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Diseases of Relation.
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DISEASES OF ASSOCIATION.
- I. 1. Sympathy or consent of parts. Primary and secondary parts of an associated train of motions reciprocally affect each other. Parts of irritative trains of motion affect each other in four ways. Sympathies of the skin and stomach. Flushing of the face after a meal. Eruption of the small-pox on the face. Chilness after a meal. 2. Vertigo from intoxication. 3. Absorption from the lungs and pericardium by emetics. In vomiting the actions of the stomach are decreased, not increased. Digestion strengthened after an emetic. Vomiting from deficiency of sensorial power. 4. Dyspnœa from cold bathing. Slow pulse from digitalis. Death from gout in the stomach. II. 1. Primary and secondary parts of sensitive associations affect each other. Pain from gall-stone, from urinary stone, Hemicrania. Painful epilepsy. 2. Gout and red face from inflamed liver. Shingles from inflamed kidney. 3. Coryza from cold applied to the feet. Pleurisy. Hepatitis. 4. Pain of shoulders from inflamed liver. III. Diseases from the associations of ideas.
I. 1. Many synchronous and successive motions of our muscular fibres, and of our organs of sense, or ideas, become associated so as to form indissoluble tribes or trains of action, as shewn in Section X. on Associate Motions. Some constitutions more easily establish these associations, whether by voluntary, sensitive, or irritative repetitions, and some more easily lose them again, as shewn in Section XXXI. on Temperaments.
When the beginning of such a train of actions becomes by any means disordered, the succeeding part is liable to become disturbed in consequence, and this is commonly termed sympathy or consent of parts by the writers of medicine. For the more clear understanding of these sympathies we must consider a tribe or train of actions as divided into two parts, and call one of them the primary or original motions, and the other the secondary or sympathetic ones.
The primary and secondary parts of a train of irritative actions may reciprocally affect each other in four different manners. 1. They may both be exerted with greater energy than natural. 2. The former may act with greater, and the latter with less energy. 3. The former may act with less, and the latter with greater energy. 4. They may both act with less energy than natural. I shall now give an example of each kind of these modes of action, and endeavour to shew, that though the primary and secondary parts of these trains or tribes of motion are connected by irritative association, or their previous habits of acting together, as described in Sect. XX. on Vertigo. Yet that their acting with similar or dissimilar degrees of energy, depends on the greater or less quantity of sensorial power, which the primary part of the train expends in its exertions.
The actions of the stomach constitute so important a part of the associations of both irritative and sensitive motions, that it is said to sympathize with almost every part of the body; the first example, which I shall adduce to shew that both the primary and secondary parts of a train of irritative associations of motion act with increased energy, is taken from the consent of the skin with this organ. When the action of the fibres of the stomach is increased, as by the stimulus of a full meal, the exertions of the cutaneous arteries of the face become increased by their irritative associations with those of the stomach, and a glow or flushing of the face succeeds. For the small vessels of the skin of the face having been more accustomed to the varieties of action, from their frequent exposure to various degrees of cold and heat become more easily excited into increased action, than those of the covered parts of our bodies, and thus act with more energy from their irritative or sensitive associations with the stomach. On this account in small-pox the eruption in consequence of the previous affection of the stomach breaks out a day sooner on the face than on the hands, and two days sooner than on the trunk, and recedes in similar times after maturation.
But secondly, in weaker constitutions, that is, in those who possess less sensorial power, so much of it is expended in the increased actions of the fibres of the stomach excited by the stimulus of a meal, that a sense of chilness succeeds instead of the universal glow above mentioned; and thus the secondary part of the associated train of motions is diminished in energy, in consequence of the increased activity of the primary part of it.
2. Another instance of a similar kind, where the secondary part of the train acts with less energy in consequence of the greater exertions of the primary part, is the vertigo attending intoxication; in this circumstance so much sensorial power is expended on the stomach, and on its nearest or more strongly associated motions, as those of the subcutaneous vessels, and probably of the membranes of some internal viscera, that the irritative motions of the retina become imperfectly exerted from deficiency of sensorial power, as explained in Sect. XX. and XXI. 3. on Vertigo and on Drunkenness, and hence the staggering inebriate cannot completely balance himself by such indistinct vision.
3. An instance of the third circumstance, where the primary part of a train of irritative motions acts with less, and the secondary part with greater energy, may be observed by making the following experiment. If a person lies with his arms and shoulders out of bed, till they become cold, a temporary coryza or catarrh is produced; so that the passage of the nostrils becomes totally obstructed; at least this happens to many people; and then on covering the arms and shoulders, till they become warm, the passage of the nostrils ceases again to be obstructed, and a quantity of mucus is discharged from them. In this case the quiescence of the vessels of the skin of the arms and shoulders, occasioned by exposure to cold air, produces by irritative association an increased action of the vessels of the membrane of the nostrils; and the accumulation of sensorial power during the torpor of the arms and shoulders is thus expended in producing a temporary coryza or catarrh.
Another instance may be adduced from the sympathy or consent of the motions of the stomach with other more distant links of the very extensive tribes or trains of irritative motions associated with them, described in Sect. XX. on Vertigo. When the actions of the fibres of the stomach are diminished or inverted, the actions of the absorbent vessels, which take up the mucus from the lungs, pericardium, and other cells of the body, become increased, and absorb the fluids accumulated in them with greater avidity, as appears from the exhibition of foxglove, antimony, or other emetics in cases of anasarca, attended with unequal pulse and difficult respiration.
That the act of nausea and vomiting is a decreased exertion of the fibres of the stomach may be thus deduced; when an emetic medicine is administered, it produces the pain of sickness, as a disagreeable taste in the mouth produces the pain of nausea; these pains, like that of hunger, or of cold, or like those, which are usually termed nervous, as the head-ach or hemicrania, do not excite the organ into greater action; but in this case I imagine the pains of sickness or of nausea counteract or destroy the pleasurable sensation, which seems necessary to digestion, as shewn in Sect. XXXIII. 1. 1. The peristaltic motions of the fibres of the stomach become enfeebled by the want of this stimulus of pleasurable sensation, and in consequence stop for a time, and then become inverted; for they cannot become inverted without being previously stopped. Now that this inversion of the trains of motion of the fibres of the stomach is owing to the deficiency of pleasurable sensation is evinced from this circumstance, that a nauseous idea excited by words will produce vomiting as effectually us a nauseous drug.
Hence it appears, that the act of nausea or vomiting expends less sensorial power than the usual peristaltic motions of the stomach in the digestion of our aliment; and that hence there is a greater quantity of sensorial power becomes accumulated in the fibres of the stomach, and more of it in consequence to spare for the action of those parts of the system, which are thus associated with the stomach, as of the whole absorbent series of vessels, and which are at the same time excited by their usual stimuli.
From this we can understand, how after the operation of an emetic the stomach becomes more irritable and sensible to the stimulus, and the pleasure of food; since as the sensorial power becomes accumulated during the nausea and vomiting, the digestive power is afterwards exerted more forceably for a time. It should, however, be here remarked, that though vomiting is in general produced by the defect of this stimulus of pleasurable sensation, as when a nauseous drug is administered; yet in long continued vomiting, as in sea-sickness, or from habitual dram-drinking, it arises from deficiency of sensorial power, which in the former case is exhausted by the increased exertion of the irritative ideas of vision, and in the latter by the frequent application of an unnatural stimulus.
4. An example of the fourth circumstance above mentioned, where both the primary and secondary parts of a train of motions proceed with energy less than natural, may be observed in the dyspnœa, which occurs in going into a very cold bath, and which has been described and explained in Sect. XXXII. 3. 2.
And by the increased debility of the pulsations of the heart and arteries during the operation of an emetic. Secondly, from the slowness and intermission of the pulsations of the heart from the incessant efforts to vomit occasioned by an overdose of digitalis. And thirdly, from the total stoppage of the motions of the heart, or death, in consequence of the torpor of the stomach, when affected with the commencement or cold paroxysm of the gout. See Sect. XXV. 17.
II. 1. The primary and secondary parts of the trains of sensitive association reciprocally affect each other in different manners. 1. The increased sensation of the primary part may cease, when that of the secondary part commences. 2. The increased action of the primary part may cease, when that of the secondary part commences. 3. The primary part may have increased sensation, and the secondary part increased action. 4. The primary part may have increased action, and the secondary part increased sensation.
Examples of the first mode, where the increased sensation of the primary part of a train of sensitive association ceases, when that of the secondary part commences, are not unfrequent; as this is the general origin of those pains, which continue some time without being attended with inflammation, such as the pain at the pit of the stomach from a stone at the neck of the gall-bladder, and the pain of strangury in the glans penis from a stone at the neck of the urinary bladder. In both these cases the part, which is affected secondarily, is believed to be much more sensible than the part primarily affected, as described in the catalogue of diseases, Class II. 1. 1. 11. and IV. 2. 2. 2. and IV. 2. 2. 4.
The hemicrania, or nervous headach, as it is called, when it originates from a decaying tooth, is another disease of this kind; as the pain of the carious tooth always ceases, when the pain over one eye and temple commences. And it is probable, that the violent pains, which induce convulsions in painful epilepsies, are produced in the same manner, from a more sensible part sympathizing with a diseased one of less sensibility. See Catalogue of Diseases, Class IV. 2. 2. 8. and III. 1. 1. 6.
The last tooth, or dens sapientiæ, of the upper jaw most frequently decays first, and is liable to produce pain over the eye and temple of that side. The last tooth of the under-jaw is also liable to produce a similar hemicrania, when it begins to decay. When a tooth in the upper-jaw is the cause of the headach, a slighter pain is sometimes perceived on the cheek-bone. And when a tooth in the lower-jaw is the cause of headach, a pain sometimes affects the tendons of the muscles of the neck, which are attached near the jaws. But the clavus hystericus, or pain about the middle of the parietal bone on one side of the head, I have seen produced by the second of the molares, or grinders, of the under-jaw; of which I shall relate the following case. See Class IV. 2. 2. 8.
Mrs. ——, about 30 years of age, was seized with great pain about the middle of the right parietal bone, which had continued a whole day before I saw her, and was so violent as to threaten to occasion convulsions. Not being able to detect a decaying tooth, or a tender one, by examination with my eye, or by striking them with a tea-spoon, and fearing bad consequences from her tendency to convulsion, I advised her to extract the last tooth of the under-jaw on the affected side; which was done without any good effect. She was then directed to lose blood, and to take a brisk cathartic; and after that had operated, about 60 drops of laudanum were given her, with large doses of bark; by which the pain was removed. In about a fortnight she took a cathartic medicine by ill advice, and the pain returned with greater violence in the same place; and, before I could arrive, as she lived 30 miles from me, she suffered a paralytic stroke; which affected her limbs and her face on one side, and relieved the pain of her head.
About a year afterwards I was again called to her on account of a pain as violent as before exactly on the same part of the other parietal bone. On examining her mouth I found the second molaris of the under-jaw on the side before affected was now decayed, and concluded, that this tooth had occasioned the stroke of the palsy by the pain and consequent exertion it had caused. On this account I earnestly entreated her to allow the sound molaris of the same jaw opposite to the decayed one to be extracted; which was forthwith done, and the pain of her head immediately ceased, to the astonishment of her attendants.
In the cases above related of the pain existing in a part distant from the seat of the disease, the pain is owing to defect of the usual motions of the painful part. This appears from the coldness, paleness, and emptiness of the affected vessels, or of the extremities of the body in general, and from there being no tendency to inflammation. The increased action of the primary part of these associated motions, as of the hepatic termination of the bile-duct; from the stimulus of a gall-stone, or of the interior termination of the urethra from the stimulus of a stone in the bladder, or lastly, of a decaying tooth in hemicrania, deprives the secondary part of these associated motions, namely, the exterior terminations of the bile-duct or urethra, or the pained membranes of the head in hemicrania, of their natural share of sensorial power: and hence the secondary parts of these sensitive trains of association become pained from the deficiency of their usual motions, which is accompanied with deficiency of secretions and of heat. See Sect. IV. 5. XII. 5. 3. XXXIV. 1.
Why does the pain of the primary part of the association cease, when that of the secondary part commences? This is a question of intricacy, but perhaps not inexplicable. The pain of the primary part of these associated trains of motion was owing to too great stimulus, as of the stone at the neck of the bladder, and was consequently caused by too great action of the pained part. This greater action than natural of the primary part of these associated motions, by employing or expending the sensorial power of irritation belonging to the whole associated train of motions, occasioned torpor, and consequent pain in the secondary part of the associated train; which was possessed of greater sensibility than the primary part of it. Now the great pain of the secondary part of the train, as soon as it commences, employs or expends the sensorial power of sensation belonging to the whole associated train of motions; and in consequence the motions of the primary part, though increased by the stimulus of an extraneous body, cease to be accompanied with pain or sensation.
If this mode of reasoning be just it explains a curious fact, why when two parts of the body are strongly stimulated, the pain is felt only in one of them, though it is possible by voluntary attention it may be alternately perceived in them both. In the same manner, when two new ideas are presented to us from the stimulus of external bodies, we attend to but one of them at a time. In other words, when one set of fibres, whether of the muscles or organs of sense, contract so strongly as to excite much sensation; another set of fibres contracting more weakly do not excite sensation at all, because the sensorial power of sensation is pre-occupied by the first set of fibres. So we cannot will more than one effect at once, though by associations previously formed we can move many fibres in combination.
Thus in the instances above related, the termination of the bile duct in the duodenum, and the exterior extremity of the urethra, are more sensible than their other terminations. When these parts are deprived of their usual motions by deficiency of sensorial power, as above explained, they become painful according to law the fifth in Section IV. and the less pain originally excited by the stimulus of concreted bile, or of a stone at their other extremities ceases to be perceived. Afterwards, however, when the concretions of bile, or the stone on the urinary bladder, become more numerous or larger, the pain from their increased stimulus becomes greater than the associated pain; and is then felt at the neck of the gall bladder or urinary bladder; and the pain of the glans penis, or at the pit of the stomach, ceases to be perceived.
2. Examples of the second mode, where the increased action of the primary part of a train of sensitive association ceases, when that of the secondary part commences, are also not unfrequent; as this is the usual manner of the translation of inflammations from internal to external parts of the system, such as when an inflammation of the liver or stomach is translated to the membranes of the foot, and forms the gout; or to the skin of the face, and forms the rosy drop; or when an inflammation of the membranes of the kidneys is translated to the skin of the loins, and forms one kind of herpes, called shingles; in these cases by whatever cause the original inflammation may have been produced, as the secondary part of the train of sensitive association is more sensible, it becomes exerted with greater violence than the first part of it; and by both its increased pain, and the increased motion of its fibres, so far diminishes or exhausts the sensorial power of sensation; that the primary part of the train being less sensible ceases both to feel pain, and to act with unnatural energy.
3. Examples of the third mode, where the primary part of a train of sensitive association of motions may experience increased sensation, and the secondary part increased action, are likewise not unfrequent; as it is in this manner that most inflammations commence. Thus, after standing some time in snow, the feet become affected with the pain of cold, and a common coryza, or inflammation of the membrane of the nostrils, succeeds. It is probable that the internal inflammations, as pleurisies, or hepatitis, which are produced after the cold paroxysm of fever, originate in the same manner from the sympathy of those parts with some others, which were previously pained from quiescence; as happens to various parts of the system during the cold fits of fevers. In these cases it would seem, that the sensorial power of sensation becomes accumulated during the pain of cold, as the torpor of the vessels occasioned by the defect of heat contributes to the increase or accumulation of the sensorial power of irritation, and that both these become exerted on some internal part, which was not rendered torpid by the cold which affected the external parts, nor by its association with them; or which sooner recovered its sensibility. This requires further consideration.
4. An example of the fourth mode, or where the primary part of a sensitive association of motions may have increased action, and the secondary part increased sensation, may be taken from the pain of the shoulder, which attends inflammation of the membranes of the liver, see Class IV. 2. 2. 9.; in this circumstance so much sensorial power seems to be expended in the violent actions and sensations of the inflamed membranes of the liver, that the membranes associated with them become quiescent to their usual stimuli, and painful in consequence.
There may be other modes in which the primary and secondary parts of the trains of associated sensitive motions may reciprocally affect each other, as may be seen by looking over Class IV. in the catalogue of diseases; all which may probably be resolved into the plus and minus of sensorial power, but we have not yet had sufficient observations made upon them with a view to this doctrine.
III. The associated trains of our ideas may have sympathies, and their primary and secondary parts affect each other in some manner similar to those above described; and may thus occasion various curious phenomena not yet adverted to, besides those explained in the Sections on Dreams, Reveries, Vertigo, and Drunkenness; and may thus disturb the deductions of our reasonings, as well as the streams of our imaginations; present us with false degrees of fear, attach unfounded value to trivial circumstances; give occasion to our early prejudices and antipathies; and thus embarrass the happiness of our lives. A copious and curious harvest might be reaped from this province of science, in which, however, I shall not at present wield my sickle.