Part 16 (1/2)
The laws of nature are constant and uniform, and the same, or similar causes, both in the animate and inanimate world, are always productive of the same, or similar effects.
The cure of these complaints is at least obvious, if not easy. It consists in deserting crowded and heated rooms, at least for part of the time they have been usually occupied; in abstaining from strong wines; in keeping the bed rooms moderately cool; and retiring to rest at a proper hour.
With respect to the effects of nutriment, in producing asthenic diseases, we may observe, that all watery vegetable food, too sparing a use of animal food, as also meat which is too salt, and deprived of its nutritious juices by keeping, when more nutritious matter is at the same time withheld, constantly weaken, and thereby tend to produce asthenic diseases. Hence would appear to arise that remarkable imbecility of body and mind which distinguishes the Gentoos. Hence arise the diseases with which the poor are every where afflicted; hence scrofula, epilepsy, and the whole band of asthenic diseases.
But intemperance in eating and drinking, or taking nutritious and highly stimulant substances too freely, will, infallibly, bring on asthenic disease, or a state of indirect debility, by exhausting the excitability; and it must be observed, that this species of debility is much worse to cure than the direct kind; for in the latter we have abundance of excitability, and a variety of stimuli, by which we can exhaust it to the proper degree, and thus bring about the healthy state; whereas, in indirect debility, the vital principle or excitability is deficient; and we have not the means of reproducing it, at pleasure, absolutely under our command. Besides, the subtraction of stimulants, which is one of the most certain means we have of acc.u.mulating excitability, if carried to a great extent, in diseases of indirect debility, would produce death, before the system had power to reproduce the lost or exhausted excitability. Hence the cure, in these two kinds of debility, must be very different: in cases of direct debility, as in epilepsy, we must begin with gentle stimulants, and increase them with the greatest caution, till the healthy state is established: we must, however, guard most carefully against over doing it; for, if we should once overstep the bounds of excitement, and convert the direct into indirect debility, we shall have a disease to combat, in which we have both a want of excitement and of exciting power.
In cases of violent indirect debility, as, for instance, in gout, when it affects the stomach: it would be wrong to withdraw the stimulus, for the excitability is in such an exhausted state as to produce no action, or very imperfect and diseased, from the effect of the common exciting powers; we must, therefore, here apply a stimulus greater than natural, to bring on a vigorous and healthy action, and this stimulus we should gradually diminish, in order to allow the excitability to acc.u.mulate, by which the healthy state will be gradually restored.
This method was very judiciously recommended, by a very eminent physician, in the case of a Highland chieftain, who had brought on dreadful symptoms of indigestion by the use of whisky, of which he drank a large silver cup full five or six times in the day. The doctor did not merely say, diminish the quant.i.ty of spirits gradually, for that simple advice would not have been followed; but he advised him to drink the cup the same number of times full, but each morning to melt into it as much wax as would receive the impression of the family seal. This direction, which had something magical in it in the mind of the chieftain, was punctually obeyed. In a few months the cup was filled with wax, and would hold no more spirits; but it had thus been gradually diminished, and the patient was cured.
This reminds me of a number of cases, which had been brought on by drinking porter, and other stimulant liquors, without knowing the taste of water. In many of these cases if a moderate quant.i.ty of water were drank every day they would be cured; but you would find few who would follow such plain and simple directions. How then must a physician proceed? Why, as is generally done by the most judicious: they direct their patients to Bath or Buxton, and there advise them to swallow a certain quant.i.ty of water every day, which they do most scrupulously, and, of course, return home cured.
As causes of asthenic disease, we must not omit the undue exercise of the intellectual functions. Thinking is a powerful exciting cause, and produces effects similar to those of intoxication. None of the exciting powers have more influence upon our activity, than the exercise of the intellectual powers, as well as pa.s.sion and emotion.
Homer, the great observer and copyist of nature, observes of the hero, whom he gives for a pattern of eloquence, that, upon his first address, before he had got into his train of thought, he was awkward in every motion, and in his whole att.i.tude; he looked down upon the ground, and his hands hung straight along his sides, as if they had lost the power of motion; and his whole appearance was a picture of torpidity. But when he had once fairly entered upon his subject, his eyes were all on fire, his limbs all motion, grace, and energy.
Hence, as the exercise of the intellectual functions evidently stimulates, an excess of thinking must bring on indirect debility, by exhausting the excitability. But though we do meet with instances of indirect debility arising from this source, it must be confessed that they much oftener arise from the use of very different stimulants.
As excessive exercise of the intellectual powers will bring on indirect debility, so the deficient, weak, or vacant state of mind, which is unable to carry on a train of thinking, will produce direct debility. Indeed this debility often occurs to those whose minds have been all their life actively engaged in business, but who have at last retired to enjoy themselves, without having a cultivated mind fit for retirement. They become languid, inert, and low spirited, for want of the stimulus of mental exertion; and in many cases cannot be completely restored to health, till they are again engaged in their usual occupations.
Violent pa.s.sions of the mind, such as great anger, keen grief, or immoderate joy, often go to such an extent as to exhaust the excitability, and bring on diseases of indirect debility. Hence both epilepsy and apoplexy have been the consequences of violent pa.s.sion.
On the contrary, when there is a deficiency of exciting pa.s.sion, as in melancholy, fear, despair, &c. which are only lower degrees or diminutions of joy, a.s.surance, and hope, in the same way that cold is a diminution of heat, this produces a state of direct debility. The immediate consequences observable are, loss of appet.i.te, loathing of food, sickness of the stomach, vomiting, pain of the stomach, colic, and even low fevers.
The effect of impure air, or air containing too small a proportion of oxygen, is likewise a very powerful cause of debility.
In short, when any or several of these causes, which have been mentioned, act upon the body, asthenic diseases are the consequence.
Asthenic diseases, as has frequently been hinted, may be divided into two cla.s.ses, those of direct debility, and those of indirect debility.
Among the diseases of direct debility may be enumerated dyspepsia, hypochondriasis, hysteric complaints, epilepsy, bleeding of the nose, spitting and other effusions of blood, cholera morbus, ch.o.r.ea, rickets, scrofula, scurvy, diabetes, dropsy, worms, diarrhoea, asthma, cramp, intermittent fevers.
Among those of indirect debility, or which are produced by over stimulating, which exhausts the excitability, may be enumerated, gout, apoplexy, palsy, jaundice, and chronic inflammation of the liver, violent indigestion, confluent small pox, typhous fever, and probably the plague, dysentery, putrid sore throat, teta.n.u.s.
Diseases, therefore, according to this system, may be divided into two cla.s.ses. First, general diseases, which commence with an affection of the whole system, and which must be accounted general, though some part may be more affected than the rest. Secondly, local diseases, which originate in a part, and which are to be regarded as local, though they may sometimes in their progress affect the whole system, like universal diseases: still however they are to be cured by remedies, applied not to the whole system, but to the part affected only.
A pleurisy or peripneumony, for instance, is a general disease, though the chief seat of the symptoms seems confined to a portion of the thorax: but the affection of this part, though it may be somewhat greater than that of any other equal part, is vastly less than the affection or diathesis diffused over the whole body. The exciting or hurtful causes which produce these diseases, by no means exert their whole power upon a small portion of the superficial vessels of the lungs, and leave the rest untouched; on the contrary, they affect exery part of the system, and the whole body partakes of the morbid change. Indeed the general or universal affection; viz. a sense of heaviness and fullness, uneasy sleep, and other symptoms of increased excitement, are commonly perceived some time before the pain of the thorax becomes sensible. The remedies which remove the disease; viz.
venesection, abstaining from animal food, and every mode of debilitating, do not exert their whole efficacy on an inflamed portion of the lungs; for by removing the affection of the lungs we should go but a little way towards removing the disease.
Among local diseases we may enumerate wounds, or solutions of the continuity of the part, bruises, fractures, inflammations from local irritation, &c. Hence it is evident that the treatment of general diseases is the province of the physician; and of local ones of the surgeon. But there are some general diseases which are apt to degenerate into local, and therefore require the attention both of the physician and the surgeon. Among these we may reckon suppuration and gangrene, sphacelus, and some others.
The first cla.s.s, or general diseases, may be divided into two orders; sthenic, and asthenic. The asthenic order may be subdivided into two genera; viz. diseases of direct debility, and diseases of indirect debility; for debility, according to the system I am explaining, is that relaxed or atonic state of the system which accompanies a deficient action of the stimulant or exciting powers; and this deficient action may arise immediately from the partial or too sparing application of the exciting powers; the excitability or capacity of the system to receive their actions, being unaffected or sufficiently abundant; or it may arise from the excitability being exhausted, by the violent or long continued action of the exciting powers.
This arrangement of diseases, which naturally follows from the fundamental principles of the doctrine, and which is guided by the state and degree of excitement, is widely different from that of former nosologists, who have arranged or cla.s.sed them according to symptoms, which have already been shown to be fallacious; and which method of arrangement brings together diseases the most opposite in their nature, and separates those most nearly allied. This is evident in every part of the nosology of Sauvages and Cullen. In the genus cynanche of the latter, are placed the common sthenic or inflammatory sore throat, or cynanche tonsillaris, and the putrid or gangrenous sore throat, the cynanche maligna: the former is a sthenic disease; the latter one of the greatest debility; yet they have the same generic name.
The mode of cla.s.sing diseases which I have adopted, after the example of Dr. Brown, is the consequence of first taking a view of the nature of life, and the manner in which it is supported; and from thence observing how those variations from the healthy state, called diseases, are produced; and this is certainly the proper plan; for, as every effect will be produced with more accuracy, whilst its cause is acting in a proper degree, it is certainly right to begin by drawing our general propositions from the healthy state; by which means we avoid being misled by those false appearances which the living system puts on, during a morbid state; and though the contrary has been the general practice of nosologists and pathologists, I must confess it appears to me like beginning where the end should be; for to lay down rules for restoring health, and begin by observing the phenomena of disease, is like building a house, and beginning with the roof.
In the last lecture I pointed out the general method of curing sthenic diseases; I shall now proceed to the cure of asthenic, and shall begin with those depending on direct debility, as in these diseases the excitability is morbidly acc.u.mulated, and consequently more liable to be overpowered by the action of a stimulus, we must, therefore, at first, apply very gentle stimulants, increasing them by degrees, till the excitement be arrived at the healthy state.
In cases of indirect debility, the excitability is so far exhausted as not to be sufficiently acted on by the ordinary powers which support life; we must therefore employ, at first, pretty strong stimulants, to keep up such a degree of action as is necessary to preserve life; we should, however, be careful not to overdo it; for our intention here, in giving these stimuli, is only to keep up life, while the cure must depend upon the acc.u.mulation of the excitability.
That this may take place, therefore, we must gradually lessen the quant.i.ty of stimulus, till the excitability become capable of being sufficiently acted on by the exciting powers, when the cure will be affected.