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not well-understood relief of the whole system, far beyond that from the mere escape of a Graafian vesicle, is called for, the generally accompanying neurotic excitement, which in our ignorance we term "hysteric," may justly be presumed to have an influence through the great sympathetic upon the pulmonary functions, thereby augmenting existing irritation or causes of irritation.
The frequent occurrences of vicarious menstruation, whether pulmonary, gastric, or nasal, will support this view.
Through the gastric plexus, which, as I have before mentioned, will ultimately, sooner or later, sympathise with the pulmonary (and here I would add vice versa), a hyperæsthetic condition of the gastric mucous membrane may under the circumstances be engendered, which might cause articles of diet and drink, previously taken with impunity, to be painful, irritating, and indigestible. Consequently there would be mal-assimilation, flatulency distressing the heart's action and pulmonary circulation; acidity and imperfect chyme, affecting renal, hepatic, intestinal, and perhaps cutaneous functions, inducing constipation alternating with diarrhoea; functional derangements of the whole alimentary canal, disturbances of animal life, telling their tale, through the medium of the sympathetic, at head-quarters of organic life.
Lastly, the enfeebling influence upon the system of frequent and excessive menorrhagic losses, induced by a mechanical uterine irritation from a constantly overloaded sigmoid flexure, should be taken into account, as few in the present day will not acquiesce in the Abernethian dogma of the convertibility of the terms debility, irritability.
To such a group of predisposing influences would I attribute the reason why slight exciting causes, otherwise inadequate, were attended with such violent results.
They always came on in the middle of the night, awakening the patient from sound lethargic sleep; there never was any attack during the daytime.
Defective functional excretion embarrasses the organs of the system; the sensibility and irritability of those organs become cumulative up to a certain point, when spasm of the bronchial circular muscles sets in, most probably with the "dry asthmatic
symptoms;" subsequently congestion of the mucous membrane, followed by effusion, the "humid asthma," when, after copious expectoration, relief to the system is obtained and the attack subsides.
Any theory of the causation of a disease is very fairly strengthened or invalidated by reasonings drawn from the Adjuvantia" and "Sedentia."
Upon the latter sufficient may be inferred from the above description of this case. As to the former, the continued respiration of impure air, the dyspeptic symptoms, the constipation and overloaded renal secretion, and oft-recurring menorrhagia, with the times and circumstances under which the attacks would supervene, pointed directly to a series of probable causes of the malady, which being obviated, relief might be expected. Such unquestionably was the result; and though stimulating into greater activity the emunctories of the system did not at first remove the tendency to a periodic recurrence, yet its continuance, and the occasional exhibition of a nervine sedative, as a few minims of chloroform or grains of belladonna, sufficed to allay the habitual sensibility of the pneumogastric and stop any threatened invasion.
Our most able writers upon asthma hardly, I think, attach sufficient importance to the excerning function of the lungs. Nature will invariably make that function supplementary to deficient action of other excreting organs, or it of itself will take on proportionate action when all others are labouring to eliminate some materies morbi from the system; to wit, in the exanthemata, gout, uræmia, and others. So that I question the advisability of checking in the first instance, by sedatives only, excessive bronchial secretions, but rather attempt removing that necessity by stimulating other organs into more vigorous action.
In ordinary cases of bronchitic asthma, I have seen but little benefit resulting from expectorants and sedatives given until the digestive, hepatic, urinary, and intestinal functions have first been regulated and kept up for some time in gentle but continuous action. When such has been established I have seen the happiest results from a grain of blue pill with four of the pil. scillæ comp. night and morning, with four-minim doses of chloroform suspended by mucilage in camphor mixture taken
upon any impending attack: and the modus operandi of such remedies is quite intelligible.
The atmospheric and constitutional conditions under which catarrhus æstivus, or hay asthma, is induced are at present obscure and unsatisfactory. Alleged exciting causes, whether ipecacuan, pollen of the Anthoxanthrum, chlorine vapour, or other irritating substance, seem inadequate to account for such sudden and violent symptoms. Should, however, the above reasonings be tenable, of a cumulating influence of predisposing causes, it may be somewhat more intelligible why some trifling exciting cause, such as the above-mentioned, may so suddenly develop such grave attacks. It is curious that genuine hay asthma is a disease of early summer, when warmer and consequently more humid atmosphere renders the pulmonary evolution of carbonic acid less free than in colder and drier weather; also that females are more prone to such attacks just before the catamenial periods, and especially those who are plagued with emotional irritability of temperament.
Leaving out of the question asthmas complicated with cardiac, tubercular, pleuritic, or emphysematous lesions, I fully entertain an opinion that those arising from functional causes can be most surely and permanently relieved by continued attention to the cutaneous, hepatic, urinary, and intestinal emunctories, by which we reduce to a minimum the excretory function of the bronchial mucous membrane.
OBSERVATIONS ON THE USE AND EFFECTS PRODUCED BY THE EMPLOYMENT OF COLD IN TYPHUS AND ITS VARIETIES.
BY DR. ALLVEY.1
TAKING a man from his bed in what is called a burning fever, placing him in a tub, and throwing a pail of cold water on him, at any time of the year, but more particularly during the severity of winter, appears to the ignorant a practice so extremely harsh, cruel, and unnatural, that where the practice is not common, or the parties rational and well informed, if success do not follow the means made use of, the practice, especially in that particular case, is sure to be called in question. In order therefore, under such circumstances, that we may not be altogether losers of the good effects to be produced by the employment of cold in fever, I thought my time would be well employed by informing the Society of the method I have lately made use of in several instances to remove the prejudice of the patient and friends, and at the same time acquire some of the advantages procured in fever by the employment of cold affusions. But in order that the observations I have to make respecting the relative powers of heat and cold upon the sensations of the human body may be better understood, I shall take the liberty of first bringing forward a few postulata upon the subject of cold.
1 The date of this paper is 1801, and we have thought it might be interesting to reproduce a record of the impression which Currie's cold-water practice had made before it unhappily sank into neglect and oblivion. We owe the MS. to the kindness of Dr. Wilson Fox, who found it in an old manuscript volume of "Reports of the Proceedings of a Medical Society in the Country" which has come into his hands.-ED. Pract.
I set out with considering cold as only a diminution of heat. Heat in all its degrees within a certain range proves stimulant to all animals, in an exact proportion of its degree.
The degree of cold which produces death in some animals is still stimulant, since it can sustain the phenomena of life in others. There is a certain place in the scale of heat called an agreeable state, and the various points below this are called cold, the effects of which are to diminish the living, moving, and acting state of all animals.
But this degree of agreeable temperature does not prove such to all bodies, since the excitability or capability of being acted upon varies in different persons and animals. The effects of excessive cold are a disagreeable sensation, a desire of warmth, universal tremor, numbness, and torpor. When in this situation, if moderate warmth be applied, a sensation analogous to that called burning is induced; but when the cold is carried further, either in duration or degree, and in no degree diminished by the intervention of heat, its effects become similar to burning from heat, and both (i.e. heat and cold) similar in their painful and corroding effects to that of the fossil acids or caustic alkalies. When cold is carried further, first all pain, then all uneasy sensations, and lastly all feeling, ceases; a universal suspension to both voluntary and involuntary motion, together with the action of all the functions. Deep sleep of course follows, which, if allowed to continue for no great length of time, is not to be overcome by any exciting power, but terminates in death. Cold applied in a more moderate degree, but continued longer, will produce death as in the former case, although the intermediate parts of the process may be in some degree different.
The redness of the face and vigour of the body so common in cold countries and cold seasons do not arise from the application of cold itself, but from the brisk exercise to which the person is impelled by the inconvenient sensation of cold, the addition of clothes, the use of stimulants in much larger quantities, the employment of strong drink, and the stimulus of food.
Hence it appears that cold does not produce this vigorous state, but the stimuli, and on such occasions evidently counteracting the effects of cold. If the effects of cold be separated