GEN. VI. SPEC. II. Syncope recurrens. Fainting-fit. causes ope rate. Periodical swoonings. Patient's idiosyncrasy to return. In such a frame of body any sudden alarm, a longer abstinence than usual, a fuller dinner than usual, unwonted exercise, and a thousand minute excitements of daily occurrence will often succeed in producing a fainting-fit: and especially where a morbid habit of recurrence has been once established, and there is a predisposition 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 periodic 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 +. In all cases of this kind, therefore, it is of the utmost to be studied, importance to study minutely the character of the patient'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. Remedial treatment. 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. I. Obs. 10. + Id. Dec. 11. Ann. v. Obs. 53. GENUS VII. SYSPASIA. Comatose Spasm. CLONIC SPASM; DIMINISHED SENSIBILITY; INABILITY GEN. VII. Origin of SYSPASIA, or SYSPASIS from Guoπáw, “ contraho, convello", literally imports convulsion in the popular sense the generic 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 scems 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: The author has entered so fully into the nature and principle of clonic or agitatory spasm under the genus CLONUS, that a very few remarks will be necessary in explaining 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 Outline of the pathology given under clonus, GEN. VII Syspasia. Comatose spasm. character of tain to the genus. well as of a restrained and deficient supply, and consequently to an intermixture of constrictive or entastic 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 the species intermixture are still more striking; for there is not one that apper- of them but evinces an union of both descriptions of spasmodic 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 complete. Pathological principles already advanced ap plied to the present genus. Nervous far we are acquainted with it. Of the essence of the nervous power we have repeatedly stated that we know nothing, for we can trace it only by its effects: but we are compelled to conceive of it as a fine 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 can be no difficulty in contemplating as the brain singly, 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 secretions, this may be produced in excess or in deficiency, or be imperfectly elaborated, and, however produced, it deficiency; may be irregularly communicated in its flow, as well by precipitation 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. fluid and : pro hence ducible in excess and in by mental, mechanical, Now it is in persons of relaxed or debilitated fibres sympathetic, that we find these exciting causes chiefly operative. For in those of high health, full vessels, and a firm constitution, GEN. VII. however the circulation may be accelerated, or the nervous Comatose Syspasia. 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 chemia far less tendency to such abnormities, than in persons These of lax and debilitated fibres, possessing, necessarily, more causes, mobility, or facility of being put into new actions from where chiefly the very quality of debility itself. cal causes, operative. Hence the tion, weak The common predisponent, then, is weakness, parti- common cularly of the nervous system; and the common excite- predisposi ment, irritation. The peculiar effect must, however, be ness, espe modified by the idiosyncrasy or peculiarity of the consti- nervous tution, or of collateral circumstances, by which it may be influenced at the time. And hence the very exciting cause that in one individual may produce hysteria, in another may produce epilepsy, and in a third the more fugitive and less impressive attack of syspasia, as convulsion *. system: but effects modithe peculiar fied by other circum stances, and hence the different species be different in dividuals. Idiosyn crasy rarely within medical control: but not so the collateral circum stances. Overdis tended ves The nature of the idiosyncrasy, or, more particularly, of fore us in the individual constitution, is rarely within our control; but the collateral circumstances are often before us: they constitute the occasional cause of the disease, and should form a prominent point in our attention to its progress. There are, perhaps, few more common causes of weakness than over-distended vessels; and hence plethora is a frequent occasional cause of each of the diseases belonging to the genus before us, the species actually produced depending, as just observed, upon the influence of other circumstances. Thus, if such plethora take place in a young woman of eighteen or nineteen, whose menstrual flux has been accidentally suppressed or retarded, it is most probable, if an irregularity in the nervous system be hereby excited, that such an irregularity will lead to a fit of hysterics rather than to one of convulsion or epilepsy, since we shall find, as we proceed, that this species of spasm is peculiarly connected with an irritable and espe- hysterics: cially an orgastic state of the genital organs. • Pritchard on Nervous Diseases, p. 139. sels a common cause of whence plethora a freque occa and may different circumstances weakness, sional cause: lead under to a fit of GEN. VII. Syspasia. Comatose spasm. or of epilepsy; or of con On the contrary, if the plethora produce chiefly a distention of the vessels of the brain, epilepsy is more likely to be the result; in other words, that form of spasmodic action in which the sensation and the intellect suffer more severely than in either of the others. While, if the plethora be general, we have reason to expect that the spasmodic effect will be general also, or, in other words, take the form of convulsion in which no single organ is tried more than another. Yet plethora, in a firm and vigorous bust persons frame, is seldom found to produce either of these affections, 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. vulsion. Why ple thora in ro less fre Plethora in one sense a mechanical stimulus. More direct mechanical stimulants. Mental causes. Plethora thus acting by over-distention may be regarded 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. The more direct mechanical stimulants are sharp-pointed 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 mobile ha- in weakly or relaxed habits there is in every organ a bits the tem- greater mobility, or facility of passing from one state of as the fibres, action to another, than in the firm and robust, we see also table and per as fickle |