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IV. Obfervations on the Nature, Caufes, and Cure of thofe Disorders which have been commonly called Nervous, Hypochondriac, or Hy. fteric. To which are prefixea fome Remarks on the Sympathy of the Nerves. By Robert Whytt, M. D. F. R. S. Phyfician to his Majefly, Prefident of the Royal College of Phyficians, and Profeffor of Medicine in the University of Edinburgh. 8vo. Pr. 6s. Becket. [Concluded.}

UR ingenious and accurate author enumerates in chap. vi. among the most remarkable fymptoms of thefe diforders, 1. An uncommon fenfe of cold or heat in different parts of the body, fometimes fuddenly fucceeding each other. This he imputes to an irregular irritation of the nerves, producing a spafmodic ftricture in the capillaries, which impedes the circulation. in thofe parts. To this nervous ftriature he alfo afcribes the cold fit in an intermittent, rather than to an obftruction from a vifcidity of the juices. The fame cause excites the rigores which happen in the beginning of almost every fever.

2dly. He mentions pains in different parts of the body, fuddenly moving from one place to another; which fome phyfcians have afcribed to the motion of air between the skin and mufcles: but he fuppofes them owing either to some vifcid or acrid matter finking for a fhort time in the final veffels of certain parts, and irritating them, or to a fpafmodic contraction of thefe veffels from a fympathy between their nerves and those of the ftomach and inteftines, or fome other very fenfible part.

From the fame caufes (fays he) affecting the veffels or nerves of the pericranium, or other parts of the head, proceed flying pains in this part, and the clavus hy ericus, which Sydenham, who imagined the hyfteric difeafe to proceed from a :confufion of the animal fpirits, afcribed to the whole fpirits of the body being contracted into a fmall part of the head, and producing much the fame fenfation, as if a nail were driven into it.

That thofe pains in the head often proceed from a fympathy with the ftomach, is rendered probable by the violent vomiting which fometimes accompanies the clavus hyflericus, and by obferving, that people much troubled with wind in their ftomach, and flying pains in their head, are not fo often affected with thefe pains, when they are free from the flatulence.'

3dly. Our author proceeds to remark upon hyfteric faintings and convulfions, which he refers to an irritation of the nerves of the ftomach or inteftines, from wind, acrid humours, &c. to a fudden fuppreffion of the menfes; a very acute pain in any of the more fenfible parts of the body; and violent af

fections

fe&tions of the mind. The other fymptoms on which he expatiates, are the catalepfis and tetanus; wind in the ftomach and bowels; which (by the bye) he had confidered before as the cause of convulfions; a great craving for food; a black vomiting; a fudden and great flux of pale urine; a nervous atrophy; a nervous or fpafmodic afthma; a nervous cough; palpitations of the heart; variation of the pulfe; periodical head achs; a giddinefs; a dimnefs of fight, without any vifible fault in the eyes; low fpirits, melancholy, and a mania; and finally, the incubus, or night-mare. Each of these symptoms is elucidated by arguments and obfervations equally curious and inftru&tive; which, however, the nature of our plan will not allow us to particularize. In difcuffing the article of nervous atrophy, he obferves, p. 259. Sometimes this disease, after it has brought the patient very low, will take a fudden turn, without any apparent caufe. The patient, who had little inclination to eat, will get an uncommon craving and quick digeftion, even of solid food, which used to lie remarkably heavy on his ftomach: his pulfe will become quicker than natural, and his skin warm; his veins, which were contracted, will appear fwelled with blood; from being lowe fpirited, he will become chearful, and daily grow stronger and plumper all which effects feem to proceed, in a great mea fure, if not folely, from fome change in the nerves of the ftomach and bowels.

In other cafes, this diforder goes off as lowly as it came on, and the patient does not recover fully, till after a long time.'

We ourselves can vouch for the truth of this obfervation: we knew a perfon reduced to the laft ftage of this distemper, whofe recovery was attended with no apparent critical evacuation; nor could it be afcribed to any other caufe, but a fimple rarefaction and acceleration of the blood from heat.

In fpeaking of the nervous, or fpafmodic afthma, he says, among the many patients liable to periodical fits of the afthma, there are but very few who have not fome obftruction, or other obfiacle, conftantly remaining in their lungs; fo that a true nervous or fpafmodic afthma, without any other fault in that organ than an uncommon delicacy or irritability of the nerves, is a difeafe we feldom meet with.

Of the nervous cough he gives a very fingular inftance, in a young girl who coughed inceffantly while up, but was easy and quiet while the lay a-bed; nay, while the fat up in the bed with her legs and thighs in a horizontal pofture, fhe coughed none; but when her legs hung over the bed, or her feet touched the floor, or her legs were drawn up close to her thighs, D 3 The

she was always attacked by a cough and pain in her breaft, and the velocity of her pulfe increafed furprisingly. Yet while the fat, or food with her feet in warm water, fhe had neither pain, cough, nor difficulty in breathing; and the fame ease she enjoyed when her hands were dipped in warm water: but one hand and one foot dipped at the fame time, produced no effect; nor did the cough ceafe when her feet and hands were fomented with the fame degree of heat, or covered with warm fand, In a word, here is a detail of very extraordinary fymptoms, which (as we cannot infert the whole) we recommend to the attention of the reader, We cannot help, however, mentioning the corollaries he deduces from thefe experiments.

From the experiments already related (says he) I was ready to imagine that the cough might be owing to fome tumor or other fixed caufe in the breaft, which, in certain poftures, fo ftrongly irritated that part of the lungs which it touched, as to occafion a conftant convulfive motion of the muscles of respiration; but the following experiment, which I frequently repeated, foon diffipated this theoretical illufion.

When my patient lay in bed, upon extending one of her feet, fo as to bring it nearly to a right line with the leg, fhe coughed violently, and her pulfe rofe from 94 in a minute to 18 in five feconds: but when her hands were either ftrongly bent inwards or extended outwards, or when he pulled ftrongly, or raised a confiderable weight with them, no coughing enfued.

When the cough was raised by stretching her feet, warm water applied to her hands immediately put a stop to it.

From this experiment it may appear, that this extraordinary cough did not depend on any fixed obftruction. or tumour within the thorax, irritating the lungs in certain poftures. But, in this patient, the nerves of the lungs feem to have been endued with an uncommon degree of fenfibility, and to have had a peculiar fympathy with the legs and feet; whence as often as they were in a depending fituation, or the nerves, tendons, and ligaments at the ancles, were stretched, an uneafy fenfation was felt in the lungs, which occafioned an inceffant cough. Although the fympathy between the lungs and the other parts, appears to have been less remarkable, yet the fhock which their nerves fuffered from cold water, was fo ftrongly felt in the lungs,, as to occafion a pain in the breaft, together with the cough.

• When the head and fhoulders were lower than the body, the cough was more fevere than in any other fituation, probably, because in that posture the respiration is lefs free, and the blood would pafs with more difficulty through the lungs.

"Warm

* Warm water did not, by its preffure on the nerves or bloodlels of the feet, prevent the cough, because it was excited by cold water, whole weight is greater. Neither did the pediluvium produce this effect by its heat alone, or even by its heat and moisture; for fand or wet flannel of an equal or greater degree of heat applied to the feet, did not prevent the cough.

As the effects of the pediluvium cannot be deduced from its rarefying the blood by its heat, neither can they be owing to any derivation of this fluid towards the inferior extremities, because warm water, whether it was applied to the hands or the feet, had the fame influence in stopping the cough; and as foon as the foles of her feet touched the water, the cough! ceafed.

'It remains, therefore, that warm water, by its particular action on the extremities of the nerves to which it is applied, renders the whole fyftem lefs fenfible of any irritation; whence the too delicate lungs would be lefs affected in consequence of their fympathy with the inferior extremities. However, when the patient lay with her head lower than her body, the warm water did not then prevent the cough; because, in that position, the irritation in the lungs was too great to be wholly removed by the anodyne power of the warm water: and, for the fame reason, it feems to have been, that the pediluvium did not prevent the pain within her breast and the cough, which were raised by dipping her hands in cold water.

'It appears from the above experiments, that warm water affects our nerves very differently, not only from a dry heat, but alfo from warm fteams, or cloths dipt in hot water; a fact which feems not have been known, or, at least, not sufficiently attended to, and which, perhaps, may afford fome ufeful hints in practice.

'Since warm water, applied to the nerves, has a fuperior anodyne effect, not only to fubftances that are warm and dry, but even to warm fteams or vapour; it is easy to fee, how`clyfters of warm water may give relief in pains of the bowels and other abdominal vifcera, altho' they do not communicate more heat to the great guts than they poffeffed before.

Laftly, the effects of the warm water in this cafe appear the more remarkable, as a pill, confifting of half a grain of opium, and three grains of afa fœtida, given every evening and morning, for feveral days, had not the least effect in either preventing or leffening the cough.

Between the zoth of January and the 25th of March, a variety of remedies were prefcribed for this patient, without any advantage, viz. vomits, blifters, and an iffue between the

fhoulders, the bark, powder of tin, rhubarb with calomel, pills of opium with afa foetida, bolufes of theriaca, with camphire and valerian.

Towards the end of March, I put her on a course of pills made of the extract of hemlock, which the continued for two months. About the middle of May he began to have lefs pain in her breaft, and lefs fenfe of fuffocation and coughing, when the fat up out of bed, or walked through the room. Upon the 22d of May, thefe complaints left her altogether; and on the 28th of that month, the cough was neither raifed by ftanding nor walking, nor when her head was laid lower than her body alfo cold water applied to her hands, had NOW no effect in exciting the cough or pain in her breaft. On the 30th of May, after walking a little abroad, the cough returned for a day or two. Upon the third of June, after having made a journey of about ten English miles in a chaise, the cough attacked her with as great violence as ever. Being now fully convinced, that this ailment was not owing to any fixed obstruction in the lungs, but to an uncommon delicacy or sensibility in their nerves, I ordered for her, pills of extract of gentian and limatura martis, which the took twice a day for about ten weeks. Towards the end of July, the violence of the cough began to abate, and for the first eight or ten days of Auguft, fhe was feldom troubled with it. On the 10th of Auguft, it returned and continued to the 2d of September, when it left her entirely. In the month of November following, he had a flight attack of the cough and uneafiness in her breaft; which fymptoms returned, for one day, in September 1762, fince which he has been very rarely affected with them in any confiderable degree. It was obferved, that the returns of her cough after September 1761, were always owing to her ufing exercise too freely,'

Dr. Whytt has bestowed fome pains to prove that the incubus, or night mare, does not proceed from a stagnation of blood in the finuses of the brain, or in the veffels of the lungs, or from too great a quantity of blood being fent to the head; but that it generally arifes from a difordered, ftomach, and a difagreeable affection of the nerves of that organ.-We should imagine that both causes often concur in producing this disorder.It must be owned, however, that young plethoric perfons who, have no complaint in their ftomachs are fubject to the incubus, especially when they eat heavy suppers, or drink wine to excefs; and it is obferved alfo, that in fuch cafes, they are more subject to it when they lie on their backs, than in any other pofture. Circumstances that feem to prove, beyond all doubt, that it fometimes arifes from an impeded and difordered circu

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