Chapter XVIII: Section XXXVI: 2. 3 (6)

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

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

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

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

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

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

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

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

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

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ORDO I.

_Increased Associate Motions._

GENUS III.

_Catenated with Voluntary Motions_

SPECIES.

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

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

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

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

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

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

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

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

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

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

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

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

* * * * *

ORDO I.

_Increased Associate Motions._

GENUS IV.

_Catenated with External Influences._

SPECIES.

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

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

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

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

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

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

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

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

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

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

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

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ORDO II.

_Decreased Associate Motions._

GENUS I.

_Catenated with Irritative Motions._

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

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

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

SPECIES.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

When vertigo affects people about fifty years of age, their sight has generally been suddenly impaired; and from their less accurate vision they do not soon enough perceive the apparent motions of objects; like a person in a room, the walls of which are stained with the uniform figures of lozenges, explained in Sect. XX. 1. This is generally ascribed to indigestion; but it ceases spontaneously, as the patient acquires the habit of balancing himself by less distinct objects.

A gentleman about 50 was seized with an uncommon degree of vertigo, so as to fall on the ground, and not to be able to turn his head, as he sat up either in his chair or in his bed, and this continued eight or ten weeks. As he had many decayed teeth in his mouth, and the vertigo was preceded and sometimes accompanied by pains on one side of his head, the disease of a tooth was suspected to be the cause. And as his timidity was too great to admit the extraction of those which were decayed; after the trial of cupping repeatedly, fomentations on his head, repeated blisters, with valerian, Peruvian bark, musk, opium, and variety of other medicines; mercurials were used, both externally and internally, with design to inflame the membranes of the teeth, and by that means to prevent the torpor of the action of the membranes about the temple, and parietal bone; which are catenated with the membranes of the teeth by irritative association, but not by sensitive association. The event was, that as soon as the gums became sore with a slight ptyalism, the pains about the head and vertigo gradually diminished, and during the soreness of his gums entirely ceased; but I believe recurred afterwards, though in less degree.

The idea of inflaming the membranes of the teeth to produce increased sensation in them, and thus to prevent their irritative connection with those of the cranium, was taken from the treatment of trismus, or locked jaw, by endeavouring to inflame the injured tendon; which is said to prevent or to remove the spasm of the muscles of the jaw. See Class III. 1. 1. 13. and 15.

M. M. Emetics. Blisters. Issues about the head. Extraction of decayed teeth. Slight salivation. Sorbentia. Incitantia.

12. _Vertigo ebriosa._ Vertigo from intoxication is owing to the association of the irritative ideas of vision with the irritative motions of the stomach. Whence when these latter become much increased by the immoderate stimulus of wine, the irritative motions of the retina are produced with less energy by reverse sympathy, and become at the same time succeeded by sensation in consequence of their decreased action. See Sect. XXI. 3. and XXXV. 1. 2. So conversely when the irritative motions of vision are increased by turning round, or by our unaccustomed agitation at sea, those of the stomach become inverted by reverse sympathy, and are attended in consequence with disagreeable sensation. Which decreased action of the stomach is in consequence of the increased expenditure of the sensorial power on the irritative ideas of vision, as explained in Vertigo rotatoria.

Whence though a certain quantity of vinous spirit stimulates the whole system into increased action, and perhaps even increases the secretion of sensorial power in the brain; yet as soon as any degree of vertigo is produced, it is a proof, that by the too great expenditure of sensorial power by the stomach, and its nearest associated motions, the more distant ones, as those of vision, become imperfectly exerted. From hence may be deduced the necessity of exhibiting wine in fevers with weak pulse in only appropriated quantity; because if the least intoxication be induced, some part of the system must act more feebly from the unnecessary expenditure of sensorial power.

13. _Vertigo febriculosa._ Vertigo in fevers either proceeds from the general deficiency of sensorial power belonging to the irritative associations, or to a greater expenditure of it on some links of the trains and tribes of associated irritative motions. There is however a slighter vertigo attending all people, who have been long confined in bed, on their first rising; owing to their having been so long unused to the apparent motions of objects in their erect posture, or as they pass by them, that they have lost in part the habit of balancing themselves by them.

14. _Vertigo cerebrosa._ Vertigo from injuries of the brain, either from external violence, or which attend paralytic attacks, are owing to the general deficiency of sensorial power. In these distressful situations the vital motions, or those immediately necessary to life, claim their share of sensorial power in the first place, otherwise the patient must die; and those motions, which are less necessary, feel a deficiency of it, as these of the organs of sense and muscles; which constitute vertigo; and lastly the voluntary motions, which are still less immediately necessary to life, are frequently partially destroyed, as in palsy; or totally, as in apoplexy.

15. _Murmur aurium vertiginosum._ The vertiginous murmur in the ears, or noise in the head, is compared to the undulations of the sound of bells, or to the humming of bees. It frequently attends people about 60 years of age; and like the visual vertigo described above is owing to our hearing less perfectly from the gradual inirritability of the organ on the approach of age; and the disagreeable sensation of noise attending it is owing to the less energetic action of these irritative motions; which not being sufficiently distinct to excite their usual associations become succeeded by our attention, like the indistinct view of the apparent motions of objects mentioned in vertigo visualis. This may be better understood from considering the use, which blind men make of these irritative sounds, which they have taught themselves to attend to, but which escape the notice of others. The late blind Justice Fielding walked for the first time into my room, when he once visited me, and after speaking a few words said, "this room is about 22 feet long, 18 wide, and 12 high;" all which he guessed by the ear with great accuracy. Now if these irritative sounds from the partial loss of hearing do not correspond with the size or usual echoes of the places, where we are; their catenation with other irritative ideas, as those of vision, becomes dissevered or disturbed; and we attend to them in consequence, which I think unravels this intricate circumstance of noises being always heard in the head, when the sense of hearing begins to be impaired, from whatever cause it occurs.

This ringing in the ears also attends the vertigo from intoxication; for the irritative ideas of sound are then more weakly excited in consequence of the deficiency of the sensorial power of association. As is known by this also being attended with disagreeable sensation, and by its accompanying other diseases of debility, as strokes on the head, fainting fits, and paralytic seizures. For in this vertigo from intoxication so much sensorial power in general is expended on the increased actions of the stomach, and its nearest connections, as the capillaries of the skin; that there is a deficiency for the purposes of the other irritative associations of motions usually connected with it. This auditory vertigo attends both the rotatory and the visual vertigo above mentioned; in the former it is introduced by reverse sympathy, that is, by the diminution of sensorial power; too great a quantity of it being expended on the increased irritative motions of vision; in the latter it is produced either by the same causes which produce the visual vertigo, or by direct sympathy with it. See Sect. XX. 7.

M. M. Stimulate the internal ear by ether, or with essential oil diluted with expressed oil, or with a solution of opium in wine, or in water. Or with salt and water.

16. _Tactus, gustus, olfactius vertiginosi._ Vertiginous touch, taste, and smell. In the vertigo of intoxication, when the patient lies down in bed, it sometimes happens even in the dark, that the bed seems to librate under him, and he is afraid of falling out of it. The same occurs to people, who are sea-sick, even when they lie down in the dark. In these the irritative motions of the nerves of touch, or irritative tangible ideas, are performed with less energy, in one case by reverse sympathy with the stomach, in the other by reverse sympathy with the nerves of vision, and in consequence become attended with sensation, and produce the fear of falling by other associations.

A vertigo of the sense of touch may be produced, if any one turns round for a time with his eyes shut, and suddenly stops without opening them; for he will for a time seem to be still going forwards; which is difficult to explain. See the notes at the end of the first and second volume belonging to Sect. XX. 6.

In the beginning of some fevers, along with incessant vomiting, the patients complain of disagreeable tastes in their mouth, and disagreeable odours; which are to be ascribed to the general debility of the great trains and tribes of associated irritative motions, and to be explained from their direct sympathy with the decreased action of a sick stomach; or from the less secretion of sensorial power in the brain. These organs of sense are constantly stimulated into action by the saliva or by the air; hence, like the sense of hunger, when they are torpid from want of stimulus, or from want of sensorial power, pain or disagreeable sensation ensues, as of hunger, or faintness, or sickness in one case; and the ideas of bad tastes or odours in the other. This accords with the laws of causation, Sect. IV. 5.

17. _Pulsus mollis in vomitione._ The softness of the pulse in the act of vomiting is caused by direct association between the heart and the stomach; as explained in Sect. XXV. 17. A great slowness of the pulsation of the heart sometimes attends sickness, and even with intermissions of it, as in the exhibition of too great a dose of digitalis.

18. _Pulsus intermittens a ventriculo._ When the pulse first begins to intermit, it is common for the patient to bring up a little air from his stomach; which if he accomplishes before the intermission occurs, always prevents it; whence that this debility of the heart is owing to the direct association of its motions with those of the stomach is well evinced. See Sect. XXV. 17.

I this morning saw Mr. ----, who has long had at times an unequal pulse, with indigestion and flatulency, and occasional asthma; he was seized two days ago with diarrhoea, and this morning with sickness, and his pulse was every way unequal. After an emetic his pulse still continued very intermittent and unequal. He then took some breakfast of toast and butter, and tea, and to my great surprise his pulse became immediately perfectly regular, about 100 in a minute, and not weak, by this stimulus on his stomach.

A person, who for many years had had a frequent intermission of his pulse, and occasional palpitation of his heart, was relieved from them both for a time by taking about four drops of a saturated solution of arsenic three or four times a day for three or four days. As this intermission of the pulse is occasioned by the direct association of the motions of the heart with those of the stomach, the indication of cure must be to strengthen the action of the stomach by the bark. Spice. Moderate quantities of wine. A blister. Half a grain of opium twice a day. Solution of arsenic?

19. _Febris inirritativa._ Inirritative fever described in Class I. 2. 1. 1. belongs to this place, as it consists of disordered trains and tribes of associated irritative motions, with lessened actions of the associated organs. In this fever the pulsations of the heart and arteries are weakened or lessened, not only in the cold paroxysm, as in the irritative fever, but also in the hot paroxysm. The capillary arteries or glands have their actions nevertheless increased after the first cold fit, as appears by the greater production of heat, and the glow of arterial blood, in the cutaneous vessels; and lastly, the action of the stomach is much impaired or destroyed, as appears by the total want of appetite to solid food. Whence it would seem, that the torpid motions of the stomach, whatever may occasion them, are a very frequent cause of continued fever with weak pulse; and that these torpid motions of the stomach do not sufficiently excite the sensorial power of association, which contributes in health to actuate the heart and arteries along with the irritation produced by the stimulus of the blood; and hence the actions of these organs are weaker. And lastly, that the accumulation of the sensorial power of association, which ought to be expended on the motions of the heart and arteries, becomes now exerted on the cutaneous and pulmonary capillaries. See Supplement I. 8. and Sect. XXXV. 1. 1. and XXXIII. 2. 10.

I have dwelt longer on the vertiginous diseases in this genus, both because of their great intricacy, and because they seem to open a road to the knowledge of fever, which consists of associated trains and tribes of irritative or sensitive motions, which are sometimes mixed with the vertiginous ones, and sometimes separate from them.

* * * * *

ORDO II.

_Decreased Associate Motions._

GENUS II.

_Catenated with Sensitive Motions._

In this genus the sensorial power of association is exerted with less energy, and thence the actions produced by it are less than natural; and pain is produced in consequence, according to the fifth law of animal causation, Sect. IV. This pain is generally attended with coldness of the affected part, and is seldom succeeded by inflammation of it. This decreased action of the secondary link of the associated motions, belonging to this genus, is owing to the previous exhaustion of sensorial power either in the increased actions of the primary link of the associated motions, or by the pain which attends them; both which are frequently the consequence of the stimulus of something external to the affected fibres.

As pain is produced either by excess or defect of the natural exertions of the fibres, it is not, considered separately, a criterion of the presence of either. In the associations belonging to this genus the sensation of pain or pleasure produces or attends the primary link of the associated motions, and very often gives name to the disease.