Part 2 — SUPPLEMENT TO CLASS IV.

Sympathetic Theory of Fever.

As fever consists in the increase or diminution of direct or reverse associated motions, whatever may have been the remote cause of them, it properly belongs to the fourth class of diseases; and is introduced at the end of the class, that its great difficulties might receive elucidation from the preceding parts of it. These I shall endeavour to enumerate under the following heads, trusting that the candid reader will discover in these rudiments of the theory of fever a nascent embryon, an infant Hercules, which Time may rear to maturity, and render serviceable to mankind.

I.Simple fever of two kinds.

II.Compound fever.

III.Termination of the cold fit.

IV.Return of the cold fit.

V.Sensation excited in fever.

VI.Circles of associated motions.

VII.Alternations of cold and hot fits.

VIII.Orgasm of the capillaries.

IX.Torpor of the lungs.

X.Torpor of the brain.

XI.Torpor of the heart and arteries.

XII.Torpor of the stomach and intestines.

XIII.Case of continued fever explained.

XIV.Termination of continued fever.

XV.Inflammation excited in fever.

XVI.Recapitulation.

I. Simple fever.

1. When a small part of the cutaneous capillaries with their mucous or perspirative glands are for a short time exposed to a colder medium, as when the hands are immersed in iced water for a minute, these capillary vessels and their glands become torpid or quiescent, owing to the eduction of the stimulus of heat. The skin then becomes pale, because no blood passes through the external capillaries; and appears shrunk, because their sides are collapsed from inactivity, not contracted by spasm; the roots of the hair are left prominent from the seceding or subsiding of the skin around them; and the pain of coldness is produced.

In this situation, if the usual degree of warmth be applied, these vessels regain their activity; and having now become more irritable from an accumulation of the sensorial power of irritation during their quiescence, a greater exertion of them follows, with an increased glow of the skin, and another kind of pain, which is called the hot-ach; but no fever, properly so called, is yet produced; as this effect is not universal, nor permanent, nor recurrent.

2. If a greater part of the cutaneous capillaries with their mucous and perspirative glands be exposed for a longer time to cold, the torpor or quiescence becomes extended by direct sympathy to the heart and arteries; which is known by the weakness, and consequent frequency of the pulse in cold fits of fever.

This requires to be further explained. The movements of the heart and arteries, and the whole of the circulatory vessels, are in general excited into action by the two sensorial powers of irritation, and of association. The former is excited by stimulus, the latter by the previous actions of a part of the vital circle of motions. In the above situation the capillaries act weakly from defect of irritation, which is caused by deficient stimulus of heat; but the heart and arteries act weakly from defect of association, which is owing to the weak action of the capillaries; which does not now excite the sensorial power of association into action with sufficient energy.

After a time, either by the application of warmth, or by the increase of their irritability owing to the accumulation of the sensorial power of irritation during their previous quiescence, the capillary vessels and glands act with greater energy than natural; whence the red colour and heat of the skin. The heart and arteries acquire a greater strength of pulsation, and continue the frequency of it, owing to the accumulation of the sensorial power of association during their previous torpor, and their consequent greater associability; which is now also more strongly excited by the increased actions of the capillaries. And thus a fit of simple fever is produced, which is termed Febris irritativa; and consists of a torpor of the cutaneous capillaries with their mucous and perspirative glands, accompanied with a torpor of the heart and arteries; and afterwards of an increased action of all these vessels, by what is termed direct sympathy.

This fever, with strong pulse without inflammation, or febris irritativa, described in Class I. 1. 1. 1. is frequently seen in vernal intermittents, as the orgasm of the heart and arteries is then occasioned by their previous state of torpor; but more rarely I believe exists in the type of continued fever, except there be an evident remission, or approximation to a cold fit; at which time a new accumulation of the sensorial power of association is produced; which afterwards actuates the heart and arteries with unnatural vigour; or unless there be some stimulus perpetually acting on the system so as to induce an increased secretion of sensorial power in the brain, as occurs in slight degrees of intoxication. Since without one or other of these circumstances in continued fevers without inflammation, that is, without the additional sensorial power of sensation being introduced, it seems difficult to account for the production of so great a quantity of sensorial power, as must be necessary to give perpetual increase of action to the whole sanguiferous system.

3. On the contrary, while the cutaneous capillaries with their mucous and perspirative glands acquire an increased irritability, as above, by the accumulation of that sensorial power during their previous quiescence, and thus constitute the hot fit of fever; if the heart and arteries do not acquire any increase of associability, but continue in their state of torpor, another kind of simple fever is produced; which is generally of the continued kind, and is termed Febris inirritativa; which consists of a previous torpor of the capillaries of the skin, and of the heart and arteries by direct sympathy with them; and afterwards of an orgasm or increased action of the capillaries of the skin, with a decreased action, or continued torpor, of the heart and arteries by reverse sympathy with them. This orgasm of the cutaneous capillaries, which appears by the blush and heat of the skin, is at first owing to the accumulation of the sensorial power of irritation during their previous torpid state, as in the febris irritata above described; but which is afterwards supported or continued by the reverse sympathy of these capillaries with the torpid state of the heart and arteries, as will be further explained in article 8 of this Supplement.

4. The renovated activity of the capillaries commences as soon or sooner than that of the heart and arteries after the cold fit of irritative fever; and is not owing to their being forced open by the blood being impelled into them mechanically, by the renovated action of the heart and arteries; for these capillaries of the skin have greater mobility than the heart and arteries, as appears in the sudden blush of shame; which may be owing to their being more liable to perpetual varieties of activity from their exposure to the vicissitudes of atmospheric heat. And because in inirritative fevers, or those with arterial debility, the capillaries acquire increased strength, as is evinced by the heat of the skin, while the pulsations of the heart and arteries remain feeble.

5. It was said above, that the cutaneous capillaries, when they were rendered torpid by exposure to cold, either recovered their activity by the reapplication of external warmth; or by their increased irritability, which is caused by the accumulation of that sensorial power during their quiescence. An example of the former of these may be seen on emerging from a very cold bath; which produces a fit of simple fever; the cold fit, and consequent hot fit, of which may be prolonged by continuing in the bath; which has indeed proved fatal to some weak and delicate people, and to others after having been much exhausted by heat and exercise. See Sect. XXXII. 3. 2. An example of the latter may be taken from going into a bath of about eighty degrees of heat, as into the bath at Buxton, where the bather first feels a chill, and after a minute becomes warm, though he remains in the same medium, owing to the increase of irritability from the accumulation of that sensorial power during the short time, which the chilness continued.

6. Hence simple fevers are of two kinds; first, the febris irritativa, or fever with strong pulse; which consists of a previous torpor of the heart, arteries, and capillaries, and a succeeding orgasm of those vessels. Secondly, the febris inirritativa, or fever with weak pulse, which consists of a previous torpor of the heart, arteries, and capillaries; and of a succeeding orgasm of the capillaries, the torpor of the heart and arteries continuing. But as the frequency of the pulse occurs both in the state of torpor, and in that of orgasm, of the heart and arteries; this constitutes a criterion to distinguish fever from other diseases, which are owing to the torpor of some parts of the system, as paresis, and hemicrania.

7. The reader will please to observe, that where the cutaneous or pulmonary capillaries are mentioned, their mucous and perspirative glands are to be understood as included; but that the absorbents belonging to those systems of vessels, and the commencement of the veins, are not always included; as these are liable to torpor separately, as in anasarca, and petechiæ; or to orgasm, or increased action, as in the exhibition of strong emetics, or in the application of vinegar to the lips; yet he will also please to observe, that an increased or decreased action of these absorbents and veins generally occurs along with that of the capillaries, as appears by the dry skin in hot fits of fever; and from there being generally at the same time no accumulation of venous blood in the cutaneous vessels, which would appear by its purple colour.

II. Compound fever.

1. When other parts of the system sympathize with this torpor and orgasm of the cutaneous capillaries, and of the heart and arteries; the fever-fit becomes more complicated and dangerous; and this in proportion to the number and consequence of such affected parts. Thus if the lungs become affected, as in going into very cold water, a shortness of breath occurs; which is owing to the collapse or inactivity (not to the active contraction, or spasm), of the pulmonary capillaries; which, as the lungs are not sensible to cold, are not subject to painful sensation, and consequent shuddering, like the skin. In this case after a time the pulmonary capillaries, like the cutaneous ones, act with increased energy; the breathing, which was before quick, and the air thrown out at each respiration in less quantity, and cool to the back of the hand opposed to it, now becomes larger in quantity, and warmer than natural; which however is not accompanied with the sensation of heat in the membrane, which lines the air-vessels of the lungs, as in the skin.

2. One consequence of this increased heat of the breath is the increased evaporation of the mucus on the tongue and nostrils. A viscid material is secreted by these membranes to preserve them moist and supple, for the purposes of the senses of taste and of smell, which are extended beneath their surfaces; this viscid mucus, when the aqueous part of it is evaporated by the increased heat of the respired air, or is absorbed by the too great action of the mucous absorbents, adheres closely on those membranes, and is not without difficulty to be separated from them. This dryness of the tongue and nostrils is a circumstance therefore worthy to be attended to; as it shews the increased action of the pulmonary capillaries, and the consequent increased heat of the expired air; and may thus indicate, when colder air should be admitted to the patient. See Class I. 1. 3. 1. The middle part of the tongue becomes dry sooner, and recovers its moisture later, than the edges of it; because the currents of respired air pass most over the middle part of it. This however is not the case, when the dryness of the tongue is owing only to the increased mucous absorption. When however a frequent cough attends pulmonary inflammation, the edges of the tongue are liable to be as much furred as the middle of it; as during the action of coughing the middle of the tongue is depressed, so as to form half a cylinder, to give a greater aperture for the emission of air from the larynx; and the edges of it become thus as much exposed to the currents of air, as the middle parts of it.

3. When the internal capillaries or glands sympathize with the cutaneous capillaries; or when any of them are previously affected with torpor, and the external or cutaneous capillaries are affected secondarily; other symptoms are produced, which render the paroxysms of fever still more complicate. Thus if the spleen or pancreas are primarily or secondarily affected, so as to be rendered torpid or quiescent, they are liable to become enlarged, and to remain so even after the extinction of the fever-fit. These in some intermittent fevers are perceptible to the hand, and are called ague-cakes; their tumour seems to be owing to the permanent torpor of the absorbent system, the secerning vessels continuing to act some time afterwards. If the secretory vessels of the liver are affected first with torpor, and afterwards with orgasm, a greater secretion of bile is produced, which sometimes causes a diarrhœa. If a torpor of the kidneys, and of the absorbents of the bladder occurs, either primarily, or by sympathy with the cutaneous capillaries, the urine is in small quantity and pale, as explained in Class I. 2. 2. 5.; and if these secretory vessels of the kidneys, and the absorbents of the bladder act more strongly than natural afterwards by their increased irritability or associability, the urine becomes in larger quantity, and deeper coloured, or deposits its earthy parts, as in Class I. 1. 2. 4. which has been esteemed a favourable circumstance. But if the urine be in small quantity, and no sediment appears in it, after the hot fit is over; it shews, that the secerning vessels of the kidneys and the absorbent vessels of the bladder have not regained the whole of their activity, and thence indicates a greater tendency to a return of the cold fit.

4. When the stomach is affected with torpor either primarily; or secondarily by its sympathy with the cutaneous capillaries; or with some internal viscus; sickness occurs, with a total want of appetite to any thing solid; vomiting then supervenes, which may often be relieved by a blister on the skin, if the skin be cool and pale; but not if it be hot and flushed. The intestines cease to perform their office of absorption from a similar torpor; and a diarrhœa supervenes owing to the acrimony of their putrid, or of their acid contents. The loose undigested or fetid stools indicate the inability of the intestines to perform their proper office; as the mucus and gastric acid, which are vomited up, does that of the stomach; this torpor of the stomach is liable to continue after the cold paroxysm ceases, and to convert intermittent fevers into continued ones by its direct sympathy with the heart and arteries. See article 10 of this Supplement.

5. If the meninges of the brain sympathize with other torpid parts, or are primarily affected, delirium, stupor, and perhaps hydrocephalus internus occur, see Class II. 1. 7. 1. and I. 2. 5. 10; and sometimes the pulse becomes slow, producing paresis instead of fever. But if the membranes, which cover the muscles about the head, or of the pericranium, become torpid by their sympathy with other torpid parts, or are primarily affected, a head-ach supervenes; which however generally ceases with the cold paroxysm of fever. For as when the sensorial power of volition is exhausted by labour, a few hours, or half a solar day, passed in sleep recruits the system by accumulation of this sensorial power; so when the sensorial power of irritation is exhausted, one or two solar or lunar days of rest or quiescence of the affected part will generally restore its action by accumulation of irritability, and consequent increase of association, as in hemicrania, Class IV. 2. 2. 8. But when the heart and arteries become torpid, either primarily, or by their sympathy with the stomach, this accumulation of the sensorial power of irritation can take place but slowly; as to rest is death! This explains the cause of the duration of fevers with weak pulse, which continue a quarter, or half, or three quarters, or a whole lunation, or still longer, before sufficient accumulation of irritability can be produced to restore their natural strength of action.

6. If the absorbent vessels, which are spread around the neck of the bladder, become torpid by their direct sympathy with the absorbents of the skin in cold fits of fever; the urine, which is poured into the bladder in but small quantity from the torpid kidneys, has nevertheless none of its aqueous saline part reabsorbed; and this saline part stimulates the bladder to empty itself frequently, though the urine is in small quantity. Which is not therefore owing to any supposed spasm of the bladder, for the action of it in excluding the urine is weak, and as much controlable by the will as in ordinary micturition.

7. If the beginnings or absorbent mouths of the venous system remain torpid, petechiæ or vibices are produced in fevers, similar to those which are seen in scurvy without fever. If the skin was frequently moistened for an hour, and at the same time exposed to the common air, or to oxygen gas, it might contribute to turn the black colour of these points of extravasated blood into scarlet, and thus by increasing its stimulus facilitate its reabsorption? For oxygen gas penetrates moist animal membranes though not dry ones, as in the lungs during respiration.

8. When the sensorial power of sensation is introduced into the arterial system, other kinds of compound fevers are produced, which will be spoken of in their place.

III. Termination of the cold Fit.

1. If all the parts, which were affected with torpor, regain their irritability, and associability, the cold paroxysm of fever ceases; but as some of the parts affected were previously accustomed to incessant action, as the heart and arteries, and others only to intermitted action, as the stomach and intestines; and as those, which are subjected during health to perpetual action, accumulate sensorial power faster, when their motions are impeded, than those which are subjected to intermitted action; it happens, that some of the parts, which were affected with torpor during the cold fit, recover their irritability or associability sooner than others, and more perfectly, or acquire a greater quantity of them than natural; as appears by the partial heat and flushings previous to the general hot fit.

Hence if all the parts, which were previously torpid, regain their due degree of irritability, or of associability, the disease is removed, and health restored. If some or all of them acquire more than their natural degree of these sensorial powers; increased actions, and consequent increased secretions, and greater heat occur, and constitute the hot fit of fever. If after this hot fit of fever all the parts, which had acquired too great irritability, or associability, regain their natural degree of it; the disease is removed, and health restored. But if some of these parts do not regain their natural degree of these sensorial powers, the actions of those parts remain imperfect, and are more or less injurious to the system, according to the importance of their functions.

2. Thus if a torpor of the heart and arteries remains; the quick pulse without strength, which began in the cold fit, persists; and a continued fever is produced. If the torpor of the stomach and intestines remains, which are known by sickness and undigested stools, the fever is liable to be of considerable length and danger; the same if the kidnies and absorbent system retain some degree of torpor, as is shewn by the pale urine in not unusual quantity. If part of the absorbent system remains torpid, as the absorbent vessels of the spleen, a tumour of that viscus occurs, which may be felt by the hand; the same sometimes happens to the liver; and these from their tendency to more complete torpor are afterwards liable to give occasion to a return of the cold fit. If the cellular absorbents do not completely recover their activity, a pale and bloated countenance with swelled legs mark their want of action.

3. As the termination of the cold fit is owing to the accumulation of the sensorial power of irritation and of association during the previous quiescence of the system; and as those parts, which are in perpetual action during health, are more subject to this accumulation during their torpor, or quiescence; one should have imagined, that the heart and arteries would acquire this accumulation of sensorial power sooner or in greater degree than other parts. This indeed so happens, where the pulse is previously strong, as in febris irritativa; or where another sensorial power, as that of sensation, is exerted on the arterial system, as in inflammations. The heart and arteries in these cases soon recover from their torpor, and are exerted with great violence.

Many other parts of the system subject to perpetual motion in health may rest for a time without much inconvenience to the whole; as when the fingers of some people become cold and pale; and during this complete rest great accumulation of irritability may be produced, But where the heart and arteries are previously feeble, they cannot much diminish their actions, and certainly cannot rest entirely, for that would be death; and therefore in this case their accumulation of the sensorial power of irritation or of association is slowly produced, and a long fever supervenes in consequence; or sudden death, as frequently happens, terminates the cold fit.

Whence it appears, that in fevers with weak pulse, if the action of the heart, arteries, and capillaries could be diminished, or stopped for a short time without occasioning the death of the patient, as happens in cold bathing, or to persons apparently drowned, that a great accumulation of the sensorial powers of irritation or of association might soon be produced, and the pulse become stronger, and consequently slower, and the fever cease. Hence cold ablution may be of service in fevers with weak pulse, by preventing the expenditure and producing accumulation of the sensorial power of irritation or association. Stupor may be useful on the same account. Could a centrifugal swing be serviceable for this purpose, either by placing the head or the feet in the outward part of the circle, as described in Art. 15. 7. of this Supplement?

IV. Return of the cold Fit.

1. If the increased action of the cutaneous and pulmonary capillaries, and of the heart and arteries, in febris irritativa continues long and with violence, a proportional expenditure or exhaustion of sensorial power occurs; which by its tendency to induce torpor of some part, or of the whole, brings on a return of the cold fit.

2. Another cause which contributes to induce torpor of the whole system by the sympathy of its parts with each other, is the remaining torpor of some viscus; which after the last cold paroxysm had not recovered itself, as of the spleen, liver, kidnies, or of the stomach and intestines, or absorbent vessels, as above mentioned.

3. Other causes are the deficiency of the natural stimuli, as hunger, thirst, and want of fresh air. Other causes are great fatigue, want of rest, fear, grief, or anxiety of mind. And lastly, the influence of external ethereal fluids, as the defect of external heat, and of solar or lunar gravitation. Of the latter the return of the paroxysms of continued fevers about six o'clock in the evening, when the solar gravitation is the least, affords an example of the influence of it; and the usual periods of intermittents, whether quotidian, tertian, or quartan, which so regularly obey solar or lunar days, afford instances of the influence of those luminaries on these kinds of fevers.

4. If the tendency to torpor of some viscus is considerable, this will be increased at the time, when the terrene gravitation is greatest, as explained in the introduction to Class IV. 2. 4. and may either produce a cold paroxysm of quotidian fever; or it may not yet be sufficient in quantity for that purpose, but may nevertheless become greater, and continue so till the next period of the greatest terrene gravitation, and may then either produce a paroxysm of tertian fever; or may still become greater, and continue so till the next period of greatest terrene gravitation, and then produce a paroxysm of quartan ague. And lastly, the periodical times of these paroxysms may exceed, or fall short of, the time of greatest diurnal terrene gravitation according to the time of day, or period of the moon, in which the first fit began; that is, whether the diurnal terrene gravitation was then in an increasing or decreasing state.

V. Sensation excited in Fever.

1. A curious observation is related by Dr. Fordyce in his Tract on Simple fever, page 168. He asserts, that those people, who have been confined some time in a very warm atmosphere, as of 120 or 130 degrees of heat, do not feel cold, nor are subject to paleness of their skins, on coming into a temperature of 30 or 40 degrees; which would produce great paleness and painful sensation of coldness in those, who had been some time confined in an atmosphere of only 86 or 90 degrees. Analogous to this, an observing friend of mine assured me, that once having sat up to a very late hour with three or four very ingenious and humorous companions, and drank a considerable quantity of wine; both contrary to his usual habits of life; and being obliged to rise early, and to ride a long journey on the next day; he expected to have found himself weak and soon fatigued; but on the contrary he performed his journey with unusual ease and alacrity; and frequently laughed, as he rode, at the wit of the preceding evening. In both these cases a degree of pain or pleasure actuated the system; and thus a sensorial power, that of sensation, was superadded to that of irritation, or volition. See Sect. XXXIV. 2. 6.

2. Similar to this, when the energetic exertions of some parts of the system in the hot fit of fever arise to a certain excess, a degree of sensation is produced; as of heat, which particularly increases the actions of the cutaneous vessels, which are more liable to be excited by this stimulus. When this additional sensorial power of sensation exists to a greater degree, the pulse, which was before full, now becomes hard, owing to the inflammation of the vasa vasorum, or coats of the arteries. In these cases, whether there is any topical inflammation or not, the fever ceases to intermit; but nevertheless there are daily remissions and exacerbations of it; which recur for the most part about six in the evening, when the solar gravitation is the least, as mentioned in Sect. XXXVI. 3. 7.

3. Thus the introduction of another sensorial power, that of sensation, converts an intermittent fever into a continued one. If it be attended with strong pulse, it is termed febris sensitiva irritata, or pyrexia, or inflammation; if with a weak pulse, it is termed febris sensitiva inirritata, or typhus gravior, or malignant fever. The seat of the inflammation is in the glandular or capillary system, as it consists in the secretion of new fluids, or new fibres, which form new vessels, as they harden, like the silk of the silk-worm. See Art. 15. of this Supplement.

VI. Circles of irritative Associate Motions.

1. There are some associate motions, which are perpetually proceeding in our waking hours, and are catenated by their first link, or in some subsequent parts of the chain, with the stimuli or the influence of external things; which we shall here enumerate, as they contribute to the knowledge of fever. Of these are the irritative ideas, or sensual motions of the organs of sense, and the muscular motions associated with them; which, when the chain is disturbed or interrupted, excite the sensorial power of sensation, and proceed in confusion. Thus if the irritative ideas of sight are disturbed, the paralactic motions of objects, which in general are unperceived, become sensible to us; and the locomotive muscles associated with them, which ought to preserve the body erect, stagger from this decrease or interruption of the sensorial power of association; and vertigo is produced.

When the irritative sensual motions, or ideas, belonging to one sense are increased or diminished, the irritative sensual motions, or ideas, of the other senses are liable to become disturbed by their general catenations; whence occur noises in the ears, bad tastes in the mouth, bad odours, and numbness or tingling of the limbs, as a greater or less number of senses are affected. These constitute concomitant circles of disturbed irritative ideas; or make a part of the great circle of irritative ideas, or motions of the organs of sense; and when thus disturbed occasion many kinds of hallucination of our other senses, or attend on the vertigo of vision.

2. Another great circle of irritative associated motions consists of those of the alimentary canal; which are catenated with stimuli or with influences external to the system, but continue to be exerted in our sleeping as well as in our waking hours. When these associations of motion are disturbed by the too great or too small stimulus of the food taken into the stomach, or by the too great excess or deprivation of heat, or by indigestible substances, or by torpor or orgasm occasioned by their association with other parts, various diseases are induced under the names of apepsia, hypochondriasis, hysteria, diarrhœa, cholera, ileus, nephritis, fever.

3. A third circle of irritative associate motions consists of those of the absorbent system; which may be divided into two, the lacteals, and the lymphatics. When the stomach and intestines are recently filled with food and fluid, the lacteal system is stimulated into great action; at the same time the cellular, cutaneous, and pulmonary lymphatics act with less energy; because less fluid is then wanted from those branches, and because more sensorial power is expended by the lacteal branch. On this account these two systems of absorbents are liable to act by reverse sympathy; hence pale urine is made after a full dinner, as less of the aqueous part of it is imbibed by the urinary lymphatics; and hence the water in anasarca of the lungs and limbs is speedily absorbed, when the actions of the lacteals of the stomach or intestines are weakened or inverted by the exhibition of those drugs, which produce nausea, or by violent vomiting, or violent cathartics.

Hence in diabetes the lacteal system acts strongly, at the same time that the urinary lymphatics invert their motions, and transmit the chyle into the bladder; and in diarrhœa from crapula, or too great a quantity of food and fluid taken at a time, the lacteals act strongly, and absorb chyle or fluids from the stomach and upper intestines; while the lymphatics of the lower intestines revert their motions, and transmit this over-repletion into the lower intestines, and thus produce diarrhœa; which accounts for the speedy operation of some cathartic drugs, when much fluid is taken along with them.

4. Other circles of irritative associate motions of great importance are those of the secerning system; of these are the motions of the larger congeries of glands, which form the liver, spleen, pancreas, gastric glands, kidneys, salivary glands, and many others; some of which act by direct and others by reverse sympathy with each other. Thus when the gastric glands act most powerfully, as when the stomach is filled with food, the kidneys act with less energy; as is shewn by the small secretion of urine for the first hour or two after dinner; which reverse sympathy is occasioned by the greater expenditure of sensorial power on the gastric glands, and to the newly absorbed fluids not yet being sufficiently animalized, or otherwise prepared, to stimulate the secretory vessels of the kidneys.

But those very extensive glands, which secrete the perspirable matter of the skin and lungs, with the mucus, which lubricates all the internal cells and cavities of the body, claim our particular attention. These glands, as well as all the others, proceed from the capillary vessels, which unite the arteries with the veins, and are not properly a part of them; the mucous and perspirative glands, which arise from the cutaneous and pulmonary capillaries, are associated by direct sympathy; as appears from immersion in the cold bath, which is therefore attended with a temporary difficult respiration; while those from the capillaries of the stomach and heart and arteries are more generally associated by reverse sympathy with those of the cutaneous capillaries; as appears in fevers with weak pulse and indigestion, and at the same time with a hot and dry skin.

The disturbed actions of this circle of the associate motions of the secerning system, when the sensorial power of sensation is added to that of irritation, frequently produces inflammation, which consists in the secretion of new fluids or new vessels. Nevertheless, if these disturbed actions be of the torpid kind, the pain, which attends them, is seldom productive of inflammation, as in hemicrania; but is liable to excite voluntary actions, and thus to expend much sensorial power, as in the shuddering in cold fits of fever, or in convulsions; or lastly the pain itself, which attends torpid actions, is liable to expend or exhaust much sensorial power without producing any increased actions; whence the low pulse, and cold extremities, which usually attend hemicrania; and hence when inert, or inactive sensation attends one link of associated action, the succeeding link is generally rendered torpid, as a coldness of the cheek attends tooth-ach.

5. A fifth important circle of irritative motions is that of the sanguiferous system, in which the capillary vessels are to be included, which unite the arterial and venous systems, both pulmonary and aortal. The disturbed action of this system of the heart and arteries, and capillaries, constitute simple fever; to which may be added, that the secerning and absorbent vessels appending to the capillaries, and the bibulous mouths of the veins, are in some measure at the same time generally affected.

6. Now, though the links of each of these circles of irritative motions are more strictly associated together, yet are they in greater or less degree associated or catenated with each other by direct or reverse sympathy. Thus the sickness, or inverted irritative motions of the stomach, are associated or catenated with the disturbed irritative ideas, or sensual motions, in vertigo; as in sea-sickness. This sickness of the stomach is also associated or catenated with the torpor of the heart and arteries by direct sympathy, and with the capillaries and absorbents by reverse sympathy; and are thus all of them liable occasionally to be disturbed, when one of them is diseased; and constitute the great variety of the kinds or symptoms of fevers.

VII. Alternation of the cold and hot Fits.

1. When any cause occurs, which diminishes to a certain degree the supply of sensorial power in respect to the whole system; as suppose a temporary inexertion of the brain; what happens? First, those motions are exerted with less energy, which are not immediately necessary to life, as the locomotive muscles; and those ideas, which are generally excited by volition; at the same time this deficiency of voluntary motion is different from that which occurs in sleep; as in that the movements of the arterial system are increased in energy though not in frequency. Next, the motions of the alimentary canal become performed with less energy, or cease altogether; and a total want of appetite to solid food occurs, or sickness, or a diarrhœa occasioned by the indigested aliment. Then the absorbent vessels cease to act with their due energy; whence thirst, and pale urine, though in small quantities. Fourthly, the secerning vessels become affected by the general diminution of sensorial power; whence all the secreted fluids are produced in less quantity. And lastly, the sanguiferous canals feel the general torpor; the pulsations of the heart and arteries become feeble, and consequently quick; and the capillaries of the skin become inactive, acquire less blood from the arteries, and are consequently paler and shrunk.

In this last circumstance of the torpor of the sanguiferous system consists inirritative fever; as all the others are rather accidental or concomitant symptoms, and not essential ones; as fewer or more of them may be present, or may exist with a greater or less degree of inactivity.

2. Now as the capillaries of the skin are exposed to greater varieties of heat and cold, than the heart and arteries, they are supposed to be more mobile, that is, more susceptible of torpor or exertion, or to inflammation, by external stimuli or influences, than the other parts of the sanguiferous system; and as the skin is more sensible to the presence of heat, than the internal parts of the body, the commencement of the cold paroxysms of fever generally either first exists in, or is first perceived by, the coldness and paleness of the skin; and the commencement of the hot fits by the heat and redness of it.

3. The accumulation of sensorial power occurs in these organs soonest, and in greatest quantity, during their quiescence, which were most perpetually in action during health; hence those parts of the system soonest recover from torpor in intermittent fever, and soonest fall into the contrary extreme of increased activity; as the sanguiferous system of the heart and arteries and capillaries. But of these the capillaries seem first to acquire a renovation of their action, as the heat of the skin becomes first renewed, as well as increased beyond its natural quantity, and this in some parts sooner than in others; which quantity of heat is however not to be estimated simply by the rise of the mercury in the thermometer, but also by the quantity carried away into the atmosphere, or diffused amongst other bodies in a given time; as more heat passes through water, which boils vehemently, than when it boils gently, though the rise of the thermometer in both cases continues the same. This fact may be known by boiling an egg in water, the white of which coagulates in much less time, if the water boils vehemently, than if it boils moderately, though the sensible heat of the water is the same in both cases.

Another cause, which induces the cutaneous capillaries to renew their actions sooner than the heart and arteries after immersion in the cold bath, is, that their torpor was occasioned by defect of irritation; whereas that of the heart and arteries was occasioned by defect of association; which defect of association was owing to the decreased actions of the capillaries, and is now again excited by their renewed action; which excitement must therefore be subsequent to that increased action of the capillaries; and in consequence the increased action of the heart and arteries at the commencement of the hot fit of some fevers is subsequent to the increased action of the cutaneous capillaries. There is, however, in this case an accumulation of the sensorial power of association in the heart and arteries, which must contribute to increase their orgasm in the hot fit, as well as the increased excitement of it by the increased action of the capillaries.

4. Now this increased action of the system, during the hot fit, by exhausting the sensorial powers of irritation and association, contributes to induce a renewal of the cold paroxysm; as the accumulation of those sensorial powers in the cold fit produces the increased actions of the hot fit; which two states of the system reciprocally induce each other by a kind of libration, or a plus and minus, of the sensorial powers of irritation and association.

If the exhaustion of sensorial power during the hot fit of fever only reduces the quantity of irritability and associability to its natural standard, the fever is cured, not being liable to return. If the quantity of these sensorial powers be reduced only so much, as not to produce a second cold fit during the present quantity of external stimuli or influences; yet it may be so far reduced, that a very small subtraction of stimulus, or of influence, may again induce a cold fit; such as the coldness of the night-air, or the diminution of solar or lunar gravitation, as in intermittent fevers.

5. Another cause of the renovation of the cold fits of fever is from some parts of the system not having completely recovered from the former cold paroxysm; as happens to the spleen, liver, or other internal viscus; which sometimes remains tumid, and either occasions a return of the cold fit by direct sympathy with other parts of the body, or by its own want of action causes a diminution of the general quantity of heat, and thus facilitates the renovation of the torpor of the whole system, and gives cause to intermittent fevers catenated with lunar or solar influence.

VIII. Orgasm of the Capillaries.

As the remaining torpor of some less essential part of the system, as of the spleen, when the hot fit ceases, produces after one, two, or three days a return of cold fit by direct sympathy with the cutaneous capillaries, when joined with some other cause of torpor, as the defect of solar or lunar influences, or the exposure to cold or hunger, and thus gives origin to intermittent fever; so the remaining torpor of some more essential parts of the system, as of the stomach and intestines, is probably the cause of the immediate recurrence of the cold paroxysm, at the time the hot one ceases, by their direct sympathy with the cutaneous capillaries, without the assistance of any other cause of torpor; and thus produces remittent fever. And lastly the remaining torpor of some still more essential parts of the system, as the heart and arteries, after the hot fit ought to cease, is liable by reverse sympathy with the cutaneous capillaries to continue their orgasm, and thus to render a fever continual, which would otherwise remit or intermit.

Many difficulties here occur, which we shall endeavour to throw some light upon, and leave to future investigation; observing only that difficulties were to be expected, otherwise fevers would long since have been understood, as they have employed the unremitted attention of the physicians of all ages of the world.

1. Why do the same parts of successive trains of action sometimes affect each other by direct, and sometimes by reverse sympathy?—1st, When any irritative motion ceases, or becomes torpid, which was before in perpetual action; it is either deprived of its usual stimulus, and thence the sensorial power of irritation is not excited; or it has been previously too much stimulated, and the sensorial power has been thus exhausted.

In the former case an accumulation of sensorial power soon occurs, which is excitable by a renewal of the stimulus; as when the fingers, which have been immersed some time in snow, are again exposed to the usual warmth of a room. Or, secondly, the sensorial power of irritation becomes so much accumulated, that the motions, which were torpid, are now performed by less stimulus than natural; as appears by the warmth, which soon occurs after the first chill in going into frosty air, or into the bath at Buxton, which is about eighty degrees of heat. Or, lastly, this accumulation of the sensorial power of irritation so far abounds, that it increases the action of the next link of the associated train or tribe of motions; thus on exposing the skin to cold air, as in walking out in a frosty morning, the actions of the stomach are increased, and digestion strengthened.

But where the torpor of some irritative motion is owing to the previous exhaustion of the sensorial power of irritation by too great stimulus, the restoration of it occurs either not at all, or much more slowly than in the former instances; thus after intoxication the stomach is very slow in recovering its due quantity of the sensorial power of irritation, and never shews any accumulation of it.

2. When an associate motion, as described in the introduction to Class IV. 1. 1. acts with less energy, the sensorial power of association is either not sufficiently excited by the preceding fibrous motions; or it has been expended or exhausted by the too violent actions of the preceding fibrous motions. In the former case there occurs an accumulation of the sensorial power of association; exactly as, where the usual stimulus is withdrawn, there occurs an accumulation of the sensorial power of irritation. Thus when the actions of the capillaries of the skin are diminished by immersion in cold water, the capillaries of the lungs are rendered torpid by the want of the excitement of the sensorial power of association, owing to the lessened actions of the previous fibrous motions, namely, of those of the skin. Nevertheless as soon as the capillaries of the skin regain their increased activity by the accumulation of the sensorial power of irritation, these capillaries of the lungs act with greater energy also owing to their accumulated sensorial power of association. These are instances of direct sympathy, and constitute the cold and hot paroxysms of intermittent fever; or the first paroxysm of a continued one.

3. When the first link of a train of associated motions, which is subject to perpetual action, becomes a considerable time torpid for want of being excited by the previous exertions of the irritative motions, with which it is catenated; the sensorial power of association becomes accumulated in so great a degree as to affect the second link of the train of associated motions, and to excite it into stronger action. Thus when the stomach is rendered torpid by contagious matter swallowed into it mixed with the saliva, the heart and arteries act more feebly; because the sensorial power of association, which used to be excited by the fibrous motions of the stomach, is not now excited; and in consequence the motions of the heart and arteries act only by the sensorial power of irritation, which is excited by the stimulus of the blood.

But during this torpor of the stomach, and less action of the heart and arteries, so great an accumulation of the sensorial powers of irritation and of association occurs, that it adds to the action of the next link of this vital circle of actions, that is, to that of the cutaneous capillaries. Whence in this situation the torpor of the stomach occasions a diminished action of the heart and arteries by direct sympathy, and may be said to occasion an increased one of the cutaneous capillaries by reverse sympathy; which constitute continued fever with weak pulse.

Nor is this increased action of the capillaries in consequence of the decreased action of the heart and arteries, as in fevers with weak pulse, a single fact in the animal economy; though it exists in this case in the greatest degree or duration, because the heart and arteries are perpetually in greater action than any other part of the system. But a similar circumstance occurs, when the stomach is rendered inactive by defective excitement of the sensorial power of association, as in sea-sickness, or in nephritis. In these cases the sensorial power of association becomes much accumulated in the stomach, and seems by its superabundance to excite the absorbent system, which is so nearly connected with it, into great increase of action; as is known by the great quantity frequently in these situations rejected by vomit, which could not otherways be supplied. It is probable the increase of digestion by walking in frosty air, with many other animal facts, may by future observations be found to be dependent on this principle, as well as the increased action of the capillaries in continued fevers with weak pulse.

Whereas in continued fever with strong pulse, which may perhaps occur sometimes on the first day even of the plague, the stomach with the heart and arteries and the capillaries act by direct sympathy; that is, the stomach is excited into stronger action by increased irritation owing to the stimulus of contagious matter; these stronger irritative motions of the stomach excite a greater quantity of the sensorial power of association, which then actuates the heart and arteries with greater energy, as these are catenated with the stomach; and in the same manner the increased actions of the heart and arteries excite a greater quantity of the sensorial power of association, which actuates the cutaneous capillaries with increase of energy. See Class IV. 1. 1.

4. I shall dwell a little longer on this intricate subject. The commencement of fever-fits is known by the inactivity of the cutaneous capillaries, which inactivity is observable by the paleness and coldness of the skin, and also by the pain of coldness, which attends it. There is nevertheless in most cases, except those which are owing to exposure to external cold, a torpor of the capillaries of some internal viscus preceding this inactivity of the cutaneous capillaries; which is known, by the tumour or hardness of the viscus, or by an aching pain of it. The capillaries of the lungs are at the same time rendered inactive or torpid, as appears by the difficulty of breathing, and coldness of the breath in cold fits of fever, and in going into the cold bath; but the lungs are not affected with the pain either of coldness or of torpor.

One cause of this synchronous or successive inactivity of the cutaneous capillaries, in consequence of the previous torpor of some internal viscus, may be owing to the deficiency of heat; which must occur, when any part becomes inactive; because the secretions of that part cease or are lessened, and the quantity of heat of it in consequence. But the principal cause of it I suppose to be owing to the defect of the sensorial power of association; which power of association is excited by some previous or concomitant motions of the parts of every great circle of actions. This appears on going into the cold bath, because the shortness of breath instantly occurs, sooner than one can conceive the diminution of the heat of the skin could affect the lungs by the want of its stimulus; but not sooner than the defect of the sensorial power of association could affect them; because this must cease to be excited into action on the instant that the cutaneous capillaries cease to act; whence in the first moment of contact of the cold water the cutaneous capillaries cease to act from defect of irritation; which is caused by defect of the stimulus of heat; and in the second moment the capillaries of the lungs cease to act from the defect of association; which is caused by the defect of the motions of the cutaneous capillaries. Thus the universal torpor in the cold paroxysm of fever is an example of direct sympathy, though occasioned in part by defect of irritation, and in part by defect of association.

5. Thus in walking out in a frosty morning the skin is cooled by the contact of the cold air, whence the actions of its capillaries are diminished for want of their usual stimulus of heat to excite a sufficient quantity of the sensorial power of irritation. Hence there is at first a saving of sensorial power of irritation for the purpose of actuating the other parts of the system with greater energy. Secondly the sensorial power of association, which used to be excited by the motions of the cutaneous capillaries, is now not so powerfully excited; and in consequence the parts, which constitute the next links of the circles of associated motions, are for a time actuated with less energy, and a temporary general chillness succeeds; which is so far similar to the cold fit of intermittent fever.

In this situation there is a curious circumstance occurs, which merits peculiar attention: after a short time, though the external skin continues cool by its exposure to the cold air, and the actions of its capillaries are consequently diminished, yet the capillaries of the stomach act with greater energy; as is known by increased digestion and consequent hunger. This is to be ascribed to the accumulation of the sensorial power of irritation, which now excites by its superabundance, or overflowing, as it were, the stomach into increased action; though it is at the same time excited less powerfully than usual by the sensorial power of association. Thus the accumulation of the sensorial power of irritation in the vessels of the skin increases in this case the action of the stomach, in the same manner as an accumulation of the sensorial power of association in the heart and arteries in fevers with weak pulse increases the action of the capillaries.

If nevertheless the coldness of the skin be too long continued, or exists in too great a degree, so as in some measure to impair the life of the part, no further accumulation of the sensorial power of irritation occurs; and in consequence the actions of the stomach become less than natural by the defect of the sensorial power of association; which has ceased to be excited by the want of action of the cutaneous capillaries. Whence continued coldness of the feet is accompanied with indigestion and heartburn. See Class IV. 2. 1. 6.

6. Similar to this when the actions of the stomach are rendered torpid by the previous stimulus of a violent emetic, and its motions become retrograde in consequence, a great quantity of sensorial power is exerted on the lymphatics of the lungs, and other parts of the body; which excites them into greater direct action, as is evinced by the exhibition of digitalis in anasarca. In this situation I suppose the emetic drug stimulates the muscular fibres of the stomach into too great action; and that in consequence a great torpor soon succeeds; and that this inaction of the muscular parts of the stomach is not followed by much accumulation of the sensorial power of irritation; because that sensorial power is in great measure exhausted by the previous excessive stimulus. But the lymphatics of the stomach have their actions lessened by defect of the sensorial power of association, which is not now excited into action, owing to the lessened motions of the muscular parts of it, with which the lymphatics are associated. The sensorial power of association becomes therefore accumulated in these lymphatics of the stomach, because it is not excited into action; exactly as the power of irritation becomes accumulated in the hand, when immersed in snow; and this accumulated sensorial power of association excites the lymphatic of the lungs and of other parts, which are most nearly associated with those of the stomach, into more energetic actions. Thus the muscular fibres of the stomach act with the lymphatics of that organ in direct sympathy; and the lymphatics of the stomach act in reverse sympathy with those of the lungs and of other parts of the body; the former of which is caused by defect of the excitement of the sensorial power of association, and the latter by the accumulation of it.

Besides the efficient cause, as above explained, the final cause, or convenience, of these organic actions are worthy our attention. In this case of an acrid drug swallowed into the stomach the reverted actions of the muscular fibres of the stomach tend to eject its enemy; the reverted actions of its lymphatics pour a great quantity of fluids into the stomach for the purpose of diluting or washing off the noxious drug; and the increased actions of the other lymphatics supply these retrograde ones of the stomach with an inconceivable supply of fluids, as is seen in Ileus and Cholera.

7. The inquisitive reader will excuse my continuing this subject, though perhaps with some repetitions, as it envelopes the very essence of fever. When the first link of a train of actions is excited by excessive stimulus, or excessive irritability, and thus acts with unusual energy by the increased quantity of irritation, these increased motions excite a greater quantity of the sensorial power of association, which causes increased motions in the second link, which is catenated with the first; and then the excessive action of this second link excites also a greater quantity of the sensorial power of association, which increases the motions of the third link of this chain of association, and thus the increase of the stimulus on the irritative motions, to which the chain of association is catenated, increases the action of the whole chain or circle of associated motions.

After a time the irritative motions become torpid by expenditure of the sensorial power of irritation, and then the power of association also becomes less exerted, both because it has been in part exhausted by too great action, and is now less excited by the lessened action of the irritative motions, which used to excite it. These are both instances of direct sympathy, and frequently constitute the cold and hot fit of intermittents.

But though the accumulation of the sensorial power of irritation during the quiescence of some motion owing to want of stimulus generally induces torpor in the first link of the train of associated motions catenated with it; as the capillaries of the lungs become torpid immediately on immersion of the skin into cold water; yet in some situations an orgasm or excess of action is produced in the first link of the associated motions thus catenated with irritative ones; as in the increased action of the stomach, when the skin is for a time exposed to cold air; which may in part be ascribed to the general increase of action of the whole system, owing to the diminished expenditure of sensorial power, but particularly of the parts, which have habitually acted together; as when one arm is paralytic the other is liable to more frequent or almost continual motion; and when one eye becomes blind the other frequently becomes stronger; which is well known to farriers, who are said sometimes to destroy the sight of one eye to strengthen that of the other in diseased horses.

Hence there is sometimes a direct sympathy, and sometimes a reverse one succeeds the torpor occasioned by defect of stimulus, the latter of which is perhaps owing to a certain time being required for the production of an accumulation of the sensorial power of irritation by the nervous branches of the torpid organ; which accumulation is now in part or entirely derived to the next link of the association. Thus in going into a coldish bath, as into a river in the summer months, we at first experience a difficulty of breathing from the torpid action of the pulmonary capillaries, owing to the deficient excitement of the sensorial power of association in consequence of the torpor of the cutaneous capillaries. But in a very short time, as in one minute, the sensorial power of irritation becomes accumulated by the inactivity of the cutaneous capillaries; and as its superabundance becomes now expended on the pulmonary capillaries, the difficult respiration ceases; though the cutaneous capillaries continue torpid by their contact with the cold water, and consequently the sensorial power of association, which used to contribute to actuate the pulmonary capillaries, is less excited.

8. In like manner when there exists an accumulation of the sensorial power of association, owing to defect of its excitement by some previous irritative or associate motions, it is generally accompanied for a certain time by a torpor not only of the link first affected, but of the subsequent parts, or of the whole train of associated motions, as in the cold fits of intermittent fevers. Yet after a time an increased action of the next links of associated motions succeeds the torpor of the first, as the absorbent vessels of the lungs act more violently in consequence of the deficient action of those of the stomach; and the skin at the commencement of sickness is pale and cold, but in a little time becomes flushed and warm.

Thus we see in associate motions, which are rendered torpid by defect of excitement, that sometimes a direct, and sometimes a reverse sympathy succeeds in the subsequent links of the chain. But I believe where a torpor of irritative or of the associate motions is caused by a previous too great expenditure or exhaustion of the sensorial powers of irritation or association, no increase of action in the subsequent link ever occurs, or not till after a very long time.

Thus when the stomach becomes torpid by previous violent exertion, and consequent exhaustion of the sensorial power of irritation, as after intoxication with wine or opium, or after the exhibition of some violent emetic drug, the torpor is communicated to the heart and arteries, as in continued fevers with weak pulse. But where the torpor of the stomach is produced from defective association, as in sea-sickness; or in the sickness which occurs, when a stone stimulates the ureter; no torpor is then communicated to the heart and arteries. For in the former case there is no accumulation of sensorial power in the stomach, which was previously exhausted by too great stimulus; but in the latter case the accumulation of sensorial power in the stomach during its torpor is evinced by this circumstance; that in sea-sickness the patients eat and drink voraciously at intervals; and the pulse is generally not affected by the sickness occasioned by a stone in the ureter. For the action of the stomach is then lessened, and in consequence becomes retrograde, not owing to the exhaustion of the sensorial power of irritation, but to the want of excitement of the sensorial power of association; which is caused by the defective action of the ureter, which becomes occasionally torpid by the great stimulus of the stone it contains; or which is caused by the great exhaustion of sensorial power by the pain; which affects the ureter without exciting inflammation, or increased action of it.

9. Thus though the stomach after the great stimulus of intoxication from excess of wine or opium will continue many hours without accumulation of sensorial power, as appears from the patient's experiencing no appetite at the intervals of sickness; yet after long abstinence from food, at length not only the exhausted quantity of sensorial power is renewed, but an accumulation of it at length occurs, and hunger returns. In this situation the stomach is generally about a whole day before it regains its usual powers of digestion; but if it has been still more violently stimulated, and its actions further impaired, a still more permanent torpor along with a continued fever with weak pulse is liable to occur; and a fourth part, or a half, or three fourths, or a whole lunar period passes, before it recovers its due irritability and consequent action.

In similar manner, after a person has been confined in a very warm room for some hours, the cutaneous capillaries, with their secretory and absorbent vessels, become exhausted of their sensorial power of irritation by the too great violent exertions occasioned by the unusual stimulus of heat; and in coming into a colder atmosphere an inactivity of the cutaneous vessels exists at first for some time without accumulation of sensorial power; as is shewn by the continuance of the pain of cold and the paleness; but after a time both the pain of cold and paleness vanish, which now indicates an accumulation of the sensorial power of irritation, as less degrees of heat stimulate the system into due action.

In the same manner, after any one has been some time in the summer sunshine, on coming into a dark cell he continues much longer before he can clearly distinguish objects, than if his eyes had only been previously exposed to the light of a cloudy day in winter; because the sensorial power of irritation, and consequent sensation, had in the first case been previously much expended or exhausted; and therefore required a much longer time before it could be produced in the brain, or derived to the optic nerves, in such quantity as to restore the deficiency, and to cause an accumulation of it; whereas in the latter case no deficiency had occurred.

10. Thus the accumulation or deficiency of sensorial power in a torpid organ, which had previously been accustomed to perpetual action, depends on the manner in which it becomes torpid; that is, whether by great previous stimulus, or great previous excitement of the power of association; or by defect of its accustomed stimulus, or of its accustomed excitement of the power of association. In the former case the sensorial power is in an exhausted state, and therefore is not likely to become so soon accumulated, as after drunkenness, or exposure to great heat, or to great light; in the latter a great accumulation of sensorial power occurs, as after exposure to cold, or hunger, or darkness.

Hence when the stomach continues torpid by previous violent stimulus, as in the exhibition of digitalis, no accumulation of sensorial power of irritation supervenes; and in consequence the motions of the heart and arteries, which are associated with those of the stomach, become weak, and slow, and intermittent, from the defect of the excitement of the sensorial power of association. But what follows? as the actions of the heart and arteries are lessened by the deficient action of the sensorial power of association, and not by previous increased excitement of it; a great accumulation of the sensorial power of association occurs, which is exerted on the pulmonary and cutaneous absorbents by reverse sympathy, and produces a great absorption of the fluid effused into the cellular membrane in anasarca, with dry skin; constituting one kind of atrophy.

But if at the same time the secerning vessels of the stomach are stimulated into so violent activity as to induce great consequent torpor, as probably happens when contagious matter is swallowed into the stomach with our saliva, those of the heart and arteries act feebly from the deficient excitement of the power of association; and then the cutaneous and pulmonary secerning vessels act with greater force than natural, owing to the accumulation of the sensorial power of association; and unnatural heat of the skin, and of the breath succeed; but without frequency of pulse, constituting the paresis irritativa of Class I. 2. 1. 2. And lastly, if a paucity of blood attends this paresis, or some other cause inducing a frequency of pulse, the febris inirritativa, or fever with weak pulse, is produced.

But on the contrary when the stomach has previously been rendered torpid by defect of stimulus, as by hunger, if food be too hastily supplied, not only great exertion of the stomach itself succeeds, but fever with strong pulse is induced in consequence; that is, the heart and arteries are excited into more energetic action by the excess of the power of association, which catenates their motions with those of the stomach. For the redundancy of sensorial power of irritation, which was accumulated during the inactivity of the stomach, and is now called into action by stimulus, actuates that organ with increased energy, and excites by these increased motions the sensorial power of association; which has also been accumulated during the inactivity of the heart and arteries; and thus these organs also are now excited into greater action.

So after the skin has been exposed some hours to greater heat than natural in the warm room, other parts, as the membranes of the nostrils, or of the lungs, or of the stomach, are liable to become torpid from direct sympathy with it, when we come into air of a moderate temperature; whence catarrhs, coughs, and fevers. But if this torpor be occasioned by defect of stimulus, as after being exposed to frosty air, the accumulation of sensorial power is exerted, and a glow of the skin follows, with increased digestion, full respiration, and more vigorous circulation.

11. It may be asked, Why is there a great and constant accumulation of the sensorial power of association, owing to the torpor of the stomach and heart and arteries, in continued fever with weak pulse; which is exerted on the cutaneous and pulmonary capillaries, so as to excite them into increased action for many weeks, and yet no such exuberance of sensorial power produces fever in winter-sleeping animals, or in chlorosis, or apepsia, or hysteria?

In winter-sleeping animals I suppose the whole nervous system is torpid, or paralysed, as in the sleep of frozen people; and that the stomach is torpid in consequence of the inactivity or quiescence of the brain; and that all other parts of the body, and the cutaneous capillaries with the rest, labour under a similar torpor.

In chlorosis, I imagine, the actions of the heart and arteries, as well as those of the cutaneous and pulmonary capillaries, suffer along with those of the stomach from the deficient stimulus of the pale blood; and that though the liver is probably the seat of the original torpor in this disease, with which all other parts sympathize from defect of the excitation of the sensorial power of association; yet as this torpor occurs in so small a degree as not to excite a shuddering or cold fit, no observable consequences are in general occasioned by the consequent accumulation of sensorial power. Sometimes indeed in chlorosis there does occur a frequent pulse and hot skin; in which circumstances I suppose the heart and arteries are become in some degree torpid by direct sympathy with the torpid liver; and that hence not only the pulse becomes frequent, but the capillaries of the skin act more violently by reverse sympathy with the heart and arteries, owing to the accumulation of the sensorial power of association in them during their torpid state, as occurs in irritative fever. See Article 11 of this Supplement.

In apepsia chronica the actions of the stomach are not so far impaired or destroyed as totally to prevent the excitation of the sensorial power of association, which therefore contributes something towards the actions of the heart and arteries, though less than natural, as a weak pulse always I believe attends this disease.

There is a torpor of the stomach, and of the upper part of the alimentary canal in hysteria, as is evident from the retrograde actions of the duodenum, stomach, and œsophagus, which constitute the globus hystericus, or sensation of a globe rising into the throat. But as these retrograde actions are less than those, which induce sickness or vomiting, and are not occasioned by previous exhaustion of the sensorial power of irritation, they do not so totally prevent the excitement of the sensorial power of association, as to lessen the motion of the heart and arteries so much as to induce fever; yet in this case, as in apepsia, and in chlorosis, the pulsations of the heart and arteries are weaker than natural, and are sometimes attended with occasionally increased action of the capillaries; as appears from the flushings of the face, and hot skin, which generally form an evening febricula in diseases attended with weak digestion.

12. The increased action, or orgasm, of the cutaneous, pulmonary, and cellular capillaries, with their secerning and absorbent vessels, in those fevers which are attended with deficiency of vital action, exhausts the patient both by the additional expenditure of sensorial power on those organs of secretion, and by the too great absorption of the mucus and fat of the body; whence great debility and great emaciation. Hence one great indication of cure of continued fever with arterial debility is to diminish the too great action of the capillaries; which is to be done by frequent ablutions, or bathing the whole skin in tepid or in cold water, as recommended by Dr. Currie of Liverpool (Philos. Trans. for 1792), for half an hour, twice a day, or at those times when the skin feels dryest and hottest. Much cool air should also be admitted, when the breath of the patient feels hot to one's hand; or when the tongue, especially its middle part, is dry, and covered with a crust of indurated mucus; as these indicate the increased action of the pulmonary capillaries; in the same manner as the dry and hot skin indicates the orgasm of the cutaneous capillaries; and the emaciation of the body that of the cellular ones.

For this purpose of abating the action of the capillaries by frequent ablution or fomentation, water of any degree of heat beneath that of the body will be of service, and ought in accurate language to be called a cold bath; but the degree of coldness, where the patient is sensible, should in some measure be governed by his sensations; as it is probable, that the degree of coldness, which is most grateful to him, will also be of the greatest benefit to him. See Class III. 2. 1. 12. and Article 15 of this Supplement.

Another great use of frequent ablutions, or fomentations, or baths, in fevers, where the stomach is in some degree torpid, is to supply the system with aqueous fluid by means of the cutaneous absorbents; which is dissipated faster by the increased action of the secerning capillaries, than the stomach can furnish, and occasions great thirst at the intervals of the sickness.

IX. Torpor of the Lungs.

1. The lungs in many cases of contagion may first be affected with torpor, and the skin become cold by sympathy; in the same manner as a cold skin on going into the cold bath induces difficulty of breathing. Or the stomach may become affected with torpor by its sympathy with the lungs, as in the experiments of Mr. Watt with hydro-carbonate gas; a few respirations of which induced sickness, and even syncope. When the stomach or skin is thus affected secondarily by association, an accumulation of sensorial power occurs much sooner, than when these parts become torpid in consequence of previous excess of stimulus; and hence they sooner recover their accustomed action, and the fever ceases. The particles of contagious matter thus received by respiration somewhat resemble in their effects the acid gases from burning sulphur, or from charcoal; which, if they do not instantly destroy, induce a fever, and the patient slowly recovers.

2. I was some years ago stooping down to look, which way the water oozed from a morass, as a labourer opened it with a spade, to detect the source of the spring, and inhaled a vapour, which occasioned an instant sense of suffocation. Immediately recoiling I believe I inhaled it but once; yet a few hours afterwards in the cool of the evening, when I returned home rather fatigued and hungry, a shivering and cold fit occurred, which was followed by a hot one; and the whole disease began and terminated in about twelve hours without return. In this case the power of fear, or of imagination, was not concerned; as I neither thought of the bad air of a morass before I perceived it; nor expected a fever-fit, till it occurred.

In this case the torpor commenced in the lungs, and after a few hours, by the addition of fatigue, and cold, and hunger, was propagated by direct sympathy to the rest of the system. An orgasm or increased action of the whole system was then induced by the accumulation of sensorial power of irritation in the lungs, and of association in the other organs; and when these subsided, the disease ceased. It may be asked, could a torpor of the capillaries of the air-vessels of the lungs be so suddenly produced by great stimulation?—It appears probable, that it might, because great exertion of irritative motions may be instantly produced without our perceiving them; that is, without their being attended by sensation, both in the lungs and stomach; and the organs may become torpid by the great expenditure of the sensorial power of irritation in an instant of time; as paralysis frequently instantly follows too great an exertion of voluntary power.

3. When the capillaries of the lungs act too violently, as in some continued fevers; which is known by the heat of the breath, and by the dryness of the tongue, especially of the middle part of it; not only cooler air might be admitted more freely into a sick room to counteract this orgasm of the pulmonary capillaries; but perhaps the patient might breathe with advantage a mixture of carbonic acid gas, or of hydrogene gas, or of azote with atmospheric air. And on the contrary, when there exists an evident torpor of the pulmonary capillaries, which may be known by the correspondent chilness of the skin; and by a tickling cough, which sometimes attends cold paroxysms of fever, and is then owing to the deficient absorption of the pulmonary mucus, the saline parts of which stimulate the bronchiæ, or air-vessels; a mixture of one part of oxygen gas with 10 or 20 parts of atmospheric air might probably be breathed with great advantage.

X. Torpor of the Brain.

As the inactivity or torpor of the absorbent vessels of the brain is the cause of hydrocephalus internus; and as the deficiency of venous absorption in the brain, or torpor of the extremities of its veins, is believed frequently to be the cause of apoplexies; so there is reason to conclude, that the torpor of the secerning vessels of the brain, which are supposed to produce the sensorial power, may constitute the immediate cause of some fevers with arterial debility. And also that the increased action of these secerning vessels may sometimes constitute the immediate cause of fevers with arterial strength.

It is nevertheless probable, that the torpor or orgasm of the sanguiferous, absorbent, or secerning vessels of the brain may frequently exist as a secondary effect, owing to their association with other organs, as the stomach or lungs; and may thus be produced like the torpor of the heart and arteries in inirritative fevers, or like the orgasm of those organs in irritative fevers, or inflammatory ones.

Where there exists a torpor of the brain, might not very slight electric shocks passed frequently through it in all directions be used with advantage? Might not fomentations of 94 or 96 degrees of heat on the head for an hour at a time, and frequently repeated, stimulate the brain into action; as in the revival of winter-sleeping animals by warmth? Ether externally might be frequently applied, and a blister on the shaved head.

Where the secerning vessels of the brain act with too great energy, as in some inflammatory fevers, might it not be diminished by laying the patient horizontally on a mill-stone, and whirling him, till sleep should be produced, as the brain becomes compressed by the centrifugal force? See Article 15 of this Supplement.

XI. Torpor of the Heart and Arteries.

1. It was shewn in Class IV. 1. 1. 6. in IV. 2. 1. 2. and in Suppl. I. 6. 3. that a reverse sympathy generally exists between the lacteal and lymphatic branches of the absorbent system. Hence, when the motions of the absorbents of the stomach are rendered torpid or retrograde in fevers with arterial debility, those of the skin, lungs, and cellular membrane, act with increased energy. But the actions of the muscular fibres of the heart and arteries are at the same time associated with those of the muscular fibres of the stomach by direct sympathy. Both these actions occur during the operation of powerful emetics, as squill, or digitalis; while the motions of the stomach continue torpid or retrograde, the cellular and cutaneous absorbents act with greater energy, and the pulsations of the heart and arteries become weaker, and sometimes slower.

2. The increased action of the stomach after a meal, and of the heart and arteries at the same time from the stimulus of the new supply of chyle, seems originally to have produced, and to have established, this direct sympathy between them. As the increased action of the absorbents of the stomach after a meal has been usually attended with diminished action of the other branches of the absorbent system, as mentioned in Class IV. 1. 1. 6. and has thus established a reverse sympathy between them.

2. Besides the reverse sympathy of the absorbent vessels and the muscles of the stomach, and of the heart and arteries, with those of the skin, lungs, and cellular membrane; there exists a similar reverse sympathy between the secerning vessels or glands of the former of these organs with those of the latter; that is the mucous glands of the heart and arteries act generally by direct sympathy with those of the stomach; and the mucous glands of the cellular membrane of the lungs, and of the skin, act by reverse sympathy with them both.

Hence when the stomach is torpid, as in sickness, this torpor sometimes only affects the absorbent vessels of it; and then the absorbents of the cellular membrane and the skin only act with increased energy by reverse sympathy. If the torpor affects the muscular fibres of the stomach, those of the heart and arteries act by direct sympathy with it, and a weak pulse is produced, as in the exhibition of digitalis, but without increase of heat. But if the torpor also affects the glands of the stomach, the cutaneous and pulmonary glands act with greater energy by their reverse sympathy with those of the stomach, and of the heart and arteries; and great heat is produced along with increased perspiration both from the skin and lungs.

3. There is some difficulty in explaining, why the actions of the extensive system of capillary glands, which exist on every other membrane and cell in the body for the purpose of secreting mucus and perspirable matter, should so generally act by reverse sympathy with those of the stomach and upper part of the intestines. It was shewn in Class IV. 1. 1. 6. that when the stomach was filled with solid and fluid aliment, the absorbents of the cellular membrane, and of the bladder, and of the skin acted with less energy; as the fluids they were used to absorb and transmit into the circulation, were now less wanted; and that hence by habit a reverse sympathy obtained between these branches of the absorbents of the alimentary canal, and those of the other parts of the body.

Now, as at this time less fluid was absorbed by the cutaneous and cellular lymphatics, it would happen, that less would be secreted by their correspondent secerning vessels, or capillary glands; and that hence by habit, these secerning vessels would acquire a reverse sympathy of action with the secerning vessels of the alimentary canal.

Thus when the absorption of the tears by the puncta lacrymalia is much increased by the stimulus of snuff; or of an affecting idea, on the nasal dusts, as explained in Sect. XVI. 8. 2. a great increase of the secretion of tears from the lacrymal glands is produced by the direct sympathy of the action of these glands with those of their correspondent absorbents; and that though in this case they are placed at so great a distance from each other.

4. A difficult question here occurs; why does it happen, that in fevers with weak pulse the contractions of the heart and arteries become at the same time more frequent; which also sometimes occurs in chlorosis, and in some hysteric and hypochondriac diseases, and in some insanities; yet at other times the weak pulse becomes at the same time slow, as in the exhibition of digitalis, and in paresis irritativa, described in Class I. 2. 1. 2. which may be termed a fever with slow pulse? this frequency of pulse can not depend on heat, because it sometimes exists without heat, as towards the end of some fevers with debility.

Now as apoplexies, which are sometimes ascribed to fulness of blood, are attended with slow pulse; and as in animals dying in the slaughter house from deficiency of blood the pulse becomes frequent in extreme; may not the frequency of pulse in fevers with arterial debility be in general owing to paucity of blood? as explained in Sect. XXXII. 2. 3. and its slowness in paresis irritativa be caused by the debility being accompanied with due quantity of blood? or may not the former circumstance sometimes depend on a concomitant affection of the brain approaching to sleep? or to the unusual facility of the passage of the blood through the pulmonary and aortal capillaries? in which circumstance the heart may completely empty itself at each pulsation, though its contractions may be weak. While the latter depends on the difficulty of the passage of the blood through the pulmonary or aortal capillaries, as in the cold fits of intermittents, and in some palpitations of the heart, and in some kinds of hæmoptoe? in these cases the increased resistance prevents the heart from emptying itself, and in consequence a new diastole sooner occurs, and thus the number of pulsations becomes greater in a given time.

5. In respect to the sympathies of action, which produce or constitute fever with debility, the system may be divided into certain provinces, which are assentient or opposite to each other. First, the lacteals or absorbent vessels of the stomach, and upper part of the intestines; secondly, the lymphatics or all the other branches of the absorbent vessels, which arise from the skin, mucous membranes, cellular membranes, and the various glands. These two divisions act by reverse sympathy with each other in the hot fits of fever with debility, though by direct sympathy in the cold ones. The third division consists of the secerning vessels of the stomach and upper intestines; and the fourth of the secerning vessels of all the other parts of the body, as the capillary glands of the skin, lungs, and cellular membrane, and the various other glands belonging to the sanguiferous system. Many of these frequently, but the capillaries always, act by reverse sympathy with those of the third division above mentioned in the hot fits of fever with debility, though by direct sympathy with them in the cold fits. Fifthly, the muscular fibres of the stomach, and upper intestines; and sixthly, the muscular fibres of the heart and arteries. The actions of these two last divisions of moving fibres act by direct sympathy with each other, both in the cold and hot fits of fevers with debility.

The efficient cause of those apparent sympathies in fevers with weak pulse may be thus understood. In the cold paroxysm of fever with weak pulse the part first affected I believe to be the stomach, and that it has become torpid by previous violent exertion, as by swallowing contagious matter mixed with saliva, and not by defect of stimulus, as from cold or hunger. The actions of this important organ, which sympathizes with almost every part of the body, being thus much diminished or nearly destroyed, the sensorial power of association is not excited; which in health contributes to move the heart and arteries, and all the rest of the system; whence an universal torpor occurs.

When the hot fit approaches, the stomach in fevers with strong pulse regains its activity by the accumulation of the sensorial power of either irritation, if it was the part first affected, or of association if it was affected in sympathy with some other torpid part, as the spleen or liver; which accumulation is produced during its torpor. At the same time all the other parts of the system acquire greater energy of action by the accumulation of the sensorial power of association, which was produced, during their inactivity in the cold fit.

But in fevers with weak pulse the stomach, whose sensorial power of irritation had been previously exhausted by violent action, acquires no such quick accumulation of sensorial power, but remains in a state of torpor after the hot fit commences. The heart and arteries remain also in a state of torpor, because there continues to be no excitement of their power of association owing to the torpid motions of the stomach; but hence it happens, that there exists at this time a great accumulation of the power of association in the less active fibres of the heart and arteries; which, as it is not excited and expended by them, increases the associability of the next link of the associated chain of motions, which consists of the capillaries or other glands; and that in so great a degree as to actuate them with unnatural energy, and thus to produce a perpetual hot fit of fever. Because the associability of the capillaries is so much increased by the accumulation of this power, owing to the lessened activity of the heart and arteries, as to over-balance the lessened excitement of it by the weaker movements of the heart and arteries.

6. When the accumulation of the sensorial power of irritation caused by defect of stimulus is greater in the first link of a train of actions, to which associated motions are catenated, than the deficiency of the excitement of the sensorial power of association in the next link, what happens?—the superabundance of the unemployed sensorial power of the first link is derived to the second; the associability of which thus becomes so greatly increased, that it acts more violently than natural, though the excitement of its power of association by the lessened action of the first link is less than natural. So that in this situation the withdrawing of an accustomed stimulus in some parts of the system will decrease the irritative motions of that part, and at the same time occasion an increase of the associate motion of another part, which is catenated with it.

This circumstance nevertheless can only occur in those parts of the system, whose natural actions are perpetual, and the accumulation of sensorial power on that account very great, when their activity is much lessened by the deduction of their usual stimulus; and are therefore only to be found in the sanguiferous system, or in the alimentary canal, or in the glands and capillaries. Of the first of which the following is an instance.

The respiration of a reduced atmosphere, that is of air mixed with hydrogene or azote, quickens the pulse, as observed in the case of Mrs. Eaton by Dr. Reynolds and Dr. Thornton; to which Dr. Beddoes adds in a note, that "he never saw an instance in which a lowered atmosphere did not at the moment quicken the pulse, while it weakened the action of the heart and arteries." Considerations on Factitious Airs, by Thomas Beddoes and James Watt, Part III. p. 67. Johnson, London. By the assistance of this new fact the curious circumstance of the quick production of warmth of the skin on covering the head under the bed-clothes, which every one must at some time have experienced, receives a more satisfactory explanation, than that which is given in Class IV. 1. 1. 2. which was printed before this part of Dr. Beddoes's Considerations was published.

For if the blood be deprived of its accustomed quantity of oxygen, as in covering the head in bed, and thus breathing an air rendered impure by repeated respiration, or by breathing a factitious air with less proportion of oxygen, which in common respiration passes through the moist membranes of the lungs, and mixes with the blood, the pulsations of the heart and arteries become weaker, and consequently quicker, by the defect of the stimulus of oxygen. And as these vessels are subject to perpetual motion, the accumulation of the sensorial power of irritation becomes so great by their lessened activity, that it excites the vessels next connected, the cutaneous capillaries for instance, into more energetic actions, so as to produce increased heat of the skin, and greater perspiration.

How exactly this resembles a continued fever with weak and quick pulse!—in the latter the action of the heart and arteries are lessened by defect of the excitement of the sensorial power of association, owing to the torpor or lessened actions of the stomach; hence the accumulation of the sensorial power of association in this case, as the accumulation of that of irritation in the former, becomes so abundant as to excite into increased action the parts most nearly connected, as the cutaneous capillaries.

In respect to the circumstance mentioned by Sydenham, that covering the head in bed in a short time relieved the pertinacious sickness of the patient, it must be observed, that when the action of the heart and arteries become weakened by the want of the due stimulus of the proper quantity of oxygen in the blood, that an accumulation of the sensorial power of irritation occurs in the fibres of the heart and arteries, which then is expended on those of the capillary glands, increasing their actions and consequent secretions and heat. And then the stomach is thrown into stronger action, both by the greater excitement of its natural quantity of the sensorial power of association by the increased actions of the capillaries, and also by some increase of associability, as it had been previously a long time in a state of torpor, or less activity than natural, as evinced by its perpetual sickness.

In a manner somewhat similar to this, is the redness of the skin produced in angry people by the superabundance of the unemployed sensorial power of volition, as explained in Class IV. 2. 3. 5. Rubor ex irâ. From hence we learn how, when people in fevers with weak pulse, or in dropsies, become insane, the abundance of the unemployed sensorial power of volition increases the actions of the whole moving system, and cures those diseases.

7. As the orgasm of the capillaries in fevers with weak pulse is immediately caused by the torpid actions of the heart and arteries, as above explained, this supplies us with another indication of cure in such fevers, and that is to stimulate these organs. This may probably be done by some kind of medicines, which are known to pass into the blood unchanged in some of their properties. It is possible that nitre, or its acid, may pass into the blood and increase the colour of it, and thus increase its stimulus, and the same may be supposed of other salts, neutral or metallic? As rubia tinctoria, madder, colours the bones of young animals, it must pass into the blood with its colouring matter at least unchanged, and perhaps many other medicines may likewise affect the blood, and thus act by stimulating the heart and arteries, as well as by stimulating the stomach; which circumstance deserves further attention.

Another way of immediately stimulating the heart and arteries would be by transfusing new blood into them. Is it possible that any other fluid besides blood, as chyle, or milk, or water, could, if managed with great art, be introduced safely or advantageously into the vein of a living animal?