Zoonomia; Or, the Laws of Organic Life, Vol. I

by Erasmus Darwin

[1]. Where the exertion of the sensorial powers is much decreased, as in the cold fits of fever, a gradual accumulation of the spirit of animation takes place; as occurs in all cases where inactivity or torpor of a part of the system exists; this accumulation of sensorial power increases, till stimuli less than natural are sufficient to throw it into action, then the cold fit ceases; and from the action of the natural stimuli a hot one succeeds with increased activity of the whole system.

So in fainting fits, or syncope, there is a temporary deficiency of sensorial exertion, and a consequent quiescence of a great part of the system. This quiescence continues, till the sensorial power becomes again accumulated in the torpid organs; and then the usual diurnal stimuli excite the revivescent parts again into action; but as this kind of quiescence continues but a short time compared to the cold paroxysm of an ague, and less affects the circulatory system, a less superabundancy of exertion succeeds in the organs previously torpid, and a less excess of arterial activity. See Sect. [XXXIV. 1. 6].

[2]. In the diseases occasioned by a defect of sensorial exertion, as in cold fits of ague, hysteric complaint, and nervous fever, the following means are those commonly used. 1. Increase the stimulation above its natural quantity for some weeks, till a new habit of more energetic contraction of the fibres is established. This is to be done by wine, opium, bark, steel, given at exact periods, and in appropriate quantities; for if these medicines be given in such quantity, as to induce the least degree of intoxication, a debility succeeds from the useless exhaustion of spirit of animation in consequence of too great exertion of the muscles or organs of sense. To these irritative stimuli should be added the sensitive ones of cheerful ideas, hope, affection.

[3]. Change the kinds of stimulus. The habits acquired by the constitution depend on such nice circumstances, that when one kind of stimulus ceases to excite the sensorial power into the quantity of exertion necessary to health, it is often sufficient to change the stimulus for another apparently similar in quantity and quality. Thus when wine ceases to stimulate the constitution, opium in appropriate doses supplies the defect; and the contrary. This is also observed in the effects of cathartic medicines, when one loses its power, another, apparently less efficacious, will succeed. Hence a change of diet, drink, and stimulating medicines, is often advantageous in diseases of debility.

[4]. Stimulate the organs, whose motions are associated with the torpid parts of the system. The actions of the minute vessels of the various parts of the external skin are not only associated with each other, but are strongly associated with those of some of the internal membranes, and particularly of the stomach. Hence when the exertion of the stomach is less than natural, and indigestion and heartburn succeed, nothing so certainly removes these symptoms as the stimulus of a blister on the back. The coldness of the extremities, as of the nose, ears, or fingers, are hence the best indication for the successful application of blisters.

[5]. Decrease the stimulus for a time. By lessening the quantity of heat for a minute or two by going into the cold bath, a great accumulation of sensorial power is produced; for not only the minute vessels of the whole external skin for a time become inactive, as appears by their paleness; but the minute vessels of the lungs lose much of their activity also by concert with those of the skin, as appears from the difficulty of breathing at first going into cold water. On emerging from the bath the sensorial power is thrown into great exertion by the stimulus of the common degree of the warmth of the atmosphere, and a great production of animal heat is the consequence. The longer a person continues in the cold bath the greater must be the present inertion of a great part of the system, and in consequence a greater accumulation of sensorial power. Whence M. Pomè recommends some melancholy patients to be kept from two to six hours in spring-water, and in baths still colder.

[6]. Decrease the stimulus for a time below the natural, and then increase it above natural. The effect of this process, improperly used, is seen in giving much food, or applying much warmth, to those who have been previously exposed to great hunger, or to great cold. The accumulated sensorial power is thrown into so violent exertion, that inflammations and mortifications supervene, and death closes the catastrophe. In many diseases this method is the most successful; hence the bark in agues produces more certain effect after the previous exhibition of emetics. In diseases attended with violent pain, opium has double the effect, if venesection and a cathartic have been previously used. On this seems to have been founded the successful practice of Sydenham, who used venesection and a cathartic in chlorosis before the exhibition of the bark, steel, and opiates.

[7]. Prevent any unnecessary expenditure of sensorial power. Hence in fevers with debility, a decumbent posture is preferred, with silence, little light, and such a quantity of heat as may prevent any chill sensation, or any coldness of the extremities. The pulse of patients in fevers with debility increases in frequency above ten pulsations in a minute on their rising out of bed. For the expenditure of sensorial power to preserve an erect posture of the body adds to the general deficiency of it, and thus affects the circulation.

[8]. The longer in time and the greater in degree the quiescence or inertion of an organ has been, so that it still retains life or excitability, the less stimulus should at first be applied to it. The quantity of stimulation is a matter of great nicety to determine, where the torpor or quiescence of the fibres has been experienced in a great degree, or for a considerable time, as in cold fits of the ague, in continued fevers with great debility, or in people famished at sea, or perishing with cold. In the two last cases, very minute quantities of food should be first supplied, and very few additional degrees of heat. In the two former cases, but little stimulus of wine or medicine, above what they had been lately accustomed to, should be exhibited, and this at frequent and stated intervals, so that the effect of one quantity may be observed before the exhibition of another.

If these circumstances are not attended to, as the sensorial power becomes accumulated in the quiescent fibres, an inordinate exertion takes place by the increase of stimulus acting on the accumulated quantity of sensorial power, and either the paralysis, or death of the contractile fibres ensues, from the total expenditure of the sensorial power in the affected organ, owing to this increase of exertion, like the debility after intoxication. Or, secondly, the violent exertions above mentioned produce painful sensation, which becomes a new stimulus, and by thus producing inflammation, and increasing the activity of the fibres already too great, sooner exhausts the whole of the sensorial power in the acting organ, and mortification, that is, the death of the part, supervenes.