Zoonomia/III.V

ART. V.

INVERTENTIA.

I. Those things, which invert the natural order of the successive irritative motions, are termed invertentia.

1 . Emetics invert the motions of the stomach, duodenum, and œsophagus.

2 . Violent cathartics invert the motions of the lacteals, and intestinal lymphatics.

3 . Violent errhines invert the nasal lymphatics, and those of the frontal and maxillary sinuses. And medicines producing nausea, invert the motions of the lymphatics about the sauces.

4 . Medicines producing much pale urine, as a certain quantity of alcohol, invert the motions of the urinary absorbents; if the dose of alcohol is greater, it inverts the stomach, producing the drunken sickness.

5 . Medicines producing cold sweats, palpitation of the heart, globus hystericus; as violent evacuations, some poisons, fear, anxiety, act by inverting the natural order of the vascular motions.

II.

I. 1 . The action of vomiting seems originally to have been occasioned by disagreeable sensation from the distention or acrimony of the aliment; in the same manner as when any disgustful material is taken into the mouth, as a bitter drug, and is rejected by the retrograde motions of the tongue and lips; as explained in Class IV. 1. 1. 2. and mentioned in Sect. XXXV. 1. 3. Or the disagreeable sensation may thus excite the power of volition, which may also contribute to the retrograde actions of the stomach and œsophagus, as when cows bring up the contents of their first stomach to re-masticate it. To either of these is to be attributed the action of mild emetics, which soon cease to operate, and leave the stomach stronger, or more irritable, after their operation; owing to the accumulation of the sensorial power of irritation during its torpid or inverted action. Such appears to be the operation of ipecacuanha, or of antimonium tartarizatum, in small doses.

2 . But there is reason to believe, that the stronger emetics, as digitalis, first stimulate the absorbent vessels of the stomach into greater action; and that the inverted motions of these absorbents next occur, pouring the lymph, lately taken up, or obtained from other lymphatic branches, into the stomach: the quantity of which in some diseases, as in the cholera morbus, is inconceivable. This inverted motion, first of the absorbents of the stomach, and afterwards of the stomach itself, seems to originate from the exhaustion or debility, which succeeds the unnatural degree of action, into which they had been previously stimulated. An unusual defect of stimulus, as of food without spice or wine in the stomachs of those, who have been much accustomed to spice or wine, will induce sickness or vomiting; in this case the defective energy of the stomach is owing to defect of accustomed stimulus; while the action of vomiting from digitalis is owing to a deficiency of sensorial power, which is previously exhausted by the excess of its stimulus. See Sect. XXXV. 1. 3. and Class IV. 1. 1. 2.

For first, no increase of heat arises from this action of vomiting; which always occurs, when the secerning system is stimulated into action. Secondly, the motions of the absorbent vessels are as liable to inversion as the stomach itself; which last, with the œsophagus, may be considered as the absorbent mouth and belly of that great gland, the intestinal canal. Thirdly, the class of sorbentia, as bitters and metallic salts, given in large doses, become invertentia, and vomit, or purge. And lastly, the sickness and vomiting induced by large potations of wine, or opium, does not occur till next day in some people, in none till some time after their ingurgitation. And tincture of digitalis in the dose of 30 or 60 drops, though applied in solution, is a considerable time before it produces its effect; though vomiting is instantaneously induced by a nauseous idea, or a nauseous taste in the mouth. At the same time there seem to be some materials, which can immediately stimulate the stomach into such powerful action, as to be immediately succeeded by paralysis of it, and consequent continued fever, or immediate death; and this without exciting sensation, that is, without our perceiving it. Of these are the contagious matter of some fevers swallowed with the saliva, and probably a few grains of arsenic taken in solution. See Suppl. I. 8. 8. Art. IV. 2. 6. 9.

3 . Some branches of the lymphatic system become inverted by their sympathy with other branches, which are only stimulated into too violent absorption. Thus when the stomach and duodenum are much stimulated by alcohol, by nitre, or by worms, in some persons the urinary lymphatics have their motion inverted, and pour that material into the bladder, which is absorbed from the intestines. Hence the drunken diabetes is produced; and hence chyle is seen in the urine in worm cases.

When on the contrary some branches of the absorbent systems have their motions inverted in consequence of the previous exhaustion of their sensorial power by any violent stimulus, other branches of it have their absorbent power greatly increased. Hence continued vomiting, or violent cathartics, produce great absorption from the cellular membrane in cases of dropsy; and the fluids thus absorbed are poured into the stomach and intestines by the inverted motions of the lacteals and lymphatics. See Sect. XXIX. 4. and 5.

4 . The quantity of the dose of an emetic is not of so great consequence as of other medicines, as the greatest part of it is rejected with the first effort. All emetics are said to act with greater certainty when given in a morning, if an opiate had been given the night before. For the sensorial power of irritation of the stomach had thus been in some measure previously exhausted by the stimulus of the opium, which thus facilitates the action of the emetic; and which, when the dose of opium has been large, is frequently followed on the next day by spontaneous sickness and vomitings, as after violent intoxication.

Ipecacuanha is the most certain in its effect from five grains to thirty; white vitriol is the most expeditious in its effect, from twenty grains to thirty dissolved in warm water; but emetic tartar, antimonium tartarizatum, from one grain to four to sane people, and from thence to twenty to insane patients, will answer most of the useful purposes of emetics; but nothing equals the digitalis purpurea for the purpose of absorbing water from the cellular membrane in the anasarca pulmonum, or hydrops pectoris. See Art. IV. 2. 3. 7.

II. Violent cathartics. 1 . Where violent cathartics are required, as in dropsies, the squill in dried powder made into small pills of a grain, or a grain and a half, one to be given every hour till they operate briskly, is very efficacious; or half a grain of emetic tartar dissolved in an ounce of peppermint-water, and given every hour, till it operates. Scammony, and other strong purges, are liable to produce hypercatharsis, if they are not nicely prepared, and accurately weighed, and are thence dangerous in common practice. Gamboge is uncertain in its effects, it has otherwise the good property of being tasteless; and on that account some preparation of it might be useful for children, by which its dose could be ascertained, and its effects rendered more uniform.

2 . In inflammations of the bowels with constipation calomel, given in the dose from ten to twenty grains after due venesection, is most efficacious; and if made into very small pills is not liable to be rejected by vomiting, which generally attends those cases. When this fails, a grain of aloes every hour will find its way, if the bowel is not destroyed; and sometimes, I believe, if it be, when the mortification is not extensive. If the vomiting continues after the pain ceases, and especially if the bowels become tumid with air, which sounds on being struck with the finger, these patients seldom recover. Opiates given along with the cathartics I believe to be frequently injurious in inflammation of the bowels, though they may thus be given with advantage in the saturnine colic; the pain and constipation in which disease are owing to torpor or inactivity, and not to too great action.

III. Violent errhines and sialagogues. 1 . Turpeth mineral in the quantity of one grain mixed with ten grains of sugar answers every purpose to be expected from errhines. Their operation is by inverting the motions of the lymphatics of the membrane, which lines the nostrils, and the caverns of the forehead and cheeks; and may thence possibly be of service in the hydrocephalus internus.

Some other violent errhines, as the powder of white hellebore, or Cayan pepper, diluted with some less acrid powder, are said to cure some cold or nervous head-achs; which may be effected by inflaming the nostrils, and thus introducing the sensorial power of sensation, as well as increasing that of irritation; and thus to produce violent action of the membranes of the nostrils, and of the frontal and maxillary sinuses, which may by association excite into action the torpid membranes, which occasion the head-ach.

2 . A copious salivation without any increase of heat often attends hysteric diseases, and fevers with debility, owing to an inversion of the lymphatics of the mouth, see Class I. 1. 2. 6. The same occurs in the nausea, which precedes vomiting; and is also excitable by disagreeable tastes, as by squills, or by nauseous smells, or by nauseous ideas. These are very similar to the occasional discharge of a thin fluid from the nostrils of some people, which recurs at certain periods, and differs from defective absorption.

IV. Violent diuretics. 1 . If nitre be given from a dram to half an ounce in a morning at repeated draughts, the patient becomes sickish, and much pale water is thrown into the bladder by the inverted action of the urinary lymphatics. Hence the absorption in ulcers is increased and the cure forwarded, as observed by Dr. Rowley.

2 . Cantharides taken inwardly so stimulate the neck of the bladder as to increase the discharge of mucus, which appears in the urine; but I once saw a large dose taken by mistake, not less than half an ounce or an ounce of the tincture, by which I suppose the urinary lymphatics were thrown into violent inverted motions, for the patient drank repeated draughts of subtepid water to the quantity of a gallon or two in a few hours; and during the greatest part of that time he was not I believe two entire minutes together without making water. A little blood was seen in his water the next day, and a soreness continued a day longer without any other inconvenience.

3 . The decoction of foxglove should also be mentioned here, as great effusions of urine frequently follow its exhibition. See Art. IV. 2. 3. 7. And an infusion or tincture of tobacco as recommended by Dr. Fowler of York.

4 . Alcohol, and opium, if taken so as to induce slight intoxication, and the body be kept cool, and much diluting liquids taken along with them, have similar effect in producing for a time a greater flow of urine, as most intemperate drinkers must occasionally have observed. This circumstance seems to have introduced the use of gin, and other vinous spirits as a diuretic, unfortunately in the gravel, amongst ignorant people; which disease is generally produced by fermented or spirituous liquors, and always increased by them.

5 . Fear and anxiety are well known to produce a great frequency of making water. A person, who believed he had made a bad purchase concerning an estate, told me, that he made five or six pints of water during a sleepless night, which succeeded his bargain; and it is usual, where young men are waiting in an anti-room to be examined for college preferment, to see the chamber-pot often wanted.

V. Cold sweats about the head, neck, and arms, frequently attend those, whose lungs are oppressed, as in some dropsies and asthma. A cold sweat is also frequently the harbinger of death. These are from the inverted motions of the cutaneous lymphatic branches of those parts.

III.

I. Emetics, ipecacuanha, emetic tartar, antimonium tartarisatum, squill, scilla maritima, carduus benedictus, cnicus acarna, chamœmile, anthemis nobilis, white vitriol, vitriolum zinci, foxglove, digitalis purpurea, clysters of tobacco.

II. Violent cathartics, emetic tartar, squill, buckthorn, rhamnus catharticus, scammonium, convolvulus scammonia, gamboge, elaterium, colocynth, cucumis colocynthis, veratrum.

III. Violent errhines and sialagogues, Turpeth mineral, hydrargyrus vitriolatus, asarum europæum, euphorbium, capsicum, veratrum, nauseous smells, nauseous ideas.

IV. Violent diuretics, nitre, squill, seneka, cantharides, alcohol, foxglove, tobacco, anxiety.

V. Cold sudorifics, poisons, fear, approaching death.