Popular Lectures on Zoonomia

But though I have no doubt whatever, that this equable temperature would prevent a number of diseases, which originate in too low a temperature, yet I am far from wishing to have it thought that I would not induce a hardy state of the constitution, which would enable it to bear the vicissitudes to which it must be exposed in its journey through life, by every means in my power. Hardiness is the most enviable of all the attributes of animal nature, and can neither be acquired, nor recovered when it is lost, but upon certain terms, to which many people submit with reluctance, because they must give up many indulgences and gratifications with which it is utterly inconsistent.

One of the causes that chiefly contributes to reduce persons living in affluence below the standard of hardiness, is the dependence they place on a considerable degree of external warmth, for preserving a comfortable state of sensation. From what has been said again and again in some of the latest of these lectures, it must be evident that continued warmth renders the living system less capable of being excited to strong, healthy, and pleasant action: heat in excess, whether it may be excess of duration or intensity, constantly debilitates, by exhausting the excitability of the system, and thus producing a state of indirect debility. Every muscle steeped in a heated medium, whether of air or water, loses much of its contractibility. A heart kept in heated air, or put in hot water, will not contract on the application of a stimulus; even the limb of a frog, when heated in this manner, ceases to move on the application of the galvanic exciters. Every nerve grows languid, and when it does become excited, it acquires a disposition to throw the moving fibres, with which it is connected, into starts, twitchings, and other irregular convulsive motions. Though therefore nothing can more contribute to the health of the body than a moderate and well regulated temperature, about 48 or 50 degrees, sometimes for a short interval a little lower, when exercise is taken at the same time, yet when we consider the life led by persons of fashion, we should hope that it proceeded from ignorance of these consequences; so diametrically opposite is it to the dictates of nature and reason.

Instead of rising from table after dinner, and availing themselves of the cooling and refreshing qualities of the air, even in the finest seasons, when every thing which pure and simple nature can offer, invites them abroad, they do every thing they can, as Dr. Beddoes observes, to add to the overstimulating operation of a full and hearty dinner. After taking strong wine with their food, they sit in rooms rendered progressively warmer, all the afternoon, by the presence of company, by the increase of fires, and for more than half the year, by the early closing of the shutters, and letting down of the window curtains. After a short interval, tea and coffee succeed; liquors stimulating both by their inherent qualities, and by virtue of the temperature at which they are often drank. And that nothing may be wanting to their pernicious effect, they are frequently taken in the very stew and squeeze of a fashionable mob. The season of sleep succeeds, and to crown the adventures of the evening, the bed room is fastened close, and made stifling by a fire: and though the robust may not quickly feel the effects of this mode of life, with the feeble it is quite otherwise. These, as they usually manage, rarely pass a few hours of sleep without feverishness and uneasy dreams; both of which contribute to their finding themselves by far more spent and spiritless in the morning, than after their evening fit of forced excitement, instead of having their spirits and strength recruited by the "chief nourisher in life's feast," Perhaps they drink tea before rising, and indulge in a morning nap; this weakens much more than the greatest muscular exertion they would be capable of supporting for an equal time. For the sleep at this time is almost invariably disturbed, and attended by a heat of the skin. The reason of this must be evident to every one who has attended these lectures.

The effect of sleep is to accumulate the excitability, or render it more sensible to the effects of any stimulants applied. This takes place in every constitution, and much more in the more delicate: hence the heat of the bed, and of the tea, acts so powerfully on the surface, as, in general, to produce great perspiration, or, at any rate, great languor and debility.

Let me ask, can any one, who lives in this manner, expect to enjoy good health? With as great probability might we expect, that when we plunged a thermometer into hot water, the mercury would not rise, or when we applied a lighted match to gunpowder, it would not explode. 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 accumulating 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 accumulate, 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 quantity 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 quantity 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 quantity 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 passion 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 attitude; 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 passions 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 passion.

On the contrary, when there is a deficiency of exciting passion, as in melancholy, fear, despair, &c. which are only lower degrees or diminutions of joy, assurance, 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 appetite, 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 classes, 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, chorea, 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, tetanus.

Diseases, therefore, according to this system, may be divided into two classes. 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 class, 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 classed 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 classing 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 accumulated, 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 accumulation of the excitability. That this may take place, therefore, we must gradually lessen the quantity of stimulus, till the excitability become capable of being sufficiently acted on by the exciting powers, when the cure will be affected.

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 principal 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 passing over the line of health, instead of the intended cure, to substitute 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 practitioners 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 constitution 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 appetite, 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 accumulate, and the constitution, 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 constitution, 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 astonishing 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.