ORDO III.
Retrograde Irritative Motions.
GENUS I.
Of the Alimentary Canal.
The retrograde motions of our system originate either from defect of stimulus, or from defect of irritability. Thus sickness is often induced by hunger, which is a want of stimulus; and from ipecacuanha, in which last case it would seem, that the sickness was induced after the violence of the stimulus was abated, and the consequent torpor had succeeded. Hence spice, opium, or food relieves sickness.
The globus hystericus, salivation, diabætes, and other inversions of motion attending hysteric paroxysms, seem to depend on the want of irritability of those parts of the body, because they are attended with cold extremities, and general debility, and are relieved by wine, opium, steel, and flesh diet; that is, by any additional stimulus.
When the longitudinal muscles are fatigued by long action, or are habitually weaker than natural, the antagonist muscles replace the limb by stretching it in a contrary direction; and as these muscles have had their actions associated in synchronous tribes, their actions cease together. But as the hollow muscles propel the fluids, which they contain, by motions associated in trains; when one ring is fatigued from its too great debility, and brought into retrograde action; the next ring, and the next, from its association in train falls into retrograde action. Which continue so long as they are excited to act, like the tremors of the hands of infirm people, so long as they endeavour to act. Now as these hollow muscles are perpetually stimulated, these retrograde actions do not cease as the tremors of the longitudinal muscles, which are generally excited only by volition. Whence the retrograde motions of hollow muscles depend on two circumstances, in which they differ from the longitudinal muscles, namely, their motions being associated in trains, and their being subject to perpetual stimulus. For further elucidation of the cause of this curious source of diseases, see Sect. XXIX. 11. 5.
The fluids disgorged by the retrograde motions of the various vascular muscles may be distinguished, 1. From those, which are produced by secretion, by their not being attended by increase of heat, which always accompanies increased secretion. 2. They may be distinguished from those fluids, which are the consequence of deficient absorption, by their not possessing the saline acrimony, which those fluids possess; which inflames the skin or other membranes on which they fall; and which have a saline taste to the tongue. 3. They may be distinguished from those fluids, which are the consequence both of increased secretion and absorption, as these are attended with increase of warmth, and are inspissated by the abstraction of their aqueous parts. 4. Where chyle, or milk, are found in the feces or urine, or when other fluids, as matter, are translated from one part of the system to another, they have been the product of retrograde action of lymphatic or other canals. As explained in Sect. XXIX. 8.
SPECIES.
1. Ruminatio. In the rumination of horned cattle the retrograde motions of the œsophagus are visible to the eye, as they bring up the softened grass from their first stomach. The vegetable aliment in the first stomach of cattle, which have filled themselves too full of young clover, is liable to run into fermentation, and distend the stomach, so as to preclude its exit, and frequently to destroy the animal. To discharge this air the farmers frequently make an opening into the stomach of the animal with success. I was informed, I believe by the late Dr. Whytt of Edinburgh, that of twenty cows in this situation two had died, and that he directed a pint of gin or whisky, mixed with an equal quantity of water, to be given to the other eighteen; all of which eructed immense quantities of air, and recovered.
There are histories of ruminating men, and who have taken pleasure in the act of chewing their food a second time. Philos. Transact.
2. Ructus. Eructation. An inverted motion of the stomach excluding through its upper valve an elastic vapour generated by the fermentation of the aliment; which proceeds so hastily, that the digestive power does not subdue it. This is sometimes acquired by habit, so that some people can eruct when they please, and as long as they please; and there is gas enough generated to supply them for this purpose; for by Dr. Hale's experiments, an apple, and many other kinds of aliment, give up above six hundred times their own bulk of an elastic gas in fermentation. When people voluntarily eject the fixable air from their stomachs, the fermentation of the aliment proceeds the faster; for stopping the vessels, which contain new wines, retards their fermentation, and opening them again accelerates it; hence where the digestion is impaired, and the stomach somewhat distended with air, it is better to restrain than to encourage eructations, except the quantity makes it necessary. When wine is confined in bottles the fermentation still proceeds slowly even for years, till all the sugar is converted into spirit; but in the process of digestion, the saccharine part is absorbed in the form of chyle by the bibulous mouths of the numerous lacteals, before it has time to run into the vinous fermentation.
3. Apepsia. Indigestion. Water-qualm. A few mouthfuls of the aliment are rejected at a time for some hours after meals. When the aliment has had time to ferment, and become acid, it produces cardialgia, or heart-burn. This disease is perhaps generally left after a slight inflammation of the stomach, called a surfeit, occasioned by drinking cold liquors, or eating cold vegetables, when heated with exercise. This inflammation of the stomach is frequently, I believe, at its commencement removed by a critical eruption on the face, which differs in its appearance as well as in its cause from the gutta rosea of drunkards, as the skin round the base of each eruption is less inflamed. See Class II. 1. 4. 6. This disease differs from Cardialgia, Class I. 2. 4. 5. in its being not uniformly attended with pain of the cardia ventriculi, and from its retrograde motions of a part of the stomach about the upper orifice of it. In the same manner as hysteria differs from hypochondriasis; the one consisting in the weakness and indigestion of the same portions of the alimentary canal, and the other in the inverted motions of some parts of it. This apepsia or water-qualm continues many years, even to old age; Mr. G—— of Lichfield suffered under this disease from his infancy; and, as he grew old, found relief only from repeated doses of opium.
M. M. A blister, rhubarb, a grain of opium twice a day. Soap, iron-powder. Tin-powder.
4. Vomitus. An inverted order of the motions of the stomach and œsophagus with their absorbent vessels, by which their contents are evacuated. In the act of vomiting less sensorial power is employed than in the usual peristaltic motion of the stomach, as explained in Sect. XXXV. 1. 3. Whence after the operation of an emetic the digestion becomes stronger by an accumulation of sensorial power during its decreased action. This decreased action of the stomach may be either induced by want of stimulus, as in the sickness which attends hunger; or it may be induced by temporary want of irritability, as in cold fits of fever; or from habitual want of irritability, as the vomiting of enfeebled drunkards. Or lastly, by having been previously too violently stimulated by an emetic drug, as by ipecacuanha.
M. M. A blister. An emetic. Opium. Warmth of a bed, covering the face for a while with the bed-clothes. Crude mercury. A poultice with opium or theriaca externally.
5. Cholera. When not only the stomach, as in the last article, but also the duodenum, and ilium, as low as the valve of the colon, have their motions inverted; and great quantities of bile are thus poured into the stomach; while at the same time some branches of the lacteals become retrograde, and disgorge their contents into the upper part of the alimentary canal; and other branches of them disgorge their contents into the lower parts of it beneath the valve of the colon; a vomiting and purging commence together, which is called cholera, as it is supposed to have its origin from increased secretion of bile; but I suppose more frequently arises from putrid food, or poisonous drugs, as in the case narrated in Sect. XXV. 13. where other circumstances of this disease are explained. See Class II. 1. 2. 11.
The cramps of the legs, which are liable to attend cholera, are explained in Class III. 1. 1. 14.
6. Ileus. Consists in the inverted motions of the whole intestinal canal, from the mouth to the anus; and of the lacteals and absorbents which arise from it. In this pitiable disease, through the valve of the colon, through the pylorus, the cardia, and the pharinx, are ejected, first, the contents of the stomach and intestines, with the excrement and even clysters themselves; then the fluid from the lacteals, which is now poured into the intestines by their retrograde motions, is thrown up by the mouth; and, lastly, every fluid, which is absorbed by the other lymphatic branches, from the cellular membrane, the skin, the bladder, and all other cavities of the body; and which is then poured into the stomach or intestines by the retrograde motions of the lacteals; all which supply that amazing quantity of fluid, which is in this disease continually ejected by vomiting. See Sect. XXV. 15. for a further explanation of this disease.
M. M. Copious venesection. Twenty grains of calomel in small pills, or one grain of aloe every hour till stools are procured. Blisters. Warm bath. Crude mercury. Clyster of ice-water. Smear the skin all over with grease, as mentioned in Sect. XXV. 15.
As this malady is occasioned sometimes by an introsusception of a part of the intestine into another part of it, especially in children, could holding them up by their heels for a second or two of time be of service after venesection? Or the exhibition of crude quicksilver two ounces every half hour, till a pound is taken, be particularly serviceable in this circumstance? Or could half a pound, or a pound, of crude mercury be injected as a clyster, the patient being elevated by the knees and thighs so as to have his head and shoulders much lower than his bottom, or even for a short time held up by the heels? Could this also be of advantage in strangulated hernia?
Where the disease is owing to strangulated hernia, the part should be sprinkled with cold water, or iced water, or salt and water recently mixed, or moistened with ether. In cases of strangulated hernia, could acupuncture, or puncture with a capillary trocar, be used with safety and advantage to give exit to air contained in the strangulated bowel? Or to stimulate it into action? It is not uncommon for bashful men to conceal their being afflicted with a small hernia, which is the cause of their death; this circumstance should therefore always be enquired into. Is the seat or cause of the ileus always below the valve of the colon, and that of the cholera above it? See Class II. 1. 2. 11.
7. Globus hystericus. Hysteric suffocation is the perception of a globe rolling round in the abdomen, and ascending to the stomach and throat, and there inducing strangulation. It consists of an ineffectual inversion of the motions of the œsophagus, and other parts of the alimentary canal; nothing being rejected from the stomach.
M. M. Tincture of castor. Tinct. of opium of each 15 drops. See Hysteria, Class I. 3. 1. 10.
8. Vomendi conamen inane. An ineffectual effort to vomit. It frequently occurs, when the stomach is empty, and in some cases continues many hours; but as the lymphatics of the stomach are not inverted at the same time, there is no supply of materials to be ejected; it is sometimes a symptom of hysteria, but more frequently attends irregular epilepsies or reveries; which however may be distinguished by their violence of exertion, for the exertions of hysteric motions are feeble, as they are caused by debility; but those of epilepsies, as they are used to relieve pain, are of the most violent kind; insomuch that those who have once seen these ineffectual efforts to vomit in some epilepsies, can never again mistake them for symptoms of hysteria. See a case in Sect. XIX. 2.
M. M. Blister. Opium. Crude mercury.
9. Borborigmus. A gurgling of the bowels proceeds from a partial invertion of the peristaltic motions of them, by which the gas is brought into a superior part of the bowel, and bubbles through the descending fluid, like air rushing into a bottle as the water is poured out of it. This is sometimes a distressing symptom of the debility of the bowels joined with a partial inversion of their motions. I attended a young lady about sixteen, who was in other respects feeble, whose bowels almost incessantly made a gurgling noise so loud as to be heard at a considerable distance, and to attract the notice of all who were near her. As this noise never ceased a minute together for many hours in a day, it could not be produced by the uniform descent of water, and ascent of air through it, but there must have been alternately a retrograde movement of a part of the bowel, which must again have pushed up the water above the air; or which might raise a part of the bowel, in which the fluid was lodged, alternately above and below another portion of it; which might readily happen in some of the curvatures of the smaller intestines, the air in which might be moved backward and forward like the air-bubble in a glass-level.
M. M. Essential oil. Ten corns of black pepper swallowed whole after dinner, that its effect might be slower and more permanent; a small pipe occasionally introduced into the rectum to facilitate the escape of the air. Crude mercury. See Class I. 2. 4. 9.
10. Hysteria. The three last articles, together with the lymphatic diabætes, are the most common symptoms of the hysteric disease; to which sometimes is added the lymphatic salivation, and fits of syncope, or convulsion, with palpitation of the heart (which probably consists of retrograde motions of it), and a great fear of dying. Which last circumstance distinguishes these convulsions from the epileptic ones with greater certainty than any other single symptom. The pale copious urine, cold skin, palpitation, and trembling, are the symptoms excited by great fear. Hence in hysteric diseases, when these symptoms occur, the fear, which has been usually associated with them, recurs at the same time, as in hypochondriasis, Class I. 2. 4. 10. See Sect. XVI. 8. 1.
The convulsions which sometimes attend the hysteric disease, are exertions to relieve pain, either of some torpid, or of some retrograde organ; and in this respect they resemble epileptic convulsions, except that they are seldom so violent as entirely to produce insensibility to external stimuli; for these weaker pains cease before the total exhaustion of sensorial power is produced, and the patient sinks into imperfect syncope; whereas the true epilepsy generally terminates in temporary apoplexy, with perfect insensibility to external objects. These convulsions are less to be dreaded than the epileptic ones, as they do not originate from so permanent a cause.
The great discharge of pale urine in this disease is owing to the inverted motions of the lymphatics, which arise about the neck of the bladder, as described in Sect. XXIX. 4. 5. And the lymphatic salivation arises from the inverted motions of the salivary lymphatics.
Hysteria is distinguished from hypochondriasis, as in the latter there are no retrograde motions of the alimentary canal, but simply a debility or inirritability of it, with distention and flatulency. It is distinguished from apepsia and cardialgia by there being nothing ejected from the stomach by the retrograde motions of it, or of the œsophagus.
M. M. Opium. Camphor. Assafœtida. Castor, with sinapisms externally; to which must be added a clyster of cold water, or iced water; which, according to Mons. Pomme, relieves these hysteric symptoms instantaneously like a charm; which it may effect by checking the inverted motions of the intestinal canal by the torpor occasioned by cold; or one end of the intestinal canal may become strengthened, and regain its peristaltic motion by reverse sympathy, when the other end is rendered torpid by ice-water. (Pomme des Affections Vaporeuses, p. 25.) These remove the present symptoms; and bark, steel, exercise, coldish bath, prevent their returns. See Art. VI. 2. 1.
11. Hydrophobia. Dread of water occasioned by the bite of a mad dog, is a violent inversion of the motions of the œsophagus on the contact or even approach of water or other fluids. The pharinx seems to have acquired the sensibility of the larinx in this disease, and is as impatient to reject any fluid, which gets into it. Is not the cardia ventriculi the seat of this disease? As in cardialgia the pain is often felt in the pharinx, when the acid material stimulates the other end of the canal, which terminates in the stomach. As this fatal disease resembles tetanus, or locked jaw, in its tendency to convulsion from a distant wound, and affects some other parts by association, it is treated of in Class III. 1. 1. 15. and IV. 1. 2. 7.