Volume I Part 29 (1/2)

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 gla.s.ses 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 quant.i.ty of stimulus? but if you increase the quant.i.ty 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 gla.s.s 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 quant.i.ty 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 a.s.sociated 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 const.i.tutions which are deficient in quant.i.ty 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 circ.u.mstance needs no ill.u.s.tration; 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 circ.u.mstance 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 quant.i.ty 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 princ.i.p.al 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 quant.i.ty 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. x.x.xI. 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 pa.s.s 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 acc.u.mulated 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 a.s.sociations 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 ma.s.s of fluids with unceasing a.s.siduity. 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 ma.s.s 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 acc.u.mulation of sensorial power; as its production in these organs, which are subject to perpetual activity, is continued during their quiescence, and is in consequence acc.u.mulated.

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 acc.u.mulation 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 pa.s.ses 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 acc.u.mulation of sensorial power, and hence a greater quant.i.ty 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 acc.u.mulation 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 pa.s.ses 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 pa.s.ses 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 a.s.sociated together, that when one is affected either with quiescence or exertion, the other sympathizes with it, according to the laws of irritative a.s.sociation.

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 a.s.sociations 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 acc.u.mulation 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 a.s.sociated, 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 quant.i.ty of stimulus, or too small a quant.i.ty 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 const.i.tutions 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 flus.h.i.+ngs, 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 const.i.tutions, 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 quant.i.ty 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 quant.i.ty 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 quant.i.ty of vessels affects, by irritative a.s.sociation, 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. x.x.xVI. 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.