3. _Clamor._ Screaming from pain. The talkative animals, as dogs, and swine, and children, scream most, when they are in pain, and even from fear; as they have used this kind of exertion from their birth most frequently and most forcibly; and can therefore sooner exhaust the acc.u.mulation of sensorial power in the affected muscular or sensual organs by this mode of exertion; as described in Sect. x.x.xIV. 1. 3. This facility of relieving pain by screaming is the source of laughter, as explained below.

4. _Risus._ The pleasurable sensations, which occasion laughter, are perpetually pa.s.sing into the bounds of pain; for pleasure and pain are often produced by different degrees of the same stimulus; as warmth, light, aromatic or volatile odours, become painful by their excess; and the tickling on the soles of the feet in children is a painful sensation at the very time it produces laughter. When the pleasurable ideas, which excite us to laugh, pa.s.s into pain, we use some exertion, as a scream, to relieve the pain, but soon stop it again, as we are unwilling to lose the pleasure; and thus we repeatedly begin to scream, and stop again alternately. So that in laughing there are three stages, first of pleasure, then pain, then an exertion to relieve that pain. See Sect. x.x.xIV. 1. 3.

Every one has been in a situation, where some ludicrous circ.u.mstance has excited him to laugh; and at the same time a sense of decorum has forbid the exertion of these interrupted screams; and then the pain has become so violent, as to occasion him to use some other great action, as biting his tongue, and pinching himself, in lieu of the reiterated screams which const.i.tute laughter.

5. _Convulsio._ Convulsion. When the pains from defect or excess of motion are more distressing than those already described, and are not relievable by such partial exertions, as in screaming, or laughter, more general convulsions occur; which vary perhaps according to the situation of the pained part, or to some previous a.s.sociations formed by the early habits of life. When these convulsive motions bend the body forwards, they are termed emprosthotonoi; when they bend it backward, they are termed opisthotonoi.

They frequently succeed each other, but the opisthotonoi are generally more violent; as the muscles, which erect the body, and keep it erect, are naturally in more constant and more forcible action than their antagonists.

The causes of convulsion are very numerous, as from toothing in children, from worms or acidity in their bowels, from eruption of the distinct small-pox, and lastly, from breathing too long the air of an unventilated bed-room. Sir G. Baker, in the Transactions of the College, described this disease, and detected its cause; where many children in an orphan-house were crowded together in one chamber without a chimney, and were almost all of them affected with convulsion; in the hospital at Dublin, many died of convulsions before the real cause was understood. See Dr. Beddoes's Guide to Self-preservation. In a large family, which I attended, where many female servants slept in one room, which they had contrived to render inaccessible to every blast of air; I saw four who were thus seized with convulsions, and who were believed to have been affected by sympathy from the first who fell ill. They were removed into more airy apartments, but were some weeks before they all regained their perfect health.

Convulsion is distinguished from epilepsy, as the patient does not intirely lose all perception during the paroxysm. Which only shews, that a less exhaustion of sensorial power renders tolerable the pains which cause convulsion, than those which cause epilepsy. The hysteric convulsions are distinguished from those, owing to other causes, by the presence of the expectation of death, which precedes and succeeds them, and generally by a flow of pale urine; these convulsions do not constantly attend the hysteric disease, but are occasionally superinduced by the disagreeable sensation arising from the torpor or inversion of a part of the alimentary ca.n.a.l.

Whence the convulsion of laughter is frequently sufficient to restrain these hysteric pains, which accounts for the fits of laughter frequently attendant on this disease.

M. M. To remove the peculiar pain which excites the convulsions.

Venesection. An emetic. A cathartic with calomel. Warm-bath. Opium in large quant.i.ties, beginning with smaller ones. Mercurial frictions. Electricity.

Cold-bath in the paroxysm; or cold aspersion. See Memoirs of Med. Society, Lon. V. 3. p. 147. a paper by Dr. Currie.

_Convulsio debilis._ The convulsions of dying animals, as of those which are bleeding to death in the slaughter-house, are an effort to relieve painful sensation, either of the wound which occasions their death, or of faintness from want of due distention of the blood-vessels. Similar to this in a less degree is the subsultus tendinum, or starting of the tendons, in fevers with debility; these actions of the muscles are too weak to move the limb, but the belly of the acting muscles is seen to swell, and the tendon to be stretched. These weak convulsions, as they are occasioned by the disagreeable sensation of faintness from inanition, are symptoms of great general debility, and thence frequently precede the general convulsions of the act of dying. See a case of convulsion of a muscle of the arm, and of the fore-arm, without moving the bones to which they were attached, Sect.

XVII. 1. 8. See twitchings of the face, Cla.s.s IV. 1. 3. 2.

6. _Convulsio dolorifica._ Raphania. Painful convulsion. In this disease the muscles of the arms and legs are exerted to relieve the pains left after the rheumatism in young and delicate people; it recurs once or twice a-day, and has been mistaken for the ch.o.r.ea, or St. Vitus's dance; but differs from it, as the undue motions in that disease only occur, when the patient endeavours to exert the natural ones; are not attended with pain; and cease, when he lies down without trying to move: the ch.o.r.ea, or dance of St. Vitus, is often introduced by the itch, this by the rheumatism.

It has also been improperly called nervous rheumatism; but is distinguished from rheumatism, as the pains recur by periods once or twice a day; whereas in the chronic rheumatism they only occur on moving the affected muscles.

And by the warmth of a bed the pains of the chronic rheumatism are increased, as the muscles or membranes then become more sensible to the stimulus of the extraneous mucaginous material deposited under them.

Whereas the pains of the raphania, or painful convulsion, commence with coldness of the part, or of the extremities. See Rheumatismus chronicus, Cla.s.s I. 1. 3. 12.

The pains which accompany the contractions of the muscles in this disease, seem to arise from the too great violence of those contractions, as happens in the cramp of the calf of the leg; from which they differ in those being fixed, and these being reiterated contractions. Thus these convulsions are generally of the lower limbs, and recur at periodical times from some uneasy sensation from defect of action, like other periodic diseases; and the convulsions of the limbs relieve the original uneasy painful sensation, and then produce a greater pain from their own too vehement contractions.

There is however another way of accounting for these pains, when they succeed the acute rheumatism; and that is by the coagulable lymph, which may be left still unabsorbed on the membranes; and which may be in too small quant.i.ty to affect them with pain in common muscular exertions, but may produce great pain, when the bellies of the muscles swell to a larger bulk in violent action.

M. M. Venesection. Calomel. Opium. Bark. One grain of calomel and one of opium for ten successive nights. A bandage spread with emplastrum de minio put tight on the affected part.

7. _Epilepsia_ is originally induced, like other convulsions, by a voluntary exertion to relieve some pain. This pain is most frequently about the pit of the stomach, or termination of the bile-duct; and in some cases the torpor of the stomach, which probably occasioned the epileptic fits, remains afterwards, and produces a chronical anorexia; of which a case is related in Cla.s.s II. 2. 2. 1. There are instances of its beginning in the heel, of which a case is published by Dr. Short, in the Med. Essays, Edinb.

I once saw a child about ten years old, who frequently fell down in convulsions, as she was running about in play; on examination a wart was found on one ancle, which was ragged and inflamed; which was directed to be cut off, and the fits never recurred.

When epilepsy first commences, the patients are liable to utter one scream before they fall down; afterwards the convulsions so immediately follow the pain, which occasions them, that the patient does not recollect or seem sensible of the preceding pain. Thus in laughter, when it is not excessive, a person is not conscious of the pain, which so often recurs, and causes the successive screams or exertions of laughter, which give a temporary relief to it.

Epileptic fits frequently recur in sleep from the increase of sensibility at that time, explained in Sect. XVIII. 14. In two such cases, both of young women, one grain of opium given at night, and continued many months, had success; in one of them the opium was omitted twice at different times, and the fit recurred on both the nights. In the more violent case, described in Sect. XVIII. 15, opium had no effect.

Epileptic fits generally commence with setting the teeth, by which means the tongue is frequently wounded; and with rolling the eyeb.a.l.l.s in every kind of direction; for the muscles which suspend the jaw, as well as those which move the eyes, are in perpetual motion during our waking hours; and yet continue subservient to volition; hence their more facile and forcible actions for the purpose of relieving pain by the exhaustion of sensorial power. See Section x.x.xIV. 1. 4.

Epileptic convulsions are not attended with the fear of death, as in the hysteric disease, and the urine is of a straw colour. However it must be noted, that the disagreeable sensations in hysteric diseases sometimes are the cause of true epileptic convulsions, of syncope, and of madness.

The pain, which occasions some fits of epilepsy, is felt for a time in a distant part of the system, as in a toe or heel; and is said by the patient gradually to ascend to the head, before the general convulsions commence.

This ascending sensation has been called aura epileptica, and is said to have been prevented from affecting the head by a tight bandage round the limb. In this malady the pain, probably of some torpid membrane, or diseased tendon, is at first only so great as to induce slight spasms of the muscular fibres in its vicinity; which slight spasms cease on the numbness introduced by a tight bandage; when no bandage is applied, the pain gradually increases, till generally convulsions are exerted to relieve it. The course of a lymphatic, as when poisonous matter is absorbed; or of a nerve, as in the sciatica, may, by the sympathy existing between their extremities and origins, give an idea of the ascent of an aura or vapour.

In difficult parturition it sometimes happens, that general convulsions are excited to relieve the pain of labour, instead of the exertions of those muscles of the abdomen and diaphragm, which ought to forward the exclusion of the child. See Cla.s.s III. 1. 1. That is, instead of the particular muscular actions, which ought to be excited by sensation to remove the offending cause, general convulsions are produced by the power of volition, which still the pain, as in common epilepsy, without removing the cause; and, as the parturition is not thus promoted, the convulsions continue, till the sensorial power is totally exhausted, that is, till death. In patients afflicted with epilepsy from other causes, I have seen the most violent convulsions recur frequently during pregnancy without miscarriage, as they did not tend to forward the exclusion of the fetus.

M. M. Venesection. A large dose of opium. Delivery.

The later in life epileptic fits are first experienced, the more dangerous they may be esteemed in general; as in these cases the cause has generally been acquired by the habits of the patient, or by the decay of some part, and is thus probably in an increasing state. Whereas in children the changes in the system, as they advance to p.u.b.erty, sometimes removes the cause. So in toothing, fits of convulsion with stupor frequently occur, and cease when the tooth advances; but this is not to be expected in advanced life. Sir ----, about sixty years of age, had only three teeth left in his upper jaw, a canine tooth, and one on each side of it. He was seized with epileptic fits, with pain commencing in these teeth. He was urged to have them extracted, which he delayed too long, till the fits were become habitual, and then had them extracted in vain, and in a few months sunk under the disease.

Mr. F----, who had lived intemperately, and had been occasionally affected with the gout, was suddenly seized with epileptic fits; the convulsions were succeeded by apoplectic snoring; from which he was, in about 20 minutes, disturbed by fresh convulsions, and had continued in this situation above four-and-twenty hours. About eight ounces of blood were then taken from him; and after having observed, that the apoplectic's torpor continued about 20 minutes, I directed him to be forcibly raised up in bed, after he had thus lain about fifteen minutes, to gain an interval between the termination of the sleep, and the renovation of convulsion. In this interval he was induced to swallow forty drops of laudanum. Twenty more were given him in the same manner in about half an hour, both which evidently shortened the convulsion fits, and the consequent stupor; he then took thirty more drops, which for the present removed the fits. He became rather insane the next day, and after about three more days lost the insanity, and recovered his usual state of health.

The case mentioned in Sect. XXVII. 2. where the patient was left after epileptic fits with a suffusion of blood beneath the tunica adjunctiva of the eye, was in almost every respect similar to the preceding, and submitted to the same treatment. Both of them suffered frequent relapses, which were relieved by the same means, and at length perished, I believe, by the epileptic fits.

In those patients, who have not been subject to epilepsy before they have arrived to about forty years of age, and who have been intemperate in respect to spirituous potation, I have been induced to believe, that the fits were occasioned by the pain of a diseased liver; and this became more probable in one of the above subjects, who had used means to repel eruptions on the face; and thus by some stimulant application had prevented an inflammation taking place on the skin of the face instead of on some part of the liver. Secondly, as in these cases insanity had repeatedly occurred, which could not be traced from an hereditary source; there is reason to believe, that this as well as the epileptic convulsions were caused by spirituous potation; and that this therefore is the original source both of epilepsy and of insanity in those families, which are afflicted with them. This idea however brings some consolation with it; as it may be inferred, that in a few sober generations these diseases may be eradicated, which otherwise destroy the family.

M. M. Venesection. Opium. Bark. Steel. a.r.s.enic. Opium one grain twice a day for years together. See the preceding article.

8. _Epilepsia dolorifica._ Painful epilepsy. In the common epilepsy the convulsions are immediately induced, as soon as the disagreeable sensation, which causes them, commences; but in this the pain continues long with cold extremities, gradually increasing for two or three hours, till at length convulsions or madness come on; which terminate the daily paroxysm, and cease themselves in a little time afterwards.

This disease sometimes originates from a pain about the lower edge of the liver, sometimes in the temple, and sometimes in the pudendum; it recurs daily for five or six weeks, and then ceases for several months. The pain is owing to defect of action, that is, to the acc.u.mulation of sensorial power in the part, which probably sympathizes with some other part, as explained in Sect. x.x.xV. 2. XII. 5. 3. and Cla.s.s II. 1. 1. 11. and IV. 2.

2. 3.

It is the most painful malady that human nature is liable to!--See Sect.

x.x.xIV. 1. 4.

Mrs. C---- was seized every day about the same hour with violent pain on the right side of her bowels about the situation of the lower edge of the liver, without fever, which increased for an hour or two, till it became totally intolerable. After violent screaming she fell into convulsions, which terminated sometimes in fainting, with or without stertor, as in common epilepsy; at other times a tempory insanity supervened; which continued about half an hour, and the fit ceased. These paroxysms had returned daily for two or three weeks, and were at length removed by large doses of opium, like the fits of reverie or somnambulation. About half an hour before the expected return of the fit three or four grains of opium were exhibited, and then tincture of opium was given in warm brandy and water about 20 or 30 drops every half hour, till the eyes became somewhat inflamed, and the nose began to itch, and by the sharp movements of the patient, or quick speech, an evident intoxication appeared; and then it generally happened that the pain ceased. But the effects of this large dose of opium was succeeded by perpetual sickness and efforts to vomit, with great general debility all the succeeding day.

The rationale of this temporary cure from the exhibition of opium and vinous spirit depends on the great expenditure of sensorial power in the increased actions of all the irritative motions, by the stimulus of such large quant.i.ties of opium and vinous spirit; together with the production of much sensation, and many movements of the organs of sense or ideas in consequence of that sensation; and lastly, even the motions of the arterial system become accelerated by this degree of intoxication, all which soon exhausted so much sensorial power as to relieve the pain; which would otherwise have caused convulsions or insanity, which are other means of expending sensorial power. The general debility on the succeeding day, and the particular debility of the stomach, attended in consequence with sickness and frequent efforts to vomit, were occasioned by the system having previously been so strongly stimulated, and those parts in particular on which the opium and wine more immediately acted. This sickness continued so many hours as to break the catenation of motions, which had daily reproduced the paroxysm; and thus it generally happened, that the whole disease ceased for some weeks or months from one great intoxication, a circ.u.mstance not easily to be explained on any other theory.

The excess or defect of motion in any part of the system occasions the production of pain in that part, as in Sect. XII. 1. 6. This defect or excess of fibrous action is generally induced by excess or defect of the stimulus of objects external to the moving organ. But there is another source of excessive fibrous action, and consequent pain, which is from excess of volition, which is liable to affect those muscles, that have weak antagonists; as those which support the under jaw, and close the mouth in biting, and those of the calf of the leg; which are thus liable to fixed or painful contractions, as in trismus, or locked jaw, and in the cramp of the calf of the leg; and perhaps in some colics, as in that of j.a.pan: these pains, from contraction arising from excess of volition in the part from the want of the counteraction of antagonist muscles, may give occasional cause to epileptic fits, and may be relieved in the same way, either by exciting irritative and sensitive motions by the stimulus of opium and wine; or by convulsions or insanity, as described above, which are only different methods of exhausting the general quant.i.ty of sensorial power.

Considering the great resemblance between this kind of painful epilepsy and the colic of j.a.pan, as described by Kemfer; and that that disease was said to be cured by acupuncture, or the p.r.i.c.k of a needle; I directed some very thin steel needles to be made about three inches long, and of such a temper, that they would bend double rather than break; and wrapped wax thread over about half an inch of the blunt end for a handle. One of these needles, when the pain occurred, was pushed about an inch into the painful part, and the pain instantly ceased; but I was not certain, whether the fear of the patient, or the stimulus of the puncture, occasioned the cessation of pain; and as the paroxysm had continued some weeks, and was then declining, the experiment was not tried again. The disease is said to be very frequent in j.a.pan, and its seat to be in the bowels, and that the acupuncture eliminates the air, which is supposed to distend the bowel. But though the aperture thus made is too small to admit of the eduction of air; yet as the stimulus of so small a puncture may either excite a torpid part into action, or cause a spasmodic one to cease to act; and lastly, as no injury could be likely to ensue from so small a perforation, I should be inclined at some future time to give this a fairer trial in similar circ.u.mstances.

Another thing worth trial at the commencement of this deplorable disease would be electricity, by pa.s.sing strong shocks through the painful part; which, whether the pain was owing to the inaction of that part, or of some other membrane a.s.sociated with it, might stimulate them into exertion; or into inactivity, if owing to fixed painful contraction.

And lastly, the cold bath, or aspersions with cold water on the affected part, according to the method of Dr. Currie in the Memoirs of a Med. Soc.

London, V. iii. p. 147, might produce great effect at the commencement of the pain. Nevertheless opium duly administered, so as to precede the expected paroxysm, and in such doses, given by degrees, as to induce intoxication, is princ.i.p.ally to be depended upon in this deplorable malady.

To which should be added, that if venesection can be previously performed, even to but few ounces, the effect of the opium is much more certain; and still more so, if there be time to premise a brisk cathartic, or even an emetic. The effect of increased stimulus is so much greater after previous defect of stimulus; and this is still of greater advantage where the cause of the disease happens to consist in a material, which can be absorbed. See Art. IV. 2. 8.

M. M. Venesection. An emetic. A cathartic. Warm bath. Opium a grain every half hour. Wine. Spirit of wine. If the patient becomes intoxicated by the above means, the fit ceases, and violent vomitings and debility succeed on the subsequent day, and prevent a return. Blisters or sinapisms on the small of the leg, taken off when they give much pain, are of use in slighter convulsions. Acupuncture. Electricity. Aspersion with cold water on the painful part.

9. _Somnambulismus._ Sleep-walking is a part of reverie, or studium inane, described in Sect. XIX. In this malady the patients have only the general appearance of being asleep in respect to their inattention to the stimulus of external objects, but, like the epilepsies above described, it consists in voluntary exertions to relieve pain. The muscles are subservient to the will, as appears by the patient's walking about, and sometimes doing the common offices of life. The ideas of the mind also are obedient to the will, because their discourse is consistent, though they answer imaginary questions. The irritative ideas of external objects continue in this malady, because the patients do not run against the furniture of the room; and when they apply their volition to their organs of sense, they become sensible of the objects they attend to, but not otherwise, as general sensation is destroyed by the violence of their voluntary exertions. At the same time the sensations of pleasure in consequence of ideas excited by volition are vividly experienced, and other ideas seem to be excited by these pleasurable sensations, as appears in the case of Master A. Sect.

x.x.xIV. 3. 1. where a history of a hunting scene was voluntarily recalled, with all the pleasurable ideas which attended it. In melancholy madness the patient is employed in voluntarily exciting one idea, with those which are connected with it by voluntary a.s.sociations only, but not so violently as to exclude the stimuli of external objects. In reverie variety of ideas are occasionally excited by volition, and those which are connected with them either by sensitive or voluntary a.s.sociations, and that so violently as to exclude the stimuli of external objects. These two situations of our sensual motions, or ideas, resemble convulsion and epilepsy; as in the former the stimulus of external objects is still perceived, but not in the latter. Whence this disease, so far from being connected with sleep, though it has by universal mistake acquired its name from it, arises from excess of volition, and not from a suspension of it; and though, like other kinds of epilepsy, it often attacks the patients in their sleep, yet those two, whom I saw, were more frequently seized with it while awake, the sleep-walking being a part of the reverie. See Sect. XIX. and x.x.xIV. 3. and Cla.s.s II. 1. 7. 4. and III. 1. 2. 18.

M. M. Opium in large doses before the expected paroxysm.

10. _Asthma convulsivum._ The fits of convulsive asthma return at periods, and are attended with cold extremities, and so far resemble the access of an intermittent fever; but, as the lungs are not sensible to the pain of cold, a shivering does not succeed, but instead of it violent efforts of respiration; which have no tendency, as in the humoral asthma, to dislodge any offending material, but only to relieve the pain by exertion, like the shuddering in the beginning of ague-fits, as explained Cla.s.s III. 1. 1. 2.

The insensibility of the lungs to cold is observable on going into frosty air from a warm room; the hands and face become painfully cold, but no such sensation is excited in the lungs; which is another argument in favour of the existence of a peculiar set of nerves for the purpose of perceiving the universal fluid matter of heat, in which all things are immersed. See Sect.

XIV. 6. Yet are the lungs nevertheless very sensible to the deficiency of oxygen in the atmosphere, as all people experience, when they go into a room crowded with company and candles, and complain, that it is so close, they can scarcely breathe; and the same in some hot days in summer.

There are two diseases, which bear the name of asthma. The first is the torpor or inability of the minute vessels of the lungs, consisting of the terminations of the pulmonary and bronchial arteries and veins, and their attendant lymphatics; in this circ.u.mstance it resembles the difficulty of breathing, which attends cold bathing. If this continues long, a congestion of fluid in the air-cells succeeds, as the absorbent actions cease completely before the secerning ones; as explained in Cla.s.s I. 1. 2. 3. And the coldness, which attends the inaction of these vessels, prevents the usual quant.i.ty of exhalation. Some fits cease before this congestion takes place, and in them no violent sweating nor any expuition of phlegm occurs.

This is the humoral asthma, described at Cla.s.s II. 1. 1. 7.

The second kind of asthma consists in the convulsive actions in consequence of the disagreeable sensations thus induced; which in some fits of asthma are very great, as appears in the violent efforts to raise the ribs, and to depress the diaphragm, by lifting the shoulders. These, so long as they contribute to remove the cause of the disease, are not properly convulsions, but exertions immediately caused by sensation; but in this kind of asthma they are only efforts to relieve pain, and are frequently preceded by other epileptic convulsions.

These two kinds of asthmas have so many resembling features, and are so frequently intermixed, that it often requires great attention to distinguish them; but as one of them is allied to anasarca, and the other to epilepsy, we shall acquire a clearer idea of them by comparing them with those disorders. A criterion of the humoral or hydropic asthma is, that it is relieved by copious sweats about the head and breast, which are to be ascribed to the sensitive exertions of the pulmonary vessels to relieve the pain occasioned by the anasarcous congestion in the air-cells; and which is effected by the increased absorption of the mucus, and its elimination by the retrograde action of those lymphatics of the skin, whose branches communicate with the pulmonary ones; and which partial sweats do not easily admit of any other explanation. See Cla.s.s I. 3. 2. 8. Another criterion of it is, that it is generally attended with swelled legs, or other symptoms of anasarca. A criterion of the convulsive asthma may be had from the absence of these cold clammy sweats of the upper part of the body only, and from the patient having occasionally been subject to convulsions of the limbs, as in the common epilepsy.