degree of heat which is most grateful to your sensations. Eat meat constantly at dinner, and with it any kind of tender vegetables you please. Keep the body open by two evacuations daily, if possible without medicine, if not take the size of a nutmeg of lenitive electuary occasionally, or five grains of rhubarb every night. Use no violent exercise, which may subject yourself to sudden changes from heat to cold; but as much moderate exercise as may be, without being much fatigued or starved with cold. Take some supper every night; a small quantity of animal food is preferred; but if your palate refuses this, take vegetable food, as fruit pie, or milk; something should be eaten, as it might be injurious to you to fast too long." To the whole of this I adhered most scrupulously, and soon found my appetite improve, and with it my strength and spirits. I had in December a fevere attack, and two or three slight ones in the course of twelve months; but the improvement in the general state of my health induced me to persevere. On the 18th of August 1790 I had another severe attack, but it went off easier than before, and I soon recovered sufficiently to go to Buxton, which you advised me to, and from which I reaped great benefit; nevertheless on the 29th of December I had a slight attack in comparison of some that I had before experienced, and from that time I was free from gout, and enjoyed my health perfectly well till the fourth week in October 1791; from that till the third week in October 1792; from that till the third week in October 1793; and from that till June 1794. From what happened for the last three years I dreaded the month of October; but I escaped then, and have enjoyed my health most perfectly ever since till within the last week, that I have had a slight attack in one knee, which is nearly gone, without any symptom to lead me to suppose that it will go further.

"I adhered to your advice most scrupulously for the first year; and in regard to the not drinking malt liquor, and taking only the two glasses of wine with water, I have never deviated but two days; and then the first day I only drank one glass of ale and one glass of Champaigne; on the second only one glass of Champaigne. With regard to the warm bath, I only use it now when I have gouty symptoms upon me, and in such situations I find it of infinite service; and in other respects I continue to live according to your direction.

"Many persons have laughed at the idea of my perseverance in a system, which has not been able to cure the gout after five years trial; but such persons are either ignorant of what I before suffered, or totally unacquainted with the nature of the disorder. Under the blessing of Providence, by an adherence to your advice, I am reaping all the benefit you flattered me I might expect from it, viz. my attacks less frequent, my sufferings less acute, and an improvement in the general state of my health.

"I have been particular in this account of myself at your request, and am, Sir, &c.

There are situations nevertheless in which a paroxysm of gout has been believed to be desirable, as relieving the patient from other disagreeable diseases, or debilities, or sensations. Thus when the liver is torpid, a perpetual uneasiness and depression of spirits occur; which a fit of gout is supposed to cure by a metastasis of the disease. Others have acquired epileptic fits, probably from the disagreeable sensation of a chronically inflamed liver; which they suppose the pain and inflammation of gout would relieve. When gouty patients become much debilitated by the progress of the disease, they are liable to dropsy of the chest, which they suppose a fit of the gout would relieve. But in all these cases the attempt to procure a paroxysm of gout by wine, or aromatics, or volatiles, or blisters, or mineral waters, seldom succeeds; and the patients are obliged to apply to other methods of relief adapted to their particular cases. In the two former situations small repeated doses of calomel, or mercurial unction on the region of the liver may succeed, by giving new activity to the vessels of the liver, either to secrete or to absorb their adapted fluids, and thus to remove the cause of the gout, rather than to promote a fit of it. In the last case the tincture of digitalis, and afterwards the class of sorbentia, must be applied to.

M. M. In young strong patients the gout should be cured by venesection and cathartics and diluents, with poultices externally. But it has a natural crisis by producing calcareous matter on the inflamed membrane, and therefore in old enfeebled people it is safest to wait for this crisis, attending to the natural evacuations and the degree of fever; and in young ones, where it is not attended with much fever, it is customary and popular not to bleed, but only to keep the body open with aloes, to use gentle sudorifics, as neutral salts, and to give the bark at the decline of the fit; which is particularly useful where the patient is much debilitated. See Arthritis ventriculi, Class I. 2. 4. 6. and Sect. XXV. 17.

When there is not much fever, and the patient is debilitated with age, or the continuance of the disease, a moderate opiate, as twenty drops of tincture of opium, or one grain of solid opium, may be taken every night with advantage. Externally a paste made with double the quantity of yeast is a good poultice; and booterkins made with oiled silk, as they confine the perspirable matter, keep the part moist and supple, and thence relieve the pain like poultices.

The only safe way of moderating the disease is by an uniform and equal diminution, or a total abstinence from fermented liquors, with the cautions directed in Sect. XII. 7. 8. The continued use of strong bitters, as of Portland's powder, or bark, has been frequently injurious, as spoken of in the Materia Medica, Art. IV. 2. 11.

One of my acquaintance, who was much afflicted with the gout, abstained for about half a year from beer and wine; and not having resolution to persist, returned to his former habits of potation in less quantity; and observed that he was then for one winter stronger and freer from the gout than usual. This however did not long continue, as the disease afterwards returned with its usual or increased violence. This I think is a circumstance not unlikely to occur, as opium has a greater effect after its use has been a while intermitted; and the debility or torpor, which is the cause of gout, is thus for a few months prevented by the greater irritability of the system, acquired during the lessened use of fermented liquor.

For the same reason an ounce of spirituous tincture of guaiacum, or of bark, is said to have for some time prevented returns of the gout; which has afterwards, like all other great stimuli when long continued, been succeeded by greater debility, and destroyed the patient. This seems to have been exemplified in the case of the ingenious Dr. Bown, see Preface to his Elementa Medicinæ; he found temporary relief from the stimulus of wine, regardless of its future effects.

16. Rheumatismus. Acute rheumatism. There is reason to suspect, that rheumatic inflammations, like the gouty ones, are not a primary disease; but that they are the consequence of a translation of morbid action from one part of the system to another. This idea is countenanced by the frequent change of place of rheumatic-like gouty inflammations, and from their attacking two similar parts at the same time, as both ankles and both wrists, and these attacks being in succession to each other. Whereas it is not probable that both feet or both hands should at the same time be equally exposed to any external cause of the disease, as to cold or moisture; and less so that these should occur in succession. Lastly, from the inflammatory diathesis in this disease being more difficult to subdue, and more dangerous in event, than other common inflammations, especially to pregnant women, and in weak constitutions.

From this idea of the rheumatism being not a primary disease, like the gout, but a transferred morbid action owing to the previous torpor of some other part of the system, we perceive why it attacks weak people with greater pertinacity than strong ones; resisting or recurring again and again after frequent evacuations, in a manner very different from primary inflammations; because the cause is not removed, which is at a distance from the seat of the inflammation.

This also accounts for rheumatic inflammations so very rarely terminating in suppuration, because like the gout the original cause is not in the inflamed part, and therefore does not continue to act after the inflammation commences. Instead of suppuration in this disease, as well as in the gout, a quantity of mucus or coagulable lymph is formed on the inflamed membrane; which in the gout changes into chalkstones, and in the rheumatism is either reabsorbed, or lies on the membrane, producing pains on motion long after the termination of the inflammation, which pains are called chronic rheumatism. The membranes, which have thus been once or repeatedly inflamed, become less mobile, or less liable to be affected by sympathy, as appears by the gout affecting new parts, when the joints of the foot have been frequently inflamed by it; hence as the cause of the inflammation does not exist in the inflamed part, and as this part becomes less liable to future attacks, it seldom suppurates.

Secondly, when rheumatism affects the muscles of the chest, it produces symptoms similar to pleurisy, but are distinguished from that by the patient having previously suffered rheumatic affections in other parts, and by the pertinacity or continuance of the inflammatory state of the patient, this should be termed pleurodyne rheumatica.

Thirdly, when rheumatic inflammation affects the bowels, it produces a disease very different from enteritis, or common inflammation of the bowels, and should be termed enteralgia rheumatica. The pain is less than in enteritis, and the disease of longer continuance, with harder pulse, and the blood equally sizy. It is attended with frequent dejections, with much mucus, and previous griping pains, but without vomiting; and differs perhaps from dysentery from its not being attended with bloody stools, and not being infectious.

Fourthly, there is another kind of rheumatism attended with debility, which suppurates, and should be termed rheumatismus suppurans. It is generally believed to be the gout, till suppuration takes place on the swelled joint; and, as the patient sinks, there are sloughs formed over the whole mouth; and he seems to be destroyed by inflammation or gangrene of the mucous membranes. I have twice seen this disease in patients about sixty. Some other diseases are erroneously called rheumatic, as hemicrania, and odontalgia. See Sect. XXVI. 3.

M.M. In the three former kinds venesection repeatedly. Cathartics. Antimonials. Diluents. Neutral salts. Oil. Warm bath. Afterwards the bark. Opium with or without ipecacuanha; but not till the patient is considerably weakened. Sweats forced early in the disease do injury. Opium given early in the disease prolongs it. In the last kind, gentle stimulants, as wine and water, mucilage, sorbentia.

The following is a case of suppurative rheumatism. Mr. F——, about sixty, was supposed to have the gout in his hand, which however suppurated, and it was then called the suppurative rheumatism. He had lived rather intemperately in respect to wine, and was now afflicted with a tendency to inflammation of the mucous membranes. As he lay on the bed half resupine, propped up with pillows, and also slept in that posture, his lower jaw dropped by its own weight, when the voluntary power of the muscles was suspended. The mucus of his mouth and throat became quite dry, and at length was succeeded with sloughs; this was a most distressing circumstance to him, and was in vain endeavoured to be relieved by supporting his jaw by slender steel springs fixed to his night-cap, and by springs of elastic gum. The sloughs spread and seemed to accelerate his death. See Class I. 1. 3. 2.

17. Erysipelas. The erysipelas differs from the zona ignea, and other species of herpes, in its being attended with fever, which is sometimes of the sensitive irritated or inflammatory kind, with strong and full pulse; and at other times with weak pulse and great inirritability, as when it precedes or attends mortifications. See Class II. 1. 3. 2.

Like the zona ignea above described, it seems to be a secondary disease, having for its primary part the torpor or inflammation of some internal or distant membrane, as appears from its so frequently attending wounds; sometimes spreading from issues over the whole limb, or back, by sympathy with a tendon or membrane, which is stimulated by the pease in them. In its more violent degree I suppose that it sympathizes with some extensive internal membranes, as of the liver, stomach, or brain. Another reason, which countenances this idea, is, that the inflammation gradually changes its situation, one part healing as another inflames; as happens in respect to more distant parts in gout and rheumatism; and which seems to shew, that the cause of the disease is not in the same place with the inflammation. And thirdly, because the erysipelas of the face and head is liable to affect the membranes of the brain; which were probably in these cases the original or primary seat of the disease; and lastly, because the fits of erysipelas, like those of the gout, are liable to return at certain annual or monthly periods, as further treated of in Class II. 1. 3. 2.

Many cases of erysipelas from wounds or bruises are related in Default's Surgical Journal, Vol. II. in which poultices are said to do great injury, as well as oily or fatty applications. Saturnine solutions were sometimes used with advantage. A grain of emetic tartar given to clear the stomach and bowels, is said to be of great service.

18. Testium tumor in gonorrhœa. Mr. Hunter in his Treatise on the Venereal Disease observes, that the tumor of the testes in gonorrhœa arises from their sympathy with the inflammation of the urethra; and that they are not similar to the actions arising from the application of venereal matter, whether by absorption or otherwise; as they seldom or never suppurate; and when suppuration happens, the matter produced is not venereal. Treatise on Venereal Disease, p. 53.

19. Testium tumor in parotidite. The sympathy between some parts about the throat and the genitals has been treated of in Class IV. 1. 2. 7. The swelling of the testes, when that of the parotis subsides, seems to arise from the association of successive action; as the tension of the penis in hydrophobia appears to arise from the previous synchronous associations of the sensitive motions of these parts; but the manner of the production of both these associations is yet very obscure. In women a swelling of the breasts often succeeds the decline of the mumps by another wonderful sympathy. See Class IV. 1. 2. 7. and I. 1. 2. 15. In many persons a delirium succeeds the swelling of the parotis, or the subsequent ones of the testes or breasts; which is sometimes fatal, and seems to arise from a sympathy of successive action, and not of synchronous action, of the membranes of the brain with those of the parotide glands. Sometimes a stupor comes on instead of this delirium, which is relieved by fomenting the shaved head for an hour or two. See Class II. 1. 3. 4.

ORDO I.

Increased Associate Motions.

GENUS III.

Catenated with Voluntary Motions

SPECIES.

1. Deglutitio invita. When any one is told not to swallow his saliva, and that especially if his throat be a little sore, he finds a necessity of immediately swallowing it; and this the more certainly, the more he voluntarily endeavours not to do so.

In this case the voluntary power exerted by our attention to the pharinx renders it more sensible to irritation, and therefore occasions it to be more frequently induced to swallow the saliva. Here the irritation induces a volition to swallow it, which is more powerful than the desire not to swallow it. See XXIV. 1. 7. So in reverie, when the voluntary power was exerted on any of the senses, as of sight or taste, the objects of those senses became perceived; but not otherwise. Sect. XIX. 6. This is a troublesome symptom in some sore throats.

M. M. Mucilage, as sugar and gum arabic. Warm water held in the mouth frequently, as a fomentation to the inflamed throat.

2. Nictitatio invita. Involuntary winking with the eye-lids, and twitchings of the face, are originally induced by an endeavour to relieve some disagreeable sensations about inflamed eyes, as the dazzling of light; and afterwards these motions become catenated with other motions or sensations, so as not to be governed by the will. Here the irritation first produces a volition to wink, which by habit becomes stronger than the anti-volition not to wink.

This subject is rendered difficult from the common acceptation of the word, volition, including previous deliberation, as well as the voluntary exertion, which succeeds it. In the volitions here spoken of there is no time for deliberation or choice of objects, but the voluntary act immediately succeeds the sensation which excites it.

M. M. Cover the affected parts with a sticking plaster or a blister. Pass a fine needle and thread through a part of the skin over the muscle, which moves, and attach the other end of the thread by a sticking plaster to a distant part. An issue behind the ear. To practise daily by a looking-glass to stop the motions with the hand. See the cure of a case of the leaping of a muscle of the arm, Sect. XVII. 1. 8. See Convulsio debilis, Class III. 1. 1. 5.

3. Risus invitus. Involuntary laughter. When the pleasure arising from new combinations of words and ideas, as in puns; or of other circumstances, which are so trivial, as to induce no voluntary exertion to compare or consider their present importance or their future consequence; the pleasure is liable to rise into pain; that is, the ideas or sensual motions become exerted too violently for want of some antithetistic ideas; in the same manner as those muscles, which have weak antagonists, as those of the calf of the leg, are liable to fall into cramp or painful contraction. In this situation a scream is begun to relieve this pain of ideas too violently exerted, which is stopped again soon, as explained in Sect. XXXIV. 1. 4. and Class III. 1. 1. 4. and IV. 2. 3. 3.

The pain, into which this pleasure rises, which would excite the scream of laughter, has been felt forcibly by every one; when they have been under such circumstances, as have induced them to restrain it by a counter-volition; till at length the increased associate motions produce so much pain as to overcome the counter-volition, and the patient bursts out into indecent laughter, contrary to his will in the common acceptation of that word.

4. Lusus digitorum invitus. An awkward playing with the fingers in speaking in public. These habits are began through bashfulness, and seem rather at first designed to engage the attention in part, and thus prevent the disagreeable ideas of mauvaise hont; as timorous boys whistle, when they are obliged to walk in the dark; and as it is sometimes necessary to employ raw soldiers in perpetual manœuvres, as they advance to the first charge.

5. Unguium morsiuncula invita. Biting the nails is a depraved habit arising from similar causes as those of the last article.

M. M. Dip the fingers in solution of aloes.

6. Vigilia invita. Watchfulness, where the person wishes, and endeavours to fall asleep, properly belongs to this place, as the wish or volition to sleep prevents the desired effect; because sleep consists in an abolition of volition. See Class III. 1. 2. 3.

ORDO I.

Increased Associate Motions.

GENUS IV.

Catenated with External Influences.

SPECIES.

1. Vita ovi. Life of an egg. The eggs of fowls were shewn by Mr. J. Hunter to resist the freezing process in their living state more powerfully, than when they were killed by having the yolk and white shook together. Philos. Trans. It may be asked, does the heat during the incubation of eggs act as a stimulus exciting the living principle into activity? Or does it act simply as a causa sine quâ non, as an influence, which penetrating the mass, removes the particles of it to a greater distance from each other, so as to allow their movement over each other, in the same manner as heat is conceived to produce the fluidity of water; not by stimulus, but by its penetrating influence? Or may elementary heat in its uncombined state be supposed to act only as an influence necessary to life in its natural quantity; whence torpor and death follows the eduction of it from the body; but in its increased state above what is natural, or usual, that it acts as a stimulus; which we have a sense to perceive; and which excites many parts of the system into unnatural action? See Class IV. 1. 1. C.

2. Vita hiemi-dormientium. The torpor of insects, and birds, and quadrupeds, during the cold season, has been called sleep; but I suppose it must differ very much from that state of animal life, since not only all voluntary power is suspended, but sensation and vascular motion has ceased, and can only be restored by the influence of heat. There have been related instances of snails, which have recovered life and motion on being put into water after having experienced many years of torpidity, or apparent death, in the cabinets of the curious. Here the water as well as the heat are required not only as a stimulus, but as a causa sine quâ non of fluidity and motion, and consequent life.

3. Pullulatio arborum. The annual revivescence of the buds of trees seems not only to be owing to the influence of the returning warmth of the spring, but also to be catenated with solar gravitation; because seeds and roots and buds, which are analogous to the eggs of animals, put forth their shoots by a less quantity of heat in spring, than they had undergone in the latter part of autumn, which may however be ascribed to their previous torpid state, and consequent accumulation of sensorial power, or irritability; as explained in Botanic Garden, Part II. Cant. I. l. 322. note. Other circumstances, which countenance the idea, that vegetation is affected by solar gravitation, as well as by heat, may be observed in the ripening of the seeds of plants both in those countries where the summers are short, and in those where they are long. And by some flowers closing their bells at noon, or soon after; and hence seem to sleep rather at solar diurnal periods, than from the influence of cold, or the deficiency of light.

4. Orgasmatis venerei periodus. The venereal orgasm of birds and quadrupeds commences or returns about the vernal or autumnal equinoxes, and thence seems in respect to their great periods to be governed by solar influence. But if this orgasm be disappointed of its object, it is said to recur at about monthly periods, as observed in mares and bitches in this respect resembling the female catamenia. See Sect. XXXVI. 2. 3. and Sect. XVI. 13.

5. Brachii concussio electrica. The movement of the arm, even of a paralytic patient, when an electric shock is passed through it, is owing to the stimulus of the excess of electricity. When a piece of zinc and silver, each about the size of a crown-piece, are placed one under the upper lip, and the other on the tongue, so as the outer edges may be brought into contact, there is an appearance of light in the eyes, as often as the outer edges of these metals are brought into contact or separated; which is another instance of the stimulus of the passage of electric shocks through the fibres of the organs of sense, as well as through the muscular fibres. See Sect. XII. 1. 1. and first addit. note to Vol. I. of this work. But in its natural state electricity seems only to act as an influence on animal and vegetable bodies; of the salutary or injurious effects of which we have yet no precise knowledge.

Yet if regular journals were kept of the variations of atmospheric electricity, it is probable some discoveries of its influence on our system might in time be discovered. For this purpose a machine on the principle of Mr. Bennet's electric doubler might be applied to the pendulum of a clock, so as to manifest, and even to record the daily or hourly variations of aerial electricity. Which has already been executed, and applied to the pendulum of a Dutch wooden clock, by Mr. Bennet, curate of Wirksworth in Derbyshire.

Besides the variations of the degree or kind of atmospheric electricity, some animals, and some men, seem to possess a greater power of accumulating this fluid in themselves than others. Of which a famous history of a Russian prince was lately published; who, during the clear and severe frosts of that country, could not move himself in bed without luminous corruscations. Such may have been the case of those people, who have been related to have taken fire spontaneously, and to have been reduced to ashes. The electric concussion from the gymnotus electricus, and torpedo, are other instances of the power of the animal system to accumulate electricity, as in these it is used as a weapon of defence, or for the purpose of taking their prey.

Some have believed that the accumulation or passage of the magnetic fluid might affect the animal system, and have asserted that the application of a large magnet to an aching tooth has quickly effected a cure. If this experiment is again tried in odontalgia, or hemicrania, the painful membrane of the tooth or head should be included between the south and north poles of a horse-shoe magnet, or between the contrary poles of two different magnets, that the magnetism may be accumulated on the torpid part.

6. Oxygenatio sanguinis. The variation of the quantity of oxygen gas existing in the atmosphere must affect all breathing animals; in its excess this too must be esteemed a stimulus; but in its natural quantity would seem to act as an influence, or cause, without which, animal life cannot exist even a minute. It is hoped that Dr. Beddoes's plan for a pneumatic infirmary, for the purpose of putting this and various other airs to the test of experiment, will meet with public encouragement, and render consumption, asthma, cancer, and many diseases conquerable, which at present prey with unremitted devastation on all orders and ages of mankind.

7. Humectatio corporis. Water, and probably the vapour of water dissolved or diffused in the atmosphere, unites by mechanical attraction with the unorganized cuticle, and softens and enlarges it; as may be seen in the loose and wrinkled skin of the hands of washerwomen; the same probably occurs to the mucous membrane of the lungs in moist weather; and by thickening it increases the difficulty of respiration of some people, who are said to be asthmatical. So far water may be said to act as an influx or influence, but when it is taken up by the mouths of the absorbent system, it must excite those mouths into action, and then acts as a stimulus.

There appears from hence to be four methods by which animal bodies are penetrated by external things. 1. By their stimulus, which induces the absorbent vessels to imbibe them. 2. By mechanical attraction, as when water softens the cuticle. 3. By chemical attraction, as when oxygen passes through the membranes of the air-vessels of the lungs, and combines with the blood. And lastly, by influx without mechanical attraction, chemical combination, or animal absorption, as the universal fluids of heat, gravitation, electricity, magnetism, and perhaps of other ethereal fluids yet unknown.

ORDO II.

Decreased Associate Motions.

GENUS I.

Catenated with Irritative Motions.

As irritative muscular motions are attended with pain, when they are exerted too weakly, as well as when they are exerted too strongly; so irritative ideas become attended with sensation, when they are exerted too weakly, as well as when they are exerted too strongly. Which accounts for these ideas being attended with sensation in the various kinds of vertigo described below.

There is great difficulty in tracing the immediate cause of the deficiences of action of some links of the associations of irritative motions; first, because the trains and tribes of motions, which compose these links, are so widely extended as to embrace almost the whole animal system; and secondly, because when the first link of an associated train of actions is exerted with too great energy, the second link by reverse sympathy may be affected with torpor. And then this second link may transmit, as it were, this torpor to a third link, and at the same time regain its own energy of action; and it is possible this third link may in like manner transmit its torpor to a fourth, and thus regain its own natural quantity of motion.

I shall endeavour to explain this by an example taken from sensitive associated motions, as the origin of their disturbed actions is more easily detected. This morning I saw an elderly person, who had gradually lost all the teeth in his upper jaw, and all of the under except three of the molares; the last of these was now loose, and occasionally painful; the fangs of which were almost naked, the gums being much wasted both within and without the jaw. He is a man of attentive observation, and assured me, that he had again and again noticed, that, when a pain commenced in the membranes of the alveolar process of the upper jaw opposite to the loose tooth in the under one (which had frequently occurred for several days past), the pain of the loose tooth ceased. And that, when the pain afterwards extended to the ear and temple on that side, the pain in the membranes of the upper jaw ceased. In this case the membranes of the alveolar process of the upper jaw became torpid, and consequently painful, by their reverse sympathy with the too violent actions of the inflamed membranes of the loose tooth; and then by a secondary sympathy the membranes about the ear and temple became torpid, and painful; and those of the alveolar process of the upper jaw regained their natural quantity of action, and ceased to be painful. A great many more nice and attentive observations are wanted to elucidate these curious circumstances of association, which will be found to be of the greatest importance in the cure of many diseases, and lead us to the knowledge of fever.

SPECIES.

1. Cutis frigida pransorum. Chillness after dinner frequently attends weak people, or those who have been exhausted by exercise; it arises from the great expenditure of the sensorial power on the organs of digestion, which are stimulated into violent action by the aliment; and the vessels of the skin, which are associated with them, become in some measure torpid by reverse sympathy; and a consequent chillness succeeds with less absorption of atmospheric moisture. See the subsequent article.

2. Pallor urinæ pransorum. The paleness of urine after a full meal is an instance of reverse association; where the secondary part of a train of associate motions acts with less energy in consequence of the greater exertions of the primary part. After dinner the absorbent vessels of the stomach and intestines are stimulated into greater action, and drink up the newly taken aliment; while those, which are spread in great number on the neck of the bladder, absorb less of the aqueous part of the urine than usual, which is therefore discharged in a more dilute state; and has been termed crude by some medical writers, but it only indicates, that so great a proportion of the sensorial power is expended on digestion and absorption of the aliment, that other parts of the system act for a time with less energy. See Class IV. I. 1. 6.

3. Pallor urinæ a frigore cutaneo. There is a temporary discharge of pale water, and a diarrhœa, induced by exposing the skin to the cold air; as is experienced by boys, who strip themselves before bathing. In this case the mouths of the cutaneous lymphatics become torpid by the subduction of their accustomed degree of heat, and those of the bladder and intestines become torpid by direct sympathy; whence less of the thinner part of the urinary secretion, and of the mucus of the intestines, is reabsorbed. See Sect. XXIX. 4. 6. This effect of suddenly cooling the skin by the aspersion of cold water has been used with success in costiveness, and has produced evacuations, when other means have failed. When young infants are afflicted with griping joined with costiveness, I have sometimes directed them to be taken out of a warm bed, and carried about for a few minutes in a cool room, with almost instant relief.

4. Pallor ex ægritudine. When sickness of stomach first occurs, a paleness of the skin attends it; which is owing to the association or catenation between the capillaries of the stomach and the cutaneous ones; which at first act by direct sympathy. But in a short time there commences an accumulation of the sensorial power of association in the cutaneous capillaries during their state of inactivity, and then the skin begins to glow, and sweats break out, from the increased action of the cutaneous glands or capillaries, which is now in reverse sympathy with those of the stomach. So in continued fevers, when the stomach is totally torpid, which is known by the total aversion to solid food, the cutaneous capillaries are by reverse sympathy in a perpetual state of increased activity, as appears from the heat of the skin.

5. Dyspnœa a balneo frigido. The difficulty of breathing on going up to the middle in cold water is owing to the irritative association or catenation of the action of the extreme vessels of the lungs with those of the skin. So that when the latter are rendered torpid or inactive by the application of sudden cold, the former become inactive at the same time, and retard the circulation of the blood through the lungs, for this difficulty of breathing cannot be owing to the pressure of the water impeding the circulation downwards, as it happens equally by a cold shower-bath, and is soon conquered by habitual immersions. The capillaries of the skin are rendered torpid by the subduction of the stimulus of heat, and by the consequent diminution of the sensorial power of irritation. The capillaries of the lungs are rendered torpid by the diminution of the sensorial power of association, which is now excited in less quantity by the lessened actions of the capillaries of the skin, with which they are catenated. So that at this time both the cutaneous and pulmonary capillaries are principally actuated, as far as they have any action, by the stimulus of the blood. But in a short time the sensorial powers of irritation, and of association, become accumulated, and very energetic action of both these membranes succeed. Which thus resemble the cold and hot fit of an intermittent fever.

6. Dyspepsia a pedibus frigidis. When the feet are long cold, as in riding in cold and wet weather, some people are very liable to indigestion and consequent heart-burn. The irritative motions of the stomach become torpid, and do their office of digestion imperfectly, in consequence of their association with the torpid motions of the vessels of the extremities. Fear, as it produces paleness and torpidity of the skin, frequently occasions temporary indigestion in consequence of this association of the vessels of the skin with those of the stomach; as riding in very bad roads will give flatulency and indigestion to timorous people.

A short exposure to cold air increases digestion, which is then owing to the reverse sympathy between the capillary vessels of the skin, and of the stomach. Hence when the body is exposed to cold air, within certain limits of time and quantity of cold, a reverse sympathy of the stomach and the skin first occurs, and afterwards a direct sympathy. In the former case the expenditure of sensorial power by the skin being lessened, but not its production in the brain; the second link of the association, viz. the stomach, acquires a greater share of it. In the latter case, by the continuation of the deficient stimulus of heat, the torpor becomes extended to the brain itself, or to the trunks of the nerves; and universal inactivity follows.

7. Tussis a pedibus frigidis. On standing with the feet in thawing snow, many people are liable to incessant coughing. From the torpidity of the absorbent vessels of the lungs, in consequence of their irritative associations with those of the skin, they cease to absorb the saline part of the secreted mucus; and a cough is thus induced by the irritation of this saline secretion; which is similar to that from the nostrils in frosty weather, but differs in respect to its immediate cause; the former being from association with a distant part, and the latter from defect of the stimulus of heat on the nostrils themselves. See Catarrhus frigidus, Class I. 2. 3. 3.

8. Tussis hepatica. The cough of inebriates, which attends the enlargement of the liver, or a chronical inflammation of its upper membrane, is supposed to be produced by the inconvenience the diaphragm suffers from the compression or heat of the liver. It differs however essentially from that attending hepatitis, from its not being accompanied with fever. And is perhaps rather owing to irritative association, or reverse sympathy, between the lungs and the liver. As occurs in sheep, which are liable to a perpetual dry cough, when the fleuk-worm is preying on the substance of their livers. See Class II. 1. 1. 5.

M. M. From half a grain to a grain of opium twice a day. A drachm of mercurial ointment rubbed on the region of the liver every night for eight or ten times.

9. Tussis arthritica. Gout-cough. I have seen a cough, which twice recurred at a few years distance in the same person, during his fits of the gout, with such pertinacity and violence as to resist venesection, opiates, bark, blisters, mucilages, and all the usual methods employed in coughs. It was for a time supposed to be the hooping-cough, from the violence of the action of coughing; it continued two or three weeks, the patient never being able to sleep more than a few minutes at once during the whole time, and being propped up in bed with pillows night and day.

As no fever attended this violent cough, and but little expectoration, and that of a thin and frothy kind, I suspected the membrane of the lungs to be rather torpid than inflamed, and that the saline part of the mucus not being absorbed stimulated them into perpetual exertion. And lastly, that though the lungs are not sensible to cold and heat, and probably therefore less mobile; yet, as they are nevertheless liable to consent with the torpor of cold feet, as described in Species 6 of this Genus, I suspected this torpor of the lungs to succeed the gout in the feet, or to act a vicarious part for them.

10. Vertigo rotatoria. In the vertigo from circumgyration the irritative motions of vision are increased; which is evinced from the pleasure that children receive on being rocked in a cradle, or by swinging on a rope. For whenever sensation arises from the production of irritative motion with less energy than natural, it is of the disagreeable kind, as from cold or hunger; but when it arises from their production with greater energy than natural, if it be confined within certain limits, it is of the pleasurable kind, as by warmth or wine. With these increased irritative motions of vision, I suppose those of the stomach are performed with greater energy by direct sympathy; but when the rotatory motions, which produce this agreeable vertigo, are continued too long, or are too violent, sickness of the stomach follows; which is owing to the decreased action of that organ from its reverse sympathy with the increased actions of the organ of vision. For the expenditure of sensorial power by the organ of vision is always very great, as appears by the size of the optic nerves; and is now so much increased as to deprive the next link of association of its due share. As mentioned in Article 6 of this Genus.

In the same manner the undulations of water, or the motions of a ship, at first give pleasure by increasing the irritative motions belonging to the sense of vision; but produce sickness at length by expending on one part of the associated train of irritative actions too much of that sensorial power, which usually served the whole of it; whence some other parts of the train acquire too little of it, and perform their actions in consequence too feebly, and thence become attended with disagreeable sensation.

It must also be observed, that when the irritative motions are stimulated into unusual action, as in inebriation, they become succeeded by sensation, either of the pleasurable or painful kind; and thus a new link is introduced between the irritative motions thus excited, and those which used to succeed them; whence the association is either dissevered or much weakened, and thus the vomiting in sea-sickness occurs from the defect of the power of association, rather than from the general deficiency of sensorial power.

When a blind man turns round, or when one, who is not blind, revolves in the dark, a vertigo is produced belonging to the sense of touch. A blind man balances himself by the sense of touch, which being a less perfect means of determining small quantities of deviation from the perpendicular, occasions him to walk more carefully upright than those, who balance themselves by vision. When he revolves, the irritative associations of the muscular motions, which were used to preserve his perpendicularity, become disordered by their new modes of successive exertion; and he begins to fall. For his feet now touch the floor in manners or directions different from those they have been accustomed to; and in consequence he judges less perfectly of the situation of the parts of the floor in respect to that of his own body, and thus loses his perpendicular attitude. This may be illustrated by the curious experiment of crossing one finger over the next to it, and feeling of a nut or bullet with the ends of them. When, if the eyes be closed, the nut or bullet appears to be two, from the deception of the sense of touch.

In this vertigo from gyration, both of the sense of sight, and of the sense of touch, the primary link of the associated irritative motions is increased in energy, and the secondary ones are increased at first by direct sympathy; but after a time they become decreased by reverse sympathy with the primary link, owing to the exhaustion of sensorial power in general, or to the power of association in particular; because in the last case, either pleasurable or painful sensation has been introduced between the links of a train of irritative motions, and has dissevered, or much enfeebled them.

Dr. Smyth, in his Essay on Swinging in Pulmonary Consumption, has observed, that swinging makes the pulse slower. Dr. Ewart of Bath confirmed this observation both on himself and on Col. Cathcart, who was then hectic, and that even on shipboard, where some degree of vertigo might be supposed previously to exist. Dr. Currie of Liverpool not only confirmed this observation frequently on himself, when he was also phthisical, but found that equitation had a similar effect on him, uniformly retarding his pulse. This curious circumstance cannot arise from the general effect of exercise, or fatigue, as in those cases the pulse becomes weaker and quicker; it must therefore be ascribed to a degree of vertigo, which attends all those modes of motion, which we are not perpetually accustomed to.

Dr. Currie has further observed, that "in cases of great debility the voluntary muscular exertion requisite in a swing produces weariness, that is, increases debility; and that in such instances he had frequently noticed, that the diminution of the frequency of the pulse did not take place, but the contrary." These circumstances may thus be accounted for.

The links of association, which are effected in the vertigo occasioned by unusual motion, are the irritative motions of the sense of vision, those of the stomach, and those of the heart and arteries. When the irritative ideas of vision are exerted with greater energy at the beginning of vertigo, a degree of sensation is excited, which is of the pleasurable kind, as above mentioned; whence the associated trains of irritative motions of the stomach, and heart, and arteries, act at first with greater energy, both by direct sympathy; and by the additional sensorial power of sensation. Whence the pulse of a consumptive patient becomes stronger and consequently slower.

But if this vertigo becomes much greater in degree or duration, the first link of this train of associated irritative motions expends too much of the sensorial power, which was usually employed on the whole train; and the motions of the stomach become in consequence exerted with less energy. This appears, because in this degree of vertigo sickness supervenes, as in sea-sickness, which has been shewn to be owing to less energetic action of the stomach. And the motions of the heart and arteries then become weaker, and in consequence more frequent, by their direct sympathy with the lessened actions of the stomach. See Supplement, I. 12. and Class II. 1. 6. 7. The general weakness from fatigue is owing to a similar cause, that is, to the too great expenditure of sensorial power in the increased actions of one part of the system, and the consequent deficiency of it in other parts, or in the whole.

The abatement of the heat of the skin in hectic fever by swinging, is not only owing to the increased ventilation of cool air, but to the reverse sympathy of the motions of the cutaneous capillaries with those of the heart and arteries; which occurs in all fevers with arterial debility, and a hot or dry skin. Hence during moderate swinging the action of the heart and arteries becomes stronger and slower, and the action of the capillaries, which was before too great, as appeared by the heat of the skin, now is lessened by their reverse sympathy with that of the heart and arteries. See Supplement, I. 8.

11. Vertigo visualis. Visual vertigo. The vertigo rotatoria described above, was induced by the rotation or undulation of external objects, and was attended with increased action of the primary link of the associated motions belonging to vision, and with consequent pleasure. The vertigo visualis is owing to less perfect vision, and is not accompanied with pleasurable sensation. This frequently occurs in strokes of the palsy, and is then succeeded by vomiting; it sometimes precedes epileptic fits, and often attends those, whose sight begins to be impaired by age.

In this vertigo the irritative ideas of the apparent motions of objects are less distinct, and on that account are not succeeded by their usual irritative associations of motion; but excite our attention. Whence the objects appear to librate or circulate according to the motions of our heads, which is called dizziness; and we lose the means of balancing ourselves, or preserving our perpendicularity, by vision. So that in this vertigo the motions of the associated organs are decreased by direct sympathy with their primary link of irritation; as in the preceding case of sea-sickness they are decreased by reverse sympathy.