« السابقةمتابعة »
The remark applies to many states of the skin, both in fevers and other disorders, where simple diluents, freely given, form the safest and most effectual sudorifics we can employ. And the same remark applies to various cutaneous disorders, where the use of this remedy, even in its simplest form of pure water, might be very beneficially extended, to the exclusion of many diaphoretics and alteratives of much more doubtful character and effect.
This is, according to my experience, a point singularly meriting attention in practice; and the simplicity and safety of the trial warrant every recommendation of it. In exanthematous fevers, though the treatment by such means is more ambiguous, yet I believe that a freer employment of diluents than is commonly adopted might be beneficial; certainly to the fullest extent in which they are called for by the feelings of the patient.
On the same principle, there is good reason for their use even in certain cases of dropsical effusion, where the object is to restore a due action of the kidneys. Popular feeling, and indeed medical opinion, inclines to the opposite treatment; and with some reason, as respects the habit of drinking largely in such cases. But I have experience of the good often obtained by the sudden and copious use of diluents in recovering these organs from a dormant state; an object which may best be effected after the bowels have been freely relieved.
The latter fact is important in regard to the action of almost all diuretics. They have little effect as such, while there is need of alvine evacuation; and in ascites and anasarcous swellings, particularly, it is commonly desirable to preface all other treatment in this way. The ignorance or neglect of these precautions in practice often produces a hurtful activity where nothing can be gained, and a delay no less injurious in the actual relief of disease.
As I have been treating of this remedy only in its simplest form, I do not advert to the use of the different mineral waters further than to state that they confirm these general views; separating, as far as can be done, their effect as diluents from that of the ingredients they contain. The copious employment of some of them in continental practice gives room for observation, which is wanting under our more limited use. I have often seen five or six pints taken daily for some weeks together (a great part of it in the morning while fasting) with singular benefit in many cases to the general health, and most obviously to the state of the secretions. The functions of the kidneys and skin were maintained in great activity during the whole of this period; but without assuming any disordered character, and passing readily again into their natural state when the cause of increased action was removed. These courses, however, were always conjoined with ample exercise and regular habits of life; doubtless influencing much the action of the waters, and aiding their salutary effect. In cases where such aids are omitted, or only partially employed, a much smaller quantity generally disturbs the stomach, and the treatment altogether is of little avail for the amendment of health.
Without reference, however, to these extreme cases, it must be repeated, that the use of water, simply as a diluent, scarcely receives attention and discrimination enough in our English practice. This is a point wholly distinct from the question regarding the fit proportion of liquids as a part of diet. The process of digestion suffers more or less from any excess in quantity of these; and, though the natural appetite may be unduly controlled, yet some rule is often required, in dyspeptic cases especially, to obviate such excess, even where the simplest and most innocuous liquids alone are concerned. For in these cases a morbid craving for them is
often created, partly by the vitiated sensations of the patient, partly from the actual state of the membrane lining the palate, œsophagus, and stomach, and from the disordered secretions and products of digestion acting on this surface.
It is obviously another question, how far and in what way diluents may be employed, expressly as such, for medical purposes; including under this question what relates to thirst as a symptom of disease, to the use of liquids in disordered states of the alimentary canal, and to their employment in cases of general cachexia and vitiated secretion. These are the points to which the preceding remarks apply; less, however, as furnishing explicit rules, than as suggesting the views upon which this part of treatment may best be founded, and rendered more generally useful.
ON MORBID ACTIONS OF INTERMITTENT KIND.
HAS sufficient weight been assigned in our pathological reasonings to that principle, which associates together so many facts in the history of disease, viz., the tendency in various morbid actions to distinct intermission, of longer or shorter duration, and more or less perfect in kind? Few objects of inquiry are more interesting than this, either to the physician or the physiologist. The subjection of so many diseased actions to this common law establishes relations which could not have been learnt from other sources, and which have much value even in the details of practice. To the physiologist the facts are of great interest, as being effect and part of that more general principle in the animal economy by which various natural and healthy functions of the system are subject to similar intermission.
This principle, though in some of its workings it must ever have been obvious to all who observed the phenomena of life, has in later times only been distinctly recognised as such. And to modern inquiry also we owe the remark, that this intermittent or periodical character belongs especially to the animal functions; and that those of organic life show it in a much more obscure and indeterminate form. The most dubious cases are those in which both functions seem to be concerned in supporting one action, as in the instance of respiration; but the general distinction may be admitted as well-marked and striking.*
* Bichat was one of the earliest to call attention to this principle, under the name of the "Loi d'Intermittence," in its application to the functions
ON MORBID ACTIONS OF INTERMITTENT KIND. 329
This tendency to intermission in the animal functions may justly be termed a law; inasmuch as it is natural, general, and manifestly designed. All the phenomena of mind, and all those of body which have direct relation to mind, are more or less submitted to it. The alternation of sleep and waking a phenomenon in which so many separate functions have part, and by which all are regulated or controlled is the instance at once most familiar and remarkable. Each organ of sense is more or less connected with this one important condition of existence; while they have besides various shorter and more irregular intermissions, depending on changes in the action upon them from without, and the proportion of this action to the excitability they possess. A closer view may lead us to associate these also with the phenomena of sleep; admitting the view as to this function, that though for the most part simultaneously extending to many different organs and actions, these are not necessarily affected in the same degree, nor always at the same time. Thus considering it, one sense may be said to be partially asleep, when all the others, as well as the mental functions, are in state of perfect wakefulness. This general principle, stated at length in another chapter, is one which not only associates more distinctly all intermittent actions with the great common function of sleep, but is also important in illustrating many varieties of intermittent disorder, and indicating methods for their treatment.
of muscular action, sleep, &c. (Anatomie Générale, tom. i.) It cannot be doubted, however, that he has limited the law too exclusively to the animal organs, as opposed to those of organic life; in conformity with his other views of the relation of these parts in the animal economy. And the same is the case with respect to the kindred law of habit, which he has been led, by attachment to this principle of distinction, to confine too especially to the parts of animal life.