Zoonomia/II.III.II.I
ORDO II.
Decreased Volition.
GENUS I.
With decreased Actions of the Muscles.
Our muscles become fatigued by long contraction, and cease for a time to be excitable by the will; owing to exhaustion of the sensorial power, which resides in them. After a short interval of relaxation the muscle regains its power of voluntary contraction; which is probably occasioned by a new supply of the spirit of animation. In weaker people these contractions cease sooner, and therefore recur more frequently, and are attended with shorter intervals of relaxation, as exemplified in the quickness of the pulse in fevers with debility, and in the tremors of the hands of aged or feeble people.
After a common degree of exhaustion of the sensorial power in a muscle, it becomes again gradually restored by the rest of the muscle; and even accumulated in those muscles, which are most frequently used; as in those which constitute the capillaries of the skin after having been rendered torpid by cold. But in those muscles, which are generally obedient to volition, as those of locomotion, though their usual quantity of sensorial power is restored by their quiescence, or in sleep (for sleep affects these parts of the system only), yet but little accumulation of it succeeds. And this want of accumulation of the sensorial power in these muscles, which are chiefly subservient to volition, explains to us one cause of their greater tendency to paralytic affection.
It must be observed, that those parts of the system, which have been for a time quiescent from want of stimulus, as the vessels of the skin, when exposed to cold, acquire an accumulation of sensorial power during their inactivity; but this does not happen at all, or in much less quantity, from their quiescence after great expenditure of sensorial power by a previous excessive stimulus, as after intoxication. In this case the muscles or organs of sense gradually acquire their natural quantity of sensorial power, as after sleep; but not an accumulation or superabundance of it. And by frequent repetitions of exhaustion by great stimulus, these vessels cease to acquire their whole natural quantity of sensorial power; as in the schirrous stomach, and schirrous liver, occasioned by the great and frequent stimulus of vinous spirit; which may properly be termed irritative paralysis of those parts of the system.
In the same manner in common palsies the inaction of the paralytic muscle seems not to be owing to defect of the stimulus of the will, but to exhaustion of sensorial power. Whence it frequently follows great exertion, as in Sect. XXXIV. 1. 7. Thus some parts of the system may cease to obey the will, as in common paralysis; others may cease to be obedient to sensation, as in the impotency of age; others to irritation, as in schirrous viscera; and others to association, as in impediment of speech; yet though all these may become inexcitable, or dead, in respect to that kind of stimulus, which has previously exhausted them, whether of volition, or sensation, or irritation, or association, they may still in many cases be excited by the others.
SPECIES.
1. Lassitudo. Fatigue or weariness after much voluntary exertion. From the too great expenditure of sensorial power the muscles are with difficulty brought again into voluntary contraction; and seem to require a greater quantity or energy of volition for this purpose. At the same time they still remain obedient to the stimulus of agreeable sensation, as appears in tired dancers finding a renovation of their aptitude to motion on the acquisition of an agreeable partner; or from a tired child riding on a gold-headed cane, as in Sect. XXXIV. 2. 6. These muscles are likewise still obedient to the sensorial power of association, because the motions, when thus excited, are performed in their designed directions, and are not broken into variety of gesticulation, as in St. Vitus's dance.
A lassitude likewise frequently occurs with yawning at the beginning of ague-fits; where the production of sensorial power in the brain is less than its expenditure. For in this case the torpor may either originate in the brain, or the torpor of some distant parts of the system may by sympathy affect the brain, though in a less proportionate degree than the parts primarily affected.
2. Vacillatio senilis. Some elderly people acquire a see-saw motion of their bodies from one side to the other, as they sit, like the oscillation of a pendulum. By these motions the muscles, which preserve the perpendicularity of the body, are alternately quiescent, and exerted; and are thus less liable to fatigue or exhaustion. This therefore resembles the tremors of old people above mentioned, and not those spasmodic movements of the face or limbs, which are called tricks, described in Class IV. 1. 3. 2. which originate from excess of sensorial power, or from efforts to relieve disagreeable sensation, and are afterwards continued by habit.
3. Tremor senilis. Tremor of old age consists of a perpetual trembling of the hands, or of the head, or of other muscles, when they are exerted; and is erroneously called paralytic; and seems owing to the small quantity of animal power residing in the muscular fibres. These tremors only exist when the affected muscles are excited into action, as in lifting a glass to the mouth, or in writing, or in keeping the body upright; and cease again, when no voluntary exertion is attempted, as in lying down. Hence these tremors evidently originate from the too quick exhaustion of the lessened quantity of the spirit of animation. So many people tremble from fear or anger, when too great a part of the sensorial power is exerted on the organs of sense, so as to deprive the muscles, which support the body erect, of their due quantity.
4. Brachiorum paralysis. A numbness of the arms is a frequent symptom in hydrops thoracis, as explained in Class I. 2. 3. 14. and in Sect. XXIX. 5. 2.; it also accompanies the asthma dolorificum, Class III. 1. 1. 11. and is owing probably to the same cause in both. In the colica saturnina a paralysis affects the wrists, as appears on the patient extending his arm horizontally with the palm downwards, and is often attended with a tumor on the carpal or metacarpal bones. See Class IV. 1. 2. 10.
Mr. M——, a miner and well-sinker, about three years ago, lost the power of contracting both his thumbs; the balls or muscles of the thumbs are much emaciated, and remain paralytic. He ascribes his disease to immersing his hands too long in cold water in the execution of his business. He says his hands had frequently been much benumbed before, so that he could not without difficulty clench them; but that they recovered their motion, as soon as they began to glow, after he had dried and covered them.
In this case there existed two injurious circumstances of different kinds; one the violent and continued action of the muscles, which destroys by exhausting the sensorial power; and the other, the application of cold, which destroys by defect of stimulus. The cold seems to have contributed to the paralysis by its long application, as well as the continued exertion; but as during the torpor occasioned by the exposure to cold, if the degree of it be not so great as to extinguish life, the sensorial power becomes accumulated; there is reason to believe, that the exposing a paralytic limb to the cold for a certain time, as by covering it with snow or iced water for a few minutes, and then covering it with warm flannel, and this frequently repeated, might, by accumulation of sensorial power, contribute to restore it to a state of voluntary excitability. As this accumulation of sensorial power, and consequent glow, seems, in the present case, several times to have contributed to restore the numbness or inability of those muscles, which at length became paralytic. See Class I. 2. 3. 21.
M. M. Ether externally. Friction. Saline warm bath. Electricity.
5. Raucedo paralytica. Paralytic hoarseness consists in the almost total loss of voice, which sometimes continues for months, or even years, and is occasioned by inability or paralysis of the recurrent nerves, which serve the muscles of vocality, by opening or closing the larynx. The voice generally returns suddenly, even so as to alarm the patient. A young lady, who had many months been affected with almost a total loss of voice, and had in vain tried variety of advice, recovered her voice in an instant, on some alarm as she was dancing at an assembly. Was this owing to a greater exertion of volition than usual? like the dumb young man, the son of Crœsus, who is related to have cried out, when he saw his father's life endangered by the sword of his enemy, and to have continued to speak ever afterwards. Two young ladies in this complaint seemed to be cured by electric shocks passed through the larynx every day for a fortnight. See Raucedo catarrhalis, Class II. 1. 3. 5.
M. M. An emetic. Electric shocks. Mustard-seed, a large spoonful swallowed whole, or a little bruised, every morning. Valerian. Burnt sponge. Blisters on each side of the larynx. Sea-bathing. A gargle of decoction of seneca. Friction. Frequent endeavours to shout and sing.
6. Vesicæ urinariæ paralysis. Paralysis of the bladder is frequently a symptom in inirritative fever; in this case the patient makes no water for a day or two; and the tumor of the bladder distended with urine may be seen by the shape of the abdomen, as if girt by a cord below the navel, or distinguished by the hand. Many patients in this situation make no complaint, and suffer great injury by the inattention of their attendants; the water must be drawn off once or twice a day by means of a catheter, and the region of the bladder gently pressed by the hand, whilst the patient be kept in a sitting or erect posture. Take here an addition
M. M. Bark. Wine. Opium, a quarter of a grain every six hours. Balsam of copaiva or of Peru. Tincture of cantharides 20 drops twice a day, or repeated small blisters.
7. Recti paralysis. Palsy of the rectum. The rectum intestinum, like the urinary bladder in the preceding article, possesses voluntary power of motion; though these volitions are at times uncontrollable by the will, when the acrimony of the contained feces, or their bulk, stimulate it to a greater degree. Hence it happens, that this part is liable to lose its voluntary power by paralysis, but is still liable to be stimulated into action by the contained feces. This frequently occurs in fevers, and is a bad sign as a symptom of general debility; and it is the sensibility of the muscular fibres of this and of the urinary bladder remaining, after the voluntarity has ceased, which occasions these two reservoirs so soon to regain, as the fever ceases, their obedience to volition; because the paralysis is thus shewn to be less complete in those cases than in common hemiplegia; as in the latter the sense of touch, though perhaps not the sense of pain, is generally destroyed in the paralytic limb.
M. M. A sponge introduced within the sphincter ani to prevent the constant discharge, which should have a string put through it, by which it may be retracted.
8. Paresis voluntaria. Indolence; or inaptitude to voluntary action. This debility of the exertion of voluntary efforts prevents the accomplishment of all great events in life. It often originates from a mistaken education, in which pleasure or flattery is made the immediate motive of action, and not future advantage; or what is termed duty. This observation is of great value to those, who attend to the education of their own children. I have seen one or two young married ladies of fortune, who perpetually became uneasy, and believed themselves ill, a week after their arrival in the country, and continued so uniformly during their stay; yet on their return to London or Bath immediately lost all their complaints, and this repeatedly; which I was led to ascribe to their being in their infancy surrounded with menial attendants, who had flattered them into the exertions they then used. And that in their riper years, they became torpid for want of this stimulus, and could not amuse themselves by any voluntary employment; but required ever after, either to be amused by other people, or to be flattered into activity. This I suppose, in the other sex, to have supplied one source of ennui and suicide.
9. Catalepsis is sometimes used for fixed spasmodic contractions or tetanus, as described in Sect. XXXIV. 1. 5. and in Class III. 1. 1. 13. but is properly simply an inaptitude to muscular motion, the limbs remaining in any attitude in which they are placed. One patient, whom I saw in this situation, had taken much mercury, and appeared universally torpid. He sat in a chair in any posture he was put, and held a glass to his mouth for many minutes without attempting to drink, or withdrawing his hand. He never spoke, and it was at first necessary to compel him to drink broth; he recovered in a few weeks without relapse.
10. Hemiplegia. Palsy of one side consists in the total disobedience of the affected muscles to the power of volition. As the voluntary motions are not perpetually exerted, there is little sensorial power accumulated during their quiescence, whence they are less liable to recover from torpor, and are thus more frequently left paralytic, or disobedient to the power of volition, though they are sometimes still alive to painful sensation, as to the prick of a pin, and to heat; also to irritation, as in stretching and yawning; or to electric shocks. Where the paralysis is complete the patient seems gradually to learn to use his limbs over again by repeated efforts, as in infancy; and, as time is required for this purpose, it becomes difficult to know, whether the cure is owing to the effect of medicines, or to the repeated efforts of the voluntary power.
The dispute, whether the nerves decussate or cross each other before they leave the cavities of the skull or spine, seems to be decided in the affirmative by comparative anatomy; as the optic nerves of some fish have been shewn evidently to cross each other; as seen by Haller, Elem. Physiol. t. v. p. 349. Hence the application of blisters, or of ether, or of warm fomentations, should be on the side of the head opposite to that of the affected muscles. This subject should nevertheless be nicely determined, before any one should trepan for the hydrocephalus internus, when the disease is shewn to exist only on one side of the brain, by a squinting affecting but one eye; as proposed in Class I. 2. 5. 4. Dr. Sommering has shewn, that a true decussation of the optic nerves in the human subject actually exists, Elem. of Physiology by Blumenbach, translated by C. Caldwell, Philadelphia. This further appears probable from the oblique direction and insertion of each optic nerve, into the side of the eye next to the nose, in a direct line from the opposite side of the brain.
The vomiting, which generally attends the attack of hemiplegia, is mentioned in Sect. XX. 8. and is similar to that attending vertigo in sea-sickness, and at the commencement of some fevers. Black stools sometimes attend the commencement of hemiplegia, which is probably an effusion of blood from the biliary duct, where the liver is previously affected; or some blood may be derived to the intestines by its escaping from the vena cava into the receptacle of chyle during the distress of the paralytic attack; and may be conveyed from thence into the intestines by the retrograde motions of the lacteals; as probably sometimes happens in diabætes. See Sect. XXVII. 2. Palsy of one side of the face is mentioned in Class II. 1. 4. 6. Paralysis of the lacteals, of the liver, and of the veins, which are described in Sect. XXVIII. XXX. and XXVII. do not belong to this class, as they are not diseases of voluntary motions.
M. M. The electric sparks and shocks, if used early in the disease, are frequently of service. A purge of aloes, or calomel. A vomit. Blister. Saline draughts. Then the bark. Mercurial ointment or sublimate, where the liver is evidently diseased; or where the gutta rosea has previously existed. Sudden alarm. Frequent voluntary efforts. Externally ether. Volatile alcali. Fomentation on the head. Friction. When children, who have suffered an hemiplegia, begin to use the affected arm, the other hand should be tied up for half an hour three or four times a day; which obliges them at their play to use more frequent voluntary efforts with the diseased limb, and thus sooner to restore the dissevered associations of motion.
Dr. J. Alderson has lately much recommended the leaves of rhus toxicodendon (sumach), from one gr. to iv. of the dried powder to be taken three or four times a day. Essay on Rhus Toxic. Johnson, London, 1793. But it is difficult to know what medicine is of service, as the movements of the muscles must be learned, as in infancy, by frequent efforts.
11. Paraplegia. A palsy of the lower half of the body divided horizontally. Animals may be conceived to have double bodies, one half in general resembling so exactly the other, and being supplied with separate sets of nerves; this gives rise to hemiplegia, or palsy of one half of the body divided vertically; but the paraplegia, or palsy of the lower parts of the system, depends on an injury of the spinal marrow, or that part of the brain which is contained in the vertebræ of the back; by which all the nerves situated below the injured part are deprived of their nutriment, or precluded from doing their proper offices; and the muscles, to which they are derived, are in consequence disobedient to the power of volition.
This sometimes occurs from an external injury, as a fall from an eminence; of which I saw a deplorable instance, where the bladder and rectum, as well as the lower limbs, were deprived of so much of their powers of motion, as depended on volition or sensation; but I suppose not of that part of it, which depends on irritation. In the same manner as the voluntary muscles in hemiplegia are sometimes brought into action by irritation, as in stretching or pendiculation, described in Sect. VII. 1. 3.
But the most frequent cause of paraplegia is from a protuberance of one of the spinal vertebræ; which is owing to the innutrition or softness of bones, described in Class I. 2. 2. 17. The cure of this deplorable disease is frequently effected by the stimulus of an issue placed on each side of the prominent spine, as first published by Mr. Pott. The other means recommended in softness of bones should also be attended to; both in respect to the internal medicines, and to the mechanical methods of supporting, or extending the spine; which last, however, in this case requires particular caution.
12. Somnus. In sleep all voluntary power is suspended, see Sect. XVIII. An unusual quantity of sleep is often produced by weakness. In this case small doses of opium, wine, and bark, may be given with advantage. For the periods of sleep, see Class IV. 2. 4. 1.
The subsequent ingenious observations on the frequency of the pulse, which sometimes occurs in sleep, are copied from a letter of Dr. Currie of Liverpool to the author.
- "Though rest in general perhaps renders the healthy pulse slower, yet under certain circumstances the contrary is the truth. A full meal without wine or other strong liquor does not increase the frequency of my pulse, while I sit upright, and have my attention engaged. But if I take a recumbent posture after eating, my pulse becomes more frequent, especially if my mind be vacant, and I become drowsy; and, if I slumber, this increased frequency is more considerable with heat and flushing.
- "This I apprehend to be a general truth. The observation may be frequently made upon children; and the restless and feverish nights experienced by many people after a full supper are, I believe, owing to this cause. The supper occasions no inconvenience, whilst the person is upright and awake; but, when he lies down and begins to sleep, especially if he does not perspire, the symptoms above mentioned occur. Which may be thus explained in part from your principles. When the power of volition is abolished, the other sensorial actions are increased. In ordinary sleep this does not occasion increased frequency of the pulse; but where sleep takes place during the process of digestion, the digestion itself goes on with increased rapidity. Heat is excited in the system faster than it is expended; and operating on the sensitive actions, it carries them beyond the limitation of pleasure, producing, as is common in such cases, increased frequency of pulse.
- "It is to be observed, that in speaking of the heat generated under these circumstances, I do not allude to any chemical evolution of heat from the food in the process of digestion. I doubt if this takes place to any considerable degree, for I do not observe that the parts incumbent on the stomach are increased in heat during the most hurried digestion. It is on some parts of the surface, but more particularly on the extremities of the body, that the increased heat excited by digestion appears, and the heat thus produced arises, as it should seem, from the sympathy between the stomach and the vessels of the skin. The parts most affected are the palms of the hands and the soles of the feet. Even there the thermometer seldom rises above 97 or 98 degrees, a temperature not higher than that of the trunk of the body; but three or four degrees higher than the common temperature of these parts, and therefore producing an uneasy sensation of heat, a sensation increased by the great sensibility of the parts affected.
- "That the increased heat excited by digestion in sleep is the cause of the accompanying fever, seems to be confirmed by observing, that if an increased expenditure of heat accompanies the increased generation of it (as when perspiration on the extremities or surface attends this kind of sleep) the frequent pulse and flushed countenance do not occur, as I know by experiment. If, during the feverish sleep already mentioned, I am awakened, and my attention engaged powerfully, my pulse becomes almost immediately slower, and the fever gradually subsides."
From these observations of Dr. Currie it appears, that, while in common sleep the actions of the heart, arteries, and capillaries, are strengthened by the accumulation of sensorial power during the suspension of voluntary action, and the pulse in consequence becomes fuller and slower; in the feverish sleep above described the actions of the heart, arteries, and capillaries, are quickened as well as strengthened by their consent with the increased actions of the stomach, as well as by the stimulus of the new chyle introduced into the circulation. For the stomach, and all other parts of the system, being more sensible and more irritable during sleep, Sect. XVIII. 15. and probably more ready to act from association, are now exerted with greater velocity as well as strength, constituting a temporary fever of the sensitive irritated kind, resembling the fever excited by wine in the beginning of intoxication; or in some people by a full meal in their waking hours. Sect. XXXV. 1.
On waking, this increased sensibility and irritability of the system ceases by the renewed exertions of volition; in the same manner as more violent exertions of volition destroy greater pains; and the pulse in consequence subsides along with the increase of heat; if more violent efforts of volition are exerted, the system becomes still less affected by sensation or irritation. Hence the fever and vertigo of intoxication are lessened by intense thinking, Sect. XXI. 8; and insane people are known to bear the pain of cold and hunger better than others, Sect. XXXIV. 2. 5; and lastly, if greater voluntary efforts exist, as in violent anger or violent exercise, the whole system is thrown into more energetic action, and a voluntary fever is induced, as appears by the red skin, quickened pulse, and increase of heat; whence dropsies and fevers with debility are not unfrequently removed by insanity.
Hence the exertion of the voluntary power in its natural degree diminishes the increased sensibility, and irritability, and probably the increased associability, which occurs during sleep; and thus reduces the frequency of the pulse in the feverish sleep after a full meal. In its more powerful state of exertion, it diminishes or destroys sensations and irritations, which are stronger than natural, as in intoxication, or which precede convulsions, or insanity. In its still more powerful degree, the superabundance of this sensorial power actuates and invigorates the whole moving system, giving strength and frequency to the pulse, and an universal glow both of colour and of heat, as in violent anger, or outrageous insanities.
If, in the feverish sleep above described, the skin becomes cooled by the evaporation of much perspirable matter, or by the application of cooler air, or thinner clothes, the actions of the cutaneous capillaries are lessened by defect of the stimulus of heat, which counteracts the increase of sensibility during sleep, and the pulsations of the heart and arteries become slower from the lessened stimulus of the particles of blood thus cooled in the cutaneous and pulmonary vessels. Hence the admission of cold air, or ablution with subtepid or with cold water, in fevers with hot skin, whether they be attended with arterial strength, or arterial debility, renders the pulse slower; in the former case by diminishing the stimulus of the blood, and in the latter by lessening the expenditure of sensorial power. See Suppl. I. 8. and 15.
13. Incubus. The night-mare is an imperfect sleep, where the desire of locomotion is vehement, but the muscles do not obey the will; it is attended with great uneasiness, a sense of suffocation, and frequently with fear. It is caused by violent fatigue, or drunkenness, or indigestible food, or lying on the back, or perhaps from many other kinds of uneasiness in our sleep, which may originate either from the body or mind.
Now as the action of respiration is partly voluntary, this complaint may be owing to the irritability of the system being too small to carry on the circulation of the blood through the lungs during sleep, when the voluntary power is suspended. Whence the blood may accumulate in them, and a painful oppression supervene; as in some hæmorrhages of the lungs, which occur during sleep; and in patients much debilitated by fevers. See Somnus interruptus, Class I. 2. 1. 3. and I. 2. 1. 9.
Great fatigue with a full supper and much wine, I have been well informed by one patient, always produced this disease in himself to a great degree. Now the general irritability of the system is much decreased by fatigue, as it exhausts the sensorial power; and secondly, too much wine and stimulating food will again diminish the irritability of some parts of the system, by employing a part of the sensorial power, which is already too small, in digesting a great quantity of aliment; and in increasing the motions of the organs of sense in consequence of some degree of intoxication, whence difficulty of breathing may occur from the inirritability of the lungs, as in Class I. 2. 1. 3.
M. M. To sleep on a hard bed with the head raised. Moderate supper. The bark. By sleeping on a harder bed the patient will turn himself more frequently, and not be liable to sleep too profoundly, or lie too long in one posture. To be awakened frequently by an alarm clock.
14. Lethargus. The lethargy is a slighter apoplexy. It is supposed to originate from universal pressure on the brain, and is said to be produced by compressing the spinal marrow, where there is a deficiency of the bone in the spina bifida. See Sect. XVIII. 20. Whereas in the hydrocephalus there is only a partial pressure of the brain; and probably in nervous fevers with stupor the pressure on the brain may affect only the nerves of the senses, which lie within the skull, and not those nerves of the medulla oblongata, which principally contribute to move the heart and arteries; whence in the lethargic or apoplectic stupor the pulse is slow as in sleep, whereas in nervous fever the pulse is very quick and feeble, and generally so in hydrocephalus.
In cases of obstructed kidneys, whether owing to the tubuli uriniferi being totally obstructed by calculous matter, or by their paralysis, a kind of drowsiness or lethargy comes on about the eighth or ninth day, and the patient gradually sinks. See Class I. 1. 3. 9.
15. Syncope epileptica, is a temporary apoplexy, the pulse continuing in its natural state, and the voluntary power suspended. This terminates the paroxysms of epilepsy.
When the animal power is much exhausted by the preceding convulsions, so that the motions from sensation as well as those from volition are suspended; in a quarter or half an hour the sensorial power becomes restored, and if no pain, or irritation producing pain, recurs, the fit of epilepsy ceases; if the pain recurs, or the irritation, which used to produce it, a new fit of convulsion takes place, and is succeeded again by a syncope. See Epilepsy, Class III. 1. 1. 7.
16. Apoplexia. Apoplexy may be termed an universal palsy, or a permanent sleep. In which, where the pulse is weak, copious bleeding must be injurious; as is well observed by Dr. Heberden, Trans. of the College.
Mr. ——, about 70 years of age, had an apoplectic seizure. His pulse was strong and full. One of the temporal arteries was opened, and about ten ounces of blood suddenly taken from it. He seemed to receive no benefit from this operation; but gradually sunk, and lived but a day or two.
If apoplexy arises from the pressure of blood extravasated on the brain, one moderate venesection may be of service to prevent the further effusion of blood; but copious venesection must be injurious by weakening the patient; since the effused blood must have time, as in common vibices or bruises, to undergo a chemico-animal process, so to change its nature as to fit it for absorption; which may take two or three weeks, which time a patient weakened by repeated venesection or arteriotomy may not survive.
Mrs. ——, about 40 years old, had an apoplectic seizure after great exertion from fear; she had lain about 24 hours without speech, or having swallowed any liquid. She was then forcibly raised in bed, and a spoonful of solution of aloes in wine put into her mouth, and the end of the spoon withdrawn, that she might more easily swallow the liquid.—This was done every hour, with broth, and wine and water intervening, till evacuations were procured; which with other means had good effect, and she recovered, except that a considerable degree of hemiplegia remained, and some imperfection of her speech.
Many people, who have taken so much vinous spirit as to acquire the temporary apoplexy of intoxication, and are not improperly said to be dead-drunk, have died after copious venesection, I suppose in consequence of it. I once saw at a public meeting two gentlemen in the drunken apoplexy; they were totally insensible with low pulse, on this account they were directed not to lose blood, but to be laid on a bed with their heads high, and to be turned every half hour; as soon as they could swallow, warm tea was given them, which evacuated their stomachs, and they gradually recovered, as people do from less degrees of intoxication.
M. M. Cupping on the occiput. Venesection once in moderate quantity. Warm fomentations long continued and frequently repeated on the shaved head. Solution of aloes. Clysters with solution of aloe and oil of amber. A blister on the spine. An emetic. Afterwards the bark, and small doses of chalybeates. Small electric shocks through the head. Errhines. If small doses of opium?
17. Mors a frigore. Death from cold. The unfortunate travellers, who almost every winter perish in the snow, are much exhausted by their efforts to proceed on their journey, as well as benumbed by cold. And as much greater exercise can be borne without fatigue in cold weather than in warm; because the excessive motions of the cutaneous vessels are thus prevented, and the consequent waste of sensorial power; it may be inferred, that the fatigued traveller becomes paralytic from violent exertion as well as by the application of cold.
Great degrees of cold affect the motions of those vessels most, which have been generally excited into action by irritation; for when the feet are much benumbed by cold, and painful, and at the same time almost insensible to the touch of external objects, the voluntary muscles retain their motions, and we continue to walk on; the same happens to the fingers of children in throwing snow-balls, the voluntary motions of the muscles continue, though those of the cutaneous vessels are benumbed into inactivity.
Mr. Thompson, an elderly gentleman of Shrewsbury, was seized with hemiplegia in the cold bath; which I suppose might be owing to some great energy of exertion, as much as to the coldness of the water. As in the instance given of Mr. Nairn, who, by the exertion to save his relation, perished himself. See Sect. XXXIV. 1. 7.
Whence I conclude, that though heat is a fluid necessary to muscular motion, both perhaps by its stimulus, and by its keeping the minute component parts of the ultimate fibrils of the muscles or organs of sense at a proper distance from each other; yet that paralysis, properly so called, is the consequence of exhaustion of sensorial power by exertion. And that the accumulations of it during the torpor of the cutaneous vessels by exposure to cold, or of some internal viscus in the cold fits of agues, are frequently instrumental in recovering the use of paralytic limbs, or of the motions of other paralytic parts of the system. See Spec. 4. of this genus.
Animal bodies resist the power of cold probably by their exertions in consequence of the pain of cold, see Botan. Gard. V. 1. additional note xii. But if these increased exertions be too violent, so as to exhaust the sensorial power in producing unnecessary motions, the animal will probably sooner perish. Thus a moderate quantity of wine or spirit repeated at proper intervals of time might be of service to those, who are long exposed to excessive cold, both by increasing the action of the capillary vessels, and thus producing heat, and perhaps by increasing in some degree the secretion of sensorial power in the brain. But the contrary must happen when taken immoderately, and not at due intervals. A well attested history was once related to me of two men, who set out on foot to travel in the snow, one of whom drank two or three glasses of brandy before they began their journey, the other contented himself with his usual diet and potation; the former of whom perished in spite of any assistance his companion could afford him; and the other performed his journey with safety. In this case the sensorial power was exhausted by the unnecessary motions of incipient intoxication by the stimulus of the brandy, as well as by the exertions of walking; which so weakened the dram-drinker, that the cold sooner destroyed him; that is, he had not power to produce sufficient muscular or arterial action, and in consequence sufficient heat, to supply the great expenditure of it. Hence the capillaries of the skin first cease to act, and become pale and empty; next those which are immediately associated with them, as the extremities of the pulmonary artery, as happens on going into the cold bath. By the continued inaction of these parts of the vascular system the blood becomes accumulated in the internal arteries, and the brain is supposed to be affected by its compression; because these patients are said to sleep, or to become apoplectic, before they die. I overtook a fishman asleep on his panniers on a very cold frosty night, but on waking him he did not appear to be in any degree of stupor. See Class I. 2. 2. 1.
When travellers are benighted in deep snow, they might frequently be saved by covering themselves in it, except a small aperture for air; in which situation the lives of hares, sheep, and other animals, are so often preserved. The snow, both in respect to its component parts, and to the air contained in its pores, is a bad conductor of heat, and will therefore well keep out the external cold; and as the water, when part of it dissolves, is attracted into the pores of the remainder of it, the situation of an animal beneath it is perfectly dry; and, if he is in contact with the earth, he is in a degree of heat between 48, the medium heat of the earth, and 32, the freezing point; that is, in 40 degrees of heat, in which a man thus covered will be as warm as in bed. See Botan. Garden, V. II. notes on Anemone, Barometz, and Muschus. If these facts were more generally understood, it might annually save the lives of many.
After any part of the vascular system of the body has been long exposed to cold, the sensorial power is so much accumulated in it, that on coming into a warm room the pain of hotach is produced, and inflammation, and consequent mortification, owing to the great exertion of those vessels, when again exposed to a moderate degree of warmth. See Sect. XII. 5. Whence the propriety of applying but very low degrees of heat to limbs benumbed with cold at first, as of snow in its state of dissolving, which is at 32 degrees of heat, or of very cold water. A French writer has observed, that if frozen apples be thawed gradually by covering them with thawing snow, or immersing them in very cold water, that they do not lose their taste; if this fact was well ascertained, it might teach us how to preserve other ripe fruits in ice-houses for winter consumption.