GENUS III.

Catenated with Voluntary Motions.

SPECIES.

1. Ruminatio. Rumination. 2. Vomitio voluntaria. Voluntary vomiting. 3. Eructatio voluntaria. —— eructation.

GENUS IV.

Catenated with External Influences.

SPECIES.

1. Catarrhus periodicus. Periodical catarrh. 2. Tussis periodica. Periodic cough. 3. Histeria a frigore. Hysterics from cold. 4. Nausea pluvialis. Sickness against rain.

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CLASS IV.

DISEASES OF ASSOCIATION.

ORDO I.

Increased Associate Motions.

GENUS I.

Catenated with Irritative Motion.

The importance of the subsequent class not only consists in its elucidating all the sympathetic diseases, but in its opening a road to the knowledge of fever. The difficulty and novelty of the subject must plead in excuse for the present imperfect state of it. The reader is entreated previously to attend to the following circumstances for the greater facility of investigating their intricate connections; which I shall enumerate under the following heads.

A. Associate motions distinguished from catenations. B. Associate motions of three kinds. C. Associations affected by external influences. D. Associations affected by other sensorial motions. E. Associations catenated with sensation. F. Direct and reverse sympathy. G. Associations affected four ways. H. Origin of associations. I. Of the action of vomiting. K. Tertian associations.

A. Associate Motions distinguished from Catenations.

Associate motions properly mean only those, which are caused by the sensorial power of association. Whence it appears, that those fibrous motions, which constitute the introductory link of an associate train of motions, are excluded from this definition, as not being themselves caused by the sensorial power of association, but by irritation, or sensation, or volition. I shall give for example the flushing of the face after dinner; the capillary vessels of the face increase their actions in consequence of their catenation, not their association, with those of the stomach; which latter are caused to act with greater energy by the irritation excited by the stimulus of food. These capillaries of the face are associated with each other reciprocally, as being all of them excited by the sensorial power of association; but they are only catenated with those of the stomach, which are not in this case associate motions but irritative ones. The common use of the word association for almost every kind of connection has rendered this subject difficult; from which inaccuracy I fear some parts of this work are not exempt.

B. Associate Motions of three Kinds.

Those trains or tribes of associate motions, whose introductory link consists of an irritative motion, are termed irritative associations; as when the muscles of the eyelids close the eye in common nictitation. Those, whose introductory link consists of a sensitive motion, are termed sensitive associations; as when the pectoral and intercostal muscles act in sneezing. And lastly, those, whose introductory link consists of a voluntary motion, are termed voluntary associations; as when the muscles of the lower limbs act in concert with those of the arm in fencing.

C. Associations affected by external Influences.

Circles of associate motions, as well as trains and tribes of them, are liable to be affected by external influences, which consist of etherial fluids, and which, by penetrating the system, act upon it perhaps rather as a causa sine qua non of its movements, than directly as a stimulus; except when they are accumulated in unusual quantity. We have a sense adapted to the perception of the excess or defect of one of these fluids; I mean that of elementary heat; in which all things are immersed. See Class IV. 1. 4. 7. But there are others of them, which as we have no power to evade their influence, so we have no sense to perceive it; these are the solar, and lunar, and terrestrial gravitation, in which also all things are immersed; the electric aura, which pervades us, and is perpetually varying, See Class IV. 1. 4. 5; the magnetic fluid, Class IV. 1. 4. 5; and lastly, the great life-preserver oxygen gas, and the aqueous vapour of the atmosphere, see Class IV. 1. 4. 6. and 7. and 2.

Of these external influences those of heat, and of gravity, have diurnal periods of increase and decrease; besides their greater periods of monthly or annual variation. The manner in which they act by periodical increments on the system, till some effect is produced, is spoken of in Sect. XXXII. 3. and 6.

D. Associations affected by other Sensorial Motions.

Circles and trains of associate motions are also liable to be affected by their catenations with other sensorial powers, as of irritation, or sensation, or volition; which other sensorial powers either thus simply form some of the links of the catenation, or add to the energy of the associated motions. Thus when vomiting is caused by the stimulus of a stone in the ureter, the sensation of pain seems to be a link of the catenation rather than an efficient cause of the vomiting. But when the capillary vessels of the skin increase their action from the influence of external heat, they are excited both by the stimulus of unusual heat, as well as by the stimulus of the blood, and by their accustomed association with the actions of the heart and arteries. And lastly, in the blush of anger the sensorial power of volition is added to that of association, and irritation, to excite the capillaries of the face with increased action. See Class IV. 2. 3. 5.

E. Associations catenated with Sensation.

Pain frequently accompanies associate trains or circles of motion without its being a cause, or a link, of them, but simply an attendant symptom; though it frequently gives name to the disease, as head-ach. Thus in the cramp of the calves of the legs in diarrhoea, the increased sensorial power of association is the proximate cause; the preceding increased action of the bowels is the remote cause; and the proximate effect is the violent contractions of the musculi gastrocnemii; but the pain of these muscles is only an attendant symptom, or a remote effect. See Sect. XVIII. 15. Other sensitive associations are mentioned in Class IV. 1. 2. and IV. 1. 2. 15.

Thus, if the flushing of the face above mentioned after dinner be called a disease, the immediate or proximate cause is the increased power of association, the remote cause is the increased irritative motions of the stomach in consequence of the stimulus of food and wine. The disease or proximate effect consists in the increased actions of the cutaneous vessels of the face; and the sensation of heat, the existence of heat, and the red colour, are attendants or symptoms, or remote effects, of the increased actions of these cutaneous vessels.

F. Direct and reverse Sympathy.

The increased actions of the primary part of the trains of associated motions are sometimes succeeded by increased actions of the secondary part of the train; and sometimes by decreased actions of it. So likewise the decreased actions of the primary part of a train of associate motions are sometimes succeeded by decreased actions of the secondary part, and sometimes by increased actions of it. The former of these situations is called direct sympathy, and the latter reverse sympathy. In general I believe, where the primary part of the train of associated motions is exerted more than natural, it produces direct sympathy in strong people, and reverse sympathy in weak ones, as a full meal makes some people hot, and others chill. And where the primary part of the train is exerted less than natural, it produces direct sympathy in weak people, and reverse sympathy in strong ones, as on being exposed for a certain length of time on horseback in a cold day gives indigestion and consequent heart-burn to weak people, and strengthens the digestion, and induces consequent hunger in strong ones. See Sect. XXXV. 1.

This may perhaps be more easily understood, by considering strength and weakness, when applied to animal bodies, as consisting in the quantity of sensorial power residing in the contracting fibres, and the quantity of stimulus applied, as shewn in Sect. XII. 2. 1. Now when defective stimulus, within certain limits, is partially applied to parts subject to perpetual motion, the expenditure of sensorial power is for a while lessened, but not its general production in the brain, nor its derivation into the weakly-stimulated part. Hence in strong people, or such whose fibres abound with sensorial power, if the first tribe of an associate train of motions be deprived in part of its accustomed stimulus, its action becomes diminished; and the sensorial power becomes accumulated, and by its superabundance, or overflowing as it were, increases the action of the second tribe of the associate actions by reverse sympathy. As exposing the warm skin for a moderate time to cold air increases the action of the stomach, and thus strengthens the power of digestion.

On the reverse, when additional stimulus within certain limits is partially applied to parts, which are deficient in respect to the natural quantity of sensorial power, the expenditure of sensorial power is increased, but in a less degree than the increased production of it in the brain, or its increased derivation into the strongly-stimulated organ. Hence in weak people, or such whose fibres are deficient of sensorial power, if the first tribe of an associate train of motions be subjected for a while to greater stimulus than usual, a greater production of sensorial power, or a greater derivation of it into the stimulated parts occurs; which by its excess, or overflowing as it were, increases the actions of the second tribe of the associate motions by direct sympathy. Thus when vomiting occurs with cold extremities, a blister on the back in a few hours occasions universal warmth of the skin, and stops the vomiting. And when a diarrhoea occurs with pale skin and cold extremities, the pricking of the points of a flannel shirt, worn next the skin, occasions universal warmth of it, and checks or cures the diarrhoea.

In some associate trains of action nevertheless reverse sympathies more frequently occur than direct ones, and in others direct ones more frequently than reverse ones. Thus in continued fever with debility there appears to be a reverse sympathy between the capillary vessels of the stomach and those of the skin; because there exists a total aversion to solid food, and constant heat on the surface of the body. Yet these two systems of vessels are at other times actuated by direct sympathy, as when paleness attends sickness, or cold feet induces indigestion. This subject requires to be further investigated, as it probably depends not only on the present or previous plus or minus of the sensorial power of association, but also on the introduction of other kinds of sensorial power, as in Class IV. 1. 1. D; or the increased production of it in the brain, or the greater mobility of one part of a train of actions than another.

Thus when much food or wine is taken into the stomach, if there be no superfluity of sensorial power in the system, that is, none to be spared from the continual actions of it, a paleness and chillness succeeds for a time; because now the expenditure of it by the increased actions of the stomach is greater than the present production of it. In a little time however the stimulus of the food and wine increases the production of sensorial power in the brain, and this produces a superfluity of it in the system; in consequence of which the skin now becomes warm and florid, which was at first cold and pale; and thus the reverse sympathy is shortly converted into a direct one; which is probably owing to the introduction of a second sensorial power, that of pleasurable sensation.

On the contrary, when an emetic drug produces sickness, the skin is at first pale for a time by direct sympathy with the capillaries of the stomach; but in a few minutes, by the accumulation of sensorial power in the stomach during its less active state in sickness, the capillaries of the skin, which are associated with those of the stomach, act with greater energy by reverse sympathy, and a florid colour returns. Where the quantity of action is diminished in the first part of a train of motions, whether by previous diminution of sensorial power, or present diminution of stimulus, the second part of the train becomes torpid by direct sympathy. And when the quantity of action of the first part becomes increased by the accumulation of sensorial power during its previous torpor, or by increase of stimulus, the actions of the second part of it likewise become increased by direct sympathy.

In moderate hunger the skin is pale, as before dinner, and in moderate sickness, as no great accumulation of sensorial power has commenced; but in violent hunger, and in greater torpor of the stomach, as from contagious matter, the accumulation of sensorial power becomes so great as to affect the arterial and capillary system, and fever is produced in both cases.

In contagious fevers with arterial debilities commencing with torpor of the stomach, why is the action of the heart weakened, and that of the capillaries increased? Is it because the mobility of the heart is less than that of the stomach, and the mobility of the capillaries greater? Or is it because the association between the muscular fibres of the stomach and those of the heart have been uniformly associated by direct sympathy; and the capillaries of the stomach and those of the skin have been more frequently associated by reverse sympathy?

Where the actions of the stomach have been previously exhausted by long stimulus, as on the day after intoxication, little or no accumulation of sensorial power occurs, during the torpor of the organ, beyond what is required to replace the deficiency of it, and hence fever seldom follows intoxication. And a repetition of the stimulus sometimes becomes necessary even to induce its natural action, as in dram-drinkers.

Where there has been no previous exhaustion of sensorial power, and the primary link of associate motions is violently actuated by the sensorial power of sensation, the secondary link is also violently actuated by direct sympathy, as in inflammatory fevers. Where however the sensorial power of the system is less than natural, the secondary link of associated motions becomes torpid by reverse sympathy, as in the inoculated small-pox during the eruption on the face the feet are frequently cold.

G. Associations affected four Ways.

Hence associated trains or circles of motions may be affected four different ways. 1. By the greater or less energy of action of the first link with which they are catenated, and from which they take their names; as irritative, sensitive, or voluntary associations. 2. By being excited by two or more sensorial powers at the same time, as by irritation and association, as in the instance of the application of the stimulus of increased external heat to the cutaneous capillaries. 3. By catenation with other sensorial powers, as with pain or pleasure, which are in this case not the proximate cause of motion, but which, by becoming a link of catenation, excites the sensorial power of association into action; as the pain at the neck of the gall-bladder occasioned by a gall-stone is transferred to the other end of that canal, and becomes a link of catenation between the action of the two extremities of it. 4. The influence of ethereal fluids, as of heat and gravitation. To which last perhaps might be added moisture and oxygen gas as constituting necessary parts of the system, rather than stimuli to excite it into action.

H. The Origin of Associations.

Some trains or circles of associate motions must have been formed before our nativity, as those of the heart, arteries, and capillaries; others have been associated, as occasion required them, as the muscles of the diaphragm and abdomen in vomiting; and others by perpetual habit, as those of the stomach with the heart and arteries directly, as in weak pulse during sickness; with the capillaries directly, as in the flushed skin after dinner; and lastly, with the cellular absorbents reversely, as in the increased absorption in anasarca during sickness; and with the irritative motions of the organs of sense reversely, as in vertigo, or sea-sickness. Some of these associations shall be here shortly described to facilitate the investigation of others.

First, other congeries of glands occupy but a particular part of the system, or constitute a particular organ, as the liver, or kidneys; but those glands, which secrete the mucus, and perspirable matter, which are called capillaries, are of very great extent; they receive the blood from the arteries, separate from it the mucus, which lines every cell, and covers every cavity of body; and the perspirable matter, which softens and lubricates the whole surface of the skin, and the more extensive surface of the air-vessels, which compose the lungs. These are supplied with blood by the perpetual action of the heart and arteries, and have therefore their motions associated with the former, and with each other, by sympathy, which is sometimes direct, and sometimes reverse.

One branch of this association, the capillaries of the skin, are very irritable by the increased quantities of cold and heat, another branch, that of the lungs, has not the perception of cold and heat, but is liable by direct sympathy to act in concert with the former, as in going into the cold bath. And it is probable the capillaries of the internal membranes are likewise directly affected by their sympathy with those of the skin, as appears from the defect of secretion in ulcers during the cold fits of agues.

The motions of this extensive system of capillaries, thus associated by direct sympathy, are also associated with those of the heart and arteries, sometimes by reverse and sometimes by direct sympathy; and thus constitute simple fever. The cold paroxysm of which consists in their torpor, and the hot one in their orgasm, or increased activity.

I. Of the Action of Vomiting.

The manner, in which the stomach and the diaphragm and abdominal muscles acquire their associate action in vomiting, requires some attention. It is not probable, that this action of vomiting occurs before nativity; as the uniform application of the nutritive liquor amnii to the mouth of the foetus, and the uniform expenditure of its nourishment, would not seem to give occasion to too great temporary repletion of the stomach; and would preclude the deglutition of any improper material. After nativity the stomach of the child may be occasionally too much distended with milk; as previous hunger may induce it to overgorge itself; and by repeated efforts the act of vomiting is learned, as a means of getting free from a disagreeable sensation. Thus when any disgustful material, as a bitter drug, is taken into the mouth; certain retrograde motions of the tongue and lips are produced, for the purpose of putting the disagreeable material out of the mouth again.

When the stomach is disagreeably stimulated by the distention or acrimony of the aliment, a similar effort to regurgitate it must occur; and by repeated trials the action of the diaphragm and abdominal muscles by squeezing the stomach assists its retrograde exertion to disgorge its contents. In the same manner when a piece of gravel is pushed into the urethra, or a piece of indurated bile into the neck of the gall-bladder, after they have been in vain pressed forward by the usual motions of those ducts, they return into the bladders of gall and urine by the retrograde motions of them.

That this is one mode, in which vomiting is induced, appears from the instantaneous rejection from the stomach occasioned by some nauseous drug, or from some nauseous idea; and lastly, from the voluntary power, which some people have been said to have acquired, of emptying their stomachs, much in the same manner as ruminating animals bring up the grass from their first stomach.

There are nevertheless many modes by which these inverted motions of the stomach and oesophagus are induced, and which it is of consequence to distinguish from each other. The first is the mode above described, where an effort is made to dislodge something, which stimulates the stomach into disagreeable sensation; and which is returned by repeated exertions; as when a nauseous drug is taken into the mouth, or a bit of sand falls into the eye, or a drop of water into the wind-pipe. In this the peristaltic motions of the stomach are first stopped, and then reverted by painful sensation; and the abdominal muscles and diaphragm by repeated efforts become associated with them. Now as less sensorial power is expended on the retrograde actions of the stomach, and of the lymphatics, which open their mouths on its surface, than by their natural motions, an accumulation of sensorial power in the fibres of the stomach follows the exhibition of an emetic, and on that account an emetic will sometimes stop a spontaneous vomiting which was owing to sensorial deficiency. See Sect. XXXV. 1. 3. and Art. V. 2. 1.

As bitters and metallic salts, exhibited in small doses, stimulate the stomach into greater action, as appears by their increasing the power of digestion, and yet become emetic, when given in larger doses; one might suspect, that they became emetic by inducing debility, and consequent retrograde actions of the stomach, by their previously exhausting the sensorial power by their great stimulus; which might be effected in a moment without producing pain, and in consequence without our perceiving it. But on the contrary, there does not in general appear on the exhibition of emetics to be any previous exhaustion of sensorial power; because there is evidently an accumulation of it during the sickness, as appears from the digestion being stronger afterwards; and from the increased action of the cellular and cutaneous absorbents during its operation. See Art. V. 2. 1.

Another mode, by which vomiting is induced, is owing to debility or deficiency of sensorial power, from the previous exhaustion of it; as on the day after intoxication, or which occurs in people enfeebled with the gout, and in dropsy, and in some fevers with debility. In these, when the vomiting ceases, there is no appearance of accumulation of sensorial power, as the digestion still remains weak and imperfect.

Another mode by which sickness or vomiting is induced, is by defect of stimulus, as in great hunger; and in those, who have been habituated to spice and spirit with their meals, who are liable to be sick after taking food without these additional stimuli. Other means of inducing sickness by vertigo, or by nauseous ideas, will be mentioned below.

We shall only add, that the motions of the muscular fibres of the stomach are associated with those of the heart and arteries by direct sympathy, as appears by the weakness of the pulse during the exhibition of an emetic; and that the absorbents of the stomach are associated with the cellular and cutaneous absorbents by reverse sympathy, as is shewn by the great absorption of the mucus of the cells in anasarca during sickness; at the same time that the absorbents of the stomach invert their actions, and pour the mucus and water thus absorbed into that viscus.

In cold paroxysms of fever the stomach partakes of the general torpor, and vomiting is induced by its debility, either by its association with the torpid capillaries, or other torpid parts, or by its own torpor commencing first, and causing the cold fit. The disordered motions of the stomach frequently seem to be the cause or primary seat of fever, as where contagious miasmata are swallowed with the saliva, and where fever is produced by sea-sickness, which I once saw. Nevertheless a disorder of the stomach does not always induce fever, as in that case it should constantly attend indigestion, and vertigo, and sea-sickness; but is itself frequently induced by association with the disordered movements of other parts of the system, as when it arises from gravel in the ureter, or from a percussion on the head.

The connexion of the motions of the stomach with irritative ideas, or motions of the organs of sense, in vertigo, is shewn in Sect. XX. and thus it appears, that many circles of association are either directly or reversely associated, or catenated, with this viscus; which will much contribute to unfold some of the symptoms of fever.

K. Tertian Associations.

The third link of associate trains of motion is sometimes actuated by reverse sympathy, with the second link, and that by reverse sympathy with the first link; so that the first and third link may act by direct sympathy, and the intermediate one by reverse sympathy. Of this instances are given in the syngultus nephriticus, Class IV. 1. 1. 7. and IV. 2. 1. At other times the tertian or quartan links of associate motions are actuated by direct sympathy; and that sometimes forwards and sometimes backwards in respect to the usual order of those trains of associate motions, as in Class IV. 1. 2. 1.

SPECIES.

1. Rubor vultus prandorum. Flushing of the face after dinner is explained in Sect. XXXV. 1. In the beginning of intoxication the whole skin becomes florid from the association of the actions of the cutaneous arteries with those of the stomach, because vinous spirit excites the fibres of the stomach into more violent action than the stimulus of common food; and the cutaneous capillaries of the face, from their more frequent exposure to the vicissitudes of cold and heat, possess more mobility or irritability than those of other parts of the skin, as further explained in Sect. XXXIII. 2. 10. Vinegar is liable to produce this flushing of the face, which probably is owing to the quantity of vinous spirit it contains, as I believe the unfermented vegetable acids do not produce this effect. In every kind of blush the arterial blood is propelled into the capillaries faster than the venous absorption can carry it forwards into the veins, in this respect resembling the tensio phalli.

Can the beginning vinous or acetous fermentation of the aliment in weak stomachs contribute to this effect? or is it to be ascribed to the greater power of association between the arteries of the face and the fibres of the stomach in some people than in others?

M. M. Eat and drink less at a time, and more frequently. Put 20 drops of weak acid of vitriol into water to be drank at meals. Let the dress over the stomach and bowels be loose. Use no fermented liquors, or vinegar, or spice.

2. Sudor stragulis immersorum. Sweat from being covered in bed. In the commencement of an epidemic fever, in which the perpetual efforts to vomit was a distressing symptom, Dr. Sydenham discovered, that if the patient's head was for a short time covered over with the bed clothes, warmth was produced, and a sweat broke out upon the skin, and the tendency to vomit ceased. In this curious fact two trains of associated motions are excited into increased action. First, the vessels of the lungs are known to have their motion associated with those of the skin by the difficulty of breathing on going into the cold bath, as described in Sect. XXXII. 3. 2. Hence, when the vessels of the lungs become excited into stronger action, by the bad air under the bed clothes, warmed and adulterated by frequent breathing, those of the external skin soon become excited by their association into more energetic action, and generate more heat along with a greater secretion of perspirable matter. Secondly, the sympathy between the stomach and skin is evident in variety of circumstances; thus the cold air of frosty days applied to the skin for a short time increases the action of the stomach by reverse sympathy, but decreases it if continued too long by direct sympathy; so in the circumstance above mentioned the action of the stomach is increased by direct sympathy with that of the skin; and the tendency to vomit, which was owing to its diminished action, ceases.

3. Cessatio aegritudinis cute excitata. The cure of sickness by stimulating the skin. This is explained in the preceding article; and further noticed in IV. 2. 2. 4. and in IV. 1. 1. f.

Similar to these is the effect of a blister on the back in relieving sickness, indigestion, and heart-burn; and, on the contrary, by these symptoms being frequently induced by coldness of the extremities. The blister stimulates the cutaneous vessels into greater action; whence warmth and pain are produced at the same time, and the fibres of the stomach are excited into greater action by their association with those of the skin. It does not appear, that the concomitant pain of the blister causes the increased energy of the stomach, because the motions of it are not greater than natural; though it is sometimes difficult to determine, whether the primary part of some associated trains be connected with irritative or sensitive motions.

In the same manner a flannel shirt, to one who has not been in the habit of wearing one, stimulates the skin by its points, and thus stops vomiting in some cases; and is particularly efficacious in checking some chronical diarrhoeas, which are not attended with fever; for the absorbents of the skin are thus stimulated into greater action, with which those of the intestines consent by direct sympathy.

This effect cannot be ascribed to the warmth alone of the flannel shirt, as being a covering of loose texture, and confining air in its pores, like a sponge, which air is known to be a bad conductor of heat, since in that case its use should be equally efficacious, if it were worn over a linen shirt; and an increased warmth of the room of the patient would be equally serviceable.

4. Digestio aucta frigore cutaneo. Digestion increased by coldness of the skin. Every one has experienced the increase of his appetite after walking in the cool air in frosty days; for there is at this time not only a saving of sensorial power by the less exertion of the cutaneous vessels; but, as these consent with those of the stomach and bowels, this saving of sensorial power is transferred by reverse sympathy from the cutaneous capillaries and absorbents to those of the stomach and intestines.

Hence weak people should use the cold air of winter as a cold bath; that is, they should stay in it but a short time at once, but should immerse themselves in it many times a day.

5. Catarrhus a frigore cutaneo. Catarrh from cold skin. This has been already explained in Class I. 1. 2. 7. and is further described in Sect. XXXV. 1. 3. In this disease the vessels of the membrane, which lines the nostrils, are excited into greater action; when those of the skin, with which they are associated, are excited into less action by the deficiency of external heat, by reverse sympathy; and though the pain of cold attends the torpor of the primary link of this association, yet the increased motions of the membrane of the nostrils are associated with those of the cutaneous vessels, and not with the pain of them, because no inflammation follows.

6. Absorptio cellularis aucta vomitu. In the act of vomiting the irritative motions of the stomach are inverted, and of the absorbents, which open their mouths into it; while the cutaneous, cellular, and pulmonary absorbents are induced, by reverse sympathy with them, to act with greater energy. This is seen in cases of anasarca, when long sickness and vomiting are caused by squills, or antimonial salts, or most of all by the decoction of digitalis purpurea, foxglove; and Mr. J. Hunter mentions a case, in which a large bubo, which was just ready to break, was absorbed in a few days by sickness at sea. Treatise on the Blood, p. 501, which is thus accounted for; less sensorial power is expended during sickness by the decreased action of the fibres of the stomach, and of its absorbents; as shewn in Sect. XXXV. 1. 3. whence an accumulation of it is produced, and there is in consequence a greater quantity of sensorial power for the exertion of those motions, which are associated with the absorbents of the stomach by reverse sympathy.

The reverse sympathy between the lacteal and lymphatic branches of the absorbent system have been produced by the one branch being less excited to act, when the other supplies sufficient fluid or nutriment to the sanguiferous vessels. Thus when the stomach is full, and the supply of chyle and mucus and water is in sufficient quantity; the pulmonary, cellular, and cutaneous lymphatics are not excited into action; whence the urine is pale, and the skin moist, from the defect of absorption on those surfaces.

7. Syngultus nephriticus. When a stone irritates the ureter, and that even without its being attended with pain or fever, sometimes a chronical hiccough occurs, and continues for days and weeks, instead of sickness or vomiting; which are the common symptoms. In this case the motions of the stomach are decreased by their sympathy with those of the ureter, which are increased by the stimulus of the stone in it; and the increased motions of the diaphragm seem to exist in consequence of their association with the stomach by a second reverse sympathy. This hiccough may nevertheless admit of another explanation, and be supposed to be a convulsive exertion of the diaphragm to relieve the disagreeable sensation of the stomach in consequence of its disordered irritative associations; and in that case it would belong to Class III. 1. 1. See Class IV. 2. 1. for another example of tertiary association.

M. M. Venesection. Emetic. Calomel. Cathartic, opium, oil of cinnamon from two to ten drops. Aerated alcaline water. Peruvian bark.

8. Febris irritativa. Irritative fever, described in Class I. 1. 1. 1. The diseases above explained in this genus are chiefly concerning the sympathies of the absorbent system, or the alimentary canal, which are not so much associated with the arterial system, as to throw it into disorder, when they are slightly deranged; but when any great congeries of conglomerate glands, which may be considered as the extremities of the arterial system, are affected with torpor, the whole arterial system and the heart sympathize with the torpid glands, and act with less energy; which constitutes the cold fit of fever; which is therefore at first a decreased action of the associate organ; but as this decrease of action is only a temporary effect, and an increase of exertion both of the torpid glands, and of the whole arterial system, soon follows; the hot fit of irritative fever, or fever with strong pulse, properly belongs to this class and genus of diseases.

* * * * *

ORDO I.

Increased Associate Motions.

GENUS II.

Catenated with Sensitive Motions.

The primary links of the associated actions of this genus are either produced or attended by painful or pleasurable sensation. The secondary links of the first ten species are attended with increased motions without inflammation, those of the remainder are attended with inflammation. All inflammations, which do not arise in the part which was previously torpid, belong to this genus; as the gout, rheumatism, erysipelas. It is probable many other inflammations may, by future observation, require to be transplanted into this class.

The circles of sensitive associate motions consist chiefly of the excretory ducts of the capillaries and of the mouths of the absorbent vessels, which constitute the membranes; and which have been induced into action at the same time; or they consist of the terminations of canals; or of parts which are endued with greater sensibility than those which form the first link of the association. An instance of the first of those is the sympathy between the membranes of the alveolar processes of the jaws, and the membranes above or beneath the muscles about the temples in hemicrania. An instance of the second is in the sympathy between the excretory duct of the lacrymal gland, and the nasal duct of the lacrymal sack. And an instance of the third is the sympathy between the membranes of the liver, and the skin of the face in the gutta rosea of inebriates.

SPECIES.

1. Lacrymarum fluxus sympatheticus. A flow of tears from grief or joy. When the termination of the duct of the lacrymal sac in the nostrils becomes affected either by painful or pleasurable sensations, in consequence of external stimulus, or by its association with agreeable or disagreeable ideas, the motions of the lacrymal gland are at the same time exerted with greater energy, and a profusion of tears succeeds by sensitive association, as explained in Sect. XVI. 8. 2.

In this case there exists a chain of associated actions, the secretion of the lacrymal gland is increased by whatever stimulates the surface of the eye, at the same time the increased abundance of tears stimulates the puncta lacrymalia into greater action; and the fluid thus absorbed stimulates the lacrymal sac, and its nasal duct in the nose into greater action. In a contrary direction of this chain of association the present increase of action is induced. First, the nasal duct of the lacrymal sac is excited into increased action by some pleasurable or painful idea, as described in Sect. XVI. 8. 2. 2d. The puncta lacrymalia or other extremity of the lacrymal sac sympathizes with it (as the two ends of all other canals sympathize with each other). 3d. With these increased motions of the puncta lacrymalia those of the excretory duct of the lacrymal gland are associated from their having so perpetually acted together. And, lastly, with the increased actions of the excretory duct of this gland are associated those of the other end of it by their frequently acting together; in the same manner as the extremities of other canals are associated; and thus a greater flow of tears is poured into the eye.

When a flow of tears is produced in grief, it is believed to relieve the violence of it, which is worthy a further inquiry. Painful sensations, when great, excite the faculty of volition; and the person continues voluntarily to call up or perform those ideas, which occasion the painful sensation; that is, the afflicted person becomes so far insane or melancholy; but tears are produced by the sensorial faculty of association, and shew that the pain is so far relieved as not to excite the excessive power of volition, or insanity, and are therefore a sign of the abatement of the painful state of grief, rather than a cause of that abatement. See Class III. 1. 2. 10.

2. Sternutatio a lumine. Some persons sneeze from looking up at the light sky in a morning after coming out of a dark bedroom. The olfactory nerves are brought into too great action by their sympathy with the optic nerves, or by their respective sympathies with some intervening parts, as probably with the two extremities of the lacrymal sac; that is, with the puncta lacrymalia and the nasal duct. See Class II. 1. 1. 3.

3. Dolor dentium Stridore. Tooth-edge from grating sounds, and from the touch of certain substances, and even from imagination alone, is described and explained in Sect. XVI. 10. The increased actions of the alveolar vessels or membranes are associated with the ideas, or sensual motions of the auditory nerves in the first case; and of those of the sense of touch, in the second case; and by imagination, or ideas exerted of painful sensation alone, in the last.

4. Risus sardonicus. A disagreeable smile attends inflammations of the diaphragm arising from the associations of the reiterated exertions of that muscle with those of the lips and cheeks in laughing. See Diaphragmitis, Class II. 1. 2. 6.

5. Salivae fluxus cibo viso. The flow of saliva into the mouths of hungry animals at the sight or smell of food is seen in dogs standing round a dinner-table. The increased actions of the salivary glands have been usually produced by the stimulus of agreeable food on their excretory ducts during the mastication of it; and with this increased action of their excretory ducts the other terminations of those glands in the capillary arteries have been excited into increased action by the mutual association of the ends of canals; and at the same time the pleasurable ideas, or sensual motions, of the sense of smell and of sight have accompanied this increased secretion of saliva. Hence this chain of motions becomes associated with those visual or olfactory ideas, or with the pleasure, which produces or attends them.

6. Tensio mamularum viso puerulo. The nipples of lactescent women are liable to become turgid at the sight of their young offspring. The nipple has generally been rendered turgid by the titillation of the lips or gums of the child in giving suck; the visible idea of the child has thus frequently accompanied this pleasurable sensation of parting with the milk, and turgescence of the tubes, which constitute the nipple. Hence the visual idea of the child, and the pleasure which attends it, become associated with those increased arterial actions, which swell the cells of the mamula, and extend its tubes; which is very similar to the tensio phalli visa muliere nuda etiam in insomnio.

7. Tensio penis in hydrophobia. An erection of the penis occurs in the hydrophobia, and is a troublesome symptom, as observed by Coelius Aurelianus, Fothergill, and Vaughn, and would seem to be produced by an unexplained sympathy between the sensations about the fauces and the penis. In men the hair grows about both these parts, the voice changes, and the neck thickens at puberty. In the mumps, when the swellings about the throat subsides, the testicles are liable to swell. Venereal infection received by the penis is very liable to affect the throat with ulcers. Violent coughs, with soreness or rawness about the fauces are often attended with erection of the penis; which is also said to happen to male animals, that are hanged; which last circumstance has generally been ascribed to the obstruction of the circulation of the blood, but is more probably occasioned by the stimulus of the cord in compressing the throat; since if it was owing to impeded circulation it ought equally to occur in drowning animals.

In men the throat becomes so thickened at the time of puberty, that a measure of this is used to ascertain the payment of a poll-tax on males in some of the islands of the Mediterranean, which commences at puberty; a string is wrapped twice round the thinnest part of the neck, the ends of it are then put into each corner of the mouth; and if, when thus held in the teeth, it passes readily over the head, the subject is taxable.

It is difficult to point out by what circumstance the sensitive motions of the penis and of the throat and nose become associated; I can only observe, that these parts are subjected to greater pleasurable sensations than any other parts of the body; one being designed to preserve ourselves by the pleasure attending the smell and deglutition of food, and the other to ensure the propagation of our species; and may thus gain an association of their sensitive motion by their being eminently sensible to pleasure. See Class I. 3. 1. 11. and III. 1. 1. 15. and Sect. XVI. 5.

In the female sex this association between the face, throat, nose, and pubis does not exist; whence no hair grows on their chins at the time of puberty, nor does their voices change, or their necks thicken. This happens probably from there being in them a more exquisite sensitive sympathy between the pubis and the breasts. Hence their breasts swell at the time of puberty, and secrete milk at the time of parturition. And in the parotitis, or mumps, the breasts of women swell, when the tumor of the parotitis subsides. See Class I. 1. 2. 15. Whence it would appear, that their breasts possess an intermediate sympathy between the pubis and the throat; as they are the seat of a passion, which men do not possess, that of suckling children.

8. Tenesmus calculosus. The sphincter of the rectum becomes painful or inflamed from the association of its sensitive motions with those of the sphincter of the bladder, when the latter is stimulated into violent pain or inflammation by a stone.

9. Polypus narium ex ascaridibus? The stimulation of ascarides in the rectum produces by sensitive sympathy an itching of the nose, as explained in IV. 2. 2. 6; and in three children I have seen a polypus in the nose, who were all affected with ascarides; to the perpetual stimulation of which, and the consequent sensitive association, I was led to ascribe the inflammation and thickening of the membrane of the nostrils.

10. Crampus surarum in cholera. A cramp of the muscles of the legs occurs in violent diarrhoea, or cholera, and from the use of too much acid diet in gouty habits. This seems to sympathize with uneasy sensation in the bowels. See Class III. 1. 1. 14. This association is not easily accounted for, but is analogous in some degree to the paralysis of the muscles of the arms in colica saturnina. It would seem, that the muscles of the legs in walking get a sympathy with the lower parts of the intestines, and those of the arms in variety of employment obtain a sympathy with the higher parts of them. See Cholera and Ileus.

11. Zona ignea nephritica. Nephritic shingles. The external skin about the loins and sides of the belly I suppose to have greater mobility in respect to sensitive association, than the external membrane of the kidney; and that their motions are by some unknown means thus associated. When the torpor or beginning inflammation of this membrane ceases, the external skin becomes inflamed, in its stead, and a kind of herpes, called the shingles, covers the loins and sides of the belly. See Class II. 1. 5. 9.

12. Eruptio variolarum. After the inflammation of the inoculated arm has spread for a quarter of a lunation, it affects the stomach by reverse sympathy; that is, the actions of the stomach are associated with those of the skin; and as much sensorial power is now exerted on the inflamed skin, the other part of this sensitive association is deprived of its natural share, and becomes torpid, or inverts its motions. After this torpor of the stomach has continued a time, and much sensorial power is thus accumulated; other parts of the skin, which are also associated with it, as that of the face first, are thrown into partial inflammation; that is, the eruptions of the small-pox appear on the face.

For that the variolous matter affects the stomach previous to its eruption on the skin appears from the sickness at the commencement of the fever; and because, when the morbid motions affect the skin, those of the stomach cease; as in the gout and erysipelas, mentioned below. The consent between the stomach and the skin appears in variety of other diseases; and as they both consist of surfaces, which absorb and secrete a quantity of moisture, their motions must frequently be produced together or in succession; which is the foundation of all the sympathies of animal motions, whether of the irritative, sensitive, or voluntary kinds.

Now as the skin, which covers the face, is exposed to greater variations of heat and cold than any other part of the body; it probably possesses more mobility to sensitive associations, not only than the stomach, but than any other part of the skin; and is thence affected at the eruption of the small-pox with violent action and consequent inflammation, by the association of its motions with those of the stomach, a day before the other parts of the skin; and becomes fuller of pustules, than any other part of the body. See Class II. 1. 3. 9.

It might be supposed, that the successive swelling of the hands, when the face subsides, at the height of the small-pox, and of the feet, when the hands subside, were governed by some unknown associations of those parts of the system; but these successions of tumor and subsidence more evidently depend on the times of the eruption of the pustules on those parts, as they appear a day sooner on the face than on the hands, and a day sooner on the hands than on the feet, owing to the greater comparative mobility of those parts of the skin.

13. Gutta rosea stomatica. Stomatic red face. On drinking cold water, or cold milk, when heated with exercise, or on eating cold vegetables, as raw turnips, many people in harvest-time have been afflicted with what has been called a surfeit. The stomach becomes painful, with indigestion and flatulency, and after a few days an eruption of the face appears, and continues with some relief, but not with entire relief; as both the pimpled face and indigestion are liable to continue even to old age.

M. M. Venesection. A cathartic with calomel. Then half a grain of opium twice a day for many weeks. If saturated solution of arsenic three or five drops twice or thrice a day for a week?

14. Gutta rosea hepatica. The rosy drop of the face of some drinking people is produced like the gout described below, in consequence of an inflamed liver. In these constitutions the skin of the face being exposed to greater variation of heat and cold than the membranes of the liver, possesses more mobility than those hepatic membranes; and hence by whatever means these membranes are induced to sympathize, when this sensitive association occurs, the cutaneous vessels of the face run into greater degrees of those motions, which constitute inflammation, than previously existed in the membranes of the liver; and then those motions of the liver cease. See Class II. 1. 4. 6.

An inflammation of the liver so frequently attends the great potation of vinous spirit, there is reason to suspect, that this viscus itself becomes inflamed by sensitive association with the stomach; or that, when one termination of the bile-duct, which enters the duodenum is stimulated violently, the other end may become inflamed by sensitive association.

15. Podagra. The gout, except when it affects the liver or stomach, seems always to be a secondary disease, and, like the rheumatism and erysipelas mentioned below, begins with the torpor of some distant part of the system.

The most frequent primary seat of the gout I suppose to be the liver, which is probably affected with torpor not only previous to the annual paroxysms of the gout, but to every change of its situation from one limb to another. The reasons, which induce me to suspect the liver to be first affected, are not only because the jaundice sometimes attends the commencement of gout, as described in Sect. XXIV. 2. 8. but a pain also over the pit of the stomach, which I suppose to be of the termination of the bile-duct in the duodenum, and which is erroneously supposed to be the gout of the stomach, with indigestion and flatulency, generally attends the commencement of the inflammation of each limb. See Arthritis ventriculi, Class I. 2. 4. 6. In the two cases, which I saw, of the gout in the limbs being preceded by jaundice, there was a cold shivering fit attended the inflammation of the foot, and a pain at the pit of the stomach; which ceased along with the jaundice, as soon as the foot became inflamed. This led me to suspect, that there was a torpor of the liver, and perhaps of the foot also, but nevertheless the liver might also in this case be previously inflamed, as observed in Sect. XXIV. 2. 8.

Now as the membranes of the joints of the feet suffer greater variations of heat and cold than the membranes of the liver, and are more habituated to extension and contraction than other parts of the skin in their vicinity; I suppose them to be more mobile, that is, more liable to run into extremes of exertion or quiescence; and are thence more susceptible of inflammation, than such parts as are less exposed to great variations of heat and cold, or of extension and contraction.

When a stone presses into the sphincter of the bladder, the glans penis is affected with greater pain by sympathy, owing to its greater sensibility, than the sphincter of the bladder; and when this pain commences, that of the sphincter ceases, when the stone is not too large, or pushed too far into the urethra. Thus when the membrane, which covers the ball of the great toe, sympathizes with some membranous part of a torpid or inflamed liver; this membrane of the toe falls into that kind of action, whether of torpor or inflammation, with greater energy, than those actions excited in the diseased liver; and when this new torpor or inflammation commences, that with which it sympathises ceases; which I believe to be a general law of associated inflammations.

The paroxysms of the gout would seem to be catenated with solar influence, both in respect to their larger annual periods, and to their diurnal periods—See Sect. XXXVI. 3. 6.—as the former occur about the same season of the year, and the latter commence about an hour before sun-rise; nevertheless the annual periods may depend on the succession of great vicissitudes of cold and heat, and the diurnal ones on our increased sensibility to internal sensations during sleep, as in the fits of asthma, and of some epilepsies. See Sect. XVIII. 15.

In respect to the pre-remote cause or disposition to the gout, there can be no doubt of its individually arising from the potation of fermented or spirituous liquors in this country; whether opium produces the same effect in the countries, where it is in daily use, I have never been well informed. See Sect. XXI. 10, where this subject is treated of; to which I have to add, that I have seen some, and heard of others, who have moderated their paroxysms of gout, by diminishing the quantity of fermented liquors, which they had been accustomed to; and others who, by a total abstinence from fermented liquors, have entirely freed themselves from this excruciating malady; which otherwise grows with our years, and curtails or renders miserable the latter half, or third, of the lives of those, who are subject to it. The remote cause is whatever induces temporary torpor or weakness of the system; and the proximate cause is the inirritability, or defective irritation, of some part of the system; whence torpor and consequent inflammation. The great Sydenham saw the beneficial effects of the abstinence from fermented liquors in preventing the gout, and adds, "if an empiric could give small-beer only to gouty patients as a nostrum, and persuade them not to drink any other spirituous fluids, that he might rescue thousands from this disease, and acquire a fortune for his ingenuity." Yet it is to be lamented, that this accurate observer of diseases had not resolution to practise his own prescription, and thus to have set an example to the world of the truth of his doctrine; but, on the contrary, recommends Madeira, the strongest wine in common use, to be taken in the fits of the gout, to the detriment of thousands; and is said himself to have perished a martyr to the disease, which he knew how to subdue!

As example has more forcible effect: than simple assertion, I shall now concisely relate my own case, and that of one of my most respected friends. E. D. was about forty years of age, when he was first seized with a fit of the gout. The ball of his right great toe was very painful, and much swelled and inflamed, which continued five or six days in spite of venesection, a brisk cathartic with ten grains of calomel, and the application of cold air and cold water to his foot. He then ceased to drink ale or wine alone; confining himself to small beer, or wine diluted with about thrice its quantity of water. In about a year he suffered two other fits of the gout, in less violent degree. He then totally abstained from all fermented liquors, not even tasting small-beer, or a drop of any kind of wine; but eat plentifully of flesh-meat, and all kinds of vegetables, and fruit, using for his drink at meals chiefly water alone, or lemonade, or cream and water; with tea and coffee between them as usual.

By this abstinence from fermented liquors he kept quite free from the gout for fifteen or sixteen years; and then began to take small-beer mixed with water occasionally, or wine and water, or perry and water, or cyder and water; by which indulgence after a few months he had again a paroxysm of gout, which continued about three days in the ball of his toe; which occasioned him to return to his habit of drinking water, and has now for above twenty years kept in perpetual health, except accidental colds from the changes of the seasons. Before he abstained from fermented or spirituous liquors, he was frequently subject to the piles, and to the gravel, neither of which he has since experienced.

In the following case the gout was established by longer habit and greater violence, and therefore required more cautious treatment. The Rev. R. W. was seized with the gout about the age of thirty-two, which increased so rapidly that at the age of forty-one he was confined to his room seven months in that year; he had some degree of lameness during the intervals, with chalky swellings of his heels and elbows. As the disease had continued so long and so violently, and the powers of his digestion were somewhat weakened, he was advised not entirely to leave off all fermented liquors; and as small-beer is of such various strength, he was advised to drink exactly two wine glasses, about four ounces, of wine mixed with three or four times its quantity of water, with or without lemon and sugar, for his daily potation at dinner, and no other fermented liquor of any kind; and was advised to eat flesh-meat with any kind of boiled vegetables, and fruit, with or without spice. He has now scrupulously continued this regimen for above five years, and has had an annual moderate gouty paroxysm of a few weeks, instead of the confinement of so many months, with great health and good spirits during the intervals.

The following is a more particular account of the history of this case; being part of a letter which Mr. Wilmot wrote on that subject at my entreaty.

"I entered into the army with an excellent constitution at the age of fifteen. The corps I served in was distinguished by its regularity, that is, the regular allowance of the mess was only one pint of wine per man each day; unless we had company to dine with us; then, as was the general custom of the time, the bottle circulated without limit. This mode of living, though by no means considered as excess for men, was certainly too great for a youth of my age. This style of living I continued, when with the regiment, till the latter end of the year 1769, when I had the misfortune to sleep in a damp bed at Sheffield on a journey to York, but arrived there before I felt the ill effects of it. I was then seized with a violent inflammatory rheumatism with great inflammation of my eyes, and was attended by Dr. Dealtry; so violent was the disorder, that I was bled for it eight times in less than a fortnight; and was three months, before I could consider my health perfectly re-established. Dr. Dealtry told me, that I should be subject to similar attacks for many years; and that he had no doubt, from the tendency he found in my habit to inflammation, that, when I was farther advanced in life, I should change that complaint for the gout. He predicted truly; for the three succeeding winters I had the same complaint, but not so violently; the fourth winter I escaped, and imputed my escape to the continuance of cold bathing during the whole of that winter; after that I never escaped it, till I had a regular and severe fit of the gout: after the first attack of rheumatic fever I was more abstemious in my manner of living, though when in company I never subjected myself to any great restraint. In the year 1774 I had quitted the army, and being in a more retired situation, was seldom led into any excess; in 1776 and 1777 I was in the habit of drinking a good deal of wine very frequently, though not constantly. After that period till the year 1781, I drank a larger quantity of wine regularly, but very seldom to any degree of intoxication. I lived much at that time in the society of some gentlemen, who usually drank nearly a bottle of wine daily after dinner. I must here however observe, that at no part of my life was I accustomed to drink wine in an evening, and very seldom drank any thing more than a single half-pint glass of some sort of spirits diluted with much water. Till the year 1781 I had always been accustomed to use very violent and continued exercise on horseback; in the winter months I pursued all field diversions, and in the summer months I rode frequent and long journeys; and with this exercise was liable to perspire to great excess; besides which I was subject to very profuse night-sweats, and had frequently boils break out all over me, especially in the spring and autumn; for which I took no medicine, except a little flour of sulphur with cream of tartar in honey.

"You will observe I bring every thing down to the date of 1781. In the month of October in that year, when I was just entered into the thirty-second year of my age, I had the first attack of gout; that fit was very severe, and of many weeks continuance. I now determined upon a more abstemious method of living, in respect to wine; and indeed the society, in which I had before been accustomed to live, being considerably changed, I had less frequent temptations to excess. From this time I enjoyed the most perfect good state of health till August 1784, when I had my second attack of gout. I never perfectly recovered from this attack through the succeeding winter, and in March 1785 was advised to try the Bath waters, and drank them under the direction of one of the faculty of that place. I was there soon seized with a fever, and a slight attack of gout in one knee. I should observe, that when I set out from home, I was in a weak and low state, and unequal to much fatigue; as appeared by my having a fainting fit one day on the road, after having travelled only about fifty miles; in the course of the summer I had two or three more slight attacks of gout of less consequence, till the month of October; when I was afflicted with it all over me in such a manner, as to be without the possibility of the least degree of removal for some days; and was about two months without being able to get into the air. This was the severest attack I had then experienced; though I have since had several equally severe. In the course of this summer I had a fall with my horse; and soon after it, having discovered an enlargement on one elbow, I concluded I had hurt it at that time; but in the course of this last attack having a similar enlargement on the other elbow, I found my mistake, and that they were collections of gouty matter; these increased to the size of pullet's eggs, and continue in that state. I had soon after similar enlargements on my heels; the right heel being severely bruised, I was under the necessity of having it lanced, and a large quantity of chalky matter was discharged from it; and have since that time frequently had chalky matter taken from it, and sometimes small bits of apparently perfect chalk. My right hand soon was afflicted in the same way, and I have scarcely a joint on those fingers now in a natural state. My left hand has escaped tolerably well. After this last attack (viz. October 1785), I had two or three slight attacks before the month of June 1787, when I had a very severe intermittent fever; from that time I continued very well till the latter end of the year, when I began to feel the gout about me very much, but was not confined by it. I was in this state advised to try what is called the American Recipe (gum guaiacum and nitre dissolved in spirits); it had apparently been of essential service to a friend of mine, who from the inability to walk a mile for some years, was believed to be restored by the use of this medicine to a good state of health, so as to walk ten miles a day. In addition to this medicine I drank, as my common beverage with my meals, spruce beer. I had so high an opinion of this medicine in the gout, and of spruce beer as an antiscorbutic, that I contemplated with much satisfaction, and with very little doubt, the perfect restoration of my health and strength; but I was miserably deceived; for in September 1788 I was seized with the gout in a degree that none but arthritics, and indeed but few of those, can easily conceive. From this time till August 1789 I scarcely ever passed a comfortable day; seven months of this time I had been confined, my health seemed much impaired, my strength was diminished, and my appetite almost gone. In this state my friends pressed me to consult you. I was unwilling for some time to do it, as I had lost all hope of relief; however, when I had determined to apply to you, I likewise determined to give up every prejudice of my own respecting my case, and to adhere most strictly to your advice. On the 20th of August 1789 I consulted you, on the 25th I entered upon the regimen, which you prescribed, and which was as follows.

"Drink no malt liquor on any account. Let your beverage at dinner consist of two glasses of wine diluted with three half-pints of water. On no account drink any more wine or spirituous liquors in the course of the day; but, if you want more liquid, take cream and water, or milk and water, or lemonade, with tea, coffee, chocolate. Use the warm bath twice a week for half an hour before going to bed, at the degree of heat which is most grateful to your sensations. Eat meat constantly at dinner, and with it any kind of tender vegetables you please. Keep the body open by two evacuations daily, if possible without medicine, if not take the size of a nutmeg of lenitive electuary occasionally, or five grains of rhubarb every night. Use no violent exercise, which may subject yourself to sudden changes from heat to cold; but as much moderate exercise as may be, without being much fatigued or starved with cold. Take some supper every night; a small quantity of animal food is preferred; but if your palate refuses this, take vegetable food, as fruit pie, or milk; something should be eaten, as it might be injurious to you to fast too long." To the whole of this I adhered most scrupulously, and soon found my appetite improve, and with it my strength and spirits. I had in December a fevere attack, and two or three slight ones in the course of twelve months; but the improvement in the general state of my health induced me to persevere. On the 18th of August 1790 I had another severe attack, but it went off easier than before, and I soon recovered sufficiently to go to Buxton, which you advised me to, and from which I reaped great benefit; nevertheless on the 29th of December I had a slight attack in comparison of some that I had before experienced, and from that time I was free from gout, and enjoyed my health perfectly well till the fourth week in October 1791; from that till the third week in October 1792; from that till the third week in October 1793; and from that till June 1794. From what happened for the last three years I dreaded the month of October; but I escaped then, and have enjoyed my health most perfectly ever since till within the last week, that I have had a slight attack in one knee, which is nearly gone, without any symptom to lead me to suppose that it will go further.

"I adhered to your advice most scrupulously for the first year; and in regard to the not drinking malt liquor, and taking only the two glasses of wine with water, I have never deviated but two days; and then the first day I only drank one glass of ale and one glass of Champaigne; on the second only one glass of Champaigne. With regard to the warm bath, I only use it now when I have gouty symptoms upon me, and in such situations I find it of infinite service; and in other respects I continue to live according to your direction.

"Many persons have laughed at the idea of my perseverance in a system, which has not been able to cure the gout after five years trial; but such persons are either ignorant of what I before suffered, or totally unacquainted with the nature of the disorder. Under the blessing of Providence, by an adherence to your advice, I am reaping all the benefit you flattered me I might expect from it, viz. my attacks less frequent, my sufferings less acute, and an improvement in the general state of my health.

"I have been particular in this account of myself at your request, and am, Sir, &c.

MORLEY, near DERBY, February 10th, 1795. ROBERT WILMOT."

There are situations nevertheless in which a paroxysm of gout has been believed to be desirable, as relieving the patient from other disagreeable diseases, or debilities, or sensations. Thus when the liver is torpid, a perpetual uneasiness and depression of spirits occur; which a fit of gout is supposed to cure by a metastasis of the disease. Others have acquired epileptic fits, probably from the disagreeable sensation of a chronically inflamed liver; which they suppose the pain and inflammation of gout would relieve. When gouty patients become much debilitated by the progress of the disease, they are liable to dropsy of the chest, which they suppose a fit of the gout would relieve. But in all these cases the attempt to procure a paroxysm of gout by wine, or aromatics, or volatiles, or blisters, or mineral waters, seldom succeeds; and the patients are obliged to apply to other methods of relief adapted to their particular cases. In the two former situations small repeated doses of calomel, or mercurial unction on the region of the liver may succeed, by giving new activity to the vessels of the liver, either to secrete or to absorb their adapted fluids, and thus to remove the cause of the gout, rather than to promote a fit of it. In the last case the tincture of digitalis, and afterwards the class of sorbentia, must be applied to.

M. M. In young strong patients the gout should be cured by venesection and cathartics and diluents, with poultices externally. But it has a natural crisis by producing calcareous matter on the inflamed membrane, and therefore in old enfeebled people it is safest to wait for this crisis, attending to the natural evacuations and the degree of fever; and in young ones, where it is not attended with much fever, it is customary and popular not to bleed, but only to keep the body open with aloes, to use gentle sudorifics, as neutral salts, and to give the bark at the decline of the fit; which is particularly useful where the patient is much debilitated. See Arthritis ventriculi, Class I. 2. 4. 6. and Sect. XXV. 17.

When there is not much fever, and the patient is debilitated with age, or the continuance of the disease, a moderate opiate, as twenty drops of tincture of opium, or one grain of solid opium, may be taken every night with advantage. Externally a paste made with double the quantity of yeast is a good poultice; and booterkins made with oiled silk, as they confine the perspirable matter, keep the part moist and supple, and thence relieve the pain like poultices.

The only safe way of moderating the disease is by an uniform and equal diminution, or a total abstinence from fermented liquors, with the cautions directed in Sect. XII. 7. 8. The continued use of strong bitters, as of Portland's powder, or bark, has been frequently injurious, as spoken of in the Materia Medica, Art. IV. 2. 11.

One of my acquaintance, who was much afflicted with the gout, abstained for about half a year from beer and wine; and not having resolution to persist, returned to his former habits of potation in less quantity; and observed that he was then for one winter stronger and freer from the gout than usual. This however did not long continue, as the disease afterwards returned with its usual or increased violence. This I think is a circumstance not unlikely to occur, as opium has a greater effect after its use has been a while intermitted; and the debility or torpor, which is the cause of gout, is thus for a few months prevented by the greater irritability of the system, acquired during the lessened use of fermented liquor.

For the same reason an ounce of spirituous tincture of guaiacum, or of bark, is said to have for some time prevented returns of the gout; which has afterwards, like all other great stimuli when long continued, been succeeded by greater debility, and destroyed the patient. This seems to have been exemplified in the case of the ingenious Dr. Bown, see Preface to his Elementa Medicinae; he found temporary relief from the stimulus of wine, regardless of its future effects.

16. Rheumatismus. Acute rheumatism. There is reason to suspect, that rheumatic inflammations, like the gouty ones, are not a primary disease; but that they are the consequence of a translation of morbid action from one part of the system to another. This idea is countenanced by the frequent change of place of rheumatic-like gouty inflammations, and from their attacking two similar parts at the same time, as both ankles and both wrists, and these attacks being in succession to each other. Whereas it is not probable that both feet or both hands should at the same time be equally exposed to any external cause of the disease, as to cold or moisture; and less so that these should occur in succession. Lastly, from the inflammatory diathesis in this disease being more difficult to subdue, and more dangerous in event, than other common inflammations, especially to pregnant women, and in weak constitutions.

From this idea of the rheumatism being not a primary disease, like the gout, but a transferred morbid action owing to the previous torpor of some other part of the system, we perceive why it attacks weak people with greater pertinacity than strong ones; resisting or recurring again and again after frequent evacuations, in a manner very different from primary inflammations; because the cause is not removed, which is at a distance from the seat of the inflammation.

This also accounts for rheumatic inflammations so very rarely terminating in suppuration, because like the gout the original cause is not in the inflamed part, and therefore does not continue to act after the inflammation commences. Instead of suppuration in this disease, as well as in the gout, a quantity of mucus or coagulable lymph is formed on the inflamed membrane; which in the gout changes into chalkstones, and in the rheumatism is either reabsorbed, or lies on the membrane, producing pains on motion long after the termination of the inflammation, which pains are called chronic rheumatism. The membranes, which have thus been once or repeatedly inflamed, become less mobile, or less liable to be affected by sympathy, as appears by the gout affecting new parts, when the joints of the foot have been frequently inflamed by it; hence as the cause of the inflammation does not exist in the inflamed part, and as this part becomes less liable to future attacks, it seldom suppurates.

Secondly, when rheumatism affects the muscles of the chest, it produces symptoms similar to pleurisy, but are distinguished from that by the patient having previously suffered rheumatic affections in other parts, and by the pertinacity or continuance of the inflammatory state of the patient, this should be termed pleurodyne rheumatica.

Thirdly, when rheumatic inflammation affects the bowels, it produces a disease very different from enteritis, or common inflammation of the bowels, and should be termed enteralgia rheumatica. The pain is less than in enteritis, and the disease of longer continuance, with harder pulse, and the blood equally sizy. It is attended with frequent dejections, with much mucus, and previous griping pains, but without vomiting; and differs perhaps from dysentery from its not being attended with bloody stools, and not being infectious.

Fourthly, there is another kind of rheumatism attended with debility, which suppurates, and should be termed rheumatismus suppurans. It is generally believed to be the gout, till suppuration takes place on the swelled joint; and, as the patient sinks, there are sloughs formed over the whole mouth; and he seems to be destroyed by inflammation or gangrene of the mucous membranes. I have twice seen this disease in patients about sixty. Some other diseases are erroneously called rheumatic, as hemicrania, and odontalgia. See Sect. XXVI. 3.

M.M. In the three former kinds venesection repeatedly. Cathartics. Antimonials. Diluents. Neutral salts. Oil. Warm bath. Afterwards the bark. Opium with or without ipecacuanha; but not till the patient is considerably weakened. Sweats forced early in the disease do injury. Opium given early in the disease prolongs it. In the last kind, gentle stimulants, as wine and water, mucilage, sorbentia.

The following is a case of suppurative rheumatism. Mr. F——, about sixty, was supposed to have the gout in his hand, which however suppurated, and it was then called the suppurative rheumatism. He had lived rather intemperately in respect to wine, and was now afflicted with a tendency to inflammation of the mucous membranes. As he lay on the bed half resupine, propped up with pillows, and also slept in that posture, his lower jaw dropped by its own weight, when the voluntary power of the muscles was suspended. The mucus of his mouth and throat became quite dry, and at length was succeeded with sloughs; this was a most distressing circumstance to him, and was in vain endeavoured to be relieved by supporting his jaw by slender steel springs fixed to his night-cap, and by springs of elastic gum. The sloughs spread and seemed to accelerate his death. See Class I. 1. 3. 2.

17. Erysipelas. The erysipelas differs from the zona ignea, and other species of herpes, in its being attended with fever, which is sometimes of the sensitive irritated or inflammatory kind, with strong and full pulse; and at other times with weak pulse and great inirritability, as when it precedes or attends mortifications. See Class II. 1. 3. 2.

Like the zona ignea above described, it seems to be a secondary disease, having for its primary part the torpor or inflammation of some internal or distant membrane, as appears from its so frequently attending wounds; sometimes spreading from issues over the whole limb, or back, by sympathy with a tendon or membrane, which is stimulated by the pease in them. In its more violent degree I suppose that it sympathizes with some extensive internal membranes, as of the liver, stomach, or brain. Another reason, which countenances this idea, is, that the inflammation gradually changes its situation, one part healing as another inflames; as happens in respect to more distant parts in gout and rheumatism; and which seems to shew, that the cause of the disease is not in the same place with the inflammation. And thirdly, because the erysipelas of the face and head is liable to affect the membranes of the brain; which were probably in these cases the original or primary seat of the disease; and lastly, because the fits of erysipelas, like those of the gout, are liable to return at certain annual or monthly periods, as further treated of in Class II. 1. 3. 2.

Many cases of erysipelas from wounds or bruises are related in Default's Surgical Journal, Vol. II. in which poultices are said to do great injury, as well as oily or fatty applications. Saturnine solutions were sometimes used with advantage. A grain of emetic tartar given to clear the stomach and bowels, is said to be of great service.

18. Testium tumor in gonorrhoea. Mr. Hunter in his Treatise on the Venereal Disease observes, that the tumor of the testes in gonorrhoea arises from their sympathy with the inflammation of the urethra; and that they are not similar to the actions arising from the application of venereal matter, whether by absorption or otherwise; as they seldom or never suppurate; and when suppuration happens, the matter produced is not venereal. Treatise on Venereal Disease, p. 53.

19. Testium tumor in parotidite. The sympathy between some parts about the throat and the genitals has been treated of in Class IV. 1. 2. 7. The swelling of the testes, when that of the parotis subsides, seems to arise from the association of successive action; as the tension of the penis in hydrophobia appears to arise from the previous synchronous associations of the sensitive motions of these parts; but the manner of the production of both these associations is yet very obscure. In women a swelling of the breasts often succeeds the decline of the mumps by another wonderful sympathy. See Class IV. 1. 2. 7. and I. 1. 2. 15. In many persons a delirium succeeds the swelling of the parotis, or the subsequent ones of the testes or breasts; which is sometimes fatal, and seems to arise from a sympathy of successive action, and not of synchronous action, of the membranes of the brain with those of the parotide glands. Sometimes a stupor comes on instead of this delirium, which is relieved by fomenting the shaved head for an hour or two. See Class II. 1. 3. 4.

* * * * *

ORDO I.

Increased Associate Motions.

GENUS III.

Catenated with Voluntary Motions

SPECIES.

1. Deglutitio invita. When any one is told not to swallow his saliva, and that especially if his throat be a little sore, he finds a necessity of immediately swallowing it; and this the more certainly, the more he voluntarily endeavours not to do so.

In this case the voluntary power exerted by our attention to the pharinx renders it more sensible to irritation, and therefore occasions it to be more frequently induced to swallow the saliva. Here the irritation induces a volition to swallow it, which is more powerful than the desire not to swallow it. See XXIV. 1. 7. So in reverie, when the voluntary power was exerted on any of the senses, as of sight or taste, the objects of those senses became perceived; but not otherwise. Sect. XIX. 6. This is a troublesome symptom in some sore throats.

M. M. Mucilage, as sugar and gum arabic. Warm water held in the mouth frequently, as a fomentation to the inflamed throat.

2. Nictitatio invita. Involuntary winking with the eye-lids, and twitchings of the face, are originally induced by an endeavour to relieve some disagreeable sensations about inflamed eyes, as the dazzling of light; and afterwards these motions become catenated with other motions or sensations, so as not to be governed by the will. Here the irritation first produces a volition to wink, which by habit becomes stronger than the anti-volition not to wink.