The reverse sympathy between the lacteal and lymphatic branches of the absorbent system have been produced by the one branch being less excited to act, when the other supplies sufficient fluid or nutriment to the sanguiferous vessels. Thus when the stomach is full, and the supply of chyle and mucus and water is in sufficient quant.i.ty; the pulmonary, cellular, and cutaneous lymphatics are not excited into action; whence the urine is pale, and the skin moist, from the defect of absorption on those surfaces.

7. _Syngultus nephriticus._ When a stone irritates the ureter, and that even without its being attended with pain or fever, sometimes a chronical hiccough occurs, and continues for days and weeks, instead of sickness or vomiting; which are the common symptoms. In this case the motions of the stomach are decreased by their sympathy with those of the ureter, which are increased by the stimulus of the stone in it; and the increased motions of the diaphragm seem to exist in consequence of their a.s.sociation with the stomach by a second reverse sympathy. This hiccough may nevertheless admit of another explanation, and be supposed to be a convulsive exertion of the diaphragm to relieve the disagreeable sensation of the stomach in consequence of its disordered irritative a.s.sociations; and in that case it would belong to Cla.s.s III. 1. 1. See Cla.s.s IV. 2. 1. for another example of tertiary a.s.sociation.

M. M. Venesection. Emetic. Calomel. Cathartic, opium, oil of cinnamon from two to ten drops. Aerated alcaline water. Peruvian bark.

8. _Febris irritativa._ Irritative fever, described in Cla.s.s I. 1. 1. 1.

The diseases above explained in this genus are chiefly concerning the sympathies of the absorbent system, or the alimentary ca.n.a.l, which are not so much a.s.sociated with the arterial system, as to throw it into disorder, when they are slightly deranged; but when any great congeries of conglomerate glands, which may be considered as the extremities of the arterial system, are affected with torpor, the whole arterial system and the heart sympathize with the torpid glands, and act with less energy; which const.i.tutes the cold fit of fever; which is therefore at first a decreased action of the a.s.sociate organ; but as this decrease of action is only a temporary effect, and an increase of exertion both of the torpid glands, and of the whole arterial system, soon follows; the hot fit of irritative fever, or fever with strong pulse, properly belongs to this cla.s.s and genus of diseases.

ORDO I.

_Increased a.s.sociate Motions._

GENUS II.

_Catenated with Sensitive Motions._

The primary links of the a.s.sociated actions of this genus are either produced or attended by painful or pleasurable sensation. The secondary links of the first ten species are attended with increased motions without inflammation, those of the remainder are attended with inflammation. All inflammations, which do not arise in the part which was previously torpid, belong to this genus; as the gout, rheumatism, erysipelas. It is probable many other inflammations may, by future observation, require to be transplanted into this cla.s.s.

The circles of sensitive a.s.sociate motions consist chiefly of the excretory ducts of the capillaries and of the mouths of the absorbent vessels, which const.i.tute the membranes; and which have been induced into action at the same time; or they consist of the terminations of ca.n.a.ls; or of parts which are endued with greater sensibility than those which form the first link of the a.s.sociation. An instance of the first of those is the sympathy between the membranes of the alveolar processes of the jaws, and the membranes above or beneath the muscles about the temples in hemicrania. An instance of the second is in the sympathy between the excretory duct of the lacrymal gland, and the nasal duct of the lacrymal sack. And an instance of the third is the sympathy between the membranes of the liver, and the skin of the face in the gutta rosea of inebriates.

SPECIES.

1. _Lacrymarum fluxus sympatheticus._ A flow of tears from grief or joy.

When the termination of the duct of the lacrymal sac in the nostrils becomes affected either by painful or pleasurable sensations, in consequence of external stimulus, or by its a.s.sociation with agreeable or disagreeable ideas, the motions of the lacrymal gland are at the same time exerted with greater energy, and a profusion of tears succeeds by sensitive a.s.sociation, as explained in Sect. XVI. 8. 2.

In this case there exists a chain of a.s.sociated actions, the secretion of the lacrymal gland is increased by whatever stimulates the surface of the eye, at the same time the increased abundance of tears stimulates the puncta lacrymalia into greater action; and the fluid thus absorbed stimulates the lacrymal sac, and its nasal duct in the nose into greater action. In a contrary direction of this chain of a.s.sociation the present increase of action is induced. First, the nasal duct of the lacrymal sac is excited into increased action by some pleasurable or painful idea, as described in Sect. XVI. 8. 2. 2d. The puncta lacrymalia or other extremity of the lacrymal sac sympathizes with it (as the two ends of all other ca.n.a.ls sympathize with each other). 3d. With these increased motions of the puncta lacrymalia those of the excretory duct of the lacrymal gland are a.s.sociated from their having so perpetually acted together. And, lastly, with the increased actions of the excretory duct of this gland are a.s.sociated those of the other end of it by their frequently acting together; in the same manner as the extremities of other ca.n.a.ls are a.s.sociated; and thus a greater flow of tears is poured into the eye.

When a flow of tears is produced in grief, it is believed to relieve the violence of it, which is worthy a further inquiry. Painful sensations, when great, excite the faculty of volition; and the person continues voluntarily to call up or perform those ideas, which occasion the painful sensation; that is, the afflicted person becomes so far insane or melancholy; but tears are produced by the sensorial faculty of a.s.sociation, and shew that the pain is so far relieved as not to excite the excessive power of volition, or insanity, and are therefore a sign of the abatement of the painful state of grief, rather than a cause of that abatement. See Cla.s.s III. 1. 2. 10.

2. _Sternutatio a lumine._ Some persons sneeze from looking up at the light sky in a morning after coming out of a dark bedroom. The olfactory nerves are brought into too great action by their sympathy with the optic nerves, or by their respective sympathies with some intervening parts, as probably with the two extremities of the lacrymal sac; that is, with the puncta lacrymalia and the nasal duct. See Cla.s.s II. 1. 1. 3.

3. _Dolor dentium Stridore._ Tooth-edge from grating sounds, and from the touch of certain substances, and even from imagination alone, is described and explained in Sect. XVI. 10. The increased actions of the alveolar vessels or membranes are a.s.sociated with the ideas, or sensual motions of the auditory nerves in the first case; and of those of the sense of touch, in the second case; and by imagination, or ideas exerted of painful sensation alone, in the last.

4. _Risus sardonicus._ A disagreeable smile attends inflammations of the diaphragm arising from the a.s.sociations of the reiterated exertions of that muscle with those of the lips and cheeks in laughing. See Diaphragmitis, Cla.s.s II. 1. 2. 6.

5. _Salivae fluxus cibo viso._ The flow of saliva into the mouths of hungry animals at the sight or smell of food is seen in dogs standing round a dinner-table. The increased actions of the salivary glands have been usually produced by the stimulus of agreeable food on their excretory ducts during the mastication of it; and with this increased action of their excretory ducts the other terminations of those glands in the capillary arteries have been excited into increased action by the mutual a.s.sociation of the ends of ca.n.a.ls; and at the same time the pleasurable ideas, or sensual motions, of the sense of smell and of sight have accompanied this increased secretion of saliva. Hence this chain of motions becomes a.s.sociated with those visual or olfactory ideas, or with the pleasure, which produces or attends them.

6. _Tensio mamularum viso puerulo._ The nipples of lactescent women are liable to become turgid at the sight of their young offspring. The nipple has generally been rendered turgid by the t.i.tillation of the lips or gums of the child in giving suck; the visible idea of the child has thus frequently accompanied this pleasurable sensation of parting with the milk, and turgescence of the tubes, which const.i.tute the nipple. Hence the visual idea of the child, and the pleasure which attends it, become a.s.sociated with those increased arterial actions, which swell the cells of the mamula, and extend its tubes; which is very similar to the tensio phalli visa muliere nuda etiam in insomnio.

7. _Tensio p.e.n.i.s in hydrophobia._ An erection of the p.e.n.i.s occurs in the hydrophobia, and is a troublesome symptom, as observed by Coelius Aurelia.n.u.s, Fothergill, and Vaughn, and would seem to be produced by an unexplained sympathy between the sensations about the fauces and the p.e.n.i.s.

In men the hair grows about both these parts, the voice changes, and the neck thickens at p.u.b.erty. In the mumps, when the swellings about the throat subsides, the t.e.s.t.i.c.l.es are liable to swell. Venereal infection received by the p.e.n.i.s is very liable to affect the throat with ulcers. Violent coughs, with soreness or rawness about the fauces are often attended with erection of the p.e.n.i.s; which is also said to happen to male animals, that are hanged; which last circ.u.mstance has generally been ascribed to the obstruction of the circulation of the blood, but is more probably occasioned by the stimulus of the cord in compressing the throat; since if it was owing to impeded circulation it ought equally to occur in drowning animals.

In men the throat becomes so thickened at the time of p.u.b.erty, that a measure of this is used to ascertain the payment of a poll-tax on males in some of the islands of the Mediterranean, which commences at p.u.b.erty; a string is wrapped twice round the thinnest part of the neck, the ends of it are then put into each corner of the mouth; and if, when thus held in the teeth, it pa.s.ses readily over the head, the subject is taxable.

It is difficult to point out by what circ.u.mstance the sensitive motions of the p.e.n.i.s and of the throat and nose become a.s.sociated; I can only observe, that these parts are subjected to greater pleasurable sensations than any other parts of the body; one being designed to preserve ourselves by the pleasure attending the smell and deglut.i.tion of food, and the other to ensure the propagation of our species; and may thus gain an a.s.sociation of their sensitive motion by their being eminently sensible to pleasure. See Cla.s.s I. 3. 1. 11. and III. 1. 1. 15. and Sect. XVI. 5.

In the female s.e.x this a.s.sociation between the face, throat, nose, and pubis does not exist; whence no hair grows on their chins at the time of p.u.b.erty, nor does their voices change, or their necks thicken. This happens probably from there being in them a more exquisite sensitive sympathy between the pubis and the b.r.e.a.s.t.s. Hence their b.r.e.a.s.t.s swell at the time of p.u.b.erty, and secrete milk at the time of parturition. And in the parot.i.tis, or mumps, the b.r.e.a.s.t.s of women swell, when the tumor of the parot.i.tis subsides. See Cla.s.s I. 1. 2. 15. Whence it would appear, that their b.r.e.a.s.t.s possess an intermediate sympathy between the pubis and the throat; as they are the seat of a pa.s.sion, which men do not possess, that of suckling children.

8. _Tenesmus calculosus._ The sphincter of the r.e.c.t.u.m becomes painful or inflamed from the a.s.sociation of its sensitive motions with those of the sphincter of the bladder, when the latter is stimulated into violent pain or inflammation by a stone.

9. _Polypus narium ex ascaridibus?_ The stimulation of ascarides in the r.e.c.t.u.m produces by sensitive sympathy an itching of the nose, as explained in IV. 2. 2. 6; and in three children I have seen a polypus in the nose, who were all affected with ascarides; to the perpetual stimulation of which, and the consequent sensitive a.s.sociation, I was led to ascribe the inflammation and thickening of the membrane of the nostrils.

10. _Crampus surarum in cholera._ A cramp of the muscles of the legs occurs in violent diarrhoea, or cholera, and from the use of too much acid diet in gouty habits. This seems to sympathize with uneasy sensation in the bowels.

See Cla.s.s III. 1. 1. 14. This a.s.sociation is not easily accounted for, but is a.n.a.logous in some degree to the paralysis of the muscles of the arms in colica saturnina. It would seem, that the muscles of the legs in walking get a sympathy with the lower parts of the intestines, and those of the arms in variety of employment obtain a sympathy with the higher parts of them. See Cholera and Ileus.

11. _Zona ignea nephritica._ Nephritic shingles. The external skin about the loins and sides of the belly I suppose to have greater mobility in respect to sensitive a.s.sociation, than the external membrane of the kidney; and that their motions are by some unknown means thus a.s.sociated. When the torpor or beginning inflammation of this membrane ceases, the external skin becomes inflamed, in its stead, and a kind of herpes, called the shingles, covers the loins and sides of the belly. See Cla.s.s II. 1. 5. 9.

12. _Eruptio variolarum._ After the inflammation of the inoculated arm has spread for a quarter of a lunation, it affects the stomach by reverse sympathy; that is, the actions of the stomach are a.s.sociated with those of the skin; and as much sensorial power is now exerted on the inflamed skin, the other part of this sensitive a.s.sociation is deprived of its natural share, and becomes torpid, or inverts its motions. After this torpor of the stomach has continued a time, and much sensorial power is thus acc.u.mulated; other parts of the skin, which are also a.s.sociated with it, as that of the face first, are thrown into partial inflammation; that is, the eruptions of the small-pox appear on the face.

For that the variolous matter affects the stomach previous to its eruption on the skin appears from the sickness at the commencement of the fever; and because, when the morbid motions affect the skin, those of the stomach cease; as in the gout and erysipelas, mentioned below. The consent between the stomach and the skin appears in variety of other diseases; and as they both consist of surfaces, which absorb and secrete a quant.i.ty of moisture, their motions must frequently be produced together or in succession; which is the foundation of all the sympathies of animal motions, whether of the irritative, sensitive, or voluntary kinds.

Now as the skin, which covers the face, is exposed to greater variations of heat and cold than any other part of the body; it probably possesses more mobility to sensitive a.s.sociations, not only than the stomach, but than any other part of the skin; and is thence affected at the eruption of the small-pox with violent action and consequent inflammation, by the a.s.sociation of its motions with those of the stomach, a day before the other parts of the skin; and becomes fuller of pustules, than any other part of the body. See Cla.s.s II. 1. 3. 9.

It might be supposed, that the successive swelling of the hands, when the face subsides, at the height of the small-pox, and of the feet, when the hands subside, were governed by some unknown a.s.sociations of those parts of the system; but these successions of tumor and subsidence more evidently depend on the times of the eruption of the pustules on those parts, as they appear a day sooner on the face than on the hands, and a day sooner on the hands than on the feet, owing to the greater comparative mobility of those parts of the skin.

13. _Gutta rosea stomatica._ Stomatic red face. On drinking cold water, or cold milk, when heated with exercise, or on eating cold vegetables, as raw turnips, many people in harvest-time have been afflicted with what has been called a surfeit. The stomach becomes painful, with indigestion and flatulency, and after a few days an eruption of the face appears, and continues with some relief, but not with entire relief; as both the pimpled face and indigestion are liable to continue even to old age.

M. M. Venesection. A cathartic with calomel. Then half a grain of opium twice a day for many weeks. If saturated solution of a.r.s.enic three or five drops twice or thrice a day for a week?

14. _Gutta rosea hepatica._ The rosy drop of the face of some drinking people is produced like the gout described below, in consequence of an inflamed liver. In these const.i.tutions the skin of the face being exposed to greater variation of heat and cold than the membranes of the liver, possesses more mobility than those hepatic membranes; and hence by whatever means these membranes are induced to sympathize, when this sensitive a.s.sociation occurs, the cutaneous vessels of the face run into greater degrees of those motions, which const.i.tute inflammation, than previously existed in the membranes of the liver; and then those motions of the liver cease. See Cla.s.s II. 1. 4. 6.

An inflammation of the liver so frequently attends the great potation of vinous spirit, there is reason to suspect, that this viscus itself becomes inflamed by sensitive a.s.sociation with the stomach; or that, when one termination of the bile-duct, which enters the duodenum is stimulated violently, the other end may become inflamed by sensitive a.s.sociation.

15. _Podagra._ The gout, except when it affects the liver or stomach, seems always to be a secondary disease, and, like the rheumatism and erysipelas mentioned below, begins with the torpor of some distant part of the system.

The most frequent primary seat of the gout I suppose to be the liver, which is probably affected with torpor not only previous to the annual paroxysms of the gout, but to every change of its situation from one limb to another.

The reasons, which induce me to suspect the liver to be first affected, are not only because the jaundice sometimes attends the commencement of gout, as described in Sect. XXIV. 2. 8. but a pain also over the pit of the stomach, which I suppose to be of the termination of the bile-duct in the duodenum, and which is erroneously supposed to be the gout of the stomach, with indigestion and flatulency, generally attends the commencement of the inflammation of each limb. See Arthritis ventriculi, Cla.s.s I. 2. 4. 6. In the two cases, which I saw, of the gout in the limbs being preceded by jaundice, there was a cold shivering fit attended the inflammation of the foot, and a pain at the pit of the stomach; which ceased along with the jaundice, as soon as the foot became inflamed. This led me to suspect, that there was a torpor of the liver, and perhaps of the foot also, but nevertheless the liver might also in this case be previously inflamed, as observed in Sect. XXIV. 2. 8.

Now as the membranes of the joints of the feet suffer greater variations of heat and cold than the membranes of the liver, and are more habituated to extension and contraction than other parts of the skin in their vicinity; I suppose them to be more mobile, that is, more liable to run into extremes of exertion or quiescence; and are thence more susceptible of inflammation, than such parts as are less exposed to great variations of heat and cold, or of extension and contraction.

When a stone presses into the sphincter of the bladder, the glans p.e.n.i.s is affected with greater pain by sympathy, owing to its greater sensibility, than the sphincter of the bladder; and when this pain commences, that of the sphincter ceases, when the stone is not too large, or pushed too far into the urethra. Thus when the membrane, which covers the ball of the great toe, sympathizes with some membranous part of a torpid or inflamed liver; this membrane of the toe falls into that kind of action, whether of torpor or inflammation, with greater energy, than those actions excited in the diseased liver; and when this new torpor or inflammation commences, that with which it sympathises ceases; which I believe to be a general law of a.s.sociated inflammations.

The paroxysms of the gout would seem to be catenated with solar influence, both in respect to their larger annual periods, and to their diurnal periods--See Sect. x.x.xVI. 3. 6.--as the former occur about the same season of the year, and the latter commence about an hour before sun-rise; nevertheless the annual periods may depend on the succession of great vicissitudes of cold and heat, and the diurnal ones on our increased sensibility to internal sensations during sleep, as in the fits of asthma, and of some epilepsies. See Sect. XVIII. 15.

In respect to the pre-remote cause or disposition to the gout, there can be no doubt of its individually arising from the potation of fermented or spirituous liquors in this country; whether opium produces the same effect in the countries, where it is in daily use, I have never been well informed. See Sect. XXI. 10, where this subject is treated of; to which I have to add, that I have seen some, and heard of others, who have moderated their paroxysms of gout, by diminishing the quant.i.ty of fermented liquors, which they had been accustomed to; and others who, by a total abstinence from fermented liquors, have entirely freed themselves from this excruciating malady; which otherwise grows with our years, and curtails or renders miserable the latter half, or third, of the lives of those, who are subject to it. The remote cause is whatever induces temporary torpor or weakness of the system; and the proximate cause is the inirritability, or defective irritation, of some part of the system; whence torpor and consequent inflammation. The great Sydenham saw the beneficial effects of the abstinence from fermented liquors in preventing the gout, and adds, "if an empiric could give small-beer only to gouty patients as a nostrum, and persuade them not to drink any other spirituous fluids, that he might rescue thousands from this disease, and acquire a fortune for his ingenuity." Yet it is to be lamented, that this accurate observer of diseases had not resolution to practise his own prescription, and thus to have set an example to the world of the truth of his doctrine; but, on the contrary, recommends Madeira, the strongest wine in common use, to be taken in the fits of the gout, to the detriment of thousands; and is said himself to have perished a martyr to the disease, which he knew how to subdue!

As example has more forcible effect: than simple a.s.sertion, I shall now concisely relate my own case, and that of one of my most respected friends.

E. D. was about forty years of age, when he was first seized with a fit of the gout. The ball of his right great toe was very painful, and much swelled and inflamed, which continued five or six days in spite of venesection, a brisk cathartic with ten grains of calomel, and the application of cold air and cold water to his foot. He then ceased to drink ale or wine alone; confining himself to small beer, or wine diluted with about thrice its quant.i.ty of water. In about a year he suffered two other fits of the gout, in less violent degree. He then totally abstained from all fermented liquors, not even tasting small-beer, or a drop of any kind of wine; but eat plentifully of flesh-meat, and all kinds of vegetables, and fruit, using for his drink at meals chiefly water alone, or lemonade, or cream and water; with tea and coffee between them as usual.

By this abstinence from fermented liquors he kept quite free from the gout for fifteen or sixteen years; and then began to take small-beer mixed with water occasionally, or wine and water, or perry and water, or cyder and water; by which indulgence after a few months he had again a paroxysm of gout, which continued about three days in the ball of his toe; which occasioned him to return to his habit of drinking water, and has now for above twenty years kept in perpetual health, except accidental colds from the changes of the seasons. Before he abstained from fermented or spirituous liquors, he was frequently subject to the piles, and to the gravel, neither of which he has since experienced.

In the following case the gout was established by longer habit and greater violence, and therefore required more cautious treatment. The Rev. R. W.

was seized with the gout about the age of thirty-two, which increased so rapidly that at the age of forty-one he was confined to his room seven months in that year; he had some degree of lameness during the intervals, with chalky swellings of his heels and elbows. As the disease had continued so long and so violently, and the powers of his digestion were somewhat weakened, he was advised not entirely to leave off all fermented liquors; and as small-beer is of such various strength, he was advised to drink exactly two wine gla.s.ses, about four ounces, of wine mixed with three or four times its quant.i.ty of water, with or without lemon and sugar, for his daily potation at dinner, and no other fermented liquor of any kind; and was advised to eat flesh-meat with any kind of boiled vegetables, and fruit, with or without spice. He has now scrupulously continued this regimen for above five years, and has had an annual moderate gouty paroxysm of a few weeks, instead of the confinement of so many months, with great health and good spirits during the intervals.

The following is a more particular account of the history of this case; being part of a letter which Mr. Wilmot wrote on that subject at my entreaty.