PATHOLOGY. 
206 
ftituting the phenomena of the cold ftage, are explicable 
on the fuppofition of a deprelllon or diminution of the 
nervous energy, however induced; and chiefly adding by 
conftriCHng the capillaries, or by conftri&ion of thofe 
capillaries which involve the brain in torpor. In like 
manner, the fymptoms of the hot -ftage and the fubfe- 
quent phenomena, in continued fevers, are refera¬ 
ble to an imperfeCt recoiling, as it were, of the ner¬ 
vous power, and more immediately to the increafed 
aCtion of the heart and arteries, and of the capillary 
veflels.' 
The heat, the rednefs of Ikin, and flufhed counte¬ 
nance, the returning fize of the external parts, the ref- 
toration or even increafe of the fenfibility of the organs, 
are all the refult of the diflention of the extreme veflels 
by the red blood, as the oppofite fymptoms of the cold 
ftage were the confequence of an oppofite condition of 
the circulation. Hence the frequent forenefs of the 
body, which cannot bear its own preflure without pain ; 
hence intolerance of light in the eye, and the quick fen¬ 
fibility to noife in the ear, both of which increafe the 
head-ache, which is now more acute, and deep-feated: 
hence alfo difeafed parts become more painful. The 
quick and ftrong pulfe implies the greater force of the 
heart, and of the arterial aCtion ; neverthelefs the dry- 
nefs of the flcin, and the continued fuppreflion of the 
reft of the fecretions, evince the continuance of a mor¬ 
bid condition of the extremities of the exhalantsand fe- 
cernents by which their funftions are impeded. 
This laft circumftance has been varioufly explained. 
Cullen attributed it (as before ftated) to a fpafmodic 
contraction of the termination of the veflels; but, as 
we before fhowed, it did not explain how this was pro¬ 
duced ; and it feemed curious that a fufpenfion of fecre¬ 
tions ftiould arife both in the hot and cold ftage from the 
famecaufe. A new explanation has been promulgated by 
a late author, Dr. Park. He conceives that, “ During the 
hot ftage of fever, that thefe mouths are clofed can hard¬ 
ly admit of difpute; as it feems impoflible in any other 
way to explain, when the veflels to which they belong 
are gorged and diftended with fluids, what prevents thefe 
fluids from tranfuding at every pore. 
“ In order to explain why they are thus conftriCted in 
the hot ftage, and to underftand the nature of thefe pa¬ 
tulous mouths which perform an important part in the 
production of both fever and inflammation, we have 
only to regard them in the light of fphinCters, to which 
they are perfectly analogous. The office of both is to re¬ 
tain the contents of the organ to which they belong, or 
to allow their tranfmiinon only at fuitable times, and in 
proper quantity. Accordingly, the aCtion of the fphinc- 
ter appears to be vicarious with that of the organ, as its 
office requires it ffiould be; that is, the fphinCter relaxes 
when the organ contracts, and, on the other hand, the 
fphinCter contracts when the organ relaxes. Tl^us, for 
example, when the ftomach is roufed to inordinate ef¬ 
forts of contraction by an emetic, its fphinCter, the py¬ 
lorus, relaxes, and bile is tranfmitted through the duo¬ 
denum in vomiting. When the inteftines are excited to 
contraction by a ftrong purgative, the fphinCter of the 
rectum relaxes, and faeces are with difficulty retained. 
When the bladder contracts for the expulfion of urine, 
its fphinCter relaxes, and allows the tranfmiffion of this 
fluid. So likewife, when the veflels of the furface fltrink, 
and palenefs is produced by fear, a cold fweat breaks 
out, and the furface becomes moift. Or, when the vef- 
fels collapfe from lofs of blood, the fame clamminefs of 
the furface attends, and is the forerunner of fyncope.; 
and thus tranfpiration is increafed, and not fufpended, 
as Dr. Cullen fuppofed, by moderate contraction of the 
veflels. 
“ On the other hand, the fphinCters and the pores alike 
become conftriCted when the organs or veflels to which 
they belong are relaxed and over-diftended. Thus, when 
the ftomach is diftended with food, the pylorus clofes. 
and fuffers nothing to be tranfmitted till the bulk of its 
contents is reduced by abforption. When the reCtum is 
over-diftended by immoderate accumulation of faces, its 
fphinCter contracts, and the molt obftinate conftipation 
is apt toenfue. When the bladderis over-diftended with 
urine, its fphinCter becomes conftriCted, and ftrangury 
is the confequence. In like manner, when the veflels of 
the furface are over-diftended by immoderate determina¬ 
tion of blood in fever or inflammation, the pores then 
become conftriCted, and tranfpiration is fupprefied. And 
for the fame reafon, the fecretion of bile is fupprefied in 
aCtive inflammation of the liver; and that of urine in 
acute inflammation of the kidneys. Thus the mouths 
of theexhalent veflels, terminating on the external and 
internal furface, appear to be governed by the fame laws, 
and to exhibit the fame modes of aCtion, as the fphinc- 
ters belonging to larger organs. In the hot ftage of fe¬ 
ver, then, tranfpiration is fupprefied, and morbid heat 
kept up by over-diftention of the veflels exciting fpafmo¬ 
dic conftriCtion of their mouths ; and accordingly it is 
to the removal of vafcular diflention that we mull look 
for a ceflation of that conftridion, and the return of 
tranfpiration.” 
To us, this idea of the fphinCter-like properties of the 
fecreting veflels appears as vifionary and gratuitous as 
the notion before mentioned of Cullen. Moreover, 
much mult, in the relaxation of fphinCters, be attributed 
to the form which their antecedent mufcular parts oppofe 
to them. At all events, this fuppofition is not required. 
If fecretion were a procefs dependant on the mere drain¬ 
ing or letting-through of certain parts of the blood, we 
could account well for the hindrance of fecretion on the 
notion of contraction in the veflels; but the products of 
fecretion depend on nervous influence; take away the 
nerves going to a part, and fecretion ceafes. Can this 
be becaufe fuch deprivation caufes a contraction of their 
mouths ? 
The alteration of the fecretion in fever is thus ex¬ 
plained. Secretion is diminiflied in the firft ftage, be¬ 
caufe the conftriCtion of the capillaries brings to the fe- 
cernents fmaller quantities of blood. It is ftill more di- 
miniffied, or it is altered or fufpended, in the hot ftage 
of fever, becaufe, the nerves being prefled on by the dif¬ 
tended capillaries, or the nervous power being more ra¬ 
pidly expended in the blood in the generation of heat, 
perhaps a more rapid motion in the fanguineous circula¬ 
tion is hindered from aCling on the fecernents. It mat¬ 
ters not whether the latter be diftended or contracted, or 
in a mean ftate : they are too fmall to receive blood; and 
the ftate of its parts depends on the faculties de¬ 
rived from the nerves, which we fee have here loft their 
power. 
Cullen erred in confidering the hot to be an invariable 
confequence of the cold ftage of fever. The cold ftage 
may happen ; and fo great may be the debility induced, 
that re-aCtion may never return ; or the hot ftage may 
be manifefted at once, as in fymptomatic fevers and fome 
other kinds. The fweating ftage is produced in a man¬ 
ner not very well underftood. It was fuppofed by the 
older phyiiologifts, as Albinus, Haller, &c. that the 
fweat, as well as the infenfible perfpiration, is a mere 
exudation of the watery part of the blood through the 
cuticle ; hence it w\as faid to arife, in fever, from a me¬ 
chanical relaxation of the extreme arteries, which were 
fuppofedtobe fpafmodically contracted during the hot 
ftage. But it has been obferved by later phyfiologifts, 
that this opinion refpeCting the nature of the perfpiration 
is contrary to all analogy, and founded only upon expe¬ 
riments made on the dead body. The opinion of Dr. 
Fordyce and Mr. Crufcklhanks appears to be the true one; 
namely, that the matter of perfpiration is fecreted from 
the blood by the capillary arteries, and thrown out on 
the furface by organic pores in the cuticle, (however dif¬ 
ficult to be difcovered,) connefted with the extremities 
of thefe arteries ; and that in this procefs there is not a 
4 feparation 
