Chapter XVIII: Section XXIV: and XXV. but as all parts of the body, that have been (2)

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.

From the quiescence of the anastomosing capillaries a paleness of the skin succeeds, and a less secretion of the perspirable matter; from the quiescence of the pulmonary capillaries a difficulty of respiration arises; and from the quiescence of the other glands less bile, less gastric and pancreatic juice, are secreted into the stomach and intestines, and less mucus and saliva are poured into the mouth; whence arises the dry tongue, costiveness, dry ulcers, and paucity of urine. From the quiescence of the absorbent system arises the great thirst, as less moisture is absorbed from the atmosphere. The absorption from the atmosphere was observed by Dr. Lyster to amount to eighteen ounces in one night, above what he had at the same time insensibly perspired. See Langrish. On the same account the urine is pale, though in small quantity, for the thinner part is not absorbed from it; and when repeated ague-fits continue long, the legs swell from the diminished absorption of the cellular absorbents.

From the quiescence of the intestinal canal a loss of appetite and flatulencies proceed. From the partial quiescence of the glandular viscera a swelling and tension about the præcordia becomes sensible to the touch; which is occasioned by the delay of the fluids from the defect of venous or lymphatic absorption. The pain of the forehead, and of the limbs, and of the small of the back, arises from the quiescence of the membranous fascia, or muscles of those parts, in the same manner as the skin becomes painful, when the vessels, of which it is composed, become quiescent from cold. The trembling in consequence of the pain of coldness, the restlessness, and the yawning, and stretching of the limbs, together with the shuddering, or rigours, are convulsive motions; and will be explained amongst the diseases of volition; Sect. XXXIV.

Sickness and vomiting is a frequent symptom in the beginnings of fever-fits, the muscular fibres of the stomach share the general torpor and debility of the system; their motions become first lessened, and then stop, and then become retrograde; for the act of vomiting, like the globus hystericus and the borborigmi of hypochondriasis, is always a symptom of debility, either from want of stimulus, as in hunger; or from want of sensorial power, as after intoxication; or from sympathy with some other torpid irritative motions, as in the cold fits of ague. See Sect. XII. 5. 5. XXIX. 11. and XXXV. 1. 3. where this act of vomiting is further explained.

The small pulse, which is said by some writers to be slow at the commencement of ague-fits, and which is frequently trembling and intermittent, is owing to the quiescence of the heart and arterial system, and to the resistance opposed to the circulating fluid from the inactivity of all the glands and capillaries. The great weakness and inability to voluntary motions, with the insensibility of the extremities, are owing to the general quiescence of the whole moving system; or, perhaps, simply to the deficient production of sensorial power.

If all these symptoms are further increased, the quiescence of all the muscles, including the heart and arteries, becomes complete, and death ensues. This is, most probably, the case of those who are starved to death with cold, and of those who are said to die in Holland from long skaiting on their frozen canals.

2. As soon as this general quiescence of the system ceases, either by the diminution of the cause, or by the accumulation of sensorial power, (as in syncope, Sect. XII. 7. 1.) which is the natural consequence of previous quiescence, the hot fit commences. Every gland of the body is now stimulated into stronger action than is natural, as its irritability is increased by accumulation of sensorial power during its late quiescence, a superabundance of all the secretions is produced, and an increase of heat in consequence of the increase of these secretions. The skin becomes red, and the perspiration great, owing to the increased action of the capillaries during the hot part of the paroxysm. The secretion of perspirable matter is perhaps greater during the hot fit than in the sweating fit which follows; but as the absorption of it also is greater, it does not stand on the skin in visible drops: add to this, that the evaporation of it also is greater, from the increased heat of the skin. But at the decline of the hot fit, as the mouths of the absorbents of the skin are exposed to the cooler air, or bed-clothes, these vessels sooner lose their increased activity, and cease to absorb more than their natural quantity: but the secerning vessels for some time longer, being kept warm by the circulating blood, continue to pour out an increased quantity of perspirable matter, which now stands on the skin in large visible drops; the exhalation of it also being lessened by the greater coolness of the skin, as well as its absorption by the diminished action of the lymphatics. See Class I. 1. 2. 3.

The increased secretion of bile and of other fluids poured into the intestines frequently induce a purging at the decline of the hot fit; for as the external absorbent vessels have their mouths exposed to the cold air, as above mentioned, they cease to be excited into unnatural activity sooner than the secretory vessels, whose mouths are exposed to the warmth of the blood: now, as the internal absorbents sympathize with the external ones, these also, which during the hot fit drank up the thinner part of the bile, or of other secreted fluids, lose their increased activity before the gland loses its increased activity, at the decline of the hot fit; and the loose dejections are produced from the same cause, that the increased perspiration stands on the surface of the skin, from the increased absorption ceasing sooner than the increased secretion.

The urine during the cold fit is in small quantity and pale, both from a deficiency of the secretion and a deficiency of the absorption.

During the hot fit it is in its usual quantity, but very high coloured and turbid, because a greater quantity had been secreted by the increased action of the kidnies, and also a greater quantity of its more aqueous part had been absorbed from it in the bladder by the increased action of the absorbents; and lastly, at the decline of the hot fit it is in large quantity and less coloured, or turbid, because the absorbent vessels of the bladder, as observed above, lose their increased action by sympathy with the cutaneous ones sooner than the secretory vessels of the kidnies lose their increased activity. Hence the quantity of the sediment, and the colour of the urine, in fevers, depend much on the quantity secreted by the kidnies, and the quantity absorbed from it again in the bladder: the kinds of sediment, as the lateritious, purulent, mucous, or bloody sediments, depend on other causes. It should be observed, that if the sweating be increased by the heat of the room, or of the bed-clothes, that a paucity of turbid urine will continue to be produced, as the absorbents of the bladder will have their activity increased by their sympathy with the vessels of the skin, for the purpose of supplying the fluid expended in perspiration.

The pulse becomes strong and full owing to the increased irritability of the heart and arteries, from the accumulation of sensorial power during their quiescence, and to the quickness of the return of the blood from the various glands and capillaries. This increased action of all the secretory vessels does not occur very suddenly, nor universally at the same time. The heat seems to begin about the center, and to be diffused from thence irregularly to the other parts of the system. This may be owing to the situation of the parts which first became quiescent and caused the fever-fit, especially when a hardness or tumour about the præcordia can be felt by the hand; and hence this part, in whatever viscus it is seated, might be the first to regain its natural or increased irritability.

3. It must be here noted, that, by the increased quantity of heat, and of the impulse of the blood at the commencement of the hot fit, a great increase of stimulus is induced, and is now added to the increased irritability of the system, which was occasioned by its previous quiescence. This additional stimulus of heat and momentum of the blood augments the violence of the movements of the arterial and glandular system in an increasing ratio. These violent exertions still producing more heat and greater momentum of the moving fluids, till at length the sensoral power becomes wasted by this great stimulus beneath its natural quantity, and predisposes the system to a second cold fit.

At length all these unnatural exertions spontaneously subside with the increased irritability that produced them; and which was itself produced by the preceding quiescence, in the same manner as the eye, on coming from darkness into day-light, in a little time ceases to be dazzled and pained, and gradually recovers its natural degree of irritability.

4. But if the increase of irritability, and the consequent increase of the stimulus of heat and momentum, produce more violent exertions than those above described; great pain arises in some part of the moving system, as in the membranes of the brain, pleura, or joints; and new motions of the vessels are produced in consequence of this pain, which are called inflammation; or delirium or stupor arises; as explained in Sect. XXI. and XXXIII.: for the immediate effect is the same, whether the great energy of the moving organs arises from an increase of stimulus or an increase of irritability; though in the former case the waste of sensorial power leads to debility, and in the latter to health.

_Recapitulation._

X. Those muscles, which are less frequently exerted, and whose actions are interrupted by sleep, acquire less accumulation of sensorial power during their quiescent state, as the muscles of locomotion. In these muscles after great exertion, that is, after great exhaustion of sensorial power, the pain of fatigue ensues; and during rest there is a renovation of the natural quantity of sensorial power; but where the rest, or quiescence of the muscle, is long continued, a quantity of sensorial power becomes accumulated beyond what is necessary; as appears by the uneasiness occasioned by want of exercise; and which in young animals is one cause exciting them into action, as is seen in the play of puppies and kittens.

But when those muscles, which are habituated to perpetual actions, as those of the stomach by the stimulus of food, those of the vessels of the skin by the stimulus of heat, and those which constitute the arteries and glands by the stimulus of the blood, become for a time quiescent, from the want of their appropriated stimuli, or by their associations with other quiescent parts of the system; a greater accumulation of sensorial power is acquired during their quiescence, and a greater or quicker exhaustion of it is produced during their increased action.

This accumulation of sensorial power from deficient action, if it happens to the stomach from want of food, occasions the pain of hunger; if it happens to the vessels of the skin from want of heat, it occasions the pain of cold; and if to the arterial system from the want of its adapted stimuli, many disagreeable sensations are occasioned, such as are experienced in the cold fits of intermittent fevers, and are as various, as there are glands or membranes in the system, and are generally termed universal uneasiness.

When the quiescence of the arterial system is not owing to defect of stimulus as above, but to the defective quantity of sensorial power, as in the commencement of nervous fever, or irritative fever with weak pulse, a great torpor of this system is quickly induced; because both the irritation from the stimulus of the blood, and the association of the vascular motions with each other, continue to excite the arteries into action, and thence quickly exhaust the ill-supplied vascular muscles; for to rest is death; and therefore those vascular muscles continue to proceed, though with feebler action, to the extreme of weariness or faintness: while nothing similar to this affects the locomotive muscles, whose actions are generally caused by volition, and not much subject either to irritation or to other kinds of associations besides the voluntary ones, except indeed when they are excited by the lash of slavery.

In these vascular muscles, which are subject to perpetual action, and thence liable to great accumulation of sensorial power during their quiescence from want of stimulus, a great increase of activity occurs, either from the renewal of their accustomed stimulus, or even from much less quantities of stimulus than usual. This increase of action constitutes the hot fit of fever, which is attended with various increased secretions, with great concomitant heat, and general uneasiness. The uneasiness attending this hot paroxysm of fever, or fit of exertion, is very different from that, which attends the previous cold fit, or fit of quiescence, and is frequently the cause of inflammation, as in pleurisy, which is treated of in the next section.

A similar effect occurs after the quiescence of our organs of sense; those which are not subject to perpetual action, as the taste and smell, are less liable to an exuberant accumulation of sensorial power after their having for a time been inactive; but the eye, which is in perpetual action during the day, becomes dazzled, and liable to inflammation after a temporary quiescence.

Where the previous quiescence has been owing to a defect of sensorial power, and not to a defect of stimulus, as in the irritative fever with weak pulse, a similar increase of activity of the arterial system succeeds, either from the usual stimulus of the blood, or from a stimulus less than usual; but as there is in general in these cases of fever with weak pulse a deficiency of the quantity of the blood, the pulse in the hot fit is weaker than in health, though it is stronger than in the cold fit, as explained in No. 2. of this section. But at the same time in those fevers, where the defect of irritation is owing to the defect of the quantity of sensorial power, as well as to the defect of stimulus, another circumstance occurs; which consists in the partial distribution of it, as appears in partial flushings, as of the face or bosom, while the extremities are cold; and in the increase of particular secretions, as of bile, saliva, insensible perspiration, with great heat of the skin, or with partial sweats, or diarrhoea.

There are also many uneasy sensations attending these increased actions, which, like those belonging to the hot fit of fever with strong pulse, are frequently followed by inflammation, as in scarlet fever; which inflammation is nevertheless accompanied with a pulse weaker, though quicker, than the pulse during the remission or intermission of the paroxysms, though stronger than that of the previous cold fit.

From hence I conclude, that both the cold and hot fits of fever are necessary consequences of the perpetual and incessant action of the arterial and glandular system; since those muscular fibres and those organs of sense, which are most frequently exerted, become necessarily most affected both with defect and accumulation of sensorial power: and that hence _fever-fits are not an effort of nature to relieve herself_, and that therefore they should always be prevented or diminished as much as possible, by any means which decrease the general or partial vascular actions, when they are greater, or by increasing them when they are less than in health, as described in Sect. XII. 6. 1.

Thus have I endeavoured to explain, and I hope to the satisfaction of the candid and patient reader, the principal symptoms or circumstances of fever without the introduction of the supernatural power of spasm. To the arguments in favour of the doctrine of spasm it may be sufficient to reply, that in the evolution of medical as well as of dramatic catastrophe,

Nec Deus intersit, nisi dignus vindice nodus inciderit.--HOR.

* * * * *

SECT. XXXIII.

DISEASES OF SENSATION.

I. 1. _Motions excited by sensation. Digestion. Generation. Pleasure of
existence. Hypochondriacism._ 2. _Pain introduced. Sensitive fevers of
two kinds._ 3. _Two sensorial powers exerted in sensitive fevers. Size
of the blood. Nervous fevers distinguished from putrid ones. The septic
and antiseptic theory._ 4. _Two kinds of delirium._ 5. _Other animals
are less liable to delirium, cannot receive our contagious diseases,
and are less liable to madness._ II. 1. _Sensitive motions generated._
2. _Inflammation explained._ 3. _Its remote causes from excess of
irritation, or of irritability, not from those pains which are owing to
defect of irritation. New vessels produced, and much heat._ 4.
_Purulent matter secreted._ 5. _Contagion explained._ 6. _Received but
once._ 7. _If common matter be contagious?_ 8. _Why some contagions are
received but once._ 9. _Why others may be received frequently.
Contagions of small-pox and measles do not act at the same times. Two
cases of such patients._ 10. _The blood from patients in the small-pox
will not infect others. Cases of children thus inoculated. The
variolous contagion is not received into the blood. It acts by
sensitive association between the stomach and skin._ III. 1.
_Absorption of solids and fluids._ 2. _Art of healing ulcers._ 3.
_Mortification attended with less pain in weak people._

I. 1. As many motions of the body are excited and continued by irritations, so others require, either conjunctly with these, or separately, the pleasurable or painful sensations, for the purpose of producing them with due energy. Amongst these the business of digestion supplies us with an instance: if the food, which we swallow, is not attended with agreeable sensation, it digests less perfectly; and if very disagreeable sensation accompanies it, such as a nauseous idea, or very disgustful taste, the digestion becomes impeded; or retrograde motions of the stomach and oesophagus succeed, and the food is ejected.

The business of generation depends so much on agreeable sensation, that, where the object is disgustful, neither voluntary exertion nor irritation can effect the purpose; which is also liable to be interrupted by the pain of fear or bashfulness.

Besides the pleasure, which attends the irritations produced by the objects of lust and hunger, there seems to be a sum of pleasurable affection accompanying the various secretions of the numerous glands, which constitute the pleasure of life, in contradistinction to the tedium vitæ. This quantity or sum of pleasurable affection, seems to contribute to the due or energetic performance of the whole moveable system, as well that of the heart and arteries, as of digestion and of absorption; since without the due quantity of pleasurable sensation, flatulency and hypochondriacism affect the intestines, and a languor seizes the arterial pulsations and secretions; as occurs in great and continued anxiety of the mind.

2. Besides the febrile motions occasioned by irritation, described in Sect. XXXII. and termed irritative fever, it frequently happens that pain is excited by the violence of the fibrous contractions; and other new motions are then superadded, in consequence of sensation, which we shall term febris sensitiva, or sensitive fever. It must be observed, that most irritative fevers begin with a decreased exertion of irritation, owing to defect of stimulus; but that on the contrary the sensitive fevers, or inflammations, generally begin with the increased exertion of sensation, as mentioned in Sect. XXXI. on temperaments: for though the cold fit, which introduces inflammation, commences with decreased irritation, yet the inflammation itself commences in the hot fit during the increase of sensation. Thus a common pustule, or phlegmon, in a part of little sensibility does not excite an inflammatory fever; but if the stomach, intestines, or the tender substance beneath the nails, be injured, great sensation is produced, and the whole system is thrown into that kind of exertion, which constitutes inflammation.

These sensitive fevers, like the irritative ones, resolve themselves into those with arterial strength, and those with arterial debility, that is with excess or defect of sensorial power; these may be termed the febris sensitiva pulsu forti, sensitive fever with strong pulse, which is the synocha, or inflammatory fever; and the febris sensitiva pulsu debili, sensitive fever with weak pulse, which is the typhus gravior, or putrid fever of some writers.

3. The inflammatory fevers, which are here termed sensitive fevers with strong pulse, are generally attended with some topical inflammation, as pleurisy, peripneumony, or rheumatism, which distinguishes them from irritative fevers with strong pulse. The pulse is strong, quick, and full; for in this fever there is great irritation, as well as great sensation, employed in moving the arterial system. The size, or coagulable lymph, which appears on the blood, is probably an increased secretion from the inflamed internal lining of the whole arterial system, the thinner part being taken away by the increased absorption of the inflamed lymphatics.

The sensitive fevers with weak pulse, which are termed putrid or malignant fevers, are distinguished from irritative fevers with weak pulse, called nervous fevers, described in the last section, as the former consist of inflammation joined with debility, and the latter of debility alone. Hence there is greater heat and more florid colour of the skin in the former, with petechiæ, or purple spots, and aphthæ, or sloughs in the throat, and generally with previous contagion.

When animal matter dies, as a slough in the throat, or the mortified part of a carbuncle, if it be kept moist and warm, as during its abhesion to a living body, it will soon putrify. This, and the origin of contagion from putrid animal substances, seem to have given rise to the septic and antiseptic theory of these fevers.

The matter in pustules and ulcers is thus liable to become putrid, and to produce microscopic animalcula; the urine, if too long retained, may also gain a putrescent smell, as well as the alvine feces; but some writers have gone so far as to believe, that the blood itself in these fevers has smelt putrid, when drawn from the arm of the patient: but this seems not well founded; since a single particle of putrid matter taken into the blood can produce fever, how can we conceive that the whole mass could continue a minute in a putrid state without destroying life? Add to this, that putrid animal substances give up air, as in gangrenes; and that hence if the blood was putrid, air should be given out, which in the blood-vessels is known to occasion immediate death.

In these sensitive fevers with strong pulse (or inflammations) there are two sensorial faculties concerned in producing the disease, viz. irritation and sensation; and hence, as their combined action is more violent, the general quantity of sensorial power becomes further exhausted during the exacerbation, and the system more rapidly weakened than in irritative fever with strong pulse; where the spirit of animation is weakened by but one mode of its exertion: so that this febris sensitiva pulsu forti (or inflammatory fever,) may be considered as the febris irritativa pulsu forti, with the addition of inflammation; and the febris sensitiva pulsu debili (or malignant fever) may be considered as the febris irritativa pulsu debili (or nervous fever), with the addition of inflammation.

4. In these putrid or malignant fevers a deficiency of irritability accompanies the increase of sensibility; and by this waste of sensorial power by the excess of sensation, which was already too small, arises the delirium and stupor which so perpetually attend these inflammatory fevers with arterial debility. In these cases the voluntary power first ceases to act from deficiency of sensorial spirit; and the stimuli from external bodies have no effect on the exhausted sensorial power, and a delirium like a dream is the consequence. At length the internal stimuli cease to excite sufficient irritation, and the secretions are either not produced at all, or too parsimonious in quantity. Amongst these the secretion of the brain, or production of the sensorial power, becomes deficient, till at last all sensorial power ceases, except what is just necessary to perform the vital motions, and a stupor succeeds; which is thus owing to the same cause as the preceding delirium exerted in a greater degree.

This kind of delirium is owing to a suspension of volition, and to the disobedience of the senses to external stimuli, and is always occasioned by great debility, or paucity of sensorial power; it is therefore a bad sign at the end of inflammatory fevers, which had previous arterial strength, as rheumatism, or pleurisy, as it shews the presence of great exhaustion of sensorial power in a system, which having lately been exposed to great excitement, is not so liable to be stimulated into its healthy action, either by additional stimulus of food and medicines, or by the accumulation of sensorial power during its present torpor. In inflammatory fevers with debility, as those termed putrid fevers, delirium is sometimes, as well as stupor, rather a favourable sign; as less sensorial power is wasted during its continuance (see Class II. 1. 6. 8.), and the constitution not having been previously exposed to excess of stimulation, is more liable to be excited after previous quiescence.

When the sum of general pleasurable sensation becomes too great, another kind of delirium supervenes, and the ideas thus excited are mistaken for the irritations of external objects: such a delirium is produced for a time by intoxicating drugs, as fermented liquors, or opium: a permanent delirium of this kind is sometimes induced by the pleasures of inordinate vanity, or by the enthusiastic hopes of heaven. In these cases the power of volition is incapable of exertion, and in a great degree the external senses become incapable of perceiving their adapted stimuli, because the whole sensorial power is employed or expended on the ideas excited by pleasurable sensation.

This kind of delirium is distinguished from that which attends the fevers above mentioned from its not being accompanied with general debility, but simply with excess of pleasurable sensation; and is therefore in some measure allied to madness or to reverie; it differs from the delirium of dreams, as in this the power of volition is not totally suspended, nor are the senses precluded from external stimulation; there is therefore a degree of consistency, in this kind of delirium, and a degree of attention to external objects, neither of which exist in the delirium of fevers or in dreams.

5. It would appear, that the vascular system of other animals are less liable to be put into action by their general sum of pleasurable or painful sensation; and that the trains of their ideas, and the muscular motions usually associated with them, are less powerfully connected than in the human system. For other animals neither weep, nor smile, nor laugh; and are hence seldom subject to delirium, as treated of in Sect. XVI. on Instinct. Now as our epidemic and contagious diseases are probably produced by disagreeable sensation, and not simply by irritation; there appears a reason, why brute animals are less liable to epidemic or contagious diseases; and secondly, why none of our contagions, as the small-pox or measles, can be communicated to them, though one of theirs, viz. the hydrophobia, as well as many of their poisons, as those of snakes and of in insects, communicate their deleterious or painful effects to mankind.

Where the quantity of general painful sensation is too great in the system, inordinate voluntary exertions are produced either of our ideas, as in melancholy and madness, or of our muscles, as in convulsion. From these maladies also brute animals are much more exempt than mankind, owing to their greater inaptitude to voluntary exertion, as mentioned in Sect. XVI. on Instinct.

II. 1. When any moving organ is excited into such violent motions, that a quantity of pleasurable or painful sensation is produced, it frequently happens (but not always) that new motions of the affected organ are generated in consequence of the pain or pleasure, which are termed inflammation.

These new motions are of a peculiar kind, tending to distend the old, and to produce new fibres, and thence to elongate the straight muscles, which serve locomotion, and to form new vessels at the extremities or sides of the vascular muscles.

2. Thus the pleasurable sensations produce an enlargement of the nipples of nurses, of the papillæ of the tongue, of the penis, and probably produce the growth of the body from its embryon state to its maturity; whilst the new motions in consequence of painful sensation, with the growth of the fibres or vessels, which they occasion, are termed inflammation.

Hence when the straight muscles are inflamed, part of their tendons at each extremity gain new life and sensibility, and thus the muscle is for a time elongated; and inflamed bones become soft, vascular, and sensible. Thus new vessels shoot over the cornea of inflamed eyes, and into scirrhous tumours, when they become inflamed; and hence all inflamed parts grow together by intermixture, and inosculation of the new and old vessels.

The heat is occasioned from the increased secretions either of mucus, or of the fibres, which produce or elongate the vessels. The red colour is owing to the pellucidity of the newly formed vessels, and as the arterial parts of them are probably formed before their correspondent venous parts.

3. These new motions are excited either from the increased quantity of sensation in consequence of greater fibrous contractions, or from increased sensibility, that is, from the increased quantity of sensorial power in the moving organ. Hence they are induced by great external stimuli, as by wounds, broken bones; and by acrid or infectious materials; or by common stimuli on those organs, which have been some time quiescent; as the usual light of the day inflames the eyes of those, who have been confined in dungeons; and the warmth of a common fire inflames those, who have been previously exposed to much cold.

But these new motions are never generated by that pain, which arises from defect of stimulus, as from hunger, thirst, cold, or inanition, with all those pains, which are termed nervous. Where these pains exist, the motions of the affected part are lessened; and if inflammation succeeds, it is in some distant parts; as coughs are caused by coldness and moisture being long applied to the feet; or it is in consequence of the renewal of the stimulus, as of heat or food, which excites our organs into stronger action after their temporary quiescence; as kibed heels after walking in snow.

4. But when these new motions of the vascular muscles are exerted with greater violence, and these vessels are either elongated too much or too hastily, a new material is secreted from their extremities, which is of various kinds according to the peculiar animal motions of this new kind of gland, which secretes it; such is the pus laudabile or common matter, the variolous matter, venereal matter, catarrhous matter, and many others.

5. These matters are the product of an animal process; they are secreted or produced from the blood by certain diseased motions of the extremities of the blood-vessels, and are on that account all of them contagious; for if a portion of any of these matters is transmitted into the circulation, or perhaps only inserted into the skin, or beneath the cuticle of an healthy person, its stimulus in a certain time produces the same kind of morbid motions, by which itself was produced; and hence a similar kind is generated. See Sect. XXXIX. 6. 1.

6. It is remarkable, that many of these contagious matters are capable of producing a similar disease but once; as the small-pox and measles; and I suppose this is true of all those contagious diseases, which are spontaneously cured by nature in a certain time; for if the body was capable of receiving the disease a second time, the patient must perpetually infect himself by the very matter, which he has himself produced, and is lodged about him; and hence he could never become free from the disease. Something similar to this is seen in the secondary fever of the confluent small-pox; there is a great absorption of variolous matter, a very minute part of which would give the genuine small-pox to another person; but here it only stimulates the system into common fever; like that which common puss, or any other acrid material might occasion.

7. In the pulmonary consumption, where common matter is daily absorbed, an irritative fever only, without new inflammation, is generally produced; which is terminated like other irritative fevers by sweats, or loose stools. Hence it does not appear, that this absorbed matter always acts as a contagious material producing fresh inflammation or new abscesses. Though there is reason to believe, that the first time any common matter is absorbed, it has this effect, but not the second time, like the variolous matter above mentioned.

This accounts for the opinion, that the pulmonary consumption is sometimes infectious, which opinion was held by the ancients, and continues in Italy at present; and I have myself seen three or four instances, where a husband and wife, who have slept together, and have thus much received each other's breath, who have infected each other, and both died in consequence of the original taint of only one of them. This also accounts for the abscesses in various parts of the body, that are sometimes produced after the inoculated small-pox is terminated; for this second absorption of variolous matter acts like common matter, and produces only irritative fever in those children, whose constitutions have already experienced the absorption of common matter; and inflammation with a tendency to produce new abscesses in those, whose constitutions have not experienced the absorptions of common matter.

It is probable, that more certain proofs might have been found to shew, that common matter is infectious the first time it is absorbed, tending to produce similar abscesses, but not the second time of its absorption, if this subject had been attended to.

8. These contagious diseases are very numerous, as the plague, small-pox, chicken-pox, measles, scarlet-fever, pemphigus, catarrh, chincough, venereal disease, itch, trichoma, tinea. The infectious material does not seem to be dissolved by the air, but only mixed with it perhaps in fine powder, which soon subsides; since many of these contagions can only be received by actual contact; and others of them only at small distances from the infected person; as is evident from many persons having been near patients of the small-pox without acquiring the disease.

The reason, why many of these diseases are received but once, and others repeatedly, is not well understood; it appears to me, that the constitution becomes so accustomed to the stimuli of these infectious materials, by having once experienced them, that though irritative motions, as hectic fevers, may again be produced by them, yet no sensation, and in consequence no general inflammation succeeds; as disagreeable smells or tastes by habit cease to be perceived; they continue indeed to excite irritative ideas on the organs of sense, but these are not succeeded by sensation.

There are many irritative motions, which were at first succeeded by sensation, but which by frequent repetition cease to excite sensation, as explained in Sect. XX. on Vertigo. And, that this circumstance exists in respect to infectious matter appears from a known fact; that nurses, who have had the small-pox, are liable to experience small ulcers on their arms by the contact of variolous matter in lifting their patients; and that when patients, who have formerly had the small-pox have been inoculated in the arm, a phlegmon, or inflamed sore, has succeeded, but no subsequent fever. Which shews, that the contagious matter of the small-pox has not lost its power of stimulating the part it is applied to, but that the general system is not affected in consequence. See Section XII. 7. 6. XIX. 9.

9. From the accounts of the plague, virulent catarrh, and putrid dysentery, it seems uncertain, whether these diseases are experienced more than once; but the venereal disease and itch are doubtless repeatedly infectious; and as these diseases are never cured spontaneously, but require medicines, which act without apparent operation, some have suspected, that the contagious material produces similar matter rather by a chemical change of the fluids, than by an animal process; and that the specific medicines destroy their virus by chemically combining with it. This opinion is successfully combated by Mr. Hunter, in his Treatise on Venereal Disease,