In conducting the education of young people, it is a nice matter to inspire them with so much benevolent sympathy, or compa.s.sion, as may render them good and amiable; and yet not so much as to make them unhappy at the sight of incurable distress. We should endeavour to make them alive to sympathize with all remediable evils, and at the same time to arm them with fort.i.tude to bear the sight of such irremediable evils, as the accidents of life must frequently present before their eyes. About this I have treated more at large in a plan for the conduct of a boarding school for ladies, which I intend to publish in the course of the next year.
25. _Educatio heroica._ From the kinds and degrees of insanities already enumerated, the reader will probably recollect many more from his own observation; he will perceive that all extraordinary exertions of voluntary action in consequence of some false idea or hallucination, which strongly affects us, may philosophically, though not popularly, be termed an insanity; he will then be liable to divide these voluntary exertions into disagreeable, pernicious, detestable, or into meritorious, delectable, and even amiable, insanities. And will lastly be induced to conceive, that a good education consists in the art of producing such happy hallucinations of ideas, as may be followed by such voluntary exertions, as may be termed meritorious or amiable insanities.
The old man of the mountain in Syria, who governed a small nation of people called a.s.sa.s.sines, is recorded thus to have educated those of his army who were designed to a.s.sa.s.sinate the princes with whom he was at war. A young man of natural activity was chosen for the purpose, and thrown into a deep sleep by opium mixed with his food; he was then carried into a garden made to represent the paradise of Mahomet, with flowers of great beauty and fragrance, fruits of delicious flavor, and beautiful houries beckoning him into the shades. After a while, on being a second time stupified with opium, the young enthusiast was reconveyed to his apartment; and on the next day was a.s.sured by a priest, that he was designed for some great exploit, and that by obeying the commands of their prince, immortal happiness awaited him.
Hence it is easy to collect how the first impressions made on us by accidental circ.u.mstances in our infancy continue through life to bias our affections, or mislead our judgments. One of my acquaintance can trace the origin of his own energies of action from some such remote sources; which justifies the observation of M. Rousseau, that the seeds of future virtues or vices are oftener sown by the mother, than the tutor.
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 acc.u.mulated in those muscles, which are most frequently used; as in those which const.i.tute 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 quant.i.ty of sensorial power is restored by their quiescence, or in sleep (for sleep affects these parts of the system only), yet but little acc.u.mulation of it succeeds. And this want of acc.u.mulation 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 acc.u.mulation of sensorial power during their inactivity; but this does not happen at all, or in much less quant.i.ty, 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 quant.i.ty of sensorial power, as after sleep; but not an acc.u.mulation or superabundance of it. And by frequent repet.i.tions of exhaustion by great stimulus, these vessels cease to acquire their whole natural quant.i.ty 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. x.x.xIV. 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 a.s.sociation, 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 a.s.sociation, they may still in many cases be excited by the others.
SPECIES.
1. _La.s.situdo._ 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 quant.i.ty 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 apt.i.tude to motion on the acquisition of an agreeable partner; or from a tired child riding on a gold-headed cane, as in Sect. x.x.xIV. 2. 6. These muscles are likewise still obedient to the sensorial power of a.s.sociation, 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 la.s.situde 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 Cla.s.s 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 quant.i.ty of animal power residing in the muscular fibres. These tremors only exist when the affected muscles are excited into action, as in lifting a gla.s.s 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 quant.i.ty 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 quant.i.ty.
4. _Brachiorum paralysis._ A numbness of the arms is a frequent symptom in hydrops thoracis, as explained in Cla.s.s I. 2. 3. 14. and in Sect. XXIX. 5.
2.; it also accompanies the asthma dolorific.u.m, Cla.s.s 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 Cla.s.s IV. 1. 2. 10.
Mr. M----, a miner and well-sinker, about three years ago, lost the power of contracting both his thumbs; the b.a.l.l.s 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 circ.u.mstances 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 acc.u.mulated; 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 acc.u.mulation of sensorial power, contribute to restore it to a state of voluntary excitability. As this acc.u.mulation 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 Cla.s.s I. 2. 3. 21.
M. M. Ether externally. Friction. Saline warm bath. Electricity.
5. _Raucedo paralytica._ Paralytic hoa.r.s.eness 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 a.s.sembly. Was this owing to a greater exertion of volition than usual? like the dumb young man, the son of Croesus, 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 pa.s.sed through the larynx every day for a fortnight. See Raucedo catarrhalis, Cla.s.s 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. _Vesicae urinariae 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.
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 r.e.c.t.u.m. The r.e.c.t.u.m 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 inapt.i.tude 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 s.e.x, to have supplied one source of ennui and suicide.
9. _Catalepsis_ is sometimes used for fixed spasmodic contractions or teta.n.u.s, as described in Sect. x.x.xIV. 1. 5. and in Cla.s.s III. 1. 1. 13. but is properly simply an inapt.i.tude to muscular motion, the limbs remaining in any att.i.tude 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 gla.s.s 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 acc.u.mulated 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 p.r.i.c.k 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 Cla.s.s 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 diabaetes. See Sect. XXVII. 2. Palsy of one side of the face is mentioned in Cla.s.s II. 1. 4. 6. Paralysis of the lacteals, of the liver, and of the veins, which are described in Sect. XXVIII. x.x.x. and XXVII. do not belong to this cla.s.s, 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 a.s.sociations 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 vertebrae 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 r.e.c.t.u.m, 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 vertebrae; which is owing to the innutrition or softness of bones, described in Cla.s.s 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 quant.i.ty 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 Cla.s.s 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 circ.u.mstances 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 rec.u.mbent 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 circ.u.mstances, 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 inc.u.mbent 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 acc.u.mulation 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 a.s.sociation, are now exerted with greater velocity as well as strength, const.i.tuting 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. x.x.xV. 1.