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

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

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

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

A gentleman about 50 was seized with an uncommon degree of vertigo, so as to fall on the ground, and not to be able to turn his head, as he sat up either in his chair or in his bed, and this continued eight or ten weeks.

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

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

1. 13. and 15.

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

12. _Vertigo ebriosa._ Vertigo from intoxication is owing to the a.s.sociation of the irritative ideas of vision with the irritative motions of the stomach. Whence when these latter become much increased by the immoderate stimulus of wine, the irritative motions of the retina are produced with less energy by reverse sympathy, and become at the same time succeeded by sensation in consequence of their decreased action. See Sect.

XXI. 3. and x.x.xV. 1. 2. So conversely when the irritative motions of vision are increased by turning round, or by our unaccustomed agitation at sea, those of the stomach become inverted by reverse sympathy, and are attended in consequence with disagreeable sensation. Which decreased action of the stomach is in consequence of the increased expenditure of the sensorial power on the irritative ideas of vision, as explained in Vertigo rotatoria.

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

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

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

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

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

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

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

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

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

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

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

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

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

19. _Febris inirritativa._ Inirritative fever described in Cla.s.s I. 2. 1.

1. belongs to this place, as it consists of disordered trains and tribes of a.s.sociated irritative motions, with lessened actions of the a.s.sociated organs. In this fever the pulsations of the heart and arteries are weakened or lessened, not only in the cold paroxysm, as in the irritative fever, but also in the hot paroxysm. The capillary arteries or glands have their actions nevertheless increased after the first cold fit, as appears by the greater production of heat, and the glow of arterial blood, in the cutaneous vessels; and lastly, the action of the stomach is much impaired or destroyed, as appears by the total want of appet.i.te to solid food.

Whence it would seem, that the torpid motions of the stomach, whatever may occasion them, are a very frequent cause of continued fever with weak pulse; and that these torpid motions of the stomach do not sufficiently excite the sensorial power of a.s.sociation, which contributes in health to actuate the heart and arteries along with the irritation produced by the stimulus of the blood; and hence the actions of these organs are weaker.

And lastly, that the acc.u.mulation of the sensorial power of a.s.sociation, which ought to be expended on the motions of the heart and arteries, becomes now exerted on the cutaneous and pulmonary capillaries. See Supplement I. 8. and Sect. x.x.xV. 1. 1. and x.x.xIII. 2. 10.

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

ORDO II.

_Decreased a.s.sociate Motions._

GENUS II.

_Catenated with Sensitive Motions._

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

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

When great pain exists without causing any fibrous motions, I conjecture that it contributes to exhaust or expend the general quant.i.ty of sensorial power; because people are fatigued by enduring pain, till at length they sleep. Which is contrary to what I had perhaps erroneously supposed in Sect. x.x.xV. 2. 3. If it causes fibrous motions, it then takes the name of sensation, according to the definition of sensation in Sect. II. 2. 9.; and increased fibrous action or inflammation is the consequence. This circ.u.mstance of the general exhaustion of sensorial power by the existence of pain will a.s.sist in explaining many of the diseases of this genus.

Many of the ca.n.a.ls of the body, as the urethra, the bile-duct, the throat, have the motions of their two extremities a.s.sociated by having been accustomed to feel pleasurable or painful sensations at the same time or in succession. This is termed sensitive a.s.sociation, though those painful or pleasurable sensations do not cause the motions, but only attend them; and are thus perhaps, strictly speaking, only catenated with them.

SPECIES.

1. _Torpor genae a dolore dentis._ In tooth-ach there is generally a coldness of the cheek, which is sensible to the hand, and is attended in some degree with the pain of cold. The cheek and tooth have frequently been engaged in pleasurable action at the same time during the masticating of our food; whence they have acquired sensitive a.s.sociations. The torpor of the cheek may have for its cause the too great expenditure of sensorial power by the painful sensation of the membranes of the diseased tooth; whence the membranes of the cheek a.s.sociated with those of the alveolar process are deprived of their natural share of it, and become torpid; thus they produce less secretions, and less heat, and the pain of cold is the consequence. This torpor of the vessels of the cheek cannot be produced by the activity of the sensorial power of sensation; for then they would act more violently than natural, or become inflamed. And though the pain by exhausting so much sensorial power may be a remote cause, it is the defeat of the power of a.s.sociation, which is the immediate cause of the torpor of the cheek.

After some hours this pain occasioned by the torpor of the vessels of the cheek either gradually ceases along with the pain of the diseased tooth; or, by the acc.u.mulation of sensorial power during their state of torpor, the capillaries of the cheek act with greater violence, and produce more secretions, and heat, and consequent tumour, and inflammation. In this state the pain of the diseased tooth ceases; as the sensorial power of sensation is now expended on the inflamed vessels of the cheek. It is probable that most other internal membranous inflammations begin in a similar manner; whence there may seem to be a double kind of sensitive a.s.sociation; first, with decreased action of the a.s.sociated organ, and then with increased action of it; but the latter is in this case simply the consequence of the former; that is, the tumor or inflammation of the cheek is in consequence of its previous quiescence or torpor.

2. _Stranguria a dolore vesicae._ The strangury, which has its origin from pain at the neck of the bladder, consists of a pain in the external extremity of the urethra or of the glans p.e.n.i.s of men, and probably in the external termination of the urethra or of the c.l.i.toris of women; and is owing to the sympathy of these with some distant parts, generally with the other end of the urethra; an endeavour and difficulty of making water attends this pain.

Its remote cause is from the internal or external use of cantharides, which stimulate the neck of the bladder; or from a stone, which whenever it is pushed into the neck of the bladder, gives this pain of strangury, but not at other times; and hence it is felt most severely in this case after having made water.

The sensations or sensitive motions of the glans p.e.n.i.s, and of the sphincter of the bladder, have been accustomed to exist together during the discharge of the urine; and hence the two ends of the urethra sympathize by a.s.sociation. When there is a stone at the neck of the bladder, which is not so large or rough as to inflame the part, the sphincter of the bladder becomes stimulated into pain; but as the glans p.e.n.i.s is for the purposes of copulation more sensitive than the sphincter of the bladder, as soon as it becomes affected with pain by the a.s.sociation above mentioned, the sensation at the neck of the bladder ceases; and then the pain of the glans p.e.n.i.s would seem to be a.s.sociated with the irritative motions only of the sphincter of the bladder, and not with the sensitive ones of it. But a circ.u.mstance similar to this occurs in epileptic fits, which at first are induced by disagreeable sensation, and afterwards seem to occur without previous pain, from the suddenness in which they follow and relieve the pain, which occasioned them. From this a.n.a.logy I imagine the pain of the glans p.e.n.i.s is a.s.sociated with the pain of the sphincter of the bladder; but that _as soon as the greater pain in a more sensible part is produced; the lesser one, which occasioned it, ceases_; and that this is one of the laws of sensitive a.s.sociation. See Sect. x.x.xV. 2. 1.

A young man had by an accident swallowed a large spoonful or more of tincture of cantharides; as soon as he began to feel the pain of strangury, he was advised to drink large quant.i.ties of warmish water; to which, as soon as it could be got, some gum arabic was added. In an hour or two he drank by intervals of a few minutes about two gallons of water, and discharged his urine every four or five minutes. A little blood was voided towards the end, but he suffered no ill consequence.

M. M. Warm water internally. Clysters of warm water. Fomentation. Opium.

Solution of fixed alkali supersaturated with carbonic acid. A bougie may be used to push back a stone into the bladder. See Cla.s.s I. 1. 3. 10.

3. _Stranguria convulsiva._ The convulsive strangury, like that before described, is probably occasioned by the torpor or defective action of the painful part in consequence of the too great expenditure of sensorial power on the primary link of the a.s.sociated motions, as no heat or inflammation attends this violent pain. This kind of strangury recurs by stated periods, and sometimes arises to so great a degree, that convulsion or temporary madness terminates each period of it. It affects women oftener than men, is attended with cold extremities without fever, and is distinguished from the stone of the bladder by the regularity of its periods, and by the pain being not increased after making water.

On introducing the catheter sometimes part of the urine will come away and not the whole, which is difficult to explain; but may arise from the weakness of the muscular fibres of the bladder; which are not liable suddenly to contract themselves so far as to exclude the whole of the urine. In some old people, who have experienced a long retention of urine, the bladder never regains the power of completely emptying itself; and many who are beginning to be weak from age can make water a second time, a few minutes after they supposed they had emptied the bladder.

I have believed this pain to originate from sympathy with some distant part, as from ascarides in the r.e.c.t.u.m, or from piles in women; or from caruncles in the urethra about the caput gallinaginis in men; and that the pain has been in the glans or c.l.i.toris by reverse sympathy of these more sensible parts with those above mentioned.

M. M. Venesection. Opium in large quant.i.ties. Warm bath. Balsams. Bark.

Tincture of cantharides. Bougie, and the treatment for haemorrhoids. Leeches applied to the sphincter ani. Aerated alcaline water. Soap and sal soda.

Opium in clysters given an hour before the expected return. Smoke of tobacco in clysters. a.r.s.enic?

4. _Dolor termini intestinalis ductus choledochi._ Pain at the intestinal end of the gall-duct. When a gall-stone is protruded from the gall-bladder a little way into the end of the gall-duct, the pain is felt at the other end of the gall-duct, which terminates in the duodenum. For the actions of the two terminations of this ca.n.a.l are a.s.sociated together from the same streams of bile pa.s.sing through them in succession, exactly as the two terminations of the urethra have their actions a.s.sociated, as described in Species 2 and 3 of this genus. But as the intestinal termination of the bile-duct is made more sensible for the purpose of bringing down more bile, when it is stimulated by new supplies of food from the stomach, it falls into violent pain from a.s.sociation; and then the pain on the region of the gall-bladder ceases, exactly as above explained in the account of the pain of the glans p.e.n.i.s from a stone in the sphincter of the bladder.

The common bile-duct opens into the intestine exactly at what is called the pit of the stomach; and hence it has sometimes happened, that this pain from a.s.sociation with the sensation of a gall-stone at the other end of the bile-duct has been mistaken for a pain of the stomach.