Popular Lectures on Zoonomia / Or The Laws of Animal Life, in Health and Disease

by Thomas Garnett

Thus catarrh and rheumatism are inflammatory complaints, or depend on too great a degree of excitement, and are to be cured by lowering the excitement, or diminishing the action of the exciting powers; by bleeding, purging, low diet, and particularly keeping in a moderately cool place; and these complaints will be as speedily and certainly cured by these methods, properly and judiciously persevered in, as a slight cut or wound will be healed by what surgeons call the first intention.

There are complaints which resemble these, but whose nature, however, is very different, and which require a very different mode of treatment. After a part has been long affected with rheumatic inflammation the excitability of the muscular fibres becomes so far exhausted, that a state of indirect debility takes place, and an inflammation, accompanied with pain and redness, which is very different from that I formerly described, as it depends upon a debilitated or relaxed state of the parts, instead of too great a degree of excitement. This instance shows strongly the fallacy of symptoms; but it may be readily distinguished from the inflammatory rheumatism, by attention to the effects of the exciting causes. The inflammatory rheumatism is aggravated by heat, hence it is more violent in bed than at any other time. The latter complaint, however, is greatly relieved by heat: the warm bath alleviates all the symptoms; so does a warm bed. It is evident that these diseases, though attended by the same symptoms, are as opposite, and require as different modes of treatment as an inflammation of the brain, and a dropsy. The inflammatory state has been called the acute rheumatism, and the other, the chronic rheumatism; I would, however, prefer the terms sthenic and asthenic rheumatism.

In the same manner, there is a catarrh, which is liable to afflict persons who have often been subject to an inflammatory cold, particularly persons advanced in years; and this depends on a state of indirect debility of the parts, the excitability of which has been exhausted by frequent and violent inflammatory affections. This complaint, which I would call asthenic catarrh, requires directly opposite treatment from the inflammatory or sthenic catarrh. The latter is aggravated by heat, but relieved by a cool temperature. Warm air is peculiarly grateful to those who are afflicted with the former, and if they go into a cool temperature, they are immediately seized with cough, and expectoration; for the disease being a disease of debility, the withdrawing the stimulus of heat, must increase it. The excitability of the parts is so far exhausted, that it requires a stimulus even more than natural to keep them in tone: hence persons labouring under asthenic catarrh, and some species of asthma, which are only varieties of this disease, find themselves best when exposed to a warm temperature, but on the heat being diminished, and consequently the parts relaxed, the cough and difficulty of breathing immediately come on.

Having examined the effect of heat, in producing inflammatory or sthenic disease, I now proceed to the consideration of the other powers. Of the articles of diet, the only food in danger of being too stimulant, is perhaps flesh or land animal food, used in too great quantity, particularly when seasoned, a preparation which adds much to its stimulant power. Spirituous and vinous liquors, let them be ever so weak or much diluted, stimulate more quickly, and more readily than seasoned food, and their stimulus is in proportion to the quantity of alcohol which they contain. These substances, when conjoined with rich food, must bring on a predisposition to sthenic disease, in almost any constitution, particularly in the young and healthy, and, in many instances, those diseases actually take place; or should this not be the case, should the person avoid, or escape the effects of inflammatory diseases, the excitability will be exhausted, and diseases of indirect debility, such as gout, apoplexy, indigestion, palsy, &c. will take place.

These stimulants are never necessary to a good constitution, and their effects will always, sooner or later, be experienced: for though a person with a good constitution may continue for years to indulge in the pleasures of the bottle, or the luxuries of the table, depend upon it that a continuance of them will sap the vigour of the strongest constitution that ever existed.

As nothing contributes more to the health of the body than moderate and frequently repeated exercise, which rouses the muscles to contraction, and promotes the circulation of the blood in the veins towards the heart: it thus produces excitement; but an excess of it will produce sthenic diathesis; and, if carried to great excess, it will produce a state of indirect debility, or exhausted excitability.

When any, or all of these exciting powers act too strongly on the body, the first effect they produce is a preternatural acuteness of all the senses; the motions, both voluntary and involuntary, are performed with vigour, and there is an acuteness of genius and intellectual power. In short, every part of the body seems in a state of complete vigour and strength; that this is the case with the heart and arteries, appears from the strong and firm pulse; in the stomach it is shown by the appetite; and, in the extreme parts, by the ruddy colour and complexion. In short, every appearance marks vigour of the body, and abundance of blood. Could the body be kept in this state, nothing could be more to be desired; this, however, is impossible; the excitement, though still within the bounds of health, has overstepped the point of good health, and is verging fast to predisposition to sthenic disease; so that, to secure a permanent state of health, it is always better to keep the excitement rather under the middle point, or 40 degrees, than above it. During the predisposition to sthenic disease, which is produced by the longer continued, or increased action of these powers, no symptoms of disease appear; but shortly after, disturbed sleep, depressed spirits, languor, a sense of fulness, heaviness, particularly after eating, show that this sthenic state cannot be further increased with impunity. The least increase of sthenic diathesis now brings on a disturbance of the functions, or actual disease; the commencement of which is generally a shivering, and a sense of cold; thirst and heat succeed; and then generally a pain in some part, either external or internal: costiveness generally attends this state, the urine is clear, and secreted in small quantity; memory and imagination become diminished, and there is generally less appetite for food.

In peripneumony, inflammatory sore throat, and acute rheumatism, there is an inflamed condition of the lungs, of the parts about the throat, or of the muscles of the extremities: this shows that the excitement here is greater than in other parts of the body; but it is still increased or too great in every part, only those parts which give the peculiar character to the disease are more affected than other parts of the body, by being more exposed to the exciting causes: thus, if a person be in perfect health, or a little below, he will not be easily affected by any of the exciting causes of sthenic disease, unless their application be very violent; he will go into a warm room out of the cold air, and feel no other effect than a pleasant glow: but if, by high living, or other means, he is brought near the point of predisposition to sthenic disease, then the slightest additional stimulus will bring it on, and if the throat has been exposed to the application of cold, and the person comes afterwards into a heated room, an inflammation of the parts about the throat, or an inflammatory sore throat, accompanied by a sthenic diathesis of the whole system, will be the consequence. This cannot be cured by merely diminishing the excitement of the part, while the excitement of the whole system remains: if we apply leeches to the throat in this state, to diminish the quantity of blood, we only debilitate the vessels, while fresh quantities of blood are poured into them from the too full vessels of the body; even if we could thus remove the sthenic diathesis of the part, we should go but a little way towards removing the inflammatory disease, which universally pervades the system.

The mode to be pursued therefore is, to take a quantity of blood from the body, by opening a vein; to keep the body cool, by remaining in a room where the temperature is at temperate, or a little below; by abstaining from animal food, and from spirituous or fermented liquors; and by the exhibition of purgatives, or at least of laxatives. Then leeches or blisters applied to the part affected will produce a good effect; and even stimulant applications to the inflamed part may be advantageous; for a topical inflammation, as we shall afterwards have occasion to see, depends on a debilitated state of the minute vessels of the part, while at the same time the action of the whole system is increased.

Besides the energy of the exciting hurtful powers, which I have mentioned, there is in the parts which undergo the inflammation, a greater sensibility, or an accumulated excitability; by which it happens that some are more affected than the rest. To this we may add, that whatsoever part may have been injured by inflammation, that part in every future sthenic attack is in more danger of being inflamed than the rest. Hence inflammatory sore throat, rheumatism, and some other complaints of the kind, when once they have supervened, are very apt to recur.