GENUS. IV.

_Catenated with External Influences._

SPECIES.

1. _Catarrhus periodicus._ Periodical catarrh is not a very uncommon disease; there is a great discharge of a thin saline mucous material from the membranes of the nostrils, and probably from the maxillary and frontal sinuses, which recur once a day at exact solar periods; unless it be disturbed by the exhibition of opium; and resembles the periodic cough mentioned below. See Cla.s.s I. 3. 2. 1. It is probably owing to the retrograde action of the lymphatics of the membranes affected, and produced immediately by solar influence.

2. _Tussis periodica._ Periodic cough, called nervous cough, and tussis serina. It seems to arise from a periodic retrograde action of the lymphatics of the membrane, which lines the air-cells of the lungs. And the action of coughing, which is violently for an hour or longer, is probably excited by the stimulus of the thin fluid thus produced, as well as by the disagreeable sensation attending membranous inactivity; and resembles periodic catarrh not only in its situation on a mucous membrane, but in the discharge of a thin fluid. As it is partly restrainable, it does not come under the name of convulsion; and as it is not attended with difficult respiration, it cannot be called asthma; it is cured by very large doses of opium, see a case and cure in Sect. x.x.xVI. 3. 9. see Cla.s.s IV. 2. 4. 6. and seems immediately to be induced by solar influence.

3. _Histeria a frigore._ Hysteric paroxysms are occasioned by whatever suddenly debilitates the system, as fear, or cold, and perhaps sometimes by external moisture of the air, as all delicate people have their days of greater or less debility, see Cla.s.s IV. 3. 1. 8.

4. _Nausea pluvialis._ Sickness at the commencement of a rainy season is very common among dogs, who a.s.sist themselves by eating the agrostris canina, or dog's gra.s.s, and thus empty their stomachs. The same occurs with less frequency to cats, who make use of the same expedient. See Sect. XVI.

11. I have known one person, who from his early years has always been sick at the beginning of wet weather, and still continues so. Is this owing to a sympathy of the mucous membrane of the stomach with the mechanical relaxation of the external cuticle by a moister atmosphere, as is seen in the corrugated cuticle of the hands of washing-women? or does it sympathize with the mucous membrane of the lungs, which must be affected along with the mucus on its surface by the respiration of a moister atmosphere?

SUPPLEMENT TO CLa.s.s IV.

_Sympathetic Theory of Fever._

As fever consists in the increase or diminution of direct or reverse a.s.sociated motions, whatever may have been the remote cause of them, it properly belongs to the fourth cla.s.s of diseases; and is introduced at the end of the cla.s.s, that its great difficulties might receive elucidation from the preceding parts of it. These I shall endeavour to enumerate under the following heads, trusting that the candid reader will discover in these rudiments of the theory of fever a nascent embryon, an infant Hercules, which Time may rear to maturity, and render serviceable to mankind.

I. Simple fever of two kinds.

II. Compound fever.

III. Termination of the cold fit.

IV. Return of the cold fit.

V. Sensation excited in fever.

VI. Circles of a.s.sociated motions.

VII. Alternations of cold and hot fits.

VIII. o.r.g.a.s.m of the capillaries.

IX. Torpor of the lungs.

X. Torpor of the brain.

XI. Torpor of the heart and arteries.

XII. Torpor of the stomach and intestines.

XIII. Case of continued fever explained.

XIV. Termination of continued fever.

XV. Inflammation excited in fever.

XVI. Recapitulation.

I. _Simple fever._

1. When a small part of the cutaneous capillaries with their mucous or perspirative glands are for a short time exposed to a colder medium, as when the hands are immersed in iced water for a minute, these capillary vessels and their glands become torpid or quiescent, owing to the eduction of the stimulus of heat. The skin then becomes pale, because no blood pa.s.ses through the external capillaries; and appears shrunk, because their sides are collapsed from inactivity, not contracted by spasm; the roots of the hair are left prominent from the seceding or subsiding of the skin around them; and the pain of coldness is produced.

In this situation, if the usual degree of warmth be applied, these vessels regain their activity; and having now become more irritable from an acc.u.mulation of the sensorial power of irritation during their quiescence, a greater exertion of them follows, with an increased glow of the skin, and another kind of pain, which is called the hot-ach; but no fever, properly so called, is yet produced; as this effect is not universal, nor permanent, nor recurrent.

2. If a greater part of the cutaneous capillaries with their mucous and perspirative glands be exposed for a longer time to cold, the torpor or quiescence becomes extended by direct sympathy to the heart and arteries; which is known by the weakness, and consequent frequency of the pulse in cold fits of fever.

This requires to be further explained. The movements of the heart and arteries, and the whole of the circulatory vessels, are in general excited into action by the two sensorial powers of irritation, and of a.s.sociation.

The former is excited by stimulus, the latter by the previous actions of a part of the vital circle of motions. In the above situation the capillaries act weakly from defect of irritation, which is caused by deficient stimulus of heat; but the heart and arteries act weakly from defect of a.s.sociation, which is owing to the weak action of the capillaries; which does not now excite the sensorial power of a.s.sociation into action with sufficient energy.

After a time, either by the application of warmth, or by the increase of their irritability owing to the acc.u.mulation of the sensorial power of irritation during their previous quiescence, the capillary vessels and glands act with greater energy than natural; whence the red colour and heat of the skin. The heart and arteries acquire a greater strength of pulsation, and continue the frequency of it, owing to the acc.u.mulation of the sensorial power of a.s.sociation during their previous torpor, and their consequent greater a.s.sociability; which is now also more strongly excited by the increased actions of the capillaries. And thus a fit of simple fever is produced, which is termed Febris irritativa; and consists of a torpor of the cutaneous capillaries with their mucous and perspirative glands, accompanied with a torpor of the heart and arteries; and afterwards of an increased action of all these vessels, by what is termed direct sympathy.

This fever, with strong pulse without inflammation, or febris irritativa, described in Cla.s.s I. 1. 1. 1. is frequently seen in vernal intermittents, as the o.r.g.a.s.m of the heart and arteries is then occasioned by their previous state of torpor; but more rarely I believe exists in the type of continued fever, except there be an evident remission, or approximation to a cold fit; at which time a new acc.u.mulation of the sensorial power of a.s.sociation is produced; which afterwards actuates the heart and arteries with unnatural vigour; or unless there be some stimulus perpetually acting on the system so as to induce an increased secretion of sensorial power in the brain, as occurs in slight degrees of intoxication. Since without one or other of these circ.u.mstances in continued fevers without inflammation, that is, without the additional sensorial power of sensation being introduced, it seems difficult to account for the production of so great a quant.i.ty of sensorial power, as must be necessary to give perpetual increase of action to the whole sanguiferous system.

3. On the contrary, while the cutaneous capillaries with their mucous and perspirative glands acquire an increased irritability, as above, by the acc.u.mulation of that sensorial power during their previous quiescence, and thus const.i.tute the hot fit of fever; if the heart and arteries do not acquire any increase of a.s.sociability, but continue in their state of torpor, another kind of simple fever is produced; which is generally of the continued kind, and is termed Febris inirritativa; which consists of a previous torpor of the capillaries of the skin, and of the heart and arteries by direct sympathy with them; and afterwards of an o.r.g.a.s.m or increased action of the capillaries of the skin, with a decreased action, or continued torpor, of the heart and arteries by reverse sympathy with them. This o.r.g.a.s.m of the cutaneous capillaries, which appears by the blush and heat of the skin, is at first owing to the acc.u.mulation of the sensorial power of irritation during their previous torpid state, as in the febris irritata above described; but which is afterwards supported or continued by the reverse sympathy of these capillaries with the torpid state of the heart and arteries, as will be further explained in article 8 of this Supplement.

4. The renovated activity of the capillaries commences as soon or sooner than that of the heart and arteries after the cold fit of irritative fever; and is not owing to their being forced open by the blood being impelled into them mechanically, by the renovated action of the heart and arteries; for these capillaries of the skin have greater mobility than the heart and arteries, as appears in the sudden blush of shame; which may be owing to their being more liable to perpetual varieties of activity from their exposure to the vicissitudes of atmospheric heat. And because in inirritative fevers, or those with arterial debility, the capillaries acquire increased strength, as is evinced by the heat of the skin, while the pulsations of the heart and arteries remain feeble.

5. It was said above, that the cutaneous capillaries, when they were rendered torpid by exposure to cold, either recovered their activity by the reapplication of external warmth; or by their increased irritability, which is caused by the acc.u.mulation of that sensorial power during their quiescence. An example of the former of these may be seen on emerging from a very cold bath; which produces a fit of simple fever; the cold fit, and consequent hot fit, of which may be prolonged by continuing in the bath; which has indeed proved fatal to some weak and delicate people, and to others after having been much exhausted by heat and exercise. See Sect.

x.x.xII. 3. 2. An example of the latter may be taken from going into a bath of about eighty degrees of heat, as into the bath at Buxton, where the bather first feels a chill, and after a minute becomes warm, though he remains in the same medium, owing to the increase of irritability from the acc.u.mulation of that sensorial power during the short time, which the chilness continued.

6. Hence simple fevers are of two kinds; first, the febris irritativa, or fever with strong pulse; which consists of a previous torpor of the heart, arteries, and capillaries, and a succeeding o.r.g.a.s.m of those vessels.

Secondly, the febris inirritativa, or fever with weak pulse, which consists of a previous torpor of the heart, arteries, and capillaries; and of a succeeding o.r.g.a.s.m of the capillaries, the torpor of the heart and arteries continuing. But as the frequency of the pulse occurs both in the state of torpor, and in that of o.r.g.a.s.m, of the heart and arteries; this const.i.tutes a criterion to distinguish fever from other diseases, which are owing to the torpor of some parts of the system, as paresis, and hemicrania.

7. The reader will please to observe, that where the cutaneous or pulmonary capillaries are mentioned, their mucous and perspirative glands are to be understood as included; but that the absorbents belonging to those systems of vessels, and the commencement of the veins, are not always included; as these are liable to torpor separately, as in anasarca, and petechiae; or to o.r.g.a.s.m, or increased action, as in the exhibition of strong emetics, or in the application of vinegar to the lips; yet he will also please to observe, that an increased or decreased action of these absorbents and veins generally occurs along with that of the capillaries, as appears by the dry skin in hot fits of fever; and from there being generally at the same time no acc.u.mulation of venous blood in the cutaneous vessels, which would appear by its purple colour.

II. _Compound fever._

1. When other parts of the system sympathize with this torpor and o.r.g.a.s.m of the cutaneous capillaries, and of the heart and arteries; the fever-fit becomes more complicated and dangerous; and this in proportion to the number and consequence of such affected parts. Thus if the lungs become affected, as in going into very cold water, a shortness of breath occurs; which is owing to the collapse or inactivity (not to the active contraction, or spasm), of the pulmonary capillaries; which, as the lungs are not sensible to cold, are not subject to painful sensation, and consequent shuddering, like the skin. In this case after a time the pulmonary capillaries, like the cutaneous ones, act with increased energy; the breathing, which was before quick, and the air thrown out at each respiration in less quant.i.ty, and cool to the back of the hand opposed to it, now becomes larger in quant.i.ty, and warmer than natural; which however is not accompanied with the sensation of heat in the membrane, which lines the air-vessels of the lungs, as in the skin.

2. One consequence of this increased heat of the breath is the increased evaporation of the mucus on the tongue and nostrils. A viscid material is secreted by these membranes to preserve them moist and supple, for the purposes of the senses of taste and of smell, which are extended beneath their surfaces; this viscid mucus, when the aqueous part of it is evaporated by the increased heat of the respired air, or is absorbed by the too great action of the mucous absorbents, adheres closely on those membranes, and is not without difficulty to be separated from them. This dryness of the tongue and nostrils is a circ.u.mstance therefore worthy to be attended to; as it shews the increased action of the pulmonary capillaries, and the consequent increased heat of the expired air; and may thus indicate, when colder air should be admitted to the patient. See Cla.s.s I.

1. 3. 1. The middle part of the tongue becomes dry sooner, and recovers its moisture later, than the edges of it; because the currents of respired air pa.s.s most over the middle part of it. This however is not the case, when the dryness of the tongue is owing only to the increased mucous absorption.

When however a frequent cough attends pulmonary inflammation, the edges of the tongue are liable to be as much furred as the middle of it; as during the action of coughing the middle of the tongue is depressed, so as to form half a cylinder, to give a greater aperture for the emission of air from the larynx; and the edges of it become thus as much exposed to the currents of air, as the middle parts of it.

3. When the internal capillaries or glands sympathize with the cutaneous capillaries; or when any of them are previously affected with torpor, and the external or cutaneous capillaries are affected secondarily; other symptoms are produced, which render the paroxysms of fever still more complicate. Thus if the spleen or pancreas are primarily or secondarily affected, so as to be rendered torpid or quiescent, they are liable to become enlarged, and to remain so even after the extinction of the fever-fit. These in some intermittent fevers are perceptible to the hand, and are called ague-cakes; their tumour seems to be owing to the permanent torpor of the absorbent system, the secerning vessels continuing to act some time afterwards. If the secretory vessels of the liver are affected first with torpor, and afterwards with o.r.g.a.s.m, a greater secretion of bile is produced, which sometimes causes a diarrhoea. If a torpor of the kidneys, and of the absorbents of the bladder occurs, either primarily, or by sympathy with the cutaneous capillaries, the urine is in small quant.i.ty and pale, as explained in Cla.s.s I. 2. 2. 5.; and if these secretory vessels of the kidneys, and the absorbents of the bladder act more strongly than natural afterwards by their increased irritability or a.s.sociability, the urine becomes in larger quant.i.ty, and deeper coloured, or deposits its earthy parts, as in Cla.s.s I. 1. 2. 4. which has been esteemed a favourable circ.u.mstance. But if the urine be in small quant.i.ty, and no sediment appears in it, after the hot fit is over; it shews, that the secerning vessels of the kidneys and the absorbent vessels of the bladder have not regained the whole of their activity, and thence indicates a greater tendency to a return of the cold fit.

4. When the stomach is affected with torpor either primarily; or secondarily by its sympathy with the cutaneous capillaries; or with some internal viscus; sickness occurs, with a total want of appet.i.te to any thing solid; vomiting then supervenes, which may often be relieved by a blister on the skin, if the skin be cool and pale; but not if it be hot and flushed. The intestines cease to perform their office of absorption from a similar torpor; and a diarrhoea supervenes owing to the acrimony of their putrid, or of their acid contents. The loose undigested or fetid stools indicate the inability of the intestines to perform their proper office; as the mucus and gastric acid, which are vomited up, does that of the stomach; this torpor of the stomach is liable to continue after the cold paroxysm ceases, and to convert intermittent fevers into continued ones by its direct sympathy with the heart and arteries. See article 10 of this Supplement.

5. If the meninges of the brain sympathize with other torpid parts, or are primarily affected, delirium, stupor, and perhaps hydrocephalus internus occur, see Cla.s.s II. 1. 7. 1. and I. 2. 5. 10; and sometimes the pulse becomes slow, producing paresis instead of fever. But if the membranes, which cover the muscles about the head, or of the pericranium, become torpid by their sympathy with other torpid parts, or are primarily affected, a head-ach supervenes; which however generally ceases with the cold paroxysm of fever. For as when the sensorial power of volition is exhausted by labour, a few hours, or half a solar day, pa.s.sed in sleep recruits the system by acc.u.mulation of this sensorial power; so when the sensorial power of irritation is exhausted, one or two solar or lunar days of rest or quiescence of the affected part will generally restore its action by acc.u.mulation of irritability, and consequent increase of a.s.sociation, as in hemicrania, Cla.s.s IV. 2. 2. 8. But when the heart and arteries become torpid, either primarily, or by their sympathy with the stomach, this acc.u.mulation of the sensorial power of irritation can take place but slowly; _as to rest is death_! This explains the cause of the duration of fevers with weak pulse, which continue a quarter, or half, or three quarters, or a whole lunation, or still longer, before sufficient acc.u.mulation of irritability can be produced to restore their natural strength of action.

6. If the absorbent vessels, which are spread around the neck of the bladder, become torpid by their direct sympathy with the absorbents of the skin in cold fits of fever; the urine, which is poured into the bladder in but small quant.i.ty from the torpid kidneys, has nevertheless none of its aqueous saline part reabsorbed; and this saline part stimulates the bladder to empty itself frequently, though the urine is in small quant.i.ty. Which is not therefore owing to any supposed spasm of the bladder, for the action of it in excluding the urine is weak, and as much controlable by the will as in ordinary micturition.

7. If the beginnings or absorbent mouths of the venous system remain torpid, petechiae or vibices are produced in fevers, similar to those which are seen in scurvy without fever. If the skin was frequently moistened for an hour, and at the same time exposed to the common air, or to oxygen gas, it might contribute to turn the black colour of these points of extravasated blood into scarlet, and thus by increasing its stimulus facilitate its reabsorption? For oxygen gas penetrates moist animal membranes though not dry ones, as in the lungs during respiration.

8. When the sensorial power of sensation is introduced into the arterial system, other kinds of compound fevers are produced, which will be spoken of in their place.

III. _Termination of the cold Fit._

1. If all the parts, which were affected with torpor, regain their irritability, and a.s.sociability, the cold paroxysm of fever ceases; but as some of the parts affected were previously accustomed to incessant action, as the heart and arteries, and others only to intermitted action, as the stomach and intestines; and as those, which are subjected during health to perpetual action, acc.u.mulate sensorial power faster, when their motions are impeded, than those which are subjected to intermitted action; it happens, that some of the parts, which were affected with torpor during the cold fit, recover their irritability or a.s.sociability sooner than others, and more perfectly, or acquire a greater quant.i.ty of them than natural; as appears by the partial heat and flushings previous to the general hot fit.

Hence if all the parts, which were previously torpid, regain their due degree of irritability, or of a.s.sociability, the disease is removed, and health restored. If some or all of them acquire more than their natural degree of these sensorial powers; increased actions, and consequent increased secretions, and greater heat occur, and const.i.tute the hot fit of fever. If after this hot fit of fever all the parts, which had acquired too great irritability, or a.s.sociability, regain their natural degree of it; the disease is removed, and health restored. But if some of these parts do not regain their natural degree of these sensorial powers, the actions of those parts remain imperfect, and are more or less injurious to the system, according to the importance of their functions.

2. Thus if a torpor of the heart and arteries remains; the quick pulse without strength, which began in the cold fit, persists; and a continued fever is produced. If the torpor of the stomach and intestines remains, which are known by sickness and undigested stools, the fever is liable to be of considerable length and danger; the same if the kidnies and absorbent system retain some degree of torpor, as is shewn by the pale urine in not unusual quant.i.ty. If part of the absorbent system remains torpid, as the absorbent vessels of the spleen, a tumour of that viscus occurs, which may be felt by the hand; the same sometimes happens to the liver; and these from their tendency to more complete torpor are afterwards liable to give occasion to a return of the cold fit. If the cellular absorbents do not completely recover their activity, a pale and bloated countenance with swelled legs mark their want of action.

3. As the termination of the cold fit is owing to the acc.u.mulation of the sensorial power of irritation and of a.s.sociation during the previous quiescence of the system; and as those parts, which are in perpetual action during health, are more subject to this acc.u.mulation during their torpor, or quiescence; one should have imagined, that the heart and arteries would acquire this acc.u.mulation of sensorial power sooner or in greater degree than other parts. This indeed so happens, where the pulse is previously strong, as in febris irritativa; or where another sensorial power, as that of sensation, is exerted on the arterial system, as in inflammations. The heart and arteries in these cases soon recover from their torpor, and are exerted with great violence.

Many other parts of the system subject to perpetual motion in health may rest for a time without much inconvenience to the whole; as when the fingers of some people become cold and pale; and during this complete rest great acc.u.mulation of irritability may be produced, But where the heart and arteries are previously feeble, they cannot much diminish their actions, and certainly cannot rest entirely, for that would be death; and therefore in this case their acc.u.mulation of the sensorial power of irritation or of a.s.sociation is slowly produced, and a long fever supervenes in consequence; or sudden death, as frequently happens, terminates the cold fit.