# Zoonomia/I.XII

SECT. XII.
OF STIMULUS, SENSORIAL EXERTION, AND FIBROUS CONTRACTION.
    I. Of fibrous contraction. 1. Two particles of a fibre cannot approach without the intervention of something, as in magnetism, electricity, elasticity. Spirit of life is not electric ether. Galvani's experiments. 2. Contraction of a fibre. 3. Relaxation succeeds. 4. Successive contractions, with intervals. Quick pulse from debility, from paucity of blood. Weak contractions performed in less time, and with shorter intervals. 5. Last situation of the fibres continues after contraction. 6. Contraction greater than usual induces pleasure or pain. 7. Mobility of the fibres uniform. Quantity of sensorial power fluctuates. Constitutes excitability. II. Of sensorial exertion. 1. Animal motion includes stimulus, sensorial power, and contractile fibres. The sensorial faculties act separately or conjointly. Stimulus of four kinds. Strength and weakness defined. Sensorial power perpetually exhausted and renewed. Weakness from defect of stimulus. From defect of sensorial power, the direct and indirect debility of Dr. Brown. Why we become warm in Buxton bath after a time, and see well after a time in a darkish room. Fibres may act violently, or with their whole force, and yet feebly. Great exertion in inflammation explained. Great muscular force of some insane people. 2. Occasional accumulation of sensorial power in muscles subject to constant stimulus. In animals sleeping in winter. In eggs, seeds, schirrous tumours, tendons, bones. 3. Great exertion introduces pleasure or pain. Inflammation. Libration of the system between torpor and activity. Fever-fits. 4. Desire and aversion introduced. Excess of volition cures fevers. III. Of repeated stimulus. 1. A stimulus repeated too frequently looses effect. As opium, wine, grief. Hence old age. Opium and aloes in small doses. 2. A stimulus not repeated too frequently does not lose effect. Perpetual movement of the vital organs. 3. A stimulus repeated at uniform times produces greater effect. Irritation combined with association. 4. A stimulus repeated frequently and uniformly may be withdrawn, and the action of the organ will continue. Hence the bark cures agues, and strengthens weak constitutions. 5. Defect of stimulus repeated at certain intervals causes fever-fits. 6. Stimulus long applied ceases to act a second time. 7. If a stimulus excites sensation in an organ not usually excited into sensation, inflammation is produced. IV. Of stimulus greater than natural. 1. A stimulus greater than natural diminishes the quantity of sensorial power in general. 2. In particular organs. 3. Induces the organ into spasmodic actions. 4. Induces the antagonist fibres into action. 5. Induces the organ into convulsive or fixed spasms. 6. Produces paralysis of the organ. V. Of stimulus less than natural. 1. Stimulus less than natural occasions accumulation of sensorial power in general. 2. In particular organs, flushing of the face in a frosty morning. In fibres subject to perpetual stimulus only. Quantity of sensorial power inversely as the stimulus. 3. Induces pain. As of cold, hunger, head-ach. 4. Induces more feeble and frequent contraction. As in low fevers. Which are frequently owing to deficiency of sensorial power rather than to deficiency of stimulus. 5. Inverts successive trains of motion. Inverts ideas. 6. Induces paralysis and death. VI. Cure of increased exertion. 1. Natural cure of exhaustion of sensorial power. 2. Decrease the irritations. Venesection. Cold. Abstinence. 3. Prevent the previous cold fit. Opium. Bark. Warmth. Anger. Surprise. 4. Excite some other part of the system. Opium and warm bath relieve pains both from defect and from excess of stimulus. 5. First increase the stimulus above, and then decrease it beneath the natural quantity. VII. Cure of decreased exertion. 1. Natural cure by accumulation of sensorial power. Ague-fits. Syncope. 2. Increase the stimulation, by wine, opium, given so as not to intoxicate. Cheerful ideas. 3. Change the kinds of stimulus. 4. Stimulate the associated organs. Blisters of use in heart-burn, and cold extremities. 5. Decrease the stimulation for a time, cold bath. 6. Decrease the stimulation below natural, and then increase it above natural. Bark after emetics. Opium after venesection. Practice of Sydenham in chlorosis. 7. Prevent unnecessary expenditure of sensorial power. Decumbent posture, silence, darkness. Pulse quickened by rising out of bed. 8. To the greatest degree of quiescence apply the least stimulus. Otherwise paralysis or inflammation of the organ ensues. Gin, wine, blisters, destroy by too great stimulation in fevers with debility. Intoxication in the slightest degree succeeded by debility. Golden rule for determining the best degree of stimulus in low fevers. Another golden rule for determining the quantity of spirit which those, who are debilitated by drinking it, may safely omit.
I. Of fibrous contraction.
1. If two particles of iron lie near each other without motion, and afterwards approach each other; it is reasonable to conclude that something besides the iron particles is the cause of their approximation; this invisible something is termed magnetism. In the same manner, if the particles, which compose an animal muscle, do not touch each other in the relaxed state of the muscle, and are brought into contact during the contraction of the muscle, it is reasonable to conclude, that some other agent is the cause of this new approximation. For nothing can act, where it does not exist; for to act includes to exist; and therefore the particles of the muscular fibre (which in its state of relaxation are supposed not to touch) cannot affect each other without the influence of some intermediate agent; this agent is here termed the spirit of animation, or sensorial power, but may with equal propriety be termed the power, which causes contraction; or may be called by any other name, which the reader may choose to affix to it.
The contraction of a muscular fibre may be compared to the following electric experiment, which is here mentioned not as a philosophical analogy, but as an illustration or simile to facilitate the conception of a difficult subject. Let twenty very small Leyden phials properly coated be hung in a row by fine silk threads at a small distance from each other; let the internal charge of one phial be positive, and of the other negative alternately, if a communication be made from the internal surface of the first to the external surface of the last in the row, they will all of them instantly approach each other, and thus shorten a line that might connect them like a muscular fibre. See Botanic Garden, p. 1. Canto I. 1. 202, note on Gymnotus.
The attractions of electricity or of magnetism do not apply philosophically to the illustration of the contraction of animal fibres, since the force of those attractions increases in some proportion inversely as the distance, but in muscular motion there appears no difference in velocity or strength during the beginning or end of the contraction, but what may be clearly ascribed to the varying mechanic advantage in the approximation of one bone to another. Nor can muscular motion be assimilated with greater plausibility to the attraction of cohesion or elasticity; for in bending a steel spring, as a small sword, a less force is required to bend it the first inch than the second; and the second than the third; the particles of steel on the convex side of the bent spring endeavouring to restore themselves more powerfully the further they are drawn from each other. See Botanic Garden, P. I. addit. Note XVIII.
I am aware that this may be explained another way, by supposing the elasticity of the spring to depend more on the compression of the particles on the concave side than on the extension of them on the convex side; and by supposing the elasticity of the elastic gum to depend more on the resistance to the lateral compression of its particles than to the longitudinal extension of them. Nevertheless in muscular contraction, as above observed, there appears no difference in the velocity or force of it at its commencement or at its termination; from whence we must conclude that animal contraction is governed by laws of its own, and not by those of mechanics, chemistry, magnetism, or electricity.
On these accounts I do not think the experiments conclusive, which were lately published by Galvani, Volta, and others, to shew a similitude between the spirit of animation, which contracts the muscular fibres, and the electric fluid. Since the electric fluid may act only as a more potent stimulus exciting the muscular fibres into action, and not by supplying them with a new quantity of the spirit of life. Thus in a recent hemiplegia I have frequently observed, when the patient yawned and stretched himself, that the paralytic limbs moved also, though they were totally disobedient to the will. And when he was electrified by passing shocks from the affected hand to the affected foot, a motion of the paralytic limbs was also produced. Now as in the act of yawning the muscles of the paralytic limbs were excited into action by the stimulus of the irksomeness of a continued posture, and not by any additional quantity of the spirit of life; so we may conclude, that the passage of the electric fluid, which produced a similar effect, acted only as a stimulus, and not by supplying any addition of sensorial power.
If nevertheless this theory should ever become established, a stimulus must be called an eductor of vital ether; which stimulus may consist of sensation or volition, as in the electric eel, as well as in the appulses of external bodies; and by drawing off the charges of vital fluid may occasion the contraction or motions of the muscular fibres, and organs of sense.
2. The immediate effect of the action of the spirit of animation or sensorial power on the fibrous parts of the body, whether it acts in the mode of irritation, sensation, volition, or association, is a contraction of the animal fibre, according to the second law of animal causation. Sect. IV. Thus the stimulus of the blood induces the contraction of the heart; the agreeable taste of a strawberry produces the contraction of the muscles of deglutition; the effort of the will contracts the muscles, which move the limbs in walking; and by association other muscles of the trunk are brought into contraction to preserve the balance of the body. The fibrous extremities of the organs of sense have been shewn, by the ocular spectra in Sect. III. to suffer similar contraction by each of the above modes of excitation; and by their configurations to constitute our ideas.
3. After animal fibres have for some time been excited into contraction, a relaxation succeeds, even though the exciting cause continues to act. In respect to the irritative motions this is exemplified in the peristaltic contractions of the bowels; which cease and are renewed alternately, though the stimulus of the aliment continues to be uniformly applied; in the sensitive motions, as in strangury, tenesmus, and parturition, the alternate contractions and relaxations of the muscles exist, though the stimulus is perpetual. In our voluntary exertions it is experienced, as no one can hang long by the hands, however vehemently he wills so to do; and in the associate motions the constant change of our attitudes evinces the necessity of relaxation to those muscles, which have been long in action.
This relaxation of a muscle after its contraction, even though the stimulus continues to be applied, appears to arise from the expenditure or diminution of the spirit of animation previously resident in the muscle, according to the second law of animal causation in Sect. IV. In those constitutions, which are termed weak, the spirit of animation becomes sooner exhausted, and tremulous motions are produced, as in the hands of infirm people, when they lift a cup to their mouths. This quicker exhaustion of the spirit of animation is probably owing to a less quantity of it residing in the acting fibres, which therefore more frequently require a supply from the nerves, which belong to them.
4. If the sensorial power continues to act, whether it acts in the mode of irritation, sensation, volition, or association, a new contraction of the animal fibre succeeds after a certain interval; which interval is of shorter continuance in weak people than in strong ones. This is exemplified in the shaking of the hands of weak people, when they attempt to write. In a manuscript epistle of one of my correspondents, which is written in a small hand, I observed from four to six zigzags in the perpendicular stroke of every letter, which shews that both the contractions of the fingers, and intervals between them, must have been performed in very short periods of time.
The times of contraction of the muscles of enfeebled people being less, and the intervals between those contractions being less also, accounts for the quick pulse in fevers with debility, and in dying animals. The shortness of the intervals between one contraction and another in weak constitutions, is probably owing to the general deficiency of the quantity of the spirit of animation, and that therefore there is a less quantity of it to be received at each interval of the activity of the fibres. Hence in repeated motions, as of the fingers in performing on the harpsichord, it would at first sight appear, that swiftness and strength were incompatible; nevertheless the single contraction of a muscle is performed with greater velocity as well as with greater force by vigorous constitutions, as in throwing a javelin.
There is however another circumstance, which may often contribute to cause the quickness of the pulse in nervous fevers, as in animals bleeding to death in the slaughter-house; which is the deficient quantity of blood; whence the heart is but half distended, and in consequence sooner contracts. See Sect. XXXII. 2. 1.
For we must not confound frequency of repetition with quickness of motion, or the number of pulsations with the velocity, with which the fibres, which constitute the coats of the arteries, contract themselves. For where the frequency of the pulsations is but seventy-five in a minute, as in health; the contracting fibres, which constitute the sides of the arteries, may move through a greater space in a given time, than where the frequency of pulsation is one hundred and fifty in a minute, as in some fevers with great debility. For if in those fevers the arteries do not expand themselves in their diastole to more than half the usual diameter of their diastole in health, the fibres which constitute their coats, will move through a less space in a minute than in health, though they make two pulsations for one.
Suppose the diameter of the artery during its systole to be one line, and that the diameter of the same artery during its diastole is in health is four lines, and in a fever with, great debility only two lines. It follows, that the arterial fibres contract in health from a circle of twelve lines in circumference to a circle of three lines in circumference, that is they move through a space of nine lines in length. While the arterial fibres in the fever with debility would twice contract from a circle of six lines to a circle of three lines; that is while they move through a space equal to six lines. Hence though the frequency of pulsation in fever be greater as two to one, yet the velocity of contraction in health is greater as nine to six, or as three to two.
On the contrary in inflammatory diseases with strength, as in the pleurisy, the velocity of the contracting sides of the arteries is much greater than in health, for if we suppose the number of pulsations in a pleurisy to be half as much more than in health, that is as one hundred and twenty to eighty, (which is about what generally happens in inflammatory diseases) and if the diameter of the artery in diastole be one third greater than in health, which I believe is near the truth, the result will be, that the velocity of the contractile sides of the arteries will be in a pleurisy as two and a half to one, compared to the velocity of their contraction in a state of health, for if the circumference of the systole of the artery be three lines, and the diastole in health be twelve lines in circumference, and in a pleurisy eighteen lines; and secondly, if the artery pulsates thrice in the diseased state for twice in the healthy one, it follows, that the velocity of contraction in the diseased state to that in the healthy state will be forty-five to eighteen, or as two and a half to one.
From hence it would appear, that if we had a criterion to determine the velocity of the arterial contractions, it would at the same time give us their strength, and thus be of more service in distinguishing diseases, than the knowledge of their frequency. As such a criterion cannot be had, the frequency of pulsation, the age of the patient being allowed for, will in some measure assist us to distinguish arterial strength from arterial debility, since in inflammatory diseases with strength the frequency seldom exceeds one hundred and eighteen or one hundred and twenty pulsations in a minute; unless under peculiar circumstance, as the great additional stimuli of wine or of external heat.
5. After a muscle or organ of sense has been excited into contraction, and the sensorial power ceases to act, the last situation or configuration of it continues; unless it be disturbed by the action of some antagonist fibres, or other extraneous power. Thus in weak or languid people, wherever they throw their limbs on their bed or sofa, there they lie, till another exertion changes their attitude; hence one kind of ocular spectra seems to be produced after looking at bright objects; thus when a fire-stick is whirled round in the night, there appears in the eye a complete circle of fire; the action or configuration of one part of the retina not ceasing before the return of the whirling fire.
Thus if any one looks at the setting sun for a short time, and then covers his closed eyes with his hand, he will for many seconds of time perceive the image of the sun on his retina. A similar image of all other bodies would remain some time in the eye, but is effaced by the eternal change of the motions of the extremity of this nerve in our attention to other objects. See Sect. XVIII. 5. on Sleep. Hence the dark spots, and other ocular spectra, are more frequently attended to, and remain longer in the eyes of weak people, as after violent exercise, intoxication, or want of sleep.
6. A contraction of the fibres somewhat greater than usual introduces pleasurable sensation into the system, according to the fourth law of animal causation. Hence the pleasure in the beginning of drunkenness is owing to the increased action of the system from the stimulus of vinous spirit or of opium. If the contractions be still greater in energy or duration, painful sensations are introduced, as in consequence of great heat, or caustic applications, or fatigue.
If any part of the system, which is used to perpetual activity, as the stomach, or heart, or the fine vessels of the skin, acts for a time with less energy, another kind of painful sensation ensues, which is called hunger, or faintness, or cold. This occurs in a less degree in the locomotive muscles, and is called wearysomeness. In the two former kinds of sensation there is an expenditure of sensorial power, in these latter there is an accumulation of it.
7. We have used the words exertion of sensorial power as a general term to express either irritation, sensation, volition, or association; that is, to express the activity or motion of the spirit of animation, at the time it produces the contractions of the fibrous parts of the system. It may be supposed that there may exist a greater or less mobility of the fibrous parts of our system, or a propensity to be stimulated into contraction by the greater or less quantity or energy of the spirit of animation; and that hence if the exertion of the sensorial power be in its natural state, and the mobility of the fibres be increased, the same quantity of fibrous contraction will be caused, as if the mobility of the fibres continues in its natural state, and the sensorial exertion be increased.
Thus it may be conceived, that in diseases accompanied with strength, as in inflammatory fevers with arterial strength, that the cause of greater fibrous contraction, may exist in the increased mobility of the fibres, whose contractions are thence both more forceable and more frequent. And that in diseases attended with debility, as in nervous fevers, where the fibrous contractions are weaker, and more frequent, it may be conceived that the cause consists in a decrease of mobility of the fibres; and that those weak constitutions, which are attended with cold extremities and large pupils of the eyes, may possess less mobility of the contractile fibres, as well as less quantity of exertion of the spirit of animation.
In answer to this mode of reasoning it may be sufficient to observe, that the contractile fibres consist of inert matter, and when the sensorial power is withdrawn, as in death, they possess no power of motion at all, but remain in their last state, whether of contraction or relaxation, and must thence derive the whole of this property from the spirit of animation. At the same time it is not improbable, that the moving fibres of strong people may possess a capability of receiving or containing a greater quantity of the spirit of animation than those of weak people.
In every contraction of a fibre there is an expenditure of the sensorial power, or spirit of animation; and where the exertion of this sensorial power has been for some time increased, and the muscles or organs of sense have in consequence acted with greater energy, its propensity to activity is proportionally lessened; which is to be ascribed to the exhaustion or diminution of its quantity. On the contrary, where there has been less fibrous contraction than usual for a certain time, the sensorial power or spirit of animation becomes accumulated in the inactive part of the system. Hence vigour succeeds rest, and hence the propensity to action of all our organs of sense and muscles is in a state of perpetual fluctuation. The irritability for instance of the retina, that is, its quantity of sensorial power, varies every moment according to the brightness or obscurity of the object last beheld compared with the present one. The same occurs to our sense of heat, and to every part of our system, which is capable of being excited into action.
When this variation of the exertion of the sensorial power becomes much and permanently above or beneath the natural quantity, it becomes a disease. If the irritative motions be too great or too little, it shews that the stimulus of external things affect this sensorial power too violently or too inertly. If the sensitive motions be too great or too little, the cause arises from the deficient or exuberant quantity of sensation produced in consequence of the motions of the muscular fibres or organs of sense; if the voluntary actions are diseased the cause is to be looked for in the quantity of volition produced in consequence of the desire or aversion occasioned by the painful or pleasurable sensations above mentioned. And the diseases of associations probably depend on the greater or less quantity of the other three sensorial powers by which they were formed.
From whence it appears that the propensity to action, whether it be called irritability, sensibility, voluntarity, or associability, is only another mode of expression for the quantity of sensorial power residing in the organ to be excited. And that on the contrary the words inirritability and insensibility, together with inaptitude to voluntary and associate motions, are synonymous with deficiency of the quantity of sensorial power, or of the spirit of animation, residing in the organs to be excited.
II. Of sensorial Exertion.
1. There are three circumstances to be attended to in the production of animal motions, 1st. The stimulus. 2d. The sensorial power. 3d. The contractile fibre. 1st. A stimulus, external to the organ, originally induces into action the sensorial faculty termed irritation; this produces the contraction of the fibres, which, if it be perceived at all, introduces pleasure or pain; which in their active state are termed sensation; which is another sensorial faculty, and occasionally produces contraction of the fibres; this pleasure or pain is therefore to be considered as another stimulus, which may either act alone or in conjunction with the former faculty of the sensorium termed irritation.
This new stimulus of pleasure or pain either induces into action the sensorial faculty termed sensation, which then produces the contraction of the fibres; or it introduces desire or aversion, which excite into action another sensorial faculty, termed volition, and may therefore be considered as another stimulus, which either alone or in conjunction with one or both of the two former faculties of the sensorium produces the contraction of animal fibres. There is another sensorial power, that of association, which perpetually, in conjunction with one or more of the above, and frequently singly, produces the contraction of animal fibres, and which is itself excited into action by the previous motions of contracting fibres.
Now as the sensorial power, termed irritation, residing in any particular fibres, is excited into exertion by the stimulus of external bodies acting on those fibres; the sensorial power, termed sensation, residing in any particular fibres is excited into exertion by the stimulus of pleasure or pain acting on those fibres; the sensorial power, termed volition, residing in any particular fibres is excited into exertion by the stimulus of desire or aversion; and the sensorial power, termed association, residing in any particular fibres, is excited into action by the stimulus of other fibrous motions, which had frequently preceded them. The word stimulus may therefore be used without impropriety of language, for any of these four causes, which excite the four sensorial powers into exertion. For though the immediate cause of volition has generally been termed a motive; and that of irritation only has generally obtained the name of stimulus; yet as the immediate cause, which excites the sensorial powers of sensation, or of association into exertion, have obtained no general name, we shall use the word stimulus for them all.
Hence the quantity of motion produced in any particular part of the animal system will be as the quantity of stimulus and the quantity of sensorial power, or spirit of animation, residing in the contracting fibres. Where both these quantities are great, strength is produced, when that word is applied to the motions of animal bodies. Where either of them is deficient, weakness is produced, as applied to the motions of animal bodies.
Now as the sensorial power, or spirit of animation, is perpetually exhausted by the expenditure of it in fibrous contractions, and is perpetually renewed by the secretion or production of it in the brain and spinal marrow, the quantity of animal strength must be in a perpetual state of fluctuation on this account; and if to this be added the unceasing variation of all the four kinds of stimulus above described, which produce the exertions of the sensorial powers, the ceaseless vicissitude of animal strength becomes easily comprehended.
If the quantity of sensorial power remains the same, and the quantity of stimulus be lessened, a weakness of the fibrous contractions ensues, which may be denominated debility from defect of stimulus. If the quantity of stimulus remains the same, and the quantity of sensorial power be lessened, another kind of weakness ensues, which may be termed debility from defect of sensorial power; the former of these is called by Dr. Brown, in his Elements of Medicine, direct debility, and the latter indirect debility. The coincidence of some parts of this work with correspondent deductions in the Brunonian Elementa Medicina, a work (with some exceptions) of great genius, must be considered as confirmations of the truth of the theory, as they were probably arrived at by different trains of reasoning.
Thus in those who have been exposed to cold and hunger there is a deficiency of stimulus. While in nervous fever there is a deficiency of sensorial power. And in habitual drunkards, in a morning before their usual potation, there is a deficiency both of stimulus and of sensorial power. While, on the other hand, in the beginning of intoxication there is an excess of stimulus; in the hot-ach, after the hands have been immersed in snow, there is a redundancy of sensorial power; and in inflammatory diseases with arterial strength, there is an excess of both.
Hence if the sensorial power be lessened, while the quantity of stimulus remains the same as in nervous fever, the frequency of repetition of the arterial contractions may continue, but their force in respect to removing obstacles, as in promoting the circulation of the blood, or the velocity of each contraction, will be diminished, that is, the animal strength will be lessened. And secondly, if the quantity of sensorial power be lessened, and the stimulus be increased to a certain degree, as in giving opium in nervous fevers, the arterial contractions may be performed more frequently than natural, yet with less strength.
And thirdly, if the sensorial power continues the same in respect to quantity, and the stimulus be somewhat diminished, as in going into a darkish room, or into a coldish bath, suppose of about eighty degrees of heat, as Buxton-bath, a temporary weakness of the affected fibres is induced, till an accumulation of sensorial power gradually succeeds, and counterbalances the deficiency of stimulus, and then the bath ceases to feel cold, and the room ceases to appear dark; because the fibres of the subcutaneous vessels, or of the organs of sense, act with their usual energy.
A set of muscular fibres may thus be stimulated into violent exertion, that is, they may act frequently, and with their whole sensorial power, but may nevertheless not act strongly; because the quantity of their sensorial power was originally small, or was previously exhausted. Hence a stimulus may be great, and the irritation in consequence act with its full force, as in the hot paroxysms of nervous fever; but if the sensorial power, termed irritation, be small in quantity, the force of the fibrous contractions, and the times of their continuance in their contracted state, will be proportionally small.
In the same manner in the hot paroxysm of putrid fevers, which are shewn in Sect. XXXIII. to be inflammatory fevers with arterial debility, the sensorial power termed sensation is exerted with great activity, yet the fibrous contractions, which produce the circulation of the blood, are performed without strength, because the quantity of sensorial power then residing in that part of the system is small.
Thus in irritative fever with arterial strength, that is, with excess of spirit of animation, the quantity of exertion during the hot part of the paroxysm is to be estimated from the quantity of stimulus, and the quantity of sensorial power. While in sensitive (or inflammatory) fever with arterial strength, that is, with excess of spirit of animation, the violent and forcible actions of the vascular system during the hot part of the paroxysm are induced by the exertions of two sensorial powers, which are excited by two kinds of stimulus. These are the sensorial power of irritation excited by the stimulus of bodies external to the moving fibres, and the sensorial power of sensation excited by the pain in consequence of the increased contractions of those moving fibres.
And in insane people in some cases the force of their muscular actions will be in proportion to the quantity of sensorial power, which they possess, and the quantity of the stimulus of desire or aversion, which excites their volition into action. At the same time in other cases the stimulus of pain or pleasure, and the stimulus of external bodies, may excite into action the sensorial powers of sensation and irritation, and thus add greater force to their muscular actions.
2. The application of the stimulus, whether that stimulus be some quality of external bodies, or pleasure or pain, or desire or aversion, or a link of association, excites the correspondent sensorial power into action, and this causes the contraction of the fibre. On the contraction of the fibre a part of the spirit of animation becomes expended, and the fibre ceases to contract, though the stimulus continues to be applied; till in a certain time the fibre having received a supply of sensorial power is ready to contract again, if the stimulus continues to be applied. If the stimulus on the contrary be withdrawn, the same quantity of quiescent sensorial power becomes resident in the fibre as before its contraction; as appears from the readiness for action of the large locomotive muscles of the body in a short time after common exertion.
But in those muscular fibres, which are subject to constant stimulus, as the arteries, glands, and capillary vessels, another phenomenon occurs, if their accustomed stimulus be withdrawn; which is, that the sensorial power becomes accumulated in the contractile fibres, owing to the want of its being perpetually expended, or carried away, by their usual unremitted contractions. And on this account those muscular fibres become afterwards excitable into their natural actions by a much weaker stimulus; or into unnatural violence of action by their accustomed stimulus, as is seen in the hot fits of intermittent fevers, which are in consequence of the previous cold ones. Thus the minute vessels of the skin are constantly stimulated by the fluid matter of heat; if the quantity of this stimulus of heat be a while diminished, as in covering the hands with snow, the vessels cease to act, as appears from the paleness of the skin; if this cold application of snow be continued but a short time, the sensorial power, which had habitually been supplied to the fibres, becomes now accumulated in them, owing to the want of its being expended by their accustomed contractions. And thence a less stimulus of heat will now excite them into violent contractions.
If the quiescence of fibres, which had previously been subject to perpetual stimulus, continues a longer time; or their accustomed stimulus be more completely withdrawn; the accumulation of sensorial power becomes still greater, as in those exposed to cold and hunger; pain is produced, and the organ gradually dies from the chemical changes, which take place in it; or it is at a great distance of time restored to action by stimulus applied with great caution in small quantity, as happens to some larger animals and to many insects, which during the winter months lie benumbed with cold, and are said to sleep, and to persons apparently drowned, or apparently frozen to death. Snails have been said to revive by throwing them into water after having been many years shut up in the cabinets of the curious; and eggs and seeds in general are restored to life after many months of torpor by the stimulus of warmth and moisture.
The inflammation of schirrous tumours, which have long existed in a state of inaction, is a process of this kind; as well as the sensibility acquired by inflamed tendons and bones, which had at their formation a similar sensibility, which had so long lain dormant in their uninflamed state.
3. If after long quiescence from defect of stimulus the fibres, which had previously been habituated to perpetual stimulus, are again exposed to but their usual quantity of it; as in those who have suffered the extremes of cold or hunger; a violent exertion of the affected organ commences, owing, as above explained, to the great accumulation of sensorial power. This violent exertion not only diminishes the accumulated spirit of animation, but at the same time induces pleasure or pain into the system, which, whether it be succeeded by inflammation or not, becomes an additional stimulus, and acting along with the former one, produces still greater exertions; and thus reduces the sensorial power in the contracting fibres beneath its natural quantity.
When the spirit of animation is thus exhausted by useless exertions, the organ becomes torpid or unexcitable into action, and a second fit of quiescence succeeds that of abundant activity. During this second fit of quiescence the sensorial power becomes again accumulated, and another fit of exertion follows in train. These vicissitudes of exertion and inertion of the arterial system constitute the paroxysms of remittent fevers; or intermittent ones, when there is an interval of the natural action of the arteries between the exacerbations.
In these paroxysms of fevers, which consist of the libration of the arterial system between the extremes of exertion and quiescence, either the fits become less and less violent from the contractile fibres becoming coming less excitable to the stimulus by habit, that is, by becoming accustomed to it, as explained below XII. 3. 1. or the whole sensorial power becomes exhausted, and the arteries cease to beat, and the patient dies in the cold part of the paroxysm. Or secondly, so much pain is introduced into the system by the violent contractions of the fibres, that inflammation arises, which prevents future cold fits by expending a part of the sensorial power in the extension of old vessels or the production of new ones; and thus preventing the too great accumulation or exertion of it in other parts of the system; or which by the great increase of stimulus excites into great action the whole glandular system as well as the arterial, and thence a greater quantity of sensorial power is produced in the brain, and thus its exhaustion in any peculiar part of the system ceases to be affected.
4. Or thirdly, in consequence of the painful or pleasurable sensation above mentioned, desire and aversion are introduced, and inordinate volition succeeds; which by its own exertions expends so much of the spirit of animation, that the two other sensorial faculties, or irritation and sensation, act so much more feebly; that the paroxysms of fever, or that libration between the extremes of exertion and inactivity of the arterial system, gradually subsides. On this account a temporary insanity is a favourable sign in fevers, as I have had some opportunities of observing.
III. Of repeated Stimulus.
1. When a stimulus is repeated more frequently than the expenditure of sensorial power can be renewed in the acting organ, the effect of the stimulus becomes gradually diminished. Thus if two grains of opium be swallowed by a person unused to so strong a stimulus, all the vascular systems in the body act with greater energy, all the secretions and the absorption from those secreted fluids are increased in quantity; and pleasure or pain are introduced into the system, which adds an additional stimulus to that already too great. After some hours the sensorial power becomes diminished in quantity, expended by the great activity of the system; and thence, when the stimulus of the opium is withdrawn, the fibres will not obey their usual degree of natural stimulus, and a consequent torpor or quiescence succeeds, as is experienced by drunkards, who on the day after a great excess of spirituous potation feel indigestion, head-ach, and general debility.
In this fit of torpor or quiescence of a part or of the whole of the system, an accumulation of the sensorial power in the affected fibres is formed, and occasions a second paroxysm of exertion by the application only of the natural stimulus, and thus a libration of the sensorial exertion between one excess and the other continues for two or three days, where the stimulus was violent in degree; and for weeks in some fevers, from the stimulus of contagious matter.
But if a second dose of opium be exhibited before the fibres have regained their natural quantity of sensorial power, its effect will be much less than the former, because the spirit of animation or sensorial power is in part exhausted by the previous excess of exertion. Hence all medicines repeated too frequently gradually lose their effect, as opium and wine. Many things of disagreeable taste at first cease to be disagreeable by frequent repetition, as tobacco; grief and pain gradually diminish, and at length cease altogether, and hence life itself becomes tolerable.
Besides the temporary diminution of the spirit of animation or sensorial power, which is naturally stationary or resident in every living fibre, by a single exhibition of a powerful stimulus, the contractile fibres themselves, by the perpetual application of a new quantity of stimulus, before they have regained their natural quantity of sensorial power, appear to suffer in their capability of receiving so much as the natural quantity of sensorial power; and hence a permanent deficiency of spirit of animation takes place, however long the stimulus may have been withdrawn. On this cause depends the permanent debility of those, who have been addicted to intoxication, the general weakness of old age, and the natural debility or inirritability of those, who have pale skins and large pupils of their eyes.
There is a curious phenomenon belongs to this place, which has always appeared difficult of solution; and that is, that opium or aloes may be exhibited in small doses at first, and gradually increased to very large ones without producing stupor or diarrhœa. In this case, though the opium and aloes are given in such small doses as not to produce intoxication or catharsis, yet they are exhibited in quantities sufficient in some degree to exhaust the sensorial power, and hence a stronger and a stronger dose is required; otherwise the medicine would soon cease to act at all.
On the contrary, if the opium or aloes be exhibited in a large dose at first, so as to produce intoxication or diarrhœa; after a few repetitions the quantity of either of them may be diminished, and they will still produce this effect. For the more powerful stimulus dissevers the progressive catenations of animal motions, described in Sect. XVII. and introduces a new link between them; whence every repetition strengthens this new association or catenation, and the stimulus may be gradually decreased, or be nearly withdrawn, and yet the effect shall continue; because the sensorial power of association or catenation being united with the stimulus, increases in energy with every repetition of the catenated circle; and it is by these means that all the irritative associations of motions are originally produced.
2. When a stimulus is repeated at such distant intervals of time, that the natural quantity of sensorial power becomes completely restored in the acting fibres, it will act with the same energy as when first applied. Hence those who have lately accustomed themselves to large doses of opium by beginning with small ones, and gradually increasing them, and repeating them frequently, as mentioned in the preceding paragraph; if they intermit the use of it for a few days only, must begin again with as small doses as they took at first, otherwise they will experience the inconveniences of intoxication.
On this circumstance depend the constant unfailing effects of the various kinds of stimulus, which excite into action all the vascular systems in the body; the arterial, venous, absorbent, and glandular vessels, are brought into perpetual unwearied action by the fluids, which are adapted to stimulate them; but these have the sensorial power of association added to that of irritation, and even in some degree that of sensation, and even of volition, as will be spoken of in their places; and life itself is thus carried on by the production of sensorial power being equal to its waste or expenditure in the perpetual movement of the vascular organization.
3. When a stimulus is repeated at uniform intervals of time with such distances between them, that the expenditure of sensorial power in the acting fibres becomes completely renewed, the effect is produced with greater facility or energy. For the sensorial power of association is combined with the sensorial power of irritation, or, in common language, the acquired habit assists the power of the stimulus.
This circumstance not only obtains in the annual and diurnal catenations of animal motions explained in Sect. XXXVI. but in every less circle of actions or ideas, as in the burthen of a song, or the iterations of a dance; and constitutes the pleasure we receive from repetition and imitation; as treated of in Sect. XXII. 2.
4. When a stimulus has been many times repeated at uniform intervals, so as to produce the complete action of the organ, it may then be gradually diminished, or totally withdrawn, and the action of the organ will continue. For the sensorial power of association becomes united with that of irritation, and by frequent repetition becomes at length of sufficient energy to carry on the new link in the circle of actions, without the irritation which at first introduced it.
Hence, when the bark is given at stated intervals for the cure of intermittent fevers, if sixty grains of it be given every three hours for the twenty-four hours preceding the expected paroxysm, so as to stimulate the defective part of the system into action, and by that means to prevent the torpor or quiescence of the fibres, which constitutes the cold fit; much less than half the quantity, given before the time at which another paroxysm of quiescence would have taken place, will be sufficient to prevent it; because now the sensorial power, termed association, acts in a twofold manner. First, in respect to the period of the catenation in which the cold fit was produced, which is now dissevered by the stronger stimulus of the first doses of the bark; and, secondly, because each dose of bark being repeated at periodical times, has its effect increased by the sensorial faculty of association being combined with that of irritation.
Now, when sixty grains of Peruvian bark are taken twice a day, suppose at ten o'clock and at six, for a fortnight, the irritation excited by this additional stimulus becomes a part of the diurnal circle of actions, and will at length carry on the increased action of the system without the assistance of the stimulus of the bark. On this theory the bitter medicines, chalybeates, and opiates in appropriated doses, exhibited for a fortnight, give permanent strength to pale feeble children, and other weak constitutions.
5. When a defect of stimulus, as of heat, recurs at certain diurnal intervals, which induces some torpor or quiescence of a part of the system, the diurnal catenation of actions becomes disordered, and a new association with this link of torpid action is formed; on the next period the quantity of quiescence will be increased, suppose the same defect of stimulus to recur, because now the new association conspires with the defective irritation in introducing the torpid action of this part of the diurnal catenation. In this manner many fever-fits commence, where the patient is for some days indisposed at certain hours, before the cold paroxysm of fever is completely formed. See Sect. XVII. 3. 3. on Catenation of Animal Motions.
6. If a stimulus, which at first excited the affected organ into so great exertion as to produce sensation, be continued for a certain time, it will cease to produce sensation both then and when repeated, though the irritative motions in consequence of it may continue or be re-excited.
Many catenations of irritative motions were at first succeeded by sensation, as the apparent motions of objects when we walk past them, and probably the vital motions themselves in the early state of our existence. But as those sensations were followed by no movements of the system in consequence of them, they gradually ceased to be produced, not being joined to any succeeding link of catenation. Hence contagious matter, which has for some weeks stimulated the system into great and permanent sensation, ceases afterwards to produce general sensation, or inflammation, though it may still induce topical irritations. See Sect. XXXIII. 2. 8. XIX. 9.
Our absorbent system then seems to receive those contagious matters, which it has before experienced, in the same manner as it imbibes common moisture or other fluids; that is, without being thrown into so violent action as to produce sensation; the consequence of which is an increase of daily energy or activity, till inflammation and its consequences succeed.
7. If a stimulus excites an organ into such violent contractions as to produce sensation, the motions of which organ had not usually produced sensation, this new sensorial power, added to the irritation occasioned by the stimulus, increases the activity of the organ. And if this activity be catenated with the diurnal circle of actions, an increasing inflammation is produced; as in the evening paroxysms of small-pox, and other fevers with inflammation. And hence schirrous tumours, tendons and membranes, and probably the arteries themselves become inflamed, when they are strongly stimulated.
IV. Of Stimulus greater than natural.
1. A quantity of stimulus greater than natural, producing an increased exertion of sensorial power, whether that exertion be in the mode of irritation, sensation, volition, or association, diminishes the general quantity of it. This fact is observable in the progress of intoxication, as the increased quantity or energy of the irritative motions, owing to the stimulus of vinous spirit, introduces much pleasurable sensation into the system, and much exertion of muscular or sensual motions in consequence of this increased sensation; the voluntary motions, and even the associate ones, become much impaired or diminished; and delirium and staggering succeed. See Sect. XXI. on Drunkenness. And hence the great prostration of the strength of the locomotive muscles in some fevers, is owing to the exhaustion of sensorial power by the increased action of the arterial system.
In like manner a stimulus greater than natural, applied to a part of the system, increases the exertion of sensorial power in that part, and diminishes it in some other part. As in the commencement of scarlet fever, it is usual to see great redness and heat on the faces and breasts of children, while at the same time their feet are colder than natural; partial heats are observable in other fevers with debility, and are generally attended with torpor or quiescence of some other part of the system. But these partial exertions of sensorial power are sometimes attended with increased partial exertions in other parts of the system, which sympathize with them, as the flushing of the face after a full meal. Both these therefore are to be ascribed to sympathetic associations, explained in Sect. XXXV. and not to general exhaustion or accumulation of sensorial power.
2. A quantity of stimulus greater than natural, producing an increased exertion of sensorial power in any particular organ, diminishes the quantity of it in that organ. This appears from the contractions of animal fibres being not so easily excited by a less stimulus after the organ has been subjected to a greater. Thus after looking at any luminous object of a small size, as at the setting sun, for a short time, so as not much to fatigue the eye, this part of the retina becomes less sensible to smaller quantities of light; hence when the eyes are turned on other less luminous parts of the sky, a dark spot is seen resembling the shape of the sun, or other luminous object which we last behold. See Sect. XL. No. 2.
Thus we are some time before we can distinguish objects in an obscure room after coming from bright day-light, though the iris presently contracts itself. We are not able to hear weak sounds after loud ones. And the stomachs of those who have been much habituated to the stronger stimulus of fermented or spirituous liquors, are not excited into due action by weaker ones.
3. A quantity of stimulus something greater than the last mentioned, or longer continued, induces the organ into spasmodic action, which ceases and recurs alternately. Thus on looking for a time on the setting sun, so as not greatly to fatigue the sight, a yellow spectrum is seen when the eyes are closed and covered, which continues for a time, and then disappears and recurs repeatedly before it entirely vanishes. See Sect. XL. No. 5. Thus the action of vomiting ceases and is renewed by intervals, although the emetic drug is thrown up with the first effort. A tenesmus continues by intervals some time after the exclusion of acrid excrement; and the pulsations of the heart of a viper are said to continue some time after it is cleared from its blood.
In these cases the violent contractions of the fibres produce pain according to law 4; and this pain constitutes an additional kind or quantity of excitement, which again induces the fibres into contraction, and which painful excitement is again renewed, and again induces contractions of the fibres with gradually diminishing effect.
4. A quantity of stimulus greater than that last mentioned, or longer continued, induces the antagonist muscles into spasmodic action. This is beautifully illustrated by the ocular spectra described in Sect. XL. No. 6. to which the reader is referred. From those experiments there is reason to conclude that the fatigued part of the retina throws itself into a contrary mode of action like oscitation or pandiculation, as soon as the stimulus, which has fatigued it, is withdrawn; but that it still remains liable to be excited into action by any other colours except the colour with which it has been fatigued. Thus the yawning and stretching the limbs after a continued action or attitude seems occasioned by the antagonist muscles being stimulated by their extension during the contractions of those in action, or in the situation in which that action last left them.
5. A quantity of stimulus greater than the last, or longer continued, induces variety of convulsions or fixed spasms either of the affected organ or of the moving fibres in the other parts of the body. In respect to the spectra in the eye, this is well illustrated in No. 7 and 8, of Sect. XL. Epileptic convulsions, as the emprosthotonos and opisthotonos, with the cramp of the calf of the leg, locked jaw, and other cataleptic fits, appear to originate from pain, as some of these patients scream aloud before the convulsion takes place; which seems at first to be an effort to relieve painful sensation, and afterwards an effort to prevent it.
In these cases the violent contractions of the fibres produce so much pain, as to constitute a perpetual excitement; and that in so great a degree as to allow but small intervals of relaxation of the contracting fibres as in convulsions, or no intervals at all as in fixed spasms.
6. A quantity of stimulus greater than the last, or longer continued, produces a paralysis of the organ. In many cases this paralysis is only a temporary effect, as on looking long on a small area of bright red silk placed on a sheet of white paper on the floor in a strong light, the red silk gradually becomes paler, and at length disappears; which evinces that a part of the retina, by being violently excited, becomes for a time unaffected by the stimulus of that colour. Thus cathartic medicines, opiates, poisons, contagious matter, cease to influence our system after it has been habituated to the use of them, except by the exhibition of increased quantities of them; our fibres not only become unaffected by stimuli, by which they have previously been violently irritated, as by the matter of the small-pox or measles; but they also become unaffected by sensation, where the violent exertions, which disabled them, were in consequence of too great quantity of sensation. And lastly the fibres, which become disobedient to volition, are probably disabled by their too violent exertions in consequence of too great a quantity of volition.
After every exertion of our fibres a temporary paralysis succeeds, whence the intervals of all muscular contractions, as mentioned in No. 3 and 4 of this Section; the immediate cause of these more permanent kinds of paralysis is probably owing in the same manner to the too great exhaustion of the spirit of animation in the affected part; so that a stronger stimulus is required, or one of a different kind from that, which occasioned those too violent contractions, to again excite the affected organ into activity; and if a stronger stimulus could be applied, it must again induce paralysis.
For these powerful stimuli excite pain at the same time, that they produce irritation; and this pain not only excites fibrous motions by its stimulus, but it also produces volition; and thus all these stimuli acting at the same time, and sometimes with the addition of their associations, produce so great exertion as to expend the whole of the sensorial power in the affected fibres.
V. Of Stimulus less than natural.
1. A quantity of stimulus less than natural, producing a decreased exertion of sensorial power, occasions an accumulation of the general quantity of it. This circumstance is observable in the hemiplagia, in which the patients are perpetually moving the muscles, which are unaffected. On this account we awake with greater vigour after sleep, because during so many hours, the great usual expenditure of sensorial power in the performance of voluntary actions, and in the exertions of our organs of sense, in consequence of the irritations occasioned by external objects had been suspended, and a consequent accumulation had taken place.
In like manner the exertion of the sensorial power less than natural in one part of the system, is liable to produce an increase of the exertion of it in some other part. Thus by the action of vomiting, in which the natural exertion of the motions of the stomach are destroyed or diminished, an increased absorption of the pulmonary and cellular lymphatics is produced, as is known by the increased absorption of the fluid deposited in them in dropsical cases. But these partial quiescences of sensorial power are also sometimes attended with other partial quiescences, which sympathize with them, as cold and pale extremities from hunger. These therefore are to be ascribed to the associations of sympathy explained in Sect. XXXV. and not to the general accumulation of sensorial power.
2. A quantity of stimulus less than natural, applied to fibres previously accustomed to perpetual stimulus, is succeeded by accumulation of sensorial power in the affected organ. The truth of this proposition is evinced, because a stimulus less than natural, if it be somewhat greater than that above mentioned, will excite the organ so circumstanced into violent activity. Thus on a frosty day with wind, the face of a person exposed to the wind is at first pale and shrunk; but on turning the face from the wind, it becomes soon of a glow with warmth and flushing. The glow of the skin in emerging from the cold-bath is owing to the same cause.
It does not appear, that an accumulation of sensorial power above the natural quantity is acquired by those muscles, which are not subject to perpetual stimulus, as the locomotive muscles: these, after the greatest fatigue, only acquire by rest their usual aptitude to motion; whereas the vascular system, as the heart and arteries, after a short quiescence, are thrown into violent action by their natural quantity of stimulus.
Nevertheless by this accumulation of sensorial power during the application of decreased stimulus, and by the exhaustion of it during the action of increased stimulus, it is wisely provided, that the actions of the vascular muscles and organs of sense are not much deranged by small variations of stimulus; as the quantity of sensorial power becomes in some measure inversely as the quantity of stimulus.
3. A quantity of stimulus less than that mentioned above, and continued for some time, induces pain in the affected organ, as the pain of cold in the hands, when they are immersed in snow, is owing to a deficiency of the stimulation of heat. Hunger is a pain from the deficiency of the stimulation of food. Pain in the back at the commencement of ague-fits, and the head-achs which attend feeble people, are pains from defect of stimulus, and are hence relieved by opium, essential oils, spirit of wine.
As the pains, which originate from defect of stimulus, only occur in those parts of the system, which have been previously subjected to perpetual stimulus; and as an accumulation of sensorial power is produced in the quiescent organ along with the pain, as in cold or hunger, there is reason to believe, that the pain is owing to the accumulation of sensorial power. For, in the locomotive muscles, in the retina of the eye, and other organs of senses, no pain occurs from the absence of stimulus, nor any great accumulation of sensorial power beyond their natural quantity, since these organs have not been used to a perpetual supply of it. There is indeed a greater accumulation occurs in the organ of vision after its quiescence, because it is subject to more constant stimulus.
4. A certain quantity of stimulus less than natural induces the moving organ into feebler and more frequent contractions, as mentioned in No. I. 4. of this Section. For each contraction moving through a less space, or with less force, that is, with less expenditure of the spirit of animation, is sooner relaxed, and the spirit of animation derived at each interval into the acting fibres being less, these intervals likewise become shorter. Hence the tremours of the hands of people accustomed to vinous spirit, till they take their usual stimulus; hence the quick pulse in fevers attended with debility, which is greater than in fevers attended with strength; in the latter the pulse seldom beats above 120 times in a minute, in the former it frequently exceeds 140.
It must be observed, that in this and the two following articles the decreased action of the system is probably more frequently occasioned by deficiency in the quantity of sensorial power, than in the quantity of stimulus. Thus those feeble constitutions which have large pupils of their eyes, and all who labour under nervous fevers, seem to owe their want of natural quantity of activity in the system to the deficiency of sensorial power; since, as far as can be seen, they frequently possess the natural quantity of stimulus.
5. A certain quantity of stimulus, less than that above mentioned, inverts the order of successive fibrous contractions; as in vomiting the vermicular motions of the stomach and duodenum are inverted, and their contents ejected, which is probably owing to the exhaustion of the spirit of animation in the acting muscles by a previous excessive stimulus, as by the root of ipecacuanha, and the consequent defect of sensorial power. The same retrograde motions affect the whole intestinal canal in ileus; and the œsophagus in globus hystericus. See this further explained in Sect. XXIX. No. 11. on Retrograde Motions.
I must observe, also, that something similar happens in the production of our ideas, or sensual motions, when they are too weakly excited; when any one is thinking intensely about one thing, and carelessly conversing about another, he is liable to use the word of a contrary meaning to that which he designed, as cold weather for hot weather, summer for winter.
6. A certain quantity of stimulus, less than that above mentioned, is succeeded by paralysis, first of the voluntary and sensitive motions, and afterwards of those of irritation, and of association, which constitutes death.
VI. Cure of increased Exertion.
1. The cure, which nature has provided for the increased exertion of any part of the system, consists in the consequent expenditure of the sensorial power. But as a greater torpor follows this exhaustion of sensorial power, as explained in the next paragraph, and a greater exertion succeeds this torpor, the constitution frequently sinks under these increasing librations between exertion and quiescence; till at length complete quiescence, that is, death, closes the scene.
For, during the great exertion of the system in the hot fit of fever, an increase of stimulus is produced from the greater momentum of the blood, the greater distention of the heart and arteries, and the increased production of heat, by the violent actions of the system occasioned by this augmentation of stimulus, the sensorial power becomes diminished in a few hours much beneath its natural quantity, the vessels at length cease to obey even these great degrees of stimulus, as shewn in Sect. XL. 9. 1. and a torpor of the whole or of a part of the system ensues.
Now as this second cold fit commences with a greater deficiency of sensorial power, it is also attended with a greater deficiency of stimulus than in the preceding cold fit, that is, with less momentum of blood, less distention of the heart. On this account the second cold fit becomes more violent and of longer duration than the first; and as a greater accumulation of sensorial power must be produced before the system of vessels will again obey the diminished stimulus, it follows, that the second hot fit of fever will be more violent than the former one. And that unless some other causes counteract either the violent exertions in the hot fit, or the great torpor in the cold fit, life will at length be extinguished by the expenditure of the whole of the sensorial power. And from hence it appears, that the true means of curing fevers must be such as decrease the action of the system in the hot fit, and increase it in the cold fit; that is, such as prevent the too great diminution of sensorial power in the hot fit, and the too great accumulation of it in the cold one.
2. Where the exertion of the sensorial powers is much increased, as in the hot fits of fever or inflammation, the following are the usual means of relieving it. Decrease the irritations by blood-letting, and other evacuations; by cold water taken into the stomach, or injected as an enema, or used externally; by cold air breathed into the lungs, and diffused over the skin; with food of less stimulus than the patient has been accustomed to.
3. As a cold fit, or paroxysm of inactivity of some parts of the system, generally precedes the hot fit, or paroxysm of exertion, by which the sensorial power becomes accumulated, this cold paroxysm should be prevented by stimulant medicines and diet, as wine, opium, bark, warmth, cheerfulness, anger, surprise.
4. Excite into greater action some other part of the system, by which means the spirit of animation may be in part expended, and thence the inordinate actions of the diseased part may be lessened. Hence when a part of the skin acts violently, as of the face in the eruption of the small-pox, if the feet be cold they should be covered. Hence the use of a blister applied near a topical inflammation. Hence opium and warm bath relieve pains both from excess and defect of stimulus.
5. First increase the general stimulation above its natural quantity, which may in some degree exhaust the spirit of animation, and then decrease the stimulation beneath its natural quantity. Hence after sudorific medicines and warm air, the application of refrigerants may have greater effect, if they could be administered without danger of producing too great torpor of some part of the system; as frequently happens to people in health from coming out of a warm room into the cold air, by which a topical inflammation in consequence of torpor of the mucous membrane of the nostril is produced, and is termed a cold in the head.
VII. Cure of decreased Exertion.
1. Where the exertion of the sensorial powers is much decreased, as in the cold fits of fever, a gradual accumulation of the spirit of animation takes place; as occurs in all cases where inactivity or torpor of a part of the system exists; this accumulation of sensorial power increases, till stimuli less than natural are sufficient to throw it into action, then the cold fit ceases; and from the action of the natural stimuli a hot one succeeds with increased activity of the whole system.
So in fainting fits, or syncope, there is a temporary deficiency of sensorial exertion, and a consequent quiescence of a great part of the system. This quiescence continues, till the sensorial power becomes again accumulated in the torpid organs; and then the usual diurnal stimuli excite the revivescent parts again into action; but as this kind of quiescence continues but a short time compared to the cold paroxysm of an ague, and less affects the circulatory system, a less superabundancy of exertion succeeds in the organs previously torpid, and a less excess of arterial activity. See Sect. XXXIV. 1. 6.
2. In the diseases occasioned by a defect of sensorial exertion, as in cold fits of ague, hysteric complaint, and nervous fever, the following means are those commonly used. 1. Increase the stimulation above its natural quantity for some weeks, till a new habit of more energetic contraction of the fibres is established. This is to be done by wine, opium, bark, steel, given at exact periods, and in appropriate quantities; for if these medicines be given in such quantity, as to induce the least degree of intoxication, a debility succeeds from the useless exhaustion of spirit of animation in consequence of too great exertion of the muscles or organs of sense. To these irritative stimuli should be added the sensitive ones of cheerful ideas, hope, affection.
3. Change the kinds of stimulus. The habits acquired by the constitution depend on such nice circumstances, that when one kind of stimulus ceases to excite the sensorial power into the quantity of exertion necessary to health, it is often sufficient to change the stimulus for another apparently similar in quantity and quality. Thus when wine ceases to stimulate the constitution, opium in appropriate doses supplies the defect; and the contrary. This is also observed in the effects of cathartic medicines, when one loses its power, another, apparently less efficacious, will succeed. Hence a change of diet, drink, and stimulating medicines, is often advantageous in diseases of debility.
4. Stimulate the organs, whose motions are associated with the torpid parts of the system. The actions of the minute vessels of the various parts of the external skin are not only associated with each other, but are strongly associated with those of some of the internal membranes, and particularly of the stomach. Hence when the exertion of the stomach is less than natural, and indigestion and heartburn succeed, nothing so certainly removes these symptoms as the stimulus of a blister on the back. The coldness of the extremities, as of the nose, ears, or fingers, are hence the best indication for the successful application of blisters.
5. Decrease the stimulus for a time. By lessening the quantity of heat for a minute or two by going into the cold bath, a great accumulation of sensorial power is produced; for not only the minute vessels of the whole external skin for a time become inactive, as appears by their paleness; but the minute vessels of the lungs lose much of their activity also by concert with those of the skin, as appears from the difficulty of breathing at first going into cold water. On emerging from the bath the sensorial power is thrown into great exertion by the stimulus of the common degree of the warmth of the atmosphere, and a great production of animal heat is the consequence. The longer a person continues in the cold bath the greater must be the present inertion of a great part of the system, and in consequence a greater accumulation of sensorial power. Whence M. Pomè recommends some melancholy patients to be kept from two to six hours in spring-water, and in baths still colder.
6. Decrease the stimulus for a time below the natural, and then increase it above natural. The effect of this process, improperly used, is seen in giving much food, or applying much warmth, to those who have been previously exposed to great hunger, or to great cold. The accumulated sensorial power is thrown into so violent exertion, that inflammations and mortifications supervene, and death closes the catastrophe. In many diseases this method is the most successful; hence the bark in agues produces more certain effect after the previous exhibition of emetics. In diseases attended with violent pain, opium has double the effect, if venesection and a cathartic have been previously used. On this seems to have been founded the successful practice of Sydenham, who used venesection and a cathartic in chlorosis before the exhibition of the bark, steel, and opiates.
7. Prevent any unnecessary expenditure of sensorial power. Hence in fevers with debility, a decumbent posture is preferred, with silence, little light, and such a quantity of heat as may prevent any chill sensation, or any coldness of the extremities. The pulse of patients in fevers with debility increases in frequency above ten pulsations in a minute on their rising out of bed. For the expenditure of sensorial power to preserve an erect posture of the body adds to the general deficiency of it, and thus affects the circulation.
8. The longer in time and the greater in degree the quiescence or inertion of an organ has been, so that it still retains life or excitability, the less stimulus should at first be applied to it. The quantity of stimulation is a matter of great nicety to determine, where the torpor or quiescence of the fibres has been experienced in a great degree, or for a considerable time, as in cold fits of the ague, in continued fevers with great debility, or in people famished at sea, or perishing with cold. In the two last cases, very minute quantities of food should be first supplied, and very few additional degrees of heat. In the two former cases, but little stimulus of wine or medicine, above what they had been lately accustomed to, should be exhibited, and this at frequent and stated intervals, so that the effect of one quantity may be observed before the exhibition of another.
If these circumstances are not attended to, as the sensorial power becomes accumulated in the quiescent fibres, an inordinate exertion takes place by the increase of stimulus acting on the accumulated quantity of sensorial power, and either the paralysis, or death of the contractile fibres ensues, from the total expenditure of the sensorial power in the affected organ, owing to this increase of exertion, like the debility after intoxication. Or, secondly, the violent exertions above mentioned produce painful sensation, which becomes a new stimulus, and by thus producing inflammation, and increasing the activity of the fibres already too great, sooner exhausts the whole of the sensorial power in the acting organ, and mortification, that is, the death of the part, supervenes.
Hence there have been many instances of people, whose limbs have been long benumbed by exposure to cold, who have lost them by mortification on their being too hastily brought to the fire; and of others, who were nearly famished at sea, who have died soon after having taken not more than an usual meal of food. I have heard of two well-attested instances of patients in the cold fit of ague, who have died from the exhibition of gin and vinegar, by the inflammation which ensued. And in many fevers attended with debility, the unlimited use of wine, and the wanton application of blisters, I believe, has destroyed numbers by the debility consequent to too great stimulation, that is, by the exhaustion of the sensorial power by its inordinate exertion.
Wherever the least degree of intoxication exists, a proportional debility is the consequence; but there is a golden rule by which the necessary and useful quantity of stimulus in fevers with debility may be ascertained. When wine or beer are exhibited either alone or diluted with water, if the pulse becomes slower the stimulus is of a proper quantity; and should be repeated every two or three hours, or when the pulse again becomes quicker.
In the chronical debility brought on by drinking spirituous or fermented liquors, there is another golden rule by which I have successfully directed the quantity of spirit which they may safely lessen, for there is no other means by which they can recover their health. It should be premised, that where the power of digestion in these patients is totally destroyed, there is not much reason to expect a return to healthful vigour.
I have directed several of these patients to omit one fourth part of the quantity of vinous spirit they have been lately accustomed to, and if in a fortnight their appetite increases, they are advised to omit another fourth part; but if they perceive that their digestion becomes impaired from the want of this quantity of spirituous potation, they are advised to continue as they are, and rather bear the ills they have, than risk the encounter of greater. At the same time flesh-meat with or without spice is recommended, with Peruvian bark and steel in small quantities between their meals, and half a grain of opium or a grain, with five or eight grains of rhubarb at night.