Part 17 (2/2)
By a continuance of this plan, the inflammation again appears; but the system having become more torpid, the inflammatory action is by no means so great as it was before: if it has power to restore the equilibrium between the resistance and propelling force, and thus cure itself, this effect is entirely confined to the inflamed part.
The other foot labouring under similar torpor, or debility, now feels the effects of the propelling force, and an inflammation takes place in it, which having cured itself in the same manner, and the torpor of the foot first affected being returned, or even greater than it was before, on account of the previous excitement; the inflammation again attacks this foot, and thus the gout is supposed to emigrate from one limb to another. The gout, as a disease of general debility, however, remains the same; and it is only these symptoms, which form but a small part of the disease, that vary according to circ.u.mstances.
If, during an asthenic inflammation of the lower, or upper extremities, the torpor and debility of the whole system increase, then the force of the circulation, or propelling force, being diminished, the symptoms of inflammation will suddenly disappear; but as great debility now prevails, the stomach will be apt to be affected with cramps or convulsions, or an asthenic inflammation of some internal part will take place: for, though the propelling force is not sufficient to overdistend the debilitated vessels of the extremities, it will distend those of the internal parts nearer the heart, which are now debilitated.
In this case, it has been generally, but absurdly imagined, that the gout is translated, or recedes from the extremities to some internal part: the term of retrocedent gout has therefore been applied to occurrences of this nature. From the explanation which has been given, it is evident, that this term is improper. The general debility being increased, the propelling force becomes unable to produce an inflammation of the extremities, and this is the reason why it disappears. The disease, however, is not at all altered in its nature by this variation of symptoms. It is still the same, by whatever name it may be called.
It sometimes happens, that after full living, the stomach becomes particularly affected, and the patient is troubled with flatulency, indigestion, loss of appet.i.te, eructations, nausea, and vomiting, with great dejection of spirits, pain and giddiness of the head, disturbed recollection, or muddiness of intellect, as it is termed, with all the symptoms, which usually precede a regular fit of the gout, yet no inflammatory affection of the joints is produced. This state has been absurdly enough called the atonic gout, as if there were a gout accompanied with vigour and sthenic diathesis: but the absence of inflammation in the extremities may depend on two causes.
First, the powers producing the disease, may have debilitated the stomach and first pa.s.sages, while the vessels of the extremities are not particularly debilitated, and the resisting force is able to counterbalance the propelling force: in this case, no morbid degree of distention or inflammation of the extreme vessels can take place.
Secondly, the general debility may be such, and the power of the circulation so much diminished, that, though the extreme vessels may be debilitated, no inflammation, or preternatural distention will take place.
Hence, we see, that this is still the same disease; but that physicians have erred in their explanation of the symptoms, by regarding that as the princ.i.p.al part of the disease, which is only a symptom.
We have seen then, that by the theory which has been unfolded, all the symptoms of this. .h.i.therto mysterious disease are plainly and naturally explained. We shall next see if the only method of cure which experience warrants, cannot be explained upon the same principles.
If, on entering this part of the subject, any one should expect that I should furnish him with a receipt, consisting of certain drugs, which swallowed, will cause this terrible disease to disappear, and health to take its place, he would be very much mistaken; for, can any person in his senses suppose that a disease, which he has been almost his whole life in contracting, and an exhausted state of the excitability, which has been gradually brought on by years of intemperance, can be dispersed by a pill, a powder, or a julep? Or, if the symptoms could be relieved by medicine, which they often may, can he suppose, that they will not return, if the same mode of living, which first brought them on, be continued?
I shall, however, proceed to give some directions, which if rigidly persevered in, will not only afford relief in the fit, but will prevent its return with such violence, and at last totally eradicate it, provided the const.i.tution be not completely exhausted, and almost every joint stiffened with calcarious concretions.
The inflammation of the extremities may at any time be relieved by means of electricity, or by stimulant embrocations applied to the part, and this without any danger whatever of throwing the complaint on some more vital part, as has generally been imagined. If I were to apply any debilitating means to the part, I should then probably relieve the pain; but, by debilitating the whole system, should cause an attack of the stomach, or some other internal part, as has been already explained; but by a stimulant application to the inflamed part I run no such risk. The inflammation is of the asthenic kind, depending upon a debility of the small vessels, whereby they do not afford sufficient resistance to the propelling force, and therefore become morbidly distended, or inflamed, as it is termed, though this term is certainly improper, even in a metaphorical view: but a stimulant application to the part excites the debilitated vessels to action; their contraction diminishes the morbid quant.i.ty of blood; and the balance between the propelling and resisting forces being restored, the inflammation of course ceases. This is not a mere deduction, a priori, from the theory of inflammation, which I have delivered; it is the result of repeated experience. I have seen several very violent gouty inflammations very speedily removed by electricity. Small sparks should be drawn from the part affected, at first through flannel, and increased as the patient can bear them: sparks alone are necessary; recourse need never be had to shocks. But though we thus remove a very painful part of the disease, yet still a formidable debility remains, and unless this be removed, the inflammation will be apt to return. In endeavouring to remove this general debility, we must recollect, that it is of the indirect kind, or depends upon an exhausted state of the excitability; our great object therefore, is to allow the excitability to acc.u.mulate. But this acc.u.mulation depends as well upon the proper action of the different functions, as upon the withdrawing of stimulants: we ought therefore to guard carefully against costiveness, by which the proper action of the stomach and bowels is very much injured: but we must use warm laxatives. An infusion of senna and rhubarb in proof spirits, made still stronger by aromatics, has always seemed to me to answer the purpose best, and this should be taken of a temperature rather above blood warm; for instance, about 100 degrees. This is particularly necessary, when the gout attacks the stomach, and I have several times seen a severe attack of it removed in half an hour, by a tincture of this kind. Indeed, the most violent attacks of the stomach may be relieved; and are only to be relieved by spirits, ether, and opium.
It is on this organ, that the hurtful powers have produced their greatest effect; for to it they are immediately applied. It is by no means surprising, that the constant application of highly seasoned foods, with fermented and spirituous liquors, should at last wear out the vital principle of this organ. Indeed it is often so far exhausted, that the most terrible cramps and convulsions take place, which would soon end in its total extinction, unless it were roused to somewhat like a proper action by the most powerful stimulants.
Still, however, their effect is but temporary.
With respect to a regular fit, after the inflammation of the extremities has been subdued by the means I have mentioned, a generous, but not full diet should be used. A person who has been for a long time accustomed to wine, cannot easily be deprived of it at once; but he should drink Madeira, and those wines, which neither contain much carbonic acid, nor deposite much tartar. His food should be of the plainest kind, and generally boiled, instead of roast. The great thing is to keep the spirits and excitement rather under par, but not to let the patient sink too low. In this way, the exhausted excitability will gradually acc.u.mulate, and the healthy state be reestablished. When this is once effected, the gout may be prevented in future with the greatest certainty, if the patient will have resolution. The whole secret consists in abstaining, in toto, from alcohol, in every form, however disguised, or however diluted. He must not take it, either in the form of liqueurs, cordials, wine, or even small beer.
I believe there never was an instance of a person having the gout, who totally abstained from every form of alcohol, however he might live in other respects: and I doubt very much, if ever the gout returned after a person had abstained from fermented or spirituous liquors for two years.
Temperance in eating, and exercise, are, no doubt, powerful auxiliaries, and tend very much to promote health; but still they will not secure a person from a return of the gout, without this precaution. There seems something in alcohol, which peculiarly brings on this state of the const.i.tution, and without it, it would seem that gout could not be produced. Here then is an effectual method of curing the gout, which will no more return, if this method be strictly persevered in, than the smallpox will attack the const.i.tution after inoculation.
During the fit therefore, I would say, nearly in the words of Dr.
Darwin, Drink no malt liquor on any account. Let the beverage at dinner consist of two gla.s.ses of Madeira, diluted with three half pints of water; on no account whatever drink any more wine or spirituous liquors in the course of the day. Eat meat constantly at dinner, without any seasoning, but with any kind of tender vegetables, that are found to agree. When the fit is removed, use the warm bath twice a week, an hour before going to bed, at about 93 degrees, or 94 degrees of heat. Keep the body open by means of lenitive electuary and rhubarb; for there is an objection to the tincture I mentioned, as containing alcohol. Use constant, gentle exercise; but never so violent as to bring on great fatigue. The grand secret, however, in the cure, as has been already observed, but which cannot be too often inculcated, is to abstain, in toto, from every thing that contains alcohol.
In short, though in acute diseases medicines are highly useful, a chronic disease can never be cured, and the healthy state reestablished, by them alone. To effect a cure in such cases, we must reform our mode of life, change our bad habits into good ones; and then, if we have patience to wait the slow operations of nature, we shall have no reason to regret our former luxuries.
LECTURE XIV.
NERVOUS COMPLAINTS, &c.
In this lecture I propose to take a view of some of those affections, which have been commonly, but improperly known by the appellation of nervous complaints, because it has been supposed by many that they are owing to a deranged state of the nerves, which, however, is by no means the case; for I hope to be able to make it appear, that these symptoms arise from a general affection of the excitement of the system. In short, by far the greater number of these complaints, arise from such a state of the excitement as approaches predisposition, or perhaps ranges between predisposition and disease, but does not in general actually reach disease; or rather, it is a state of the excitement, so far departing from the point of perfect health, that the functions are not performed with that alacrity, or vigour, which ought to take place; but labour under that disturbed and uneasy action, which, though it cannot be called actual disease, yet deviates considerably from the point of perfect health.
This is a new view of these diseases, but the more I have examined it, the more I am convinced that it is just. Indeed, the name, nervous, has generally been given to an a.s.semblage of symptoms, which the physicians did not understand; and when the patient relates a history of symptoms, and expects that his physician shall inform him of the name, and nature of his complaint, he generally receives for answer, that his complaints are nervous, or bilious; terms which convey no distinct ideas, but which serve to satisfy the patient, and to conceal the ignorance of the physician, or spare him the labour of thinking.
Indeed, the idea of nervous diseases, which I have already pointed at, is not only new, but could only have arisen from such a view as we have been taking of the states of excitement and excitability.
This view will not only lead us to form a more just idea of the manner in which these diseases originate, but will point out a distinction of them into two cla.s.ses, of the utmost use in practice, but which distinction has totally escaped the attention of pract.i.tioners; for though these complaints have been generally thought to arise from a lowness of the nervous energy, or some kind of debility, or weakness of the nervous system, and, on this account, the stimulant and cordial plan of cure has been recommended, I am convinced, from observation, that nearly one half of them, if not more, originate from a state of the excitement verging towards sthenic disease; and in these cases, this general mode of treatment must be highly improper.
It has been already shown, that when the common exciting powers which support life, act in such a manner, that a middle degree of exciting power, acts upon a middle degree of excitability, the most perfect state of the system, or a state of perfect health, takes place: it is, however, seldom in our power so to proportion the state of excitement and excitability to each other. The action of the exciting powers is continually varying in strength; and the excitability, from a variety of stimulants, and other circ.u.mstances, which are not entirely under our direction, is sometimes more, and sometimes less abundant, than this middle degree. There is, however, a considerable lat.i.tude, on each side the point of health, within which the excitement may vary, and yet no disease, nor any disturbance of the functions may take place: but this has its limits, beyond which if the excitement be brought, on either side, it is evident that an uneasy or unpleasant exercise of the functions must take place. There is not, however, any precise line or boundary between this state, and that in which the functions begin to be disturbed; on the contrary, the law of continuity and gradation seems to extend throughout every part of nature. This departure from the healthy state, and approach to disease, in which what has been called the nervous state consists, is gradual and scarcely perceptible; but is apt to be produced by any circ.u.mstances, which lead the excitement beyond its proper limits.
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