Zoonomia Volume Ii Part 36

On waking, this increased sensibility and irritability of the system ceases by the renewed exertions of volition; in the same manner as more violent exertions of volition destroy greater pains; and the pulse in consequence subsides along with the increase of heat; if more violent efforts of volition are exerted, the system becomes still less affected by sensation or irritation. Hence the fever and vertigo of intoxication are lessened by intense thinking, Sect. XXI. 8; and insane people are known to bear the pain of cold and hunger better than others, Sect. x.x.xIV. 2. 5; and lastly, if greater voluntary efforts exist, as in violent anger or violent exercise, the whole system is thrown into more energetic action, and a voluntary fever is induced, as appears by the red skin, quickened pulse, and increase of heat; whence dropsies and fevers with debility are not unfrequently removed by insanity.

Hence the exertion of the voluntary power in its natural degree diminishes the increased sensibility, and irritability, and probably the increased a.s.sociability, which occurs during sleep; and thus reduces the frequency of the pulse in the feverish sleep after a full meal. In its more powerful state of exertion, it diminishes or destroys sensations and irritations, which are stronger than natural, as in intoxication, or which precede convulsions, or insanity. In its still more powerful degree, the superabundance of this sensorial power actuates and invigorates the whole moving system, giving strength and frequency to the pulse, and an universal glow both of colour and of heat, as in violent anger, or outrageous insanities.

If, in the feverish sleep above described, the skin becomes cooled by the evaporation of much perspirable matter, or by the application of cooler air, or thinner clothes, the actions of the cutaneous capillaries are lessened by defect of the stimulus of heat, which counteracts the increase of sensibility during sleep, and the pulsations of the heart and arteries become slower from the lessened stimulus of the particles of blood thus cooled in the cutaneous and pulmonary vessels. Hence the admission of cold air, or ablution with subtepid or with cold water, in fevers with hot skin, whether they be attended with arterial strength, or arterial debility, renders the pulse slower; in the former case by diminishing the stimulus of the blood, and in the latter by lessening the expenditure of sensorial power. See Suppl. I. 8. and 15.

13. _Incubus._ The night-mare is an imperfect sleep, where the desire of locomotion is vehement, but the muscles do not obey the will; it is attended with great uneasiness, a sense of suffocation, and frequently with fear. It is caused by violent fatigue, or drunkenness, or indigestible food, or lying on the back, or perhaps from many other kinds of uneasiness in our sleep, which may originate either from the body or mind.

Now as the action of respiration is partly voluntary, this complaint may be owing to the irritability of the system being too small to carry on the circulation of the blood through the lungs during sleep, when the voluntary power is suspended. Whence the blood may acc.u.mulate in them, and a painful oppression supervene; as in some haemorrhages of the lungs, which occur during sleep; and in patients much debilitated by fevers. See Somnus interruptus, Cla.s.s I. 2. 1. 3. and I. 2. 1. 9.

Great fatigue with a full supper and much wine, I have been well informed by one patient, always produced this disease in himself to a great degree.

Now the general irritability of the system is much decreased by fatigue, as it exhausts the sensorial power; and secondly, too much wine and stimulating food will again diminish the irritability of some parts of the system, by employing a part of the sensorial power, which is already too small, in digesting a great quant.i.ty of aliment; and in increasing the motions of the organs of sense in consequence of some degree of intoxication, whence difficulty of breathing may occur from the inirritability of the lungs, as in Cla.s.s I. 2. 1. 3.

M. M. To sleep on a hard bed with the head raised. Moderate supper. The bark. By sleeping on a harder bed the patient will turn himself more frequently, and not be liable to sleep too profoundly, or lie too long in one posture. To be awakened frequently by an alarm clock.

14. _Lethargus._ The lethargy is a slighter apoplexy. It is supposed to originate from universal pressure on the brain, and is said to be produced by compressing the spinal marrow, where there is a deficiency of the bone in the spina bifida. See Sect. XVIII. 20. Whereas in the hydrocephalus there is only a partial pressure of the brain; and probably in nervous fevers with stupor the pressure on the brain may affect only the nerves of the senses, which lie within the skull, and not those nerves of the medulla oblongata, which princ.i.p.ally contribute to move the heart and arteries; whence in the lethargic or apoplectic stupor the pulse is slow as in sleep, whereas in nervous fever the pulse is very quick and feeble, and generally so in hydrocephalus.

In cases of obstructed kidneys, whether owing to the tubuli uriniferi being totally obstructed by calculous matter, or by their paralysis, a kind of drowsiness or lethargy comes on about the eighth or ninth day, and the patient gradually sinks. See Cla.s.s I. 1. 3. 9.

15. _Syncope epileptica_, is a temporary apoplexy, the pulse continuing in its natural state, and the voluntary power suspended. This terminates the paroxysms of epilepsy.

When the animal power is much exhausted by the preceding convulsions, so that the motions from sensation as well as those from volition are suspended; in a quarter or half an hour the sensorial power becomes restored, and if no pain, or irritation producing pain, recurs, the fit of epilepsy ceases; if the pain recurs, or the irritation, which used to produce it, a new fit of convulsion takes place, and is succeeded again by a syncope. See Epilepsy, Cla.s.s III. 1. 1. 7.

16. _Apoplexia._ Apoplexy may be termed an universal palsy, or a permanent sleep. In which, where the pulse is weak, copious bleeding must be injurious; as is well observed by Dr. Heberden, Trans. of the College.

Mr. ----, about 70 years of age, had an apoplectic seizure. His pulse was strong and full. One of the temporal arteries was opened, and about ten ounces of blood suddenly taken from it. He seemed to receive no benefit from this operation; but gradually sunk, and lived but a day or two.

If apoplexy arises from the pressure of blood extravasated on the brain, one moderate venesection may be of service to prevent the further effusion of blood; but copious venesection must be injurious by weakening the patient; since the effused blood must have time, as in common vibices or bruises, to undergo a chemico-animal process, so to change its nature as to fit it for absorption; which may take two or three weeks, which time a patient weakened by repeated venesection or arteriotomy may not survive.

Mrs. ----, about 40 years old, had an apoplectic seizure after great exertion from fear; she had lain about 24 hours without speech, or having swallowed any liquid. She was then forcibly raised in bed, and a spoonful of solution of aloes in wine put into her mouth, and the end of the spoon withdrawn, that she might more easily swallow the liquid.--This was done every hour, with broth, and wine and water intervening, till evacuations were procured; which with other means had good effect, and she recovered, except that a considerable degree of hemiplegia remained, and some imperfection of her speech.

Many people, who have taken so much vinous spirit as to acquire the temporary apoplexy of intoxication, and are not improperly said to be dead-drunk, have died after copious venesection, I suppose in consequence of it. I once saw at a public meeting two gentlemen in the drunken apoplexy; they were totally insensible with low pulse, on this account they were directed not to lose blood, but to be laid on a bed with their heads high, and to be turned every half hour; as soon as they could swallow, warm tea was given them, which evacuated their stomachs, and they gradually recovered, as people do from less degrees of intoxication.

M. M. Cupping on the occiput. Venesection once in moderate quant.i.ty. Warm fomentations long continued and frequently repeated on the shaved head.

Solution of aloes. Clysters with solution of aloe and oil of amber. A blister on the spine. An emetic. Afterwards the bark, and small doses of chalybeates. Small electric shocks through the head. Errhines. If small doses of opium?

17. _Mors a frigore._ Death from cold. The unfortunate travellers, who almost every winter perish in the snow, are much exhausted by their efforts to proceed on their journey, as well as benumbed by cold. And as much greater exercise can be borne without fatigue in cold weather than in warm; because the excessive motions of the cutaneous vessels are thus prevented, and the consequent waste of sensorial power; it may be inferred, that the fatigued traveller becomes paralytic from violent exertion as well as by the application of cold.

Great degrees of cold affect the motions of those vessels most, which have been generally excited into action by irritation; for when the feet are much benumbed by cold, and painful, and at the same time almost insensible to the touch of external objects, the voluntary muscles retain their motions, and we continue to walk on; the same happens to the fingers of children in throwing snow-b.a.l.l.s, the voluntary motions of the muscles continue, though those of the cutaneous vessels are benumbed into inactivity.

Mr. Thompson, an elderly gentleman of Shrewsbury, was seized with hemiplegia in the cold bath; which I suppose might be owing to some great energy of exertion, as much as to the coldness of the water. As in the instance given of Mr. Nairn, who, by the exertion to save his relation, perished himself. See Sect. x.x.xIV. 1. 7.

Whence I conclude, that though heat is a fluid necessary to muscular motion, both perhaps by its stimulus, and by its keeping the minute component parts of the ultimate fibrils of the muscles or organs of sense at a proper distance from each other; yet that paralysis, properly so called, is the consequence of exhaustion of sensorial power by exertion.

And that the acc.u.mulations of it during the torpor of the cutaneous vessels by exposure to cold, or of some internal viscus in the cold fits of agues, are frequently instrumental in recovering the use of paralytic limbs, or of the motions of other paralytic parts of the system. See Spec. 4. of this genus.

Animal bodies resist the power of cold probably by their exertions in consequence of the pain of cold, see Botan. Gard. V. 1. additional note xii. But if these increased exertions be too violent, so as to exhaust the sensorial power in producing unnecessary motions, the animal will probably sooner perish. Thus a moderate quant.i.ty of wine or spirit repeated at proper intervals of time might be of service to those, who are long exposed to excessive cold, both by increasing the action of the capillary vessels, and thus producing heat, and perhaps by increasing in some degree the secretion of sensorial power in the brain. But the contrary must happen when taken immoderately, and not at due intervals. A well attested history was once related to me of two men, who set out on foot to travel in the snow, one of whom drank two or three gla.s.ses of brandy before they began their journey, the other contented himself with his usual diet and potation; the former of whom perished in spite of any a.s.sistance his companion could afford him; and the other performed his journey with safety. In this case the sensorial power was exhausted by the unnecessary motions of incipient intoxication by the stimulus of the brandy, as well as by the exertions of walking; which so weakened the dram-drinker, that the cold sooner destroyed him; that is, he had not power to produce sufficient muscular or arterial action, and in consequence sufficient heat, to supply the great expenditure of it. Hence the capillaries of the skin first cease to act, and become pale and empty; next those which are immediately a.s.sociated with them, as the extremities of the pulmonary artery, as happens on going into the cold bath. By the continued inaction of these parts of the vascular system the blood becomes acc.u.mulated in the internal arteries, and the brain is supposed to be affected by its compression; because these patients are said to sleep, or to become apoplectic, before they die. I overtook a fishman asleep on his panniers on a very cold frosty night, but on waking him he did not appear to be in any degree of stupor.

See Cla.s.s I. 2. 2. 1.

When travellers are benighted in deep snow, they might frequently be saved by covering themselves in it, except a small aperture for air; in which situation the lives of hares, sheep, and other animals, are so often preserved. The snow, both in respect to its component parts, and to the air contained in its pores, is a bad conductor of heat, and will therefore well keep out the external cold; and as the water, when part of it dissolves, is attracted into the pores of the remainder of it, the situation of an animal beneath it is perfectly dry; and, if he is in contact with the earth, he is in a degree of heat between 48, the medium heat of the earth, and 32, the freezing point; that is, in 40 degrees of heat, in which a man thus covered will be as warm as in bed. See Botan. Garden, V. II. notes on Anemone, Barometz, and Muschus. If these facts were more generally understood, it might annually save the lives of many.

After any part of the vascular system of the body has been long exposed to cold, the sensorial power is so much acc.u.mulated in it, that on coming into a warm room the pain of hotach is produced, and inflammation, and consequent mortification, owing to the great exertion of those vessels, when again exposed to a moderate degree of warmth. See Sect. XII. 5. Whence the propriety of applying but very low degrees of heat to limbs benumbed with cold at first, as of snow in its state of dissolving, which is at 32 degrees of heat, or of very cold water. A French writer has observed, that if frozen apples be thawed gradually by covering them with thawing snow, or immersing them in very cold water, that they do not lose their taste; if this fact was well ascertained, it might teach us how to preserve other ripe fruits in ice-houses for winter consumption.

ORDO II.

_Decreased Volition._

GENUS II.

_With decreased Actions of the Organs of Sense._

SPECIES.

1. _Recollectionis jactura._ Loss of recollection. This is the defect of memory in old people, who forget the actions of yesterday, being incapable of voluntary recollection, and yet remember those of their youth, which by frequent repet.i.tion are introduced by a.s.sociation or suggestion. This is properly the paralysis of the mind; the organs of sense do not obey the voluntary power; that is, our ideas cannot be recollected, or acted over again by the will.

After an apoplectic attack the patients, on beginning to recover, find themselves most at a loss in recollecting proper names of persons or places; as those words have not been so frequently a.s.sociated with the ideas they stand for, as the common words of a language. Mr. ----, a man of strong mind, of a short necked family, many of whom had suffered by apoplexy, after an apoplectic fit on his recovering the use of speech, after repeated trials to remember the name of a person or place, applauded himself, when he succeeded, with such a childish smile on the partial return of his sagacity, as very much affected me.--Not long, alas! to return; for another attack in a few weeks destroyed the whole.

I saw a child after the small-pox, which was left in this situation; it was lively, active, and even vigorous; but shewed that kind of surprise, which novelty excites, at every object it viewed; and that as often as it viewed it. I never heard the termination of the case.

2. _Stult.i.tia voluntaria._ Voluntary folly. The absence of voluntary power and consequent incapacity to compare the ideas of present and future good.

Brute animals may be said to be in this situation, as they are in general excited into action only by their present painful or pleasurable sensations. Hence though they are liable to surprise, when their pa.s.sing trains of ideas are dissevered by violent stimuli; yet are they not affected with wonder or astonishment at the novelty of objects; as they possess but in a very inferior degree, that voluntary power of comparing the present ideas with those previously acquired, which distinguishes mankind; and is termed a.n.a.logical reasoning, when deliberatively exerted; and intuitive a.n.a.logy, when used without our attention to it, and which always preserves our hourly trains of ideas consistent with truth and nature. See Sect. XVII. 3. 7.

3. _Credulitas._ Credulity. Life is short, opportunities of knowledge rare; our senses are fallacious, our reasonings uncertain, mankind therefore struggles with perpetual error from the cradle to the coffin. He is necessitated to correct experiment by a.n.a.logy, and a.n.a.logy by experiment; and not always to rest satisfied in the belief of facts even with this two-fold testimony, till future opportunities, or the observations of others, concur in their support.

Ignorance and credulity have ever been companions, and have misled and enslaved mankind; philosophy has in all ages endeavoured to oppose their progress, and to loosen the shackles they had imposed; philosophers have on this account been called unbelievers: unbelievers of what? of the fictions of fancy, of witchcraft, hobgobblins, apparitions, vampires, fairies; of the influence of stars on human actions, miracles wrought by the bones of saints, the flights of ominous birds, the predictions from the bowels of dying animals, expounders of dreams, fortune-tellers, conjurors, modern prophets, necromancy, cheiromancy, animal magnetism, with endless variety of folly? These they have disbelieved and despised, but have ever bowed their h.o.a.ry heads to Truth and Nature.

Mankind may be divided in respect to the facility of their belief or conviction into two cla.s.ses; those, who are ready to a.s.sent to single facts from the evidence of their senses, or from the serious a.s.sertions of others; and those, who require a.n.a.logy to corroborate or authenticate them.

Our first knowledge is acquired by our senses; but these are liable to deceive us, and we learn to detect these deceptions by comparing the ideas presented to us by one sense with those presented by another. Thus when we first view a cylinder, it appears to the eye as a flat surface with different shades on it, till we correct this idea by the sense of touch, and find its surface to be circular; that is, having some parts gradually receding further from the eye than others. So when a child, or a cat, or a bird, first sees its own image in a looking-gla.s.s, it believes that another animal exists before it, and detects this fallacy by going behind the gla.s.s to examine, if another tangible animal really exists there.

Another exuberant source of error consists in the false notions, which we receive in our early years from the design or ignorance of our instructors, which affect all our future reasoning by their perpetual intrusions; as those habits of muscular actions of the face or limbs, which are called tricks, when contracted in infancy continue to the end of our lives.

A third great source of error is the vivacity of our ideas of imagination, which perpetually intrude themselves by various a.s.sociations, and compose the farrago of our dreams; in which, by the suspension of volition, we are precluded from comparing the ideas of one sense with those of another, or the incongruity of their successions with the usual course of nature, and thus to detect their fallacy. Which we do in our waking hours by a perpetual voluntary exertion, a process of the mind above mentioned, which we have termed intuitive a.n.a.logy. Sect. XVII. 3. 7.

This a.n.a.logy presupposes an acquired knowledge of things, hence children and ignorant people are the most credulous, as not possessing much knowledge of the usual course of nature; and secondly, those are most credulous, whose faculty of comparing ideas, or the voluntary exertion of it, is slow or imperfect. Thus if the power of the magnetic needle of turning towards the north, or the shock given by touching both sides of an electrized coated jar, was related for the first time to a philosopher, and to an ignorant person; the former would be less ready to believe them, than the latter; as he would find nothing similar in nature to compare them to, he would again and again repeat the experiment, before he would give it his entire credence; till by these repet.i.tions it would cease to be a single fact, and would therefore gain the evidence of a.n.a.logy. But the latter, as having less knowledge of nature, and less facility of voluntary exertion, would more readily believe the a.s.sertions of others, or a single fact, as presented to his own observation. Of this kind are the bulk of mankind; they continue throughout their lives in a state of childhood, and have thus been the dupes of priests and politicians in all countries and in all ages of the world.

In regard to religious matters, there is an intellectual cowardice instilled into the minds of the people from their infancy; which prevents their inquiry: credulity is made an indispensable virtue; to inquire or exert their reason in religious matters is denounced as sinful; and in the catholic church is punished with more severe penances than moral crimes.

But in respect to our belief of the supposed medical facts, which are published by variety of authors; many of whom are ignorant, and therefore credulous; the golden rule of David Hume may be applied with great advantage. "When two miraculous a.s.sertions oppose each other, believe the less miraculous." Thus if a person is said to have received the small-pox a second time, and to have gone through all the stages of it, one may thus reason: twenty thousand people have been exposed to the variolous contagion a second time without receiving the variolous fever, to every one who has been said to have thus received it; it appears therefore less miraculous, that the a.s.sertor of this supposed fact has been deceived, or wishes to deceive, than that it has so happened contrary to the long experienced order of nature.

M. M. The method of cure is to increase our knowledge of the laws of nature, and our habit of comparing whatever ideas are presented to us with those known laws, and thus to counteract the fallacies of our senses, to emanc.i.p.ate ourselves from the false impressions which we have imbibed in our infancy, and to set the faculty of reason above that of imagination.

_The Orders and Genera of the Fourth Cla.s.s of Diseases._

CLa.s.s IV.

DISEASES OF a.s.sOCIATION.