Chapter XXII: Section XXXVI: 2. 3 (10)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A third method of exciting the heart and arteries immediately is by increasing the natural stimulus of the blood, and is well worthy experiment in all fevers with weak pulse; and that consists in supplying the blood with a greater proportion of oxygen; which may be done by respiration, if the patient was to breathe either oxygen gas pure, or diluted with atmospheric air, which might be given to many gallons frequently in a day, and by passing through the moist membranes of the lungs, according to the experiments of Dr. Priestley, and uniting with the blood, might render it more stimulant, and thus excite the heart and arteries into greater action! May not some easier method of exhibiting oxygen gas by respiration be discovered, as by using very small quantities of hyper-oxygenated marine acid gas very much diluted with atmospheric air?

XII. _Torpor of the Stomach and upper Intestines._

1. The principal circumstance, which supports the increased action of the capillaries in continued fever with weak pulse, is their reverse sympathy with those of the stomach and upper intestines, or with those of the heart and arteries. The torpor of the stomach and upper intestines is apparent in continued fevers from the total want of appetite for solid food, besides the sickness with which fevers generally commence, and the frequent diarrhoea with indigested stools, at the same time the thirst of the patient is sometimes urgent at the intervals of the sickness. Why the stomach can at this time take fluids by intervals, and not solids, is difficult to explain; except it be supposed, as some have affirmed, that the lacteal absorbents are a different branch from the lymphatic absorbents, and that in this case the former only are in a state of permanent torpor.

2. The torpor of the heart and arteries is known by the weakness of the pulse. When the actions of the absorbents of the stomach are diminished by the exhibition of small doses of digitalis, or become retrograde by larger ones, the heart and arteries act more feebly by direct sympathy; but the cellular, cutaneous, and pulmonary absorbents are excited into greater action. Whence in anasarca the fluids in the cellular membrane throughout the whole body are absorbed during the sickness, and frequently a great quantity of atmospheric moisture at the same time; as appears by the very great discharge of urine, which sometimes happens in these cases; and in ileus the prodigious evacuations by vomiting, which are often a hundred fold greater than the quantity swallowed, evince the great action of all the other absorbents during the sickness of the stomach.

3. But when the stomach is rendered permanently sick by an emetic drug, as by digitalis, it is not probable, that much accumulation of sensorial power is soon produced in this organ; because its usual quantity of sensorial power is previously exhausted by the great stimulus of the foxglove; and hence it seems probable, that the great accumulation of sensorial power, which now causes the increased action of the absorbents, is produced in consequence of the inactivity of the heart and arteries; which inactivity is induced by deficient excitement of the sensorial power of association between those organs and the stomach, and not by any previous exhaustion of their natural quantity of sensorial power; whereas in ileus, where the torpor of the stomach, and consequent sickness, is induced by reverse sympathy with an inflamed intestine, that is, by dissevered or defective association; the accumulation of sensorial power, which in that disease so violently actuates the cellular, pulmonary, and cutaneous absorbents, is apparently produced by the torpor of the stomach and lacteals, and the consequent accumulation of the sensorial power of association in them owing to their lessened action in sickness.

4. This accounts for the dry skin in fevers with weak pulse, where the stomach and the heart and arteries are in a torpid state, and for the sudden emaciation of the body; because the actions of the cellular and cutaneous absorbents are increased by reverse sympathy with those of the stomach, or with those of the heart and arteries; that is by the expenditure of that sensorial power of association, which is accumulated in consequence of the torpor of the stomach and heart and arteries, or of either of them; this also explains the sudden absorption of the milk in puerperal fevers; and contributes along with the heat of the respired air to the dryness of the mucous membrane of the tongue and nostrils.

5. Besides the reverse sympathy, with which the absorbent vessels of the stomach and upper intestines act in respect to all the other absorbent vessels, as in the exhibition of digitalis, and in ileus; there is another reverse sympathy exists between the capillaries, or secretory vessels of the stomach, and those of the skin. Which may nevertheless be occasioned by the accumulation of sensorial power by the torpor of the heart and arteries, which is induced by direct sympathy with the stomach; thus when the torpor of the stomach remains in a fever-fit which might otherwise have intermitted, the torpor of the heart and arteries remains also by direct sympathy, and the increased cutaneous capillary action, and consequent heat, are produced by reverse sympathy; and the fever is thus rendered continual, owing primarily to the torpor of the stomach.

6. The reverse sympathy, which exists between the capillaries of the stomach and the cutaneous capillaries, appears by the chillness of some people after dinner; and contrary-wise by the digestion being strengthened, when the skin is exposed to cold air for a short time; as mentioned in Class IV. 1. 1. 4. and IV. 2. 1. 1. and from the heat and glow on the skin, which attends the action of vomiting; for though when sickness first commences, the skin is pale and cold; as it then partakes of the general torpor, which induces the sickness; yet after the vomiting has continued some minutes, so that an accumulation of sensorial power exists in the capillaries of the stomach, and of the skin, owing to their diminished action; a glow of the skin succeeds, with sweat, as well as with increased absorption.

7. Nevertheless in some circumstances the stomach and the heart and arteries seem to act by direct sympathy with the cutaneous capillaries, as in the flushing of the face and glow of the skin of some people after dinner; and as in fevers with strong pulse. In these cases there appears to be an increased production of sensorial power, either of sensation, as in the blush of shame; or of volition, as in the blush of anger; or of irritation, as in the flushed face after dinner above mentioned.

This increased action of the capillaries of the skin along with the increased actions of the stomach and heart is perhaps to be esteemed a synchronous increase of action, rather than a sympathy between those organs. Thus the flushing of the face after dinner may be owing to the secretion of sensorial power in the brain being increased by the association of that organ with the stomach, in a greater proportion than the increased expenditure of it, or may be owing also to the stimulus of new chyle received into the blood.

8. When the stomach and the heart and arteries are rendered torpid in fevers, not only the cutaneous, cellular, and pulmonary absorbents are excited to act with greater energy; but also their correspondent capillaries and secerning vessels or glands, especially perhaps those of the skin, are induced into more energetic action. Whence greater heat, a greater secretion of perspirable matter, and of mucus; and a greater absorption of them both, and of aerial moisture. These reverse sympathies coincide with other animal facts, as in eruption of small pox on the face and neck the feet become cold, while the face and neck are much flushed; and in the hemiplagia, when one arm and leg become disobedient to volition, the patient is perpetually moving the other. Which are well accounted for by the accumulation of sensorial power in one part of an associated series of actions, when less of it is expended by another part of it; and by a deficiency of sensorial power in the second link of association, when too much of it is expended by the first.

9. This doctrine of reverse sympathy enables us to account for that difficult problem, why in continued fevers the increased action of the cutaneous, cellular, and pulmonary capillaries proceeds without interruption or return of cold fit; though perhaps with some exacerbations and remissions; and that during a quarter, or half, or three quarters, or a whole lunation; while at the same time the pulsations of the heart and arteries are weaker than natural.

To this should be added the direct sympathy, which exists between the peristaltic motions of the fibres of the stomach, and the pulsations of the heart. And that the stomach has become torpid by the too great stimulus of some poisonous or contagious matter; and this very intricate idea of continued fever with feeble pulse is reduced to curious simplicity.

The direct sympathy of the stomach and heart and arteries not only appears from the stronger and slower pulse of persons exhausted by fatigue, after they have drank a glass of wine, and eaten a few mouthfuls; but appears also from the exhibition of large doses of digitalis; when the patient labours under great and incessant efforts to vomit, at the same time that the actions of the absorbent system are known to be much increased by the hasty absorption of the serous fluid in anasarca, the pulsations of the heart become slow and intermittent to an alarming degree. See Class IV. 2. 1. 17. and 18.

10. It would assist us much in the knowledge and cure of fevers, if we could always determine, which part of the system was primarily affected; and whether the torpor of it was from previous excess or defect of stimulus; which the industry of future observers must discover. Thus if the stomach be affected primarily, and that by previous excess of stimulus, as when certain quantities of opium, or wine, or blue vitriol, or arsenic, are swallowed, it is some time in recovering the quantity of sensorial power previously exhausted by excess of stimulus, before any accumulation of it can occur. But if it be affected with torpor secondarily, by sympathy with some distant part; as with the torpid capillaries of the skin, that is by defective excitement of the sensorial power of association; or if it be affected by defect of stimulus of food or of heat; it sooner acquires so much accumulation of sensorial power, as to be enabled to accommodate itself to its lessened stimulus by increase of its irritability.

Thus in the hemicrania the torpor generally commences in a diseased tooth, and the membranes about the temple, and also those of the stomach become torpid by direct synchronous sympathy; and pain of the head, and sickness supervene; but no fever or quickness of pulse. In this case the torpor of the stomach is owing to defect of the sensorial power of association, which is caused by the too feeble actions of the membranes surrounding the diseased tooth, and thus the train of sympathy ceases here without affecting the motions of the heart and arteries; but where contagious matter is swallowed into the stomach, the stomach after a time becomes torpid from exhaustion of the sensorial power of irritation, and the heart and arteries act feebly from defect of the excitement of the power of association. In the former case the torpor of the stomach is conquered by accumulation of the power of association in one or two whole days; in the latter it recovers by accumulation of the power of irritation in three or four weeks.

In intermittent fevers the stomach is generally I believe affected secondarily by sympathy with the torpid cutaneous capillaries, or with some internal torpid viscus, and on this account an accumulation of sensorial power arises in a few hours sufficient to restore the natural irritability of this organ; and hence the hot fit succeeds, and the fever intermits. Or if this accumulation of sensorial power becomes excessive and permanent, the continued fever with strong pulse is produced, or febris irritativa.

In continued fevers the stomach is frequently I suppose affected with torpor by previous excess of stimulus, and consequent exhaustion of sensorial power, as when contagious matter is swallowed with the saliva, and it is then much slower in producing an accumulation of sensorial power sufficient to restore its healthy irritability; which is a frequent cause of continued fever with weak pulse or febris inirritativa. Which consists, after the cold fit is over, in a more frequent and more feeble action of the heart and arteries, owing to their direct sympathy with the muscular fibres of the torpid stomach; together with an increased action of the capillaries, glands, and absorbents of the skin, and cellular membrane, owing to their reverse sympathy with the torpid capillaries, glands, and absorbents of the stomach, or with those of the heart and arteries.

Or in more accurate language. 1. The febris inirritativa, or fever with weak pulse, commences with torpor of the stomach, occasioned by previous exhaustion of sensorial power of irritation by the stimulus of contagious matter swallowed with the saliva. 2. The whole system becomes torpid from defect of the excitement or the sensorial power of association owing to the too feeble actions of the stomach, this is the cold fit. 3. The whole system, except the stomach with the upper intestines, and the heart and arteries, falls into increased action, or orgasm, owing to accumulation of sensorial power of association during their previous torpor, this is the hot fit. 4. The stomach and upper intestines have not acquired their natural quantity of sensorial power of irritation, which was previously exhausted by violent action in consequence of the stimulus of contagious matter, and the heart and arteries remain torpid from deficient excitement of the sensorial power of association owing to the too feeble actions of the stomach. 5. The accumulation of sensorial power of association in consequence of the torpor of the heart and arteries occasions a perpetual orgasm, or increased action of the capillaries.

11. From hence it may be deducted first, that when the torpor of the stomach first occurs, either as a primary effect, or as a secondary link of some associate train or circle of motions, a general torpor of the system sometimes accompanies it, which constitutes the cold fit of fever; at other times no such general torpor occurs, as during the operation of a weak emetic, or during sea-sickness.

Secondly. After a time it generally happens, that a torpor of the stomach ceases, and its actions are renewed with increase of vigour by accumulation of sensorial power during its quiescence; as after the operation of a weak emetic, or at the intervals of sea-sickness, or after the paroxysm of an intermittent fever.

Thirdly. The stomach is sometimes much slower in recovering from a previous torpor, and is then the remote cause of continued fever with weak pulse; which is owing to a torpor of the heart and arteries, produced in consequence of the deficient excitement of the power of association by the too weak actions of the stomach; and to an orgasm of the capillaries of the other parts of the system, in consequence of the accumulation of sensorial power occasioned by the inactivity of the heart and arteries.

Fourthly. The torpor of the stomach is sometimes so complete, that probably the origin of its nerves is likewise affected, and then no accumulation of sensorial power occurs. In this case the patient dies for want of nourishment; either in three or four weeks, of the inirritative fever; or without quick pulse, by what we have called paresis irritativa. Or he continues many years in a state of total debility. When this torpor suddenly commences, the patient generally suffers epileptic fits or temporary insanity from the disagreeable sensation of so great a torpor of the stomach; which also happens sometimes at the eruption of the distinct small pox; whence we have termed this disease anorexia epileptica. See Class II. 2. 2. 1. and III. 1. 1. 7. and Suppl. I. 14. 3.

Fifthly. When this torpor of the stomach is less in degree or extent, and yet without recovering its natural irritability by accumulation of sensorial power, as it does after the cold fit of intermittent fever, or after the operation of mild emetics, or during syncope; a permanent defect of its activity, and of that of the upper intestines, remains, which constitutes apepsia, cardialgia, hypochondriasis, and hysteria. See Class I. 3. 1. 3. and I. 2. 4. 5.

Sixthly. If the torpor of the stomach be induced by direct sympathy, as in consequence of a previous torpor of the liver, or spleen, or skin, an accumulation of sensorial power will sooner be produced in the stomach; because there has been no previous expenditure of it, the present torpor of the stomach arising from defect of association. Hence some fevers perfectly intermit, the stomach recovering its complete action after the torpor and consequent orgasm, which constitute the paroxysm of fever, are terminated.

Seventhly. If the torpor of the stomach be owing to defect of irritation, as to the want of food, an accumulation of sensorial power soon occurs with an increase of digestion, if food be timely applied; or with violent inflammation, if food be given in too great quantity after very long abstinence.

Eighthly. If the torpor of the stomach be induced by defect of pleasurable sensation, as when sickness is caused by the suggestion of nauseous ideas; an accumulation of sensorial power soon occurs, and the sickness ceases with the return of hunger; for in this case the inactivity of the stomach is occasioned by the subduction of agreeable sensation, which acts as a subduction of stimulus, and not by exhausting the natural quantity of sensorial power in the fibres or nerves of the stomach.

Ninthly. If the torpor of the stomach be induced by a twofold cause, as in sea-sickness. See Vertigo rotatoria. Class IV. 2. 1. 10. in which the first link of association acts too strongly, and in consequence expends more than usual of the sensorial power of irritation; and secondly in which sensation is produced between the links of association, and dissevers or enfeebles them; the accumulation of sensorial power soon occurs in the stomach; as no previous expenditure of it in that organ has occurred. Whence in sea-sickness the persons take food with eagerness at times, when the vertigo eases for a few minutes.

Tenthly. If the gastric torpor be induced by previous violent exertion, as after intoxication, or after contagious matter has been swallowed, or some poisons, as digitalis, or arsenic; an accumulation of sensorial power very slowly succeeds; whence long sickness, or continued fever, because the quantity of sensorial power already wasted must first be renewed, before an accumulation of it can be produced.

12. This leads us to a second indication of cure in continued fevers, which consists in strengthening the actions of the stomach; as the first indication consisted in decreasing the actions of the cutaneous capillaries and absorbents. The actions of the stomach may sometimes be increased by exhibiting a mild emetic; as an accumulation of sensorial power in the fibres of the stomach is produced during their retrograde actions. Besides the evacuation of any noxious material from the stomach and duodenum, and from the absorbents, which open their mouths on their internal surfaces, by their retrograde motion.

It is probable, that when mild emetics are given, as ipecacuanha, or antimonium tartarizatum, or infusion of chamomile, they are rejected by an inverted motion of the stomach and oesophagus in consequence of disagreeable sensation, as dust is excluded from the eye; and these actions having by previous habit been found effectual, and that hence there is no exhaustion of the sensorial power of irritation. But where strong emetics are administered, as digitalis, or contagious matter, the previous exhaustion of the sensorial power of irritation seems to be a cause of the continued retrograde actions and sickness of the stomach. An emetic of the former kind may therefore strengthen the power of the stomach immediately after its operation by the accumulation of sensorial power of irritation during its action. See Class IV. 1. 1.

Another method of decreasing the action of the stomach for a time, and thence of increasing it afterwards, is by the accumulation of the sensorial power of irritation during its torpor; is by giving ice, iced water, iced creams, or iced wine. This accounts for the pleasure, which many people in fevers with weak pulse express on drinking cold beverage of any kind.

A second method of exciting the stomach into action, and of decreasing that of the capillaries in consequence, is by the stimulus of wine, opium, bark, metallic salts of antimony, steel, copper, arsenic, given in small repeated quantities; which so long as they render the pulse slower are certainly of service, and may be given warm or cold, as most agreeable to the patient. For it is possible, that the capillaries of the stomach may act too violently, and produce heat, at the same time that the large muscles of it may be in a torpid state; which curious circumstance future observations must determine.

Thirdly. Hot fomentation on the region of the stomach might be of most essential service by its stimulus, as heat penetrates the system not by the absorbent vessels, but by external influence; whence the use of hot fomentation to the head in torpor of the brain; and the use of hot bath in cases of general debility, which has been much too frequently neglected from a popular error occasioned by the unmeaning application of the word relaxation to animal power. If the fluid of heat could be directed to pass through particular parts of the body with as little diffusion of its influence, as that of electricity in the shocks from the coated jar, it might be employed with still greater advantage.

Fourthly. The use of repeated small electric shocks through the region of the stomach might be of service in fevers with weak pulse, and well deserves a trial; twenty or thirty small shocks twice a day for a week or two would be a promising experiment.

Fifthly. A blister on the back, or sides, or on the pit of the stomach, repeated in succession, by stimulating the skin frequently strengthens the action of the stomach by exciting the sensorial power of association; this especially in those fevers where the skin of the extremities, as of the hands or nose or ears, sooner becomes cold, when exposed to the air, than usual.

Sixthly. The action of the stomach may be increased by preventing too great expenditure of sensorial power in the link of previous motion with which it is catenated, especially if the action of that link be greater than natural. Thus as the capillaries of the skin act too violently in fevers with weak pulse, if these are exposed to cold air or cold water, the sensorial power, which previously occasioned their orgasm, becomes accumulated, and tends to increase the action of the stomach; thus in those fevers with weak pulse and hot skin, if the stomach be stimulated by repeated small doses of bark and wine or opium, and be further excited at the same time by accumulation of sensorial power occasioned by rendering the capillaries torpid by cold air or water, this twofold application is frequently attended with visible good effect.

By thus stimulating the torpid stomach into greater action, the motions of the heart and arteries will likewise be increased by the greater excitement of the power of association. And the capillaries of the skin will cease to act so violently, from their not possessing so great a superfluity of sensorial power as during the greater quiescence of the stomach and of the heart and arteries. Which is in some circumstances similar to the curious phenomenon mentioned in Class IV. 2. 2. 10; where, by covering the chill feet with flannel at the eruption of the small-pox, the points of the flannel stimulate the skin of the feet into greater action, and the quantity of heat, which they possess, is also confined, or insulated, and further increases by its stimulus the activity of the cutaneous vessels of the feet; and by that circumstance abates the too great action of the capillaries of the face, and the consequent heat of it.

XIII. _Case of continued fever._

The following case of continued fever which I frequently saw during its progress, as it is less complicate than usual, may illustrate this doctrine. Master S. D. an active boy about eight years of age, had been much in the snow for many days, and sat in the classical school with wet feet; he had also about a fortnight attended a writing school, where many children of the lower order were instructed. He was seized on February the 8th, 1795, with great languor, and pain in his forehead, with vomiting and perpetual sickness; his pulse weak, but not very frequent. He took an emetic, and on the next day, had a blister, which checked the sickness only for a few hours; his skin became perpetually hot, and dry; and his tongue white and furred; his pulse when asleep about 104 in a minute, and when awake about 112.

Fourth day of the disease. He has had another blister, the pain of his head is gone, but the sickness continues by intervals; he refuses to take any solid food, and will drink nothing but milk, or milk and water, cold. He has two or three very liquid stools every day, which are somtimes green, but generally of a darkish yellow, with great flatulency both upwards and downwards at those times. An antimonial powder was once given, but instantly rejected; a spoonful of decoction of bark was also exhibited with the same event. His legs are bathed, and his hands and face are moistened twice a day for half an hour in warmish water, which is nevertheless much colder than his skin.

Eighth day. His skin continues hot and dry without any observable remissions, with liquid stools and much flatulency and sickness; his water when observed was of a straw colour. He has asked for cyder, and drinks nearly a bottle a day mixed with cold water, and takes three drops of laudanum twice a day.

Twelfth day. He continues much the same, takes no milk, drinks only cyder and water, skin hot and dry, tongue hot and furred, with liquid stools, and sickness always at the same time; sleeps much.

Sixteenth day. Was apparently more torpid, and once rather delirious; pulse 112. Takes only capillaire and water; sleeps much.

Twentieth day. Pulse 100, skin dry but less hot, liquid stools not so frequent, he is emaciated to a great degree, he has eaten half a tea-cup full of custard to day, drinks only capillaire and water, has thrice taken two large spoonfuls of decoction of bark with three drops of laudanum, refuses to have his legs bathed, and will now take nothing but three drops of laudanum twice a day.

Twenty-fourth day. He has gradually taken more custard every day, and began to attend to some new play things, and takes wine syllabub.

Twenty-eighth day. He daily grows stronger, eats eggs, and and butter, and sleeps immediately after his food, can creep on his hands and knees, but cannot stand erect.

Thirty-second day. He cannot yet stand alone safely, but seems hourly to improve in strength of body, and activity of mind.

In this case the remote cause of his fever could not be well ascertained, as it might be from having his feet cold for many successive days, or from contagion; but the latter seems more probable, because his younger brother became ill of a similar fever about three weeks afterwards, and probably received the infection from him. The disease commenced with great torpor of the stomach, which was shewn by his total aversion to solid food, and perpetual sickness; the watery stools, which were sometimes green, or of a darkish yellow, were owing to the acrimony, or acidity, of the contents of the bowels; which as well as the flatulency were occasioned by indigestion. This torpor of the stomach continued throughout the whole fever, and when it ceased, the fever ceased along with it.

The contagious material of this fever I suppose to have been mixed with the saliva, and swallowed into the stomach; that it excited the vessels, which constitute the stomach, into the greatest irritative motion like arsenic; _which might not be perceived, and yet might render that organ paralytic or inirritable in a moment of time_; as animals sometimes die by one single exertion, and consequent paralysis, without a second struggle; as by lightning, or being shot through the back part of the brain; of both which I have seen instances. I had once an opportunity of inspecting two oxen, a few minutes after they were killed by lightning under a crab-tree on moist ground in long grass; and observed, that they could not have struggled, as the grass was not pressed or bent near them; I have also seen two horses shot through the cerebellum, who never once drew in their legs after they first stretched them out, but died instantaneously; in a similar manner the lungs seem to be rendered instantly inanimate by the fumes of burning sulphur.

The lungs may be sometimes primarily affected with contagious matter floating in the atmosphere as well as the stomach, as mentioned in article 9. of this Supplement. But probably this may occur much less frequently, because the oxygene of the atmosphere does not appear to be taken into the blood by animal absorption, as the saliva in the stomach, but passes through the moist membranes into the blood, like the ethereal fluids of electricity or heat, or by chemical attraction, and in consequence the contagious matter may be left behind; except it may sometimes be absorbed along with the mucus; of which however in this case there appeared no symptoms.

The tonsils are other organs liable to receive contagious matter, as in the small-pox, scarlet-fever, and in other sensitive inirritated fevers; but no symptom of this appeared here, as the tonsils were at no time of the fever inflamed, though they were in this child previously uncommonly large.

The pain of the forehead does not seem to have been of the internal parts of the head, because the nerves, which serve the stomach, are not derived from the anterior part of the brain; but it seems to have been owing to a torpor of the external membranes about the forehead from their direct sympathy with those of the stomach; that is, from the deficient excitement of the sensorial power of association; and seemed in some measure to be relieved by the emetics and blisters.

The pulsations of the heart were weaker and in consequence quicker than natural, owing to their direct sympathy with the torpid peristaltic motions of the stomach; that is to the deficient excitement of the sensorial power of association.

The action of the cutaneous capillaries and absorbents were stronger than natural, as appeared by the perpetual heat and dryness of the skin; which was owing to their reverse sympathy with the heart and arteries. This weaker and quicker action of the heart and arteries, and the stronger action of the cutaneous capillaries and absorbents, continued throughout the disease, and may be said to have constituted the fever, of which the torpor of the stomach was the remote cause.

His tongue was not very much furred or very dry, nor his breath very hot; which shewed, that there was no great increase of the action of the mucous absorbents, nor of the pulmonary capillaries, and yet sufficient to produce great emaciation. His urine was nearly natural both in quantity and colour; which shewed, that there was no increase of action either of the kidnies, or of the urinary absorbents.

The bathing his legs and hands and face for half an hour twice a day seemed to refresh him, and sometimes made his pulse slower, and thence I suppose stronger. This seems to have been caused by the water, though subtepid, being much below the heat of his skin, and consequently contributing to cool the capillaries, and by satiating the absorbents to relieve the uneasy sensation from the dryness of the skin.

He continued the use of three drops of tincture of opium from about the eighth day to the twenty-fourth, and for the three preceding days took along with if two large spoonfuls of an infusion of bark in equal parts of wine and water. The former of these by its stimulus seemed to decrease his languor for a time, and the latter to strengthen his returning power of digestion.

The daily exacerbations or remissions were obscure, and not well attended to; but he appeared to be worse on the fourteenth or fifteenth days, as his pulse was then quickest, and his inattention greatest; and he began to get better on the twentieth or twenty-first days of his disease; for the pulse then became less frequent, and his skin cooler, and he took rather more food: these circumstances seemed to observe the quarter periods of lunation.

XIV. _Termination of continued fever._

1. When the stomach is primarily affected with torpor not by defect of stimulus, but in consequence of the previous exhaustion of its sensorial power; and not secondarily by its association with other torpid parts; it seems to be the general cause of the weak pulsations of the heart and arteries, and the consequent increased action of the capillaries, which constitute continued fever with weak pulse. In this situation if the patient recovers, it is owing to the renovation of life in the torpid stomach, as happens to the whole system in winter-sleeping animals. If he perishes, it is owing to the exhaustion of the body for want of nourishment occasioned by indigestion; which is hastened by the increased actions of the capillaries and absorbents.

2. When the stomach is primarily affected by defect of stimulus, as by cold or hunger; or secondarily by defect of the power of association, as in intermittent fevers; or lastly in consequence of the introduction of the sensorial power of sensation, as in inflammatory diseases; the actions of the heart and arteries are not diminished, as when the stomach is primarily affected with torpor by its previous exhaustion of sensorial power, but become greatly increased, producing irritative or inflammatory fever. Where this fever is continued, though with some remissions and exacerbations, the excessive action is at length so much lessened by expenditure of sensorial power, as to gradually terminate in health; or it becomes totally exhausted, and death succeeds the destruction of the irritability and associability of the system.

3. There is also another termination of the diseases in consequence of great torpor of the stomach, which are not always termed fevers; one of these is attended with so great and universal torpor, that the patient dies in the first cold fit; that is, within twelve hours or less of the first seizure; this is commonly termed sudden death. But the quickness of the pulse, and the coldness with shuddering, and with sick stomach, distinguished a case, which I lately saw, from the sudden deaths occasioned by apoplexy, or ruptured blood-vessels.

In hemicrania I believe the stomach is always affected secondarily, as no quickness of pulse generally attends it, and as the stomach recovers its activity in about two whole days. But in the following case, which I saw last week, I suppose the stomach suddenly became paralytic, and caused in about a week the death of the patient. Miss ----, a fine young lady about nineteen, had bathed a few times, about a month before, in a cold spring, and was always much indisposed after it; she was seized with sickness, and cold shuddering, with very quick pulse, which was succeeded by a violent hot fit; during the next cold paroxysm she had a convulsion fit; and after that symptoms of insanity, so as to strike and bite the attendants, and to speak furious language; the same circumstances occurred during a third fit, in which I believe a strait waistcoat was put on, and some blood taken from her; during all this time her stomach would receive no nutriment, except once or twice a little wine and water. On the seventh day of the disease, when I saw her, the extremities were cold, the pulse not to be counted and she was unable to swallow, or to speak; a clyster was used with turpentine and musk and opium, with warm fomentations, but she did not recover from that cold fit.

In this case the convulsion fit and the insanity seem to have been violent efforts to relieve the disagreeable sensation of the paralytic stomach; and the quick pulse, and returning fits of torpor and of orgasm, evinced the disease to be attended with fever, though it might have been called anorexia maniacalis, or epileptica.

4. Might not many be saved in these fevers with weak pulse for a few weeks by the introduction of blood into a vein, once in two or three days; which might thus give further time for the recovery of the torpid stomach? Which seems to require some weeks to acquire its former habits of action, like the muscles of paralytic patients, who have all their habits of voluntary associations to form afresh, as in infancy.

If this experiment be again tried on the human subject, it should be so contrived, that the blood in passing from the well person to the sick one should not be exposed to the air; it should not be cooled or heated; and it should be measured; all which may be done in the following manner. Procure two silver pipes, each about an inch long, in the form of funnels, wide at top, with a tail beneath, the former something wider than a swan-quill, and the latter less than a small crow-quill. Fix one of these silver funnels by its wide end to one end of the gut of a chicken fresh killed about four or six inches long, and the other to the other end of the gut; then introduce the small end of one funnel into the vein of the arm of a well person downwards towards the hand; and laying the gut with the other end on a water-plate heated to 98 degrees in a very warm room; let the blood run through it. Then pressing the finger on the gut near the arm of the well person, slide it along so as to press out one gutful into a cup, in order to ascertain the quantity by weight. Then introduce the other end of the other funnel into a similar vein in the arm of the sick person upwards towards the shoulder; and by sliding one finger, and then another reciprocally, along the chicken's gut, so as to compress it, from the arm of the well person to the arm of the sick one, the blood may be measured, and thus the exact quantity known which is given and received. See Class I. 2. 3. 25.

XV. _Inflammation excited in fever._

1. When the actions of any part of the system of capillaries are excited to a certain degree, sensation is produced, along with a greater quantity of heat, as mentioned in the fifth article of this supplement. When this increased capillary action becomes still more energetic, by the combined sensorial powers of sensation with irritation, new fibres are secreted, or new fluids, (which harden into fibres like the mucus secreted by the silk-worm, or spider, or pinna,) from which new vessels are constructed; it is then termed inflammation: if this exists in the capillary vessels of the cellular membrane or skin only, with feeble pulsations of the heart and arteries, the febris sensitiva inirritata, or malignant fever, occurs; if the coats of the arteries are also inflamed, the febris sensitiva irritata, or inflammatory fever, exists.

In all these fevers the part inflamed is called a phlegmon, and by its violent actions excites so much pain, that is, so much of the sensorial power of sensation, as to produce more violent actions, and inflammation, throughout the whole system. Whence great heat from the excited capillaries of the skin, large and quick pulsations of the heart, full and hard arteries, with great universal secretions and absorptions. These perpetually continue, though with exacerbations and remissions; which seem to be governed by solar or lunar influence.