Chapter VII: Part II (6)

10. _Stupor._ The stupor, which occurs in fevers with debility, is generally esteemed a favourable symptom; which may arise from the less expenditure of sensorial power already existing in the brain and nerves, as mentioned in species 6 of this genus. But if we suppose, that there is a continued production of sensorial power, or an accumulation of it in the torpid parts of the system, which is not improbable, because such a production of it continues during sleep, to which stupor is much allied, there is still further reason for believing it to be a favourable symptom in inirritable fevers; and that much injury is often done by blisters and other powerful stimuli to remove the stupor. See Sect. XII. 7. 8. and XXXIII. 1. 4.

Dr. Blane in his Croonian Lecture on muscular motion for 1788, among many other ingenious observations and deductions, relates a curious experiment on salmon, and other fish, and which he repeated upon eels with similar event.

"If a fish, immediately upon being taken out of the water, is stunned
by a violent blow on the head, or by having the head crushed, the
irritability and sweetness of the muscles will be preserved much
longer, than if it had been allowed to die with the organs of sense
entire. This is so well known to fishermen, that they put it in
practice, in order to make them longer susceptible of the operation
called _crimping_. A salmon is one of the fish least tenacious of life,
insomuch, that it will lose all signs of life in less than half an hour
after it is taken out of the water, if suffered to die without any
farther injury; but if, immediately after being caught, it receives a
violent blow on the head, the muscles will shew visible irritability
for more than twelve hours afterwards."

Dr. Blane afterwards well remarks, that "in those disorders in which the exercise of the senses is in a great measure destroyed, or suspended, as in the hydrocephalus, and apoplectic palsy, it happens not uncommonly, that the appetite and digestion are better than in health."

* * * * *

ORDO III.

_Retrograde Irritative Motions._

GENUS I.

_Of the Alimentary Canal._

The retrograde motions of our system originate either from defect of stimulus, or from defect of irritability. Thus sickness is often induced by hunger, which is a want of stimulus; and from ipecacuanha, in which last case it would seem, that the sickness was induced after the violence of the stimulus was abated, and the consequent torpor had succeeded. Hence spice, opium, or food relieves sickness.

The globus hystericus, salivation, diabaetes, and other inversions of motion attending hysteric paroxysms, seem to depend on the want of irritability of those parts of the body, because they are attended with cold extremities, and general debility, and are relieved by wine, opium, steel, and flesh diet; that is, by any additional stimulus.

When the longitudinal muscles are fatigued by long action, or are habitually weaker than natural, the antagonist muscles replace the limb by stretching it in a contrary direction; and as these muscles have had their actions associated in synchronous tribes, their actions cease together. But as the hollow muscles propel the fluids, which they contain, by motions associated in trains; when one ring is fatigued from its too great debility, and brought into retrograde action; the next ring, and the next, from its association in train falls into retrograde action. Which continue so long as they are excited to act, like the tremors of the hands of infirm people, so long as they endeavour to act. Now as these hollow muscles are perpetually stimulated, these retrograde actions do not cease as the tremors of the longitudinal muscles, which are generally excited only by volition. Whence the retrograde motions of hollow muscles depend on two circumstances, in which they differ from the longitudinal muscles, namely, their motions being associated in trains, and their being subject to perpetual stimulus. For further elucidation of the cause of this curious source of diseases, see Sect. XXIX. 11. 5.

The fluids disgorged by the retrograde motions of the various vascular muscles may be distinguished, 1. From those, which are produced by secretion, by their not being attended by increase of heat, which always accompanies increased secretion. 2. They may be distinguished from those fluids, which are the consequence of deficient absorption, by their not possessing the saline acrimony, which those fluids possess; which inflames the skin or other membranes on which they fall; and which have a saline taste to the tongue. 3. They may be distinguished from those fluids, which are the consequence both of increased secretion and absorption, as these are attended with increase of warmth, and are inspissated by the abstraction of their aqueous parts. 4. Where chyle, or milk, are found in the feces or urine, or when other fluids, as matter, are translated from one part of the system to another, they have been the product of retrograde action of lymphatic or other canals. As explained in Sect. XXIX. 8.

SPECIES.

1. _Ruminatio._ In the rumination of horned cattle the retrograde motions of the oesophagus are visible to the eye, as they bring up the softened grass from their first stomach. The vegetable aliment in the first stomach of cattle, which have filled themselves too full of young clover, is liable to run into fermentation, and distend the stomach, so as to preclude its exit, and frequently to destroy the animal. To discharge this air the farmers frequently make an opening into the stomach of the animal with success. I was informed, I believe by the late Dr. Whytt of Edinburgh, that of twenty cows in this situation two had died, and that he directed a pint of gin or whisky, mixed with an equal quantity of water, to be given to the other eighteen; all of which eructed immense quantities of air, and recovered.

There are histories of ruminating men, and who have taken pleasure in the act of chewing their food a second time. Philos. Transact.

2. _Ructus._ Eructation. An inverted motion of the stomach excluding through its upper valve an elastic vapour generated by the fermentation of the aliment; which proceeds so hastily, that the digestive power does not subdue it. This is sometimes acquired by habit, so that some people can eruct when they please, and as long as they please; and there is gas enough generated to supply them for this purpose; for by Dr. Hale's experiments, an apple, and many other kinds of aliment, give up above six hundred times their own bulk of an elastic gas in fermentation. When people voluntarily eject the fixable air from their stomachs, the fermentation of the aliment proceeds the faster; for stopping the vessels, which contain new wines, retards their fermentation, and opening them again accelerates it; hence where the digestion is impaired, and the stomach somewhat distended with air, it is better to restrain than to encourage eructations, except the quantity makes it necessary. When wine is confined in bottles the fermentation still proceeds slowly even for years, till all the sugar is converted into spirit; but in the process of digestion, the saccharine part is absorbed in the form of chyle by the bibulous mouths of the numerous lacteals, before it has time to run into the vinous fermentation.

3. _Apepsia._ Indigestion. Water-qualm. A few mouthfuls of the aliment are rejected at a time for some hours after meals. When the aliment has had time to ferment, and become acid, it produces cardialgia, or heart-burn. This disease is perhaps generally left after a slight inflammation of the stomach, called a surfeit, occasioned by drinking cold liquors, or eating cold vegetables, when heated with exercise. This inflammation of the stomach is frequently, I believe, at its commencement removed by a critical eruption on the face, which differs in its appearance as well as in its cause from the gutta rosea of drunkards, as the skin round the base of each eruption is less inflamed. See Class II. 1. 4. 6.. This disease differs from Cardialgia, Class I. 2. 4. 5. in its being not uniformly attended with pain of the cardia ventriculi, and from its retrograde motions of a part of the stomach about the upper orifice of it. In the same manner as hysteria differs from hypochondriasis; the one consisting in the weakness and indigestion of the same portions of the alimentary canal, and the other in the inverted motions of some parts of it. This apepsia or water-qualm continues many years, even to old age; Mr. G---- of Lichfield suffered under this disease from his infancy; and, as he grew old, found relief only from repeated doses of opium.

M. M. A blister, rhubarb, a grain of opium twice a day. Soap, iron-powder. Tin-powder.

4. _Vomitus._ An inverted order of the motions of the stomach and oesophagus with their absorbent vessels, by which their contents are evacuated. In the act of vomiting less sensorial power is employed than in the usual peristaltic motion of the stomach, as explained in Sect. XXXV. 1. 3. Whence after the operation of an emetic the digestion becomes stronger by an accumulation of sensorial power during its decreased action. This decreased action of the stomach may be either induced by want of stimulus, as in the sickness which attends hunger; or it may be induced by temporary want of irritability, as in cold fits of fever; or from habitual want of irritability, as the vomiting of enfeebled drunkards. Or lastly, by having been previously too violently stimulated by an emetic drug, as by ipecacuanha.

M. M. A blister. An emetic. Opium. Warmth of a bed, covering the face for a while with the bed-clothes. Crude mercury. A poultice with opium or theriaca externally.

5. _Cholera._ When not only the stomach, as in the last article, but also the duodenum, and ilium, as low as the valve of the colon, have their motions inverted; and great quantities of bile are thus poured into the stomach; while at the same time some branches of the lacteals become retrograde, and disgorge their contents into the upper part of the alimentary canal; and other branches of them disgorge their contents into the lower parts of it beneath the valve of the colon; a vomiting and purging commence together, which is called cholera, as it is supposed to have its origin from increased secretion of bile; but I suppose more frequently arises from putrid food, or poisonous drugs, as in the case narrated in Sect. XXV. 13. where other circumstances of this disease are explained. See Class II. 1. 2. 11.

The cramps of the legs, which are liable to attend cholera, are explained in Class III. 1. 1. 14.

6. _Ileus._ Consists in the inverted motions of the whole intestinal canal, from the mouth to the anus; and of the lacteals and absorbents which arise from it. In this pitiable disease, through the valve of the colon, through the pylorus, the cardia, and the pharinx, are ejected, first, the contents of the stomach and intestines, with the excrement and even clysters themselves; then the fluid from the lacteals, which is now poured into the intestines by their retrograde motions, is thrown up by the mouth; and, lastly, every fluid, which is absorbed by the other lymphatic branches, from the cellular membrane, the skin, the bladder, and all other cavities of the body; and which is then poured into the stomach or intestines by the retrograde motions of the lacteals; all which supply that amazing quantity of fluid, which is in this disease continually ejected by vomiting. See Sect. XXV. 15. for a further explanation of this disease.

M. M. Copious venesection. Twenty grains of calomel in small pills, or one grain of aloe every hour till stools are procured. Blisters. Warm bath. Crude mercury. Clyster of ice-water. Smear the skin all over with grease, as mentioned in Sect. XXV. 15.

As this malady is occasioned sometimes by an introsusception of a part of the intestine into another part of it, especially in children, could holding them up by their heels for a second or two of time be of service after venesection? Or the exhibition of crude quicksilver two ounces every half hour, till a pound is taken, be particularly serviceable in this circumstance? Or could half a pound, or a pound, of crude mercury be injected as a clyster, the patient being elevated by the knees and thighs so as to have his head and shoulders much lower than his bottom, or even for a short time held up by the heels? Could this also be of advantage in strangulated hernia?

Where the disease is owing to strangulated hernia, the part should be sprinkled with cold water, or iced water, or salt and water recently mixed, or moistened with ether. In cases of strangulated hernia, could acupuncture, or puncture with a capillary trocar, be used with safety and advantage to give exit to air contained in the strangulated bowel? Or to stimulate it into action? It is not uncommon for bashful men to conceal their being afflicted with a small hernia, which is the cause of their death; this circumstance should therefore always be enquired into. Is the seat or cause of the ileus always below the valve of the colon, and that of the cholera above it? See Class II. 1. 2. 11.

7. _Globus hystericus._ Hysteric suffocation is the perception of a globe rolling round in the abdomen, and ascending to the stomach and throat, and there inducing strangulation. It consists of an ineffectual inversion of the motions of the oesophagus, and other parts of the alimentary canal; nothing being rejected from the stomach.

M. M. Tincture of castor. Tinct. of opium of each 15 drops. See Hysteria, Class I. 3. 1. 10.

8. _Vomendi conamen inane._ An ineffectual effort to vomit. It frequently occurs, when the stomach is empty, and in some cases continues many hours; but as the lymphatics of the stomach are not inverted at the same time, there is no supply of materials to be ejected; it is sometimes a symptom of hysteria, but more frequently attends irregular epilepsies or reveries; which however may be distinguished by their violence of exertion, for the exertions of hysteric motions are feeble, as they are caused by debility; but those of epilepsies, as they are used to relieve pain, are of the most violent kind; insomuch that those who have once seen these ineffectual efforts to vomit in some epilepsies, can never again mistake them for symptoms of hysteria. See a case in Sect. XIX. 2.

M. M. Blister. Opium. Crude mercury.

9. _Borborigmus._ A gurgling of the bowels proceeds from a partial invertion of the peristaltic motions of them, by which the gas is brought into a superior part of the bowel, and bubbles through the descending fluid, like air rushing into a bottle as the water is poured out of it. This is sometimes a distressing symptom of the debility of the bowels joined with a partial inversion of their motions. I attended a young lady about sixteen, who was in other respects feeble, whose bowels almost incessantly made a gurgling noise so loud as to be heard at a considerable distance, and to attract the notice of all who were near her. As this noise never ceased a minute together for many hours in a day, it could not be produced by the uniform descent of water, and ascent of air through it, but there must have been alternately a retrograde movement of a part of the bowel, which must again have pushed up the water above the air; or which might raise a part of the bowel, in which the fluid was lodged, alternately above and below another portion of it; which might readily happen in some of the curvatures of the smaller intestines, the air in which might be moved backward and forward like the air-bubble in a glass-level.

M. M. Essential oil. Ten corns of black pepper swallowed whole after dinner, that its effect might be slower and more permanent; a small pipe occasionally introduced into the rectum to facilitate the escape of the air. Crude mercury. See Class I. 2. 4. 9.

10. _Hysteria._ The three last articles, together with the lymphatic diabaetes, are the most common symptoms of the hysteric disease; to which sometimes is added the lymphatic salivation, and fits of syncope, or convulsion, with palpitation of the heart (which probably consists of retrograde motions of it), and a great fear of dying. Which last circumstance distinguishes these convulsions from the epileptic ones with greater certainty than any other single symptom. The pale copious urine, cold skin, palpitation, and trembling, are the symptoms excited by great fear. Hence in hysteric diseases, when these symptoms occur, the fear, which has been usually associated with them, recurs at the same time, as in hypochondriasis, Class I. 2. 4. 10. See Sect. XVI. 8. 1.

The convulsions which sometimes attend the hysteric disease, are exertions to relieve pain, either of some torpid, or of some retrograde organ; and in this respect they resemble epileptic convulsions, except that they are seldom so violent as entirely to produce insensibility to external stimuli; for these weaker pains cease before the total exhaustion of sensorial power is produced, and the patient sinks into imperfect syncope; whereas the true epilepsy generally terminates in temporary apoplexy, with perfect insensibility to external objects. These convulsions are less to be dreaded than the epileptic ones, as they do not originate from so permanent a cause.

The great discharge of pale urine in this disease is owing to the inverted motions of the lymphatics, which arise about the neck of the bladder, as described in Sect. XXIX. 4. 5. And the lymphatic salivation arises from the inverted motions of the salivary lymphatics.

Hysteria is distinguished from hypochondriasis, as in the latter there are no retrograde motions of the alimentary canal, but simply a debility or inirritability of it, with distention and flatulency. It is distinguished from apepsia and cardialgia by there being nothing ejected from the stomach by the retrograde motions of it, or of the oesophagus.

M. M. Opium. Camphor. Assafoetida. Castor, with sinapisms externally; to which must be added a clyster of cold water, or iced water; which, according to Mons. Pomme, relieves these hysteric symptoms instantaneously like a charm; which it may effect by checking the inverted motions of the intestinal canal by the torpor occasioned by cold; or one end of the intestinal canal may become strengthened, and regain its peristaltic motion by reverse sympathy, when the other end is rendered torpid by ice-water. (Pomme des Affections Vaporeuses, p. 25.) These remove the present symptoms; and bark, steel, exercise, coldish bath, prevent their returns. See Art. VI. 2. 1.

11. _Hydrophobia._ Dread of water occasioned by the bite of a mad dog, is a violent inversion of the motions of the oesophagus on the contact or even approach of water or other fluids. The pharinx seems to have acquired the sensibility of the larinx in this disease, and is as impatient to reject any fluid, which gets into it. Is not the cardia ventriculi the seat of this disease? As in cardialgia the pain is often felt in the pharinx, when the acid material stimulates the other end of the canal, which terminates in the stomach. As this fatal disease resembles tetanus, or locked jaw, in its tendency to convulsion from a distant wound, and affects some other parts by association, it is treated of in Class III. 1. 1. 15. and IV. 1. 2. 7.

* * * * *

ORDO III.

_Retrograde Irritative Motions._

GENUS II.

_Of the Absorbent System._

SPECIES.

1. _Catarrhus lymphaticus._ Lymphatic catarrh. A periodical defluxion of a thin fluid from the nostrils, for a few hours, occasioned by the retrograde motions of their lymphatics; which may probably be supplied with fluid by the increased absorption of some other lymphatic branches in their vicinity. It is distinguished from that mucous discharge, which happens in frosty weather from decreased absorption, because it is less salt to the taste; and from an increased secretion of mucus, because it is neither so viscid, nor is attended with heat of the part. This complaint is liable to recur at diurnal periods, like an intermittent fever, for weeks and months together, with great sneezing and very copious discharge for an hour or two.

I have seen two of these cases, both of which occurred in delicate women, and seemed an appendage to other hysteric symptoms; whence I concluded, that the discharge was occasioned by the inverted motions of the lymphatics of the nostrils, like the pale urine in hysteric cases; and that they might receive this fluid from some other branches of lymphatic vessels opening into the frontal or maxillary cavities in their vicinity.

Could such a discharge be produced by strong errhines, and excite an absorption of the congestion of lymph in the dropsy of the brain?

2. _Salivatio lymphatica._ Lymphatic salivation. A copious expuition of a pellucid insipid fluid, occasioned by the retrograde motions of the lymphatics of the mouth. It is sometimes periodical, and often attends the hysteric disease, and nervous fevers; but is not accompanied with a saline taste, or with heat of the mouth, or nausea.

3. _Nausea humida._ Moist nausea consists in a discharge of fluid, owing to the retrograde motions of the lymphatics about the fauces, without increase of heat, or saline taste, together with some retrograde motions of the fauces or pharinx; along with this nausea a sickness generally precedes the act of vomiting; which may consist of a similar discharge of mucus or chyle into the stomach by the retrograde motions of the lymphatics or lacteals, which open into it. See Class I. 2. 4. 3. and I. 2. 4. 4.

M. M. Subacid liquids. Wine. Opium. A blister.

4. _Diarrhoea lymphatica._ Lymphatic diarrhoea. A quantity of mucus and lymph are poured into the intestines by the inverted motions of the intestinal lymphatics. The feces are less fetid and more liquid; and it sometimes portends the commencement of a diabaetes, or dropsy, or their temporary relief. This lymphatic diarrhoea sometimes becomes chronical, in which the atmospheric moisture, absorbed by the cutaneous and pulmonary lymphatics, is poured into the intestines by the retrograde motions of the lacteals. See Section XXIX. 4. 6. where some cases of this kind are related.

5. _Diarrhoea chylifera, coeliaca._ Chyliferous diarrhoea. The chyle drank up by the lacteals of the upper intestines is poured into the lower ones by the retrograde motions of their lacteals, and appears in the dejections. This circumstance occurs at the beginning of diarrhoea crapulosa, where the patient has taken and digested more aliment than the system can conveniently receive, and thus eliminates a part of it; as appears when there is curdled chyle in some of the dejections. See Sect. XXIX. 4. 7. It differs from the lymphatic diarrhoea, as the chyliferous diabaetes differs from the aqueous and mucaginous diabaetes.

6. _Diabaetes._ By the retrograde motions of the urinary lymphatics, an immense quantity of fluid is poured into the bladder. It is either termed chyliferous, or aqueous, or mucaginous, from the nature of the fluid brought into the bladder; and is either a temporary disease, as in hysteric women, in the beginning of intoxication, in worm cases, or in those exposed to cold damp air, or to great fear, or anxiety, or in the commencement of some dropsies; or it becomes chronical.

When the urinary lymphatics invert their motions, and pour their refluent contents into the bladder, some other branch of the absorbent system acts with greater energy to supply this fluid. If it is the intestinal branch, the chyliferous diabaetes is produced: if it is the cutaneous or pulmonary branch, the aqueous diabaetes is produced: and if the cellular or cystic branches, the mucaginous diabaetes. In the two last the urine is pellucid, and contains no sugar.

In dropsies the fluid is sometimes absorbed, and poured into the bladder by the retrograde motions of the urinary lymphatics, as during the exhibition of digitalis. In the beginning of the dropsies of infirm gouty patients, I have frequently observed, that they make a large quantity of water for one night, which relieves them for several days. In these cases the patient previously feels a fulness about the precordia, with difficult respiration, and symptoms similar to those of hysteria. Perhaps a previous defect of absorption takes place in some part of the body in those hysteric cases, which are relieved by a copious discharge of pale urine. See Diabaetes explained at large, Section XXIX. 4.

A discharge of blood sometimes attends the diabaetes, which was occasionally a symptom of that disease in Mr. Brindley, the great navigable canal maker in this country. Which may be accounted for by the communication of a lymphatic branch with the gastric branch of the vena portarum, as discovered by J. F. Meckel. See Section XXVII. 2.

M. M. Alum. Earth of Alum. Cantharides. Calomel. Bark. Steel. Rosin. Opium. See Sect. XXIX. 4.

7. _Sudor lymphaticus._ Profuse sweats from the inverted motions of the cutaneous lymphatics, as in some fainting fits, and at the approach of death; and as perhaps in the sudor anglicanus. See Sect. XXIX. 5. These sweats are glutinous to the touch, and without increased heat of the skin; if the part is not covered, the skin becomes cold from the evaporation of the fluid. These sweats without heat sometimes occur in the act of vomiting, as in Sect. XXV. 9. and are probably the cause of the cold sweaty hands of some people. As mentioned in Sect. XXIX. 4. 9. in the case of R. Davis, which he cured by frequent application of lime. Though it is possible, that cold sweaty hands may also arise from the want of due absorption of the perspirable matter effused on them, and that the coldness may be owing to the greater evaporation in consequence.

The acid sweats described by Dr. Dobson, which he observed in a diabaetic patient, and ascribes to the chyle effused on the skin, must be ascribed to the retrograde action of the cutaneous lymphatics. See Sect. XXIX. 6.

8. _Sudor asthmaticus._ The cold sweats in this disease only cover the head, arms, and breast, and are frequently exceedingly profuse. These sweats are owing to the inverted motions of the cutaneous lymphatics of the upper part of the body, and at the same time the increased absorption of the pulmonary absorbents: hence these sweats when profuse relieve the present fit of asthma. There is no other way to account for sweats appearing on the upper parts of the body only, but by the fluid having been absorbed by the lymphatic branch of the lungs, and effused on the skin by the retrograde movements of the cutaneous lymphatics; which join those of the lungs before they enter into the venous circulation. For if they were occasioned, as generally supposed, by the difficulty of the circulation of the blood through the lungs, the whole skin must be equally affected, both of the upper and lower parts of the body; for whatever could obstruct the circulation in the upper part of the venous system, must equally obstruct it in the lower part of it. See Sect. XXIX. 6. In the convulsive asthma these sweats do not occur; hence they may be distinguished; and might be called the hydropic asthma, and the epileptic asthma.

9. _Translatio puris._ Translation of matter from one part of the system to another can only be explained from its being absorbed by one branch of the lymphatic system, and deposited in a distant part by the retrograde motions of another branch; as mentioned Sect. XXIX. 7. 1. It is curious, that these translations of matter are attended generally, I believe, with cold fits; for less heat is produced during the retrograde action of this part of the system, as no secretion in the lymphatic glands of the affected branches can exist at the same time. Do any ineffectual retrograde motions occasion the cold fits of agues? The time when the gout of the liver ceases, and the gout in the foot commences, is attended with a cold fit, as I have observed in two instances, which is difficult to explain, without supposing the new vessels, or the matter produced on the inflamed liver, to be absorbed, and either eliminated by some retrograde motion, or carried to the newly inflamed part? See Class IV. 1. 2. 15.

10. _Translatio lactis._ Translation of milk to the bowels in puerperal fevers can only be explained by the milk being absorbed by the pectoral branch of lymphatics, and carried to the bowels by the retrograde motions of the intestinal lymphatics or lacteals. See many instances of this in Sect. XXIX. 7. 4.

11. _Translatio urinae._ Translation of urine. There is a curious case related in the Transaction of the College of Physicians at Philadelphia, Vol. I. p. 96. of a girl, who labouring under an iscuria vomited her urine for many months; which could not be distinguished from that which was at other times drawn off by the catheter. After having taken much opium, she seems at length to have formed gravel, some of which was frequently brought up by vomiting. Dr. Senter ascribes this to the retrograde motions of the lymphatics of the stomach, and the increased ones of those of the bladder, and refers to those of Sect. XXIX. of this work; which section was first published in 1780; and to Macquire's Dictionary of Chemistry, Art. Urine.

The patient above described sometimes had a discharge of urine by the navel, and at other times by the rectum, and sometimes by urinous sweats.

* * * * *

ORDO III.

_Retrograde Irritative Motions._

GENUS III.

_Of the Sanguiferous System._

SPECIES.

1. _Capillarium motus retrogressus._ In microscopic experiments it is usual to see globules of blood regurgitate from the capillary vessels again and again, before they pass through them; and not only the mouths of the veins, which arise from these capillaries, are frequently seen by microscopes to regurgitate some particles of blood during the struggles of the animal; but a retrograde motion of the blood in the veins of these animals, from the very heart to the extremities of the limbs, is observable by intervals during the distresses of the dying creature. Haller, Elem. Phys. T. i. p. 216. See Section XXIX. 3. 8.

2. _Palpitatio cordis._ May not the ineffectual and weak unequal motions of the heart in hysteric cases be ascribed to the retrograde motions of it, which continue for a short time, or terminate in syncope? See Class IV. 3. 1. 6.

3. _Anhelatio spasmodica._ In some asthmas may not the difficulty of respiration arise from the inverted action of the finer branches of the bronchia, or of the pulmonary artery or vein, like those of the capillaries above described in No. 1. of this genus?

* * * * *

_The Orders and Genera of the Second Class of Diseases._

* * * * *

CLASS II.

DISEASES OF SENSATION.

ORDO I.

_Increased Sensation._

GENERA.

1. With increased action of the muscles.
2. With the production of new vessels by internal membranes or glands
with fever.
3. With the production of new vessels by external membranes or glands
with fever.
4. With the production of new vessels by internal membranes or glands
without fever.
5. With the production of new vessels by external membranes or glands
without fever.
6. With fever consequent to the production of new vessels or fluids.
7. With increased action of the organs of sense.

ORDO II.

_Decreased Sensation._

GENERA.

1. With decreased actions of the general system.
2. With decreased actions of particular organs.

ORDO III.

_Retrograde Sensitive Motions._

GENERA.

1. Of the excretory ducts.

* * * * *

_The Orders, Genera, and Species, of the Second Class Of Diseases._

* * * * *

CLASS II.

DISEASES OF SENSATION.

ORDO I.

_Increased Sensation._

GENUS I.

_With Increased Action of the Muscles._

SPECIES.

1. _Deglutitio._ Deglutition.
2. _Respiratio._ Respiration.
3. _Sternutatio._ Sneezing.
4. _Anhelitus._ Panting.
5. _Tussis ebriorum._ Cough of inebriates.
6. _Syngultus._ Hiccough.
7. _Asthma humorale._ Humoral asthma.
8. _Nictitatio sensitiva._ Winking from pain.
9. _Oscitatio et pandiculatio._ Yawning and stretching.
10. _Tenesmus._ Tenesmus.
11. _Stranguria._ Strangury.
12. _Parturitio._ Parturition.

GENUS II.

_With the Production of new Vessels by internal Membranes or Glands, with Fever._

SPECIES.

1. _Febris sensitiva irritata._ Sensitive irritated fever.
2. _Ophthalmia interna._ Inflammation of the eye.
3. _Phrenitis._ ---- of the brain.
4. _Peripneumonia._ ---- of the lungs.
---- _trachealis._ ---- the croup.
5. _Pleuritis._ ---- of the pleura.
6. _Diaphragmitis._ ---- of the diaphragm.
7. _Carditis._ ---- of the heart.
8. _Peritonitis._ ---- of the peritoneum.
9. _Mesenteritis._ ---- of the mesentery.
10. _Gastritis._ ---- of the stomach.
11. _Enteritis._ ---- of the bowels.
12. _Hepatitis._ ---- of the liver.
13. _Splenitis._ ---- of the spleen.
14. _Nephritis._ ---- of the kidney.
15. _Cystitis._ ---- of the bladder.
16. _Hysteritis._ ---- of the womb.
17. _Lumbago sensitiva._ ---- of the loins.
18. _Ischias._ ---- of the pelvis.
19. _Paronychia interna._ ---- beneath the nails.

GENUS III.

_With the Production of new Vessels by external Membranes or Glands, with Fever._

SPECIES.

1. _Febris sensitiva inirritata._ Sensitive inirritated fever.
2. _Erysipelas irritatum._ Erysipelas irritated.
_----inirritatum._ ---- inirritated.
---- _sensitivum._ ---- sensitive.
3. _Tonsillitis interna._ Angina internal.
---- _superficialis._ ---- superficial.
---- _inirritata._ ---- inirritated.
4. _Parotitis suppurans._ Mumps suppurative.
---- _mutabilis._ ---- mutable.
---- _felina._ ---- of cats.
5. _Catarrhus sensitivus._ Catarrh inflammatory.
6. ---- _contagiosus._ ---- contagious.
---- _equinus et caninus._ ---- among horses and dogs.
7. _Peripneumonia superficialis._ Superficial peripneumony.
8. _Pertussis._ Chin-cough.
9. _Variola discreta._ Small-pox distinct.
---- _confluens._ ---- confluent.
---- _inoculata._ ---- inoculated.
10. _Rubeola irritata._ Measles irritated.
---- _inirritata._ ---- inirritated.
11. _Scarlatina mitis._ Scarlet fever mild.
---- _maligna._ ---- malignant.
12. _Miliaria sudatoria._ Miliary fever sudatory.
---- _irritata._ ---- irritated.
---- _inirritata._ ---- inirritated.
13. _Pestis._ Plague.
---- _vaccina._ ---- of horned cattle.
14. _Pemphigus._ Bladdery fever.
15. _Varicella._ Chicken-pox.
16. _Urticaria._ Nettle rash.
17. _Aptha sensitiva._ Thrush sensitive.
---- _irritata._ ---- irritated.
---- _inirritata._ ---- inirritated.
18. _Dysenteria._ Bloody flux.
19. _Gastritis superficialis._ Superficial inflam. of the stomach.
20. _Enteritis superficialis._ ---- of the bowels.

GENUS IV.

_With the Production of new Vessels by internal Membranes or Glands, without Fever._

SPECIES.

1. _Ophthalmia superficialis._ Ophthalmy superficial.
---- _lymphatica._ ---- lymphatic.
---- _equina._ ---- of horses.
2. _Pterigion._ Eye-wing.
3. _Tarsitis palpebrarum._ Red eyelids.
4. _Hordeolum._ Stye.
5. _Paronychia superficialis._ Whitlow.
6. _Gutta rosea hepatica._ Pimpled face hepatic.
---- _stomatica._ ---- stomatic.
---- _hereditaria._ ---- hereditary.
7. _Odontitis._ Inflamed tooth.
8. _Otitis._ ---- ear.
9. _Fistula lacrymalis._ Fistula lacrymalis.
10. _Fistula in ano._ Fistula in ano.
11. _Fistula urethrae._ Fistula urethrae.
12. _Hepatitis chronica._ Chronical hepatitis.
13. _Scrophula suppurans._ Suppurating scrophula.
14. _Scorbutus suppurans._ Suppurating scurvy.
15. _Schirrus suppurans._ Suppurating schirrus.
16. _Carcinoma._ Cancer.
17. _Arthrocele._ Swelling of the joints.
18. _Arthropuosis._ Suppuration of the joints.
19. _Caries ossium._ Caries of the bones.

GENUS V.

_With the Production of new Vessels by external Membranes or Glands, without Fever._

SPECIES.

1. _Gonorrhoea venerea._ Clap.
2. _Syphilis._ Venereal disease.
3. _Lepra._ Leprosy.
4. _Elephantiasis._ Elephantiasis.
5. _Framboesia._ Framboesia.
6. _Psora._ Itch.
7. _Psora ebriorum._ Itch of drunkards.
8. _Herpes._ Herpes.
9. _Zona ignea._ Shingles.
10. _Annulus repens._ Ring-worm.
11. _Tinea capitis._ Scald-head.
12. _Crusta lactea._ Milk-crust.
13. _Trichoma._ Plica polonica.

GENUS VI.

_With Fever consequent to the Production of new Vessels or Fluids._

SPECIES.

1. _Febris sensitiva._ Sensitive fever.
2. ---- _a pure clauso._ Fever from concealed matter.
3. ---- _a vomica._ ---- from vomica.
4. ---- _ab empyemate._ ---- from empyema.
5. ---- _mesenterica._ ---- mesenteric.
6. ---- _a pure aerato._ ---- from aerated matter.
7. ---- _a phthisi._ ---- from consumption.
8. ---- _scrophulosa._ ---- scrophulous.
9. ---- _ischiadica._ ---- from ischias.
10. ---- _arthropuodica._ ---- from joint-evil.
11. ---- _a pure contagioso._ ---- from contagious matter.
12. ---- _variolosa secundaria._ ---- secondary of small-pox.
13. ---- _carcinomatosa._ ---- cancarous.
14. ---- _venerea._ ---- venereal.
15. ---- _a sanie contagiosa._ ---- from contagious sanies.
16. ---- _puerpera._ ---- puerperal.
17. ---- _a sphacelo._ ---- from sphacelus.

GENUS VII.

_With increased Action of the Organs of Sense._

SPECIES.

1. _Delirium febrile._ Delirium of fevers.
2. ---- _maniacale._ ---- maniacal.
3. ---- _ebrietatis._ ---- of drunkenness.
4. _Somnium._ Dreams.
5. _Hallucinatio visus._ Deception of sight.
6. ---- _auditus._ ---- of hearing.
7. _Rubor a calore._ Blush from heat.
8. ---- _jucunditatis._ ---- from joy.
9. _Priapismus amatorius._ Amorous priapism.
10. _Distentio mamularum._ Distention of the nipples.

ORDO II.

_Decreased Sensation._

GENUS I.

_With decreased Action of the general System._

SPECIES.

1. _Stultitia insensibilis._ Folly from insensibility.
2. _Taedium vitae._ Irksomeness of life.
3. _Paresis sensitiva._ Sensitive debility.

GENUS II.

_With decreased Actions of particular Organs._

SPECIES.

1. _Anorexia._ Want of appetite.
2. _Adipsia._ Want of thirst.
3. _Impotentia._ Impotence.
4. _Sterilitas._ Barrenness.
5. _Insensibilitas artuum._ Insensibility of the limbs.
6. _Dysuria insensitiva._ Insensibility of the bladder.
7. _Accumulatio alvina._ Accumulation of feces.

ORDO III.

_Retrograde Sensitive Motions._

GENUS I.

_Of Excretory Ducts._

SPECIES.

_Motus retrogressus_ Retrograde motion.
1. ---- _ureterum._ ---- of the ureters.
2. ---- _urethrae._ ---- of the urethra.
3. ---- _ductus choledoci._ ---- of the bile-duct.

* * * * *

CLASS II.

DISEASES OF SENSATION.

ORDO I.

_Increased Sensation._

GENUS I.

_With Increased Action of the Muscles._

The actions belonging to this genus are those which are immediately excited by the sensations of pain or pleasure, but which are neither followed by inflammation, nor by convulsion. The former of which belong to the subsequent genera of this order, and the latter to the class of voluntary motions.

The criterion between the actions, which are the immediate consequence of painful sensation, and convulsive actions properly so called, consists in the former having a tendency to dislodge the stimulating cause, which induces the painful sensation; and the latter being exerted for the purpose of expending the sensorial power, and thus dulling or destroying the general sensation of the system. See Class III. 1.

There is a degree of heat produced in the affected part by these sensitive actions without inflammation, but in much less quantity than when attended by inflammation; as in the latter there is a production of new vessels. See Sect. XXXIII. 2. 3.

Some of the species of this genus cannot properly be termed diseases in their natural state, but become so by their defect or excess, and are here inserted to facilitate the explanation of the others.

SPECIES.

1. _Deglutitio._ Swallowing our food is immediately caused by the pleasureable sensation occasioned by its stimulus on the palate or fauces and is acquired long before the nativity of the animal. Afterwards the pain of hunger previously produces the various voluntary exertions to procure the proper material, but the actions of masticating and of swallowing it are effected by the sensorial power of sensation; which appears by their not being always controulable by the will, as when children in vain attempt to swallow nauseous drugs. See Class IV. 1. 3. 1. The masticated food stimulates the palate, which is an organ of sense, into so much action, as to produce agreeable sensation; and the muscles subservient to deglutition are brought into action by the sensation thus produced. The pleasureable sensation is the proximate cause; the action of the fibres of the extremities of the nerves of taste is the remote cause; the sensorial power of irritation exciting these fibres of the nerves of taste into increased action is the pre-remote cause; the action of the muscles of deglutition is the proximate effect; the pushing the food into the stomach is the remote effect; and the nutrition of the body is the post-remote effect.

Though the muscles subservient to deglutition have their actions previously associated, so as to be excited into synchronous tribes or successive trains, either by volition, as when we swallow a disagreeable drug; or by sensation, as when we swallow agreeable food; or by irritation, as when we inattentively swallow our saliva; yet do all those three kinds of deglutition belong to the respective classes of volition, sensation, and irritation; because the first links of these tribes or trains of muscular action are excited by those sensorial powers, and the associated links, which accompany or succeed them, are excited by the combined powers either of volition, or of sensation, or of irritation, along with that of association.

2. _Respiratio._ Respiration is immediately caused by the sensorial power of sensation in consequence of the baneful want of vital air; and not from the accumulation of blood in the lungs, as that might be carried on by inhaling azote alone, without the oxygenous part of the atmosphere. The action of respiration is thus similar to that of swallowing our food to appease the pain of hunger; but the lungs being surrounded with air, their proper pabulum, no intermediate voluntary exertions are required, as in hunger, to obtain and prepare the wanted material.

Respiration is similar to slow combustion; the oxygenous part of the atmosphere is received through the moist membranes, which line the air-cells of the lungs, and uniting with the inflammable part of the blood generates an acid, probably the phosphoric acid; a portion of carbonic acid is likewise produced in this process; as appears by repeatedly breathing over lime-water, which then becomes turbid. See Botanic Garden, P. I. Canto I. l. 401. note.

3. _Sternutatio._ Sneezing consists of muscular actions produced by the sensorial faculty of sensation; and is an effort to dislodge, by means of air forcibly impelled through the nostrils, some material; which stimulates the membrane, which lines them, into too great action, and might thence injure the sense of smell which is diffused on it.

In this operation the too great action of the vessels of the membrane of the nostrils is the remote cause; the sensation thence induced is the proximate cause; and the muscular actions are the proximate effect.

This action of sneezing frequently precedes common respiration in new-born children, but I believe not always; as like the latter it cannot have been previously acquired in the uterus.

It is produced in some people by sudden light, as by looking up at the sky in a morning, when they come out of a gloomy bed-chamber. It then becomes an associate action, and belongs to Class IV. 1. 2. 2.

M. M. When it is exerted to excess it may be cured by snuffing starch up the nostrils. See Class I. 1. 2. 13.

4. _Anhelitus._ Panting. The quick and laborious breathing of running people, who are not accustomed to violent exercise, is occasioned by the too great conflux of blood to the lungs. As the sanguiferous system, as well as the absorbent system, is furnished in many parts of its course with valves, which in general prevent the retrograde movement of their contained fluids; and as all these vessels, in some part of their course, lie in contact with the muscles, which are brought into action in running, it follows that the blood must be accelerated by the intermitted swelling of the bellies of the muscles moving over them.

The difficulty of breathing, with which, very fat people are immediately affected on exercise, is owing to the pressure of the accumulated fat on the veins, arteries, and lymphatics; and which, by distending the skin, occasions it to act as a tight bandage on the whole surface of the body. Hence when the muscles are excited into quicker action, the progress of the blood in the veins, and of the lymph and chyle in the absorbent system, is urged on with much greater force, as under an artificial bandage on a limb, explained in Art. IV. 2. 10. and in Sect. XXXIII. 3. 2. Hence the circulation is instantly quickened to a great degree, and the difficulty of breathing is the consequence of a more rapid circulation through the lungs. The increased secretion of the perspirable matter is another consequence of this rapid circulation; fat people, when at rest, are believed to perspire less than others, which may be gathered from their generally having more liquid stools, more and paler urine, and to their frequently taking less food than many thin people; and lastly, from the perspiration of fat people being generally more inodorous than that of lean ones; but when corpulent people are put in motion, the sweat stands in drops on their skins, and they "lard the ground" as they run. The increase of heat of corpulent people on exercise, is another consequence of their more rapid circulation, and greater secretion. See Class I. 2. 3. 17.

Other causes of difficult or quick respiration will be treated of under Asthma, Pertussis, Peripneumony, Tonsillitis.

5. _Tussis ebriorum._ Sensitive cough is an exertion of the muscles used in expiration excited into more violent action by the sensorial power of sensation, in consequence of something which too powerfully stimulates the lungs. As the saline part of the secreted mucus, when the absorption of it is impeded; or the too great viscidity of it, when the absorption is increased; or the too great quantity of the mucus, when the secretion is increased; or the inflammation of the membranes of the lungs; it is an effort to dislodge any of these extraneous materials.

Of this kind is the cough which attends free-drinkers after a debauch; it consists of many short efforts to cough, with a frequent expuition of half a tea-spoonful of frothy mucus, and is attended with considerable thirst. The thirst is occasioned by the previous dissipation of the aqueous parts of the blood by sensible or insensible perspiration; which was produced by the increased action of the cutaneous and pulmonary capillaries during the stimulus of the wine. In consequence of this an increased absorption commences to replace this moisture, and the skin and mouth become dry, and the pulmonary mucus becomes inspissated; which stimulates the bronchia, and is raised into froth by the successive currents of air in evacuating it. This production of froth is called by some free-drinkers "spitting sixpences" after a debauch. This subsequent thirst, dry mouth, and viscid expectoration in some people succeeds the slightest degree of intoxication, of which it may be esteemed a criterion. See Class IV. 2. 1. 8.

As coughs are not always attended with pain, the muscular actions, which produce them, are sometimes excited by the sensorial faculty of irritation, as in Class I. 1. 2. 8. I. 1. 3. 4. I. 1. 4. 3. I. 2. 3. 4. Coughs are also sometimes convulsive, as in Class III. 1. 1. 10. and sometimes sympathetic, as Class IV. 2. 1. 7.

M. M. Venesection, when the cough is attended with inflammation. Mucilages. Opium. Torpentia. Blister.

6. _Singultus._ Hiccough is an exertion of the muscles used in inspiration excited into more violent action by the sensorial power of sensation, in consequence of something which too powerfully stimulates the cardia ventriculi, or upper orifice of the stomach. As when solid food is too hastily taken without sufficient dilution. And is an effort to dislodge that offensive material, and push it to some less sensible part of the stomach, or into the middle of the contained aliment.

At the end of fatal fevers it may arise from the acrimony of the undigested aliment, or from a part of the stomach being already dead, and by its weight or coldness affecting the surviving part with disagreeable sensation. The pain about the upper orifice of the stomach is the proximate cause, the too great or too little action of the fibres of this part of the stomach is the remote cause, the action of the muscles used in inspiration is the proximate effect, and the repercussion of the offending material is the remote effect.

Hiccough is sometimes sympathetic, occasioned by the pain of gravel in the kidney or ureter, as in Class IV. 1. 1. 7. and is sometimes a symptom of epilepsy or reverie, as in Sect. XIX. 2.

M. M. Oil of cinnamon from one drop gradually increased to ten, on sugar, or on chalk. Opium. Blister. Emetic.

7. _Asthma humorale._ The humoral asthma probably consists in a temporary anasarca of the lungs, which may be owing to a temporary defect of lymphatic absorption. Its cause is nevertheless at present very obscure, since a temporary deficiency of venous absorption, at the extremities of the pulmonary or bronchial veins, might occasion a similar difficulty of respiration. See Abortio, Class I. 2. 1. 14. Or it might be supposed, that the lymph effused into the cavity of the chest might, by some additional heat during sleep, acquire an aerial form, and thus compress the lungs; and on this circumstance the relief, which these patients receive from cold air, would be readily accounted for.

The paroxysms attack the patient in his first sleep, when the circulation through the lungs in weak people wants the assistance of the voluntary power. Class I. 2. 1. 3. And hence the absorbents of the lungs are less able to fulfil the whole of their duty. And part of the thin mucus, which is secreted into the air-cells, remains there unabsorbed, and occasions the difficult respiration, which awakes the patient. And the violent exertions of the muscles of respiration, which succeed, are excited by the pain of suffocation, for the purpose of pushing forwards the blood through the compressed capillaries, and to promote the absorption of the effused lymph.

In this the humoral differs from the convulsive asthma, treated of in Class III. 1. 1. 10. as in that there is probably no accumulated fluid to be absorbed; and the violent respiration is only an exertion for the purpose of relieving pain, either in the lungs or in some distant part, as in other convulsions, or epilepsy; and in this respect the fits of humoral and convulsive asthma essentially differ from each other, contrary to the opinion expressed without sufficient consideration in Sect. XVIII. 15.

The patients in the paroxysms both of humoral and convulsive asthma find relief from cold air, as they generally rise out of bed, and open the window, and put out their heads; for the lungs are not sensible to cold, and the sense of suffocation is somewhat relieved by there being more oxygen contained in a given quantity of cold fresh air, than in the warm confined air of a close bed-chamber.

I have seen humoral asthma terminate in confirmed anasarca, and destroy the patient, who had been an excessive drinker of spirituous potation. And M. Savage asserts, that this disease frequently terminates in diabetes; which seems to shew, that it is a temporary dropsy relieved by a great flow of urine. Add to this, that these paroxysms of the asthma are themselves relieved by profuse sweats of the upper parts of the body, as explained in Class I. 3. 2. 8. which would countenance the idea of their being occasioned by congestions of lymph in the lungs.

The congestion of lymph in the lungs from the defective absorption of it is probably the remote cause of humoral asthma; but the pain of suffocation is the immediate cause of the violent exertions in the paroxysms. And whether this congestion of lymph in the air-cells of the lungs increases during our sleep, as above suggested, or not; the pain of suffocation will be more and more distressing after some hours of sleep, as the sensibility to internal stimuli increases during that time, as described in Sect. XVIII. 15. For the same reason many epileptic fits, and paroxysms of the gout, occur during sleep.

In two gouty cases, complicated with jaundice, and pain, and sickness, the patients had each of them a shivering fit, like the commencement of an ague, to the great alarm of their friends; both which commenced in the night, I suppose during their sleep; and the consequence was a cessation of the jaundice, and pain about the stomach, and sickness; and instead of that the gout appeared in their extremities. In these cases I conjecture, that there was a metastasis not only of the diseased action from the membranes of the liver to those of the foot; but that some of the new vessels, or new fluids, which were previously produced in the inflamed liver, were translated to the feet during the cold fit, by the increased absorption of the hepatic lymphatics, and by the retrograde motions of those of the affected limbs.

This I think resembles in some respects a fit of humoral asthma, where stronger motions of the absorbent vessels of the lungs are excited, and retrograde ones of the correspondent cutaneous lymphatics; whence the violent sweats of the upper parts of the body only are produced; and for a time the patient becomes relieved by the metastasis and elimination of the offending material by sensitive exertion. For a further account of this intricate subject see Class III. 1. 1. 10.

M. M. To relieve the paroxysm a tea-spoonful of ether may be given mixed with water, with 10 drops of laudanum, to be repeated three or four times. Venesection. An emetic. A blister. Afterwards the Peruvian bark, with a grain of opium at night, and two or three of aloes. A flannel shirt in winter, but not in summer. Issues. Digitalis?