Part 15 (1/2)
Heat is one of the exciting or stimulant powers which support life, and one of the most powerful of these stimulants; but cold is only a diminution of it: how then can this produce a sthenic state, or a state of too high excitement? The blood is one of the exciting powers, which, by its continual circulation supports life; but surely if we abstracted a quant.i.ty of this fluid from the body, no person will be bold enough to say, that we by that means should produce an inflammatory disease. Cold renders the body more liable to be affected by heat, or any other stimulus applied, but does not of itself produce any stimulant or inflammatory effects.
To see more clearly the manner in which cold acts, let us inquire how it produces or contributes towards the production of catarrh. When we go into the cold air, at every respiration we take a quant.i.ty of it into the lungs, which brushes over the surface of the mucous membrane that lines the nostrils and trachea, and thus, robbing them of their heat, allows the excitability to acc.u.mulate. But we feel no fever, no sense of tightness or stuffing, nor any other symptom of catarrh, so long as we continue in the cold. If however we afterwards go into a warm room, and particularly near a fire, we receive by the act of respiration the warm air into those very parts which have been previously exposed to cold, and whose excitability is consequently acc.u.mulated. The first effect we perceive is a glow of the parts, which is by no means unpleasant, this however increases; and, in the course of half an hour or an hour, a sense of dryness and huskiness comes on, with a sensation of stuffing in the nostrils, and a tendency to a short dry cough: often likewise, if the exposure to cold has been considerable, and the heat afterwards applied great and sudden, we experience a s.h.i.+vering, and other symptoms of fever. These symptoms are all increased by taking into the stomach any liquid that is either of warm temperature or stimulating quality, or particularly both; we spend a restless night, and awake with all the symptoms of a catarrh, or cold, as it is improperly called. For it is evidently an inflammatory fever, and can be speedily cured by the debilitating plan, and particularly by keeping in a moderately cool place, where the temperature is equable, and not subject to alternations of heat and cold.
But how easily might this complaint have been avoided, were the person subject to it acquainted with its real nature, and the manner in which it is brought on. When we come out of a very cold atmosphere, we should not at first go into a room that has a fire in it; or, if this cannot be well avoided, we should keep for a considerable time at as great a distance from the fire as possible, that the acc.u.mulated excitability may be gradually exhausted by the moderate and gentle action of heat; and then we may bear the heat of the fire without any danger; but above all, we should refrain from taking warm or strong liquors while we are hot. In confirmation of this opinion, numerous instances might be brought, where catarrh was cured merely by exposure to cold.
When a part of the body only has been exposed to the action of cold, and the rest kept heated; if, for instance, a person in a warm room has been sitting so that a current of air, coming through a broken window, has fallen upon any part of the body, that part will soon be affected with an inflammation, or what is called a rheumatic affection. In this case, the excitability of the part exposed to the action of the cold, becomes acc.u.mulated, and the warm blood, rus.h.i.+ng through it, from every other part of the body, excites an inflammation.
Thus catarrh and rheumatism are inflammatory complaints, or depend on too great a degree of excitement, and are to be cured by lowering the excitement, or diminis.h.i.+ng the action of the exciting powers; by bleeding, purging, low diet, and particularly keeping in a moderately cool place; and these complaints will be as speedily and certainly cured by these methods, properly and judiciously persevered in, as a slight cut or wound will be healed by what surgeons call the first intention.
There are complaints which resemble these, but whose nature, however, is very different, and which require a very different mode of treatment. After a part has been long affected with rheumatic inflammation the excitability of the muscular fibres becomes so far exhausted, that a state of indirect debility takes place, and an inflammation, accompanied with pain and redness, which is very different from that I formerly described, as it depends upon a debilitated or relaxed state of the parts, instead of too great a degree of excitement. This instance shows strongly the fallacy of symptoms; but it may be readily distinguished from the inflammatory rheumatism, by attention to the effects of the exciting causes. The inflammatory rheumatism is aggravated by heat, hence it is more violent in bed than at any other time. The latter complaint, however, is greatly relieved by heat: the warm bath alleviates all the symptoms; so does a warm bed. It is evident that these diseases, though attended by the same symptoms, are as opposite, and require as different modes of treatment as an inflammation of the brain, and a dropsy. The inflammatory state has been called the acute rheumatism, and the other, the chronic rheumatism; I would, however, prefer the terms sthenic and asthenic rheumatism.
In the same manner, there is a catarrh, which is liable to afflict persons who have often been subject to an inflammatory cold, particularly persons advanced in years; and this depends on a state of indirect debility of the parts, the excitability of which has been exhausted by frequent and violent inflammatory affections. This complaint, which I would call asthenic catarrh, requires directly opposite treatment from the inflammatory or sthenic catarrh. The latter is aggravated by heat, but relieved by a cool temperature.
Warm air is peculiarly grateful to those who are afflicted with the former, and if they go into a cool temperature, they are immediately seized with cough, and expectoration; for the disease being a disease of debility, the withdrawing the stimulus of heat, must increase it.
The excitability of the parts is so far exhausted, that it requires a stimulus even more than natural to keep them in tone: hence persons labouring under asthenic catarrh, and some species of asthma, which are only varieties of this disease, find themselves best when exposed to a warm temperature, but on the heat being diminished, and consequently the parts relaxed, the cough and difficulty of breathing immediately come on.
Having examined the effect of heat, in producing inflammatory or sthenic disease, I now proceed to the consideration of the other powers. Of the articles of diet, the only food in danger of being too stimulant, is perhaps flesh or land animal food, used in too great quant.i.ty, particularly when seasoned, a preparation which adds much to its stimulant power. Spirituous and vinous liquors, let them be ever so weak or much diluted, stimulate more quickly, and more readily than seasoned food, and their stimulus is in proportion to the quant.i.ty of alcohol which they contain. These substances, when conjoined with rich food, must bring on a predisposition to sthenic disease, in almost any const.i.tution, particularly in the young and healthy, and, in many instances, those diseases actually take place; or should this not be the case, should the person avoid, or escape the effects of inflammatory diseases, the excitability will be exhausted, and diseases of indirect debility, such as gout, apoplexy, indigestion, palsy, &c. will take place.
These stimulants are never necessary to a good const.i.tution, and their effects will always, sooner or later, be experienced: for though a person with a good const.i.tution may continue for years to indulge in the pleasures of the bottle, or the luxuries of the table, depend upon it that a continuance of them will sap the vigour of the strongest const.i.tution that ever existed.
As nothing contributes more to the health of the body than moderate and frequently repeated exercise, which rouses the muscles to contraction, and promotes the circulation of the blood in the veins towards the heart: it thus produces excitement; but an excess of it will produce sthenic diathesis; and, if carried to great excess, it will produce a state of indirect debility, or exhausted excitability.
When any, or all of these exciting powers act too strongly on the body, the first effect they produce is a preternatural acuteness of all the senses; the motions, both voluntary and involuntary, are performed with vigour, and there is an acuteness of genius and intellectual power. In short, every part of the body seems in a state of complete vigour and strength; that this is the case with the heart and arteries, appears from the strong and firm pulse; in the stomach it is shown by the appet.i.te; and, in the extreme parts, by the ruddy colour and complexion. In short, every appearance marks vigour of the body, and abundance of blood. Could the body be kept in this state, nothing could be more to be desired; this, however, is impossible; the excitement, though still within the bounds of health, has overstepped the point of good health, and is verging fast to predisposition to sthenic disease; so that, to secure a permanent state of health, it is always better to keep the excitement rather under the middle point, or 40 degrees, than above it. During the predisposition to sthenic disease, which is produced by the longer continued, or increased action of these powers, no symptoms of disease appear; but shortly after, disturbed sleep, depressed spirits, languor, a sense of fulness, heaviness, particularly after eating, show that this sthenic state cannot be further increased with impunity. The least increase of sthenic diathesis now brings on a disturbance of the functions, or actual disease; the commencement of which is generally a s.h.i.+vering, and a sense of cold; thirst and heat succeed; and then generally a pain in some part, either external or internal: costiveness generally attends this state, the urine is clear, and secreted in small quant.i.ty; memory and imagination become diminished, and there is generally less appet.i.te for food.
In peripneumony, inflammatory sore throat, and acute rheumatism, there is an inflamed condition of the lungs, of the parts about the throat, or of the muscles of the extremities: this shows that the excitement here is greater than in other parts of the body; but it is still increased or too great in every part, only those parts which give the peculiar character to the disease are more affected than other parts of the body, by being more exposed to the exciting causes: thus, if a person be in perfect health, or a little below, he will not be easily affected by any of the exciting causes of sthenic disease, unless their application be very violent; he will go into a warm room out of the cold air, and feel no other effect than a pleasant glow: but if, by high living, or other means, he is brought near the point of predisposition to sthenic disease, then the slightest additional stimulus will bring it on, and if the throat has been exposed to the application of cold, and the person comes afterwards into a heated room, an inflammation of the parts about the throat, or an inflammatory sore throat, accompanied by a sthenic diathesis of the whole system, will be the consequence. This cannot be cured by merely diminis.h.i.+ng the excitement of the part, while the excitement of the whole system remains: if we apply leeches to the throat in this state, to diminish the quant.i.ty of blood, we only debilitate the vessels, while fresh quant.i.ties of blood are poured into them from the too full vessels of the body; even if we could thus remove the sthenic diathesis of the part, we should go but a little way towards removing the inflammatory disease, which universally pervades the system.
The mode to be pursued therefore is, to take a quant.i.ty of blood from the body, by opening a vein; to keep the body cool, by remaining in a room where the temperature is at temperate, or a little below; by abstaining from animal food, and from spirituous or fermented liquors; and by the exhibition of purgatives, or at least of laxatives. Then leeches or blisters applied to the part affected will produce a good effect; and even stimulant applications to the inflamed part may be advantageous; for a topical inflammation, as we shall afterwards have occasion to see, depends on a debilitated state of the minute vessels of the part, while at the same time the action of the whole system is increased.
Besides the energy of the exciting hurtful powers, which I have mentioned, there is in the parts which undergo the inflammation, a greater sensibility, or an acc.u.mulated excitability; by which it happens that some are more affected than the rest. To this we may add, that whatsoever part may have been injured by inflammation, that part in every future sthenic attack is in more danger of being inflamed than the rest. Hence inflammatory sore throat, rheumatism, and some other complaints of the kind, when once they have supervened, are very apt to recur.
Among the sthenic or inflammatory diseases may be enumerated rheumatism, catarrh, cynanche, or sore throat, scarlet fever, inflammations of the brain, stomach, lungs, &c. &c.
Many of the contagious diseases, particularly small pox and measles, produce a sthenic state, and are to be cured, or their action moderated, by the debilitating plan which has been pointed out; and particularly by a moderate, constant, and equable diminution of temperature. Hence the violence of these diseases is greater when they attack a person already predisposed to sthenic diathesis, but much more mild when the excitement is rather under par.
LECTURE XII.
ON INFLAMMATION AND ASTHENIC DISEASES.
The last lecture was taken up chiefly with an account of sthenic diseases, or those depending on too great a degree of excitement, and which have been generally, but improperly, called inflammatory or phlogistic. In that lecture I attempted to show, that when the natural exciting powers, which support life, act with too much power, or particularly if we employ any stimulants not natural to the body, the functions both of body and mind become increased in vigour; but if the exciting causes are continued and increased, the functions become disturbed, and their action becomes painful and distressing.
This state, which is called sthenic diathesis, is often accompanied by a redness, swelling, pain, and increased heat of some particular part: these symptoms const.i.tute what is usually termed an inflammation of the part.
The method of cure in sthenic diseases was shown to be, by reducing or moderating the action of the exciting powers; by keeping the body cool; abstaining from high seasoned, and, in general, from animal food; by the use of purgatives, and in many cases by diminis.h.i.+ng the quant.i.ty of blood in the body. I mentioned likewise, that it would be but of little use to attempt to subdue the excitement of the inflamed part, unless the excitement of the whole system was previously diminished; but that after a general bloodletting, stimulant remedies applied to the inflamed part, might be employed with success. This is strictly agreeable to experience, but at first sight seems so very contrary to the principles that have been advanced, that I shall endeavour to explain the phenomena of inflammation, which do not seem to be in general well understood.
All kinds of inflammation agree, in being attended with redness, increased temperature, pain, and swelling; but they vary according to the situation and texture of the part affected. All parts of the body, excepting the cuticle, nails, hardest part of the teeth, and hair, are subject to inflammation.
Among the causes of these complaints, may be enumerated too full a diet, particularly too free a use of fermented liquors, and whatever increases the impetus of the blood towards the part, as mechanical and chemical irritation, and sudden changes of temperature, particularly from cold to heat.
To explain the nature of inflammation, it may be observed, that such is the wise const.i.tution of the animal body, that whatever injures it, excites motions calculated to correct or expel the offending cause. Thus if an irritating substance is received into the stomach, it excites vomiting; if into the lungs, a violent fit of coughing is excited, and if into the nostrils, sneezing is the consequence. In such cases we can readily trace the motions excited, and the manner in which they act; but cannot trace the manner in which the offending cause excites these motions.
Now if it can be shown that inflammation, like vomiting and coughing, is an effort of the system to remove an offending cause, and if we can trace every step of this operation, with the exception of the changes induced on the nervous system, we shall understand the nature of inflammation as completely as that of any function of the body.
The circ.u.mstance the most difficult to explain, is the increased redness of the part affected, which can only depend on an increased quant.i.ty of blood in the vessels. This has been supposed to depend upon an increased action of the vessels of the part; but that this is not the case, must be evident from what was said when we were speaking of the circulation of the blood. It was shown, that the circulation could not be carried on by the mere force of elasticity alone; this force, were it perfect, would produce no effect; but as there is no body with which we are acquainted that is perfectly elastic; so the coats of the arteries are very far from being so, hence their effect as elastic tubes will be to diminish the force of the heart, instead of adding to it; for a certain quant.i.ty of this force will be spent in distending the vessels, which, were they perfectly elastic, would be restored to them, but as this is not the case, this force is by no means restored. Indeed a variety of considerations, observations, and experiments, tend to prove, that the vessels are endowed with a power very different from elasticity, which differs only in degree from that of the heart; in short, they are possessed of muscular power.