DISEASES OF ASSOCIATION.
I. 1. Sympathy or consent of parts. Primary and secondary parts of an associated train of motions reciprocally affect each other. Parts of irritative trains of motion affect each other in four ways. Sympathies of the skin and stomach. Flushing of the face after a meal. Eruption of the small-pox on the face. Chilness after a meal. 2. Vertigo from intoxication. 3. Absorption from the lungs and pericardium by emetics. In vomiting the actions of the stomach are decreased, not increased. Digestion strengthened after an emetic. Vomiting from deficiency of sensorial power. 4. Dyspnœa from cold bathing. Slow pulse from digitalis. Death from gout in the stomach. II. 1. Primary and secondary parts of sensitive associations affect each other. Pain from gall-stone, from urinary stone, Hemicrania. Painful epilepsy. 2. Gout and red face from inflamed liver. Shingles from inflamed kidney. 3. Coryza from cold applied to the feet. Pleurisy. Hepatitis. 4. Pain of shoulders from inflamed liver. III. Diseases from the associations of ideas.
I. 1. Many synchronous and successive motions of our muscular fibres, and of our organs of sense, or ideas, become associated so as to form indissoluble tribes or trains of action, as shewn in Section X. on Associate Motions. Some constitutions more easily establish these associations, whether by voluntary, sensitive, or irritative repetitions, and some more easily lose them again, as shewn in Section XXXI. on Temperaments.
When the beginning of such a train of actions becomes by any means disordered, the succeeding part is liable to become disturbed in consequence, and this is commonly termed sympathy or consent of parts by the writers of medicine. For the more clear understanding of these sympathies we must consider a tribe or train of actions as divided into two parts, and call one of them the primary or original motions, and the other the secondary or sympathetic ones.
The primary and secondary parts of a train of irritative actions may reciprocally affect each other in four different manners. 1. They may both be exerted with greater energy than natural. 2. The former may act with greater, and the latter with less energy. 3. The former may act with less, and the latter with greater energy. 4. They may both act with less energy than natural. I shall now give an example of each kind of these modes of action, and endeavour to shew, that though the primary and secondary parts of these trains or tribes of motion are connected by irritative association, or their previous habits of acting together, as described in Sect. XX. on Vertigo. Yet that their acting with similar or dissimilar degrees of energy, depends on the greater or less quantity of sensorial power, which the primary part of the train expends in its exertions.
The actions of the stomach constitute so important a part of the associations of both irritative and sensitive motions, that it is said to sympathize with almost every part of the body; the first example, which I shall adduce to shew that both the primary and secondary parts of a train of irritative associations of motion act with increased energy, is taken from the consent of the skin with this organ. When the action of the fibres of the stomach is increased, as by the stimulus of a full meal, the exertions of the cutaneous arteries of the face become increased by their irritative associations with those of the stomach, and a glow or flushing of the face succeeds. For the small vessels of the skin of the face having been more accustomed to the varieties of action, from their frequent exposure to various degrees of cold and heat become more easily excited into increased action, than those of the covered parts of our bodies, and thus act with more energy from their irritative or sensitive associations with the stomach. On this account in small-pox the eruption in consequence of the previous affection of the stomach breaks out a day sooner on the face than on the hands, and two days sooner than on the trunk, and recedes in similar times after maturation.
But secondly, in weaker constitutions, that is, in those who possess less sensorial power, so much of it is expended in the increased actions of the fibres of the stomach excited by the stimulus of a meal, that a sense of chilness succeeds instead of the universal glow above mentioned; and thus the secondary part of the associated train of motions is diminished in energy, in consequence of the increased activity of the primary part of it.
2. Another instance of a similar kind, where the secondary part of the train acts with less energy in consequence of the greater exertions of the primary part, is the vertigo attending intoxication; in this circumstance so much sensorial power is expended on the stomach, and on its nearest or more strongly associated motions, as those of the subcutaneous vessels, and probably of the membranes of some internal viscera, that the irritative motions of the retina become imperfectly exerted from deficiency of sensorial power, as explained in Sect. XX. and XXI. 3. on Vertigo and on Drunkenness, and hence the staggering inebriate cannot completely balance himself by such indistinct vision.
3. An instance of the third circumstance, where the primary part of a train of irritative motions acts with less, and the secondary part with greater energy, may be observed by making the following experiment. If a person lies with his arms and shoulders out of bed, till they become cold, a temporary coryza or catarrh is produced; so that the passage of the nostrils becomes totally obstructed; at least this happens to many people; and then on covering the arms and shoulders, till they become warm, the passage of the nostrils ceases again to be obstructed, and a quantity of mucus is discharged from them. In this case the quiescence of the vessels of the skin of the arms and shoulders, occasioned by exposure to cold air, produces by irritative association an increased action of the vessels of the membrane of the nostrils; and the accumulation of sensorial power during the torpor of the arms and shoulders is thus expended in producing a temporary coryza or catarrh.
Another instance may be adduced from the sympathy or consent of the motions of the stomach with other more distant links of the very extensive tribes or trains of irritative motions associated with them, described in Sect. XX. on Vertigo. When the actions of the fibres of the stomach are diminished or inverted, the actions of the absorbent vessels, which take up the mucus from the lungs, pericardium, and other cells of the body, become increased, and absorb the fluids accumulated in them with greater avidity, as appears from the exhibition of foxglove, antimony, or other emetics in cases of anasarca, attended with unequal pulse and difficult respiration.
That the act of nausea and vomiting is a decreased exertion of the fibres of the stomach may be thus deduced; when an emetic medicine is administered, it produces the pain of sickness, as a disagreeable taste in the mouth produces the pain of nausea; these pains, like that of hunger, or of cold, or like those, which are usually termed nervous, as the head-ach or hemicrania, do not excite the organ into greater action; but in this case I imagine the pains of sickness or of nausea counteract or destroy the pleasurable sensation, which seems necessary to digestion, as shewn in Sect. XXXIII. 1. 1. The peristaltic motions of the fibres of the stomach become enfeebled by the want of this stimulus of pleasurable sensation, and in consequence stop for a time, and then become inverted; for they cannot become inverted without being previously stopped. Now that this inversion of the trains of motion of the fibres of the stomach is owing to the deficiency of pleasurable sensation is evinced from this circumstance, that a nauseous idea excited by words will produce vomiting as effectually us a nauseous drug.
Hence it appears, that the act of nausea or vomiting expends less sensorial power than the usual peristaltic motions of the stomach in the digestion of our aliment; and that hence there is a greater quantity of sensorial power becomes accumulated in the fibres of the stomach, and more of it in consequence to spare for the action of those parts of the system, which are thus associated with the stomach, as of the whole absorbent series of vessels, and which are at the same time excited by their usual stimuli.
From this we can understand, how after the operation of an emetic the stomach becomes more irritable and sensible to the stimulus, and the pleasure of food; since as the sensorial power becomes accumulated during the nausea and vomiting, the digestive power is afterwards exerted more forceably for a time. It should, however, be here remarked, that though vomiting is in general produced by the defect of this stimulus of pleasurable sensation, as when a nauseous drug is administered; yet in long continued vomiting, as in sea-sickness, or from habitual dram-drinking, it arises from deficiency of sensorial power, which in the former case is exhausted by the increased exertion of the irritative ideas of vision, and in the latter by the frequent application of an unnatural stimulus.
4. An example of the fourth circumstance above mentioned, where both the primary and secondary parts of a train of motions proceed with energy less than natural, may be observed in the dyspnœa, which occurs in going into a very cold bath, and which has been described and explained in Sect. XXXII. 3. 2.
And by the increased debility of the pulsations of the heart and arteries during the operation of an emetic. Secondly, from the slowness and intermission of the pulsations of the heart from the incessant efforts to vomit occasioned by an overdose of digitalis. And thirdly, from the total stoppage of the motions of the heart, or death, in consequence of the torpor of the stomach, when affected with the commencement or cold paroxysm of the gout. See Sect. XXV. 17.
II. 1. The primary and secondary parts of the trains of sensitive association reciprocally affect each other in different manners. 1. The increased sensation of the primary part may cease, when that of the secondary part commences. 2. The increased action of the primary part may cease, when that of the secondary part commences. 3. The primary part may have increased sensation, and the secondary part increased action. 4. The primary part may have increased action, and the secondary part increased sensation.
Examples of the first mode, where the increased sensation of the primary part of a train of sensitive association ceases, when that of the secondary part commences, are not unfrequent; as this is the general origin of those pains, which continue some time without being attended with inflammation, such as the pain at the pit of the stomach from a stone at the neck of the gall-bladder, and the pain of strangury in the glans penis from a stone at the neck of the urinary bladder. In both these cases the part, which is affected secondarily, is believed to be much more sensible than the part primarily affected, as described in the catalogue of diseases, Class II. 1. 1. 11. and IV. 2. 2. 2. and IV. 2. 2. 4.
The hemicrania, or nervous headach, as it is called, when it originates from a decaying tooth, is another disease of this kind; as the pain of the carious tooth always ceases, when the pain over one eye and temple commences. And it is probable, that the violent pains, which induce convulsions in painful epilepsies, are produced in the same manner, from a more sensible part sympathizing with a diseased one of less sensibility. See Catalogue of Diseases, Class IV. 2. 2. 8. and III. 1. 1. 6.
The last tooth, or dens sapientiæ, of the upper jaw most frequently decays first, and is liable to produce pain over the eye and temple of that side. The last tooth of the under-jaw is also liable to produce a similar hemicrania, when it begins to decay. When a tooth in the upper-jaw is the cause of the headach, a slighter pain is sometimes perceived on the cheek-bone. And when a tooth in the lower-jaw is the cause of headach, a pain sometimes affects the tendons of the muscles of the neck, which are attached near the jaws. But the clavus hystericus, or pain about the middle of the parietal bone on one side of the head, I have seen produced by the second of the molares, or grinders, of the under-jaw; of which I shall relate the following case. See Class IV. 2. 2. 8.
Mrs. ——, about 30 years of age, was seized with great pain about the middle of the right parietal bone, which had continued a whole day before I saw her, and was so violent as to threaten to occasion convulsions. Not being able to detect a decaying tooth, or a tender one, by examination with my eye, or by striking them with a tea-spoon, and fearing bad consequences from her tendency to convulsion, I advised her to extract the last tooth of the under-jaw on the affected side; which was done without any good effect. She was then directed to lose blood, and to take a brisk cathartic; and after that had operated, about 60 drops of laudanum were given her, with large doses of bark; by which the pain was removed. In about a fortnight she took a cathartic medicine by ill advice, and the pain returned with greater violence in the same place; and, before I could arrive, as she lived 30 miles from me, she suffered a paralytic stroke; which affected her limbs and her face on one side, and relieved the pain of her head.
About a year afterwards I was again called to her on account of a pain as violent as before exactly on the same part of the other parietal bone. On examining her mouth I found the second molaris of the under-jaw on the side before affected was now decayed, and concluded, that this tooth had occasioned the stroke of the palsy by the pain and consequent exertion it had caused. On this account I earnestly entreated her to allow the sound molaris of the same jaw opposite to the decayed one to be extracted; which was forthwith done, and the pain of her head immediately ceased, to the astonishment of her attendants.
In the cases above related of the pain existing in a part distant from the seat of the disease, the pain is owing to defect of the usual motions of the painful part. This appears from the coldness, paleness, and emptiness of the affected vessels, or of the extremities of the body in general, and from there being no tendency to inflammation. The increased action of the primary part of these associated motions, as of the hepatic termination of the bile-duct; from the stimulus of a gall-stone, or of the interior termination of the urethra from the stimulus of a stone in the bladder, or lastly, of a decaying tooth in hemicrania, deprives the secondary part of these associated motions, namely, the exterior terminations of the bile-duct or urethra, or the pained membranes of the head in hemicrania, of their natural share of sensorial power: and hence the secondary parts of these sensitive trains of association become pained from the deficiency of their usual motions, which is accompanied with deficiency of secretions and of heat. See Sect. IV. 5. XII. 5. 3. XXXIV. 1.
Why does the pain of the primary part of the association cease, when that of the secondary part commences? This is a question of intricacy, but perhaps not inexplicable. The pain of the primary part of these associated trains of motion was owing to too great stimulus, as of the stone at the neck of the bladder, and was consequently caused by too great action of the pained part. This greater action than natural of the primary part of these associated motions, by employing or expending the sensorial power of irritation belonging to the whole associated train of motions, occasioned torpor, and consequent pain in the secondary part of the associated train; which was possessed of greater sensibility than the primary part of it. Now the great pain of the secondary part of the train, as soon as it commences, employs or expends the sensorial power of sensation belonging to the whole associated train of motions; and in consequence the motions of the primary part, though increased by the stimulus of an extraneous body, cease to be accompanied with pain or sensation.
If this mode of reasoning be just it explains a curious fact, why when two parts of the body are strongly stimulated, the pain is felt only in one of them, though it is possible by voluntary attention it may be alternately perceived in them both. In the same manner, when two new ideas are presented to us from the stimulus of external bodies, we attend to but one of them at a time. In other words, when one set of fibres, whether of the muscles or organs of sense, contract so strongly as to excite much sensation; another set of fibres contracting more weakly do not excite sensation at all, because the sensorial power of sensation is pre-occupied by the first set of fibres. So we cannot will more than one effect at once, though by associations previously formed we can move many fibres in combination.
Thus in the instances above related, the termination of the bile duct in the duodenum, and the exterior extremity of the urethra, are more sensible than their other terminations. When these parts are deprived of their usual motions by deficiency of sensorial power, as above explained, they become painful according to law the fifth in Section IV. and the less pain originally excited by the stimulus of concreted bile, or of a stone at their other extremities ceases to be perceived. Afterwards, however, when the concretions of bile, or the stone on the urinary bladder, become more numerous or larger, the pain from their increased stimulus becomes greater than the associated pain; and is then felt at the neck of the gall bladder or urinary bladder; and the pain of the glans penis, or at the pit of the stomach, ceases to be perceived.
2. Examples of the second mode, where the increased action of the primary part of a train of sensitive association ceases, when that of the secondary part commences, are also not unfrequent; as this is the usual manner of the translation of inflammations from internal to external parts of the system, such as when an inflammation of the liver or stomach is translated to the membranes of the foot, and forms the gout; or to the skin of the face, and forms the rosy drop; or when an inflammation of the membranes of the kidneys is translated to the skin of the loins, and forms one kind of herpes, called shingles; in these cases by whatever cause the original inflammation may have been produced, as the secondary part of the train of sensitive association is more sensible, it becomes exerted with greater violence than the first part of it; and by both its increased pain, and the increased motion of its fibres, so far diminishes or exhausts the sensorial power of sensation; that the primary part of the train being less sensible ceases both to feel pain, and to act with unnatural energy.
3. Examples of the third mode, where the primary part of a train of sensitive association of motions may experience increased sensation, and the secondary part increased action, are likewise not unfrequent; as it is in this manner that most inflammations commence. Thus, after standing some time in snow, the feet become affected with the pain of cold, and a common coryza, or inflammation of the membrane of the nostrils, succeeds. It is probable that the internal inflammations, as pleurisies, or hepatitis, which are produced after the cold paroxysm of fever, originate in the same manner from the sympathy of those parts with some others, which were previously pained from quiescence; as happens to various parts of the system during the cold fits of fevers. In these cases it would seem, that the sensorial power of sensation becomes accumulated during the pain of cold, as the torpor of the vessels occasioned by the defect of heat contributes to the increase or accumulation of the sensorial power of irritation, and that both these become exerted on some internal part, which was not rendered torpid by the cold which affected the external parts, nor by its association with them; or which sooner recovered its sensibility. This requires further consideration.
4. An example of the fourth mode, or where the primary part of a sensitive association of motions may have increased action, and the secondary part increased sensation, may be taken from the pain of the shoulder, which attends inflammation of the membranes of the liver, see Class IV. 2. 2. 9.; in this circumstance so much sensorial power seems to be expended in the violent actions and sensations of the inflamed membranes of the liver, that the membranes associated with them become quiescent to their usual stimuli, and painful in consequence.
There may be other modes in which the primary and secondary parts of the trains of associated sensitive motions may reciprocally affect each other, as may be seen by looking over Class IV. in the catalogue of diseases; all which may probably be resolved into the plus and minus of sensorial power, but we have not yet had sufficient observations made upon them with a view to this doctrine.
III. The associated trains of our ideas may have sympathies, and their primary and secondary parts affect each other in some manner similar to those above described; and may thus occasion various curious phenomena not yet adverted to, besides those explained in the Sections on Dreams, Reveries, Vertigo, and Drunkenness; and may thus disturb the deductions of our reasonings, as well as the streams of our imaginations; present us with false degrees of fear, attach unfounded value to trivial circumstances; give occasion to our early prejudices and antipathies; and thus embarrass the happiness of our lives. A copious and curious harvest might be reaped from this province of science, in which, however, I shall not at present wield my sickle.
OF THE PERIODS OF DISEASES.
I. Muscles excited by volition soon cease to contract, or by sensation, or by irritation, owing to the exhaustion of sensorial power. Muscles subjected to less stimulus have their sensorial power accumulated. Hence the periods of some fevers. Want of irritability after intoxication. II. 1. Natural actions catenated with daily habits of life. 2. With solar periods. Periods of sleep. Of evacuating the bowels. 3. Natural actions catenated with lunar periods. Menstruation. Venereal orgasm of animals. Barrenness. III. Periods of diseased animal actions from stated returns of nocturnal cold, from solar and lunar influence. Periods of diurnal fever, hectic fever, quotidian, tertian, quartan fever. Periods of gout, pleurisy, of fevers with arterial debility, and with arterial strength, Periods of rhaphania, of nervous cough, hemicrania, arterial hæmorrhages, hæmorrhoids, hæmoptoe, epilepsy, palsy, apoplexy, madness. IV. Critical days depend on lunar periods. Lunar periods in the small pox.
I. If any of our muscles be made to contract violently by the power of volition, as those of the fingers, when any one hangs by his hands on a swing, fatigue soon ensues; and the muscles cease to act owing to the temporary exhaustion of the spirit of animation; as soon as this is again accumulated in the muscles, they are ready to contract again by the efforts of volition.
Those violent muscular actions induced by pain become in the same manner intermitted and recurrent; as in labour-pains, vomiting, tenesmus, strangury; owing likewise to the temporary exhaustion of the spirit of animation, as above mentioned.
When any stimulus continues long to act with unnatural violence, so as to produce too energetic action of any of our moving organs, those motions soon cease, though the stimulus continues to act; as in looking long on a bright object, as on an inch-square of red silk laid on white paper in the sunshine. See Plate I. in Sect. III. 1.
On the contrary, where less of the stimulus of volition, sensation, or irritation, have been applied to a muscle than usual; there appears to be an accumulation of the spirit of animation in the moving organ; by which it is liable to act with greater energy from less quantity of stimulus, than was previously necessary to excite it into so great action; as after having been immersed in snow the cutaneous vessels of our hands are excited into stronger action by the stimulus of a less degree of heat, than would previously have produced that effect.
From hence the periods of some fever-fits may take their origin, either simply, or by their accidental coincidence with lunar and solar periods, or with the diurnal periods of heat and cold, to be treated of below; for during the cold fit at the commencement of a fever, from whatever cause that cold fit may have been induced, it follows, 1. That the spirit of animation must become accumulated in the parts, which exert during this cold fit less than their natural quantity of action. 2. If the cause producing the cold fit does not increase, or becomes diminished; the parts before benumbed or inactive become now excitable by smaller stimulus, and are thence thrown into more violent action than is natural; that is a hot fit succeeds the cold one. 3. By the energetic action of the system during the hot fit, if it continues long, an exhaustion of the spirit of animation takes place; and another cold fit is liable to succeed, from the moving system not being excitable into action from its usual stimulus. This inirritability of the system from a too great previous stimulus, and consequent exhaustion of sensorial power, is the cause of the general debility, and sickness, and head-ach, some hours after intoxication. And hence we see one of the causes of the periods of fever-fits; which however are frequently combined with the periods of our diurnal habits, or of heat and cold, or of solar or lunar periods.
When besides the tendency to quiescence occasioned by the expenditure of sensorial power during the hot fit of fever, some other cause of torpor, as the solar or lunar periods, is necessary to the introduction of a second cold fit; the fever becomes of the intermittent kind; that is, there is a space of time intervenes between the end of the hot fit, and the commencement of the next cold one. But where no exteriour cause is necessary to the introduction of the second cold fit; no such interval of health intervenes; but the second cold fit commences, as soon as the sensorial power is sufficiently exhausted by the hot fit; and the fever becomes continual.
II. 1. The following are natural animal actions, which are frequently catenated with our daily habits of life, as well as excited by their natural irritations. The periods of hunger and thirst become catenated with certain portions of time, or degrees of exhaustion, or other diurnal habits of life. And if the pain of hunger be not relieved by taking food at the usual time, it is liable to cease till the next period of time or other habits recur; this is not only true in respect to our general desire of food, but the kinds of it also are governed by this periodical habit; insomuch that beer taken to breakfast will disturb the digestion of those, who have been accustomed to tea; and tea taken at dinner will disagree with those, who have been accustomed to beer. Whence it happens, that those, who have weak stomachs, will be able to digest more food, if they take their meals at regular hours; because they have both the stimulus of the aliment they take, and the periodical habit, to assist their digestion.
The periods of emptying the bladder are not only dependent on the acrimony or distention of the water in it, but are frequently catenated with external cold applied to the skin, as in cold bathing, or washing the hands; or with other habits of life, as many are accustomed to empty the bladder before going to bed, or into the house after a journey, and this whether it be full or not.
Our times of respiration are not only governed by the stimulus of the blood in the lungs, or our desire of fresh air, but also by our attention to the hourly objects before us. Hence when a person is earnestly contemplating an idea of grief, he forgets to breathe, till the sensation in his lungs becomes very urgent; and then a sigh succeeds for the purpose of more forceably pushing forwards the blood, which is accumulated in the lungs.
Our times of respiration are also frequently governed in part by our want of a steady support for the actions of our arms, and hands, as in threading a needle, or hewing wood, or in swimming; when we are intent upon these objects, we breathe at the intervals of the exertion of the pectoral muscles.
2. The following natural animal actions are influenced by solar periods. The periods of sleep and of waking depend much on the solar period, for we are inclined to sleep at a certain hour, and to awake at a certain hour, whether we have had more or less fatigue during the day, if within certain limits; and are liable to wake at a certain hour, whether we went to bed earlier or later, within certain limits. Hence it appears, that those who complain of want of sleep, will be liable to sleep better or longer, if they accustom themselves to go to rest, and to rise, at certain hours.
The periods of evacuating the bowels are generally connected with some part of the solar day, as well as with the acrimony or distention occasioned by the feces. Hence one method of correcting costiveness is by endeavouring to establish a habit of evacuation at a certain hour of the day, as recommended by Mr. Locke, which may be accomplished by using daily voluntary efforts at those times, joined with the usual stimulus of the material to be evacuated.
3. The following natural animal actions are connected with lunar periods. 1. The periods of female menstruation are connected with lunar periods to great exactness, in some instances even to a few hours. These do not commence or terminate at the full or change, or at any other particular part of the lunation, but after they have commenced at any part of it, they continue to recur at that part with great regularity, unless disturbed by some violent circumstance, as explained in Sect. XXXII. No. 6. their return is immediately caused by deficient venous absorption, which is owing to the want of the stimulus, designed by nature, of amatorial copulation, or of the growing fetus. When the catamenia returns sooner than the period of lunation, it shows a tendency of the constitution to inirritability; that is to debility, or deficiency of sensorial power, and is to be relieved by small doses of steel and opium.
The venereal orgasm of birds and quadrupeds seems to commence, or return about the most powerful lunations at the vernal or autumnal equinoxes; but if it be disappointed of its object, it is said to recur at monthly periods; in this respect resembling the female catamenia. Whence it is believed, that women are more liable to become pregnant at or about the time of their catamenia, than at the intermediate times; and on this account they are seldom much mistaken in their reckoning of nine lunar periods from the last menstruation; the inattention to this may sometimes have been the cause of supposed barrenness, and is therefore worth the observation of those, who wish to have children.
III. We now come to the periods of diseased animal actions. The periods of fever-fits, which depend on the stated returns of nocturnal cold, are discussed in Sect. XXXII. 3. Those, which originate or recur at solar or lunar periods, are also explained in Section XXXII. 6. These we shall here enumerate; observing, however, that it is not more surprising, that the influence of the varying attractions of the sun and moon, should raise the ocean into mountains, than that it should affect the nice sensibilities of animal bodies; though the manner of its operation on them is difficult to be understood. It is probable however, that as this influence gradually lessens during the course of the day, or of the lunation, or of the year, some actions of our system become less and less; till at length a total quiescence of some part is induced; which is the commencement of the paroxysms of fever, of menstruation, of pain with decreased action of the affected organ, and of consequent convulsion.
1. A diurnal fever in some weak people is distinctly observed to come on towards evening, and to cease with a moist skin early in the morning, obeying the solar periods. Persons of weak constitutions are liable to get into better spirits at the access of the hot fit of this evening fever; and are thence inclined to sit up late; which by further enfeebling them increases the disease; whence they lose their strength and their colour.
2. The periods of hectic fever, supposed to arise from absorption of matter, obeys the diurnal periods like the above, having the exacerbescence towards evening, and its remission early in the morning, with sweats, or diarrhœa, or urine with white sediment.
3. The periods of quotidian fever are either catenated with solar time, and return at the intervals of twenty-four hours; or with lunar time, recurring at the intervals of about twenty-five hours. There is great use in knowing with what circumstances the periodical return or new morbid motions are conjoined, as the most effectual times of exhibiting the proper medicines are thus determined. So if the torpor, which ushers in an ague fit, is catenated with the lunar day: it is known, when the bark or opium must be given, so as to exert its principal effect about the time of the expected return. Solid opium should be given about an hour before the expected cold fit; liquid opium and wine about half an hour; the bark repeatedly for six or eight hours previous to the expected return.
4. The periods of tertian fevers, reckoned from the commencement of one cold fit to the commencement of the next cold fit, recur with solar intervals of forty-eight hours, or with lunar ones of about fifty hours. When these of recurrence begin one or two hours earlier than the solar period, it shews, that the torpor or cold fit is produced by less external influence; and therefore that it is more liable to degenerate into a fever with only remissions; so when menstruation recurs sooner than the period of lunation, it shews a tendency of the habit to torpor of inirritability.
5. The periods of quartan fevers return at solar intervals of seventy-two hours, or at lunar ones of about seventy-four hours and an half. This kind of ague appears most in moist cold autumns, and in cold countries replete with marshes. It is attended with greater debility, and its cold access more difficult to prevent. For where there is previously a deficiency of sensorial power, the constitution is liable to run into greater torpor from any further diminution of it; two ounces of bark and some steel should be given on the day before the return of the cold paroxysm, and a pint of wine by degrees a few hours before its return, and thirty drops of laudanum one hour before the expected cold fit.
6. The periods of the gout generally commence about an hour before sun-rise, which is usually the coldest part of the twenty-four hours. The greater periods of the gout seem also to observe the solar influence, returning about the same season of the year.
7. The periods of the pleurisy recur with exacerbation of the pain and fever about sun-set, at which time venesection is of most service. The same may be observed of the inflammatory rheumatism, and other fevers with arterial strength, which seem to obey solar periods; and those with debility seem to obey lunar ones.
8. The periods of fevers with arterial debility seem to obey the lunar day, having their access daily nearly an hour later; and have sometimes two accesses in a day, resembling the lunar effects upon the tides.
9. The periods of rhaphania, or convulsions of the limbs from rheumatic pains, seem to be connected with solar influence, returning at nearly the same hour for weeks together, unless disturbed by the exhibition of powerful doses of opium.
So the periods of Tussis ferina, or violent cough with slow pulse, called nervous cough, recurs by solar periods. Five grains of opium, given at the time the cough commenced disturbed the period, from seven in the evening to eleven, at which time it regularly returned for some days, during which time the opium was gradually omitted. Then 120 drops of laudanum were given an hour before the access of the cough, and it totally ceased. The laudanum was continued a fortnight, and then gradually discontinued.
10. The periods of hemicrania, and of painful epilepsy, are liable to obey lunar periods, both in their diurnal returns, and in their greater periods of weeks, but are also induced by other exciting causes.
11. The periods of arterial hæmorrhages seem to return at solar periods about the same hour of the evening or morning. Perhaps the venous hæmorrhages obey the lunar periods, as the catamenia, and hæmorrhoids.
12. The periods of the hæmorrhoids, or piles, in some recur monthly, in others only at the greater lunar influence about the equinoxes.
13. The periods of hæmoptoe sometimes obey solar influence, recurring early in the morning for several days; and sometimes lunar periods, recurring monthly; and sometimes depend on our hours of sleep. See Class I. 2. 1. 9.
14. Many of the first periods of epileptic fits obey the monthly lunation with some degree of accuracy; others recur only at the most powerful lunations before the vernal equinox, and after the autumnal one; but when the constitution has gained a habit of relieving disagreeable sensations by this kind of exertion, the fit recurs from any slight cause.
15. The attack of palsy and apoplexy are known to recur with great frequency about the equinoxes.
16. There are numerous instances of the effect of the lunations upon the periods of insanity, whence the name of lunatic has been given to those afflicted with this disease.
IV. The critical days, in which fevers are supposed to terminate, have employed the attention of medical philosophers from the days of Hippocrates to the present time. In whatever part of a lunation a fever commences, which owes either its whole cause to solar and lunar influence, or to this in conjunction with other causes; it would seem, that the effect would be the greatest at the full and new moon, as the tides rise highest at those times, and would be the least at the quadratures; thus if a fever-fit should commence at the new or full moon, occasioned by the solar and lunar attraction diminishing some chemical affinity of the particles of blood, and thence decreasing their stimulus on our sanguiferous system, as mentioned in Sect. XXXII. 6. this effect will daily decrease for the first seven days, and will then increase till about the fourteenth day, and will again decrease till about the twenty-first day, and increase again till the end of the lunation. If a fever-fit from the above cause should commence on the seventh day after either lunation, the reverse of the above circumstances would happen. Now it is probable, that those fevers, whose crisis or terminations are influenced by lunations, may begin at one or other of the above times, namely at the changes or quadratures; though sufficient observations have not been made to ascertain this circumstance. Hence I conclude, that the small-pox and measles have their critical days, not governed by the times required for certain chemical changes in the blood, which affect or alter the stimulus of the contagious matter, but from the daily increasing or decreasing effect of this lunar link of catenation, as explained in Section XVII. 3. 3. And as other fevers terminate most frequently about the seventh, fourteenth, twenty-first, or about the end of four weeks, when no medical assistance has disturbed their periods, I conclude, that these crises, or terminations, are governed by periods of the lunations; though we are still ignorant of their manner of operation.
In the distinct small-pox the vestiges of lunation are very apparent, after inoculation a quarter of a lunation precedes the commencement of the fever, another quarter terminates with the complete eruption, another quarter with the complete maturation, and another quarter terminates the complete absorption of a material now rendered inoffensive to the constitution.
OF DIGESTION, SECRETION, NUTRITION.
I. Crystals increase by the greater attraction of their sides. Accretion by chemical precipitations, by welding, by pressure, by agglutination. II. Hunger, digestion, why it cannot be imitated out of the body. Lacteals absorb by animal selection or appetency. III. The glands and pores absorb nutritious particles by animal selection. Organic particles of Buffon. Nutrition applied at the time of elongation of fibres. Like inflammation. IV. It seems easier to have preserved animals than to reproduce them. Old age and death from inirritability. Three causes of this. Original fibres of the organs of sense and muscles unchanged. V. Art of producing long life.
I. The larger crystals of saline bodies may be conceived to arise from the combination of smaller crystals of the same form, owing to the greater attractions of their sides than of their angles. Thus if four cubes were floating in a fluid, whose friction or resistance is nothing, it is certain the sides of these cubes would attract each other stronger than their angles; and hence that these four smaller cubes would so arrange themselves as to produce one larger one.
There are other means of chemical accretion, such as the depositions of dissolved calcareous or siliceous particles, as are seen in the formation of the stalactites of limestone in Derbyshire, or of calcedone in Cornwall. Other means of adhesion are produced by heat and pressure, as in the welding of iron-bars; and other means by simple pressure, as in forcing two pieces of caoutchou, or elastic gum, to adhere; and lastly, by the agglutination of a third substance penetrating the pores of the other two, as in the agglutination of wood by means of animal gluten. Though the ultimate particles of animal bodies are held together during life, as well as after death, by their specific attraction of cohesion, like all other matter; yet it does not appear, that their original organization was produced by chemical laws, and their production and increase must therefore only be looked for from the laws of animation.
II. When the pain of hunger requires relief, certain parts of the material world, which surround us, when applied to our palates, excite into action the muscles of deglutition; and the material is swallowed into the stomach. Here the new aliment becomes mixed with certain animal fluids, and undergoes a chemical process, termed digestion; which however chemistry has not yet learnt to imitate out of the bodies of living animals or vegetables. This process seems very similar to the saccharine process in the lobes of farinaceous seeds, as of barley, when it begins to germinate; except that, along with the sugar, oil and mucilage are also produced; which form the chyle of animals, which is very similar to their milk.
The reason, I imagine, why this chyle-making, or saccharine process, has not yet been imitated by chemical operations, is owing to the materials being in such a situation in respect to warmth, moisture, and motion; that they will immediately change into the vinous or acetous fermentation; except the new sugar be absorbed by the numerous lacteal or lymphatic vessels, as soon as it is produced; which is not easy to imitate in the laboratory.
These lacteal vessels have mouths, which are irritated into action by the stimulus of the fluid, which surrounds them; and by animal selection, or appetency, they absorb such part of the fluid as is agreeable to their palate; those parts, for instance, which are already converted into chyle, before they have time to undergo another change by a vinous or acetous fermentation. This animal absorption of fluid is almost visible to the naked eye in the action of the puncta lacrymalia; which imbibe the tears from the eye, and discharge them again into the nostrils.
III. The arteries constitute another reservoir of a changeful fluid; from which, after its recent oxygenation in the lungs, a further animal selection of various fluids is absorbed by the numerous glands; these select their respective fluids from the blood, which is perpetually undergoing a chemical change; but the selection by these glands, like that of the lacteals, which open their mouths into the digesting aliment in the stomach, is from animal appetency, not from chemical affinity; secretion cannot therefore be imitated in the laboratory, as it consists in a selection of part of a fluid during the chemical change of that fluid.
The mouths of the lacteals, and lymphatics, and the ultimate terminations of the glands, are finer than can easily be conceived; yet it is probable, that the pores, or interstices of the parts, or coats, which constitute these ultimate vessels, may still have greater tenuity; and that these pores from the above analogy must posses a similar power of irritability, and absorb by their living energy the particles of fluid adapted to their purposes, whether to replace the parts abraded or dissolved, or to elongate and enlarge themselves. Not only every kind of gland is thus endued with its peculiar appetency, and selects the material agreeable to its taste from the blood, but every individual pore acquires by animal selection the material, which it wants; and thus nutrition seems to be performed in a manner so similar to secretion; that they only differ in the one retaining, and the other parting again with the particles, which they have selected from the blood.
This way of accounting for nutrition from stimulus, and the consequent animal selection of particles, is much more analogous to other phenomena of the animal microcosm, than by having recourse to the microscopic animalcula, or organic particles of Buffon, and Needham; which being already compounded must themselves require nutritive particles to continue their own existence. And must be liable to undergo a change by our digestive or secretory organs; otherwise mankind would soon resemble by their theory the animals, which they feed upon. He, who is nourished by beef or venison, would in time become horned; and he, who feeds on pork or bacon, would gain a nose proper for rooting into the earth, as well as for the perception of odours.
The whole animal system may be considered as consisting of the extremities of the nerves, or of having been produced from them; if we except perhaps the medullary part of the brain residing in the head and spine, and in the trunks of the nerves. These extremities of the nerves are either of those of locomotion, which are termed muscular fibres; or of those of sensation, which constitute the immediate organs of sense, and which have also their peculiar motions. Now as the fibres, which constitute the bones and membranes, possessed originally sensation and motion; and are liable again to possess them, when they become inflamed; it follows, that those were, when first formed, appendages to the nerves of sensation or locomotion, or were formed from them. And that hence all these solid parts of the body, as they have originally consisted of extremities of nerves, require an apposition of nutritive particles of a similar kind, contrary to the opinion of Buffon and Needham above recited.
Lastly, as all these filaments have possessed, or do possess, the power of contraction, and of consequent inertion or elongation; it seems probable, that the nutritive particles are applied during their times of elongation; when their original constituent particles are removed to a greater distance from each other. For each muscular or sensual fibre may be considered as a row or string of beads; which approach, when in contraction, and recede during its rest or elongation; and our daily experience shews us, that great action emaciates the system, and that it is repaired during rest.
Something like this is seen out of the body; for if a hair, or a single untwisted fibre of flax or silk, be soaked in water; it becomes longer and thicker by the water, which is absorbed into its pores. Now if a hair could be supposed to be thus immersed in a solution of particles similar to those, which compose it; one may imagine, that it might be thus increased in weight and magnitude; as the particles of oak-bark increase the substance of the hides of beasts in the process of making leather. I mention these not as philosophic analogies, but as similes to facilitate our ideas, how an accretion of parts may be effected by animal appetences, or selections, in a manner somewhat similar to mechanical or chemical attractions.
If those new particles of matter, previously prepared by digestion and sanguification, only supply the places of those, which have been abraded by the actions of the system, it is properly termed nutrition. If they are applied to the extremities of the nervous fibrils, or in such quantity as to increase the length or crassitude of them, the body becomes at the same time enlarged, and its growth is increased, as well as its deficiences repaired.
In this last case something more than a simple apposition or selection of particles seems to be necessary; as many parts of the system during its growth are caused to recede from those, with which they were before in contact; as the ends of the bones, or cartilages, recede from each other, as their growth advances: this process resembles inflammation, as appears in ophthalmy, or in the production of new flesh in ulcers, where old vessels are enlarged, and new ones produced; and like that is attended with sensation. In this situation the vessels become distended with blood, and acquire greater sensibility, and may thus be compared to the erection of the penis, or of the nipples of the breasts of women; while new particles become added at the same time; as in the process of nutrition above described.
When only the natural growth of the various parts of the body are produced, a pleasurable sensation attends it, as in youth, and perhaps in those, who are in the progress of becoming fat. When an unnatural growth is the consequence, as in inflammatory diseases, a painful sensation attends the enlargement of the system.
IV. This apposition of new parts, as the old ones disappear, selected from the aliment we take, first enlarges and strengthens our bodies for twenty years, for another twenty years it keeps us in health and vigour, and adds strength and solidity to the system; and then gradually ceases to nourish us properly, and for another twenty years we gradually sink into decay, and finally cease to act, and to exist.
On considering this subject one should have imagined at first view, that it might have been easier for nature to have supported her progeny for ever in health and life, than to have perpetually reproduced them by the wonderful and mysterious process of generation. But it seems our bodies by long habit cease to obey the stimulus of the aliment, which should support us. After we have acquired our height and solidity we make no more new parts, and the system obeys the irritations, sensations, volitions; and associations, with, less and less energy, till the whole sinks into inaction.
Three causes may conspire to render our nerves less excitable, which have been already mentioned, 1. If a stimulus be greater than natural, it produces too great an exertion of the stimulated organ, and in consequence exhausts the spirit of animation; and the moving organ ceases to act, even though the stimulus be continued. And though rest will recruit this exhaustion, yet some degree of permanent injury remains, as is evident after exposing the eyes long to too strong a light. 2. If excitations weaker than natural be applied, so as not to excite the organ into action, (as when small doses of aloe or rhubarb are exhibited,) they may be gradually increased, without exciting the organ into action; which will thus acquire a habit of disobedience to the stimulus; thus by increasing the dose by degrees, great quantities of opium or wine may be taken without intoxication. See Sect. XII. 3. 1.
3. Another mode, by which life is gradually undermined, is when irritative motions continue to be produced in consequence of stimulus, but are not succeeded by sensation; hence the stimulus of contagious matter is not capable of producing fever a second time, because it is not succeeded by sensation. See Sect. XII. 3. 6. And hence, owing to the want of the general pleasurable sensation, which ought to attend digestion and glandular secretion, an irksomeness of life ensues; and, where this is in greater excess, the melancholy of old age occurs, with torpor or debility.
From hence I conclude, that it is probable that the fibrillæ, or moving filaments at the extremities of the nerves of sense, and the fibres which constitute the muscles (which are perhaps the only parts of the system that are endued with contractile life) are not changed, as we advance in years, like the other parts of the body; but only enlarged or elongated with our growth; and in consequence they become less and less excitable into action. Whence, instead of gradually changing the old animal, the generation of a totally new one becomes necessary with undiminished excitability; which many years will continue to acquire new parts, or new solidity, and then losing its excitability in time, perish like its parent.
V. From this idea the art of preserving long health and life may be deduced; which must consist in using no greater stimulus, whether of the quantity or kind of our food and drink, or of external circumstances, such as heat, and exercise, and wakefulness, than is sufficient to preserve us in vigour; and gradually, as we grow old to increase the stimulus of our aliment, as the irritability of our system increases.
The debilitating effects ascribed by the poet MARTIAL to the excessive use of warm bathing in Italy, may with equal propriety be applied to the warm rooms of England; which, with the general excessive stimulus of spirituous or fermented liquors, and in some instances of immoderate venery, contribute to shorten our lives.