Part 16 (2/2)
There is, however, an important point, with respect to the cure of diseases of exhausted excitability, which could not be known to Dr.
Brown; and this depends on the fact which was formerly pointed out; viz. that the degree of excitability was in proportion to the oxydation of the system. On this account I have given the oxygenated muriate of potash in typhus, which is a disease of diminished excitability, in more than one hundred cases, without the loss of one, a success which has attended no other mode of practice in this disease, if we except, perhaps, the affusion of cold water, as described by Dr. Currie, the effects of which are wonderful, but which can only be applied at the commencement of the disease. In all diseases of indirect debility, therefore, it is proper to attempt the introduction of oxygen into the system, by the oxygenated muriate of potash, acid fruits, nitre, &c. I do not think that the inhaling of oxygen gas for a few minutes in the day can do much good; but free ventilation of apartments, and gentle exercise in the open air, are highly useful.
In either case of debility, we should by no means rely on the action of medicines alone; for though there are a variety of stimulants which will produce excitement, yet this is only temporary, we must therefore endeavour, by nutritious substances, to fill the vessels with blood, and employ all the natural exciting powers in due proportion as soon as possible.
But in the cure of either sthenic or asthenic diseases we shall seldom succeed by the use of one remedy only: for since no stimulus exerts its effects equally on all parts of the body, but always acts more powerfully on some part than on others, we cannot by the use of one remedy alone obtain an equal increase or diminution of excitement.
There are few diseases however in which the excitement is equally increased or diminished over the body; some part being generally more affected than the rest; and this inequality produces the various phenomena or forms of disease; indeed no disease but increase or diminution of strength would take place, on the supposition that an equal increase or diminution of excitement all over the body, were produced by the hurtful powers causing the disease.
From what has been said, it necessarily follows, that every stimulus will not be equally efficacious in curing every form of disease; which is sufficiently confirmed by experience. Hence there may be some ground for the appellation of specifics, as some medicines may act more powerfully upon the part which is the princ.i.p.al seat of the disease, than others do.
In the cure of diseases we ought always to attend to two things most carefully: first, to employ the proper kinds of powers, and then not to overdo them, so as to convert either diathesis into the other; and by pa.s.sing over the line of health, instead of the intended cure, to subst.i.tute one disease instead of another, and thereby bring life itself into danger.
LECTURE XIII.
ON THE GOUT.
There is no disease, with which the human race is afflicted, whose nature has been more mistaken than that which is to form the subject of our present consideration. It has been regarded by most pract.i.tioners as a salutary effort of the body to expel some hurtful cause, and restore health; and therefore has been looked upon as desirable to the patient. To attempt to cure it, therefore, would have been wrong, had it been curable; but it has likewise been looked upon as beyond the reach of medicine, or perfectly incurable; and, on both these accounts, after having tried a variety of drugs, without any good effect, the physicians have at last abandoned their patients, to the care of patience and flannel, which, if the const.i.tution be not very much shattered, will often see them through the disease.
But that it is a salutary disease I deny; and I affirm, that it restores health in no other way, than the indigestion of a habitual dram drinker would be relieved by a disease in the throat, which would, for a time, prevent his swallowing any more liquor; the consequence would be, that his digestive powers would recover their tone, and he would, after a few weeks, feel himself better.
In the same way the pain and fever, which attend gout, and at the same time the inability to move, with the weakened stomach, and bad appet.i.te, prevent the continuance of the mode of life which brought on the disease; and thus, a truce being obtained, the exhausted excitability of the body is allowed to acc.u.mulate, and the const.i.tution, of course, feels itself renovated.
Were the disease to be viewed in this light, it is probable that many patients might in future desist from their former mode of life, which brought on the disease; and we might venture to promise them, if they did, that they would have no return of the complaint. But the misfortune is, they think the gout has restored their const.i.tution, and that therefore they may return to their old mode of living with impunity; in consequence of which, after a few months more, the excitability is again exhausted; symptoms of indigestion come on, and the stimulant mode of living is increased, with a view to bring on the disease, which is to cure these symptoms. In this way, each time, a greater and greater degree of indirect debility is induced, and at last the system becomes so enfeebled, that the asthenic inflammation is not confined to the extremities, but attacks the head, the stomach, the lungs, and often puts a period to the existence of the patient, which has for some time been miserable.
Besides, the idea, that the gout is incurable, is a false, and a very dangerous doctrine; this is very far from being the case, and I am firmly persuaded, not only from the nature of the disease, but from experience, that it may always be cured, if taken in time, and proper directions be followed. If, by the cure of gout be meant the administration of some pill, some powder, or some potion, which shall drive away the complaint, I firmly believe, that it never was, nor ever will be cured. Indeed, it is astonis.h.i.+ng that such an idea should have ever entered the mind of any person, who has any knowledge of nature, or particularly of the human frame; for, if the gout is a disease of indirect debility, and the effect of intemperance, as will be shown by and by, then a medicine to cure it must be something to enable a man to bear the daily effects of intemperance, during his future life, unhurt by the gout, or any other disease; that is, it must be something given now, that will take away the effects of a future cause; as well might a medicine be given to prevent a man breaking his leg, or his arm, seven years hence.
But no rational physician, or surgeon, would give a medicine with this view, in such a case as I have supposed; on the contrary, he would caution his patient against mounting precipices, scaling walls, or bringing himself again into a situation, such as produced the accident; and if he took his advice, he would, in all probability, escape a broken limb in future.
In the same way a rational physician would advise a person recovering from gout, to abstain totally and entirely from the course of life which brought it on; and this being complied with, we might venture to predict, with as much certainty in the one case as in the other, that he would in future escape it.
What I have frequently endeavoured to inculcate in the course of these lectures, always appears to me of the utmost importance: I mean, the general diffusion of physiological knowledge, or a knowledge of the human frame; this knowledge ought to form a part of general education, and is, in my opinion, as necessary for a person to learn as writing, or accounts, or any other branch of education; for if it is necessary that a young man should learn these, that he may be able to take care of his affairs, it surely can be no less necessary, that he should learn to take care of his health; for to enjoy good health, as a celebrated practical philosopher observes, is better than to command the world.
If knowledge of this kind were generally diffused, people would cease to imagine that the human const.i.tution was so badly contrived, that a state of general health could be overset by every trifle; for instance, by a little cold; or that the recovery of it lay concealed in a few drops, or a pill. Did they better understand the nature of chronic diseases, and the causes which produce them, they could not be so unreasonable as to think, that they might live as they chose with impunity; or did they know any thing of medicine, they would soon be convinced, that though fits of pain have been relieved, and sickness cured, for a time, the reestablishment of health depends on very different powers and principles. Those who are acquainted with the nature and functions of the living body, well know, that health is not to be established by drugs; but that if it can be restored, it must be by nicely adjusting the action of the exciting powers to the state of the const.i.tution, and the excitability; and thus gently and gradually calling forth the powers of the body to act for themselves.
And though I believe that most general diseases will admit of a cure, yet I am confident, that no invalid was ever made a healthy man by the mere power of drugs. If this is a truth, should it not be universally known? If it were, there would undoubtedly be an end of quackery, for all quack medicines, from the balm of Gilead, to the botanical syrup, are supposed to cure diseases, or at least a.s.serted to do so, in this mysterious manner.
Dr. Cullen, in his Nosology, gives us the following definition of the gout.
”Morbus haereditarius, oriens sine causa externa evidente; sed praeeunte plerumque ventriculi affectione insolita; pyrexia; dolor ad articulum, et plerumque pedis pollici, certe pedum et manuum juncturis, potissimum infestus; per intervalla revertens, et saepe c.u.m ventriculi et internarum partium affectionibus alternans.”
Now, though this definition comprises a tolerably good general character of the disease, it contains some notions, depending on the prejudice of hypothesis, which, on a careful examination, ought not, I think, to be admitted.
In the first place, I would deny, that the gout, considered as a diseased state of the system, is hereditary. This may perhaps excite some degree of surprise; and, ”I had it from my father,” is in the mouth of a great majority of gouty patients.
If the diseased state of the system, which occurs in gout, were hereditary, it would necessarily be transmitted from father to son; and no man, whose father had it, could possibly be free from it.
There are, however, many instances to the contrary. Our parents undoubtedly give us const.i.tutions similar to their own, and there is no doubt, that if we live in the same manner in which they did, we shall have the same diseases. This, however, by no means proves the disease to be hereditary.
We shall hereafter see, that the gout is a disease of indirect debility, brought on by a long continued use of high seasoned food and fermented liquors. There is no doubt that particular const.i.tutions are more liable to be affected by this mode of living than others; and if my father's const.i.tution be such, I, who probably resemble him in const.i.tution, shall in all probability be like him, subject to the gout, provided I live in the same way; this however by no means proves the disease to be hereditary. The sons of the rich, indeed, who succeed to their fathers estate, generally succeed also to his gout, while those who are excluded from the former, are also exempted from the latter, and for very obvious reasons, unless they acquire it by their own merit.
<script>