PARALYSIS OF THE LIVER AND KIDNEYS.
I. 1.Bile-ducts less irritable after having been stimulated much. 2. Jaundice from paralysis of the bile-ducts cured by electric shocks. 3. From bile-stones. Experiments on bile-stones. Oil vomit. 4. Palsy of the liver, two cases. 5. Schirrosity of the liver. 6. Large livers of geese. II. Paralysis of the kidneys. III. Story of Prometheus.
I. 1. From the ingurgitation of spirituous liquors into the stomach and duodenum, the termination of the common bile-duct in that bowel becomes stimulated into unnatural action, and a greater quantity of bile is produced from all the secretory vessels of the liver, by the association of their motions with those of their excretory ducts; as has been explained in Section XXIV. and XXV. but as all parts of the body, that have been affected with stronger stimuli for any length of time, become less susceptible of motion, from their natural weaker stimuli, it follows, that the motions of the secretory vessels, and in consequence the secretion of bile, is less than is natural during the intervals of sobriety. 2. If this ingurgitation of spirituous liquors has been daily continued in considerable quantity, and is then suddenly intermitted, a languor or paralysis of the common bile-duct is induced; the bile is prevented from being poured into the intestines; and as the bilious absorbents are stimulated into stronger action by its accumulation, and by the acrimony or viscidity, which it acquires by delay, it is absorbed, and carried to the receptacle of the chyle; or otherwise the secretory vessels of the liver, by the above-mentioned stimulus, invert their motions, and regurgitate their contents into the blood, as sometimes happens to the tears in the lachrymal sack, see Sect. XXIV. 2. 7. and one kind of jaundice is brought on.
There is reason to believe, that the bile is most frequently returned into the circulation by the inverted motions of these hepatic glands, for the bile does not seem liable to be absorbed by the lymphatics, for it soaks through the gall-ducts, and is frequently found in the cellular membrane. This kind of jaundice is not generally attended with pain, neither at the extremity of the bile-duct, where it enters the duodenum, nor on the region of the gall-bladder.
Mr. S. a gentleman between 40 and 50 years of age, had had the jaundice about six weeks, without pain, sickness, or fever; and had taken emetics, cathartics, mercurials, bitters, chalybeates, essential oil, and ether, without apparent advantage. On a supposition that the obstruction of the bile might be owing to the paralysis, or torpid action of the common bile-duct, and the stimulants taken into the stomach seeming to have no effect, I directed half a score smart electric shocks from a coated bottle, which held about a quart, to be passed through the liver, and along the course of the common gall-duct, as near as could be guessed, and on that very day the stools became yellow; he continued the electric shocks a few days more, and his skin gradually became clear.
3. The bilious vomiting and purging, that affects some people by intervals of a few weeks, is a less degree of this disease; the bile-duct is less irritable than natural, and hence the bile becomes accumulated in the gall-bladder, and hepatic ducts, till by its quantity, acrimony or viscidity, a greater degree of irritation is produced, and it is suddenly evacuated, or lastly from the absorption of the more liquid parts of the bile, the remainder becomes inspissated, and chrystallizes into masses too large to pass, and forms another kind of jaundice, where the bile-duct is not quite paralytic, or has regained its irritability.
This disease is attended with much pain, which at first is felt at the pit of the stomach, exactly in the centre of the body, where the bile-duct enters the duodenum; afterwards, when the size of the bile-stones increase, it is also felt on the right side, where the gall-bladder is situated. The former pain at the pit of the stomach recurs by intervals, as the bile-stone is pushed against the neck of the duct; like the paroxysms of the stone in the urinary bladder, the other is a more dull and constant pain.
Where these bile-stones are too large to pass, and the bile-ducts possess their sensibility, this becomes a very painful and hopeless disease. I made the following experiments with a view to their chemical solution.
Some fragments of the same bile-stone were put into the weak spirit of marine salt, which is sold in the shops, and into solution of mild alcali; and into a solution of caustic alcali; and into oil of turpentine; without their being dissolved. All these mixtures were after some time put into a heat of boiling water, and then the oil of turpentine dissolved its fragments of bile-stone, but no alteration was produced upon those in the other liquids except some change of their colour.
Some fragments of the same bile-stone were put into vitriolic æther, and were quickly dissolved without additional heat. Might not æther mixed with yolk of egg or with honey be given advantageously in bilious concretions?
I have in two instances seen from 30 to 50 bile-stones come away by stool, about the size of large peas, after having given six grains of calomel in the evening, and four ounces of oil of almonds or olives on the succeeding morning. I have also given half a pint of good olive or almond oil as an emetic during the painful fit, and repeated it in half an hour, if the first did not operate, with frequent good effect.
4. Another disease of the liver, which I have several times observed, consists in the inability or paralysis of the secretory vessels. This disease has generally the same cause as the preceding one, the too frequent potation of spirituous liquors, or the too sudden omission of them, after the habit is confined; and is greater or less in proportion, as the whole or a part of the liver is affected, and as the inability or paralysis is more or less complete.
This palsy of the liver is known from these symptoms, the patients have generally passed the meridian of life, have drank fermented liquors daily, but perhaps not been opprobrious drunkards; they lose their appetite, then their flesh and strength diminish in consequence, there appears no bile in their stools, nor in their urine, nor is any hardness or swelling perceptible on the region of the liver. But what is peculiar to this disease, and distinguishes it from all others at the first glance of the eye, is the bombycinous colour of the skin, which, like that of full-grown silkworms, has a degree of transparency with a yellow tint not greater than is natural to the serum of the blood.
Mr. C. and Mr. B. both very strong men, between 50 and 60 years of age, who had drank ale at their meals instead of small beer, but were not reputed hard-drinkers, suddenly became weak, lost their appetite, flesh, and strength, with all the symptoms above enumerated, and died in about two months from the beginning of their malady. Mr. C. became anasarcous a few days before his death, and Mr. B. had frequent and great hæmorrhages from an issue, and some parts of his mouth, a few days before his death. In both these cases calomel, bitters and chalybeates were repeatedly used without effect.
One of the patients described above, Mr. C, was by trade a plumber; both of them could digest no food, and died apparently for want of blood. Might not the transfusion of blood be used in these cases with advantage?
5. When the paralysis of the hepatic glands is less complete, or less universal, a schirrosity of some part of the liver is induced; for the secretory vessels retaining some of their living power take up a fluid from the circulation, without being sufficiently irritable to carry it forwards to their excretory ducts; hence the body, or receptacle of each gland, becomes inflated, and this distension increases, till by its very great stimulus inflammation is produced, or till those parts of the viscus become totally paralytic. This disease is distinguishable from the foregoing by the palpable hardness or largeness of the liver; and as the hepatic glands are not totally paralytic, or the whole liver not affected, some bile continues to be made. The inflammations of this viscus, consequent to the schirrosity of it, belong to the diseases of the sensitive motions, and will be treated of hereafter.
6. The ancients are said to have possessed an art of increasing the livers of geese to a size greater than the remainder of the goose. Martial. l. 13. epig. 58.—This is said to have been done by fat and figs. Horace, l. 2. sat. 8.—Juvenal sets these large livers before an epicure as a great rarity. Sat. 5. l. 114; and Persius, sat. 6. l. 71. Pliny says these large goose-livers were soaked in mulled milk, that is, I suppose, milk mixed with honey and wine; and adds, "that it is uncertain whether Scipio Metellus, of consular dignity, or M. Sestius, a Roman knight, was the great discoverer of this excellent dish." A modern traveller, I believe Mr. Brydone, asserts that the art of enlarging the livers of geese still exists in Sicily; and it is to be lamented that he did not import it into his native country, as some method of affecting the human liver might perhaps have been collected from it; besides the honour he might have acquired in improving our giblet pies.
Our wiser caupones, I am told, know how to fatten their fowls, as well as their geese, for the London markets, by mixing gin instead of figs and fat with their food; by which they are said to become sleepy, and to fatten apace, and probably acquire enlarged livers; as the swine are asserted to do, which are fed on the sediments of barrels in the distilleries; and which so frequently obtains in those, who ingurgitate much ale, or wine, or drams.
II. The irritative diseases of the kidneys, pancreas, spleen, and other glands, are analogous to those of the liver above described, differing only in the consequences attending their inability to action. For instance, when the secretory vessels of the kidneys become disobedient to the stimulus of the passing current of blood, no urine is separated or produced by them; their excretory mouths become filled with concreted mucus, or calculus matter, and in eight or ten days stupor and death supervenes in consequence of the retention of the feculent part of the blood.
This disease in a slighter degree, or when only a part of the kidney is affected, is succeeded by partial inflammation of the kidney in consequence of previous torpor. In that case greater actions of the secretory vessels occur, and the nucleus of gravel is formed by the inflamed mucous membranes of the tubuli uriniferi, as farther explained in its place.
This torpor, or paralysis of the secretory vessels of the kidneys, like that of the liver, owes its origin to their being previously habituated to too great stimulus; which in this country is generally owing to the alcohol contained in ale or wine; and hence must be registered amongst the diseases owing to inebriety; though it may be caused by whatever occasionally inflames the kidney; as too violent riding on horseback, or the cold from a damp bed, or by sleeping on the cold ground; or perhaps by drinking in general too little aqueous fluids.
III. I shall conclude this section on the diseases of the liver induced by spirituous liquors, with the well known story of Prometheus, which seems indeed to have been invented by physicians in those ancient times, when all things were clothed in hieroglyphic, or in fable. Prometheus was painted as stealing fire from heaven, which might well represent the inflammable spirit produced by fermentation; which may be said to animate or enliven the man of clay: whence the conquests of Bacchus, as well as the temporary mirth and noise of his devotees. But the after punishment of those, who steal this accursed fire, is a vulture gnawing the liver; and well allegorises the poor inebriate lingering for years under painful hepatic diseases. When the expediency of laying a further tax on the distillation of spirituous liquors from grain was canvassed before the House of Commons some years ago, it was said of the distillers, with great truth, "They take the bread from the people, and convert it into poison!" Yet is this manufactory of disease permitted to continue, as appears by its paying into the treasury above 900,000l. near a million of money annually. And thus, under the names of rum, brandy, gin, whisky, usquebaugh, wine, cyder, beer, and porter, alcohol is become the bane of the Christian world, as opium of the Mahometan.
Evoe! parce, liber?
Parce, gravi metuende thirso!—Hor.
OF TEMPERAMENTS.
I. The temperament of decreased irritability known by weak pulse, large pupils of the eyes, cold extremities. Are generally supposed to be too irritable. Bear pain better than labour. Natives of North-America contrasted with those upon the coast of Africa. Narrow and broad shouldered people. Irritable constitutions bear labour better than pain. II. Temperament of increased sensibility. Liable to intoxication, to inflammation, hæmoptoe, gutta serena, enthusiasm, delirium, reverie. These constitutions are indolent to voluntary exertions, and dull to irritations. The natives of South-America, and brute animals of this temperament. III. Of increased voluntarity; these are subject to locked jaw, convulsions, epilepsy, mania. Are very active, bear cold, hunger, fatigue. Are suited to great exertions. This temperament distinguishes mankind from other animals. IV. Of increased association. These have great memories, are liable to quartan agues, and stronger sympathies of parts with each other. V. Change of temperaments into one another.
Antient writers have spoken much of temperaments, but without sufficient precision. By temperament of the system should be meant a permanent predisposition to certain classes of diseases: without this definition a temporary predisposition to every distinct malady might be termed a temperament. There are four kinds of constitution, which permanently deviate from good health, and are perhaps sufficiently marked to be distinguished from each other, and constitute the temperaments or predispositions to the irritative, sensitive, voluntary, and associate classes of diseases.
I. The Temperament of decreased Irritability.
The diseases, which are caused by irritation, most frequently originate from the defect of it; for those, which are immediately owing to the excess of it, as the hot fits of fever, are generally occasioned by an accumulation of sensorial power in consequence of a previous defect of irritation, as in the preceding cold fits of fever. Whereas the diseases, which are caused by sensation and volition, most frequently originate from the excess of those sensorial powers, as will be explained below.
The temperament of decreased irritability appears from the following circumstances, which shew that the muscular fibres or organs of sense are liable to become torpid or quiescent from less defect of stimulation than is productive of torpor or quiescence in other constitutions.
1. The first is the weak pulse, which in some constitutions is at the same time quick. 2. The next most marked criterion of this temperament is the largeness of the aperture of the iris, or pupil of the eye, which has been reckoned by some a beautiful feature in the female countenance, as an indication of delicacy, but to an experienced observer it is an indication of debility, and is therefore a defect, not an excellence. The third most marked circumstance in this constitution is, that the extremities, as the hands and feet, or nose and ears, are liable to become cold and pale in situations in respect to warmth, where those of greater strength are not affected. Those of this temperament are subject to hysteric affections, nervous fevers, hydrocephalus, scrophula, and consumption, and to all other diseases of debility.
Those, who possess this kind of constitution, are popularly supposed to be more irritable than is natural, but are in reality less so.
This mistake has arisen from their generally having a greater quickness of pulse, as explained in Sect. XII. 1. 4. XII. 3. 3.; but this frequency of pulse is not necessary to the temperament, like the debility of it.
Persons of this temperament are frequently found amongst the softer sex, and amongst narrow-shouldered men; who are said to bear labour worse, and pain better than others. This last circumstance is supposed to have prevented the natives of North America from having been made slaves by the Europeans. They are a narrow-shouldered race of people, and will rather expire under the lash, than be made to labour. Some nations of Asia have small hands, as may be seen by the handles of their scymetars; which with their narrow shoulders shew, that they have not been accustomed to so great labour with their hands and arms, as the European nations in agriculture, and those on the coasts of Africa in swimming and rowing. Dr. Maningham, a popular accoucheur in the beginning of this century, observes in his aphorisms, that broad-shouldered men procreate broad-shouldered children. Now as labour strengthens the muscles employed, and increases their bulk, it would seem that a few generations of labour or of indolence may in this respect change the form and temperament of the body.
On the contrary, those who are happily possessed of a great degree of irritability, bear labour better than pain; and are strong, active, and ingenious. But there is not properly a temperament of increased irritability tending to disease, because an increased quantity of irritative motions generally induces an increase of pleasure or pain, as in intoxication, or inflammation; and then the new motions are the immediate consequences of increased sensation, not of increased irritation; which have hence been so perpetually confounded with each other.
II. Temperament of Sensibility.
There is not properly a temperament, or predisposition to disease, from decreased sensibility, since irritability and not sensibility is immediately necessary to bodily health. Hence it is the excess of sensation alone, as it is the defect of irritation, that most frequently produces disease. This temperament of increased sensibility is known from the increased activity of all those motions of the organs of sense and muscles, which are exerted in consequence of pleasure or pain, as in the beginning of drunkenness, and in inflammatory fever. Hence those of this constitution are liable to inflammatory diseases, as hepatitis; and to that kind of consumption which is hereditary, and commences with slight repeated hæmoptoe. They have high-coloured lips, frequently dark hair and dark eyes with large pupils, and are in that case subject to gutta serena. They are liable to enthusiasm, delirium, and reverie. In this last circumstance they are liable to start at the clapping of a door; because the more intent any one is on the passing current of his ideas, the greater surprise he experiences on their being dissevered by some external violence, as explained in Sect. XIX. on reverie.
As in these constitutions more than the natural quantities of sensitive motions are produced by the increased quantity of sensation existing in the habit, it follows, that the irritative motions will be performed in some degree with less energy, owing to the great expenditure of sensorial power on the sensitive ones. Hence those of this temperament do not attend to slight stimulations, as explained in Sect. XIX. But when a stimulus is so great as to excite sensation, it produces greater sensitive actions of the system than in others; such as delirium or inflammation. Hence they are liable to be absent in company; sit or lie long in one posture; and in winter have the skin of their legs burnt into various colours by the fire. Hence also they are fearful of pain; covet music and sleep; and delight in poetry and romance.
As the motions in consequence of sensation are more than natural, it also happens from the greater expenditure of sensorial power on them, that the voluntary motions are less easily exerted. Hence the subjects of this temperament are indolent in respect to all voluntary exertions, whether of mind or body.
A race of people of this description seems to have been found by the Spaniards in the islands of America, where they first landed, ten of whom are said not to have consumed more food than one Spaniard, nor to have been capable of more than one tenth of the exertion of a Spaniard. Robertson's History.—In a state similar to this the greatest part of the animal world pass their lives, between sleep or inactive reverie, except when they are excited by the call of hunger.
III. The Temperament of increased Voluntarity.
Those of this constitution differ from both the last mentioned in this, that the pain, which gradually subsides in the first, and is productive of inflammation or delirium in the second, is in this succeeded by the exertion of the muscles or ideas, which are most frequently connected with volition; and they are thence subject to locked jaw, convulsions, epilepsy, and mania, as explained in Sect. XXXIV. Those of this temperament attend to the slightest irritations or sensations, and immediately exert themselves to obtain or avoid the objects of them; they can at the same time bear cold and hunger better than others, of which Charles the Twelfth of Sweden was an instance. They are suited and generally prompted to all great exertions of genius or labour, as their desires are more extensive and more vehement, and their powers of attention and of labour greater. It is this facility of voluntary exertion, which distinguishes men from brutes, and which has made them lords of the creation.
IV. The Temperament of increased Association.
This constitution consists in the too great facility, with which the fibrous motions acquire habits of association, and by which these associations become proportionably stronger than in those of the other temperaments. Those of this temperament are slow in voluntary exertions, or in those dependent on sensation, or on irritation. Hence great memories have been said to be attended with less sense and less imagination from Aristotle down to the present time; for by the word memory these writers only understood the unmeaning repetition of words or numbers in the order they were received, without any voluntary efforts of the mind.
In this temperament those associations of motions, which are commonly termed sympathies, act with greater certainty and energy, as those between disturbed vision and the inversion of the motion of the stomach, as in sea-sickness; and the pains in the shoulder from hepatic inflammation. Add to this, that the catenated circles of actions are of greater extent than in the other constitutions. Thus if a strong vomit or cathartic be exhibited in this temperament, a smaller quantity will produce as great an effect, if it be given some weeks afterwards; whereas in other temperaments this is only to be expected, if it be exhibited in a few days after the first dose. Hence quartan agues are formed in those of this temperament, as explained in Section XXXII. on diseases from irritation, and other intermittents are liable to recur from slight causes many weeks after they have been cured by the bark.
V. The first of these temperaments differs from the standard of health from defect, and the others from excess of sensorial power; but it sometimes happens that the same individual, from the changes introduced into his habit by the different seasons of the year, modes or periods of life, or by accidental diseases, passes from one of these temperaments to another. Thus a long use of too much fermented liquor produces the temperament of increased sensibility; great indolence and solitude that of decreased irritability; and want of the necessaries of life that of increased voluntarity.
DISEASES OF IRRITATION.
I. Irritative fevers with strong pulse. With weak pulse. Symptoms of fever, Their source. II. 1. Quick pulse is owing to decreased irritability. 2. Not in sleep or in apoplexy. 3. From inanition. Owing to deficiency of sensorial power. III. 1. Causes of fever. From defect of heat. Heat from secretions. Pain of cold in the loins and forehead. 2. Great expense of sensorial power in the vital motions. Immersion in cold water. Succeeding glow of heat. Difficult respiration in cold bathing explained. Why the cold bath invigorates. Bracing and relaxation are mechanical terms. 3. Uses of cold bathing. Uses of cold air in fevers. 4. Ague fits from cold air. Whence their periodical returns. IV. Defect of distention a cause of fever. Deficiency of blood. Transfusion of blood. V. 1. Defect of momentum of the blood from mechanic stimuli. 2. Air injected into the blood-vessels. 3. Exercise increases the momentum of the blood. 4. Sometimes bleeding increases the momentum of it. VI. Influence of the sun and moon on diseases. The chemical stimulus of the blood. Menstruation obeys the lunations. Queries. VII. Quiesence of large glands a cause of fever. Swelling of the præcordia. VIII. Other causes of quiescence, as hunger, bad air, fear, anxiety. IX. 1. Symptoms of the cold fit. 2. Of the hot fit. 3. Second cold fit why. 4. Inflammation introduced, or delirium, or stupor. X. Recapitulation. Fever not an effort of nature to relieve herself. Doctrine of spasm.
I. When the contractile sides of the heart and arteries perform a greater number of pulsations in a given time, and move through a greater area at each pulsation, whether these motions are occasioned by the stimulus of the acrimony or quantity of the blood, or by their association with other irritative motions, or by the increased irritability of the arterial system, that is, by an increased quantity of sensorial power, one kind of fever is produced; which may be called Synocha irritativa, or Febris irritativa pulsu forti, or irritative fever with strong pulse.
When the contractile sides of the heart and arteries perform a greater number of pulsations in a given time, but move through a much less area at each pulsation, whether these motions are occasioned by defect of their natural stimuli, or by the defect of other irritative motions with which they are associated, or from the inirritability of the arterial system, that is, from a decreased quantity of sensorial power, another kind of fever arises; which may be termed, Typhus irritativus, or Febris irritativa pulsu debili, or irritative fever with weak pulse. The former of these fevers is the synocha of nosologists, and the latter the typhus mitior, or nervous fever. In the former there appears to be an increase of sensorial power, in the latter a deficiency of it; which is shewn to be the immediate cause of strength and weakness, as defined in Sect. XII. 1. 3.
It should be added, that a temporary quantity of strength or debility may be induced by the defect or excess of stimulus above what is natural; and that in the same fever debility always exists during the cold fit, though strength does not always exist during the hot fit.
These fevers are always connected with, and generally induced by, the disordered irritative motions of the organs of sense, or of the intestinal canal, or of the glandular system, or of the absorbent system; and hence are always complicated with some or many of these disordered motions, which are termed the symptoms of the fever, and which compose the great variety in these diseases.
The irritative fevers both with strong and with weak pulse, as well as the sensitive fevers with strong and with weak pulse, which are to be described in the next section, are liable to periodical remissions, and then they take the name of intermittent fevers, and are distinguished by the periodical times of their access.
II. For the better illustration of the phenomena of irritative fevers we must refer the reader to the circumstances of irritation explained in Sect. XII. and shall commence this intricate subject by speaking of the quick pulse, and proceed by considering many of the causes, which either separately or in combination most frequently produce the cold fits of fevers.
1. If the arteries are dilated but to half their usual diameters, though they contract twice as frequently in a given time, they will circulate only half their usual quantity of blood: for as they are cylinders, the blood which they contain must be as the squares of their diameters. Hence when the pulse becomes quicker and smaller in the same proportion, the heart and arteries act with less energy than in their natural state. See Sect. XII. 1. 4.
That this quick small pulse is owing to want of irritability, appears, first, because it attends other symptoms of want of irritability; and, secondly, because on the application of a stimulus greater than usual, it becomes slower and larger. Thus in cold fits of agues, in hysteric palpitations of the heart, and when the body is much exhausted by hæmorrhages, or by fatigue, as well as in nervous fevers, the pulse becomes quick and small; and secondly, in all those cases if an increase of stimulus be added, by giving a little wine or opium; the quick small pulse becomes slower and larger, as any one may easily experience on himself, by counting his pulse after drinking one or two glasses of wine, when he is faint from hunger or fatigue.
Now nothing can so strongly evince that this quick small pulse is owing to defect of irritability, than that an additional stimulus, above what is natural, makes it become slower and larger immediately: for what is meant by a defect of irritability, but that the arteries and heart are not excited into their usual exertions by their usual quantity of stimulus? but if you increase the quantity of stimulus, and they immediately act with their usual energy, this proves their previous want of their natural degree of irritability. Thus the trembling hands of drunkards in a morning become steady, and acquire strength to perform their usual offices, by the accustomed stimulus of a glass or two of brandy.
2. In sleep and in apoplexy the pulse becomes slower, which is not owing to defect of irritability, for it is at the same time larger; and thence the quantity of the circulation is rather increased than diminished. In these cases the organs of sense are closed, and the voluntary power is suspended, while the motions dependent on internal irritations, as those of digestion and secretion, are carried on with more than their usual vigour; which has led superficial observers to confound these cases with those arising from want of irritability. Thus if you lift up the eyelid of an apoplectic patient, who is not actually dying, the iris will, as usual, contract itself, as this motion is associated with the stimulus of light; but it is not so in the last stages of nervous fevers, where the pupil of the eye continues expanded in the broad day-light: in the former case there is a want of voluntary power, in the latter a want of irritability.
Hence also those constitutions which are deficient in quantity of irritability, and which possess too great sensibility, as during the pain of hunger, of hysteric spasms, or nervous headachs, are generally supposed to have too much irritability; and opium, which in its due dose is a most powerful stimulant, is erroneously called a sedative; because by increasing the irritative motions it decreases the pains arising from defect of them.
Why the pulse should become quicker both from an increase of irritation, as in the synocha irritativa, or irritative fever with strong pulse; and from the decrease of it, as in the typhus irritativus, or irritative fever with weak pulse; seems paradoxical. The former circumstance needs no illustration; since if the stimulus of the blood, or the irritability of the sanguiferous system be increased, and the strength of the patient not diminished, it is plain that the motions must be performed quicker and stronger.
In the latter circumstance the weakness of the muscular power of the heart is soon over-balanced by the elasticity of the coats of the arteries, which they possess besides a muscular power of contraction; and hence the arteries are distended to less than their usual diameters. The heart being thus stopped, when it is but half emptied, begins sooner to dilate again; and the arteries being dilated to less than their usual diameters, begin so much sooner to contract themselves; insomuch, that in the last stages of fevers with weakness the frequency of pulsation of the heart and arteries becomes doubled; which, however, is never the case in fevers with strength, in which they seldom exceed 118 or 120 pulsations in a minute. It must be added, that in these cases, while the pulse is very small and very quick, the heart often feels large, and labouring to one's hand; which coincides with the above explanation, shewing that it does not completely empty itself.
3. In cases however of debility from paucity of blood, as in animals which are bleeding to death in the slaughter-house, the quick pulsations of the heart and arteries may be owing to their not being distended to more than half their usual diastole; and in consequence they must contract sooner, or more frequently, in a given time. As weak people are liable to a deficient quantity of blood, this cause may occasionally contribute to quicken the pulse in fevers with debility, which may be known by applying one's hand upon the heart as above; but the principal cause I suppose to consist in the diminution of sensorial power. When a muscle contains, or is supplied with but little sensorial power, its contraction soon ceases, and in consequence may soon recur, as is seen in the trembling hands of people weakened by age or by drunkenness. See Sect. XII. 1. 4. XII. 3. 4.
It may nevertheless frequently happen, that both the deficiency of stimulus, as where the quantity of blood is lessened (as described in No. 4. of this section), and the deficiency of sensorial power, as in those of the temperament of irritability, described in Sect. XXXI. occur at the same time; which will thus add to the quickness of the pulse and to the danger of the disease.
III. 1. A certain degree of heat is necessary to muscular motion, and is, in consequence, essential to life. This is observed in those animals and insects which pass the cold season in a torpid state, and which revive on being warmed by the fire. This necessary stimulus of heat has two sources; one from the fluid atmosphere of heat, in which all things are immersed, and the other from the internal combinations of the particles, which form the various fluids, which are produced in the extensive systems of the glands. When either the external heat, which surrounds us, or the internal production of it, becomes lessened to a certain degree, the pain of cold is perceived.
This pain of cold is experienced most sensibly by our teeth, when ice is held in the mouth; or by our whole system after having been previously accustomed to much warmth. It is probable, that this pain does not arise from the mechanical or chemical effects of a deficiency of heat; but that, like the organs of sense by which we perceive hunger and thirst, this sense of heat suffers pain, when the stimulus of its object is wanting to excite the irritative motions of the organ; that is, when the sensorial power becomes too much accumulated in the quiescent fibres. See Sect. XII. 5. 3. For as the peristaltic motions of the stomach are lessened, when the pain of hunger is great, so the action of the cutaneous capillaries are lessened during the pain of cold; as appears by the paleness of the skin, as explained in Sect. XIV. 6. on the production of ideas.
The pain in the small of the back and forehead in the cold fits of the ague, in nervous hemicrania, and in hysteric paroxysms, when all the irritative motions are much impaired, seems to arise from this cause; the vessels of these membranes or muscles become torpid by their irritative associations with other parts of the body, and thence produce less of their accustomed secretions, and in consequence less heat is evolved, and they experience the pain of cold; which coldness may often be felt by the hand applied upon the affected part.
2. The importance of a greater or less deduction of heat from the system will be more easy to comprehend, if we first consider the great expense of sensorial power used in carrying on the vital motions; that is, which circulates, absorbs, secretes, aerates, and elaborates the whole mass of fluids with unceasing assiduity. The sensorial power, or spirit of animation, used in giving perpetual and strong motion to the heart, which overcomes the elasticity and vis inertiæ of the whole arterial system; next the expense of sensorial power in moving with great force and velocity the innumerable trunks and ramifications of the arterial system; the expense of sensorial power in circulating the whole mass of blood through the long and intricate intortions of the very fine vessels, which compose the glands and capillaries; then the expense of sensorial power in the exertions of the absorbent extremities of all the lacteals, and of all the lymphatics, which open their mouths on the external surface of the skin, and on the internal surfaces of every cell or interstice of the body; then the expense of sensorial power in the venous absorption, by which the blood is received from the capillary vessels, or glands, where the arterial power ceases, and is drank up, and returned to the heart; next the expense of sensorial power used by the muscles of respiration in their office of perpetually expanding the bronchia, or air-vessels, of the lungs; and lastly in the unceasing peristaltic motions of the stomach and whole system of intestines, and in all the secretions of bile, gastric juice, mucus, perspirable matter, and the various excretions from the system. If we consider the ceaseless expense of sensorial power thus perpetually employed, it will appear to be much greater in a day than all the voluntary exertions of our muscles and organs of sense consume in a week; and all this without any sensible fatigue! Now, if but a part of these vital motions are impeded, or totally stopped for but a short time, we gain an idea, that there must be a great accumulation of sensorial power; as its production in these organs, which are subject to perpetual activity, is continued during their quiescence, and is in consequence accumulated.
While, on the contrary, where those vital organs act too forcibly by increase of stimulus without a proportionally-increased production of sensorial power in the brain, it is evident, that a great deficiency of action, that is torpor, must soon follow, as in fevers; whereas the locomotive muscles, which act only by intervals, are neither liable to so great accumulation of sensorial power during their times of inactivity, nor to so great an exhaustion of it during their times of action.
Thus, on going into a very cold bath, suppose at 33 degrees of heat on Fahrenheit's scale, the action of the subcutaneous capillaries, or glands, and of the mouths of the cutaneous absorbents is diminished, or ceases for a time. Hence less or no blood passes these capillaries, and paleness succeeds. But soon after emerging from the bath, a more florid colour and a greater degree of heat is generated on the skin than was possessed before immersion; for the capillary glands, after this quiescent state, occasioned by the want of stimulus, become more irritable than usual to their natural stimuli, owing to the accumulation of sensorial power, and hence a greater quantity of blood is transmitted through them, and a greater secretion of perspirable matter; and, in consequence, a greater degree of heat succeeds. During the continuance in cold water the breath is cold, and the act of respiration quick and laborious; which have generally been ascribed to the obstruction of the circulating fluid by a spasm of the cutaneous vessels, and by a consequent accumulation of blood in the lungs, occasioned by the pressure as well as by the coldness of the water. This is not a satisfactory account of this curious phænomenon, since at this time the whole circulation is less, as appears from the smallness of the pulse and coldness of the breath; which shew that less blood passes through the lungs in a given time; the same laborious breathing immediately occurs when the paleness of the skin is produced by fear, where no external cold or pressure are applied.
The minute vessels of the bronchia, through which the blood passes from the arterial to the venal system, and which correspond with the cutaneous capillaries, have frequently been exposed to cold air, and become quiescent along with those of the skin; and hence their motions are so associated together, that when one is affected either with quiescence or exertion, the other sympathizes with it, according to the laws of irritative association. See Sect. XXVII. 1. on hæmorrhages.
Besides the quiescence of the minute vessels of the lungs, there are many other systems of vessels which become torpid from their irritative associations with those of the skin, as the absorbents of the bladder and intestines; whence an evacuation of pale urine occurs, when the naked skin is exposed only to the coldness of the atmosphere; and sprinkling the naked body with cold water is known to remove even pertinacious constipation of the bowels. From the quiescence of such extensive systems of vessels as the glands and capillaries of the skin, and the minute vessels of the lungs, with their various absorbent series of vessels, a great accumulation of sensorial powers is occasioned; part of which is again expended in the increased exertion of all these vessels, with an universal glow of heat in consequence of this exertion, and the remainder of it adds vigour to both the vital and voluntary exertions of the whole day.
If the activity of the subcutaneous vessels, and of those with which their actions are associated, was too great before cold immersion, as in the hot days of summer, and by that means the sensorial power was previously diminished, we see the cause why the cold bath gives such present strength; namely, by stopping the unnecessary activity of the subcutaneous vessels, and thus preventing the too great exhaustion of sensorial power; which, in metaphorical language, has been called bracing the system: which is, however, a mechanical term, only applicable to drums, or musical strings: as on the contrary the word relaxation, when applied to living animal bodies, can only mean too small a quantity of stimulus, or too small a quantity of sensorial power; as explained in Sect. XII. 1.
3. This experiment of cold bathing presents us with a simple fever-fit; for the pulse is weak, small, and quick during the cold immersion; and becomes strong, full, and quick during the subsequent glow of heat; till in a few minutes these symptoms subside, and the temporary fever ceases.
In those constitutions where the degree of inirritability, or of debility, is greater than natural, the coldness and paleness of the skin with the quick and weak pulse continue a long time after the patient leaves the bath; and the subsequent heat approaches by unequal flushings, and he feels himself disordered for many hours. Hence the bathing in a cold spring of water, where the heat is but forty-eight degrees on Fahrenheit's thermometer, much disagrees with those of weak or inirritable habits of body; who possess so little sensorial power, that they cannot without injury bear to have it diminished even for a short time; but who can nevertheless bear the more temperate coldness of Buxton bath, which is about eighty degrees of heat, and which strengthens them, and makes them by habit less liable to great quiescence from small variations of cold, and thence less liable to be disordered by the unavoidable accidents of life. Hence it appears, why people of these inirritable constitutions, which is another expression for sensorial deficiency, are often much injured by bathing in a cold spring of water; and why they should continue but a very short time in baths, which are colder than their bodies; and should gradually increase both the degree of coldness of the water, and the time of their continuance in it, if they would obtain salutary effects from cold immersions. See Sect. XII. 2. 1.
On the other hand, in all cases where the heat of the external surface of the body, or of the internal surface of the lungs, is greater than natural, the use of exposure to cool air may be deduced. In fever-fits attended with strength, that is with great quantity of sensorial power, it removes the additional stimulus of heat from the surfaces above mentioned, and thus prevents their excess of useless motion; and in fever-fits attended with debility, that is with a deficiency of the quantity of sensorial power, it prevents the great and dangerous waste of sensorial power expended in the unnecessary increase of the actions of the glands and capillaries of the skin and lungs.
4. In the same manner, when any one is long exposed to very cold air, a quiescence is produced of the cutaneous and pulmonary capillaries and absorbents, owing to the deficiency of their usual stimulus of heat; and this quiescence of so great a quantity of vessels affects, by irritative association, the whole absorbent and glandular system, which becomes in a greater or less degree quiescent, and a cold fit of fever is produced.
If the deficiency of the stimulus of heat is very great, the quiescence becomes so general as to extinguish life, as in those who are frozen to death.
If the deficiency of heat be in less degree, but yet so great as in some measure to disorder the system, and should occur the succeeding day, it will induce a greater degree of quiescence than before, from its acting in concurrence with the period of the diurnal circle of actions, explained in Sect. XXXVI. Hence from a small beginning a greater and greater degree of quiescence may be induced, till a complete fever-fit is formed; and which will continue to recur at the periods by which it was produced. See Sect. XVII. 3. 6.
If the degree of quiescence occasioned by defect of the stimulus of heat be very great, it will recur a second time by a slighter cause, than that which first induced it. If the cause, which induces the second fit of quiescence, recurs the succeeding day, the quotidian fever is produced; if not till the alternate day, the tertian fever; and if not till after seventy-two hours from the first fit of quiescence, the quartan fever is formed. This last kind of fever recurs less frequently than the other, as it is a disease only of those of the temperament of associability, as mentioned in Sect. XXXI.; for in other constitutions the capability of forming a habit ceases, before the new cause of quiescence is again applied, if that does not occur sooner than in seventy-two hours.
And hence those fevers, whose cause is from cold air of the night or morning, are more liable to observe the solar day in their periods; while those from other causes frequently observe the lunar day in their periods, their paroxysms returning near an hour later every day, as explained in Sect. XXXVI.
IV. Another frequent cause of the cold fits of fever is the defect of the stimulus of distention. The whole arterial system would appear, by the experiments of Haller, to be irritable by no other stimulus, and the motions of the heart and alimentary canal are certainly in some measure dependant on the same cause. See Sect. XIV. 7. Hence there can be no wonder, that the diminution of distention should frequently induce the quiescence, which constitutes the beginning of fever-fits.
Monsieur Leiutaud has judiciously mentioned the deficiency of the quantity of blood amongst the causes of diseases, which he says is frequently evident in dissections: fevers are hence brought on by great hæmorrhages, diarrhœas, or other evacuations; or from the continued use of diet, which contains but little nourishment; or from the exhaustion occasioned by violent fatigue, or by those chronic diseases in which the digestion is much impaired; as where the stomach has been long affected with the gout or schirrus; or in the paralysis of the liver, as described in Sect. XXX. Hence a paroxysm of gout is liable to recur on bleeding or purging; as the torpor of some viscus, which precedes the inflammation of the foot, is thus induced by the want of the stimulus of distention. And hence the extremities of the body, as the nose and fingers, are more liable to become cold, when we have long abstained from food; and hence the pulse is increased both in strength and velocity above the natural standard after a full meal by the stimulus of distention.
However, this stimulus of distention, like the stimulus of heat above described, though it contributes much to the due action not only of the heart, arteries, and alimentary canal, but seems necessary to the proper secretion of all the various glands; yet perhaps it is not the sole cause of any of these numerous motions: for as the lacteals, cutaneous absorbents, and the various glands appear to be stimulated into action by the peculiar pungency of the fluids they absorb, so in the intestinal canal the pungency of the digesting aliment, or the acrimony of the fæces, seem to contribute, as well as their bulk, to promote the peristaltic motions; and in the arterial system, the momentum of the particles of the circulating blood, and their acrimony, stimulate the arteries, as well as the distention occasioned by it. Where the pulse is small this defect of distention is present, and contributes much to produce the febris irritativa pulsu debili, or irritative fever with weak pulse, called by modern writers nervous fever, as a predisponent cause. See Sect. XII. 1. 4. Might not the transfusion of blood, suppose of four ounces daily from a strong man, or other healthful animal, as a sheep or an ass, be used in the early state of nervous or putrid fevers with great prospect of success?
V. 1. The defect of the momentum of the particles of the circulating blood is another cause of the quiescence, with which the cold fits of fever commence. This stimulus of the momentum of the progressive particles of the blood does not act over the whole body like those of heat and distention above described, but is confined to the arterial system; and differs from the stimulus of the distention of the blood, as much as the vibration of the air does from the currents of it. Thus are the different organs of our bodies stimulated by four different mechanic properties of the external world: the sense of touch by the pressure of solid bodies so as to distinguish their figure; the muscular system by the distention, which they occasion; the internal surface of the arteries, by the momentum of their moving particles; and the auditory nerves, by the vibration of them: and these four mechanic properties are as different from each other as the various chemical ones, which are adapted to the numerous glands, and to the other organs of sense.
2. The momentum of the progressive particles of blood is compounded of their velocity and their quantity of matter: hence whatever circumstances diminish either of these without proportionally increasing the other, and without superadding either of the general stimuli of heat or distention, will tend to produce a quiescence of the arterial system, and from thence of all the other irritative motions, which are connected with it.
Hence in all those constitutions or diseases where the blood contains a greater proportion of serum, which is the lightest part of its composition, the pulsations of the arteries are weaker, as in nervous fevers, chlorosis, and hysteric complaints; for in these cases the momentum of the progressive particles of blood is less: and hence, where the denser parts of its composition abound, as the red part of it, or the coagulable lymph, the arterial pulsations are stronger; as in those of robust health, and in inflammatory diseases.
That this stimulus of the momentum of the particles of the circulating fluid is of the greatest consequence to the arterial action, appears from the experiment of injecting air into the blood vessels, which seems to destroy animal life from the want of this stimulus of momentum; for the distention of the arteries is not diminished by it, it possesses no corrosive acrimony, and is less liable to repass the valves than the blood itself; since air-valves in all machinery require much less accuracy of construction than those which are opposed to water.
3. One method of increasing the velocity of the blood, and in consequence the momentum of its particles, is by the exercise of the body, or by the friction of its surface: so, on the contrary, too great indolence contributes to decrease this stimulus of the momentum of the particles of the circulating blood, and thus tends to induce quiescence; as is seen in hysteric cases, and chlorosis, and the other diseases of sedentary people.
4. The velocity of the particles of the blood in certain circumstances is increased by venesection, which, by removing a part of it, diminishes the resistance to the motion of the other part, and hence the momentum of the particles of it is increased. This may be easily understood by considering it in the extreme, since, if the resistance was greatly increased, so as to overcome the propelling power, there could be no velocity, and in consequence no momentum at all. From this circumstance arises that curious phænomenon, the truth of which I have been more than once witness to, that venesection will often instantaneously relieve those nervous pains, which attend the cold periods of hysteric, asthmatic, or epileptic diseases; and that even where large doses of opium have been in vain exhibited. In these cases the pulse becomes stronger after the bleeding, and the extremities regain their natural warmth; and an opiate then given acts with much more certain effect.
VI. There is another cause, which seems occasionally to induce quiescence into some part of our system, I mean the influence of the sun and moon; the attraction of these luminaries, by decreasing the gravity of the particles of the blood, cannot affect their momentum, as their vis inertiæ remains the same; but it may nevertheless produce some chemical change in them, because whatever affects the general attractions of the particles of matter may be supposed from analogy to affect their specific attractions or affinities: and thus the stimulus of the particles of blood may be diminished, though not their momentum. As the tides of the sea obey the southing and northing of the moon (allowing for the time necessary for their motion, and the obstructions of the shores), it is probable, that there are also atmospheric tides on both sides of the earth, which to the inhabitants of another planet might so deflect the light as to resemble the ring of Saturn. Now as these tides of water, or of air, are raised by the diminution of their gravity, it follows, that their pressure on the surface of the earth is no greater than the pressure of the other parts of the ocean, or of the atmosphere, where no such tides exist; and therefore that they cannot affect the mercury in the barometer. In the same manner, the gravity of all other terrestrial bodies is diminished at the times of the southing and northing of the moon, and that in a greater degree when this coincides with the southing and northing of the sun, and this in a still greater degree about the times of the equinoxes. This decrease of the gravity of all bodies during the time the moon passes our zenith or nadir might possibly be shewn by the slower vibrations of a pendulum, compared with a spring clock, or with astronomical observation. Since a pendulum of a certain length moves slower at the line than near the poles, because the gravity being diminished and the vis inertiæ continuing the same, the motive power is less, but the resistance to be overcome continues the same. The combined powers of the lunar and solar attraction is estimated by Sir Isaac Newton not to exceed one 7,868,850th part of the power of gravitation, which seems indeed but a small circumstance to produce any considerable effect on the weight of sublunary bodies, and yet this is sufficient to raise the tides at the equator above ten feet high; and if it be considered, what small impulses of other bodies produce their effects on the organs of sense adapted to the perception of them, as of vibration on the auditory nerves, we shall cease to to be surprised, that so minute a diminution in the gravity of the particles of blood should so far affect their chemical changes, or their stimulating quality, as, joined with other causes, sometimes to produce the beginnings of diseases.
Add to this, that if the lunar influence produces a very small degree of quiescence at first, and if that recurs at certain periods even with less power to produce quiescence than at first, yet the quiescence will daily increase by the acquired habit acting at the same time, till at length so great a degree of quiescence is induced as to produce phrensy, canine madness, epilepsy, hysteric pains or cold fits of fever, instances of many of which are to be found in Dr. Mead's work on this subject. The solar influence also appears daily in several diseases; but as darkness, silence, sleep, and our periodical meals mark the parts of the solar circle of actions, it is sometimes dubious to which of these the periodical returns of these diseases are to be ascribed.
As far as I have been able to observe, the periods of inflammatory diseases observe the solar day; as the gout and rheumatism have their greatest quiescence about noon and midnight, and their exacerbations some hours after; as they have more frequently their immediate cause from cold air, inanition, or fatigue, than from the effects of lunations: whilst the cold fits of hysteric patients, and those in nervous fevers, more frequently occur twice a day, later by near half an hour each time, according to the lunar day; whilst some fits of intermittents, which are undisturbed by medicines, return at regular solar periods, and others at lunar ones; which may, probably, be owing to the difference of the periods of those external circumstances of cold, inanition, or lunation, which immediately caused them.
We must, however, observe, that the periods of quiescence and exacerbation in diseases do not always commence at the times of the syzygies or quadratures of the moon and sun, or at the times of their passing the zenith or nadir; but as it is probable, that the stimulus of the particles of the circumfluent blood is gradually diminished from the time of the quadratures to that of the syzygies, the quiescence may commence at any hour, when co-operating with other causes of quiescence, it becomes great enough to produce a disease: afterwards it will continue to recur at the same period of the lunar or solar influence; the same cause operating conjointly with the acquired habit, that is with the catenation of this new motion with the dissevered links of the lunar or solar circles of animal action.
In this manner the periods of menstruation obey the lunar month with great exactness in healthy patients (and perhaps the venereal orgasm in brute animals does the same), yet these periods do not commence either at the syzygies or quadratures of the lunations, but at whatever time of the lunar periods they begin, they observe the same in their returns till some greater cause disturbs them.
Hence, though the best way to calculate the time of the expected returns of the paroxysms of periodical diseases is to count the number of hours between the commencement of the two preceding fits, yet the following observations may be worth attending to, when we endeavour to prevent the returns of maniacal or epileptic diseases; whose periods (at the beginning of them especially) frequently observe the syzygies of the moon and sun, and particularly about the equinox.
The greatest of the two tides happening in every revolution of the moon, is that when the moon approaches nearest to the zenith or nadir; for this reason, while the sun is in the northern signs, that is during the vernal and summer months, the greater of the two diurnal tides in our latitude is that, when the moon is above the horizon; and when the sun is in the southern signs, or during the autumnal and winter months, the greater tide is that, which arises when the moon is below the horizon: and as the sun approaches somewhat nearer the earth in winter than in summer, the greatest equinoctial tides are observed to be a little before the vernal equinox, and a little after the autumnal one.
Do not the cold periods of lunar diseases commence a few hours before the southing of the moon during the vernal and summer months, and before the northing of the moon during the autumnal and winter months? Do not palsies and apoplexies, which occur about the equinoxes, happen a few days before the vernal equinoctial lunation, and after the autumnal one? Are not the periods of those diurnal diseases more obstinate, that commence many hours before the southing or northing of the moon, than of those which commence at those times? Are not those palsies and apoplexies more dangerous which commence many days before the syzygies of the moon, than those which happen at those times? See Sect. XXXVI. on the periods of diseases.
VII. Another very frequent cause of the cold fit of fever is the quiescence of some of those large congeries of glands, which compose the liver, spleen, or pancreas; one or more of which are frequently so enlarged in the autumnal intermittents as to be perceptible to the touch externally, and are called by the vulgar ague-cakes. As these glands are stimulated into action by the specific pungency of the fluids, which they absorb, the general cause of their quiescence seems to be the too great insipidity of the fluids of the body, co-operating perhaps at the same time with other general causes of quiescence.
Hence, in marshy countries at cold seasons, which have succeeded hot ones, and amongst those, who have lived on innutritious and unstimulating diet, these agues are most frequent. The enlargement of these quiescent viscera, and the swelling of the præcordia in many other fevers, is, most probably, owing to the same cause; which may consist in a general deficiency of the production of sensorial power, as well as in the diminished stimulation of the fluids; and when the quiescence of so great a number of glands, as constitute one of those large viscera, commences, all the other irritative motions are affected by their connection with it, and the cold fit of fever is produced.
VIII. There are many other causes, which produce quiescence of some part of the animal system, as fatigue, hunger, thirst, bad diet, disappointed love, unwholesome air, exhaustion from evacuations, and many others; but the last cause, that we shall mention, as frequently productive of cold fits of fever, is fear or anxiety of mind. The pains, which we are first and most generally acquainted with, have been produced by defect of some stimulus; thus, soon after our nativity we become acquainted with the pain from the coldness of the air, from the want of respiration, and from the want of food. Now all these pains occasioned by defect of stimulus are attended with quiescence of the organ, and at the same time with a greater or less degree of quiescence of other parts of the system: thus, if we even endure the pain of hunger so as to miss one meal instead of our daily habit of repletion, not only the peristaltic motions of the stomach and bowels are diminished, but we are more liable to coldness of our extremities, as of our noses, and ears, and feet, than at other times.
Now, as fear is originally excited by our having experienced pain, and is itself a painful affection, the same quiescence of other fibrous motions accompany it, as have been most frequently connected with this kind of pain, as explained in Sect. XVI. 8. 1. as the coldness and paleness of the skin, trembling, difficult respiration, indigestion, and other symptoms, which contribute to form the cold fit of fevers. Anxiety is fear continued through a longer time, and, by producing chronical torpor of the system, extinguishes life slowly, by what is commonly termed a broken heart.
IX. 1. We now step forwards to consider the other symptoms in consequence of the quiescence which begins the fits of fever. If by any of the circumstances before described, or by two or more of them acting at the same time, a great degree of quiescence is induced on any considerable part of the circle of irritative motions, the whole class of them is more or less disturbed by their irritative associations. If this torpor be occasioned by a deficient supply of sensorial power, and happens to any of those parts of the system, which are accustomed to perpetual activity, as the vital motions, the torpor increases rapidly, because of the great expenditure of sensorial power by the incessant activity of those parts of the system, as shewn in No. 3. 2. of this Section. Hence a deficiency of all the secretions succeeds, and as animal heat is produced in proportion to the quantity of those secretions, the coldness of the skin is the first circumstance, which is attended to. Dr. Martin asserts, that some parts of his body were warmer than natural in the cold fit of fever; but it is certain, that those, which are uncovered, as the fingers, and nose, and ears, are much colder to the touch, and paler in appearance. It is possible, that his experiments were made at the beginning of the subsequent hot fits; which commence with partial distributions of heat, owing to some parts of the body regaining their natural irritability sooner than others.