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Gen. VI. In such a frame of body any sudden alarm, a longer Spec. II.
· abstinence than usual, a fuller dinner than usual, unSyncope recurrens. wonted exercise, and a thousand minute excitements of Fainting-fit.
daily occurrence will often succeed in producing a faintHow such causes ope ing-fit: and especially where a morbid habit of recurrence
has been once established, and there is a predisposition to return. Atonic plethora is another frequent cause in the peculiar constitution we are now considering, and a cause far too liable itself to establish a circle of recurrence, and consequently to give recurrence to the form of
syncope before us. There is a singular example of periswoonings.
odic swooning in the Ephemera of Natural Curiosities*, which seems to have been dependent upon this state of body : and another example in which it was evidently produced by a return of the term of menstruation, and became its regular harbinger t.
In all cases of this kind, therefore, it is of the utmost idiosyncrasy to be studied, importance to study minutely the character of the pa
tient's idiosyncrasy and habit, and not to excite any alarm concerning organic mischief, and thus add another excitement to those which already exist, while there is a probability that the affection may be owing to one or other of these lighter and more manageable causes.
In the latter case tonics, cold bathing, equitation, regular hours and light meals will form the best prescription we can lay down. Where we are compelled to suspect some organic impediment or other mischief about the heart, small bleedings that may anticipate the usual time of the return, camphor, nitre, hyoscyamus, and whatever other sedative may be found best to agree with the patient and diminish the rapidity of the circulation, will form the most rational medical plan we can devise ; while tranquillity of body and mind, an abstinence from all stimulant foods, and a regular attention to the state of the bowels should form a standard rule for the whole tenour of his life.
* Dec. 11. Ann. 1. Obs. 10.
+ Id. Dec. II. Ann. v. Obs. 55.
G E N U SVII.
CLONIC SPASM; DIMINISHED SENSIBILITY ; INABILITY
Syspasia, or sYSPAsis from ouonów, “ contraho, con- Gen. VII. vello”, literally imports convulsion in the popular sense the generic
" Origin of of the term, or, in other words, clonus or agitatory spasm, term. in combination with a greater or less degree of failure of the sensation and the understanding. The term seems wanted as a generic name for the three following diseases, whose symptoms, and, for the most part, mode of treatment, are so accordant, as to establish the propriety of linking them under a common division :
1. SYSPASIA CONVULSIO. CONVULSION.
EPILEPSIA. EPILEPSY. The author has entered so fully into the nature and Outline of
the pathoprinciple of clonic or agitatory spasm under the genus is CLONUS, that a very few remarks will be necessary in ex- under plaining the pathology of these three species. They are all of them clonic spasms, as expressed in the definition, but complicated with other morbid affections, and particularly with those of the two preceding genera : for if we combine clonic or synclonic spasm with different modifications of vertigo or syncope we shall produce the three species that are now before us.
In explaining the nature of clonic spasm we noticed the tendency there frequently exists when the uniformity of the flow or secretion of the sensorial power is once interfered with, to alternations of a hurried and excessive, as
tain to the
Gen. VII. well as of a restrained and deficient supply, and conseSyspasia.
quently to an intermixture of constrictive or entastic spasm Comatose quenny w spasm.
with clonic or agitatory, of which palpitation, and various
other affections of this kind afford perspicuous examples. Distinctive In the diseases immediately before us the proofs of such an character of the species intermixture are still more striking; for there is not one that apper
of them but evinces an union of both descriptions of spasgenus.
modic action in a high, though not an equal degree of vehemence. In convulsion-fit the two kinds of spasm are nearly upon a balance, commonly with a retention of some share of both sentient and percipient power. In hysteria the spastic or entastic action, in its sudden and transient irruptions, is more violent than the clonic, the force exercised at this time is enormous, and there is also, in many cases, a small retention of sensation and understanding. In epilepsy the clonic action is most conspicuous, and the failure of the mental and sentient faculties generally com
Of the essence of the nervous power we have repeatedly principles already ads stated that we know nothing, for we can trace it only by plied to the
· its effects : but we are compelled to conceive of it as a fine present volatile and energetic fluid, not existing out of the animal
system, and, therefore formed, and consequently secreted, power, how by some particular organ within it: which organ there far we are can be no difficulty in contemplating as the brain singly, acquainted
or the brain and nerves jointly, which constitute only dif
ferent parts of one common apparatus. Admitting, then, A secreted the nervous power to be a secreted fluid, like all other sefluid : and
pro- cretions, this may be produced in excess or in deficiency, ducible in or be imperfectly elaborated, and, however produced, it excess and in deticiency; may be irregularly communicated in its flow, as well by pre
cipitation as by interruption. The means by which these diseased actions take place, we have already touched upon; and have shown that the common causes are sometimes mental, sometimes mechanical, sometimes sympathetic, and sometime chemical, as narcotics and other poisons,
and particularly those of repelled eruptions. by mental,
Now it is in persons of relaxed or debilitated fibres mechanical, sympathetic, that we find these exciting causes chiefly operative. For in
those of high health, full vessels, and a firm constitution, Gen. VII.
Syspasia. however the circulation may be accelerated, or the nervous power excited, it is rarely that we meet with clonic spasms, spasm. or indeed, spasms of any kind : or, at least, we meet with and chemi
cal causes. a far less tendency to such abnormities, than in persons of lax and debilitated fibres, possessing, necessarily, more
causes, mobility, or facility of being put into new actions from
operative. the very quality of debility itself.
Hence the The common predisponent, then, is weakness, parti- common cularly of the nervous system; and the common excite
tion, weakment, irritation. The peculiar effect must, however, be ness, espemodified by the idiosyncrasy or peculiarity of the constitution, or of collateral circumstances, by which it may system : but be influenced at the time. And hence the very exciting the percmuara cause that in one individual may produce hysteria, in fied by other
circumanother may produce epilepsy, and in a third the more fugitive and less impressive attack of syspasia, as con- hence the
different vulsion *
species beThe nature of the idiosyncrasy, or, more particularly, of fore us in
different inthe individual constitution, is rarely within our control; divide but the collateral circumstances are often before us : they Idiosynconstitute the occasional cause of the disease, and should crasy rarely
within mediform a prominent point in our attention to its progress. There are, perhaps, few more common causes of weak- but not so
the collateral ness than over-distended vessels ; and hence plethora is a cir frequent occasional cause of each of the diseases belong- stances. ing to the genus before us, the species actually produced Overdis
tended vesdepending, as just observed, upon the influence of other se circumstances. Thus, if such plethora take place in a mon cause of
u weakness, young woman of eighteen or nineteen, whose menstrual whe flux has been accidentally suppressed or retarded, it is thora a fremost probable, if an irregularity in the nervous system be sional cause: hereby excited, that such an irregularity will lead to a fit and may,
lead under of hysterics rather than to one of convulsion or epilepsy, different cirsince we shall find, as we proceed, that this species of cumstances
to a fit of spasm is peculiarly connected with an irritable and espe- hysterics : cially an orgastic state of the genital organs.
sels a com
• Pritchard on Nervous Diseases, p. 199.
Gen. VII. On the contrary, if the plethora produce chiefly a disComatose
e tention of the vessels of the brain, epilepsy is more likely spasm. to be the result; in other words, that form of spasmodic or of epi- action in which the sensation and the intellect suffer more lepsy ;
severely than in either of the others. While, if the ple
thora be general, we have reason to expect that the spasor of con- modic effect will be general also, or, in other words, take vulsion. the form of convulsion in which no single organ is tried Why plece more than another. Yet plethora, in a firm and vigorous bust persons frame, is seldom found to produce either of these affec
sofrer tions, for the resistance of the coats of the blood vessels is quently produces these here sufficient to counter-balance the impetus of the saneffects.
guineous fluid, and, consequently, to prevent an over-distention. And hence, again, we see in what manner debility becomes a remote or predisponent cause of the diseases
under our consideration. Plethora in Plethora thus acting by over-distention may be regarded one sense a mechanical as a mechanical stimulus, upon the removal of which,
as upon the removal of other mechanical stimuli, the disease will cease. Venesection is the most direct means of such removal; but it labours under the inconvenience of being only a temporary remedy. It takes off the occasional cause, but by adding to the general debility it gives
strength to the predisposing cause. More direct The more direct mechanical stimulants are sharp-pointstimulants. ed ossifications formed in the membranes of the brain, or
arising from the internal surface of the cranium ; splinters of a fractured cranium, or the introduction of some wounding instrument. The occasional causes resulting from mental emotions, we have already been called to notice more than once; as also to show that while some of these appear to act by instantaneously exhausting the sensorial organ of its living principle, others operate by giving a check to the sensoral secretion. These modes
of action are indeed opposite, but the result, which is a Why in irri- depletion of the nervous apparatus, is the same. And as table and i
ad in weakly or relaxed habits there is in every organ a bits the tem- greater mobility, or facility of passing from one state of per as fickle
tesaction to another, than in the firm and robust, we see also
as the fib