the symptoms of this hitherto 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 constitution 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 quantity 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 accumulate. But
this accumulation 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 accumulate, 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 constitution, 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
constitution 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 glasses 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 assemblage 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 classes, of the utmost use in practice,
but which distinction has totally escaped the attention of
practitioners; 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 circumstances, which are not
entirely under our direction, is sometimes more, and sometimes less
abundant, than this middle degree. There is, however, a considerable
latitude, 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
circumstances, which lead the excitement beyond its proper limits.
Nervous complaints may therefore be divided, like all other diseases,
into two classes. First, those in which the excitement is increased,
or in which it verges to, or has actually reached, the point of
predisposition to sthenic disease; Secondly, those in which the
excitement is diminished, or in which it verges towards asthenic
disease. This last class, as has been done before, may be subdivided
into two orders. The first will comprise those diseases in which the
excitability is sufficiently abundant, or even accumulated, but where
the excitement is deficient from a want of energy in the exciting
powers. In the second, there has been no deficiency in the action of
the exciting powers; but on the contrary, probably for a considerable
time, some of the diffusible stimuli not natural to life have been
applied; in this case, the excitability has become exhausted, and a
proper degree of excitement cannot be produced by the action of the
common exciting powers.
No diseases show so clearly the fallacy of trusting to symptoms, as
those of the former class. I have met with innumerable cases of this
kind, in which, if you were to trust to the patients own description,
they laboured under considerable debility; and had it not been for
the particular attention I paid to my own case, I should not probably
have suspected that a directly opposite state of the system may
produce these symptoms.
From inheriting a good constitution, and being brought up in the
country in a hardy manner, I am so much predisposed to the sthenic
state, that I may consider the state of my excitement, as generally,
indeed almost always, above the point of health: and unless I live in
the most temperate, and even abstemious manner, the excitement is
extremely liable to overstep the bounds of predisposition, and fall
into sthenic disease. I have had several attacks of this kind of
disease; and indeed, I never remember to have laboured under any
disease of debility, or diminished excitement.
Health, according to the view we have taken of it, may be compared to
a musical string, tuned to a certain pitch, or note; and though
perhaps in the great bulk of mankind, either from the manner of
living, or from other circumstances, the excitement is a little
below, and requires to be screwed up to the healthy pitch, yet there
are others where it is apt to get constantly above, and where it
requires letting down to this pitch; my constitution is one of these:
but I have this consolation, that if I can for a few years ward off
the fatal effects of some acute sthenic diseases, this tendency to
sthenic diathesis will gradually wear off, and I may probably enjoy a
state of good health, at a time, when most constitutions of an
opposite cast begin to give way. Whenever I have for some time lived
rather fully, though by no means intemperately, after having for some
days, or perhaps some weeks experienced an unusually good flow of
spirits, and taken exercise with pleasure, I begin, first of all, to
have disturbed sleep, I find myself inclined to sleep in the morning,
as if I had not been refreshed by the night's sleep; my spirits
become low, and I am apt to look upon the gloomy side of every thing
I undertake or do. I feel a general sense of languor and debility,
and am ready, as I have heard many patients labouring under the same
state exclaim, to sink into the earth. From the slightest causes, I
am apt to apprehend the most serious evils, and my temper becomes
irritable, and scarcely to be pleased with any thing. If in this
state, I take exercise, I soon feel myself fatigued; a disagreeable
stupor comes on, without, however, the least degree of perspiration,
and I feel an inability to move.
At first, I used to imagine these to be symptoms of debility, or
diminished excitement, nor was it till after several ineffectual
trials to relieve them by the tonic, or stimulant plan, that I was
convinced of my mistake. This plan always caused an aggravation of
every symptom, and if I persevered in it, an inflammatory disease was
sure to be the consequence. Indeed, I might have suspected this, from
considering, that these symptoms had been brought on by full living,
and preceded by good spirits; but my mind had received such a
prejudice from the writings of medical men, who had uniformly
described these as a train of nervous symptoms, as they called them,
depending on a debilitated state of the nervous system, that I was
blind to conviction, till repeated disappointment from the
stimulating plan, convinced me I must be wrong. The only alternative
therefore, was a contrary plan, and the immediate relief I
experienced, was a proof that I had detected the real nature of the
complaint. Since that time, I can at any time prevent these
unpleasant symptoms, by an abstemious course of life, and remove
them, when they have come on, by the debilitating plan; which,
instead of weakening, gives additional elasticity and strength to the
fibres, and alacrity to the spirits. I have described the symptoms in
one case, as this will serve as a general description. We may add,
that persons labouring under this kind of predisposition, are
particularly attentive to the state of their own health, and to every
change of feeling in their bodies; and from every uneasy sensation,
perhaps of the slightest kind, they apprehend great danger, and even
death itself. In cases of this kind, the bowels are generally
costive, and the spirits of the patient are very apt to be affected
by changes in the weather, particularly by a fall of the barometer.
How the diminution of atmospheric pressure acts in increasing the
symptoms, we perhaps do not know; but its effects are experienced
almost universally.
It is evident, that the only mode of cure in cases of this kind is
extreme temperance: animal food should be taken sparingly, and wine
and spirits in general totally abstained from. The bowels should be
kept open by any mild neutral salt. I have generally found magnesia
and lemonade to agree remarkably well in such cases. Exercise on
horseback, is also particularly useful; bark, bitters, and the fetid
and antispasmodic medicines, which are generally prescribed in such
cases, are extremely hurtful.
This view of nervous complaints is, I may venture to say, as new as
it is just. It has never been imagined, that any of them depended
upon too great excitement; on the contrary, they have been
universally considered as originating in debility, and of course,
tonics were prescribed, which, though they produced the greatest
benefit in the other class of nervous complaints, in these they
occasioned the most serious evils, and often brought on real
inflammatory diseases, or even diseases of indirect debility, as I
have repeatedly seen.
These cases cannot at first sight, however, be easily distinguished
from those of the opposite class; the symptoms being nearly alike,
and the patient complaining of languor, debility, and extreme
depression of spirits in both. But by attending carefully to the
effects produced by the exciting powers, they may in general be
distinguished. A patient of this kind will tell you, that he does not
feel pleasant effects from wine, or spirituous liquors; instead of
exhilaration, his spirits become depressed by them; whereas, in the
contrary state, he finds almost instant relief. By attending to
circumstances of this kind, the nature of the complaint may in
general be ascertained.
Highly seasoned, and strongly stimulant foods should in the sthenic
hypochondriasis, if it may be so called, be avoided; but the most
mischievous agent of all, and which contributes to bring on the
greater number of these complaints, is wine. This, I believe,
produces more diseases, than all other causes put together. Every
person is ready to allow, that wine taken to excess is hurtful,
because he sees immediate evils follow; but the distant effects,
which require more attentive observation to perceive, very few see,
and believe; and, judging from pleasant and agreeable feelings, they
say that a little wine is wholesome, and good for every one; and
accordingly take it every day, and even give it to their children;
thus debauching their natural taste in the earliest infancy, and
teaching them to relish what will injure their constitutions; but
which, if properly abstained from, would prove one of the most
valuable cordial medicines we possess.
The idea that wine or spirituous liquors assist digestion, is false.
Those who are acquainted with chemistry, know that food is hardened,
and rendered less digestible by these means; and the stimulus, which
wine gives to the stomach, is not necessary, excepting to those who
have exhausted the excitability of that organ, by the excessive use
of strong liquors. In these, the stomach can scarcely be excited to
action, without the assistance of such a stimulus. If the food wants
diluting, water is the best diluent. Water is the only liquor that
nature knows, or has provided for animals; and whatever nature gives
us, is, we may depend upon it, the best, and safest for us. Wine
ought to be reserved as a cordial in sickness, and in old age; and a
most salutary remedy would it prove, did we not exhaust its power by
daily use.
I am sensible that I am treading on delicate ground, but I am
determined to speak my sentiments with plainness and sincerity, since
the health and welfare of thousands are concerned. Most persons have
so indulged themselves in this pernicious habit of drinking wine,
that they imagine they cannot live without a little every day; they
think that their very existence depends upon it, and that their
stomachs require it. Similar arguments may be brought in favour of
every other bad habit. Though, at first, the violence we do to nature
makes her revolt; in a little time she submits, and is not only
reconciled, but grows fond of the habit; and we think it necessary to
our existence: neither the flavour of wine, of opium, of snuff, or of
tobacco, are naturally agreeable to us: on the contrary, they are
highly unpleasant at first; but by the force of habit they become
pleasant.
It is, however, the business of rational beings to distinguish
carefully, between the real wants of nature, and the artificial calls
of habit; and when we find that the last begin to injure us, we ought
to use the most persevering efforts to break the enchantment of bad
customs; and though it cost us some uneasy sensations at first, we
must learn to bear them patiently; a little time will reward us for
our forbearance, by a reestablishment of health and spirits.
I shall now proceed to examine the opposite class of nervous
complaints: or such as do really depend on debility, or an asthenic
state of the system. These may be divided into two orders; viz. those
of direct, and those of indirect debility. I shall first consider
those of direct debility.
Though these complaints originate from a deficiency of stimulus, yet
it is very seldom from a deficiency of the common stimulant powers.
The only people, who in general labour under this deficiency of the
common stimulants, are the poor; they are seldom troubled with
nervous complaints; their daily exercise, and constant attention to
procure common necessaries, prevent their feeling what so grievously
afflicts the rich and luxurious. These complaints arise chiefly from
a deficiency of mental stimuli. The most common cause of them, and
whose effects are the most difficult to remove, is to be looked for
in the mind.
The passions and emotions, when exercised with moderation, and kept
within proper bounds, are the sources of life and activity; without
these precious affections, we should be reduced to a kind of
vegetation, equally removed from pleasure and from pain. For want of
these elastic springs, the animal spirits lose their regularity and
play; life becomes a lethargic sleep, and we fall into indifference
and languor.