# Zoonomia/I.XXXII

SECT. XXXII.
DISEASES OF IRRITATION.
    I. Irritative fevers with strong pulse. With weak pulse. Symptoms of fever, Their source. II. 1. Quick pulse is owing to decreased irritability. 2. Not in sleep or in apoplexy. 3. From inanition. Owing to deficiency of sensorial power. III. 1. Causes of fever. From defect of heat. Heat from secretions. Pain of cold in the loins and forehead. 2. Great expense of sensorial power in the vital motions. Immersion in cold water. Succeeding glow of heat. Difficult respiration in cold bathing explained. Why the cold bath invigorates. Bracing and relaxation are mechanical terms. 3. Uses of cold bathing. Uses of cold air in fevers. 4. Ague fits from cold air. Whence their periodical returns. IV. Defect of distention a cause of fever. Deficiency of blood. Transfusion of blood. V. 1. Defect of momentum of the blood from mechanic stimuli. 2. Air injected into the blood-vessels. 3. Exercise increases the momentum of the blood. 4. Sometimes bleeding increases the momentum of it. VI. Influence of the sun and moon on diseases. The chemical stimulus of the blood. Menstruation obeys the lunations. Queries. VII. Quiesence of large glands a cause of fever. Swelling of the præcordia. VIII. Other causes of quiescence, as hunger, bad air, fear, anxiety. IX. 1. Symptoms of the cold fit. 2. Of the hot fit. 3. Second cold fit why. 4. Inflammation introduced, or delirium, or stupor. X. Recapitulation. Fever not an effort of nature to relieve herself. Doctrine of spasm.
I. When the contractile sides of the heart and arteries perform a greater number of pulsations in a given time, and move through a greater area at each pulsation, whether these motions are occasioned by the stimulus of the acrimony or quantity of the blood, or by their association with other irritative motions, or by the increased irritability of the arterial system, that is, by an increased quantity of sensorial power, one kind of fever is produced; which may be called Synocha irritativa, or Febris irritativa pulsu forti, or irritative fever with strong pulse.
When the contractile sides of the heart and arteries perform a greater number of pulsations in a given time, but move through a much less area at each pulsation, whether these motions are occasioned by defect of their natural stimuli, or by the defect of other irritative motions with which they are associated, or from the inirritability of the arterial system, that is, from a decreased quantity of sensorial power, another kind of fever arises; which may be termed, Typhus irritativus, or Febris irritativa pulsu debili, or irritative fever with weak pulse. The former of these fevers is the synocha of nosologists, and the latter the typhus mitior, or nervous fever. In the former there appears to be an increase of sensorial power, in the latter a deficiency of it; which is shewn to be the immediate cause of strength and weakness, as defined in Sect. XII. 1. 3.
It should be added, that a temporary quantity of strength or debility may be induced by the defect or excess of stimulus above what is natural; and that in the same fever debility always exists during the cold fit, though strength does not always exist during the hot fit.
These fevers are always connected with, and generally induced by, the disordered irritative motions of the organs of sense, or of the intestinal canal, or of the glandular system, or of the absorbent system; and hence are always complicated with some or many of these disordered motions, which are termed the symptoms of the fever, and which compose the great variety in these diseases.
The irritative fevers both with strong and with weak pulse, as well as the sensitive fevers with strong and with weak pulse, which are to be described in the next section, are liable to periodical remissions, and then they take the name of intermittent fevers, and are distinguished by the periodical times of their access.
II. For the better illustration of the phenomena of irritative fevers we must refer the reader to the circumstances of irritation explained in Sect. XII. and shall commence this intricate subject by speaking of the quick pulse, and proceed by considering many of the causes, which either separately or in combination most frequently produce the cold fits of fevers.
1. If the arteries are dilated but to half their usual diameters, though they contract twice as frequently in a given time, they will circulate only half their usual quantity of blood: for as they are cylinders, the blood which they contain must be as the squares of their diameters. Hence when the pulse becomes quicker and smaller in the same proportion, the heart and arteries act with less energy than in their natural state. See Sect. XII. 1. 4.
That this quick small pulse is owing to want of irritability, appears, first, because it attends other symptoms of want of irritability; and, secondly, because on the application of a stimulus greater than usual, it becomes slower and larger. Thus in cold fits of agues, in hysteric palpitations of the heart, and when the body is much exhausted by hæmorrhages, or by fatigue, as well as in nervous fevers, the pulse becomes quick and small; and secondly, in all those cases if an increase of stimulus be added, by giving a little wine or opium; the quick small pulse becomes slower and larger, as any one may easily experience on himself, by counting his pulse after drinking one or two glasses of wine, when he is faint from hunger or fatigue.
Now nothing can so strongly evince that this quick small pulse is owing to defect of irritability, than that an additional stimulus, above what is natural, makes it become slower and larger immediately: for what is meant by a defect of irritability, but that the arteries and heart are not excited into their usual exertions by their usual quantity of stimulus? but if you increase the quantity of stimulus, and they immediately act with their usual energy, this proves their previous want of their natural degree of irritability. Thus the trembling hands of drunkards in a morning become steady, and acquire strength to perform their usual offices, by the accustomed stimulus of a glass or two of brandy.
2. In sleep and in apoplexy the pulse becomes slower, which is not owing to defect of irritability, for it is at the same time larger; and thence the quantity of the circulation is rather increased than diminished. In these cases the organs of sense are closed, and the voluntary power is suspended, while the motions dependent on internal irritations, as those of digestion and secretion, are carried on with more than their usual vigour; which has led superficial observers to confound these cases with those arising from want of irritability. Thus if you lift up the eyelid of an apoplectic patient, who is not actually dying, the iris will, as usual, contract itself, as this motion is associated with the stimulus of light; but it is not so in the last stages of nervous fevers, where the pupil of the eye continues expanded in the broad day-light: in the former case there is a want of voluntary power, in the latter a want of irritability.
Hence also those constitutions which are deficient in quantity of irritability, and which possess too great sensibility, as during the pain of hunger, of hysteric spasms, or nervous headachs, are generally supposed to have too much irritability; and opium, which in its due dose is a most powerful stimulant, is erroneously called a sedative; because by increasing the irritative motions it decreases the pains arising from defect of them.
Why the pulse should become quicker both from an increase of irritation, as in the synocha irritativa, or irritative fever with strong pulse; and from the decrease of it, as in the typhus irritativus, or irritative fever with weak pulse; seems paradoxical. The former circumstance needs no illustration; since if the stimulus of the blood, or the irritability of the sanguiferous system be increased, and the strength of the patient not diminished, it is plain that the motions must be performed quicker and stronger.
In the latter circumstance the weakness of the muscular power of the heart is soon over-balanced by the elasticity of the coats of the arteries, which they possess besides a muscular power of contraction; and hence the arteries are distended to less than their usual diameters. The heart being thus stopped, when it is but half emptied, begins sooner to dilate again; and the arteries being dilated to less than their usual diameters, begin so much sooner to contract themselves; insomuch, that in the last stages of fevers with weakness the frequency of pulsation of the heart and arteries becomes doubled; which, however, is never the case in fevers with strength, in which they seldom exceed 118 or 120 pulsations in a minute. It must be added, that in these cases, while the pulse is very small and very quick, the heart often feels large, and labouring to one's hand; which coincides with the above explanation, shewing that it does not completely empty itself.
3. In cases however of debility from paucity of blood, as in animals which are bleeding to death in the slaughter-house, the quick pulsations of the heart and arteries may be owing to their not being distended to more than half their usual diastole; and in consequence they must contract sooner, or more frequently, in a given time. As weak people are liable to a deficient quantity of blood, this cause may occasionally contribute to quicken the pulse in fevers with debility, which may be known by applying one's hand upon the heart as above; but the principal cause I suppose to consist in the diminution of sensorial power. When a muscle contains, or is supplied with but little sensorial power, its contraction soon ceases, and in consequence may soon recur, as is seen in the trembling hands of people weakened by age or by drunkenness. See Sect. XII. 1. 4. XII. 3. 4.
It may nevertheless frequently happen, that both the deficiency of stimulus, as where the quantity of blood is lessened (as described in No. 4. of this section), and the deficiency of sensorial power, as in those of the temperament of irritability, described in Sect. XXXI. occur at the same time; which will thus add to the quickness of the pulse and to the danger of the disease.
III. 1. A certain degree of heat is necessary to muscular motion, and is, in consequence, essential to life. This is observed in those animals and insects which pass the cold season in a torpid state, and which revive on being warmed by the fire. This necessary stimulus of heat has two sources; one from the fluid atmosphere of heat, in which all things are immersed, and the other from the internal combinations of the particles, which form the various fluids, which are produced in the extensive systems of the glands. When either the external heat, which surrounds us, or the internal production of it, becomes lessened to a certain degree, the pain of cold is perceived.
This pain of cold is experienced most sensibly by our teeth, when ice is held in the mouth; or by our whole system after having been previously accustomed to much warmth. It is probable, that this pain does not arise from the mechanical or chemical effects of a deficiency of heat; but that, like the organs of sense by which we perceive hunger and thirst, this sense of heat suffers pain, when the stimulus of its object is wanting to excite the irritative motions of the organ; that is, when the sensorial power becomes too much accumulated in the quiescent fibres. See Sect. XII. 5. 3. For as the peristaltic motions of the stomach are lessened, when the pain of hunger is great, so the action of the cutaneous capillaries are lessened during the pain of cold; as appears by the paleness of the skin, as explained in Sect. XIV. 6. on the production of ideas.
The pain in the small of the back and forehead in the cold fits of the ague, in nervous hemicrania, and in hysteric paroxysms, when all the irritative motions are much impaired, seems to arise from this cause; the vessels of these membranes or muscles become torpid by their irritative associations with other parts of the body, and thence produce less of their accustomed secretions, and in consequence less heat is evolved, and they experience the pain of cold; which coldness may often be felt by the hand applied upon the affected part.
2. The importance of a greater or less deduction of heat from the system will be more easy to comprehend, if we first consider the great expense of sensorial power used in carrying on the vital motions; that is, which circulates, absorbs, secretes, aerates, and elaborates the whole mass of fluids with unceasing assiduity. The sensorial power, or spirit of animation, used in giving perpetual and strong motion to the heart, which overcomes the elasticity and vis inertiæ of the whole arterial system; next the expense of sensorial power in moving with great force and velocity the innumerable trunks and ramifications of the arterial system; the expense of sensorial power in circulating the whole mass of blood through the long and intricate intortions of the very fine vessels, which compose the glands and capillaries; then the expense of sensorial power in the exertions of the absorbent extremities of all the lacteals, and of all the lymphatics, which open their mouths on the external surface of the skin, and on the internal surfaces of every cell or interstice of the body; then the expense of sensorial power in the venous absorption, by which the blood is received from the capillary vessels, or glands, where the arterial power ceases, and is drank up, and returned to the heart; next the expense of sensorial power used by the muscles of respiration in their office of perpetually expanding the bronchia, or air-vessels, of the lungs; and lastly in the unceasing peristaltic motions of the stomach and whole system of intestines, and in all the secretions of bile, gastric juice, mucus, perspirable matter, and the various excretions from the system. If we consider the ceaseless expense of sensorial power thus perpetually employed, it will appear to be much greater in a day than all the voluntary exertions of our muscles and organs of sense consume in a week; and all this without any sensible fatigue! Now, if but a part of these vital motions are impeded, or totally stopped for but a short time, we gain an idea, that there must be a great accumulation of sensorial power; as its production in these organs, which are subject to perpetual activity, is continued during their quiescence, and is in consequence accumulated.
While, on the contrary, where those vital organs act too forcibly by increase of stimulus without a proportionally-increased production of sensorial power in the brain, it is evident, that a great deficiency of action, that is torpor, must soon follow, as in fevers; whereas the locomotive muscles, which act only by intervals, are neither liable to so great accumulation of sensorial power during their times of inactivity, nor to so great an exhaustion of it during their times of action.
Thus, on going into a very cold bath, suppose at 33 degrees of heat on Fahrenheit's scale, the action of the subcutaneous capillaries, or glands, and of the mouths of the cutaneous absorbents is diminished, or ceases for a time. Hence less or no blood passes these capillaries, and paleness succeeds. But soon after emerging from the bath, a more florid colour and a greater degree of heat is generated on the skin than was possessed before immersion; for the capillary glands, after this quiescent state, occasioned by the want of stimulus, become more irritable than usual to their natural stimuli, owing to the accumulation of sensorial power, and hence a greater quantity of blood is transmitted through them, and a greater secretion of perspirable matter; and, in consequence, a greater degree of heat succeeds. During the continuance in cold water the breath is cold, and the act of respiration quick and laborious; which have generally been ascribed to the obstruction of the circulating fluid by a spasm of the cutaneous vessels, and by a consequent accumulation of blood in the lungs, occasioned by the pressure as well as by the coldness of the water. This is not a satisfactory account of this curious phænomenon, since at this time the whole circulation is less, as appears from the smallness of the pulse and coldness of the breath; which shew that less blood passes through the lungs in a given time; the same laborious breathing immediately occurs when the paleness of the skin is produced by fear, where no external cold or pressure are applied.
The minute vessels of the bronchia, through which the blood passes from the arterial to the venal system, and which correspond with the cutaneous capillaries, have frequently been exposed to cold air, and become quiescent along with those of the skin; and hence their motions are so associated together, that when one is affected either with quiescence or exertion, the other sympathizes with it, according to the laws of irritative association. See Sect. XXVII. 1. on hæmorrhages.
Besides the quiescence of the minute vessels of the lungs, there are many other systems of vessels which become torpid from their irritative associations with those of the skin, as the absorbents of the bladder and intestines; whence an evacuation of pale urine occurs, when the naked skin is exposed only to the coldness of the atmosphere; and sprinkling the naked body with cold water is known to remove even pertinacious constipation of the bowels. From the quiescence of such extensive systems of vessels as the glands and capillaries of the skin, and the minute vessels of the lungs, with their various absorbent series of vessels, a great accumulation of sensorial powers is occasioned; part of which is again expended in the increased exertion of all these vessels, with an universal glow of heat in consequence of this exertion, and the remainder of it adds vigour to both the vital and voluntary exertions of the whole day.
If the activity of the subcutaneous vessels, and of those with which their actions are associated, was too great before cold immersion, as in the hot days of summer, and by that means the sensorial power was previously diminished, we see the cause why the cold bath gives such present strength; namely, by stopping the unnecessary activity of the subcutaneous vessels, and thus preventing the too great exhaustion of sensorial power; which, in metaphorical language, has been called bracing the system: which is, however, a mechanical term, only applicable to drums, or musical strings: as on the contrary the word relaxation, when applied to living animal bodies, can only mean too small a quantity of stimulus, or too small a quantity of sensorial power; as explained in Sect. XII. 1.
3. This experiment of cold bathing presents us with a simple fever-fit; for the pulse is weak, small, and quick during the cold immersion; and becomes strong, full, and quick during the subsequent glow of heat; till in a few minutes these symptoms subside, and the temporary fever ceases.
In those constitutions where the degree of inirritability, or of debility, is greater than natural, the coldness and paleness of the skin with the quick and weak pulse continue a long time after the patient leaves the bath; and the subsequent heat approaches by unequal flushings, and he feels himself disordered for many hours. Hence the bathing in a cold spring of water, where the heat is but forty-eight degrees on Fahrenheit's thermometer, much disagrees with those of weak or inirritable habits of body; who possess so little sensorial power, that they cannot without injury bear to have it diminished even for a short time; but who can nevertheless bear the more temperate coldness of Buxton bath, which is about eighty degrees of heat, and which strengthens them, and makes them by habit less liable to great quiescence from small variations of cold, and thence less liable to be disordered by the unavoidable accidents of life. Hence it appears, why people of these inirritable constitutions, which is another expression for sensorial deficiency, are often much injured by bathing in a cold spring of water; and why they should continue but a very short time in baths, which are colder than their bodies; and should gradually increase both the degree of coldness of the water, and the time of their continuance in it, if they would obtain salutary effects from cold immersions. See Sect. XII. 2. 1.
On the other hand, in all cases where the heat of the external surface of the body, or of the internal surface of the lungs, is greater than natural, the use of exposure to cool air may be deduced. In fever-fits attended with strength, that is with great quantity of sensorial power, it removes the additional stimulus of heat from the surfaces above mentioned, and thus prevents their excess of useless motion; and in fever-fits attended with debility, that is with a deficiency of the quantity of sensorial power, it prevents the great and dangerous waste of sensorial power expended in the unnecessary increase of the actions of the glands and capillaries of the skin and lungs.
4. In the same manner, when any one is long exposed to very cold air, a quiescence is produced of the cutaneous and pulmonary capillaries and absorbents, owing to the deficiency of their usual stimulus of heat; and this quiescence of so great a quantity of vessels affects, by irritative association, the whole absorbent and glandular system, which becomes in a greater or less degree quiescent, and a cold fit of fever is produced.
If the deficiency of the stimulus of heat is very great, the quiescence becomes so general as to extinguish life, as in those who are frozen to death.
If the deficiency of heat be in less degree, but yet so great as in some measure to disorder the system, and should occur the succeeding day, it will induce a greater degree of quiescence than before, from its acting in concurrence with the period of the diurnal circle of actions, explained in Sect. XXXVI. Hence from a small beginning a greater and greater degree of quiescence may be induced, till a complete fever-fit is formed; and which will continue to recur at the periods by which it was produced. See Sect. XVII. 3. 6.
If the degree of quiescence occasioned by defect of the stimulus of heat be very great, it will recur a second time by a slighter cause, than that which first induced it. If the cause, which induces the second fit of quiescence, recurs the succeeding day, the quotidian fever is produced; if not till the alternate day, the tertian fever; and if not till after seventy-two hours from the first fit of quiescence, the quartan fever is formed. This last kind of fever recurs less frequently than the other, as it is a disease only of those of the temperament of associability, as mentioned in Sect. XXXI.; for in other constitutions the capability of forming a habit ceases, before the new cause of quiescence is again applied, if that does not occur sooner than in seventy-two hours.
And hence those fevers, whose cause is from cold air of the night or morning, are more liable to observe the solar day in their periods; while those from other causes frequently observe the lunar day in their periods, their paroxysms returning near an hour later every day, as explained in Sect. XXXVI.
IV. Another frequent cause of the cold fits of fever is the defect of the stimulus of distention. The whole arterial system would appear, by the experiments of Haller, to be irritable by no other stimulus, and the motions of the heart and alimentary canal are certainly in some measure dependant on the same cause. See Sect. XIV. 7. Hence there can be no wonder, that the diminution of distention should frequently induce the quiescence, which constitutes the beginning of fever-fits.
Monsieur Leiutaud has judiciously mentioned the deficiency of the quantity of blood amongst the causes of diseases, which he says is frequently evident in dissections: fevers are hence brought on by great hæmorrhages, diarrhœas, or other evacuations; or from the continued use of diet, which contains but little nourishment; or from the exhaustion occasioned by violent fatigue, or by those chronic diseases in which the digestion is much impaired; as where the stomach has been long affected with the gout or schirrus; or in the paralysis of the liver, as described in Sect. XXX. Hence a paroxysm of gout is liable to recur on bleeding or purging; as the torpor of some viscus, which precedes the inflammation of the foot, is thus induced by the want of the stimulus of distention. And hence the extremities of the body, as the nose and fingers, are more liable to become cold, when we have long abstained from food; and hence the pulse is increased both in strength and velocity above the natural standard after a full meal by the stimulus of distention.
However, this stimulus of distention, like the stimulus of heat above described, though it contributes much to the due action not only of the heart, arteries, and alimentary canal, but seems necessary to the proper secretion of all the various glands; yet perhaps it is not the sole cause of any of these numerous motions: for as the lacteals, cutaneous absorbents, and the various glands appear to be stimulated into action by the peculiar pungency of the fluids they absorb, so in the intestinal canal the pungency of the digesting aliment, or the acrimony of the fæces, seem to contribute, as well as their bulk, to promote the peristaltic motions; and in the arterial system, the momentum of the particles of the circulating blood, and their acrimony, stimulate the arteries, as well as the distention occasioned by it. Where the pulse is small this defect of distention is present, and contributes much to produce the febris irritativa pulsu debili, or irritative fever with weak pulse, called by modern writers nervous fever, as a predisponent cause. See Sect. XII. 1. 4. Might not the transfusion of blood, suppose of four ounces daily from a strong man, or other healthful animal, as a sheep or an ass, be used in the early state of nervous or putrid fevers with great prospect of success?
V. 1. The defect of the momentum of the particles of the circulating blood is another cause of the quiescence, with which the cold fits of fever commence. This stimulus of the momentum of the progressive particles of the blood does not act over the whole body like those of heat and distention above described, but is confined to the arterial system; and differs from the stimulus of the distention of the blood, as much as the vibration of the air does from the currents of it. Thus are the different organs of our bodies stimulated by four different mechanic properties of the external world: the sense of touch by the pressure of solid bodies so as to distinguish their figure; the muscular system by the distention, which they occasion; the internal surface of the arteries, by the momentum of their moving particles; and the auditory nerves, by the vibration of them: and these four mechanic properties are as different from each other as the various chemical ones, which are adapted to the numerous glands, and to the other organs of sense.
2. The momentum of the progressive particles of blood is compounded of their velocity and their quantity of matter: hence whatever circumstances diminish either of these without proportionally increasing the other, and without superadding either of the general stimuli of heat or distention, will tend to produce a quiescence of the arterial system, and from thence of all the other irritative motions, which are connected with it.
Hence in all those constitutions or diseases where the blood contains a greater proportion of serum, which is the lightest part of its composition, the pulsations of the arteries are weaker, as in nervous fevers, chlorosis, and hysteric complaints; for in these cases the momentum of the progressive particles of blood is less: and hence, where the denser parts of its composition abound, as the red part of it, or the coagulable lymph, the arterial pulsations are stronger; as in those of robust health, and in inflammatory diseases.
That this stimulus of the momentum of the particles of the circulating fluid is of the greatest consequence to the arterial action, appears from the experiment of injecting air into the blood vessels, which seems to destroy animal life from the want of this stimulus of momentum; for the distention of the arteries is not diminished by it, it possesses no corrosive acrimony, and is less liable to repass the valves than the blood itself; since air-valves in all machinery require much less accuracy of construction than those which are opposed to water.
3. One method of increasing the velocity of the blood, and in consequence the momentum of its particles, is by the exercise of the body, or by the friction of its surface: so, on the contrary, too great indolence contributes to decrease this stimulus of the momentum of the particles of the circulating blood, and thus tends to induce quiescence; as is seen in hysteric cases, and chlorosis, and the other diseases of sedentary people.
4. The velocity of the particles of the blood in certain circumstances is increased by venesection, which, by removing a part of it, diminishes the resistance to the motion of the other part, and hence the momentum of the particles of it is increased. This may be easily understood by considering it in the extreme, since, if the resistance was greatly increased, so as to overcome the propelling power, there could be no velocity, and in consequence no momentum at all. From this circumstance arises that curious phænomenon, the truth of which I have been more than once witness to, that venesection will often instantaneously relieve those nervous pains, which attend the cold periods of hysteric, asthmatic, or epileptic diseases; and that even where large doses of opium have been in vain exhibited. In these cases the pulse becomes stronger after the bleeding, and the extremities regain their natural warmth; and an opiate then given acts with much more certain effect.
VI. There is another cause, which seems occasionally to induce quiescence into some part of our system, I mean the influence of the sun and moon; the attraction of these luminaries, by decreasing the gravity of the particles of the blood, cannot affect their momentum, as their vis inertiæ remains the same; but it may nevertheless produce some chemical change in them, because whatever affects the general attractions of the particles of matter may be supposed from analogy to affect their specific attractions or affinities: and thus the stimulus of the particles of blood may be diminished, though not their momentum. As the tides of the sea obey the southing and northing of the moon (allowing for the time necessary for their motion, and the obstructions of the shores), it is probable, that there are also atmospheric tides on both sides of the earth, which to the inhabitants of another planet might so deflect the light as to resemble the ring of Saturn. Now as these tides of water, or of air, are raised by the diminution of their gravity, it follows, that their pressure on the surface of the earth is no greater than the pressure of the other parts of the ocean, or of the atmosphere, where no such tides exist; and therefore that they cannot affect the mercury in the barometer. In the same manner, the gravity of all other terrestrial bodies is diminished at the times of the southing and northing of the moon, and that in a greater degree when this coincides with the southing and northing of the sun, and this in a still greater degree about the times of the equinoxes. This decrease of the gravity of all bodies during the time the moon passes our zenith or nadir might possibly be shewn by the slower vibrations of a pendulum, compared with a spring clock, or with astronomical observation. Since a pendulum of a certain length moves slower at the line than near the poles, because the gravity being diminished and the vis inertiæ continuing the same, the motive power is less, but the resistance to be overcome continues the same. The combined powers of the lunar and solar attraction is estimated by Sir Isaac Newton not to exceed one 7,868,850th part of the power of gravitation, which seems indeed but a small circumstance to produce any considerable effect on the weight of sublunary bodies, and yet this is sufficient to raise the tides at the equator above ten feet high; and if it be considered, what small impulses of other bodies produce their effects on the organs of sense adapted to the perception of them, as of vibration on the auditory nerves, we shall cease to to be surprised, that so minute a diminution in the gravity of the particles of blood should so far affect their chemical changes, or their stimulating quality, as, joined with other causes, sometimes to produce the beginnings of diseases.
Add to this, that if the lunar influence produces a very small degree of quiescence at first, and if that recurs at certain periods even with less power to produce quiescence than at first, yet the quiescence will daily increase by the acquired habit acting at the same time, till at length so great a degree of quiescence is induced as to produce phrensy, canine madness, epilepsy, hysteric pains or cold fits of fever, instances of many of which are to be found in Dr. Mead's work on this subject. The solar influence also appears daily in several diseases; but as darkness, silence, sleep, and our periodical meals mark the parts of the solar circle of actions, it is sometimes dubious to which of these the periodical returns of these diseases are to be ascribed.
As far as I have been able to observe, the periods of inflammatory diseases observe the solar day; as the gout and rheumatism have their greatest quiescence about noon and midnight, and their exacerbations some hours after; as they have more frequently their immediate cause from cold air, inanition, or fatigue, than from the effects of lunations: whilst the cold fits of hysteric patients, and those in nervous fevers, more frequently occur twice a day, later by near half an hour each time, according to the lunar day; whilst some fits of intermittents, which are undisturbed by medicines, return at regular solar periods, and others at lunar ones; which may, probably, be owing to the difference of the periods of those external circumstances of cold, inanition, or lunation, which immediately caused them.
We must, however, observe, that the periods of quiescence and exacerbation in diseases do not always commence at the times of the syzygies or quadratures of the moon and sun, or at the times of their passing the zenith or nadir; but as it is probable, that the stimulus of the particles of the circumfluent blood is gradually diminished from the time of the quadratures to that of the syzygies, the quiescence may commence at any hour, when co-operating with other causes of quiescence, it becomes great enough to produce a disease: afterwards it will continue to recur at the same period of the lunar or solar influence; the same cause operating conjointly with the acquired habit, that is with the catenation of this new motion with the dissevered links of the lunar or solar circles of animal action.
In this manner the periods of menstruation obey the lunar month with great exactness in healthy patients (and perhaps the venereal orgasm in brute animals does the same), yet these periods do not commence either at the syzygies or quadratures of the lunations, but at whatever time of the lunar periods they begin, they observe the same in their returns till some greater cause disturbs them.
Hence, though the best way to calculate the time of the expected returns of the paroxysms of periodical diseases is to count the number of hours between the commencement of the two preceding fits, yet the following observations may be worth attending to, when we endeavour to prevent the returns of maniacal or epileptic diseases; whose periods (at the beginning of them especially) frequently observe the syzygies of the moon and sun, and particularly about the equinox.
The greatest of the two tides happening in every revolution of the moon, is that when the moon approaches nearest to the zenith or nadir; for this reason, while the sun is in the northern signs, that is during the vernal and summer months, the greater of the two diurnal tides in our latitude is that, when the moon is above the horizon; and when the sun is in the southern signs, or during the autumnal and winter months, the greater tide is that, which arises when the moon is below the horizon: and as the sun approaches somewhat nearer the earth in winter than in summer, the greatest equinoctial tides are observed to be a little before the vernal equinox, and a little after the autumnal one.
Do not the cold periods of lunar diseases commence a few hours before the southing of the moon during the vernal and summer months, and before the northing of the moon during the autumnal and winter months? Do not palsies and apoplexies, which occur about the equinoxes, happen a few days before the vernal equinoctial lunation, and after the autumnal one? Are not the periods of those diurnal diseases more obstinate, that commence many hours before the southing or northing of the moon, than of those which commence at those times? Are not those palsies and apoplexies more dangerous which commence many days before the syzygies of the moon, than those which happen at those times? See Sect. XXXVI. on the periods of diseases.
VII. Another very frequent cause of the cold fit of fever is the quiescence of some of those large congeries of glands, which compose the liver, spleen, or pancreas; one or more of which are frequently so enlarged in the autumnal intermittents as to be perceptible to the touch externally, and are called by the vulgar ague-cakes. As these glands are stimulated into action by the specific pungency of the fluids, which they absorb, the general cause of their quiescence seems to be the too great insipidity of the fluids of the body, co-operating perhaps at the same time with other general causes of quiescence.
Hence, in marshy countries at cold seasons, which have succeeded hot ones, and amongst those, who have lived on innutritious and unstimulating diet, these agues are most frequent. The enlargement of these quiescent viscera, and the swelling of the præcordia in many other fevers, is, most probably, owing to the same cause; which may consist in a general deficiency of the production of sensorial power, as well as in the diminished stimulation of the fluids; and when the quiescence of so great a number of glands, as constitute one of those large viscera, commences, all the other irritative motions are affected by their connection with it, and the cold fit of fever is produced.
VIII. There are many other causes, which produce quiescence of some part of the animal system, as fatigue, hunger, thirst, bad diet, disappointed love, unwholesome air, exhaustion from evacuations, and many others; but the last cause, that we shall mention, as frequently productive of cold fits of fever, is fear or anxiety of mind. The pains, which we are first and most generally acquainted with, have been produced by defect of some stimulus; thus, soon after our nativity we become acquainted with the pain from the coldness of the air, from the want of respiration, and from the want of food. Now all these pains occasioned by defect of stimulus are attended with quiescence of the organ, and at the same time with a greater or less degree of quiescence of other parts of the system: thus, if we even endure the pain of hunger so as to miss one meal instead of our daily habit of repletion, not only the peristaltic motions of the stomach and bowels are diminished, but we are more liable to coldness of our extremities, as of our noses, and ears, and feet, than at other times.
Now, as fear is originally excited by our having experienced pain, and is itself a painful affection, the same quiescence of other fibrous motions accompany it, as have been most frequently connected with this kind of pain, as explained in Sect. XVI. 8. 1. as the coldness and paleness of the skin, trembling, difficult respiration, indigestion, and other symptoms, which contribute to form the cold fit of fevers. Anxiety is fear continued through a longer time, and, by producing chronical torpor of the system, extinguishes life slowly, by what is commonly termed a broken heart.
IX. 1. We now step forwards to consider the other symptoms in consequence of the quiescence which begins the fits of fever. If by any of the circumstances before described, or by two or more of them acting at the same time, a great degree of quiescence is induced on any considerable part of the circle of irritative motions, the whole class of them is more or less disturbed by their irritative associations. If this torpor be occasioned by a deficient supply of sensorial power, and happens to any of those parts of the system, which are accustomed to perpetual activity, as the vital motions, the torpor increases rapidly, because of the great expenditure of sensorial power by the incessant activity of those parts of the system, as shewn in No. 3. 2. of this Section. Hence a deficiency of all the secretions succeeds, and as animal heat is produced in proportion to the quantity of those secretions, the coldness of the skin is the first circumstance, which is attended to. Dr. Martin asserts, that some parts of his body were warmer than natural in the cold fit of fever; but it is certain, that those, which are uncovered, as the fingers, and nose, and ears, are much colder to the touch, and paler in appearance. It is possible, that his experiments were made at the beginning of the subsequent hot fits; which commence with partial distributions of heat, owing to some parts of the body regaining their natural irritability sooner than others.
From the quiescence of the anastomosing capillaries a paleness of the skin succeeds, and a less secretion of the perspirable matter; from the quiescence of the pulmonary capillaries a difficulty of respiration arises; and from the quiescence of the other glands less bile, less gastric and pancreatic juice, are secreted into the stomach and intestines, and less mucus and saliva are poured into the mouth; whence arises the dry tongue, costiveness, dry ulcers, and paucity of urine. From the quiescence of the absorbent system arises the great thirst, as less moisture is absorbed from the atmosphere. The absorption from the atmosphere was observed by Dr. Lyster to amount to eighteen ounces in one night, above what he had at the same time insensibly perspired. See Langrish. On the same account the urine is pale, though in small quantity, for the thinner part is not absorbed from it; and when repeated ague-fits continue long, the legs swell from the diminished absorption of the cellular absorbents.
From the quiescence of the intestinal canal a loss of appetite and flatulencies proceed. From the partial quiescence of the glandular viscera a swelling and tension about the præcordia becomes sensible to the touch; which is occasioned by the delay of the fluids from the defect of venous or lymphatic absorption. The pain of the forehead, and of the limbs, and of the small of the back, arises from the quiescence of the membranous fascia, or muscles of those parts, in the same manner as the skin becomes painful, when the vessels, of which it is composed, become quiescent from cold. The trembling in consequence of the pain of coldness, the restlessness, and the yawning, and stretching of the limbs, together with the shuddering, or rigours, are convulsive motions; and will be explained amongst the diseases of volition; Sect. XXXIV.
Sickness and vomiting is a frequent symptom in the beginnings of fever-fits, the muscular fibres of the stomach share the general torpor and debility of the system; their motions become first lessened, and then stop, and then become retrograde; for the act of vomiting, like the globus hystericus and the borborigmi of hypochondriasis, is always a symptom of debility, either from want of stimulus, as in hunger; or from want of sensorial power, as after intoxication; or from sympathy with some other torpid irritative motions, as in the cold fits of ague. See Sect. XII. 5. 5. XXIX. 11. and XXXV. 1. 3. where this act of vomiting is further explained.
The small pulse, which is said by some writers to be slow at the commencement of ague-fits, and which is frequently trembling and intermittent, is owing to the quiescence of the heart and arterial system, and to the resistance opposed to the circulating fluid from the inactivity of all the glands and capillaries. The great weakness and inability to voluntary motions, with the insensibility of the extremities, are owing to the general quiescence of the whole moving system; or, perhaps, simply to the deficient production of sensorial power.
If all these symptoms are further increased, the quiescence of all the muscles, including the heart and arteries, becomes complete, and death ensues. This is, most probably, the case of those who are starved to death with cold, and of those who are said to die in Holland from long skaiting on their frozen canals.
2. As soon as this general quiescence of the system ceases, either by the diminution of the cause, or by the accumulation of sensorial power, (as in syncope, Sect. XII. 7. 1.) which is the natural consequence of previous quiescence, the hot fit commences. Every gland of the body is now stimulated into stronger action than is natural, as its irritability is increased by accumulation of sensorial power during its late quiescence, a superabundance of all the secretions is produced, and an increase of heat in consequence of the increase of these secretions. The skin becomes red, and the perspiration great, owing to the increased action of the capillaries during the hot part of the paroxysm. The secretion of perspirable matter is perhaps greater during the hot fit than in the sweating fit which follows; but as the absorption of it also is greater, it does not stand on the skin in visible drops: add to this, that the evaporation of it also is greater, from the increased heat of the skin. But at the decline of the hot fit, as the mouths of the absorbents of the skin are exposed to the cooler air, or bed-clothes, these vessels sooner lose their increased activity, and cease to absorb more than their natural quantity: but the secerning vessels for some time longer, being kept warm by the circulating blood, continue to pour out an increased quantity of perspirable matter, which now stands on the skin in large visible drops; the exhalation of it also being lessened by the greater coolness of the skin, as well as its absorption by the diminished action of the lymphatics. See Class I. 1. 2. 3.
The increased secretion of bile and of other fluids poured into the intestines frequently induce a purging at the decline of the hot fit; for as the external absorbent vessels have their mouths exposed to the cold air, as above mentioned, they cease to be excited into unnatural activity sooner than the secretory vessels, whose mouths are exposed to the warmth of the blood: now, as the internal absorbents sympathize with the external ones, these also, which during the hot fit drank up the thinner part of the bile, or of other secreted fluids, lose their increased activity before the gland loses its increased activity, at the decline of the hot fit; and the loose dejections are produced from the same cause, that the increased perspiration stands on the surface of the skin, from the increased absorption ceasing sooner than the increased secretion.
The urine during the cold fit is in small quantity and pale, both from a deficiency of the secretion and a deficiency of the absorption.
During the hot fit it is in its usual quantity, but very high coloured and turbid, because a greater quantity had been secreted by the increased action of the kidnies, and also a greater quantity of its more aqueous part had been absorbed from it in the bladder by the increased action of the absorbents; and lastly, at the decline of the hot fit it is in large quantity and less coloured, or turbid, because the absorbent vessels of the bladder, as observed above, lose their increased action by sympathy with the cutaneous ones sooner than the secretory vessels of the kidnies lose their increased activity. Hence the quantity of the sediment, and the colour of the urine, in fevers, depend much on the quantity secreted by the kidnies, and the quantity absorbed from it again in the bladder: the kinds of sediment, as the lateritious, purulent, mucous, or bloody sediments, depend on other causes. It should be observed, that if the sweating be increased by the heat of the room, or of the bed-clothes, that a paucity of turbid urine will continue to be produced, as the absorbents of the bladder will have their activity increased by their sympathy with the vessels of the skin, for the purpose of supplying the fluid expended in perspiration.
The pulse becomes strong and full owing to the increased irritability of the heart and arteries, from the accumulation of sensorial power during their quiescence, and to the quickness of the return of the blood from the various glands and capillaries. This increased action of all the secretory vessels does not occur very suddenly, nor universally at the same time. The heat seems to begin about the center, and to be diffused from thence irregularly to the other parts of the system. This may be owing to the situation of the parts which first became quiescent and caused the fever-fit, especially when a hardness or tumour about the præcordia can be felt by the hand; and hence this part, in whatever viscus it is seated, might be the first to regain its natural or increased irritability.
3. It must be here noted, that, by the increased quantity of heat, and of the impulse of the blood at the commencement of the hot fit, a great increase of stimulus is induced, and is now added to the increased irritability of the system, which was occasioned by its previous quiescence. This additional stimulus of heat and momentum of the blood augments the violence of the movements of the arterial and glandular system in an increasing ratio. These violent exertions still producing more heat and greater momentum of the moving fluids, till at length the sensoral power becomes wasted by this great stimulus beneath its natural quantity, and predisposes the system to a second cold fit.
At length all these unnatural exertions spontaneously subside with the increased irritability that produced them; and which was itself produced by the preceding quiescence, in the same manner as the eye, on coming from darkness into day-light, in a little time ceases to be dazzled and pained, and gradually recovers its natural degree of irritability.
4. But if the increase of irritability, and the consequent increase of the stimulus of heat and momentum, produce more violent exertions than those above described; great pain arises in some part of the moving system, as in the membranes of the brain, pleura, or joints; and new motions of the vessels are produced in consequence of this pain, which are called inflammation; or delirium or stupor arises; as explained in Sect. XXI. and XXXIII.: for the immediate effect is the same, whether the great energy of the moving organs arises from an increase of stimulus or an increase of irritability; though in the former case the waste of sensorial power leads to debility, and in the latter to health.
Recapitulation.
X. Those muscles, which are less frequently exerted, and whose actions are interrupted by sleep, acquire less accumulation of sensorial power during their quiescent state, as the muscles of locomotion. In these muscles after great exertion, that is, after great exhaustion of sensorial power, the pain of fatigue ensues; and during rest there is a renovation of the natural quantity of sensorial power; but where the rest, or quiescence of the muscle, is long continued, a quantity of sensorial power becomes accumulated beyond what is necessary; as appears by the uneasiness occasioned by want of exercise; and which in young animals is one cause exciting them into action, as is seen in the play of puppies and kittens.
But when those muscles, which are habituated to perpetual actions, as those of the stomach by the stimulus of food, those of the vessels of the skin by the stimulus of heat, and those which constitute the arteries and glands by the stimulus of the blood, become for a time quiescent, from the want of their appropriated stimuli, or by their associations with other quiescent parts of the system; a greater accumulation of sensorial power is acquired during their quiescence, and a greater or quicker exhaustion of it is produced during their increased action.
This accumulation of sensorial power from deficient action, if it happens to the stomach from want of food, occasions the pain of hunger; if it happens to the vessels of the skin from want of heat, it occasions the pain of cold; and if to the arterial system from the want of its adapted stimuli, many disagreeable sensations are occasioned, such as are experienced in the cold fits of intermittent fevers, and are as various, as there are glands or membranes in the system, and are generally termed universal uneasiness.
When the quiescence of the arterial system is not owing to defect of stimulus as above, but to the defective quantity of sensorial power, as in the commencement of nervous fever, or irritative fever with weak pulse, a great torpor of this system is quickly induced; because both the irritation from the stimulus of the blood, and the association of the vascular motions with each other, continue to excite the arteries into action, and thence quickly exhaust the ill-supplied vascular muscles; for to rest is death; and therefore those vascular muscles continue to proceed, though with feebler action, to the extreme of weariness or faintness: while nothing similar to this affects the locomotive muscles, whose actions are generally caused by volition, and not much subject either to irritation or to other kinds of associations besides the voluntary ones, except indeed when they are excited by the lash of slavery.
In these vascular muscles, which are subject to perpetual action, and thence liable to great accumulation of sensorial power during their quiescence from want of stimulus, a great increase of activity occurs, either from the renewal of their accustomed stimulus, or even from much less quantities of stimulus than usual. This increase of action constitutes the hot fit of fever, which is attended with various increased secretions, with great concomitant heat, and general uneasiness. The uneasiness attending this hot paroxysm of fever, or fit of exertion, is very different from that, which attends the previous cold fit, or fit of quiescence, and is frequently the cause of inflammation, as in pleurisy, which is treated of in the next section.
A similar effect occurs after the quiescence of our organs of sense; those which are not subject to perpetual action, as the taste and smell, are less liable to an exuberant accumulation of sensorial power after their having for a time been inactive; but the eye, which is in perpetual action during the day, becomes dazzled, and liable to inflammation after a temporary quiescence.
Where the previous quiescence has been owing to a defect of sensorial power, and not to a defect of stimulus, as in the irritative fever with weak pulse, a similar increase of activity of the arterial system succeeds, either from the usual stimulus of the blood, or from a stimulus less than usual; but as there is in general in these cases of fever with weak pulse a deficiency of the quantity of the blood, the pulse in the hot fit is weaker than in health, though it is stronger than in the cold fit, as explained in No. 2. of this section. But at the same time in those fevers, where the defect of irritation is owing to the defect of the quantity of sensorial power, as well as to the defect of stimulus, another circumstance occurs; which consists in the partial distribution of it, as appears in partial flushings, as of the face or bosom, while the extremities are cold; and in the increase of particular secretions, as of bile, saliva, insensible perspiration, with great heat of the skin, or with partial sweats, or diarrhœa.
There are also many uneasy sensations attending these increased actions, which, like those belonging to the hot fit of fever with strong pulse, are frequently followed by inflammation, as in scarlet fever; which inflammation is nevertheless accompanied with a pulse weaker, though quicker, than the pulse during the remission or intermission of the paroxysms, though stronger than that of the previous cold fit.
From hence I conclude, that both the cold and hot fits of fever are necessary consequences of the perpetual and incessant action of the arterial and glandular system; since those muscular fibres and those organs of sense, which are most frequently exerted, become necessarily most affected both with defect and accumulation of sensorial power: and that hence fever-fits are not an effort of nature to relieve herself, and that therefore they should always be prevented or diminished as much as possible, by any means which decrease the general or partial vascular actions, when they are greater, or by increasing them when they are less than in health, as described in Sect. XII. 6. 1.
Thus have I endeavoured to explain, and I hope to the satisfaction of the candid and patient reader, the principal symptoms or circumstances of fever without the introduction of the supernatural power of spasm. To the arguments in favour of the doctrine of spasm it may be sufficient to reply, that in the evolution of medical as well as of dramatic catastrophe,
Nec Deus intersit, nisi dignus vindice nodus inciderit.—Hor.