« السابقةمتابعة »
value to all that illustrates the action of these remedies. They are the interpreters of facts far beyond their momentary effect; and of connexions between morbid states which are in no other way so definitely made known to us.
In closing these remarks on morbid intermittent actions, I may observe, that they form a bare outline of a wide subject of inquiry, which well merits a much more complete investigation of all its parts. The principle of intermission is one so marked and characteristic of some of the most important functions of life, and affords such curious results in the variations of interval even in the same function, that we may well rank it among other bases of classification for disease. And though some of the morbid actions, thus designated, are seemingly remote from others, as respects both periods and causes of intermission, it is probable that the tendency of further inquiry will be to give them closer association, by the discovery whence these modifications arise. Every relation to general principles is of so much practical as well as theoretical value in medicine, that there is often advantage in viewing diseases under new connexions, even though less intimate than those previously adopted into use.
Since the first edition of this volume was published, I have received from Dr. Henle of Berlin his recent work (Pathologische Untersuchungen, Berlin, 1839), which contains an interesting paper connected with this subject, entitled "Verlauf und Periodicität der Krankheit."
ON DIET, AND DISORDERS OF DIGESTION.
LOOKING Over the notes I have made on this subject in the course of practice, I find them almost wholly superseded by the many and valuable treatises which have been published of late years. These works, founded upon an improved physiology of the organs of digestion, have done much to give dietetics the character of a branch of science, which it certainly in nowise possessed before.* Even now it may be doubted whether our materials are ample or exact enough, for methodical arrangement; and whether many of the rules founded on them are not calculated to foster, rather than repress, the vague and changeful fancies which prevail on this subject. It is certain on experience that no proportionate benefit has yet been obtained from all hitherto written upon it. For this there may be many causes. One doubtless is, the difficulty of establishing or applying positive rules for conditions so infinitely varied, that the evasion of these rules becomes easy, or is even apparently sanctioned by the peculiarities of each case. Nor can it be affirmed that the precepts
* I may mention particularly the works of Dr. Combe, Dr. J. Johnson, Dr. Southwood Smith, Dr. Paris, Dr. Wilson Philip, and the article on Indigestion, by Dr. Todd, in the Cyclopædia of Practical Medicine. The physicians of the United States, who now contribute so eminently to medical science in all its branches, have added to our knowledge on this subject. And their writings have the greater interest, as stating the result of manners of life differing in several respects from the ordinary habits of our own country, and of other parts of Europe.
of medical authors themselves are concurrent on the principles of diet, and the management of dyspeptic disorders. Many points are still disputed: and on few perhaps are the criteria of truth so complete as to possess the influence that is required for their successful application to practice.
These circumstances, and still more the habits of society among the higher classes, and the influence of dyspeptic complaints on the minds of those affected, render the treatment of such disorders a matter of great interest, even in a moral point of view. They unhappily furnish an arena on which all the worst parts of medical practice find their readiest display. Fraud, intrepid in its ignorance, here wins an easy triumph. Seconded on every side by prejudices, fashions, and foibles, and taking advantage of the mind and body in their weakest mood, it deals out precepts and drugs with a pernicious facility; sometimes altogether at random ;-sometimes, and even more injuriously, with one common scheme of treatment applied to the most variable and incongruous symp
These abuses indeed, in their worst form, exist only on the outskirts of the profession. But it will be admitted by all who have candour and experience, that there is no part of medical practice where knowledge and good faith are put to equal trial as in the management of dyspeptic complaints. Even the effect of the disorder in obscuring the judgment, and rendering impotent the will of the patient, becomes an embarrassment to the physician. If his own judgment be slow and wavering, he is deprived of aid; -if hasty and rash, of that control from the opinion of his patient which is frequently needful. The mind of the dyspeptic is uncertain and fickle. He interprets falsely his own sensations, and the effects of the treatment employed; - is unduly confident at one moment and under a new remedy; at another time as
irrationally desponding;-prone, moreover, to change his medical adviser, and to resort to any person or remedy where there is largest profession of relief.
All these things, familiar in practice in this country, make the situation and conduct of the physician in cases of dyspepsia hardly less difficult than in acute and dangerous diseases. Though the symptoms before him are not so critical in kind, they need sound moral management as well as discreet methods of medical treatment.* Forbearance and firmness are both required; and, together with these, integrity and good faith. The admirable precepts as to uprightness in practice, which came down to us under the great name of Hippocrates, obtain here their closest application; and may well be impressed upon all who are entering on a medical life. The mind must be fashioned early and strongly in these professional principles; as they are rarely attained afterwards, and even with difficulty preserved, amidst the many difficulties which beset the conduct of the physician.
For the reasons already named, I shall not seek to give any method to the few remarks which follow respecting diet and dyspeptic disorders. They are drawn from my experience, on no other principle of selection than that of appearing to be least regarded in proportion to their practical importance. If desultory, it may be truly affirmed that the subject to which they relate is so likewise. Even the term of dyspepsia is variously and vaguely used by medical writers themselves; and in truth is not readily defined, where so many organs are concerned, and such various causes of disorder. In a formal treatise, this difficulty needs to be met
* What Aretaus says regarding the treatment of chronic diseases in general, applies singularly to dyspepsia, as one of the most frequent of them. Ενθα δη αρετη διαείδεται ανδρος ιητρου, και μακροθυμίης, και ποικιλιης, και χαριτος αβλαβους τῶν ἡδεων, και παραφασιος.
by some sort of arrangement of the cases and causes in question. It is unnecessary here, where the object is limited. chiefly to practical views, and those of a general nature.
It is needful to say in the outset, that rules of diet may be pressed too closely, as well as too vaguely, in the treatment of disorders of digestion. Such rules may come to exercise a morbid influence over the mind of the patient, counteracting all the good obtained. Attention to his sensations is already too much awakened in the habitual dyspeptic; and often the greatest benefit which can be conferred is that of weaning it away from them. In another chapter I have alluded to the singular influence of the mind, simply directed to the digestive organs, in altering or disordering their natural functions; and this even where no solicitude exists on the subject.* Every such effect is greatly aggravated in the case of the dyspeptic. His minute and anxious watch over his sensations generates the very evils which it is the object to remove. A system of rules for diet and other management of the digestive organs may be necessary in such cases; but their effect on the mind must be observed, to see that they do not usurp too much upon it, and sanction injuriously those morbid habits which, arising out of the malady, augment the symptoms and retard their cure. A strict rule, good in itself, may often expediently be relaxed or dispensed with, if found thus to influence the temper of the patient. Austerity must bend before the variable conditions with which we have to deal in the treatment of disease.
Many points of practice connect themselves with this state of mind in dyspeptic disorders. It may be well, for instance (though the rule is by no means an invariable one), that the
* Chapter V. On the Effects of the Attention of Mind on the bodily Organs.