Perhaps if the mesenteric glands were nicely inspected in the dissections of these patients; and if the thoracic duct, and the larger branches of the lacteals, and if the lymphatics, which arise from the bladder, were well examined by injection, or by the knife, the cause of diabetes might be more certainly understood.

The opium alone, and the opium with the rosin, seem much to have served this patient, and might probably have effected a cure, if the disease had been slighter, or the medicine had been exhibited, before it had been confirmed by habit during the seven months it had continued. The increase of the quantity of water on beginning the large doses of rosin was probably owing to his omitting the morning doses of opium.

V. The Phaenomena of Dropsies explained.

I. Some inebriates have their paroxysms of inebriety terminated by much pale urine, or profuse sweats, or vomiting, or stools; others have their paroxysms terminated by stupor, or sleep, without the above evacuations.

The former kind of these inebriates have been observed to be more liable to diabetes and dropsy; and the latter to gout, gravel, and leprosy. Evoe! attend ye bacchanalians! start at this dark train of evils, and, amid your immodest jests, and idiot laughter, recollect,

Quem Deus vult perdere, prius dementat.

In those who are subject to diabetes and dropsy, the absorbent vessels are naturally more irritable than in the latter; and by being frequently disturbed or inverted by violent stimulus, and by their too great sympathy with each other, they become at length either entirely paralytic, or are only susceptible of motion from the stimulus of very acrid materials; as every part of the body, after having been used to great irritations, becomes less affected by smaller ones. Thus we cannot distinguish objects in the night, for some time after we come out of a strong light, though the iris is presently dilated; and the air of a summer evening appears cold, after we have been exposed to the heat of the day.

There are no cells in the body, where dropsy may not be produced, if the lymphatics cease to absorb that mucilaginous fluid, which is perpetually deposited in them, for the purpose of lubricating their surfaces.

If the lymphatic branch, which opens into the cellular membrane, either does its office imperfectly, or not at all; these cells become replete with a mucilaginous fluid, which, after it has stagnated some time in the cells, will coagulate over the fire; and is erroneously called water. Wherever the seat of this disease is, (unless in the lungs or other pendent viscera) the mucilaginous liquid above mentioned will subside to the most depending parts of the body, as the feet and legs, when those are lower than the head and trunk; for all these cells have communications with each other.

When the cellular absorbents are become insensible to their usual irritations, it most frequently happens, but not always, that the cutaneous branch of absorbents, which is strictly associated with them, suffers the like inability. And then, as no water is absorbed from the atmosphere, the urine is not only less diluted at the time of its secretion, and consequently in less quantity and higher coloured: but great thirst is at the same time induced, for as no water is absorbed from the atmosphere to dilute the chyle and blood, the lacteals and other absorbent vessels, which have not lost their powers, are excited into more constant or more violent action, to supply this deficiency; whence the urine becomes still less in quantity, and of a deeper colour, and turbid like the yolk of an egg, owing to a greater absorption of its thinner parts. From this stronger action of those absorbents, which still retain their irritability, the fat is also absorbed, and the whole body becomes emaciated. This increased exertion of some branches of the lymphatics, while others are totally or partially paralytic, is resembled by what constantly occurs in the hemiplagia; when the patient has lost the use of the limbs on one side, he is incessantly moving those of the other; for the moving power, not having access to the paralytic limbs, becomes redundant in those which are not diseased.

The paucity of urine and thirst cannot be explained from a greater quantity of mucilaginous fluid being deposited in the cellular membrane: for though these symptoms have continued many weeks, or even months, this collection frequently does not amount to more than very few pints. Hence also the difficulty of promoting copious sweats in anasarca is accounted for, as well as the great thirst, paucity of urine, and loss of fat; since, when the cutaneous branch of absorbents is paralytic, or nearly so, there is already too small a quantity of aqueous fluid in the blood: nor can these torpid cutaneous lymphatics be readily excited into retrograde motions.

Hence likewise we understand, why in the ascites, and some other dropsies, there is often no thirst, and no paucity of urine; in these cases the cutaneous absorbents continue to do their office.

Some have believed, that dropsies were occasioned by the inability of the kidneys, from having only observed the paucity of urine; and have thence laboured much to obtain diuretic medicines; but it is daily observable, that those who die of a total inability to make water, do not become dropsical in consequence of it: Fernelius mentions one, who laboured under a perfect suppression of urine during twenty days before his death, and yet had no symptoms of dropsy. Pathol. 1. vi. c. 8. From the same idea many physicians have restrained their patients from drinking, though their thirst has been very urgent; and some cases have been published, where this cruel regimen has been thought advantageous: but others of nicer observation are of opinion, that it has always aggravated the distresses of the patient; and though it has abated his swellings, yet by inducing a fever it has hastened his dissolution. See Transactions of the College, London, vol. ii. p. 235. Cases of Dropsy by Dr. G. Baker.

The cure of anasarca, so far as respects the evacuation of the accumulated fluid, coincides with the idea of the retrograde action of the lymphatic system. It is well known that vomits, and other drugs, which induce sickness or nausea; at the same time that they evacuate the stomach, produce a great absorption of the lymph accumulated in the cellular membrane. In the operation of a vomit, not only the motions of the stomach and duodenum become inverted, but also those of the lymphatics and lacteals, which belong to them; whence a great quantity of chyle and lymph is perpetually poured into the stomach and intestines, during the operation, and evacuated by the mouth. Now at the same time, other branches of the lymphatic system, viz. those which open on the cellular membrane, are brought into more energetic action, by the sympathy above mentioned, and an increase of their absorption is produced.

Hence repeated vomits, and cupreous salts, and small doses of squill or foxglove, are so efficacious in this disease. And as drastic purges act also by inverting the motions of the lacteals; and thence the other branches of lymphatics are induced into more powerful natural action, by sympathy, and drink up the fluids from all the cells of the body; and by their anastomoses, pour them into the lacteal branches; which, by their inverted actions, return them into the intestines; and they are thus evacuated from the body:—these purges also are used with success in discharging the accumulated fluid in anasarca.

II. The following cases are related with design to ascertain the particular kinds of dropsy in which the digitalis purpurea, or common foxglove, is preferable to squill, or other evacuants, and were first published in 1780, in a pamphlet entitled Experiments on mucilaginous and purulent Matter, &c. Cadell. London. Other cases of dropsy, treated with digitalis, were afterwards published by Dr. Darwin in the Medical Transactions, vol. iii. in which there is a mistake in respect to the dose of the powder of foxglove, which should have been from five grains to one, instead of from five grains to ten.

Anasarca of the Lungs.

1. A lady, between forty and fifty years of age, had been indisposed some time, was then seized with cough and fever, and afterwards expectorated much digested mucus. This expectoration suddenly ceased, and a considerable difficulty of breathing supervened, with a pulse very irregular both in velocity and strength; she was much distressed at first lying down, and at first rising; but after a minute or two bore either of those attitudes with ease. She had no pain or numbness in her arms; she had no hectic fever, nor any cold shiverings, and the urine was in due quantity, and of the natural colour.

The difficulty of breathing was twice considerably relieved by small doses of ipecacuanha, which operated upwards and downwards, but recurred in a few days: she was then directed a decoction of foxglove, (digitalis purpurea) prepared by boiling four ounces of the fresh leaves from two pints of water to one pint; to which was added two ounces of vinous spirit: she took three large spoonfuls of this mixture every two hours, till she had taken it four times; a continued sickness supervened, with frequent vomiting, and a copious flow of urine: these evacuations continued at intervals for two or three days, and relieved the difficulty of breathing—She had some relapses afterwards, which were again relieved by the repetition of the decoction of foxglove.

2. A gentleman, about sixty years of age, who had been addicted to an immoderate use of fermented liquors, and had been very corpulent, gradually lost his strength and flesh, had great difficulty of breathing, with legs somewhat swelled, and a very irregular pulse. He was very much distressed at first lying down, and at first rising from his bed, yet in a minute or two was easy in both those attitudes. He made straw-coloured urine in due quantity, and had no pain or numbness of his arms.

He took a large spoonful of the decoction of foxglove, as above, every hour, for ten or twelve successive hours, had incessant sickness for about two days, and passed a large quantity of urine; upon which his breath became quite easy, and the swelling of his legs subsided; but as his whole constitution was already sinking from the previous intemperance of his life, he did not survive more than three or four months.

Hydrops Pericardii.

3. A gentleman of temperate life and sedulous application to business, between thirty and forty years of age, had long been subject, at intervals, to an irregular pulse: a few months ago he became weak, with difficulty of breathing, and dry cough. In this situation a physician of eminence directed him to abstain from all animal food and fermented liquor, during which regimen all his complaints increased; he now became emaciated, and totally lost his appetite; his pulse very irregular both in velocity and strength; with great difficulty of breathing, and some swelling of his legs; yet he could lie down horizontally in his bed, though he got little sleep, and passed a due quantity of urine, and of the natural colour: no fullness or hardness could be perceived about the region of the liver; and he had no pain or numbness in his arms.

One night he had a most profuse sweat all over his body and limbs, which quite deluged his bed, and for a day or two somewhat relieved his difficulty of breathing, and his pulse became less irregular: this copious sweat recurred three or four times at the intervals of five or six days, and repeatedly alleviated his symptoms.

He was directed one large spoonful of the above decoction of foxglove every hour, till it procured some considerable evacuation: after he had taken it eleven successive hours he had a few liquid stools, attended with a great flow of urine, which last had a dark tinge, as if mixed with a few drops of blood: he continued sick at intervals for two days, but his breath became quite easy, and his pulse quite regular, the swelling of his legs disappeared, and his appetite and sleep returned.

He then took three grains of white vitriol twice a day, with some bitter medicines, and a grain of opium with five grains of rhubarb every night; was advised to eat flesh meat, and spice, as his stomach would bear it, with small beer, and a few glasses of wine; and had issues made in his thighs; and has suffered no relapse.

4. A lady, about fifty years of age, had for some weeks great difficulty of breathing, with very irregular pulse, and considerable general debility: she could lie down in bed, and the urine was in due quantity and of the natural colour, and she had no pain or numbness of her arms.

She took one large spoonful of the above decoction of foxglove every hour, for ten or twelve successive hours; was sick, and made a quantity of pale urine for about two days, and was quite relieved both of the difficulty of breathing, and the irregularity of her pulse. She then took a grain of opium, and five grains of rhubarb, every night, night, for many weeks; with some slight chalybeate and bitter medicines, and has suffered no relapse.

Hydrops Thoracis.

5. A tradesman, about fifty years of age, became weak and short of breath, especially on increase of motion, with pain in one arm, about the insertion of the biceps muscle. He observed he sometimes in the night made an unusual quantity of pale water. He took calomel, alum, and peruvian bark, and all his symptoms increased: his legs began to swell considerably; his breath became more difficult, and he could not lie down in bed; but all this time he made a due quantity of straw-coloured water.

The decoction of foxglove was given as in the preceding cases, which operated chiefly by purging, and seemed to relieve his breath for a day or two; but also seemed to contribute to weaken him.—He became after some weeks universally dropsical, and died comatous.

6. A young lady of delicate constitution, with light eyes and hair, and who had perhaps lived too abstemiously both in respect to the quantity and quality of what she eat and drank, was seized with great difficulty of breathing, so as to threaten immediate death. Her extremities were quite cold, and her breath felt cold to the back of one's hand. She had no sweat, nor could be down for a single moment; and had previously, and at present, complained of great weakness and pain and numbness of both her arms; had no swelling of her legs, no thirst, water in due quantity and colour. Her sister, about a year before, was afflicted with similar symptoms, was repeatedly blooded, and died universally dropsical.

A grain of opium was given immediately, and repeated every six hours with evident and amazing advantage; afterwards a blister, with chalybeates, bitters, and essential oils, were exhibited, but nothing had such eminent effect in relieving the difficulty of breathing and coldness of her extremities as opium, by the use of which in a few weeks she perfectly regained her health, and has suffered no relapse.

Ascites.

7. A young lady of delicate constitution having been exposed to great fear, cold, and fatigue, by the overturn of a chaise in the night, began with pain and tumour in the right hypochondrium: in a few months a fluctuation was felt throughout the whole abdomen, more distinctly perceptible indeed about the region of the stomach; since the integuments of the lower part of the abdomen generally become thickened in this disease by a degree of anasarca. Her legs were not swelled, no thirst, water in due quantity and colour.—She took the foxglove so as to induce sickness and stools, but without abating the swelling, and was obliged at length to submit to the operation of tapping.

8. A man about sixty-seven, who had long been accustomed to spirituous potation, had some time laboured under ascites; his legs somewhat swelled; his breath easy in all attitudes; no appetite; great thirst; urine in exceedingly small quantity, very deep coloured, and turbid; pulse equal. He took the foxglove in such quantity as vomited him, and induced sickness for two days; but procured no flow of urine, or diminution of his swelling; but was thought to leave him considerably weaker.

9. A corpulent man, accustomed to large potation of fermented liquors, had vehement cough, difficult breathing, anasarca of his legs, thighs, and hands, and considerable tumour, with evident fluctuation of his abdomen; his pulse was equal; his urine in small quantity, of deep colour, and turbid. These swellings had been twice considerably abated by drastic cathartics. He took three ounces of a decoction of foxglove (made by boiling one ounce of the fresh leaves in a pint of water) every three hours, for two whole days; it then began to vomit and purge him violently, and promoted a great flow of urine; he was by these evacuations completely emptied in twelve hours. After two or three months all these symptoms returned, and were again relieved by the use of the foxglove; and thus in the space of about three years he was about ten times evacuated, and continued all that time his usual potations: excepting at first, the medicine operated only by urine, and did not appear considerably to weaken him—The last time he took it, it had no effect; and a few weeks afterwards he vomited a great quantity of blood, and expired.

QUERIES.

1. As the first six of these patients had a due discharge of urine, and of the natural colour, was not the feat of the disease confined to some part of the thorax, and the swelling of the legs rather a symptom of the obstructed circulation of the blood, than of a paralysis of the cellular lymphatics of those parts?

2. When the original disease is a general anasarca, do not the cutaneous lymphatics always become paralytic at the same time with the cellular ones, by their greater sympathy with each other? and hence the paucity of urine, and the great thirst, distinguish this kind of dropsy?

3. In the anasarca of the lungs, when the disease is not very great, though the patients have considerable difficulty of breathing at their first lying down, yet after a minute or two their breath becomes easy again; and the same occurs at their first rising. Is not this owing to the time necessary for the fluid in the cells of the lungs to change its place, so as the least to incommode respiration in the new attitude?

4. In the dropsy of the pericardium does not the patient bear the horizontal or perpendicular attitude with equal ease? Does this circumstance distinguish the dropsy of the pericardium from that of the lungs and of the thorax?

5. Do the universal sweats distinguish the dropsy of the pericardium, or of the thorax? and those, which cover the upper parts of the body only, the anasarca of the lungs?

6. When in the dropsy of the thorax, the patient endeavours to lie down, does not the extravasated fluid compress the upper parts of the bronchia, and totally preclude the access of air to every part of the lungs; whilst in the perpendicular attitude the inferior parts of the lungs only are compressed? Does not something similar to this occur in the anasarca of the lungs, when the disease is very great, and thus prevent those patients also from lying down?

7. As a principal branch of the fourth cervical nerve of the left side, after having joined a branch of the third and of the second cervical nerves, descending between the subclavian vein and artery, is received in a groove formed for it in the pericardium, and is obliged to make a considerable turn outwards to go over the prominent part of it, where the point of the heart is lodged, in its course to the diaphragm; and as the other phrenic nerve of the right side has a straight course to the diaphragm; and as many other considerable branches of this fourth pair of cervical nerves are spread on the arms; does not a pain in the left arm distinguish a disease of the pericardium, as in the angina pectoris, or in the dropsy of the pericardium? and does not a pain or weakness in both arms distinguish the dropsy of the thorax?

8. Do not the dropsies of the thorax and pericardium frequently exist together, and thus add to the uncertainty and fatality of the disease?

9. Might not the foxglove be serviceable in hydrocephalus internus, in hydrocele, and in white swellings of the joints?

VI. Of cold Sweats.

There have been histories given of chronical immoderate sweatings, which bear some analogy to the diabetes. Dr. Willis mentions a lady then living, whose sweats where for many years so profuse, that all her bed-clothes were not only moistened, but deluged with them every night; and that many ounces, and sometimes pints, of this sweat, were received in vessels properly placed, as it trickled down her body. He adds, that she had great thirst, had taken many medicines, and submitted to various rules of life, and changes of climate, but still continued to have these immoderate sweats. Pharmac. ration. de sudore anglico.

Dr. Willis has also observed, that the sudor anglicanus which appeared in England, in 1483, and continued till 1551, was in some respects similar to the diabetes; and as Dr. Caius, who saw this disease, mentions the viscidity, as well as the quantity of these sweats, and adds, that the extremities were often cold, when the internal parts were burnt up with heat and thirst, with great and speedy emaciation and debility: there is great reason to believe, that the fluids were absorbed from the cells of the body by the cellular and cystic branches of the lymphatics, and poured on the skin by the retrograde motions of the cutaneous ones.

Sydenham has recorded, in the stationary fever of the year 1685, the viscid sweats flowing from the head, which were probably from the same source as those in the sweating plague above mentioned.

It is very common in dropsies of the chest or lungs to have the difficulty of breathing relieved by copious sweats, flowing from the head and neck. Mr. P. about 50 years of age, had for many weeks been afflicted with anasarca of his legs and thighs, attended with difficulty of breathing; and had repeatedly been relieved by squill, other bitters, and chalybeates.—One night the difficulty of breathing became so great, that it was thought he must have expired; but so copious a sweat came out of his head and neck, that in a few hours some pints, by estimation, were wiped off from those parts, and his breath was for a time relieved. This dyspnoea and these sweats recurred at intervals, and after some weeks he ceased to exist. The skin of his head and neck felt cold to the hand, and appeared pale at the time these sweats flowed so abundantly; which is a proof, that they were produced by an inverted motion of the absorbents of those parts: for sweats, which are the consequence of an increased action of the sanguiferous system, are always attended with a warmth of the skin, greater than is natural, and a more florid colour; as the sweats from exercise, or those that succeed the cold fits of agues. Can any one explain how these partial sweats should relieve the difficulty of breathing in anasarca, but by supposing that the pulmonary branch of absorbents drank up the fluid in the cavity of the thorax, or in the cells of the lungs, and threw it on the skin, by the retrograde motions of the cutaneous branch? for, if we could suppose, that the increased action of the cutaneous glands or capillaries poured upon the skin this fluid, previously absorbed from the lungs; why is not the whole surface of the body covered with sweat? why is not the skin warm? Add to this, that the sweats above mentioned were clammy or glutinous, which the condensed perspirable matter is not; whence it would seem to have been a different fluid from that of common perspiration.

Dr. Dobson, of Liverpool, has given a very ingenious explanation of the acid sweats, which he observed in a diabetic patient—he thinks part of the chyle is secreted by the skin, and afterwards undergoes an acetous fermentation.—Can the chyle get thither, but by an inverted motion of the cutaneous lymphatics? in the same manner as it is carried to the bladder, by the inverted motions of the urinary lymphatics. Medic. Observat. and Enq. London, vol. v.

Are not the cold sweats in some fainting fits, and in dying people, owing to an inverted motion of the cutaneous lymphatics? for in these there can be no increased arterial or glandular action.

Is the difficulty of breathing, arising from anasarca of the lungs, relieved by sweats from the head and neck; whilst that difficulty of breathing, which arises from a dropsy of the thorax, or pericardium, is never attended with these sweats of the head? and thence can these diseases be distinguished from each other? Do the periodic returns of nocturnal asthma rise from a temporary dropsy of the lungs, collected during their more torpid state in sound deep, and then re-absorbed by the vehement efforts of the disordered organs of respiration, and carried off by the copious sweats about the head and neck?

More extensive and accurate dissections of the lymphatic system are wanting to enable us to unravel these knots of science.

VII. Translations of Matter, of Chyle, of Milk, of Urine. Operation of purging Drugs applied externally.

1. The translations of matter from one part of the body to another, can only receive an explanation from the doctrine of the occasional retrograde motions of some branches of the lymphatic system: for how can matter, absorbed and mixed with the whole mass of blood, be so hastily collected again in any one part? and is it not an immutable law, in animal bodies, that each gland can secrete no other, but its own proper fluid? which is, in part, fabricated in the very gland by an animal process, which it there undergoes: of these purulent translations innumerable and very remarkable instances are recorded.

2. The chyle, which is seen among the materials thrown up by violent vomiting, or in purging stools, can only come thither by its having been poured into the bowels by the inverted motions of the lacteals: for our aliment is not converted into chyle in the stomach or intestines by a chemical process, but is made in the very mouths of the lacteals; or in the mesenteric glands; in the same manner as other secreted fluids are made by an animal process in their adapted glands.

Here a curious phaenomenon in the exhibition of mercury is worth explaining:—If a moderate dose of calomel, as six or ten grains, be swallowed, and within one or two days a cathartic is given, a salivation is prevented: but after three or four days, a salivation having come on, repeated purges every day, for a week or two, are required to eliminate the mercury from the constitution. For this acrid metallic preparation, being absorbed by the mouth of the lacteals, continues, for a time arrested by the mesenteric glands, (as the variolous or venereal poisons swell the subaxillar or inguinal glands): which, during the operation of a cathartic, is returned into the intestines by the inverted action of the lacteals, and thus carried out of the system.

Hence we understand the use of vomits or purges, to those who have swallowed either contagious or poisonous materials, even though exhibited a day or even two days after such accidents; namely, that by the retrograde motions of the lacteals and lymphatics, the material still arrested in the mesenteric, or other glands, may be eliminated from the body.

3. Many instances of milk and chyle found in ulcers are given by Haller, El. Physiol. t. vii. p. 12, 23, which admit of no other explanation than by supposing, that the chyle, imbibed by one branch of the absorbent system, was carried to the ulcer, by the inverted motions of another branch of the same system.

4. Mrs. P. on the second day after delivery, was seized with a violent purging, in which, though opiates, mucilages, the bark, and testacea were profusely used, continued many days, till at length she recovered. During the time of this purging, no milk could be drawn from her breasts; but the stools appeared like the curd of milk broken into small pieces. In this case, was not the milk taken up from the follicles of the pectoral glands, and thrown on the intestines, by a retrogression of the intestinal absorbents? for how can we for a moment suspect that the mucous glands of the intestines could separate pure milk from the blood? Doctor Smelly has observed, that loose stools, mixed with milk, which is curdled in the intestines, frequently relieves the turgescency of the breasts of those who studiously repel their milk. Cases in Midwifery, 43, No. 2. 1.

5. J.F. Meckel observed in a patient, whose urine was in small quantity and high coloured, that a copious sweat under the arm-pits, of a perfectly urinous smell, stained the linen; which ceased again when the usual quantity of urine was discharged by the urethra. Here we must believe from analogy, that the urine was first secreted in the kidneys, then re-absorbed by the increased action of the urinary lymphatics, and lastly carried to the axillae by the retrograde motions of the lymphatic branches of those parts. As in the jaundice it is necessary, that the bile should first be secreted by the liver, and re-absorbed into the circulation, to produce the yellowness of the skin; as was formerly demonstrated by the late Dr. Munro, (Edin. Medical Essays) and if in this patient the urine had been re-absorbed into the mass of blood, as the bile in the jaundice, why was it not detected in other parts of the body, as well as in the arm-pits?

6. Cathartic and vermifuge medicines applied externally to the abdomen, seem to be taken up by the cutaneous branch of lymphatics, and poured on the intestines by the retrograde motions of the lacteals, without having passed the circulation.

For when the drastic purges are taken by the mouth, they excite the lacteals of the intestines into retrograde motions, as appears from the chyle, which is found coagulated among the faeces, as was shewn above, (sect. 2 and 4.) And as the cutaneous lymphatics are joined with the lacteals of the intestines, by frequent anastomoses; it would be more extraordinary, when a strong purging drug, absorbed by the skin, is carried to the anastomosing branches of the lacteals unchanged, if it should not excite them into retrograde action as efficaciously, as if it was taken by the mouth, and mixed with the food of the stomach.

VIII. Circumstances by which the Fluids, that are effused by the retrograde Motions of the absorbent Vessels, are distinguished.

1. We frequently observe an unusual quantity of mucus or other fluids in some diseases, although the action of the glands, by which those fluids are separated from the blood, is not unusually increased; but when the power of absorption alone is diminished. Thus the catarrhal humour from the nostrils of some, who ride in frosty weather; and the tears, which run down the cheeks of those, who have an obstruction of the puncta lacrymalia; and the ichor of those phagedenic ulcers, which are not attended with inflammation, are all instances of this circumstance.

These fluids however are easily distinguished from others by their abounding in ammoniacal or muriatic salts; whence they inflame the circumjacent skin: thus in the catarrh the upper lip becomes red and swelled from the acrimony of the mucus, and patients complain of the saltness of its taste. The eyes and cheeks are red with the corrosive tears, and the ichor of some herpetic eruptions erodes far and wide the contiguous parts, and is pungently salt to the taste, as some patients have informed me.

Whilst, on the contrary, those fluids, which are effused by the retrograde action of the lymphatics, are for the most part mild and innocent; as water, chyle, and the natural mucus: or they take their properties from the materials previously absorbed, as in the coloured or vinous urine, or that scented with asparagus, described before.

2. Whenever the secretion of any fluid is increased, there is at the same time an increased heat in the part; for the secreted fluid, as the bile, did not previously exist in the mass of blood, but a new combination is produced in the gland. Now as solutions are attended with cold, so combinations are attended with heat; and it is probable the sum of the heat given out by all the secreted fluids of animal bodies may be the cause of their general heat above that of the atmosphere.

Hence the fluids derived from increased secretions are readily distinguished from those originating from the retrograde motions of the lymphatics: thus an increase of heat either in the diseased parts, or diffused over the whole body, is perceptible, when copious bilious stools are consequent to an inflamed liver; or a copious mucous salivation from the inflammatory angina.

3. When any secreted fluid is produced in an unusual quantity, and at the same time the power of absorption is increased in equal proportion, not only the heat of the gland becomes more intense, but the secreted fluid becomes thicker and milder, its thinner and saline parts being re-absorbed: and these are distinguishable both by their greater consistence, and by their heat, from the fluids, which are effused by the retrograde motions of the lymphatics; as is observable towards the termination of gonorrhoea, catarrh, chincough, and in those ulcers, which are said to abound with laudable pus.

4. When chyle is observed in stools, or among the materials ejected by vomit, we may be confident it must have been brought thither by the retrograde motions of the lacteals; for chyle does not previously exist amid the contents of the intestines, but is made in the very mouths of the lacteals, as was before explained.

5. When chyle, milk, or other extraneous fluids are found in the urinary bladder, or in any other excretory receptacle of a gland; no one can for a moment believe, that these have been collected from the mass of blood by a morbid secretion, as it contradicts all analogy.

—— Aurea durae Mala ferant quercus? Narcisco floreat alnus? Pinguia corticibus sudent electra myricae?—VIRGIL.

IX. Retrograde Motions of Vegetable juices.

There are besides some motions of the sap in vegetables, which bear analogy to our present subject; and as the vegetable tribes are by many philosophers held to be inferior animals, it may be a matter of curiosity at least to observe, that their absorbent vessels seem evidently, at times, to be capable of a retrograde motion. Mr. Perault cut off a forked branch of a tree, with the leaves on; and inverting one of the forks into a vessel of water, observed, that the leaves on the other branch continued green much longer than those of a similar branch, cut off from the same tree; which shews, that the water from the vessel was carried up one part of the forked branch, by the retrograde motion of its vessels, and supplied nutriment some time to the other part of the branch, which was out of the water. And the celebrated Dr. Hales found, by numerous very accurate experiments, that the sap of trees rose upwards during the warmer hours of the day, and in part descended again during the cooler ones. Vegetable Statics.

It is well known that the branches of willows, and of many other trees, will either take root in the earth or engraft on other trees, so as to have their natural direction inverted, and yet flourish with vigour.

Dr. Hope has also made this pleasing experiment, after the manner of Hales—he has placed a forked branch, cut from one tree, erect between two others; then cutting off a part of the bark from one fork applied it to a similar branch of one of the trees in its vicinity; and the same of the other fork; so that a tree is seen to grow suspended in the air, between two other trees; which supply their softer friend with due nourishment.

Miranturque novas frondes, et non sua poma.

All these experiments clearly evince, that the juices of vegetables can occasionally pass either upwards or downwards in their absorbent system of vessels.

X. Objections answered.

The following experiment, at first view, would seem to invalidate this opinion of the retrograde motions of the lymphatic vessels, in some diseases.

About a gallon of milk having been giving to an hungry swine, he was suffered to live about an hour, and was then killed by a stroke or two on his head with an axe.—On opening his belly the lacteals were well seen filled with chyle; on irritating many of the branches of them with a knife, they did not appear to empty themselves hastily; but they did however carry forwards their contents in a little time.

I then passed a ligature round several branches of lacteals, and irritated them much with a knife beneath the ligature, but could not make them regurgitate their contained fluid into the bowels.

I am not indeed certain, that the nerve was not at the same time included in the ligature, and thus the lymphatic rendered unirritable or lifeless; but this however is certain, that it is not any quantity of any stimulus, which induces the vessels of animal bodies to revert their motions; but a certain quantity of a certain stimulus, as appears from wounds in the stomach, which do not produce vomiting; and wounds of the intestines, which do not produce the cholera morbus.

At Nottingham, a few years ago, two shoemakers quarrelled, and one of them with a knife, which they use in their occupation, stabbed his companion about the region of the stomach. On opening the abdomen of the wounded man after his death the food and medicines he had taken were in part found in the cavity of the belly, on the outside of the bowels; and there was a wound about half an inch long at the bottom of the stomach; which I suppose was distended with liquor and food at the time of the accident; and thence was more liable to be injured at its bottom: but during the whole time he lived, which was about ten days, he had no efforts to vomit, nor ever even complained of being sick at the stomach! Other cases similar to this are mentioned in the philosophical transactions.

Thus, if you vellicate the throat with a feather, nausea is produced; if you wound it with a penknife, pain is induced, but not sickness. So if the soles of the feet of children or their armpits are tickled, convulsive laughter is excited, which ceases the moment the hand is applied, so as to rub them more forcibly.

The experiment therefore above related upon the lacteals of a dead pig, which were included in a strict ligature, proves nothing; as it is not the quantity, but the kind of stimulus, which excites the lymphatic vessels into retrograde motion.

XI. The Causes which induce the retrograde Motions of animal Vessels; and the Medicines by which the natural Motions are restored.

1. Such is the construction of animal bodies, that all their parts, which are subjected to less stimuli than nature designed, perform their functions with less accuracy: thus, when too watery or too acescent food is taken into the stomach, indigestion, and flatulency, and heartburn succeed.

2. Another law of irritation, connate with our existence, is, that all those parts of the body, which have previously been exposed to too great a quantity of such stimuli, as strongly affect them, become for some time afterwards disobedient to the natural quantity of their adapted stimuli.—Thus the eye is incapable of seeing objects in an obscure room, though the iris is quite dilated, after having been exposed to the meridian sun.

3. There is a third law of irritation, that all the parts of our bodies, which have been lately subjected to less stimulus, than they have been accustomed to, when they are exposed to their usual quantity of stimulus, are excited into more energetic motions: thus when we come from a dusky cavern into the glare of daylight, our eyes are dazzled; and after emerging from the cold bath, the skin becomes warm and red.

4. There is a fourth law of irritation, that all the parts of our bodies, which are subjected to still stronger stimuli for a length of time, become torpid, and refuse to obey even these stronger stimuli; and thence do their offices very imperfectly.—Thus, if any one looks earnestly for some minutes on an area, an inch diameter, of red silk, placed on a sheet of white paper, the image of the silk will gradually become pale, and at length totally vanish.

5. Nor is it the nerves of sense alone, as the optic and auditory nerves, that thus become torpid, when the stimulus is withdrawn or their irritability decreased; but the motive muscles, when they are deprived of their natural stimuli, or of their irritability, become torpid and paralytic; as is seen in the tremulous hand of the drunkard in a morning; and in the awkward step of age.

The hollow muscles also, of which the various vessels of the body are constructed, when they are deprived of their natural stimuli, or of their due degree of irritability, not only become tremulous, as the arterial pulsations of dying people; but also frequently invert their motions, as in vomiting, in hysteric suffocations, and diabetes above described.

I must beg your patient attention, for a few moments whilst I endeavour to explain, how the retrograde actions of our hollow muscles are the consequence of their debility; as the tremulous actions of the solid muscles are the consequence of their debility. When, through fatigue, a muscle can act no longer; the antagonist muscles, either by their inanimate elasticity, or by their animal action, draw the limb into a contrary direction: in the solid muscles, as those of locomotion, their actions are associated in tribes, which have been accustomed to synchronous action only; hence when they are fatigued, only a single contrary effort takes place; which is either tremulous, when the fatigued muscles are again immediately brought into action; or it is a pandiculation, or stretching, where they are not immediately again brought into action.

Now the motions of the hollow muscles, as they in general propel a fluid along their cavities, are associated in trains, which have been accustomed to successive actions: hence when one ring of such a muscle is fatigued from its too great debility, and is brought into retrograde action, the next ring from its association falls successively into retrograde action; and so on throughout the whole canal. See Sect. XXV. 6.

6. But as the retrograde motions of the stomach, oesophagus, and fauces in vomiting are, as it were, apparent to the eye; we shall consider this operation more minutely, that the similar operations in the more recondite parts of our system may be easier understood.

From certain nauseous ideas of the mind, from an ungrateful taste in the mouth, or from foetid smells, vomiting is sometimes instantly excited; or even from a stroke on the head, or from the vibratory motions of a ship; all which originate from association, or sympathy. See Sect. XX. on Vertigo.

But when the stomach is subjected to a less stimulus than is natural, according to the first law of irritation mentioned above, its motions become disturbed, as in hunger; first pain is produced, then sickness, and at length vain efforts to vomit, as many authors inform us.

But when a great quantity of wine, or of opium, is swallowed, the retrograde motions of the stomach do not occur till after several minutes, or even hours; for when the power of so strong a stimulus ceases, according to the second law of irritation, mentioned above, the peristaltic motions become tremulous, and at length retrograde; as is well known to the drunkard, who on the next morning has sickness and vomitings.

When a still greater quantity of wine, or of opium, or when nauseous vegetables, or strong bitters, or metallic salts, are taken into the stomach, they quickly induce vomiting; though all these in less doses excite the stomach into more energetic action, and strengthen the digestion; as the flowers of chamomile, and the vitriol of zinc: for, according to the fourth law of irritation, the stomach will not long be obedient to a stimulus so much greater than is natural; but its action becomes first tremulous and then retrograde.

7. When the motions of any vessels become retrograde, less heat of the body is produced; for in paroxysms of vomiting, of hysteric affections, of diabetes, of asthma, the extremities of the body are cold: hence we may conclude, that these symptoms arise from the debility of the parts in action; for an increase of muscular action is always attended with increase of heat.

8. But as animal debility is owing to defect of stimulus, or to defect of irritability, as shewn above, the method of cure is easily deduced: when the vascular muscles are not excited into their due action by the natural stimuli, we should exhibit those medicines, which possess a still greater degree of stimulus; amongst these are the foetids, the volatiles, aromatics, bitters, metallic salts, opiates, wine, which indeed should be given in small doses, and frequently repeated. To these should be added constant, but moderate exercise, cheerfulness of mind, and change of country to a warmer climate; and perhaps occasionally the external stimulus of blisters.

It is also frequently useful to diminish the quantity of natural stimulus for a short time, by which afterwards the irritability of the system becomes increased; according to the third law of irritation above-mentioned, hence the use of baths somewhat colder than animal heat, and of equitation in the open air.

The catalogue of diseases owing to the retrograde motions of lymphatics is here omitted, as it will appear in the second volume of this work. The following is the conclusion to this thesis of Mr. CHARLES DARWIN.

Thus have I endeavoured in a concise manner to explain the numerous diseases, which deduce their origin from the inverted motions of the hollow muscles of our bodies: and it is probable, that Saint Vitus's dance, and the stammering of speech, originate from a similar, inverted order of the associated motions of some of the solid muscles; which, as it is foreign to my present purpose, I shall not here discuss.

I beg, illustrious professors, and ingenious fellow-students, that you will recollect how difficult a talk I have attempted, to evince the retrograde motions of the lymphatic vessels, when the vessels themselves for so many ages escaped the eyes and glasses of philosophers: and if you are not yet convinced of the truth of this theory, hold, I entreat you, your minds in suspense, till ANATOMY draws her sword with happier omens, cuts asunder the knots, which entangle PHYSIOLOGY; and, like an augur inspecting the immolated victim, announces to mankind the wisdom of HEAVEN.

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SECT. XXX.

PARALYSIS OF THE LIVER AND KIDNEYS.

I. 1.Bile-ducts less irritable after having been stimulated much. 2. Jaundice from paralysis of the bile-ducts cured by electric shocks. 3. From bile-stones. Experiments on bile-stones. Oil vomit. 4. Palsy of the liver, two cases. 5. Schirrosity of the liver. 6. Large livers of geese. II. Paralysis of the kidneys. III. Story of Prometheus.

I. 1. From the ingurgitation of spirituous liquors into the stomach and duodenum, the termination of the common bile-duct in that bowel becomes stimulated into unnatural action, and a greater quantity of bile is produced from all the secretory vessels of the liver, by the association of their motions with those of their excretory ducts; as has been explained in Section XXIV. and XXV. but as all parts of the body, that have been affected with stronger stimuli for any length of time, become less susceptible of motion, from their natural weaker stimuli, it follows, that the motions of the secretory vessels, and in consequence the secretion of bile, is less than is natural during the intervals of sobriety. 2. If this ingurgitation of spirituous liquors has been daily continued in considerable quantity, and is then suddenly intermitted, a languor or paralysis of the common bile-duct is induced; the bile is prevented from being poured into the intestines; and as the bilious absorbents are stimulated into stronger action by its accumulation, and by the acrimony or viscidity, which it acquires by delay, it is absorbed, and carried to the receptacle of the chyle; or otherwise the secretory vessels of the liver, by the above-mentioned stimulus, invert their motions, and regurgitate their contents into the blood, as sometimes happens to the tears in the lachrymal sack, see Sect. XXIV. 2. 7. and one kind of jaundice is brought on.

There is reason to believe, that the bile is most frequently returned into the circulation by the inverted motions of these hepatic glands, for the bile does not seem liable to be absorbed by the lymphatics, for it soaks through the gall-ducts, and is frequently found in the cellular membrane. This kind of jaundice is not generally attended with pain, neither at the extremity of the bile-duct, where it enters the duodenum, nor on the region of the gall-bladder.

Mr. S. a gentleman between 40 and 50 years of age, had had the jaundice about six weeks, without pain, sickness, or fever; and had taken emetics, cathartics, mercurials, bitters, chalybeates, essential oil, and ether, without apparent advantage. On a supposition that the obstruction of the bile might be owing to the paralysis, or torpid action of the common bile-duct, and the stimulants taken into the stomach seeming to have no effect, I directed half a score smart electric shocks from a coated bottle, which held about a quart, to be passed through the liver, and along the course of the common gall-duct, as near as could be guessed, and on that very day the stools became yellow; he continued the electric shocks a few days more, and his skin gradually became clear.

3. The bilious vomiting and purging, that affects some people by intervals of a few weeks, is a less degree of this disease; the bile-duct is less irritable than natural, and hence the bile becomes accumulated in the gall-bladder, and hepatic ducts, till by its quantity, acrimony or viscidity, a greater degree of irritation is produced, and it is suddenly evacuated, or lastly from the absorption of the more liquid parts of the bile, the remainder becomes inspissated, and chrystallizes into masses too large to pass, and forms another kind of jaundice, where the bile-duct is not quite paralytic, or has regained its irritability.

This disease is attended with much pain, which at first is felt at the pit of the stomach, exactly in the centre of the body, where the bile-duct enters the duodenum; afterwards, when the size of the bile-stones increase, it is also felt on the right side, where the gall-bladder is situated. The former pain at the pit of the stomach recurs by intervals, as the bile-stone is pushed against the neck of the duct; like the paroxysms of the stone in the urinary bladder, the other is a more dull and constant pain.

Where these bile-stones are too large to pass, and the bile-ducts possess their sensibility, this becomes a very painful and hopeless disease. I made the following experiments with a view to their chemical solution.

Some fragments of the same bile-stone were put into the weak spirit of marine salt, which is sold in the shops, and into solution of mild alcali; and into a solution of caustic alcali; and into oil of turpentine; without their being dissolved. All these mixtures were after some time put into a heat of boiling water, and then the oil of turpentine dissolved its fragments of bile-stone, but no alteration was produced upon those in the other liquids except some change of their colour.

Some fragments of the same bile-stone were put into vitriolic aether, and were quickly dissolved without additional heat. Might not aether mixed with yolk of egg or with honey be given advantageously in bilious concretions?

I have in two instances seen from 30 to 50 bile-stones come away by stool, about the size of large peas, after having given six grains of calomel in the evening, and four ounces of oil of almonds or olives on the succeeding morning. I have also given half a pint of good olive or almond oil as an emetic during the painful fit, and repeated it in half an hour, if the first did not operate, with frequent good effect.

4. Another disease of the liver, which I have several times observed, consists in the inability or paralysis of the secretory vessels. This disease has generally the same cause as the preceding one, the too frequent potation of spirituous liquors, or the too sudden omission of them, after the habit is confined; and is greater or less in proportion, as the whole or a part of the liver is affected, and as the inability or paralysis is more or less complete.

This palsy of the liver is known from these symptoms, the patients have generally passed the meridian of life, have drank fermented liquors daily, but perhaps not been opprobrious drunkards; they lose their appetite, then their flesh and strength diminish in consequence, there appears no bile in their stools, nor in their urine, nor is any hardness or swelling perceptible on the region of the liver. But what is peculiar to this disease, and distinguishes it from all others at the first glance of the eye, is the bombycinous colour of the skin, which, like that of full-grown silkworms, has a degree of transparency with a yellow tint not greater than is natural to the serum of the blood.

Mr. C. and Mr. B. both very strong men, between 50 and 60 years of age, who had drank ale at their meals instead of small beer, but were not reputed hard-drinkers, suddenly became weak, lost their appetite, flesh, and strength, with all the symptoms above enumerated, and died in about two months from the beginning of their malady. Mr. C. became anasarcous a few days before his death, and Mr. B. had frequent and great haemorrhages from an issue, and some parts of his mouth, a few days before his death. In both these cases calomel, bitters and chalybeates were repeatedly used without effect.

One of the patients described above, Mr. C, was by trade a plumber; both of them could digest no food, and died apparently for want of blood. Might not the transfusion of blood be used in these cases with advantage?

5. When the paralysis of the hepatic glands is less complete, or less universal, a schirrosity of some part of the liver is induced; for the secretory vessels retaining some of their living power take up a fluid from the circulation, without being sufficiently irritable to carry it forwards to their excretory ducts; hence the body, or receptacle of each gland, becomes inflated, and this distension increases, till by its very great stimulus inflammation is produced, or till those parts of the viscus become totally paralytic. This disease is distinguishable from the foregoing by the palpable hardness or largeness of the liver; and as the hepatic glands are not totally paralytic, or the whole liver not affected, some bile continues to be made. The inflammations of this viscus, consequent to the schirrosity of it, belong to the diseases of the sensitive motions, and will be treated of hereafter.

6. The ancients are said to have possessed an art of increasing the livers of geese to a size greater than the remainder of the goose. Martial. l. 13. epig. 58.—This is said to have been done by fat and figs. Horace, l. 2. sat. 8.—Juvenal sets these large livers before an epicure as a great rarity. Sat. 5. l. 114; and Persius, sat. 6. l. 71. Pliny says these large goose-livers were soaked in mulled milk, that is, I suppose, milk mixed with honey and wine; and adds, "that it is uncertain whether Scipio Metellus, of consular dignity, or M. Sestius, a Roman knight, was the great discoverer of this excellent dish." A modern traveller, I believe Mr. Brydone, asserts that the art of enlarging the livers of geese still exists in Sicily; and it is to be lamented that he did not import it into his native country, as some method of affecting the human liver might perhaps have been collected from it; besides the honour he might have acquired in improving our giblet pies.

Our wiser caupones, I am told, know how to fatten their fowls, as well as their geese, for the London markets, by mixing gin instead of figs and fat with their food; by which they are said to become sleepy, and to fatten apace, and probably acquire enlarged livers; as the swine are asserted to do, which are fed on the sediments of barrels in the distilleries; and which so frequently obtains in those, who ingurgitate much ale, or wine, or drams.

II. The irritative diseases of the kidneys, pancreas, spleen, and other glands, are analogous to those of the liver above described, differing only in the consequences attending their inability to action. For instance, when the secretory vessels of the kidneys become disobedient to the stimulus of the passing current of blood, no urine is separated or produced by them; their excretory mouths become filled with concreted mucus, or calculus matter, and in eight or ten days stupor and death supervenes in consequence of the retention of the feculent part of the blood.

This disease in a slighter degree, or when only a part of the kidney is affected, is succeeded by partial inflammation of the kidney in consequence of previous torpor. In that case greater actions of the secretory vessels occur, and the nucleus of gravel is formed by the inflamed mucous membranes of the tubuli uriniferi, as farther explained in its place.

This torpor, or paralysis of the secretory vessels of the kidneys, like that of the liver, owes its origin to their being previously habituated to too great stimulus; which in this country is generally owing to the alcohol contained in ale or wine; and hence must be registered amongst the diseases owing to inebriety; though it may be caused by whatever occasionally inflames the kidney; as too violent riding on horseback, or the cold from a damp bed, or by sleeping on the cold ground; or perhaps by drinking in general too little aqueous fluids.

III. I shall conclude this section on the diseases of the liver induced by spirituous liquors, with the well known story of Prometheus, which seems indeed to have been invented by physicians in those ancient times, when all things were clothed in hieroglyphic, or in fable. Prometheus was painted as stealing fire from heaven, which might well represent the inflammable spirit produced by fermentation; which may be said to animate or enliven the man of clay: whence the conquests of Bacchus, as well as the temporary mirth and noise of his devotees. But the after punishment of those, who steal this accursed fire, is a vulture gnawing the liver; and well allegorises the poor inebriate lingering for years under painful hepatic diseases. When the expediency of laying a further tax on the distillation of spirituous liquors from grain was canvassed before the House of Commons some years ago, it was said of the distillers, with great truth, "They take the bread from the people, and convert it into poison!" Yet is this manufactory of disease permitted to continue, as appears by its paying into the treasury above 900,000l. near a million of money annually. And thus, under the names of rum, brandy, gin, whisky, usquebaugh, wine, cyder, beer, and porter, alcohol is become the bane of the Christian world, as opium of the Mahometan.

Evoe! parce, liber? Parce, gravi metuende thirso!—Hor.

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SECT. XXXI.

OF TEMPERAMENTS.

I. The temperament of decreased irritability known by weak pulse, large pupils of the eyes, cold extremities. Are generally supposed to be too irritable. Bear pain better than labour. Natives of North-America contrasted with those upon the coast of Africa. Narrow and broad shouldered people. Irritable constitutions bear labour better than pain. II. Temperament of increased sensibility. Liable to intoxication, to inflammation, haemoptoe, gutta serena, enthusiasm, delirium, reverie. These constitutions are indolent to voluntary exertions, and dull to irritations. The natives of South-America, and brute animals of this temperament. III. Of increased voluntarity; these are subject to locked jaw, convulsions, epilepsy, mania. Are very active, bear cold, hunger, fatigue. Are suited to great exertions. This temperament distinguishes mankind from other animals. IV. Of increased association. These have great memories, are liable to quartan agues, and stronger sympathies of parts with each other. V. Change of temperaments into one another.

Antient writers have spoken much of temperaments, but without sufficient precision. By temperament of the system should be meant a permanent predisposition to certain classes of diseases: without this definition a temporary predisposition to every distinct malady might be termed a temperament. There are four kinds of constitution, which permanently deviate from good health, and are perhaps sufficiently marked to be distinguished from each other, and constitute the temperaments or predispositions to the irritative, sensitive, voluntary, and associate classes of diseases.

I. The Temperament of decreased Irritability.

The diseases, which are caused by irritation, most frequently originate from the defect of it; for those, which are immediately owing to the excess of it, as the hot fits of fever, are generally occasioned by an accumulation of sensorial power in consequence of a previous defect of irritation, as in the preceding cold fits of fever. Whereas the diseases, which are caused by sensation and volition, most frequently originate from the excess of those sensorial powers, as will be explained below.

The temperament of decreased irritability appears from the following circumstances, which shew that the muscular fibres or organs of sense are liable to become torpid or quiescent from less defect of stimulation than is productive of torpor or quiescence in other constitutions.

1. The first is the weak pulse, which in some constitutions is at the same time quick. 2. The next most marked criterion of this temperament is the largeness of the aperture of the iris, or pupil of the eye, which has been reckoned by some a beautiful feature in the female countenance, as an indication of delicacy, but to an experienced observer it is an indication of debility, and is therefore a defect, not an excellence. The third most marked circumstance in this constitution is, that the extremities, as the hands and feet, or nose and ears, are liable to become cold and pale in situations in respect to warmth, where those of greater strength are not affected. Those of this temperament are subject to hysteric affections, nervous fevers, hydrocephalus, scrophula, and consumption, and to all other diseases of debility.

Those, who possess this kind of constitution, are popularly supposed to be more irritable than is natural, but are in reality less so.

This mistake has arisen from their generally having a greater quickness of pulse, as explained in Sect. XII. 1. 4. XII. 3. 3.; but this frequency of pulse is not necessary to the temperament, like the debility of it.

Persons of this temperament are frequently found amongst the softer sex, and amongst narrow-shouldered men; who are said to bear labour worse, and pain better than others. This last circumstance is supposed to have prevented the natives of North America from having been made slaves by the Europeans. They are a narrow-shouldered race of people, and will rather expire under the lash, than be made to labour. Some nations of Asia have small hands, as may be seen by the handles of their scymetars; which with their narrow shoulders shew, that they have not been accustomed to so great labour with their hands and arms, as the European nations in agriculture, and those on the coasts of Africa in swimming and rowing. Dr. Maningham, a popular accoucheur in the beginning of this century, observes in his aphorisms, that broad-shouldered men procreate broad-shouldered children. Now as labour strengthens the muscles employed, and increases their bulk, it would seem that a few generations of labour or of indolence may in this respect change the form and temperament of the body.

On the contrary, those who are happily possessed of a great degree of irritability, bear labour better than pain; and are strong, active, and ingenious. But there is not properly a temperament of increased irritability tending to disease, because an increased quantity of irritative motions generally induces an increase of pleasure or pain, as in intoxication, or inflammation; and then the new motions are the immediate consequences of increased sensation, not of increased irritation; which have hence been so perpetually confounded with each other.

II. Temperament of Sensibility.

There is not properly a temperament, or predisposition to disease, from decreased sensibility, since irritability and not sensibility is immediately necessary to bodily health. Hence it is the excess of sensation alone, as it is the defect of irritation, that most frequently produces disease. This temperament of increased sensibility is known from the increased activity of all those motions of the organs of sense and muscles, which are exerted in consequence of pleasure or pain, as in the beginning of drunkenness, and in inflammatory fever. Hence those of this constitution are liable to inflammatory diseases, as hepatitis; and to that kind of consumption which is hereditary, and commences with slight repeated haemoptoe. They have high-coloured lips, frequently dark hair and dark eyes with large pupils, and are in that case subject to gutta serena. They are liable to enthusiasm, delirium, and reverie. In this last circumstance they are liable to start at the clapping of a door; because the more intent any one is on the passing current of his ideas, the greater surprise he experiences on their being dissevered by some external violence, as explained in Sect. XIX. on reverie.

As in these constitutions more than the natural quantities of sensitive motions are produced by the increased quantity of sensation existing in the habit, it follows, that the irritative motions will be performed in some degree with less energy, owing to the great expenditure of sensorial power on the sensitive ones. Hence those of this temperament do not attend to slight stimulations, as explained in Sect. XIX. But when a stimulus is so great as to excite sensation, it produces greater sensitive actions of the system than in others; such as delirium or inflammation. Hence they are liable to be absent in company; sit or lie long in one posture; and in winter have the skin of their legs burnt into various colours by the fire. Hence also they are fearful of pain; covet music and sleep; and delight in poetry and romance.

As the motions in consequence of sensation are more than natural, it also happens from the greater expenditure of sensorial power on them, that the voluntary motions are less easily exerted. Hence the subjects of this temperament are indolent in respect to all voluntary exertions, whether of mind or body.

A race of people of this description seems to have been found by the Spaniards in the islands of America, where they first landed, ten of whom are said not to have consumed more food than one Spaniard, nor to have been capable of more than one tenth of the exertion of a Spaniard. Robertson's History.—In a state similar to this the greatest part of the animal world pass their lives, between sleep or inactive reverie, except when they are excited by the call of hunger.

III. The Temperament of increased Voluntarity.

Those of this constitution differ from both the last mentioned in this, that the pain, which gradually subsides in the first, and is productive of inflammation or delirium in the second, is in this succeeded by the exertion of the muscles or ideas, which are most frequently connected with volition; and they are thence subject to locked jaw, convulsions, epilepsy, and mania, as explained in Sect. XXXIV. Those of this temperament attend to the slightest irritations or sensations, and immediately exert themselves to obtain or avoid the objects of them; they can at the same time bear cold and hunger better than others, of which Charles the Twelfth of Sweden was an instance. They are suited and generally prompted to all great exertions of genius or labour, as their desires are more extensive and more vehement, and their powers of attention and of labour greater. It is this facility of voluntary exertion, which distinguishes men from brutes, and which has made them lords of the creation.

IV. The Temperament of increased Association.

This constitution consists in the too great facility, with which the fibrous motions acquire habits of association, and by which these associations become proportionably stronger than in those of the other temperaments. Those of this temperament are slow in voluntary exertions, or in those dependent on sensation, or on irritation. Hence great memories have been said to be attended with less sense and less imagination from Aristotle down to the present time; for by the word memory these writers only understood the unmeaning repetition of words or numbers in the order they were received, without any voluntary efforts of the mind.

In this temperament those associations of motions, which are commonly termed sympathies, act with greater certainty and energy, as those between disturbed vision and the inversion of the motion of the stomach, as in sea-sickness; and the pains in the shoulder from hepatic inflammation. Add to this, that the catenated circles of actions are of greater extent than in the other constitutions. Thus if a strong vomit or cathartic be exhibited in this temperament, a smaller quantity will produce as great an effect, if it be given some weeks afterwards; whereas in other temperaments this is only to be expected, if it be exhibited in a few days after the first dose. Hence quartan agues are formed in those of this temperament, as explained in Section XXXII. on diseases from irritation, and other intermittents are liable to recur from slight causes many weeks after they have been cured by the bark.

V. The first of these temperaments differs from the standard of health from defect, and the others from excess of sensorial power; but it sometimes happens that the same individual, from the changes introduced into his habit by the different seasons of the year, modes or periods of life, or by accidental diseases, passes from one of these temperaments to another. Thus a long use of too much fermented liquor produces the temperament of increased sensibility; great indolence and solitude that of decreased irritability; and want of the necessaries of life that of increased voluntarity.

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SECT. XXXII.

DISEASES OF IRRITATION.

I. Irritative fevers with strong pulse. With weak pulse. Symptoms of fever, Their source. II. 1. Quick pulse is owing to decreased irritability. 2. Not in sleep or in apoplexy. 3. From inanition. Owing to deficiency of sensorial power. III. 1. Causes of fever. From defect of heat. Heat from secretions. Pain of cold in the loins and forehead. 2. Great expense of sensorial power in the vital motions. Immersion in cold water. Succeeding glow of heat. Difficult respiration in cold bathing explained. Why the cold bath invigorates. Bracing and relaxation are mechanical terms. 3. Uses of cold bathing. Uses of cold air in fevers. 4. Ague fits from cold air. Whence their periodical returns. IV. Defect of distention a cause of fever. Deficiency of blood. Transfusion of blood. V. 1. Defect of momentum of the blood from mechanic stimuli. 2. Air injected into the blood-vessels. 3. Exercise increases the momentum of the blood. 4. Sometimes bleeding increases the momentum of it. VI. Influence of the sun and moon on diseases. The chemical stimulus of the blood. Menstruation obeys the lunations. Queries. VII. Quiesence of large glands a cause of fever. Swelling of the praecordia. VIII. Other causes of quiescence, as hunger, bad air, fear, anxiety. IX. 1. Symptoms of the cold fit. 2. Of the hot fit. 3. Second cold fit why. 4. Inflammation introduced, or delirium, or stupor. X. Recapitulation. Fever not an effort of nature to relieve herself. Doctrine of spasm.

I. When the contractile sides of the heart and arteries perform a greater number of pulsations in a given time, and move through a greater area at each pulsation, whether these motions are occasioned by the stimulus of the acrimony or quantity of the blood, or by their association with other irritative motions, or by the increased irritability of the arterial system, that is, by an increased quantity of sensorial power, one kind of fever is produced; which may be called Synocha irritativa, or Febris irritativa pulsu forti, or irritative fever with strong pulse.

When the contractile sides of the heart and arteries perform a greater number of pulsations in a given time, but move through a much less area at each pulsation, whether these motions are occasioned by defect of their natural stimuli, or by the defect of other irritative motions with which they are associated, or from the inirritability of the arterial system, that is, from a decreased quantity of sensorial power, another kind of fever arises; which may be termed, Typhus irritativus, or Febris irritativa pulsu debili, or irritative fever with weak pulse. The former of these fevers is the synocha of nosologists, and the latter the typhus mitior, or nervous fever. In the former there appears to be an increase of sensorial power, in the latter a deficiency of it; which is shewn to be the immediate cause of strength and weakness, as defined in Sect. XII. 1. 3.

It should be added, that a temporary quantity of strength or debility may be induced by the defect or excess of stimulus above what is natural; and that in the same fever debility always exists during the cold fit, though strength does not always exist during the hot fit.

These fevers are always connected with, and generally induced by, the disordered irritative motions of the organs of sense, or of the intestinal canal, or of the glandular system, or of the absorbent system; and hence are always complicated with some or many of these disordered motions, which are termed the symptoms of the fever, and which compose the great variety in these diseases.

The irritative fevers both with strong and with weak pulse, as well as the sensitive fevers with strong and with weak pulse, which are to be described in the next section, are liable to periodical remissions, and then they take the name of intermittent fevers, and are distinguished by the periodical times of their access.

II. For the better illustration of the phenomena of irritative fevers we must refer the reader to the circumstances of irritation explained in Sect. XII. and shall commence this intricate subject by speaking of the quick pulse, and proceed by considering many of the causes, which either separately or in combination most frequently produce the cold fits of fevers.

1. If the arteries are dilated but to half their usual diameters, though they contract twice as frequently in a given time, they will circulate only half their usual quantity of blood: for as they are cylinders, the blood which they contain must be as the squares of their diameters. Hence when the pulse becomes quicker and smaller in the same proportion, the heart and arteries act with less energy than in their natural state. See Sect. XII. 1. 4.

That this quick small pulse is owing to want of irritability, appears, first, because it attends other symptoms of want of irritability; and, secondly, because on the application of a stimulus greater than usual, it becomes slower and larger. Thus in cold fits of agues, in hysteric palpitations of the heart, and when the body is much exhausted by haemorrhages, or by fatigue, as well as in nervous fevers, the pulse becomes quick and small; and secondly, in all those cases if an increase of stimulus be added, by giving a little wine or opium; the quick small pulse becomes slower and larger, as any one may easily experience on himself, by counting his pulse after drinking one or two glasses of wine, when he is faint from hunger or fatigue.

Now nothing can so strongly evince that this quick small pulse is owing to defect of irritability, than that an additional stimulus, above what is natural, makes it become slower and larger immediately: for what is meant by a defect of irritability, but that the arteries and heart are not excited into their usual exertions by their usual quantity of stimulus? but if you increase the quantity of stimulus, and they immediately act with their usual energy, this proves their previous want of their natural degree of irritability. Thus the trembling hands of drunkards in a morning become steady, and acquire strength to perform their usual offices, by the accustomed stimulus of a glass or two of brandy.

2. In sleep and in apoplexy the pulse becomes slower, which is not owing to defect of irritability, for it is at the same time larger; and thence the quantity of the circulation is rather increased than diminished. In these cases the organs of sense are closed, and the voluntary power is suspended, while the motions dependent on internal irritations, as those of digestion and secretion, are carried on with more than their usual vigour; which has led superficial observers to confound these cases with those arising from want of irritability. Thus if you lift up the eyelid of an apoplectic patient, who is not actually dying, the iris will, as usual, contract itself, as this motion is associated with the stimulus of light; but it is not so in the last stages of nervous fevers, where the pupil of the eye continues expanded in the broad day-light: in the former case there is a want of voluntary power, in the latter a want of irritability.

Hence also those constitutions which are deficient in quantity of irritability, and which possess too great sensibility, as during the pain of hunger, of hysteric spasms, or nervous headachs, are generally supposed to have too much irritability; and opium, which in its due dose is a most powerful stimulant, is erroneously called a sedative; because by increasing the irritative motions it decreases the pains arising from defect of them.

Why the pulse should become quicker both from an increase of irritation, as in the synocha irritativa, or irritative fever with strong pulse; and from the decrease of it, as in the typhus irritativus, or irritative fever with weak pulse; seems paradoxical. The former circumstance needs no illustration; since if the stimulus of the blood, or the irritability of the sanguiferous system be increased, and the strength of the patient not diminished, it is plain that the motions must be performed quicker and stronger.

In the latter circumstance the weakness of the muscular power of the heart is soon over-balanced by the elasticity of the coats of the arteries, which they possess besides a muscular power of contraction; and hence the arteries are distended to less than their usual diameters. The heart being thus stopped, when it is but half emptied, begins sooner to dilate again; and the arteries being dilated to less than their usual diameters, begin so much sooner to contract themselves; insomuch, that in the last stages of fevers with weakness the frequency of pulsation of the heart and arteries becomes doubled; which, however, is never the case in fevers with strength, in which they seldom exceed 118 or 120 pulsations in a minute. It must be added, that in these cases, while the pulse is very small and very quick, the heart often feels large, and labouring to one's hand; which coincides with the above explanation, shewing that it does not completely empty itself.

3. In cases however of debility from paucity of blood, as in animals which are bleeding to death in the slaughter-house, the quick pulsations of the heart and arteries may be owing to their not being distended to more than half their usual diastole; and in consequence they must contract sooner, or more frequently, in a given time. As weak people are liable to a deficient quantity of blood, this cause may occasionally contribute to quicken the pulse in fevers with debility, which may be known by applying one's hand upon the heart as above; but the principal cause I suppose to consist in the diminution of sensorial power. When a muscle contains, or is supplied with but little sensorial power, its contraction soon ceases, and in consequence may soon recur, as is seen in the trembling hands of people weakened by age or by drunkenness. See Sect. XII. 1. 4. XII. 3. 4.

It may nevertheless frequently happen, that both the deficiency of stimulus, as where the quantity of blood is lessened (as described in No. 4. of this section), and the deficiency of sensorial power, as in those of the temperament of irritability, described in Sect. XXXI. occur at the same time; which will thus add to the quickness of the pulse and to the danger of the disease.

III. 1. A certain degree of heat is necessary to muscular motion, and is, in consequence, essential to life. This is observed in those animals and insects which pass the cold season in a torpid state, and which revive on being warmed by the fire. This necessary stimulus of heat has two sources; one from the fluid atmosphere of heat, in which all things are immersed, and the other from the internal combinations of the particles, which form the various fluids, which are produced in the extensive systems of the glands. When either the external heat, which surrounds us, or the internal production of it, becomes lessened to a certain degree, the pain of cold is perceived.

This pain of cold is experienced most sensibly by our teeth, when ice is held in the mouth; or by our whole system after having been previously accustomed to much warmth. It is probable, that this pain does not arise from the mechanical or chemical effects of a deficiency of heat; but that, like the organs of sense by which we perceive hunger and thirst, this sense of heat suffers pain, when the stimulus of its object is wanting to excite the irritative motions of the organ; that is, when the sensorial power becomes too much accumulated in the quiescent fibres. See Sect. XII. 5. 3. For as the peristaltic motions of the stomach are lessened, when the pain of hunger is great, so the action of the cutaneous capillaries are lessened during the pain of cold; as appears by the paleness of the skin, as explained in Sect. XIV. 6. on the production of ideas.

The pain in the small of the back and forehead in the cold fits of the ague, in nervous hemicrania, and in hysteric paroxysms, when all the irritative motions are much impaired, seems to arise from this cause; the vessels of these membranes or muscles become torpid by their irritative associations with other parts of the body, and thence produce less of their accustomed secretions, and in consequence less heat is evolved, and they experience the pain of cold; which coldness may often be felt by the hand applied upon the affected part.

2. The importance of a greater or less deduction of heat from the system will be more easy to comprehend, if we first consider the great expense of sensorial power used in carrying on the vital motions; that is, which circulates, absorbs, secretes, aerates, and elaborates the whole mass of fluids with unceasing assiduity. The sensorial power, or spirit of animation, used in giving perpetual and strong motion to the heart, which overcomes the elasticity and vis inertiae of the whole arterial system; next the expense of sensorial power in moving with great force and velocity the innumerable trunks and ramifications of the arterial system; the expense of sensorial power in circulating the whole mass of blood through the long and intricate intortions of the very fine vessels, which compose the glands and capillaries; then the expense of sensorial power in the exertions of the absorbent extremities of all the lacteals, and of all the lymphatics, which open their mouths on the external surface of the skin, and on the internal surfaces of every cell or interstice of the body; then the expense of sensorial power in the venous absorption, by which the blood is received from the capillary vessels, or glands, where the arterial power ceases, and is drank up, and returned to the heart; next the expense of sensorial power used by the muscles of respiration in their office of perpetually expanding the bronchia, or air-vessels, of the lungs; and lastly in the unceasing peristaltic motions of the stomach and whole system of intestines, and in all the secretions of bile, gastric juice, mucus, perspirable matter, and the various excretions from the system. If we consider the ceaseless expense of sensorial power thus perpetually employed, it will appear to be much greater in a day than all the voluntary exertions of our muscles and organs of sense consume in a week; and all this without any sensible fatigue! Now, if but a part of these vital motions are impeded, or totally stopped for but a short time, we gain an idea, that there must be a great accumulation of sensorial power; as its production in these organs, which are subject to perpetual activity, is continued during their quiescence, and is in consequence accumulated.

While, on the contrary, where those vital organs act too forcibly by increase of stimulus without a proportionally-increased production of sensorial power in the brain, it is evident, that a great deficiency of action, that is torpor, must soon follow, as in fevers; whereas the locomotive muscles, which act only by intervals, are neither liable to so great accumulation of sensorial power during their times of inactivity, nor to so great an exhaustion of it during their times of action.

Thus, on going into a very cold bath, suppose at 33 degrees of heat on Fahrenheit's scale, the action of the subcutaneous capillaries, or glands, and of the mouths of the cutaneous absorbents is diminished, or ceases for a time. Hence less or no blood passes these capillaries, and paleness succeeds. But soon after emerging from the bath, a more florid colour and a greater degree of heat is generated on the skin than was possessed before immersion; for the capillary glands, after this quiescent state, occasioned by the want of stimulus, become more irritable than usual to their natural stimuli, owing to the accumulation of sensorial power, and hence a greater quantity of blood is transmitted through them, and a greater secretion of perspirable matter; and, in consequence, a greater degree of heat succeeds. During the continuance in cold water the breath is cold, and the act of respiration quick and laborious; which have generally been ascribed to the obstruction of the circulating fluid by a spasm of the cutaneous vessels, and by a consequent accumulation of blood in the lungs, occasioned by the pressure as well as by the coldness of the water. This is not a satisfactory account of this curious phaenomenon, since at this time the whole circulation is less, as appears from the smallness of the pulse and coldness of the breath; which shew that less blood passes through the lungs in a given time; the same laborious breathing immediately occurs when the paleness of the skin is produced by fear, where no external cold or pressure are applied.

The minute vessels of the bronchia, through which the blood passes from the arterial to the venal system, and which correspond with the cutaneous capillaries, have frequently been exposed to cold air, and become quiescent along with those of the skin; and hence their motions are so associated together, that when one is affected either with quiescence or exertion, the other sympathizes with it, according to the laws of irritative association. See Sect. XXVII. 1. on haemorrhages.

Besides the quiescence of the minute vessels of the lungs, there are many other systems of vessels which become torpid from their irritative associations with those of the skin, as the absorbents of the bladder and intestines; whence an evacuation of pale urine occurs, when the naked skin is exposed only to the coldness of the atmosphere; and sprinkling the naked body with cold water is known to remove even pertinacious constipation of the bowels. From the quiescence of such extensive systems of vessels as the glands and capillaries of the skin, and the minute vessels of the lungs, with their various absorbent series of vessels, a great accumulation of sensorial powers is occasioned; part of which is again expended in the increased exertion of all these vessels, with an universal glow of heat in consequence of this exertion, and the remainder of it adds vigour to both the vital and voluntary exertions of the whole day.

If the activity of the subcutaneous vessels, and of those with which their actions are associated, was too great before cold immersion, as in the hot days of summer, and by that means the sensorial power was previously diminished, we see the cause why the cold bath gives such present strength; namely, by stopping the unnecessary activity of the subcutaneous vessels, and thus preventing the too great exhaustion of sensorial power; which, in metaphorical language, has been called bracing the system: which is, however, a mechanical term, only applicable to drums, or musical strings: as on the contrary the word relaxation, when applied to living animal bodies, can only mean too small a quantity of stimulus, or too small a quantity of sensorial power; as explained in Sect. XII. 1.

3. This experiment of cold bathing presents us with a simple fever-fit; for the pulse is weak, small, and quick during the cold immersion; and becomes strong, full, and quick during the subsequent glow of heat; till in a few minutes these symptoms subside, and the temporary fever ceases.

In those constitutions where the degree of inirritability, or of debility, is greater than natural, the coldness and paleness of the skin with the quick and weak pulse continue a long time after the patient leaves the bath; and the subsequent heat approaches by unequal flushings, and he feels himself disordered for many hours. Hence the bathing in a cold spring of water, where the heat is but forty-eight degrees on Fahrenheit's thermometer, much disagrees with those of weak or inirritable habits of body; who possess so little sensorial power, that they cannot without injury bear to have it diminished even for a short time; but who can nevertheless bear the more temperate coldness of Buxton bath, which is about eighty degrees of heat, and which strengthens them, and makes them by habit less liable to great quiescence from small variations of cold, and thence less liable to be disordered by the unavoidable accidents of life. Hence it appears, why people of these inirritable constitutions, which is another expression for sensorial deficiency, are often much injured by bathing in a cold spring of water; and why they should continue but a very short time in baths, which are colder than their bodies; and should gradually increase both the degree of coldness of the water, and the time of their continuance in it, if they would obtain salutary effects from cold immersions. See Sect. XII. 2. 1.

On the other hand, in all cases where the heat of the external surface of the body, or of the internal surface of the lungs, is greater than natural, the use of exposure to cool air may be deduced. In fever-fits attended with strength, that is with great quantity of sensorial power, it removes the additional stimulus of heat from the surfaces above mentioned, and thus prevents their excess of useless motion; and in fever-fits attended with debility, that is with a deficiency of the quantity of sensorial power, it prevents the great and dangerous waste of sensorial power expended in the unnecessary increase of the actions of the glands and capillaries of the skin and lungs.

4. In the same manner, when any one is long exposed to very cold air, a quiescence is produced of the cutaneous and pulmonary capillaries and absorbents, owing to the deficiency of their usual stimulus of heat; and this quiescence of so great a quantity of vessels affects, by irritative association, the whole absorbent and glandular system, which becomes in a greater or less degree quiescent, and a cold fit of fever is produced.

If the deficiency of the stimulus of heat is very great, the quiescence becomes so general as to extinguish life, as in those who are frozen to death.

If the deficiency of heat be in less degree, but yet so great as in some measure to disorder the system, and should occur the succeeding day, it will induce a greater degree of quiescence than before, from its acting in concurrence with the period of the diurnal circle of actions, explained in Sect. XXXVI. Hence from a small beginning a greater and greater degree of quiescence may be induced, till a complete fever-fit is formed; and which will continue to recur at the periods by which it was produced. See Sect. XVII. 3. 6.

If the degree of quiescence occasioned by defect of the stimulus of heat be very great, it will recur a second time by a slighter cause, than that which first induced it. If the cause, which induces the second fit of quiescence, recurs the succeeding day, the quotidian fever is produced; if not till the alternate day, the tertian fever; and if not till after seventy-two hours from the first fit of quiescence, the quartan fever is formed. This last kind of fever recurs less frequently than the other, as it is a disease only of those of the temperament of associability, as mentioned in Sect. XXXI.; for in other constitutions the capability of forming a habit ceases, before the new cause of quiescence is again applied, if that does not occur sooner than in seventy-two hours.

And hence those fevers, whose cause is from cold air of the night or morning, are more liable to observe the solar day in their periods; while those from other causes frequently observe the lunar day in their periods, their paroxysms returning near an hour later every day, as explained in Sect. XXXVI.

IV. Another frequent cause of the cold fits of fever is the defect of the stimulus of distention. The whole arterial system would appear, by the experiments of Haller, to be irritable by no other stimulus, and the motions of the heart and alimentary canal are certainly in some measure dependant on the same cause. See Sect. XIV. 7. Hence there can be no wonder, that the diminution of distention should frequently induce the quiescence, which constitutes the beginning of fever-fits.

Monsieur Leiutaud has judiciously mentioned the deficiency of the quantity of blood amongst the causes of diseases, which he says is frequently evident in dissections: fevers are hence brought on by great haemorrhages, diarrhoeas, or other evacuations; or from the continued use of diet, which contains but little nourishment; or from the exhaustion occasioned by violent fatigue, or by those chronic diseases in which the digestion is much impaired; as where the stomach has been long affected with the gout or schirrus; or in the paralysis of the liver, as described in Sect. XXX. Hence a paroxysm of gout is liable to recur on bleeding or purging; as the torpor of some viscus, which precedes the inflammation of the foot, is thus induced by the want of the stimulus of distention. And hence the extremities of the body, as the nose and fingers, are more liable to become cold, when we have long abstained from food; and hence the pulse is increased both in strength and velocity above the natural standard after a full meal by the stimulus of distention.