COLUMBIA LIBRARIES OFFSjTE HEALTH SCIENCES STANDARD HX6412129- RC46 .R39 Diseases of modem 1 RECAP W '" I) 1 1 1\ ill tih' uc \ ) : \ ( ' I )1 m:^m t "Ke^^?) in % (Utt^ of N^m fork (Haih^t nf pi][}|0trtana nnh ^ttrgrnnB yy\Ys,,c^:Q^\^^ Digitized by the Internet Archive in 2010 with funding from Open Knowledge Commons http://www.archive.org/details/diseasesofmodernOOrich DISEASES OF MODERN LIFE. BY BENJAMIN WARD RICHARDSON, M.D., M.A., F.R.S., Fellow of the Royal College of Physicians; Honorary Physician to the Royal Literary Fund, and to the Newspaper Press Fund; Honorary Member of the American Philosophical Society; Honorary Member of the Imperial Leopold Carolina Academy of the Natural Sciences. NEW YORK : BERMINGHAM & CO., UNION SQUARE. 1882. (Wi ^t^ W. L. Mershon & Co., Printers^ Electrotypers and Binders^ Rahway, N. J. TO WILLIAM FARR, M.D., D.C.L., F.R.S., CORRESPONDING MEMBER OF THE INSTITUTE OF FRANCE. My Dear Farr, I might most correctly dedicate a book to you, in simple remembrance of a friendship which, through the long spell of twenty-five years, has been an unbroken chain of pleasant memories. But I add to this reason another : In so far as an author can show admiration and respect by the act of a dedication, I would now show to you, with all my heart, how deeply I appreciate your scholarly learn- ing; your marvellous industry; your pre-eminent services to your country, and your age as a pioneer in constructing the science of vital statistics, and the incomparable aid you have rendered to all of us who have studied such subjects as are written in this volume. Yours ever faithfully, BENJAMIN W, RICHARDSON. PREFACE. Eleven years ago I published a series of essays on diseases of overworked men, in order to direct attention to the physical injuries of the body that are induced by excessive mental work and worry, and by excessive physical exertion. These essays were followed by others on disease from some occupations, from indulgence in alcohol, and from the use of tobacco. At the time they were written, and long afterwards, the essays excited much public interest, and at the instance of Mr. Macmillan I undertook to republish them in a collected form. In the work of revision many other subjects occurred to me as of similar order and interest, and I have been led, consequently, while retaining that which I have already published, to construct the volume that is herewith presented. The book, medical in all its aspects, is avowedly written for the study of the intelligent public as well as for medical men ; but whoever opens it to find " domestic medicine," 6 PREFACE. or revelations of the arcanum of medicine, will be deceived. I have written, feeling that the day of popular receipts has gone by, and that the arcanum is dissolved. Avoiding every infringement on the art proper of curing disease, I have in these pages considered only the science of prevention, which many can understand, and which is a profitable science to all who condescend to learn it. 12 HiNDE Street, Manchester Square, W, Christmas Day, 1S75. CONTENTS. PART THE FIRST. PHENOMENA OF DISEASE, ' INCIDENTAL AND GENERAL. CHAPTER I. PAGE NATURAL LIFE TO NATURAL DEATH — EUTHANASIA . , .II CHAPTER II. THE PHENOMENA OF DISEASE — CLASSIFICATION AND DISTRIBUTION I5 CHAPTER III. DISEASE ANTECEDENT TO BIRTH 22 CHAPTER IV. EXTERNAL ORIGINS AND CAUSES OF DISEASE 3 1 CHAPTER V. PHENOMENA OF DISEASE FROM CAUSES EXTERNAL AND UNCON- TROLLABLE 36 V CHAPTER VI. PHENOMENA OF DISEASE FROM CAUSES EXTERNAL AND COMMUNIC- ABLE. • . . 50 CHAPTER VII. PHENOMENA OF DISEASE INCIDENTAL TO OLD AGE AND NATURAL DECAY 62 8 CONTENTS. PART THE SECOND. PHENOMENA OF DISEASE, INDUCED AND SPECIAL. CHAPTER 1. DEFINITION AND CLASSIFICATION ..,.,.. 7I CHAPTER II. DISEASE FROM WORRY AND MENTAL STRAIN . . . . -73 CHAPTER III. DISEASE FROM WORRY AND MENTAL STRAIN — continued . . 86 CHAPTER IV. INDUCED DISEASE FROM PHYSICAL STRAIN , . . , -95 CHAPTER V. DISEASE FROM COMBINATION OF PHYSICAL WITH MENTAL STRAIN . I06 CHAPTER VI. ON DISEASE FROM THE INFLUENCE OF THE PASSIONS. . . . IIO CHAPTER VII. ON DISEASE FROM ALCOHOL — PHYSIOLOGICAL PROEM . . . II8 CHAPTER VIII. PHENOMENA OF DISEASE FROM ALCOHOL — THE FUNCTIONAL TYPE . 133 CHAPTER IX. ORGANIC DISEASE FROM ALCOHOL I3g CHAPTER X. ON DISEASE FROM TOBACCO— PHYSIOLOGICAL PHENOMENA . . I52 CHAPTER XI. PHENOMENA OF DISEASE FROM TOBACCO 159 CONTENTS. 9 CHAPTER XII. NERVOUS DISEASE FROM TOBACCO 172 CHAPTER Xni. DISEASE FROM THE USE OF NARCOTICS 179 CHAPTER XIV. DISEASE FROM FOODS. ......•• '^^ CHAPTER XV. DISEASE FROM IMPURITY OF AIR 206 CHAPTER XVI. DISEASE INCIDENT TO SOME OCCUPATIONS ..... 217 CHAPTER XVII. DISEASE FROM SLOTH AND IDLENESS 234 CHAPTER XVIII. DISEASE FROM LATE HOURS AND BROKEN SLEEP .... 237 CHAPTER XIX. DISEASE FROM ERRORS OF DRESS ....... 243 CHAPTER XX. DISEASE FROM IMITATION AND MORAL COxNTAGION . . . 250 CHAPTER XXI. AUTOMATIC DISEASE AND HYPOCHONDRIASIS 258 CHAPTER XXII. INTERMARRIAGE OF DISEASE 263 PART THE THIRD. SUMMARY OF PRACTICAL APPLICATIONS . . .265 DISEASES OF MODERN LIFE, PART THE FIRST. PHENOMENA OF DISEASES ; INCIDENTAL AND GENERAL. CHAPTER I. NATURAL LIFE TO NATURAL DEATH — EUTHANASIA. By the strict law of Nature a man should die as uncon- scious of his death as of his birth. Subjected at birth to what would be, in the after con- scious state, an ordeal to which the most cruel of deaths were not possibly more severe, he sleeps through the pro- cess, and only upon the subsequent awakening feels the impressions, painful or pleasant, of the world into which he is delivered. In this instance the perfect law is fulfilled, because the carrying of it out is retained by Nature herself : human free-will and the caprice that springs from it have no influence. By the hand of Nature death were equally a painless por- tion. The cycle of life completed, the living being sleeps into death when Nature has her way. This purely painless process, this descent by oblivious trance into oblivion, this natural physical death, is the true Euthanasia ; and it is the duty of those we call physicians to secure for man such good health as shall bear him in activity and happiness onwards in his course to this goal. For Euthanasia, though it be open to everyone born of every race, is not to be had by any save through obedience to those laws which it is the mission of the physician to learn, to teach, and to enforce. Euthanasia is the sequel of health, the happy death engrafted on the perfect life. When the physician has taught the world how this benign 12 NATURAL LIFE TO NATURAL DEATH — process of Nature may be secured, and the world has accepted the lesson, death itself will be practically banished; it will be divested equally of fear, of sorrow, of suffering. It will come as a sleep. If you ask me what proof there is of the possibility of such a consummation, I point to our knowledge of the natu- ral phenomena of one form of dissolution revealed to us even now in perfect, though exceptional, illustration. We have all seen Nature, in rare instances, vindicating herself despite the social opposition to her, and showing how ten- derly, how soothingly, how like a mother with her foot on the cradle, she would, if she were permitted, rock us all gen- tly out of the world. How, if the free-will with which she has armed us were brought into accord with her designs, she would give us the riches, the beauties, the wonders of the Universe for our portion so long as we could receive and enjoy them ; and at last would gently withdraw us from them, sense by sense, with such imperception that the pain of the withdrawal would be unfelt and indeed unknown. Ten times in my own observation I remember witnessing, with attentive mind, these phenomena of natural Euthana- sia. Without pain, anger, or sorrow, the intellectual facul- ties of the fated man lose their brightness. Ambition ceases, or sinks into desire for repose. Ideas of time, of space, of duty, lingeringly pass away. To sleep and not to dream is the pressing and, step by step, still pressing need ; until at length it whiles away nearly all the hours. The awakenings are short and shorter ; painless, careless, happy awakenings to the hum of a busy world, to the merry sounds of children at play, to the sounds of voices offering aid ; to the effort of talking on simple topics and recalling events that have dwelt longest on the memory; and then again the overpowering sleep. Thus on and on, until at length, the intellectual nature lost, the instinctive and merely animal functions, now no longer required to sustain the higher faculties, in their turn siiccumb and fall into the inertia. This is death by Nature, and when mankind has learned the truth, when the time shall come — as come it will — that *' there shall be no more an infant of days, nor an old man who hath not filled his days," this act of death, now, as a rule, so dreaded because so premature, shall, arriving only at its appointed hour, suggest no terror, inflict no agony. The sharpness of death removed from those who die, the poignancy of grief would be almost equally removed from KUTHANASIA. 13 those who survive, were natural Euthanasia tlie prevailing fact. Our sensibilities are governed by the observance of natural law and the breach of it. It is only when nature is vehemently interrupted that we either wonder or weep. Thus the old Greeks, fathers of true mirth, who looked on prolonged grief as an offence, and attached the word mad- ness to melancholy, — even they were so far imbued with sor- row when the child or the youth died, that they bore the lifeless body to the pyre in the break of the morning, lest the sun should behold so sad a sight as the young dead ; while we, who court rather than seek to dismiss melancholy, who find poetry and piety in melancholic reverie, and who indulge too often in what, after a time, becomes the luxury of woe, experience a gradation of suffering as we witness the work of death. For the loss of the child and the youth we mourn in the perfect purity of sorrow; for the loss of the man in his activity we feel grief mingled with selfish regret that so much that was useful has ceased to be. In the loss of the aged, in their days of second childishness and mere oblivion, we sympathize for something that has passed away, and for a moment recall events saddening to the memory; but how soon this consoling thought succeeds and conquers • — that the race of the life that has gone was run, and that for its own sake the dispensation of its removal was most merciful and most wise. To the rule of natural death there are a few exceptions. Unswerving in her great purposes for the universal good, Nature has imposed on the world of life her storms, earth- quakes, lightnings, and all those sublime manifestations of her supreme power which, in the infant days of the universe, cowed the boldest and implanted in the human heart fears and superstitions which in hereditary progression have passed down even to the present generations. Thus she has exposed us all io accidents of premature death, but, with infinite wisdom, and as if to tell us that her design is to pro- vide for these inevitable calamities, she has given a prepon- derance of number at birth to those of her children who by reason of masculine strength and courage shall have most frequently to face her elements of destruction. Further, she has provided that death by her, by accidental collision with herself shall, from its very velocity, be freed of pain. For pain is a product of time. To experience pain the impres- sion producing it must be transmitted from the injured part of the living body to the conscious centre, must be received T4 NATURAL LIFK TO NATURAL DEATH — at the conscious centre, and must be recognized by the mmd as a reception; the last act being in truth the conscious act. In the great majority of deaths from natural accidents there is not sufficient time for the accomplishment of these pro- gressive steps by which the consciousness is reached. The unconsciousness of existence is the first and last fact inflicted upon the stricken organism: the destruction is so mighty, that the sense of it is not revealed. The duration of time intended by Nature to extend between the birth of the individual and his natural Eutha- nasia is undetermined, except in an approximative degree. From the first, the steady, stealthy attraction of the earth is ever telling upon the living body. Some force liberated from the body during life enables it, by self-controlled resistance, to overcome its own weight. For a given part of its cycle the force produced is so efficient, that the body grows as well as moves by its agency against weight; but this special stage is limited to an extreme say of thirty years. There is then another period, limited probably also to thirty years, during which the living structure in its full develop- ment maintains its resistance to its weight. Finally, there comes a time when this resistance begins to fail, so that the earth, which never for a moment loses her grasp, commences and continues to prevail, and after a struggle, extended from twenty to thirty years, conquers, bringing the exhausted organism which has daily approached nearer and nearer to her dead self, into her dead bosom. Why the excess of power developed during growth or ascent of life should be limited as to time; why the power that maintains the developed body on the level plain should be limited as to time; why the power should decline so that the earth should be allowed to prevail and bring descent of life, are problems as yet unsolved. We call the force that resists the earth. Vital. We say it resists death, we speak of it as stronger in the young than in the old; but we know nothing more of it really, from a physical point of view, than that while it exists it opposes terrestrial weight sufficiently to enable the body to move with freedom on the surface of the earth. These facts we accept as ultimate facts. To say that the animal is at birth endowed with some reserved force, some- thing over and above what it obtains from food and air, would seem a reasonable conclusion; but we have no proofs that it is true, save that the young resist better than the old. EUTHANASIA. IS We must therefore rest content with our .vnowledge in its simple form, gathering from it the lesson that death, a part of the scheme of life, is ordained upon a natural term of life, is beneficently planned, " is rounded with a sleep." CHAPTER II. THE PHENOMENA OF DISEASE — CLASSIFICATION AND DIS- TRIBUTION. To that condition of man which leads to death before the completion of the natural cycle of life and the natural Euthanasia, we apply the term Disease. But, as disease appears under various forms, each represented by phenomena so grouped together and so steadily reappearing in the same order as to be distinctive in character, a particular name has been applied to the several forms, which thus specified, have themselves been calleddiseases. The Names of Diseases. — The naming of these groups of phenomena has been unsystematic and fanciful. The movements of an animal, the dancing of fanatics at the shrine of a saint, the sensation of strangling or suffocation, the flowing of a stream or current, the burning of a fire, the effect of being stricken or knocked down, words or terms signifying these meanings, such as cancer, St. Vitus' dance, angina, catarrh, inflammation, apoplexy, and others equally fantastic, yet often forcible, have made up from the earliest times the nomenclature of disease — a nomenclature imper- fect even for technical purposes of language, and inappli- cable altogether for the higher developments of medical scientific research and practice. In the course of time the whole subject of the naming of the phenomena of disease will have to be recast. The term disease will come to signify unity — a departure from an approximative standard of health, manifested by a series of definable phenomena, each traceable to some modification of a natural or physiological animal process. Then, to each series of defined phenomena a simple name will be given, indicating either the physiological disturbance upon which the unnatural symptoms that are presented depend, or upon the cause of the disturbance. Seventeen years ago I wrote l6 THE PHENOMENA OF DISEASE, the same suggestion, hoping that the old and crude method of naming the special phenomena of disease, as if each group were an entity, would die out. Unfortunately such hope was too earnestly precipitate. In the last few years the ancient error has been greatly exaggerated; the figures of the old gods remain on their altars, and new ones have been added as infinitely grotesque as any that have preceded. For the present I fear we must rest content with the names we possess of the varied classes of phenomena which make up the unity of disease, however foolish those names may be. It is probable that disease, as a whole, is not as yet understood with sufficient comprehensiveness to allow of a revised and simplified nomenclature. I shall nevertheless show, as I proceed, that the bases really exist on which to found a simple classification of diseases according to the causes by which they are induced. Disease in Relation to Historical Time.— The so- called diseases, or specific phenomena of disease, which we in this day recognize as in active operation, though with dif- ferent values of intensity, are fully two hundred and fifty in number. About one hundred of these help to make out the current and regular mortalities of civilized communities in our modern times. In looking back at the history of disease in so far as it is written in parallel page with the history of man, we find how distinct the groupings of the phenomena have continued in relation to time and how remarkably fixed. From age to age and from one civilization to another they have retained their integrity of type, few becoming actually lost, and few springing forth as absolutely new. It is true that certain maladies to which definite characteristics and names have been assigned are of rarer occurrence in some periods than in others. Still, the maladies remain, and when they appear, even in the most isolated form, they are as they were when they were originally described. The malady known as ague was once so common in London that the metropolitan physi- cian looked upon it as one of the most ordinary disorders he was called upon to treat; now it is so rare that a practitioner may live for years and never see an example of it; but when it is met with it is found to be made up of the same symp- toms as when Sydenham so graphically depicted it. The sweating sickness which invaded England with the Earl of Richmond, and which, when he became the triumphant Henry the Seventh, obtained the second name of '' the king CLASSIFICATION AND DISTRIBUTION. 1 7 of England's sickness," has not appeared in the epidemic form since 155 1. Yet in our time a typical, though, hap- pily, isolated, example of it has been witnessed. The black death is still represented in malignant typhus. The great plague of Athens was neither more nor less than a terrible visitation of what we now call malignant scarlet fever. Small- pox has Lhown no abatement of its fury, when it has had the opportunity of becoming fully developed, from that which it showed when Rhazes of the ninth century, follow- ing Aaron of the sixth, committed to parchment the descrip- tion of its phenomena. Carcinoma — cancer — 'is the same intractable, painful, fatal malady to us as it was to Hippo- crates, Galen, and Paulus yEgineta. Gout, as we see it here, in this century, is the same as it was to Alexander of Tralles. Modern phthisis pulmonalis is identical with the description so faithfully rendered of it by Caslius Aurelianus. Inflam- mation is practically known to us by no better signs than the four distinguishing ones left us by Celsus — "redness, swell- ing, heat, and pain;" while in these days, as in his, the contest commenced by Erasistratus continues, as to whether there can be fever without inflammation; that is to say, whether, whenever there is general fever, there is not of necessity a local inflammation in some organ or structure of the affected body, or whether a general fever may exist independently of any such local disturbance. In brief, the more deeply we study the past history of medicine the surer is the conviction that, throughout the whole of the known period o human existence on the earth, not one knew disease has been added, not one withdrawn. This is so true, that phenomena of disease which have been described by the ancients and have been ignored by sub- sequent writers, have reappeared to attest as truth what has passed for fable. The phenomenon called, in early times, " bloody sweat," has been disputed. But in our days this phenomenon has been seen. I have seen it myself, and although we now recognize, in observing it, that blood does not veritably exude from the skin when the red-colored per- spiration breaks forth, as was originally supposed, we admit that the exuded fluid is nevertheless a product of the blood, and that the primitive definition is therefore substantially correct. In like manner, the great plague which visited Constanti- nople in 543, and which Procopius and Euagrius described, the plague of hallucination, drowsiness, slumbering, distrac- 2 t8 THE PHENOMENA OF DISEASE, tion, and ardent fever, with eruption on the skin of black pimples the size of a lentil ; this plague — which usually killed in five days, and left many who recovered with withered limbs, wasted tongues, stammering speech, or such utterance of sound that their words could not be distinguished ; this plague, which had passed into mythical learning under the name of "cerebrospinal meningitis," has also in our time reappeared. Disease in relation to Terrestrial Space.— The phenomena of disease, unlimited by time and almost unchecked by science, are nevertheless, to a certain extent, bounded by space. They are, I mean, confined by certain influences belonging to certain parts of the surface of the planet. The rules on this head are simple. Some pheno- mena of disease are developed in all parts of the earth. Some phenomena which could probably be developed in all parts, are actually developed only in certain parts. Some phenomena are capable of development in certain regions and in none other. The phenomena of disease included under the first of these classes, and which may be called the universal, are many. Diseases of nervous origin, such as epilepsy, para- lysis, apoplexy, are of this kind : certain plagues, as small- pox and cholera, which spread wherever they are carried, are of this kind : those maladies which spring from the habits or social conditions of a community, whether they be acquired by imitation or by invention, — habits, for example, of uncleanliness, the use of intoxication fluids, or the mechanical restraints imposed upon the body — are also of this kind. The phenomena included under the second class are those special to localities, such as pellagra — Lombardo-Venetian leprosy — goitre and cretinism. These, either from pecu- liarities of the locality or from the hereditary susceptibilities of its inhabitants, are as distinctive and local as the hills, rivers, woods, or monuments of the same locality. The phenomena included under the third class are those which will not travel out of certain defined conditions that are obviously necessary for their existence. Of these the phenomena of disease known as yellow fever, which can only continue in parts of the earth where there is a mean tem- parature above 68° F., form a good illustration. The pheno- mena of the disease typhus fever, which flourish only in regions having a range of temperature lying between 40° and 62° F., form another illustration. The phenomena of the CLASSIFICATION AND DISTRIBUTION. 19 disease phthisis pulmonalis, which are so limited by a given degree of cold that they cannot exist in the Hebrides, the Faroe Islands, Iceland, and the Arctic regions ; and the phenomena of catarrhs or colds, which are confined within a range of temperature extending from a mean of 41° F. to the extreme cold of the Arctic climate, are other and similar examples. It would lead me too far away from my present object to use all the materials at my command in the detailed exposi- tion of the facts I have thus cited in the history of disease. I have wished simply to indicate that the history of the phe- nomena of disease is coeval with the history of man ; that some of these phenomena are universal as man himself ; that others are limited by place and condition : but that all have old foundations, coexistent with man, so that man had only to be developed for them to be potential. Disease in Relation to Race. — It is a question of great moment whether disease is modified by qualities of race. Until quite recently we had no evidence bearing upon this question that could at all elucidate it, and even now the trustworthy knowledge we possess is exceedingly small. Through the valuable labors of M M. Legoyt, Hoff- man, Neufville and Mayer we have obtained, however, some curious facts relative to the most widely disseminated of all races on the earth, the Jewish. These facts show, that, from some cause or causes, this race presents an endurance against disease that does not belong to other portions of the civilized communities amongst which its members dwell. The distinctness of the Jews in the midst of other and mixed races singles them out specially for observation, and the his- tory they present of vitality, or in other words, of the, resistance to those influences which tend to shorten the natural cycle of life, is singularly instructive. The resistance dates from the first to the last periods of life. Hoffmann finds that in Germany from 1823 to 1840 the number of still-born amongst the Jews was as i in 39, and of the other races i in 40 Mayer finds that in Furth, children from one to five years die in the proportion of 10 per cent amongst the Jewish, and 14 per cent amongst the Christian population ; and M. Neufville, dealing with the same subject from the statistics o Frankfurt, gives even a more favor- able proportion of vitality to the Jewish child-population. Continuing his estimate from the age named into riper years, the value ot life is still in favor of the Jews ; the average 20 THE PHENOMENA OF DISEASE duration of the life of the Jew being forty-eight years and nine months, and of the Christian thirty-six years and eleven months. In the total of all ages, half of the Jews born reach the age of fifty-three years and one month, r/hilst half the Christians born attain the age of thirty-six years only. A quarter of the Jewish population is found living beyond seventy-one years, but a quarter of the Christian population is found living beyond the age of fifty-nine years and ten months only. The Civil State extracts of Prussia give to the Jews a mortality of 1.61 per cent. ; to the whole king- dom 2.62 per cent. To the Jews they give an annual increase of 1.73 per cent; to the Christians, 1.36 per cent. The effectives of the Jews require a period of forty-one years and a half to double themselves; those of the other races fifty-one years. In 1849 Prussia returned one death for every forty of the Jews, and one for every thirty-two of the remaining population. The Jews escape the great epidemics more readily than the other races with whom they live. Thus the the mortal- ity from cholera amongst them is so small that the very fact of its occurrence has been disputed. Lastly, that element of mortality, suicide, which we may look upon philosophically as a phenomenon of disease, is computed by Glatter from a proportion of one million of inhabitants of Prussia, Bavaria, Wurtemburg, Austria, Hun- gary, and Transylvania, to have been committed by rather less than one of the Jewish race to four of the members of the mixed races of the Christian populations. Different causes have been assigned for this higher vitality of the Jewish race, and it were indeed wise to seek for the 'causes, since that race which presents the strongest vitality, the greatest increase of life, and the longest resistance to death, must, in course of time, become, under the influences of civilization, dominant. We see this truth indeed actually exemplified in the Jews; for no other known race has ever endured so much or resisted so much. Persecuted, oppressed by every imaginable form of tyranny, they have held together and lived, carrying on intact their customs, their beliefs, their faith for centuries, until, set free at last, they flourish as if endowed with new force. They rule more potently than ever, far more potently than when Solomon in all his glory reigned in Jerusalem. They rule, and neither fight nor waste. Happily we have not far to go to find many causes for the CLASSIFICATION AND DISTRIP.UTION. 21 high vitality of a race whicli, Ijy comparison with the Saxon and Celtic, is physically feeble. The causes are simply sum- med up in the term "Soberness of life." The Jew drinks less than his *' even Christian;" he takes, as a rule, better food; he marries earlier; he rears the children he has brought into the world with greater personal care; he tends the aged more thoughtfully; he takes better care of the poor^ and he takes better care of himself; He does not boast of to-morrow, but he provides for it; and he holds tenaciously to all he gets. To our Saxon and Celtic eyes he carries these virtues too far; but thereby he wins, becomes powerful, and, scorning boisterous mirth and passion, is com- paratively happy. The special inroads on vitality made on other races by dis- ease are not easily determined, because of the difficulties arising from temporary admixture of r^.ce I tried once to elicit some facts from a large experience of a particular dis- ease, phithisis pulmonalis, and as the results of this attempt may be useful, I put them briefly on record. At a public institution at which large numbers of persons afflicted with chest diseases applied for medical assistance, and at which I was for many years one of the physicians, I made notes, during a short portion of the time, of the con- nection that existed between race and the particular disease I have instanced — phthisis pulmonalis, or pulmonary con- sumption. The number of persons observed under the dis- ease was three hundred, and no person was put on the record who was not suffering from the malady pure and simple, — I mean without complication with any other mal- ady. They who were thus studied were of four classes: — {a) those who were by race distinctly Saxon; (d) those who were of mixed race, or whose race could not be determined; {c) those who were distinctly Celtic; (d) those who were distinctly Jewish. The results were, that, of the three hundred patients, one hundred and thirty-three, 44.33 per cent., were Saxon ; one hundred and eighteen, 39.33 per cent., were of mixed or undeterminate race ; thirty-one, 10.33 P^^ cent., were Celtic ; and eighteen, 6 per cent., were Jewish. It will be unfair to argue from these results that this proportion of Saxons suffering from pulmonary consump- tion, a proportion so extreme in comparison with the other races, is to be accepted as of general application. It may be conceded that of the persons who presented themselves 22 DISEASE ANTECEDENT TO BIRTH. before me the majority were Saxons, and that the mem- bers of them affected do but represent the relative propor- tions of the respective populations. Still the majority is large on the Saxon side, and to it ought to be added a con- siderable number of the class b^ in which the precise fact of peculiarity or race could not be determined. Further, there was this noticeable feature, viz. — that amongst the Saxon patients three-fourths at least came with an heredi- tary or family history of consumption, while as regards the other distinct races the disease in every instance had appa- rently been acquired by the sufferer, and was independent of family proclivity. In respect, therefore, to the particuliar malady named, I am led to infer that it is one to which persons of Saxon race are most susceptible. I am also led by other experience to think that the allies of this disease, struma, tabes mesen- terica, and tubercular change generally are most commonly met with in members of this race. Physiological peculiarities may account for dispositions to disease belonging to typical classes of the human family. What these peculiarities are we are as yet unable to deter- mine. Whether they are primitively impressed on a race, or are acquired, is a question that can only be answered when the exact relationships of disease to race are discov- ered. My own view is, that acquired and transmitted qualities, and specific existing social peculiarities, are suf- ficient agencies for the production of all the known vari- ations of vitality belonging to particular races. This will be somewhat elucidated by that which follows in the next chapter. CHAPTER III. DISEASE ATECEDENT TO BIRTH. The phenomena 'of disease may be pre-existent to the birth of the diseased individual, and that by the period, not only of one, but of two or more generations. To the ancients this fact, which was to obvious to be long over- looked, was an inscrutable mystery, incomprehensible on all physical grounds. It passed therefore, naturally enough, into an accepted order of events based, in simplicity and DISEASE ANTECEDENT TO P.TRTM. 2^ confidence of belief, on Divine will, without a thought as to the method of the ordinance or the cause of it. The sins of the parents were " visited upon the children until the third and fourth generation." Some sins of parents are visited as diseases upon the children until the third and fourth generations ; but there are other visitations, also descending through many genera- tions, which are due, not to the sins but to the misfortunes or accidents of those in whom they originated and from whom they have descended. We are now obliged there- fore, to modify the ancient hypothesis, and by a careful study of the phenomena presented, trace out, as far as we have the light of scientific truth to guide us, the physical nature of such phenomena. Diseases implanted in the living body previous to its birth are of two classes. In the one class the disease veritably exists in the body of the unborn, /. ^., is developed in the body while it is still in the womb of the mother. In the other class the disease, although it may pre-exist in the body previous to its birth, is not necessarily so far developed as to be recognizable at birth ; indeed it may not be recognizable for a long time — for many years perhaps — after the body has been born. The Phenomena of Disease of the first class.— The phenomena of disease of the first-named class are numerous and varied — almost as numerous and as varied as those which are manifested in the life of the being when it has attained to an independent growth and existence. They may also, while yet the being is dependent on the circulation of the mother for its support, be present while the mother is free of them, or while the mother is suffering from them. These developed phenomena of disease, existing in the unborn, may be divided into groups. The phenomena of disease which are most common to the unborn are those of a simple perversion of the nutritive pro- cesses. The body generally may thus be unduly developed in all its organs, so that it may attain to a weight even of twenty-four pounds avoirdupois. It may be unduly developed locally, so that such organs as the thyroid gland, the spleen, the tongue, the kidney, the bladder, the heart, may attain immoderate size. In the opposite direction, the body generally may be imperfectly nourished, so that at the period when its uterine life is fully accomplished, its weight may not even exceed three pounds. It may be imperfectly 24 DISEASE ANTECEDENT TO BIRTH. nourished in parts or organs only ; or it may suffer from complete arrest of nutrition in the whole or in parts, and pass into a state of general or local decomposition. A group of phenomena of an inflammatory character may occur during the intra-uterine life. There may be inflam- mation of the skin, of the mucous membrane of the lungs, of the stomach, of the intestines, of the eye-ball ; and such inflammation may be continued into ulceration. There may be inflammation of the serous membranes enveloping the spinal cord and brain, or of the serous membranes cover- ing the heart, the lungs, the intestines, giving rise to the dis- eases known as arachnitis, pleuritis, pericarditis, peritonitis. There may be inflammation of the structure of organs, or the lungs, of the thymus gland, of the kidney. Phenomena of disease consisting of exudations may inter- fere with the natural course of the child during its unborn existence. These exudations may be of blood, or of some constituent part of the blood. Thus effusion of blood has been found on the brain, in the lungs, and even in the cav- ity of the pleura ; while effusion of the serum or watery part of the blood may take place between the membranes of the brain, into the ventricles, into the spinal canal, into the peri- toneal cavity, into the cellular tissue beneath the skin, into the pelvis of the kidney, and into the pericardium or serous covering of the heart. A considerable number of the diseases which are called communicable have been discovered as affecting the body during the time of its uterine existence. That one com- municable disease which springs from vicious sexual indul- gence, and which has insignificantly been called " specific," has been met with in the unborn in all its worst forms — affecting the skin, the bones, the glands, the organs of vision and of the other senses, and indeed invading the structures of the body generally, with as severe a malignity as it invades the tissues of those who in after life may contract it. Sm.all- pox, another of the common communicable diseases, has been known to attack the unborn child ; and what is most singular, the attack in some instances has occurred in the offspring, while the mother who was bearing it, has herself remained unaffected by the disease, though exposed to the contagion. This fact the illustrious Jenner has recorded with his usual accuracy of detail. Of the other communicable diseases, measles and scarlet fever have shown themselves in the child, as contracted from DISEASE ANTECEDENT TO BIRTH. 25 the mother during the period of life that precedes birth, when the maternal organism could have been the only medium of impressions and influences derived from the outer world. The phenomena of what are called new growths have been observed as developed in the unborn. These growths, tumors, have in some instances been simple in character, in other instances malignant. The simple growths include what are known as nsevus, fibroid tumor, and cystic tumor. The malignant growths include fungoid tumor, and that form of cancer recognized as schirrus, or hard cancer. These diseases have appeared in the unborn child when the parents have been free of them, and even, as it would seem, of the taint of them. Some organs of the child may be charged, during uterine life, with tubercular matter. The lungs have been discovered tuberculous with suppuration, a condition indicating a late stage of pulmonary consumption. Parasitic forms that have existed previous to the birth have been discovered in the body of the child. Hydatid cysts have been found in the kidney, and those small wire-like worms called ascarides in the lower part of the alimentary canal. Various inorganic products have been noted amongst the diseases of the unborn. Calculus, or stone, has been dis- covered in the bladder. The surface of the skin has been found covered with a dark, reddish, gritty deposit. The same surface has also been seen covered with a scaly inor- ganic matter standing forth in tuberculated prominences, the skin itself being hard, thickened, and rent by deep irregular fissures. Many forms of mechanical derangements and injuries have been traced out in the unborn child. The heart has been discovered with diseased conditions of its valves; the arteries have been found dilated; wounds have been met with on the skin; limbs have been detected fractured, joints fixed anchylosed or dislocated. Irregular muscular movements have been known to occur in the unborn child. In instances where the mother has been suffering from ague the convulsive movements of the paroxysm have occurred in the child, but not necessarily on the same days as those in which the mother has been con- vulsed. Convulsion of an extreme and epileptiform charac- ter has also been known to attack the unborn and appar- ently to kill, the mother being unaffected. Again, irregular 26 DISEASE ANTECEDENT TO BIRTH. action of the heart has been traced as occurring to the child before its entrance to independent life. I have myself known an illustration of this nature, in which a boy was born with his heart beating intermittently, a condition which has continued through many years of his life, and has, indeed never ceased altogether, except during short inter- vals of time. In addition to these active forms of disease affecting the unborn, there are sometimes certain modifications of structures to which we give the name of malformations. The absence of fingers or toes; the extra development of those parts; webbed fingers; marks on the skin; irregular growths of hair, distorted outlines of the bones, as in club- foot; distorted position of the eyes — strabismus; these and some rarer disfigurements or failure of natural organs occur to the unborn during their brief first stage of unconscious life. An arrested development of the more important organs of the animal, or a development originally imperfect, is yet another condition incident to the unborn existence. I have known a failure of perfect development in the globe of one eye, in one hand, in one lower limb, in the heart. In deaf mutes there is a failure of construction either in the organ of hearing, in the nervous cord leading to the brain, or in the brain, in idiots there is primitive failure in the develop- ment of the brain as a whole. Other failures of development are known which in their nature are simply fortuitous. Thus a limb may be sub- jected to compression from an accidental enfolding of it in a coil of the umbilical cord, and its nutrition may thus be arrested, even to complete destruction of its life. The most common arrests of development are those occurring in parts where a junction of medial structures is required and not perfected. Cleft in the palate; division in the centre of the lip — hare lip; division in the spinal column, with protrusion through the opening of the membranes cov- ering the spinal cord — spina bifida, are illustrative examples of these abnormalties. From malformation, or from an accident happening imme- diately after birth, the course of the blood is sometimes not properly directed into the new channel, it should naturally enter in order to support the independent life in perfect manner. In these instances the opening that exists in the unborn between the right and left sides of the heart, in the DISEASE ANTECEDENT TO BIRTH. 27 auricles, and which should commence to close so soon as the child commences to respire, remains open. The venous blood under these circumstances makes its way, in part, over the arterial circuit without first passing through the lungs, and the result is that the body, fed with a blood that is only partially aerated, is imperfectly heated. It lives from one and a half to two degrees below the natural temperature, and the appearance of its surface in its more vascular parts, as in the cheek and lips, is of purple hue. The whole sur- face is preternaturally dark, and to the touch of a healthy person always cold . Children thus affected are said to suffer from cyanosis. They die, as a rule, during their first years. I have known, however, one child that lived to seven years; I have known another that lived to twenty-one years; and a third, in whom the fault was but partially developed, who has lived to thirty-five years, and indeed is still alive and in comparative health. The mode of death during cyanosis is, ordinarily, either by congestion of the lung or by the development of tubercle in the lung. All through their lives, cyanotic persons are disabled from taking active exertion; but they may live for a time in comparative comfort. They are not -themselves conscious of feeling cold, although they enjoy artificial warmth; and they usually eat with appetite, and require food at frequent intervals. Their faculties are dull, but the sense of depression is not a severe, nor even a remarkable part of their disease. These are the ordinary phenomena exhibited in per- sons in whom the opening between the right and left sides of the heart has been left unclosed after birth. At least one instance has, nevertheless, been recorded in which, through the open septum, the arterial blood has been diverted from the left side into the right side of the heart. In this patient the body was supplied with blood that was constantly super- oxygenated, — with blood, part of which had traversed through the lungs twice before making the arterial round. The phenomena observed were those of breathlessness and palpitation on the least exertion, persistent and profuse per- spirations yielding an intolerable odor, quick exhaustion on every effort, mental or physical; and an extreme deficiency of mental power. The patient in this condition was, in a in a word, like one subjected to overwhelming tropical heat — nerveless, exhausted, and requiring perpetual rest from 28 DISEASE ANTECEDENT TO BIRTH, labor. In this marked case, recorded by the late Dr. Mayne of Dublin, the sufferer, who lived to become a woman, died suddenly a few hours after the mere effort of walking across a courtyard. I intentionally omit all reference to those developments of the unborn known as monstrosities. This subject presents a field of singular interest to the physiologist. But as, up to the present time, nothing that suggests any useful measures for their prevention is known, respecting the origin and cause of these perversions of nature, the study of them would be curious rather than praotical, and therefore out of place in this work. In the brief first stage of life of the unborn, there occur to the body affections of a more refined kind, which are not immediately recognized, but which leave impressions that last throughout the after life During this state of exist- ence, the offspring, depending for its blood and for the force by which its blood is moved, on the circulation of the mother, is influenced by whatever directly influenced the maternal circulation. If any external agitation or passion make the heart beat unduly fast, or intermit, or for a brief period stop, the change of vibration passes to the child, which, uncon- scious though it be, is mechanically affected, its nervous matter being subjected to motion more or less determinate. The motion may be harmless, it may even be favorable to development, it may be prejudicial; whatever it be, it is imposed. It has been assumed that certain direct mental impressions are communicated from the mother to her unborn child, as though the nervous connection existing between the two through the blood could be a medium of such communica- tion of impression. The hypothesis is not unreasonable, but it is unsupported by any distinctive line of evidence. The extension of an influence through the circulating chan- nels is fully supported by evidence, since we know that the complete arrest of the circulation of the mother is fatal to the child. It may be, therefore, that this influence is itself sufficient to account for phenomena of nervous disturbance extending from the maternal organism to the dependent organism; for whatever interferes with the supply of blood to the brain and other nervous structures, creates disturb- ance in their nutrition and is a source of danger to their perfect development. The Phenomena of Disease of the Second Class.— DISEASE ANTECEDENT TO lURTH. 29 The phenomena of disease that are antecedent to birth, and are not marked by any developed evidences at the time of birth, constitute what are called the hereditary maladies. They all come from a condition that has been laid in the parental line, paternal or maternal. In some respects they are analogous with other hereditary qualities, such as the mental qualities of courage, fear, prodigality, frugality, or the physical qualities of shape of body, complexion, tone of voice, and feature. They differ from these qualities in that they are not of necessity present from the period of birth, but may remain for a time undeveloped, and indeed may not be developed at all unless some exciting and untoward influence call them forth. We are as yet unacquainted with all the phenomena of disease that pass in the hereditary line, but we admit the following as proved: — Phenomena of scrofula or struma, of cancer, of consumption, of epilepsy, of rheumatism, of gout, of insanity, of cretinism, of albinism, and of the "specific disease" — syphilis ; together with many varied attendant secondary phenomena, to which special names have been applied. It would be wrong, however, to limit the hereditary pro- clivities of disease to the above list. Day by day we are learning that they extend much further, and that a new line for observation is thus indicated, which industriously fol- lowed out, promises to yield the most important results. The further my own investigations extend — of the present, from experience and experiment; of the past, from historical reading — the stronger is the impression made upon my mind that the majority of the phenomena of disease have a cer- tain hereditariness of character. For instance, the phenom- enon which we call intermittent action of the heart, I have found to be distinctly hereditary. I have seen a child who exhibited it at the moment of birth, and to whom it was traceable through two generations. The phenomenon in this case, nervous in character, is induced, as we shall see in the sequel, purely by mental shocks acting definitely, but in so refined a manner, on the heart, that we as yet know nothing of the physical change that is developed in the nervous mat- ter. Again, I have known families in whom the tendency to some forms of communicable disease has been markedly apparent, and I have known instances of the reverse. Thus I have seen hereditary proclivity to scarlet fever and to diph-" theria. I have also seen, in respect to one of these diseases 30 DISEASE ANTECEDENT TO BIRTH. (scarlet fever), hereditary opposition to it, if the term be allowable. In brief, hereditary tendency means an organic construc- tion of body, framed during uterine life that is favorable to the action of those external influences which, in their ope- ration upon the animal functions, induced disturbed phe- nomena, — in other word diseases. Physical Seat of Hereditary Proclivity.— For ages past the hereditary proclivities to certain of the phe- nomena of disease have been recognized, and speculation has had its liberty in its endeavor to prove in what part of the animal body the fault is located by which such heredi- tary proclivity is manifested. Until lately, by the almost unanimous voice of learned and unlearned, the blood has been made the local seat alike of the good and of the bad qualities of the animal body. This hypothesis has found its expression in familiar terms: "The disease is in the blood." " the tendency runs in the blood," " ancestral blood." These and many other similar phrases are daily employed to express the hereditary peculiarities, mental and physical, of different families and of different men. For this phraseology, and for the hypothesis upon which it is founded, there is no basis whatever of a scientific char- acter. Ihe blood may, it is true, be changed in quality in various ways. Its specific weight may be increased or reduced; certain of its constituent parts, as its fibrine, which should be evenly distributed through the volume of the fluid, may separate; its red corpuscles may be dimin- ished in number or modified in shape; its white corpuscles may be increased, and not to mention some other changes, the blood may be charged with substances foreign to it, by which its natural properties may be impaired or even destroyed. These conditions, serious as they are when present, are of themselves to be considered as temporary. Certain of them may kill; certain of them may pass away, causing little mis- chief; and certain of them, in cases where they do not kill, may lead to injury in other parts of the body, the effects of which injury may be permanent and perhaps transmissible; but there is no disease of blood that is to be considered as directly transmissible in hereditary descent. The phenomena of diseases that are truly hereditary are due, as it would seem from all modern research, to primary injury inflicted upon nervous matter. It can indeed now be proved from direct observation on the inferior animals, that EXTERNAL ORIGINS AND CAUSES OF DISEASE. 3 1 certain injuries inflicted upon the nervous system will pro- duce symptoms which pass to th the offspring of the injured as distinctly as if the mischief had actually been inflicted upon the offspring. Thus, epilepsy, induced by nervous injury, has been transmitted directly downwards in heredi- tary course. But in what manner the primary hurt passes from the parent to the offspring, and that too by paternal as well as by maternal line, is simple mystery, on which science merely speaks as yet to tell us that the fact must be accepted. In only one direction does light dawn, in advance of this new and remarkable truth. It is observable that the injuries to nervous matter which .are capable of producing heredi- tary diseases must, in the first instance, be inflicted on a.ner- vous centre, or on the trunk of a nerve, and that no injury inflicted on the peripheral expanse of nervous matter, that expanse I mean on which we receive all the impressions that reach us from the outer world, is capable of being trans- mitted. Thus, while the effects of central injuries pass down, surface injuries and even amputations of extremities leave no mark on the succeeding generation. CHAPTER IV. EXTERNAL ORIGINS AND CAUSES OF DISEASE. If it be true that the animal organism is intended by nature to pass through a cycle, and that natural death is not a disease; but a completion of the process of life, it follows that the organism, born in health, is constructed to pass through the cycle and is not of itself, — that is to say, by its own organization, — capable of giving origin to any of the phenomena to which we apply the term disease. We must, therefore, seek for origins of the phenomena in causes lying outside the body, and affecting it in such manner as either to render the natural actions and processes irregular, or to excite actions and processes that are altogether new. Writing out in correct lists all the groups of phenomena that make up the term disease, and asking of each disease what is its origin, I finnd, as an invariable answer, that it is from without; a something, or a series of things, external to 32 EXTERNAL ORIGINS AND CAUSES OF DISEASE. the body itself, but acting upon it or through it. From this point of view all the groups of disease are in truth acci- dents; exposures to some influence or influences that pervert function or create new motion. If I fall and break a limb by coming into collision with some resisting medium, the cause of the fracture is obviously external. If I take typhus fever , the cause is equally external. I have come into contact or collision with an external, injurious agent, and have borne a less obvious, but not less certain, accident. The same with the whole list of the phenomena of disease, however classified or described. In the olden times, when each manifestation of diseased action was considered an entity; when to be epileptic or insane was, for example, to be possessed of an evil spirit; the causes of the phenomena were left as inscrutable. The diseases were the direct and dire chastisements of a Supreme Power; to ask their natural origin were to court a superflu- ous or sinful labor. Even in these days this impression is not altogether absent in civilized communities: in uncivil- ized, where it has taken root, it remains unchanged. It is not until we are brought to understand the physical design of the phenomena " disease," as opposed to the hypothesis of what has been called " visitation" and " entity" of disease, that we can move a step towards any attempt at prevention or removal of the phenomena. I shall therefore endeavor in this, and in succeeding chapters, to indicate the nature of the external causes which give the origins. The most difficult point in the acceptance of any proposi- tion on this subject has hitherto centered in those maladies which are known to descend from one generation to another. I have sought to remove such difficulty by showing that dis- eases of descent do originally come from an external impres- sion, which, in however inscrutable a manner, is nevertheless transmitted onwards from one organism to another. Nor is it more mysterious, when we think over the matter, that the impression of disease should descend, than that life and organization and form should take the same descending course. The knowledge of such descent must increase our sense of responsibility towards the unborn, but it need not add to our wonder, nor to our perplexity. What evil I inflict on myself, what injury I inflict on others, may be transmitted to those who as yet are non-existent ; what real good, physical or mental, I bring to myself, or to others, EXTERNAL ORIGINS AND CAUSES OF DISEASE. . 33 may also be transmitted to those who are yet non-existent. These are physical lessons better far to receive and act upon than the superstition, whatever its antiquity or authority may be, which places action out of our power. For each of the individual groups of disease is there, then, an individual corresponding cause, lying apart from the organism, and influencing it ? That is to say, are the causes as manifold as the diseases themselves ; or are they limited in number, and only extended in effect, so that from one series of causes many manifestations of phenomena pro- ceed ? The answer to this inquiry will probably be ultimately learned by the methods of tracing out the relationships of allied groups of phenomena, of reducing many apparently distinct groups to one type, and of discovering a common and distinguishable cause as the origin of that type. By these methods the naming and grouping of diseases, and the classification of causes, will be simplified and perfected. The science of medicine is not yet sufficiently advanced to allow of such simple classification of diseases, in relation to their causes as is above suggested. The idea exists, I do not doubt, in the mind of every medical scholar, but it has not taken the form of an approved and scholastic character. The nearest approach to classification of disease frorri cause is framed out in the returns of mortality issued weekly by our Registrar-General. Here, under the heads of "zymotic diseases," " developmental diseases," "accidents," there is an attempt at connecting disease with cause ; but the attempt is partial only : a compound of the physical reading of the phenomena of disease, and of those old read- ings in which such phenomena were considered as visita- tions, sudden, inexplicable, and belonging essentially to the one corporeal organism in which they were manifested. Withal there is a general, if unwritten, knowledge that cer- tain marked events of disease are often found occurring together, as if they depended upon some common influence. There are epidemic visitations. There are accumulated instances of sudden deaths from apoplexies, haemorrhages, congestion of the lungs, failures in the motion of the heart. The operating surgeon has a long run of successful opera- tions even of severe operations ; then he has a long run of fatal operations, in which he knows that the severity plays no part in the general result. When we put all these facts together, though we even call them coincidences, for the 3 34 EXTERNAL ORIGINS AND CAUSES OF DISEASE. want of a better term, they point circumstantially to the limitation of the phenomena of disease, and to the depend- ence of these phenomena, however apparently varied, upon the operation of a few causes, active and external. To this same suggested line of thought history lends her store. The external causes that give rise to the phenomena of disease have remained steadily in operation, producing repitition of the phenomena in such systematized order, that from patient study of history we might predict the recur- rence of some of the phenomena, as astronomers predict the return of comets and the recurrence of eclipses. The causes have remained unchanged ; the phenomena have followed with the precision of natural law. In succeeding pages, without attempting any elaborate or minute definitions of disease as dependent upon cause, I shall endeavor to consider the phenomena as originating in the following four sets of causes : — (i). Phenomena having their origin in causes which, in one or other form, are persistently present ; are parts of the natural order of the Universe ; are inseparable from that order, and are therefore beyond human control. I refer to such causes as atmospheric pressure, temperature, electrical condition, storm, earthquake, lightning stroke. (2). Phenomena having their origin in causes which, though springing out of nature in some unknown way, and though difficult of control, are, nevertheless, under an improving knowledge, controllable. I refer to such causes as pass from one person to another, and communicate from one person to another specific maladies. The diseases dependent on organic poisons, — communicable diseases, and others not communicable, except by hereditary descent, as cancer, consumption, cataract, calculus, will come under this head. (3) Phenomena of disease incidental purely to old age, and which depend on a cause uncontrollable, nay, one might say natural. I refer to the continued influence of the attraction of gravity upon the body; which influence, acting upon an organism destined to pass through a definite stage of develop- ment and developmental activity, remains in force after the maximum of organic power has been reached, and, still acting with undiminished force, at length slowly arrests nutrition, and leads to the degeneracy of senile decay. (4) Phenomena of disease dependent on such causes as modes of life, and the self-imposed acts of a person or a com- EXTERNAL ORIGINS AND CAUSES OF DISEASE. 35 munity. I refer to overwork, to indulgence in injurious foods and drinks ; to habits, exercises, studies, occupations, passions ; to privations ; to moral contagions ; and to all causes born of free-will or desire — the controllable errors of social life. In the great family of human diseases included under the above four divisions, the extremest differences of intensity and of severity of phenomena prevail. The phenomena that come under the first division are severe, and if we attach to them injuries of a secondary kind which often spring from them in their earlier stages, they are all dangerous. They yield a large return to the tables of mortality, and with such steadiness of rule and order that art seems practically power- less to arrest them in their sweeping course. The phenomena included in the second division are also severe in character, but they are fluctuating, both in respect to periods of occurrence and severity. The great Plagues came under this head, and before them, when they have become developed, art again stands powerless. Happily, however, science has supplied art with the means to avert these phenomena in certain instances, and- each day brings some new truth that helps on science in this splendid course. Other diseases belonging to this division, such as cancer and consumption, are as little under command; but inasmuch as the cause, even of them, may be connected with social errors, we may hope, as the errors are discovered, that science will find a way to their prevention if not to their cure. The phenomena included under the third division are hardly to be classified as severe, even though they lead to the death of the individual in whom they are developed. They are the natural changes of organic function and struc- ture incident to the prolonged resistance of life against death ; they are as a rule painless, and, so far as we know, irremediable. Science here lends to art the means to soften such severity of suffering as may attend these phenomena ; and science has been bold enough, in fits of unguarded enthusiasm and self-assertion, to look for means to meet and neutralize the phenomena ; to make what has been called an art of " rejuvenescence ; " to sustain the matured man in perpetual maturity ; or to bring back the declining man to adolescence. In this effort her success, should she succeed, would be but a perversion of nature ; she must needs then destroy the rejuvenescence of nature, the new physical birth, in order to sustain a race of old individualities ; or, supple- ^6 PHENOMENA OF DISEASE menting natural growth renewed forms of growth, she must invent a new planet for the excess of life she would inflict. The phenomena included in the fourth division are altogether social and controllable. They are often severe phenomena, they sustain a large mortality, and thay impose a currency of suffering, which passes like a current account from generation to generation. Science has her duties in relation to these phenomena ; she is bound to teach what they are, and how they may be avoided. The application of her teachings she must leave to the intellect, the sentiment, the self-interest of mankind. The leading object of this work is to deal with certain parts of the fourth division of the phenomena of disease. To this subject I shall devote a special part of the volume. But before proceeding to it a chapter may, with advantage, be devoted, in the present part to each of the first three of the divisions of disease to which attention has been directed. CHAPTER V. PHENOMENA OF DISEASE FROM CAUSES EXTERNAL AND UNCONTROLLABLE. The external and uncontrollable causes of disease may be called in brief, "meteorological," They include variations of season, of electrical tension, of temperature, of atmos- pheric pressure, of winds, of moisture, and of the chemical constitution of the atmosphere. They include, also, those sudden manifestations of natural force which subject the animal body to the accidents of lightning-stroke and sun- stroke. The study of these causes in relation to disease, the most simple, the most natural of studies, has been set aside often for the sake of theories the most fanciful. We observe great outbreaks of disease, and we look for their primary cause. It is "epidemic influence," says one; it is an "organic germ," says a second ; it is a *' malarious influence," says a third ; while the effect of simple atmospheric change is overlooked or forgotten. Effects of the Seasons on Life. — Let me in the first place give a striking example, which cannot fail to be remem- FROM CAUSES EXTERNAL AND UNCONTROLLABLE. 37 bered when once it has been read, of the potent influence of meteorological changes on the body. The simple narrative embraces a remarkable natural discovery made by the late Mr. Milner, while he was acting as Medical Superintendent of the Convict Establishment at Wakefield. The men under the charge of Mr. Milner, and on whom he conducted the observations about to be described, were between the ages of fifteen and sixty, were all in good health at the time they were observed, and were all liv- ing under precisely the same conditions. They occu- pied separate apartments for a period of nine months. They were fed on the same kind of food, were dressed in the same kind of clothing, and were made to take the same amount of daily exerrion. Their rooms or cells had an equal cubic space, were ventilated alike, were charged with the same quantity and character of air, and were maintained at the same temperature, viz., at a mean of 6i"^ Fahr. The question determined by Mr. Milner was, whether a large number of men thus similarly circumstanced, would undergo any general organic changes under varying condi- tions of season and meteorological variation. The observa- tions upon them commenced on the ist day of January, 1848, and were extended to the 31st of December, 1857. The men were weighed on admission, and again at the latter end of every calendar month during their stay. The number weighed exceeded 4,000 ; the average number weighed monthly was 372 ; and the total number of individual weighings was 44,004. I give these details because they refer to an experiment so great in its design and importance that it cannot be over- valued. Here were men living under the same conditions day by day, and so protected by rigid orderly care, it would at first seem that variations of organic life were all but impos- sible. The results controverted this supposition, and showed the existence of a series of organic fluctuations, marked as the variations of the seasons themselves, and extending through the whole mass of this living community. In the first months of each year, January, February, and March, the bodies of these men underwent a gradual pro- cess of wasting, the loss of weight being as 0.14 in January, 0.24 in February, and 0.95 in March. The month of March past, a change took place ; the body in each case began to acquire flesh, and continued to maintain this state until the end of August, the gain in each month being in the follow- 38 PHENOMENA OF DISEASE ing proportions : — for April, c.03 ; for May, 0.0 1 ; for June,' 0.52 ; for July, 0.08 ; for August, 0.70. August past, there was again waste of body, which continued, — except during November, — from September to December, the proportion of loss being for September 0.21 ; for October o.io; and for December 0.03. The facts gained from this remarkable experiment are, that during the months of winter the body wastes, the loss of weight var5nng in an increasing ratio ; that during summer the body gains, the gain varying in an increasing ratio ; and that the changes from gain to loss, and from loss to gain, are abrupt, and take place, the first at the beginning of Septem- ber, and the second at the beginning of April. The lesson taught by the facts recorded above is, that we are all subjected to certain persistently recurring external variations which imperceptibly produce the most marked physiological action, even on the healthy body. The lesson becomes the more impressive when it is taken in connection with the prevalence of disease. Correlative Effects of tlie Seasons ou Disease. — To show the relationship of the diseases to meteorological conditions, I may briefly adduce a series ot facts, in their way as curious as were the facts elicted by Mr. Milner. I took the returns published by the Registrar-General, and analysed the diseases causing 1393.18 deaths occurring between the years 1838 and 1853. Then, concerning these diseases, I asked how far do they classify themselves with the seasons ? The answer was singularly instructive. Of all the disorders affecting the body, not one is better inown or more generally extended, at certain times, than that called bronchitis. Turning, then, to my analysis, I find that the deaths from bronchitis attain their maximum during the months ol January, February, and March; that in April, May,, and June they decline; that in July, August, and September they reach their minimum; and in October, November, and December recommence to increase. The proportions vary in the following ratio per cent.: — In Janu- ary, February, and March, ;^6. 793; April. May, and June, 20.301; July, August, and September, 10.327; October, November, and December, 32.570. Another disease hardly less known than bronchitis, I mean inflammation of the substance ot the lung — pneumonia — affords a parallel series of facts. This disease as my tables show, has its maximum in the three first months of the year, FROM CAUSES EXTERNAL AND UNCONTROLLA15LE. 39 its first decline in the succeeding three months, its minimum in the next three months, and its ascent towards the maxi- mum in the last three months of the year. Thus in the first of these periods (January, February, and March), the per- centage of deaths averages 37.022; in the second period (April, May, and June), 19.631; in the third period (July, August, and September), 12.324; and in the fourth period (October, November, and December), 33.521. The disease called influenza — an extremely depressing cold, attended commonly with inflammation of some portion of the lung — affords stmilar data, with this variation, that the maximum of mortality from it is in the three last months of the year, instead of the three first. Thus the percentage of deaths gives the following averages: — In January, Febru- ary, and March, 23.539; in April, May, and June, 12.71; in July, August, and September, 4.502; and in October, Novem- ber, and December, 59.784. The disease of children called croup, a disease of an inflammatory nature, in which the blood is specially dis- posed to undergo separation of its fibrinous part, and in which there is inflammatory exudation into the windpipe, and often separation of fibrine in the cavities of the heart itself, is another example. The mortality from this disease, I discover by my analysis, runs side by side, as to season, with bronchitis and the other allied maladies. The per- centage of deaths yielded by it, stands, for example, in the following order: — In the months of January, February, and March, a maximum of 27.523; in April, May, and June, a decline to 25.100; in July, August, and September, a mini- mum of 19.919; in October, November, and December, a rise to 27.456. These observations were extended to many other severe diseases, viz. erysipelas, pleurisy, quinsey, and carbuncle, with the same results. They admitted of extension also — by another process of research — to that slighter, but important disease, catarrh, or common cold. For expe- rience tells us that when the more formidable diseases named above are prevalent, catarrh is also prevalent; so that this affection, which is indeed often a premonition or a modified form of the severer types of disease, may be classi- fied, in regard to its periods, with them. The causes of disease now under consideration extend their influence to, certain other affections, which they do not produce directly, but which they greatly aggravate. Acute 40 PHENOMENA OF DISEASE clironic rheumatism, gout, consumption, asthama, carbuncle, remittent fever, dysentery, diphtheria and, markedly, scarlet fever, are all diseases which, though independent in origin, are modified in intensity by the variations of season, nearly in the same order as those diseases which are directly pro- moted by meteorological influences. How these meteorological conditions act upon the living body to produce disease is a question as yet too complex to admit of any solution that may be considered scientifically perfect. There are, nevertheless some facts which, if they be put in the light of coincidence merely, are of singular interest, and which possibly stand near to the relation of cause. Thus we find during the periods when the diseases I have tabulated are most prevalent, the conditions of atmosphere then prevailing are characteristic of low barom- etrical pressure, with extreme humidity of the air, and with a temperature of from 45*^ to 50"" Fahr. These, as experi- mental data show, are the precise conditions by which febrile heat of the body is most easily produced, and in which, con- sequently, the diseases named, marked as they are by fever as a leading symptom, are most easily called forth. They are conditions unfavorable to equalization of the animal heat by evaporation and radiation; and when we recall that during the seasons in which they prevail the body is actually consuming faster than it is at other periods, is in fact wast- ing and losing power, we have before us the predisposing elements, both for the indepehdent outbreak of febrile phe- nomena, and for their intensification when they have been excited by other external agencies. Eifects of Electrified Air or Ozone. — Attempts have been made to determine the specific atmospheric influences which lead to the occurrence of catarrh and to the varied phenomena of disease that so peculiarly attend the course of the seasons. I have been led, with other observers, to inquire whether an electrical condition of the atmosphere can in any way exert an influence in exciting the phenomena. It is worthy of notice, in touching on this subject, that dur- ing the seasons specially characterized by the phenomena of disease we are now considering, there is an increased elec- trical tension. Further, during these same periods there is frequently present that electrified form of the oxygen of the atmosphere to which we apply the name of ozone. It is only since the discovery of ozone we have been able to understand how the influence of atmospheric electricity FROM CAUSES EXTERNAT> AND UNCONTROLLABLE. 4I can be exerted on a living animal body so as to lead to dis- ease; and it is, therefore, of importance to record what ozone will effect. In the year 1854, in a conjoint paper sub- mitted to the Epidemiological Society by Dr. Moffatt and myself, we showed that with certain of the winds there are periods of ozone, and that these periods correspond with those seasons in which there is an increase of the number of febrile diseases. Since then my learned friend has sus- tained the argument with great assiduity and force of evi- dence. I have on my part investigated the physiological action of ozone, and, at the meeting of the British Asso- ciation for the advancement of Science held at Birming- ham in 1866, I related the results of that investigation. I showed from experiments of inhaling ozone, made on myself and on Dr. Thomas Wood, that ozonized air would produce, under proper conditions, a distinct nasal catarrh, accompan- ied with pain in the forehead, with hoarseness, and even with irritation of the the throat, as in sore throat from a cold. -I showed by other experiments of a similar kind performed on inferior animals, and carried to a more extreme effect, that carnivorous animals are more susceptible than herbivorous to the action of ozone, and that in the carnivorous, exposure to ozonized air produces congestion of the lungs, bronchial irritation, the formation of a tenacious mucus or phlegm in the bronchial tubes, and a condition of the blood in which the red corpuscles coalesce with great rapidity and adhesion, as in inflammatory affections generally- In the same line of research, I have discovered that these physiological effects of ozone are destroyed by heat; that they cease at 75° Fahr., and that they are most marked in a iovv^er temperature when the air is charged witn moisture. It would seem on the first glance at these facts, that a connection of cause and effect, between electrified oxygen in the air and certain diseases, was proved. The connection is not proved, but it is very strongly suggested. The diffi- culty of proving lies in the process of testing for ozone in the air, for the phenomena of the diseases are often present when, according to our known tests, the assumed producing agent is not detectable. Again, although outbreaks of the phenomena of disease, are, as a rule, very general, they are not by any means universal; more persons escape than suffer, — a fact which conveys the suspicion that an agent generally dif- fused and breathed by all alike could not be at work without influencing all alike. It is but just to point out these diffi- 42 PHENOMENA OF DISEASE culties, although, perhaps, they are temporary. It is prob- able that ozone exists in the atmosphere at times when we cannot detect it by our physical tests, and that certain per- sons are more susceptible than others, to its influence, as certain of the lower animals are more susceptible than other animals, carnivora than herbivora. It is equally probable that the ozone produced in the atmosphere, in electrical storms, may not be diffused equally in the atmosphere, but in lines or local currents — stratifications, I might say — so that it may influence none but that limited number of persons, or that limited number of tests, which lie in the course of. its current. Finally, on this particular point I am satisfied from direct observation of the fact, that there are brief ozone periods localized in different parts of the atmosphere, and affecting limited areas of terrestrial surface, — just as there are short and local electrical storms, — which may in one par- ticular locality inflict much injury, and at the time be unknown elsewhere. In addition there are probably ozone periods when the activity of the ozone is modified by tem- perature. I found in inhaling air charged with ozone that the peculiar effect of the agent to produce catarrhal symp- toms was lost when the temperature was raised to 75°; and I found that this same neutralization of its action occurred to animals breathing the agent in a still more concentrated form than I could breathe it when heat was introduced. Heat, therefore, tends to destroy the special influence of ozone on animal organisms, and as, when the agent is present in the air, different persons are subjected to it under extremely different conditions of temperature, it is perfectly consistent that some should suffer and some should escape from its influence, even though it be widely diffused. From the whole of the evidence before me, I am led to the hope that in course of time we shall understand the nature of the external and uncontrollable causes of the diseases included under the names of catarrh, bronchitis, congestive bronchitis, congestion of the lungs, pneumonia, influenza, croup, and other of the inflammatory maladies which we commonly assign, in respect of origin, to cold or catarrh. Nay, I think we may indulge in the expectation of being able one day to predict, from defined meteorological read- ings, outbreaks of these diseases, and to forewarn the com- munity of the dangers by which it is threatened. Another subject of inquiry is opened to us in respect to FROM CAUSES EXTERNAL AND UNCONTROLLABLE. 43 an opposite condition of the atmosphere from that which is produced by electrical action upon the oxygen. In some researches I conducted on the inhalation of oxygen gas, I observed that if an animal were made simply to breathe an atmosphere of pure oxygen gas, although the oxygen were perfectly cleared of the products of the combustion of the animal, it would not sustain life, but would allow the animal to fall into a somnolent condition and to die. But if electrical discharges were passed at intervals through the oxygen, or if it were kept at a temperature above 75"^ Fahr., it would continue to sustain life. In another series of experiments I learned that if oxygen were freshly made, and passed in the fresh state through a chamber in which living animals were placed, the animals would continue to live. But if the oxygen that had swept through the chamber, — although it were thoroughly purified of animal products and although it still appeared to be abso- lutely pure oxygen, — were used again, it failed to sustain life until it was subjected to the action of the electric spark, when it regained its activity. I infer from these observations that oxygen may exist in the atmosphere in an inactive condition, not inducing, neces- sarily, acute disease, but depression of mind, languor, torpidity, and cachectic feebleness of body. Effects of Atmosplieric Temperature. — The influ- ence of meteorological changes is often felt in a still more simple manner than that stated above. Upon a large num- ber of our population, the mere action of cold, occurring from a sudden fall of the atmospheric temperature, strikes with telling effect. Thus, if we notice the results of a rapid decline of temperature on the mortality of persons of dif- ferent ages, — after the manner in which the facts have been observed and commented upon in the English returns of mortality by the Registrar-General, — we fmd that sudden decline of temperature leads to a mortality based on a given rule in relation to age. In persons who have not passed their thirtieth year, the effect of the cold is not indicated by an increase of mortality; but on those who are at or above thirty the effect is so definitely developed, that the mor- tality doubles with every nine years of life. For example, if the decline of temperature be sufficient to kill one person who has reached the age of thirty, it will kill two who have reached thirty-nine four who have reached forty-eight, eight who have reached fifty-seven, sixteen who have attained 44 PHENOMENA OF DISEASE sixty-six, thirty-two who have attained seventy-five, and sixty-four who have arrived at eighty-four years. We find an explanation of these effects of cold in the simple estimate we have already formed as to the force of vitality at different ages. We have assumed that the body reaches its maximum of development at the age of thirty, At this period, if it be quite healthy, it generates by its own chemical processes so much force as shall enable it, within given bounds, to work is own machinery, to call forth, at will, a limited measure of extra force, and to supply a fluctuating loss that may be conveyed away by contact with the surrounding air, and by other bodies that it may touch, and that are colder than itself. The body yields, therefore, applied force, reserved force, and waste force; and these, under ordinary circumstances, are sufficient to maintain the perfect organism in effective life. So much active force gives the body the power to perform so much labor; so much reserved force supplies it with the power to perform a measure of extra lab®r to meet emergencies; so much waste force enables it to resist the external vicissitudes without trenching on the supply which is ever wanted to keep the heart pulsating, the chest heaving, the glands secreting, the digestive apparatus digesting, and the brain receiving or thinking. Let this distribution of force be disturbed, and straight- way the life-power is reduced- If we use the active force too long, we become exhausted, and call upon the reserve; and if we still continue the process we fail at last, unless sleep forces itself upon us and brings, with the rest it ensures, renewal of power. If, again, we are robbed of the waste force quicker than we can supply it, exhaustion is produced; inefficient nervous control over the vascular canals succeeds, and therewith that congestive condition of the lungs and other vascular organs, under which death is so easy when exhaustion is severe. That the exhaustion should be more rapid in the man who has reached his prime is but natural. In his past he has been a growing, developing body, and in the course of development he has used up an excess of force com- mensurate with the demands of his growth. When he stops in development, and stands on a fair level with the external forces that are opposed to him, then his own force, for a short time balanced, soon becomes second in command. He feels cold more tenderly; if his rest be broken, his demand for artificial heat is argent; if he lose or miss food, FROM CAUSES EXTERNAL AND UNCONTROLLABLE. 45 he fails rapidly; and, returning to our facts on the influence of external temperature on mortality, these many sources of failure are the reasons why a fall in the thermometer sweeps away our population so decisively according to its age. As a matter of course, this external and uncontrollable cause of disease, as it affects even the healthy middle-aged man, still more disastrously affects the unhealthy. Has the man a weak point in the vessels of the brain ? Exposure to cold renders that point more liable to pressure and rupture, with apoplexy as the consequence. Is he suffering from bronchial disease ? His evils are doubled. Has he a fee- ble worn heart ? It sinks under the strain put upon it. Has he enfeebled circulation of the kidney ? He is threatened with complete obstruction. Is he indifferently clothed and fed ? He is subjected to intestinal congestion and diarrhoea. It is from this extent of action of sudden fall of tempera- ture, that the mortality of all diseases runs up so fast when- ever such sudden fall occurs. A ph) sical accident, though it might be more obvious, could not be more decisively fatal. Effects of Atiiiosplieric Pressure. — Variation in the atmospheric pressure exerts an influence on the animal func- tions which, up to the present time, has been but imperfectly studied. The common observations of mankind have led to the knowledge that a fall of the barometer is attended often with aches and pains in joint and limb. These pains are called, usually, rheumatic or neuralgic. Recently, light has been thrown over this subject by the experience gained of the effect of atmospheric pressure on men who are employed to work in "caissons," the tubes or coffer dams in which are laid the piers of bridges. The men in the "caisson" descend into an atmosphere where the pressure may be increased from ten even to thirty pounds to the square inch. While thus working they suffer little, albeit their venous blood is made preternaturally red, and an undue weight is borne by the exposed surfaces of the body. But when they escape from the pressure and come into the free air, their troubles begin. They are subjected then, in a greater degree, to those minor sufferings which we, who live in the freer air, feel when the barometer falls. They endure rheumatic pains in their limbs, severe neuralgic pains, and sometimes paralysis. In our ordinary existence we are never exposed to so extreme a variation as is here referred to, neither are we subjected to such severe consequences. Nevertheless, the 46 PHENOMENA OF DISEASE effects we experience, in what may be called the natural course of events, are of moment. With those in the free air, as with those in the caisson, the effect of variation is felt when the pressure is lightened. Then the compressed fluids and gases within the body undergo expansion; and what is experienced thereupon, is tension from within the body, out- wards. There is pressure of blood, pressure of the vapors and gases .within the blood, and probably, as I have shown in an essay on " The Theory of a Nervous Ether," pressure of a still more refined fluid, or vapor, which forms an atmos- phere permeating and surrounding the ultimate particles of the nervous matter. The effects of reduced pressure are sufQcient to tell with unmistakable force on large numbers of our populations. The pressure of blood on the brain disposes to apoplexy in those in whom the vessels of the brain are enfeebled; the pressure of blood on the lungs disposes to congestion, and even to haemoptysis, in those who suffer from lung disease; while the effect of the pressure on the nervous system is most strikingly evinced in the pain, rheumatic, or more cor- rectly neuralgic, which is experienced in those who are prone to such nevous derangement. In the course of acute diseases, especially in diseases of a congestive character, the influence of the atmospheric pres- sure is found, when it is carefully observed, to be most sig- nificant. I have of late years compared, day by day, the barometrical readings with the phenomena of disease which have come under my notice. I believe that the symptoms of every form of chest disease, and of phthisis pulmonalis par- ticularlv, are most severe when the barometer is low; in other words, when the atmospheric pressure is reduced. Cough is then more frequent, pain is intensified, and loss of fluid from the body, by an excess of secretion, is increased. The symptoms of other diseases also are intensified by the same atmospheric condition. In persons who are suffering from rheumatic disease the pain is more severe; in those who have irregular circulation through the brain, the tendency to gid- diness and vertigo is more easily developed. In those who are subjected to inflammatory fever the local inflammatory changes are quickened. I have specially pointed out in another work that the results even of surgical operations are unfavorably modified; and Addinell Hewson, who has regis- tered, during a period of thirty years, the mortality from surgical fever, in the Pennsylvania Hospital, has shown it to FROM CAUSES EXTERNAL AND UNCONTROLLABLE. 47 be as 10.7 per cent, with a rising, 20,6 per cent, with a sta- tionary, and 28.4 per cent, with a falling barometer. Effects of Moisture, Winds, and Atmosplieric Chemical Changes. — A great deal has to be learned on the subjects suggested by the terms, moisture of the air, winds, and chemical changes in relation to disease. There are as yet no data that show connected or regular series of facts between these influences and the phenomena of dis- ease. A few general truths are, nevertheless, known. That an air saturated with moisture is conducive to the development of rheumatic disease, and to the organic dis- eases of the heart which spring from rheumatism, is an admitted experience: that the same condition of the air favors the development of phthisis pulmonalis is equally admitted. It has been presumed, moreover, on fair evidence, that certain of the malarial fevers, supposed at one time to depend upon a specific malarial poison, are induced by exposure of the body for a long time, and especially during sleep, to moist air in low, damp buildings, or in marshy grounds. I have myself seen all these developments of disease from such exposure of the body to air charged with water vapor, but I have no precise knowledge, derived either from experiment or experience, of the degree of saturation at which danger becomes imminent; in fact no one has suc- ceeded in separating all other causes, such as electrical action, heat and cold, and atmospheric pressure from this one and particular cause — moisture. That certain winds are provocative of certain symptoms of disease, and that they intensify certain symptoms in those who are suffering from disease, is a part of universal, as well as of medical knowledge. Thus the south-west wind is known to be unfavorable to acute inflammatory conditions; the north and north-east winds to neuralgic and rheumatic conditions; while the drying, cutting, depressing east wind is fatal to those in whom the store of vital energy is very low. But here again we are wanting in method for deter- mining the precise part played by the winds as causes of disease. It is not obvious that the winds determine the origin of any disease; and whether they intensify any by a special action of their own, independently of heat, cold, moisture^ electrical tension, and other such active influences, remains to be discovered. It has been surmised that during some great perturbations of Nature, changes may take place in the chemical consti- 48 PHENOMENA OF DISEASE tution of the atmosphere, and that these changes may account for phenomena of disease. The passage of air over certain soils has been considered sufficient to disturb its natural chemical state, and to render it directly noxious to animal life. In the Grotio del Cane, and in some other rare positions, the air becomes sufficiently admixed with a pois- onous gas (carbonic acid) to render it dangerous to breathe; but beyond these exceptional and well-known instances, we have no proof whatever of any such modification of the chemical constitution of the atmosphere as would provoke a special disorder. We have seen that the oxygen of the atmospheric sea may be changed in physical quality, and with effect on life. Beyond this we have no light. To all our present experience the chemical combinations, or more correctly, admixtures of the gases that make up the atmos- phere, — of the oxygen, the nitrogen, the carbonic acid, and the ammonia, — remain always steadily balanced and fitted to support, without danger, the vital processes. The dis- eases which spring from vitiation of atmospheric air, from undue removal of oxygen, from introduction of carbonic acid or other poisonous gas or vapor, are, therefore, artificial dangers, invented and promoted by our own hands, and belonging consequently to the phenomena of disease embraced in our fourth closs as phenomena due to the con- trollable errors of social life. Effects of Lightning- stroke and Sun-stroke.— The natural accidents of lightning-stroke and sun-stroke, both singularly akin to mechanical shock, in their mode of action on the body, produce, when they are not immediately fatal, varied kinds of nervous disturbance. After lightning- shock there has followed, in some instances, a fever of reac- tion, in others, an apoplexy, in others, paralysis, and in still others, blindness. The most singular result of lightning- shock, however, is the disease known as catalepsy, which sometimes, though very rarely, has occurred. In this dis- ease the patient is left, to common observation, as if dead, while his own consciousness remains alive. He can receive impressions from the outer world, but he cannot act in response. He is as a man in whom the power of volition has been struck out. In one of my lectures on this subject, published in the Medical Ti?nes and Gazette in 1869, I have related the history of such a case, which runs briefly as follows: "A man riding in a cart with two dogs during a severe thunderstorm, was enveloped in lightning. One of FROM CAUSES EXTERNAL AND UNCONTROLLABLE. 49 the dogs was killed immediately, the other was blinded; and the horse was so severely struck that it died ultimately from wasting and general paralysis. The cart also was injured. The man was struck, but whether or not he was rendered unconscious, at the moment, cannot be ascertained. If it were so, he recovered, and was able to get to his home, which was a mile or more distant. He reached his bed extremely ill, could not take food, became emaciated, and at last sank into the condition of catalepsy. In this state he was thought to be dead; was laid out, and was tolled for in due order. He himself knew all this, and heard the pass- ing bell. Impressed with the belief that he should be buried alive, he succeeded by a desperate effort in moving one of his thumbs. The motion attracted attention; he was treated as if still alive, and recovered. A phenomenon after lightning-shock has been a decom- position of some of the animal secretions, from which has sprung a peculiar sulphurous color. In the man whose case is recorded above this phenomenon took place ; and Gaul- tier Claubry experienced it himself while recovering from the effects of a lightning-shock. Claubry calls the odour that of " gas hydrogene sulfure " — sulphuretted hydrogen gas — also " hepatic odour and taste." He said it exhaled from all his excretions, and was intolerable. Lastly, con- vulsive seizures and epilepsy have been known to follow the effects of lightning on man. Sun-stroke, a wave of heat striking the body suddenly like a mechanical blow, leads to similar diseases as the stroke of lightning. A peculiar coma-like apoplexy is one of the con- ditions that may follow ; a frequently-recurring giddiness or vertigo is another ; epilepsy is a third form of malady from this cause, and paralysis a fourth. In all these examples of disease from the extreme shocks of lightning, heat, and, I might add, of mechanical shocks, the injury inflicted is upon the nervous matter. Sometimes the injury is on the brain, sometimes on the spinal cord, sometimes on the peripheral expanses of the nervous struc- ture, sometimes on the nervous cords, and sometimes on the ganglionic nervous centres — those centres which minister to and uphold the vegetative or organic life. The phenomena of disease that follow depend on the part of the nervous organism that was accidentally stricken, and their perma- nency depends on the extent of the injury that was inflicted. On the physical nature of these nervous injuries I have 4 50 PHENOMENA OF DISEASE endeavored recently to throw some new light, by showing that the nervous matter contains a colloidal fluid which becomes pectous (thickened or coagulated) under vibration from shock, and that its active properties are, in this state, temporarily or permanently destroyed. I have spoken of the causes of disease described in the present chapter as uncontrollable ; they also may be con- sidered as persistent, because they periodically recur ; and they may be considered as inevitable, because they constitute a part of the grand scheme of the universe. The diseases they excite were probably the first to which the human fam- ily was subjected, and will probably be the last. CHAPTER VI. PHENOMENA OF DISEASE FROM CAUSES EXTERNAL AND COMMUNICABLE. The phenomena of disease to be studied in the present chapter are brought about by the primary action of a series of causes which lie external to the body, and which, though they appear obscure, and indeed are derived from nature without the intervention, I mean the conscious intervention, of m^an, are even now partially, and may in time be abso- lutely, under his control. The phenomena are chiefly those included under the names of spreading diseases — plagues or pestilences — diseases, that is to say, which pass from one person to another by means of something given off from the afflicted that communicates them to the healthy. These diseases, which I shall call the communicable, the acute scourges of mankind, are, from the sudden havoc they occasion, the most appalling. They strike us as being, beyond all other kinds of fatal dangers, unnatural, for they spare least of all the young. They attack the rich as well as' the poor, the palace as well as the shed. In the infantile days of human intelligence and learning, and even down to these days, they have been likened, in mysterious and super- natural language, to earthquakes and great storms. They have been accepted as messengers of Divine wrath, coming and going like the winds, no one knew where from, or whither onwards. Now the learned are all but unanimous in FROM CAUSES EXTERNAL AND COMMUNICABLE, 5 1 looking upon them as due to the distribution of organic poisons ; poisons which act only by coming into contact with living beings susceptible to their influence, and which may, in time, be limited in their action or altogether sup- pressed. The diseases coming under this head are fairly known and defined ; they include, with others, small-pox, cow-pox, measels, scarlet fever, diphtheria, typhus fever, typhoid fever, hooping-cough, erysipelas, hospital or pyaemic fever, diarrhoea, cholera, yellow fever, glanders, hydrophobia, syphilis, and infectious ophthalmia, I might add also to this class, affections arising ftom the bites of poisonous ani- mals, as of the cobra di capello, and other venomous rep- tiles. There is indeed so close an alliance between the secreted poisons of venomous animals and the poisons of the organic diseases, that the physiological action of the lat- ter may be usefully studied from the former. The Poisons of tlie Cominunicalble Diseases. — Much discussion has taken place on the subjects of the nature and the origin of the poisons by which the communicable dis- eases are produced and propagated. These subjects have* been to me matters of investigation for more than twenty years, I shall venture therefore, even at the risk of repeat- ing what I have often published and spoken, to narrate the conclusions which by experiment and experience I have been led to accept as nearest to the truth. The poisons are are in every case specific in their nature and their mode of action. Each one has the specific prop- erty of always bringing forth the same disease, when it excites disease, from age to age. From the time when man was first attacked by the diseases dependent upon these poisonous agencies, on to the present time, each of the dis- eases that has appeared has been developed from, and has depended on, one specific form of poisonous particle. The poisonous particle in every case is organic in its character, whether it be considered as a chemical or a phys- iological product. It belongs, that is to say, to particular matter connected with living organization, as organic struc- ture. Thus it differs from those inorganic poisons which often accompany it and are the cause of offensive odors, such as sulphuretted hydrogen, or sulphide of ammonium, bodies, which, though they are in themselves poisonous to living beings subjected to them, are not poisonous in the sense of being infectious poisons — poisons, I mean capable 52 PHENOMENA OF DISEASE of exciting a disease that can be transmitted, by communi- cation from one individual to another. The organic parti- cles, indeed, differ from the inorganic in that they are less easily diffusible, are much more concentrated, and are ino- dorous. The type of a disease producing organic poison is well represented in the secreted poison of a venomous snake. Such an animal may well be likened to a person suffering from an infectious malady, with the difference, that in the venomous animal the poison is always being produced, while in the infected person the poison, whatever group it may be- long to, is present only during the time when he is suffering from the particular disease the particular poison has excited. When we draw the virus of the venomous snake from the glandular structure in which it is formed, we find it of fluid quality. It is miscible with water, diffused through water it may be carried off, at a raised temperature, in vapour; or it may be dried down into a solid form; in all of which stages it may retain its activity. These physical qualities, belong, probably, to each of the organic poisons. In the virus of small-pox the correspondence is most perfect, and I found it equally so with a poison I succeeded in separating from the peritoneal secretion of a patient suffering from surgical fever. The particle of a specific organic poison that may produce a disease is infinitely minute, so minute that we have not yet determined the precise point of division at which its power ceases. There is, nevertheless, a limit, which, once passed, is absolutely effective in stopping the influence of the agent. This fact was well brought out in the last century by Dr. Fordyce. Fordyce, speculating on the postibility of modi- fying smallpox by the process of inoculation, conceived the happy thought that he might mitis^ate the disease by inocu- lating with virus diluted with water. He therefore inocula- ted patients with diluted solutions of variolous matter where- upon he discovered the singular fact, that up to a given point the dilution of the poison had no effect whatever in mitigating the intensity of the disease, but that a certain de- gree of dilution the activity of the poison was arrested alto- gether, so that no symptoms followed the inoculation. From its capacity for the reception of water, which is extreme, the poisonous matter reaches, at least, a point of dilution ^at which, probably, its organic constitution is changed: it then loses its specific power of exciting disease. FROM CAUSES EXTERNAL AND COMMUNICABLE. 53 In the course of some diseases the poison is separated by nature in an exceedingly pure and active condition, and shows, in the different modes by which it produces its effects, that it is capable of being carried or distributed in the various conditions of matter known as the gaseous, the fluid, and the solid. This fact is peculiarly well illustrated by the virus of smallpox. It has been proved that in the early stages of this malady the poisonous product may pass off in the volatile form, may saturate article of clothing, may be communicated again in the volatile form from such clothing to a healthy animal, and may propagate the disease. That the virus is very active in the fluid form is proved by every case of inoculation in which the fresh matter, carried on the point of a lancet and inserted into a healthy body, pro- duces the specific disorder. That the virus may be dried down to the solid form and yet retain its activity is equally well proved by the fact that, so prepared, it will still act, by inoculation. These same rules would, I believe, be found to apply to all the poisons of the communicable diseases if we could bring them under observation with the same facil- ity as we can bring the virus of smallpox. I have said that the specific poisons are destroyed by extreme dilution with water; they are destroyed also by heat, but at no degree under 212°. Pahr.. the boiling point of water, and it may not be all of them at that degree. They are destroyed by some chemical agents, viz., by moist ozon- ized oxygen, by pure chlorine, by iodine, by bromine, by nitrous acid gas, and by sulphurous acid, I infer, moreover, that they are destroyed by sunlight, for I found this to be the fact in the case of the poison of the cobra. On the other hand, they are preservable. Extreme cold, especially when it is combined with dryness, maintains them, for an unlimited time, in their active state. Some of these poisonous particles seem to require a spec- ial external temperature in which to display their action upon the living body that is exposed to them. Thus the poison of yellow fever requires a high temperature, and the disease it excites belongs, consequently, to tropical regions. The poison of typhus fever, conversely, is most active in a lower temperature, and the disease it engenders belongs to temperate regions of the earth. For the distribution of the poisonous particles from ani- mal bodies charged with them, the living action of the infected subject is required. In the dead subject the poi- 54 PHENOMENA OF DISEASE sons themselves are not inert ; but the dead body is not contagious because it requires the heat and the processes of evaporation that are proceeding from a body still alive, for the poisons to be disseminated to supply contagion. The organic poisonous particles may travel in different ways so as to reach and infect a healthy body. They may be wafted as dry, solid, but fine invisible matter, and may be thus breathed or swallowed. They may be carried on arti- cles of clothing ; they may travel in water, in solution, or in vapor of water, in the air. The organic poisons enter into the body by various ways, but always by contact. The poisons of measles, scarlet fever and typhus, are perhaps inhaled only, that is, taken in by the breathing apparatus. The virus of smallpox may be inhaled, or may be inoculated. The poisons of diphtheria, glanders, erysipelas, hospital fever, and ophthalmia, resem- ble closely the virus of smallpox in this same respect. The poisons of typhoid fever and of cholera appear to enter the body mainly in solution and by being swallowed. The poisons of the communicable diseases are controllable. This is proved convincingly by one striking example, the control of smallpox by the process of vaccination. It is proved again by the success that has attended the attempts to stamp out the infectious disorders by isolation of the infected, and by prompt disinfection or destruction of arti- cles of clothing which have been charged with the poison- ous particles. But we have to wait for science to point out to us the precise nature of the poisonous particles, and how many are the varieties of them, before the triumph of con- trol can be considered complete. Origin of the Poisonous Particles. — Of the origin of the organic poisonous particles we have no fact sufficient to establish anything more than an hypothesis, and even hypothesis is uncertain and varied. Recently, speculation has run high on what has been called the " germ" theory, which has supposed each specific poisonous particle to be a living germ that can multiply in the affected body indefi- nitely. But no one has ever seen a germ, and no one has ventured to define between the germ of typhus, the germ of smallpox, or of any other specific disorder. Moreover, no one has ventured to explain why the living germs, having once commenced to propagate in the body, should not con- tinue to propagate, until in every case they should kill their victim. FROM CAUSES EXTERNAL AND COMMUNICABLE. 55 For my part I can see no basis for the germ theory as appHed to the spreading diseases, except a barren analogy that these diseases may originate like plants or animals. This argument, purely defensive, explains none of the mani- fold phenomena which mark the character and course of spreading diseases. The hypothesis I would myself advance, and which for many years I have maintained, is — that these organic poison- ous particles are derived from the secreted fluids of animal bodies themselves. In a word, a person suffering from a communicable disease is producing, by secretion, an organic substance, which, coming into contact with a healthy and susceptible person, in the right way, will reproduce itself and the disease that attends such reproduction. On this view, the variety of the poisons depends on the variety of the animal secretions, each secretion of the animal body being susceptible, by contact with a poisonous secre- tion, of change also into a poisonous secretion. Thus the virus, once established in a secretion, is promoted through the secretion, and is ultimately eliminated by it, if life be spared for a sufficient time to ensure elimination. I have tried, and others following in the same line of research have tried to isolate these organic poisons, and to determine their precise chemical nature. In one instance I succeeded in separating from the poisonous matter exuded from the peritoneal secretion of a patient labouring under surgical fever, a substance which would give a similar disease to an inferior animal, and would reproduce in the secretions the same virus, I named this substance " septine," and I expected it might be again obtained in larger quanti- ties and be submitted to analysis ; but I have not hitherto realized this expectation. The Question of the Spontaneous Origin of the Poisonous Particles. — Bearing upon this subject of sci- entific research, there again crops up the influence of atmos- pheric changes in the production and distribution of the poisonous particles. I believe — though the proof of the belief is, I confess, difficult — I have seen a spontaneous development of a disease allied to diphtheria, and which dif- fered only from diphtheria in that it was limited to one patient. I have seen the same fact in relation to scarlet fever, and have described a special form of this disorder, under the name of idiopathic, or " doubtful," scarlet fever, in which every symptom and every fact was characteristic 56 PHENOMENA OF DISEASE of the true disease, except that the patient was never exposed to the fever poison, and did not communicate pois- onous matter. I am equally satisfied that I have seen sur- gical fever — the fever which follows upon surgical opera- tions — originate in the same manner, that is to say, sponta- neously, and afterwards become contagious. These illus- trations could be multiplied, and could, perhaps, be exten- ded to all the diseases that depend for their origin on an organic poison. If, then, the view I have propounded — that the poisons themselves are the modified secretions of the living animal — be true, we may attribute the changes that produces them to the effects of external atmospheric conditions, or to changes induced in the animal body itself by nervous per- turbation or shock ; for we know that modifications of organic fluids and varied phases of their decomposition are directly promoted by the same external influences. In the dog suffering from rabies, it is, I think, beyond dispute, that the poison in the saliva is developed, in some cases, sponta- neously through the influence of rage or fear. It is all but proved to demonstration, that in the human body, in the absence of acute disease, secretions may be produced which become poisonous and capable of pro- moting communicable diseases. Under famine the secre- tions are rendered pestilential, and hence the origin of the term " famine fever." In proof of this same view, of the origin of a contagious malady from a morbid animal secre- tion, spontaneously developed, there is on record the remarkable fact that the secretion of the hand of an accou- cheur communicated puerperal fever to his patients, the possibility of the communication of a specific particle from one infected person to another being to all conceivable evi- dence excluded. With infinite candor this practitioner tells us that the first case of the disease arose " spontaneously " under his care; that other cases followed; that he left home, traveled, and returning to his practice again, communicated the same contagion from the secretion of his own hand. To repeat the question: Whence came these organic poisonous particles originally ? I answer, from the dis- eased animal organism itself. I suggest that lower animals or men have been sometimes placed in such untoward con- ditions that their secretions have undergone the organic change by which they have become poisonous. In this way we see a simple mode of origin for these external factors of FROM CAUSES EXTERNAL AND COMMUNICABLE. 57 plagues, an origin which gives the specific basis for each specific pestilence. Nay, I think we may go even a step further. I believe it possible, from a striking fact I once observed, that through a mental impression the nervous ele- ment of secretion in man may be so modified that a fluid shall be secreted of specifically perverted and poisonous quality. One more striking fact (already touched upon) deserves to be recalled, namely, that certain individuals are by pro- clivity either disposed or indisposed to the action of the organic poisons of the communicable diseases. Thus dur- ing an epidemic say of typhoid fever or of scarlet fever; or of diphtheria, we physicians see constantly a family ten- dency of susceptibility or of unsusceptibility to the prevail- ing disease which would be inexplicable did we not recog- nize that, to the presence of the poison causing the disease must be added the peculiarities of the individual. These peculiarities, idiosyncrasies as they are technically called, are not wholly shown through the effects of the refined organic poisons of which I have been speaking; they are seen also through the effects of some ordinary poisons, and in the most marked degree. The Phenomena of Disease induced hy the Or- ganic Poisons. — It were apart from my purpose to enter into details of the special phenomena of each of the com- municable diseases. I shall simply deal, therefore, with the prominent phenomena which may be said to be common to them all. I. For the development of each of the diseases, a certain period of "incubation," as it is termed, is required. This includes the interval between the introduction of the exciting poison and the development of the first symptoms proving effect. The incubation varies with the different poisons, and certain defined periods of it are, usually, speci- fied. But, in truth, the exceptions are too numerous to admit of the construction of any definite rule. In brief, I may say that the period ranges from one or two hours to twelve or even fourteen ^ays. During the time, be it long or short, the poison increases in the part in which it has been received, and transforms the surrounding fluid that is susceptible to its action into poison like to itself. The poison, if it do not escape outwardly, is carried into the body by the circulation, and excites the symptoms by which the particular disease it induces is characterized. Then 58 PHENOMENA OF DISEASE there comes a moment when the system reacts against the poison, and a struggle is instituted, if by such a term I may express myself, whethei the poison, carried into the organ- ism, shall be disposed of more quickly than it can be repro- duced — in which case recovery from its influence is proba- bly ensured — or whether it shall be reproduced too rapidly to be disposed of — in which case death from its influence is the common fate. Anyone who has inteligently watched the simple process of vaccination has seen this order of events in the form favorable for recovery. There is first the insertion of the infecting particles; secondly, there is the local action leading to the formation of more of the infect- ing particles — lymph, as it is ordinarily designated; thirdly, there is the evidence of disturbance in the system at large; fourthly, there is the complete formation and inclosure of the infecting matter, followed by its drying up into a scale or solid substance; lastly, there is cessation of all the symp- toms which indicated the presence of the infection within the body, and recovery. The period of incubation depends, I believe, upon the extent of secreting surface infected, and .upon the natural activity of the secretion which becomes infected. From a large serous surface, such as the peritoneum, or a large mucous surface, such as the alimentary canal, the secretions infected with poisonous matter to which they are suscepti- ble, quickly produce and distribute the poisonous organic product. From a limited and open surface, on the other hand, such as the conjunctiva, the poison may not be obsorbed at all, and there may be infection without the development of any severe constitutional symptom. The poison is ultimately eliminated in every case by secretion. 2. The diseases belonging to the class we are considering, and springing from the action of an organic poison are, according to my view, all glandular diseases. Thus, scarlet fever is a disease of the lymphatic glands; measles, of the mucous glands; typhoid, of the closed intestinal glands; cholera, of the mucous glands of the stomach and open intestinal glands; yellow fever, of the liver. I reason that the glandular complication, as it is called, of these dis- eases is not accidental, but regular; and that from the secre- tion of the affected glandular structures the reproducing poison is formed, 3. The general or constitutional symptoms which charac- terise the communicable diseases present many varying FROM CAUSES EXTERNAL AND COMMUNICABLE. 59 phases ; but, with one notable exception, they have certain leading symptoms in common. The first indications that the poison has taken effect and is influencing the system at large, are a series of nervous symptoms. These consist of pains, usually in the back and in the head, followed by nausea, or vomiting ; next by shivering and coldness, and afterwards by fever. The last-named symptom, the fever, or increase of heat, becomes soon the one symptom that governs all. If it keep within due bounds, the disease runs through its stages with a certain precision of movement, with a certain farly-defined course, and with compara- tive safety. But if the temperature during the febrile state passes a given limit, the danger is imminent. So accu- rately has this danger been measured, that we know now by the readings of the thermometer the fatal increment of heat. I have determined from observations on man and on various warm-blooded animals that the increment of heat which proves fatal is from ii° to 12° Fahr. above the natural tem- perature of the animal. In the human subject a steady elevation of temperature to 100° Fahr. indicates fever ; an elevation to 105° indicates danger ; above that, great danger. At 109°, eleven degrees above the natural temperature, 98°, the condition is fatal. 4. Under the increase of heat common to the communi- cable diseases, the pulse rises, the respiration becomes quick- ened and, if the heat rapidly intensifies before there is equal- ization from perspiration, the tension of the extreme or minute blood-vessels is increased. The surface of the body is dry as well as hot there is accumulation of water in the blood, and thereupon succeed a ncAv and distinct series of symptoms, technically called symptoms of exudation. The visceral cavities, and the visceral organ themselves, may thus become charged with exuded fluid. In this manner arise those many complications which mark the course of the acute epidemic fevers. 5. While, under the influence of the fever, the solid organs are becoming affected, the fluid blood is subjected to the most serious disturbance of its constituent parts. Its plastic portion, its fibrine, may undergo one of two modifications ; it may increase by accumulation, and thereupon separate as a semi-solid obstructing mass within the blood-vessels, when it is often a cause of sudden death ; or it may be rendered intensely fluid, in which case it fails to maintain the vital functions in their full activity. Again, it may become sur- 6o PHENOMENA OF DISEASE charged with the gases intended to be excreted from the organism, under which condition, what may be correctly- termed an asphixia commences in the blood and leads to the cessation of life, by the same process, virtually, as suffoca- tion. In small-pox I have seen death produced in this man- ner within a few hours. 6. In addition to the primary organic changes of the body, occuring during the course of the communicable diseases, many secondary and local injuries may arise, leading to impor- tant after effects. These are all the results of the febrile state, either of the exudation of plastic fluid from the blood, of destruction of tissue by ulceration, of obstruction of the secreting surfaces of glandular organs, or of modification of structure in nervous matter. Thus, small-pox may be fol- lowed by pitting of the skin, by deafness, by blindness, and by other lesions incident upon ulcerative change ; scarlet- fever by arrested function of the kidney, and dropsy ; diph- theria by a local paralysis. 7. Happily, in the large majority of instances of these communicable diseases, the course of the disease is, through certain fairly defined stages, towards and to recovery. This course is, as we have seen, strongly influenced by atmos- pheric conditions ; but in the large majority of instances it prevails. 8. Still more fortunately, amidst the misfortune of the presence of these maladies, is the fact that certain of them occur, as a general rule, but once in a lifetime ; in other words, one attack precludes more. The rule is open to many exceptions, but it is maintained with sufficient exacti- tude to save an incalculable number of lives, and actually in some instances to warrant the production by art of a mild form of a disease in order to prevent the accidental develop- ment of a more severe form. I refer to the introduction of cowpox for the prevention of small-pox. The diseases that are least susceptible of recurrence are small-pox, measles, scarlet-fever, hooping-cough. 9. In the majority of instances, recovery from the effects of these communicable diseases is so perfect, that no organic disqualification remains ; for, happily, owing to the benefi- cent discovery of vaccination, the days are passed when small-pox left its millions disfigured of feature, or lame, or deaf, or blind. A Specific Communicalble Disease. — One disease stands apart for notice. The communicable malady called FROM CAUSES EXTERNAL AND COMMUNICABLE. 6l " specific," or syphilis, the moral as well as the physical blot on our civilized life, I must mention forcibly, however unpleasant and brief the utterance. The poison of this malady once engrafted into the living body, and producing its effects there, leaves, according to my experience, organic evils which are never in the whole of a lifetime completely removed. Of the many examples of this form of disease which in thirty years of medical life I have seen, I can recall not one in which some permanent evils have not been inflicted. In many instances the evils have passed in her- editary line ; in all they have remained in the organism first affected, tinging, to the end of its life, every other disorder, and producing themselves some disorders which surrepti- tiously assume independent characters, and are looked upon too often as distinct and independent constitutional or local affections. Various forms of disease of the skin ; the dis- ease known as lupus ; some forms of consumption ; some phases of struma or scrofula ; many forms of cachectic fee- bleness and impaired physical build, — what are denominated, delicate states of constitution, — these and other types of dis- ease are so directly and indirectly connected with the speci- fic taint, it becomes impossible to be too careful in tracing it out, or in measuring the degree to which it extends in the field of morbid phenomena. In a word, this communicable disease, though the most controllable, is probably, taking it all in all, the most prolific of injury to human kind. In the happier days to come, when, under moral influences, this malady shall cease, the nosologies of the learned will have to be revised, that they may be curtailed of loathsome phe- nomena now too truly registered, but then, except by the past, unknown. I have called the diseases described in this chapter con- trollable. They are so ; but they are not, as is vulgarly supposed, preventible. They are too closely dependent on refined changes in the chemical physics of living bodies to be suppressed altogether. But they may be kept within bounds, and as the mode of action of the poisons which excite them is better understood, they may all become cura- ble. Once great and mortal plagues, they are now reduced to scourges, and may be reduced, ultimately, to stripes. But to be held in check they must be held ever under the obser- vation of the physician and under the dominion of his art. 62 PHENOilEXA OF DISEASE CHAPTER VII. PHENOMENA OF DISEASE INCIDENTAL TO OLD AGE AND NATURAL DECAY. Strictly speaking, old age exhibits no active phenomenon of disease peculiar to itself. It presents to us nothing more than a declining resistance to the attractive force of the earth. During its progress the tissues become more con- densed ; the bones become firmer, the cartilages harder, the articulations closer ; the muscles fail in their tension ; the organs of the senses lose their refined adaptations, and in the eye the arcus senilis, a white interstitial deposit contain- ing fat, arches the cornea ; the skin, falling into wrinkles and folds, loses its color, softness, and elasticity. Lastly, the nervous centres, — reasoning, emotional, and sensitive, — lessen their activities ; they are no longer the readily charged receptacles of the stimulus to the animal motion. Probably their failure is, indeed, the primary cause of all the other failures, for when in the early life the nervous supplies decline, the parts imperfectly supplied grow prematurely old, from the error of nutrition that thereupon succeeds. But these are hardly to be called phenomena of disease ; they belong as naturally to the declining period of life as certain phenomena of development — the cutting and the shedding of teeth, for instance — belong to infancy and child- hood ; and, although the end of them is death, it is death according to the ordinance of nature. The end, when it comes at the duly and fully appointed time, is, I believe, always preceded by failure of the nervous stimulus. The muscles would continue to act if they were excited and directed into action ; the secretions would pro- ceed, and, in truth, often do proceed when the faculties of mind and of volition have ceased ; but the nervous organism through its varied parts fails, and with all the parts that depend upon it for animation. The order of failure of the nervous organism is systemati- cally perfect, and it is a wonderful semblance of that tem- porary death of nervous function which we call sleep. The parts that minister to the senses fail first : next the faculties of memory, reason, and volition. The passions follow. Thus the body is left at last, while yet it lives, yielding truly phenomena of life, but of the mere organic or vegetative life. The respiratory muscles move, the heart moves, the INCIDENTAL TO OLD AGE AND NATURAL DECAY. 6^ digestive organs move, and the instincts to which these parts minister, feebly and feebler, survive. The instincts die; the digestive power dies ; the breathing begins to die. In the close of the scene the heart ceases its beats, ceases not sud- denly but in fitful phase of action ; a beat or two and along pause ; a faint breath, another series of beats, a pause ; and, with diminution of breathing and diminution of series of strokes of the heart, prolongation of the pause until the complete cessation of action. On the nature of the organic change which prevents the nervous centres from receiving the impressions of the outer world, and which also prevents them from transmitting their impulses to the organs of motion under their command, I have made recently some experimental researches which throw, I hope, a light on a very curious and interesting sub- ject. I have learned that the gradual transformation of the vital organs of the body, from the advance of age, is due to a change in the colloidal matter which forms the organic basis of all the living tissues. In its active state this sub- stance is combined with water, by which its activity and flexibility is maintained in whatever organ it is present — brain, nerve, muscle, eye-ball, cartilage, membrane. In course of time this combination with water is lessened, whereupon the vital tissues become thickened, or, to use the technical term, "pectous." By attraction of cohesion the organic particles are welded more closely together ; until, at length, the nervous matter loses its mobility, and the physical inertia is complete. I have spoken of these changes towards death in the aged as natural phenomena. They are so ; but they do not pro- gress in their course without exposing the body to increasing risk from the effects of the many and varied external influ- ences which produce the phenomena of disease. As a man has greater difficulty in his old age than he had in his youth to avoid the grosser physical accidents to which he may be exposed, so has he greater difliculty to avoid many of those more refined physical accidents of disease which strike, but strike unseen. He feels every strain which he is subjected more determi- nately, and from all physical disability he recovers indiffer- ently. Thus, after such a shock as follows a capital opera- tion at surgery, he sinks so much more readily than the young that a fixed scale of mortality may be constructed on the facts. For example : in respect to one operation, that 64 PHENOMENA OF DISEASE of lithotomy. The mortaHty from this operation increases from the proportion of one in seven in the young, until it reaches to one in four in those of the third or declining period of life. The same rule obtains when the influence of serious causes of diseases are at work ; and hence the suddenness with which a slight attack of disease prostrates and destroys the aged before they have fully completed their cycle. At the same time the aged man is less exposed to danger from some diseases than he was in his earlier life. He has passed the ordeal of epidemics. He has passed through the periods of life in which tubercular consumption is commonly developed, and when he suffers from acute diseases the intensity of their phenomena is reduced. Fatal Diseases of Old Age. — The conditions of dis- ease which lead to the majority of deaths in the decline of life and which anticipate the purely natural death are, briefly, as follows : — I, Failure of the heart. — -There is a mode of death in which the heart, instead of outliving the rest of the organic parts, in the natural way, fails prematurely in its duty. The failure thus indicated is usually in the nervous supply of the heart, and is indicated by what is called intermittent action. The pulse-stroke in such cases ceases once in every few beats ; and the pulse, taken at the wrist, is found to intermit. I have never yet met with a person who has not this inter- mittent action of the heart after the seventy-fifth year of life, and in the majority of persons it is presented at an earlier period. The heart itself, I mean the muscular structure of it, is not necessarily diseased, and in truth, between disease of the muscular structure and the failure of which I now specially speak, there is no actual relationship of cause and effect. The cause of the failure is irregular nervous stimu- lation of the heart ; the centres of organic nervous force which naturally, if I must use so plain an expression, prick the muscular walls of the heart into contraction, fail at uncertain intervals ; the message for contraction is not sent, and thus the momentary pause or break in the order of pul- sation takes place. When the structure of the heart, or of its valvular machin- ery, is perfect, this hesitation of the heart may remain for many years, and in the end may not be the cause of death. It may continue even to the Euthanasia ; but whenever it is present in a marked degree, it is, indirectly, a source of dan- INCIDENTAL TO OLD AGE AND NATURAL DECAY. 65 ger. The man or woman with a hesitating heart, whatever the age may be, is thereby unfitted for sudden tasks, demands, resolves, which, when the heart is firm, are con- sidered comparatively as of little moment. For when the heart hesitates, the brain, which reposes for its power on the blood which the heart supplies to it, hesitates also. The same person is also less able to bear bodily fatigue, to lose any of the usual hours of sleep, to miss the accustomed times and quantities of food, to endure extremes of heat and cold, to meet the anxieties and calamities of life, to undergo sur- gical operations or physical accidents, and to sustain life against acute or chronic disease. The intermittent action of the heart is thus a source of failure, central in character and persistent in duration, under which, in the aged, on the addition of any new embarrass- ment, the physical powers of life rapidly succumb. A crash of sound, a fit of grief or of joy, a slight accident or shock, a severe cold, a sudden embarrassment in the circulation of the lungs from a fall of the external temperature, a suppressed secretion and therewith an increase of pressure upon the heart ; any of these influences are sufficient to make the temporary a fatal failure. The mode of death in such instances is, usually, after the manner of a gradual collapse ; but it may be from an instant collapse — syncope. By proper care it may be avoided more easily than some other dangerous conditions the existence of which are not so definitely proclaimed. This phenomenon of disease in the aged — intermittency of the heart — is, practically, a warning of danger, and the extent of failure it implies may, in a measure, be accepted as an indication of the value of life, and of the external physical risks from which the body should be protected. 2. Separation of parts of the blood. — Another phenomenon of disease presented by the aged, and which I have observed several times, is a separation of the plastic or fibrinous con- stituent of the blood from the other parts of the blood, and its condensation, in a distinct semi-solid mass, within the heart, or within the great blood-vessels. We have now for nearly two centuries past been conversant with this change of the blood in the course of some acute diseases, and it deserves to be recognized as common also in the stage of life of which I am speaking. The ultimate cause of death during the pure natural act of death — the Euthanasia — is this act of separation of the plastic matter of the blood; but 5 66 PHENOMENA OF DISEASE sometimes the change takes place prematurely. Occasionally in the aged the separation occurs in the vessels of an extrem- ity, as the foot, and then, from the arrest of the circulation through that extremity there is local death, or what is called senile gangrene. More frequently the separation, as a last act of a living character, takes place in the heart itself, checks the circulation of the blood over the body at large, and leads to dissolution. I have observed many instances of death occurring to the aged from this mode of arrest of the circulation of the blood; and, without entering into minute details, I may note that I have never made an examination of the body of a person who has died from pure old age in which saparated and solidified fibrine has not been found within the heart. As a rule, the separation has taken place on the right side, in the right auricle or ventricle, or in both these cavities of the central organ of the circulation. The separation, in such examples, has been slow, and the death prolonged, as if the two processes of dying and of separation of the blood were proceeding side by side, the act of separation making the death absolute. In other and rarer examples, the separation has been conducted slowly, but has been sudden as a cause of death. The fibrine has separated gradually, either in the pulmonary artery on the right, or in the great aorta on the left side of the circulation; and it has been laid down as a hollow cylinder, through which the blood has continued, for some days, to flow. At last, from lessening of the calibre of the cylinder of fibrine, the current of the blood has carried the mass entire, from what may be called its moorings, into the channels of the circulation where they are narrowed, and here, acting as a solid obstacle to the current, it has arrested the flow of blood, and led to instant death. The tendency to separation of fibrine is often well marked in the prime of life in those who have been reduced from loss of blood, from privation of food, or from excessive physical fatigue. Slowness in the course of the blood, and a break in the balance of the constituent parts of the blood, aid to cause the plastic colloidal fibrine, always in a state of trembling equilibrium, to pass into the pectous, or thickened state, and so to separate from the fluid blood. In the aged, the conditions of slow circulation, and of modified blood tending to separation, are always present, and life, thereby, is held by so slight a tenure it is often a marvel it endures. The circumstances leading to death of the aged from this INCIDENTAL TO OLD AGE AND NATURAL DECAY. 67 cause are few, and often, apparently, trivial. A slight cold, a sudden mental or physical shock, an attack of acute local in- flammation, as of erysipelas, an excess of fatigue, a too pro- longed abstinence from food, in short, anything that tends to disturb the equilibrium of the constituent parts of the blood, is sufficient to precipitate the plastic matter and to render it a source of fatal obstruction to the circulation. 3, Vascular congestion. — Another cause of death in persons who are near to the stage of natural death is vascular con- gestion of the vital organs, especially of the lungs or the brain. With the loss of elasticity of limb, there is loss also elasticity of the blood-vessels of the body. The arteries, which, in youth, yield before the stroke of the heart, then recoil, and by their recoil help to force onward the current of the blood, and actually, by what may be called a back- stroke, feed the heart with blood, — these arteries lose their resiliency ; at their extreme terminal parts they become rigid, and sometimes are altered in structure from degenerative changes, fatty, atheromatous, or calcareous. In this manner the refined regulation of the passage of blood in the course of the minute circulation through the vital organs is impaired; the blood is imperfectly driven over from the arterial to the venous side, and its partial arrest, or its congestion, as it is commonly said, ensues. The effect of a sudden fall of temperature is always dis- astrous to those in the decline of life, owing to the readiness with which, under the influence of cold, the vascular struc- tures become paralysed and their functional activities impaired. Cold robs the body directly of force, and it exerts a physical influence on the blood-vessels, first producing contraction of them, in their minute distribution, and afterward causing feebleness of tone in them and undue relaxation. I have already reviewed the extent of the changes in the organic life that is induced by a low wave of heat, and have pointed out the influence of such wave on the healthy life after its thirtieth year. I have also traced the increasing influence ot that wave onward as it progresses in power upon the advancing life, doubling in its potency as each nine years of existence have glided away. To the old man cold comes as a yearly messenger, ready to carry him to his rest ; in which course it is aided by many accidents, one of which daserves special attention, because it is very common, and is avoidable. 68 PHENOMENA OF DISEASE This accident, which may be called the accident of reac- tion, is induced by the attempt to restore warmth suddenly to the body after its exposure to a low temperature. It is one of the best-known facts in science that when, a part of the outer surface of the body has been exposed long to cold, the greatest risk is run in trying suddenly to' re-induce warmth. The vessels become rapidly dilated, their muscular fibres relax, and extreme congestion follows. But what is true of the skin is true equally, and with more practical force, of the lungs. An enfeebled man goes out when the wave of temperature is low and soon feels oppressed, cold, and miser- able ; the circulation through his lungs has become embar- rassed, and he is not oxidizing freely ; he returns to a warm place, he rushes to the fire, he breathes eagerly the heated air, and adds, perchance, to the warmth by taking a draught of hot stimulating drink ; then he goes to bed and wakes in a few hours with what is called pneumonia, or bronchitis, or both diseases. What has happened ? The simple physical fact of reaction under too sudden an exposure to heat, after exposure to cold. The capillaries of the lungs have become engorged and the circulation static, so that there must be reaction of heat, — inflammation, — before recovery can occur. Nearly all bronchial affections are induced in this manner, not always nor necessarily in the acute form, but more frequently by slow degrees, by repetition and repetition of the evil. Common colds are taken in this same way ; the exposed mucous surfaces of the nose and throat are subjected to a chill, then they are subjected to heat ; then there follow cong&stion, reaction of heat, pouring out of fluid matter, and the other local phenomena of catarrh. The wave of low temperature rolling over a given popula- tion finds inevitably a certain number of persons of all ages and conditions on whom to exert its power. It specially catches those who are old, and them, too often when they least expect it. An aged man, with a sluggish heart, goes to bed and reclines to sleep in a temperature say of 50° or 55° Fahr. In his sleep, were he quite uninfluenced from without his heart and his breathing would naturally decline. Gradu- ally, as the night advances, the low wave of heat steals over the sleeper, and the air he was breathing at 50° or 55° F. falls and falls to 40°, or it may be to 35° or 30°. What is less likely to follow than deeper sleep ? Is it not natural that the sleep so profound shall stop the laboring heart ? The great narcotic never travels without fastening on some victims INCIDENTAL TO OLD AGE AND NATURAL DECAY. 69 in this wise, removing them, imperceptibly to themselves, into absolute rest. The precise mode in which life is terminated, under these circumstances, is varied according to the organ in which the arrest of the circulation commences. That organ in which the vascular derangement is most determinate is commonly and naturally the first to give way, and by its failure to show, symptomatically, the signs of its distress. If the brain be the organ first affected, we define the death, usually, as from apoplexy ; if the lungs, we speak of it as from pulmonary congestion, or congestive bronchitis ; if the kidney, we record renal congestion, and so on, the name of the disease being, as a rule, assigned to the earliest developed series of the phenomena. Not unfrequently, after congestion of the lungs, there is partial recovery from the congestion, and death from a secondary cause. The animal temperature of the body being much reduced, the watery vapor that should exhale from the pulmonary circuit in expiration is not freely evaporated. Then there occurs condensation of fluid in the bronchial passages, interference with the course of the air on its way to the blood, and suffocation. The body is drowned in its own exhalation. This mode' of death is common amongst those who reach the last stage of life. 4. Faihire of digestive power. — A last, but perhaps least frequent, mode of termination of life in those of the aged who approach, yet do not realize, the Euthanasia, is by failure of the digestive function. An entire failure of appetite and in time even.a dislike for food, is manifested in these instances, as though the stomach has lost all its powers — sensitive, secreting, digest- ing, propelling. Under this condition, I have known death to occur by starvation, while still the mental faculties have remained clear until the very hour of dissolution. Happily in such states all the sensibilities which by excitement con- stitute pain, are in sympathy with the stomach, and suffering of an acute kind is saved. The final stage is one of coma, a final sleep from sheer exhaustion. In all the modes of death occurring to man during the third stage of his existence, the pain of death and the dread of it is reduced in proportion as the period for the natural termination of life is approached. The very young know only of death by what they accidentally hear of it and, hap- pily, have no more dread of it than of sleep. The adoles- 70 PHENOMENA OF DISEASE cent, full of life, think death impossible in them, even when it is closing their eyes. The continually afflicted and wretched learn to feel that death is better than a bitter life. Those who, between the meridian and the decline of life, have peace in their possessions, whose ways are prosperous in all things, and who have felt the dread of death during the transition stage from prime strength to first weakness, find their fears gradually allayed by a growing sense of lesser care for that which is, and by the development of a mental process of adaptation to the inevitable. The old, passing beyond even this phase, die, by a change of physical state, to themselves imperceptible, — when the harmony of nature is maintained to its designed end. PART THE SECOND. PHENOMENA OF DISEASE, INDUCED AND SPECIAL. CHAPTER I. DEFINITION AND CLASSIFICATION. Under the term Induced Diseases, I include those phe- nomena of disease which spring from causes which are entirely under our own control, and which need not exist at all, if the mind were fully trained to resist-them. Some few men by force of character, or by happy circum- stances, have so resisted the influences leading to these dis- eases, that, exempted from them, they have passed to Euthanasia ; and, without a doubt, all men who have most resisted them have passed the most securely to the natural death. For induced diseases, when they have become estab- lished in an organism, however perfect it may have been originally formed, not only of themselves destroy, but assist in their destructive course the maladies which are incidental and are out of the domain of volition. The induced diseases spring from several classes of causes. {a) Some of them are due to an excess of labor or excite- ment, to which the body is physically subjected in one or other of its organs or parts, {b^ Some arise from the action of agents taken into the body, and which change its material structure, {c) Others spring from the particular habits and customs of the community. () Children and students who are still at their education, {c) Men who give no name to their work, who live "by their wits." {d) The residuum of society, the still existing vagrant class. The first of these present characteristics so closely resem- bling those of the easier-going professional classes* I need not refer to them. The last are too indefinite to admit of much description, in respect to the diseases incident to the work which they perform. On classes (<^) and (c) some attention must be bestowed. Children and students are subjected to many evils from their occupations. The endeavor to fill too hastily the minds of children with artificial information leads to one of two results. Not unfre- quently, in the very young, it gives rise to direct disease of the brain itself, to deposit of tubercle if there be pre-dispo- sition to that disease, to convulsive attacks, or even to epi- lepsy. In less extreme cases it causes simple weakness and exhaustion of the mental organs, with irregularity of power. The child may grow up with a memorytaxed with technicals impressed so forcibly that it is hard to make way for other knowledge. Added to these mischiefs there may be, and often is, the further evil, that the brain, owing to the labor put on it, becomes too fully and easily developed, too firm, and too soon mature. It remains throughout life a large child's brain, very wonderful for power in a child, but very weak in a man or woman. 230 DISEASE INCIDENT fo SOME OCCUPATIONS. The development in an excessive degree of one particular faculty is another common cause of feebleness. I knew once an instance in which a child was " blessed " with a mar- vellous gift of verbal memory. This being his "forte," his teacher, who wished every scholor to be remarkable for something beyond other scholars, played on the " forte " inc'essantly, and with wonderful effect. By constant cultiva- tion of the one faculty this marvellous boy could learn off fifty lines of " Paradise Lost," or of any other English book, at a single reading, and could repeat his lesson on the spot, without missing a word or omitting a comma. But the result was so bad that when the boy was sent from school to a university to learn a profession, he was beaten in the learn- ing of detailed and detached facts by every fellow-student. Seeing, slowly but surely, where his weakness lay, the student ceased at last to call into play his remarkable talent. It was a terrible task; a task he accomplished at last to a consider- able degree, but never effectually. For a long time he made mistakes that were most annoying: he was unable, for instance, to cast up, accurately, any column of figures; he forgot dates and omitted to keep important appointments; he misnamed authors in speaking of works of art or letters; and, in reasoning, his want of analytical power was pain- fully felt. It took him full ten years to unlearn his wonder- ful technical art. Overwork in the child and in the student defeats its own object. It does not develop the powerful brain so necessary for the man; for life is ever a new and great lesson, and some young brain must be left free for the reception of lesson on lesson. But the danger of overwork is, unfortunately, not confined to the brain, it extends to the body as a whole. When the brain is overworked in the growing child, how- ever well the child may be fed, and clothed, and cared for, there will be overwaste of substance in proportion to the overwork. There will be stunted growth and a bad physical body. The men who live by their wits, who proclaim no definite occupation, but who are said " to speculate," are the out- casts, usually, of some profession in which, had their talents been properly applied, they might, perchance, have won a respectable position, or even fame. They leave the straight and correct path, and with strange ups and downs try to reach the goal of success by the insane process of seeking it through blind and devious ways. As a result, they suffer DISEASE INCIDENT TO SOME OCCUPATIONS. 23T exceptionally from both physical and mental strain. The man who during life has simply to meet his difficulties one by one, as they appear, one up and another down, has hard work; but the speculator meets obstacles on all sides, and while he is winning in front, must often find himself held back by a strong hand in the rear. His life is to waylay, to calculate how he shall make up a book that shall win, come what will. The absorption of this man's thoughts in his own labors and devices removes from him generally the idea of illness and of death. He differs from the man of ordinary busi- ness, in fact, in his carelessness as to the needs of his own physical existence. His life is surrounded with a kind of vulgar romance. His overweening self-confidence, and his consciousness that he either can or ought to devise schemes and calculations that must or should carry the day, create in him an enthusiasm which might well be devoted to a better cause. By and by, in spite of himself, and in spite of his absorption, he begins to fail, follows usually the course of resorting to stimulants, by way of support, and at last suddenly breaks down hopelessly and completely. The ailments of the speculator are usually compound in character. He is, in most instances, a man of active life ; the whole of his organism, muscular and nervous, is equally taxed, and he is exposed to a variety of exhausting influ- ences. His first symptoms are, ordinarily, an irregular action of the heart, with a failure of that organ. In the majority of cases he succumbs, after exposure, to some sub- acute inflammatory disorder. He takes cold, suffers from congestion of the lungs or kidneys, and, unable to bear the shock, sinks rapidly under it, his mind becoming intensely irritable, or even losing its balance. Often he does some foolish thing, trips in his calculation, and is pronounced " insane ; " or is left to endure a life too wretched to be worth its continuance. Signally, he adds to the lists of those who form the suicidal class of the community. Diseases incident to Domestic Occupations.— The members of the population brought under the head domestic —including in England and Wales 5,905,171 persons, of whom 5,660,443 are women — are engaged in domestic work, in superintending or carrying out the duties of the house- hold. They suffer from physical over-work, from confine- ment in the house, which leads to indigestion and anaemia, and to a few special maladies attached usually, by want of 232 DISEASE INCIDENT TO SOME OCCUPATIONS. care, to some special employment. The women who in the kneeling position scrub floors, get that inflammation of the knee-joint, with effusion of fluid, to which the common name of ■' housemaid's knee " is applied. Waiters who are obliged to carry heavy weights up long flights of stairs are subjected more frequently, perhaps, than any other class, now that the days of the postboy are so nearly ended, to aneurism of the aorta. Women engaged in laundry work, and who are exposed to intense moist heat, are rendered feeble and anaemic, and are occasionally so reduced by the work that they faint, fatally, over it : this occurred to two persons within my own knowledge, to both of whom I was called when medical aid could be of no avail. Great evil is done to domestic servants by the manner in which they are lodged at night. Young and inexperienced people on taking a house are apt, from sheer thoughtlessness, to consider the servant's bedroom of the least importance, and there are many older managers who maintain the same indifference. The domestics, consequently, are lodged in the most out-of-the-way rooms in the establishment ; in rooms having no means of ventilation, and so little healthy space that refreshing sleep is rendered impossible. I have often noticed in dispensary practice, in my capacity of physician, that more than half the illness of the domestic class were due to this one cause. It frequently happened that those servants who were best fed were worst housed at night, and many a case of pulmonary consumption have I been forced to trace to its origin, in the fatal and thoughtless error here defined, an error frequently as little recognized by the servant as by the master. Diseases incident to Agricultural Occupations.— The physical diseases incident to agricultural pursuits are those which are induced by the external uncontrollable causes, by exposure to the wind and rain, to heat and cold. Acute inflammatory and rheumatic affections are more marked amongst the agricultural than amongst other classes; and, indeed, it is now amongst them only, that we see those sthenic inflammatory attacks which the doctors of last cen- tury described so naturally, and which they cured by the free abstraction of blood. Physically the farmers have the advantage of following the healthiest occupation of the whole community, and the farm laborers, except for the indifferent homes in which they are lodged, share with their masters in this advantage. DISEASE INCIDENT TO SOME OCCUPATIONS. 233 DiseasesJncident to Industrial Occupations.— The diseases incident to industrial occupations are of extended range. Of these the largest class affect the breathing organs, so many occupations being necessary in which the lungs are exposed to the irritation arising from inhalation of foreign matters, in the form of dust or vapor. The coal-miner inhales the fine particles of carbon ; the knife-grinder the particles of steel ; the cigar and snuff maker the dust called " shorts ; " the sand-paper-maker, minute particles of sand or pounded glass ; the hemp and flax dresser the dust of those substances ; the trimming manufacturer, the fluff of silken and hempen stuffs ; the fur dyer, the fumes of nitric acid and the dust of copperas ; the bleacher, the vapors of chlorine or of sulphurous acid ; the house-painter, the vapor of turpentine. Exposure to the action of all these substances is a direct cause, in many instances, of local pulmonary diseases which are often fatal, and always serious. Consumption proper, and bronchial affection find in these occupations, and in others allied to them, their frequent causes. Other industrial occupations lead to other local diseases. Exposure to phosphorus leads sometimes to disease of the jaw-bone. Certain forced positions of the body for work lead to distortion of the spinal column or of the wall of the chest. Exposure to lead causes an intestinal spasm, " colic," or, if long-continued, a paralysis of the extensor muscles of the hand, and "drop wrist;" the glazing of pot- tery is thus injurious. Men engaged in businesses which call for violent exertion, carpenters, blacksmiths, rowers, induce singular muscular developments, nervous feeble- ness, and mechanical derangements of the vascular organs. Men working with chemical agents are subjected to injuries from them; thus, exposure to the bichromate of potassa induces sometimes a peculiar cutaneous ulceration, and exposure to arsenic an irritation of the mucous surface of the alimentary canal and of the other passages of the body which are lined with mucous membrane. 234 DISEASE FROM SLOTH AND IDLENESS. CHAPTER XVII. DISEASE FROM SLOTH AND IDLENESS. As a set-off, miserable enough truly, against disease from excess of work and deficient rest, the physician observes in the course of his life, certain phenomena originating in that mental inertia, and physical inactivity resulting therefrom, called idleness. Idleness, in the strictest sense of the word, is, according to my experience, a rare phenomenon; for those who do not work in the ordinary meaning of the word, occupy themselves, as a general rule, at play or pas- time. Some persons indeed work harder at their play than many of those who have to make a living by their industry. There are, however, sections of really idle people of whom it may be said fairly enough, as Shakespeare said of great people, " some are born to idleness, some achieve idle- ness, and some have idleness thrust upon them." The first are the idle by actual hereditary taint of feebleness. The second are men who have been industrious perhaps beyond reason, and who, having earned a competency comparatively early in life, " retire " from labor to enjoy a luxurious ease or an absolute rest. The third are those unfortunate pets, I had nearly written pests, of society, who, in the family and friendly circle, are considered privileged to do nothing; who are thought to be too weak, or too good, or too supe- rior, to be subjected to any annoyance of labor, and who feel, as a consequence, that they confer a privilege when, in allowing others to wait upon them, they are not too exacting in their demands. The idlers of the first class, those who are born to idle- ness, are often severely criticized when they ought really to be pitied. They are, I believe, one and all, deficient in organic build. Their volitional centres are incompetent to the performance of duties that are considered common duties by the majority of mankind. They lie midway between the actual embecile and the feeble but willing industrious, and with their mental inertia, they have some some marked physical infirmity. I may say of all of them that they are of strumous constitution, of relaxed muscle, of thin pale blood, and of feeble voice. Their physical configuration varies, however, in important respects, as to external appearances. Some are lank of limb, sunken of DISEASE FROM SLOTH AND IDLENESS. 235 face, and thin of body; others grow unduly fat so as to be a burthen to themselves. They all learn little, and retain only for a short time that which they have learned. They are singularly helpless with their hands; their wrists drop, as if their extensor muscles were paralyzed; and they usually have small and aberrant eyes. As children. these unfortu- nates, unless they are well protected, lead wretched existen- ces; at school they are the butts of their stronger com- panions and the torments of their teachers, who fail, equally, by persuasions, rewards, blows, to make them active or learned. Happily for themselves they are less sensitive than their fellows, and almost happily for themselves they are usually short-lived. Possessing no cerebral resistance, they rapidly sink from acute disease, from accident, or even from moderate physical efforts which they may, in emer- gency, be peremptorily forced. The idlers of the second class, those who have earned idleness, are hardly less to be pitied than the born idle. They are men worn out already, though they may still be young, and they seek in repose the pleasure for which they have yearned throughout their lives. They separate them- selves, irrevocably, from the business or profession with which they have become familiar; they feel incompetent to acquire any new pursuit; and they settle down to court rest; or, for the dignity of the thing, they give up their leisure, for short periods, to magisterial or other public duties for which they have never been trained, and for the perform- ance of which they have as little capacity as they have for commanding a fleet, or taking a transit of Venus. These victims to an acquired sloth, — for if it be persis- tently urged, sloth is so acquired, — soon become diseased, either in mind or in body. They suffer quickly from en7nii, and either fall into hypochondriacal fancies with the dread of death ever before their eyes, or sink into actual despon- dency with such acuteness of despair that suicide suggests itself as the only mode of relief. Men thus circumstanced succumb readily under any uncommon strain or injury. They fail rapidly under slight attacks of acute disease; they make but feeble resistance to the action of cold, and, at their best, they drift into the paraly- sis of premature old age. Or, rusting in idleness, and temp- ted to eat and drink more than the body, in the midst of its full powers, could dispose of, they acquire a feeble heart and a weakened vascular mechanism of the brain; then they 236 DISEASE FROM SLOTH AND- IDLENESS. succumb suddenly from failure of the heart and syncope, or from pressure of blood on the brain and, so-called, apoplec- tic stroke. The idlers of the third class, they who have idleness thrust upon them, are found in both sexes of our modern life; but I think I must say they are most fre^^uently found amongst members of the female sex. These lounge through every day and through every task they undertake; they lounge even through play, and acquire such a detestable habit of rest that to take a walk or a bath, to.do the most trifling piece of handy work, to write a letter, to accept any trouble or care becomes a veritable anxiety and pain. They know nothing of true happiness, — for life with inactivity is a physical bur- then and is carried about with a sense of its weight ever pres- sing on the mind as well as the body. If they are men, they commonly become dissolute from drink and sink into that abyss of reckless abjectness which ends in fatuity and general paralysis. If they are women, they fall into worse perils: they marry, become the helpless mothers of helpless children and persistent and intolerable anxieties to their husbands and friends. They sink into slatternly misery, lose every good look they ever possessed and, like the equal idle man, fall at last into paralysis, hastened too often, by intemperance or by the severity of neglect with which their indolence is chased to its reward, In some instances of acquired idleness of the kind now under consideration the wealth of the idler is so great that the idleness in all its varied forms, is pampered and sus- tained. The pamperers, industrious themselves, either from mistaken affection or from interest minister to the wants of the helpless physical being that lives to linger only in the world of life. To these favored idlers nature pays no heed. In her resistless course she builds up of such materials as are brought to her, and of her original designs be thwarted, regardless alike if the comfort or discomfort of the thwarter she pursues her way. They who lie out of her designs are, therefore, doomed to the penalties that must follow. They may be sustained by misapplied medical art which, by one or other purely artificial or advenititous means, shall minis- ter to induced disease. They may be protected by the warding off of all sources of trouble or irritation, and pleas- ure may be made a partial substitute for natural labor. All these arts and conveniences and substitutes do not, however DISEASE FROM LATE HOURS AND BROKEN SLEEP. 237 prevent disease. The indolent heart passes into unnatural paces of motion; the sluggish brain is reconstructed out of devitalized material; in the end there follows organic degen- eration and premature ending of life from failure- of vascular or nervous power. Or in these instances, if the physical organism works on beyond what is commonly the limit of its endurance, there is developed a mental feebleness and imbecility which end in complete failure of mental power. Doubt and hesitation are succeeded by distrust, distrust by fear, fear by despon- dency and despondency by despair. Then the burthen of life, all through so heavy, is more than the tolerated, and in the unreasoning or obviously false expressions of the invalid in the persistent and automatic complainings in the over- anxious face and helpless gesture we discern the imbecility of the insane. CHAPTER XVIII. DISEASE FROM LATE HOURS AND BROKEN SLEEP. Although it is impossible to define in one term any one disease originating from irregular sleep and late hours of retiring to rest, there are certain impairments resulting from these habits which influence the course of the health and help materially to shorten life. The man who is accustomed to go to bed moderately early and who takes his full rest of eight or nine hours feels quickly what are the symptoms of broken sleep if, for a single night only, he be deprived of his natural repose. The deprivation costs him, next day, a feverish feebleness, a wandering and hazy condition of mind, an uncertainty of action, a sense of vacuity, and a nervous susceptibility to sounds and other influences affecting the senses which, if not painful, are at least, disagreeable sensations. He detects, moreover, that two or three nights of good sleep are required to restore him to his natural state of mental and physical strength. If, in the period of his early life, a man breaks the rule against nature and by a strong and persistent effort of the will, accustoms himself to shok and disturbed rest, the signs of distress which the unrefreshed body first feels are modi- 238 DISEASE FROM LATE HOURS AND BROKEN SLEEF. fied, and extremely short hours of sleep may become the rule ot life. We sometimes hear a person say that he can do with four or five hours of sleep, that he can sleep when he likes, and that it matters not how late he goes to bed for he always rises at the same hour. We hear youths, also, exult- ing in their youthful powers, affirm that time was made for slaves, and that they don't go home till morning, as if some great virtue of courage or of wisdom were conveyed in the declaration. In time, sleeplessness acquired by habit becomes a prac- tice which, when the body has arrived at full maturity and more rest from sleep is absolutely demanded, is not easily thrown aside. At such stage the bad habit tells on the life, and the physician finds no class of patient so difficult to treat successfully, even for mere functional derangements, as the habitually sleepless. There is about the patient a restless anxiety, an irritability, and a nervous feebleness which no artificial aid can, entirely, subdue. The general symptoms which indicate the wearing influence of deficient sleep vary with the age of the sleeper. In the child too little sleep induces symptoms of restlessness, peevishness, weariness at play, emaciation, indigestion, and great pallor of the face and surface of the body. The enjoy- ments of the waking hours are curtailed, and a dulness which, by thoughtless persons, is commonly mistaken for actual stupidity, marks every effort at lesson or at play. These symptoms are followed by an inability to go to sleep at the natural time and by the occurrence of an unnatural, startled, dreamy sleep when the eyes are, at length, closed. Tha activity of the brain is thus maintained in the dream and another cause of nervous exhaustion is hereby supplied. The man who dreams does but half sleep ; the child who dreams hardly sleeps at all. I have said that no distinct name can be given to the indefinite class of symptoms which are encouraged and sus- tained by sleeplessness ; but, indefinite as they are, every watchful mother knows their import in the child. They are the beginnings of a restless, feverish, easily impressionable, easily exhausted life. In adolescents, even if they be, naturally, of sound consti- tution and firm build, deficient sleep is a persistent source of mental and bodily exhaustion. It induces pallor, muscular debility, restlessness and irritability. It interferes with that natural growth and nutrition of the body to which sound DISEASE FROM LATE HOURS AND BROKEN SLEEP. 239 sleep so beneficently ministers, and it makes the work and the pleasure of the wakeful day unduly heavy and laborious. These remarks apply to members of both the sexes, but they specially apply to girls. The anaemia, bloodlessness, weakness, and hysterical excitability that characterize the young lady of modern life, who is neither well nor ill, are due, mainly, to her bad habit of taking too limited a supply of sleep at irregular hours. The feebleness which falls to the lot of the robust who deprive themselves in youth, or who are deprived, of the due amount of sleep, taken in due season, is greatly increased and is of much more serious moment when it falls to those who by hereditary taint are disposed to an acute wasting disease ; to pulmonary consumption, to name the most familiar example. It is painful to me to recall how many times I have been obliged to see the first indications of pul- monary disease occurring as the result of late hours and broken rest ; as the result of those unearthly balls and even- ing parties where the young of both sexes are called together to dance into utter prostration of mind and body, until the daylight dawns and the sun rises to expose the tawdriness of the ball-room and the helplessness of the half-dreaming, sleepless, pale, shivering revellers. By the end of a season of pleasures no single youth or maiden who is tainted with consumption stands safely from the disease. Many, truly, escape, but some always fall and all have been in danger. In like manner the student who, over-anxious to gain the prizes of his college or school, wins by the robtery of rest, wins but to lose physical activity and length of days. Again, the poor and wretched young, they who are obliged to work into late hours and to rise early that they may earn their scanty subsistence, they, devitalized by manv causes, are stricken by none more deeply than the famishing from waut of sleep. From adolescence on towards the close of that period of age where the body reaches, what in the first chapter of this book was called the level plane, — the period when the matu- rity is attained and the downward course of life is not yet on hand, — the srtong man can resist sleep often for long periods. He is apt, in consequence, to trespass on the lib- erty he ventures to take with nature; and when from any cause he chooses to take the liberty, he congratulates him- self, perchance, on the impunity with which he is able to vio- late the natural law. The delusion is not of very long dura- 240 DISEASE FROM LATE HOURS AND BROKEN SLEEP. tion. As the middle of the second stage of his career approaches the demand for more sleep becomes more urgent, and happy is he who at this crisis can recall to his service the friend he has deserted. If in middle age the habit of taking deficient and irregu- lar sleep be still maintained, every source of depression, every latent form of disease, is quickened and intensified. The sleepless exhaustion allies itself with all other pro- cesses of exhaustion, or, it kills imperceptibly by a rapid introduction of premature old age, which leads directly to premature dissolution, A typical illustration of premature decay induced by broken and deficient sleep has been before me during the present year in the case of one of those indomitable mem- bers of my own profession, who too readily sacrifice life to duty. A man of slight build, but of singular activity of mind and body, and in all his career temperate to the utmost, this gentleman about twenty-five years ago secured a large general practice. With unremitting attention he carried out the duties of his profession year by year, without any change of scene or holiday, and for many years was accustomed to be called up at night four times in the week, on an average. To this mode of life he became, as it were, adapted, and really appeared to suffer nothing from it; but soon after he had passed his forty-fifth year he discovered that at times, in the day, he had an occasional unconscious period during which he did not actually sleep but was for a moment for- getful or lost. The attack was so trifling he was himself inclined to ascribe it to simple forgetfulness, and for a few months it nearly passed away, recurring only at moments when he had undergone a more than usual pressure of night work. At last the periods of loss of conscious recollection passed, in entire defiance of his will, into periods of actual sleep, from which, after an interval, he would wake up and be again ready for work. Step by step, week by week, these overpowering fits of sleep increased in frequency and extended in duration until they lapsed, finally, into one long sleep, with entire powerlessness of his limbs, a carelessness for nourishment and a persistent coma, from which he was aroused with difficulty. After this continuance of sleep had lasted a few days he gradually sank and slept the sleep that knows no waking. The effect of irregular hours and of deficiency of sleep is developed sometimes in another way. DISEASE FROM LATE HOURS AND BROKEN SLEEP. 24I When the exhaustion from prolonged sleeplessness is felt, it is demonstrated through the heart. Intermittent action of the heart, of which mention has been made in preceding pages, is established, and all the evils belongiug to that broken movement are set in train. This state of things is most readily induced in those persons who, while losing tiieir natural rest, are engaged in working against time. Newspa- per reporters and night pressmen are very quickly influenced in this manner, and become disabled before they are fully alive to their disablement. They feel at times a strange sensation* of faintness or coldness coming over them, as if they were suddenly enveloped in a haziness or obscurity; but, by applying more desperately to their work, they dash the sensation aside until it returns too often to be disposed of so readily. Then they are discovered to be suffering from exhausted brain and irregular circulation. Another effect is sometimes witnessed and is the most dis- tressing of all. It is that the sleeplessness acquired by habit begets sleeplessness. The most extreme insomnia is here- with induced and the mind, knowing no rest by night or by day, is quickly off its balance. The very idea that sleep will not come under any circumstances, unless it be enticed by powerful narcotics, is itself preventive of all natural repose, and, as the dread of the sleeplessness increases, other mor- bid trains of thought arise in rapid succession. Some hypo- chondriacal monomania seizes the sufferer; he imagines the most improbable accidents are about to happen to him; he is constantly restless; he bites his nails to the quick, or keeps up some peculiar motion of his limbs, a rat-tat on the table, or a gesticulatory action of an exaggerated character. A man circumstanced in this manner passes, usually, with steady advance, into insanity, too often into suicide. Those who are led into these extremest conditions of sleeplessness are most commonly men whose minds are ill at ease; who have been thwarted in some ambitious project; who have been detected in some offence against society which they hoped to keep from the world ; or who, holding from the world some really terrible or imaginary terrible secret of their lives, lie awake calculating how they may remain ever on the alert and be prepared for action if the worst should come to the worst. These men are kept awake by the sentiment known as remorse, for which there is no remedy by repentance and no end but one, viz., derange- ment of the mind from its concentration on one object, — - 242 DISEASE FROM LATE HOURS AND BROKEN SLEEP. the re-establishment of self-respect in opposition to reason and fact. Shakespeare, with all the skill and observation that might belong to the most learned physician, has grandly depicted the form of sleeplessness above defined. His Macbeth cries: — " Glaniis hath murdered sleep. ^^ His Gloucester, at dead midnight, argues with himself that he is and is not a villain. *' Fool, of thyself speak well; fool, do- not flatter f* and thus unavailingly strives to reason his mind to rest. To this day the types of the sleepless Macbeth and Gloucester live. We put them into asylums now. There be some who, by sleeping at other hours than the natural hours of the night which belong rightfully to the purpose of sleep, strive to make up for that which is natural. The attempt is better than nothing, but at the best the suc- cess is partial only. I have* seen all the evils incidents to sleeplessness follow this, supplementary remedial measure, if not with the same intensity yet with marked emphasis; and^ sure I am that no man seeks sleep at irregular times or for diminshed space of time without paying the penalty in reduction of energy and in shortness of life. I have said that those who sleep differently and irregularly are more easily affected by direct causes of disease, and are less amenable to means of cure. To this should be added the equally important fact that those who are habituated to full and regular sleep are those who recover most readily from sickness. The observation of this truth led Menander to teach that sleep is the natural cure of all diseases. It is so. Sleep reduces fever, quickens nutrition, increases elim- ination, soothes pain, and encourages the healing of wounded surfaces. Whoever is first to discover the still secret cause of natural sleep and the mode in w^hich it may be com- manded by art, for the service of mankind, will be the greatest healer who has, up to this age, helped to make medicine immortal. DISEASE FROM ERRORS OF DRESS. 243 CHAPTER XIX. DISEASE FROM ERRORS OF DRESS. At one time a widespread and very dangerous disease was induced in women by one particular error of dress, the error of lacing up the body, tightly, in stays. The disease was sometimes fatal, the heart and even the lungs being actually displaced, in extreme instances, by the pressure. In these days some improvement has taken place in respect to tight lacing of the body, but the evil is not altogether removed. Taking them as a whole the diseased conditions which arise from errors in dress are reducible to five heads — {a) Mechanical errors. (If) Errors affecting the amount of cloth- ing that should be worn at different seasons of the year, and under differing circumstances of heat and of cold {c) Errors in respect to ventilation of the body beneath the clothing, (d) Errors from the presence, in clothing, of ir- ritating chemical substances used as dyes, (e) Uncleanliness of clothing and the consequent conveyance, by it, of organic poisonous matter. From Mechanical Errors. — The worst mechanical errors in clothing are those which affect the chest and body. The tight band round the waist and the tightly-laced corset still play too important a part, and interfere with the free and healthy movements of young girls and women. The effect of the pressure is equally injurious to the organs of digestion, respiration, and circulation. The liver and stomach com- pressed, the digestive functions are impeded, and a distaste for solid food, with an inability to digest food, and with symptoms of pain and flatulency after eating, are the com- mon proofs of the injury that is being inflicted. The great breathing muscle, the diaphragm, which separates the chest from the abdomen, and which by its descent, in contraction, causes the chest to fill with air, is impeded in its motion and is therefore unable to sustain a free respiration. The large veins from the lower part of the body which pour their blood into the right side of the heart are compressed, and in the worst instances the heart itself and the lungs themselves are actually subjected to restraint. By these means the organs of the circulation, not less than the organs of respiration and digestion, are disturbed, to the detriment of the whole of the body, which 244 DISEASE FROM ERRORS OF DRESS. depends on these organs for its nervous power, its muscular force and its nutrition in every part. To the symptoms of indigestion are added breathlessness on slight exertion or excitement, coldness of the extremities, weakness of muscles, constipation, headache, and other evils not less severe. The effects of mechanical pressure of the kind described are not confined to the mere periods of time at which the pressure is applied. They extend to after life and when long continued produce an imperfect build, of the chest and of the trunk of the body, which is never lost. Women thus deformed when it is their turn to become mothers pay a penalty of suffering which would have been spared them if their bodies had developed into the healthy and beautiful form devised by the hand of Nature. The evils arising from compression of the chest and body in early life are not exclusively restricted to the female sex. Schoolboys and youths constantly practice the habit of bind- ing up their clothes, round their bodies, by means of a belt tightened firmly above the hips, instead of wearing the brace over the shoulder. Some boys and youths are also taught the plan of putting on an extra belt for " holding in the breath," before they run or leap. In the pursuit of certain active businesses in which weights have to be carried this same system of wearing a tight belt is adopted and practised by working- men, until the artificial and ingenious support, as it is assumed to be, becomes, like the corset of the woman, a veritable necessity. To the belt the same objection applies as to the tight band and corset. It impedes the free motion of the abdom- inal organs; it impedes the freedom cf the respiration; it interferes with the circulation; in the young athletics who wear it while they are running, rowing, climbing, wrestling, it tends to bring on hernia — rupture. Mechanical evils of a severe kind result from other modes of pressure on the body. The pressure of a tight cravat is injurious. By the pressure of a tight garter the leg is sometimes actually indented below the knee so that the free return of blood by the veins is prevented and the vari- cose vein of the lower limbs is, I may almost say, the natural consequence. Pressure, irregular and excessive, on the foot, by the badly-fitting shoe or boot, is another mechanical evil from DISEASE FROM ERRORS OF DRESS. 245 dress, becoming, in exceptional instances, more than local. The foot unequally compressed at particular points is dis- torted, is made subject to hardness of tissue in form of corn or bunion, is deprived of the elasticity and strength of its arch, and is enfeebled in its nutrition. By the boots and shoes made for women and children with high, pointed heels, a more than local injury is inflicted. Each time the body comes down with its full weight upon the raised heel, it receives a slight shock or vibration which extends through the vertebral column, and being often repeated injures the column and its nervous mechanism. I have known symp- toms of nausea and faintness produced by the wearing of these unnatural and absurd articles of foot dress, which put the feet on pivots, and, in addition to the mischiefs named, produce an uncertain and ungainly gait. Our ladies are further subject to weight, annoyance and impeded movement by the full, flowing and long habiliments which are suspended from their waists to trail uselessly on the ground, make friction, and gather dust. The bearers of these ridiculous garments have to move under such a load and encumbrance, it is impossible for their limbs to be properly exercised, for their breathing to be unembarrassed, or for their body to exist in such freedom from restraint as to enable their digestive apparatus to remain in active func- tion. In short, scarcely a woman in the better ranks of society, if she obey the law of fashion as to dress, — how- ever carefully she may regulate her diet, — can escape persistent indigestion, together with palpitation and breath- lessness, whenever she essays to make the slightest effort at sharp movement or healthful exertion. It is as if the fash- ion willed that to be fashionable is to be physically disabled. From Errors in Change of Dress.— In so variable a climate as that of England, many dangers spring from changes of attire at different seasons and under varying con- ditions of heat and cold. In the summer and in the early autumn the danger is not very great, but in the first part of winter and in the first part of spring it is at its highest. In the beginning of winter the light autumn clothing is worn, unconsciously, too long. Then comes a sudden fall of tem- perarure, with excess of moisture and fog, and the body, only half protected, is robbed, as by a violent shock, of its heat. Its minute vessels are thereby paralysed, reaction, fever, and congestion of the lungs succeed, and the com- mencement of a cough which lasts through the winter, or of 246 DISEASE FROM ERRORS OF DRESS. an asthma in those who are disposed to asthma, or of con- sumption in those who are tainted with that malady, or of croup in the child is the result. It is in the pulmonary circulation that the congestive evil is most frequently developed ; but that rule is not without exceptions, I have seen the bad influence of sudden cold manifest itself in acute diarrhoea ; and, indeed, amongst our poorer and worst protected classes, there is rarely ever a sudden accession of cold weather, in the latter part of autumn and the beginning of winter, unaccompanied by an epidemic diarrhoea. During the winter it is the practice to adapt the dress to the weather, and to be always rather well provided with extra warm clothes than the contrary, so that in this, the most inclement period, the risk is less than it is at the periods when the warm and cold seasons are on the turn. Neverthless, an error of serious import is committed, even at this time, when, as one would think, all who value life and have means to cherish it, would be on their guard. As the " season " arrives, as the evening parties commence, the error commences. It applies almost exclusively to the female sex, and to the youngest and feeblest of them. From the warm room at home, dressed in the low thin ball dress, with the shoulders and chest and neck but loosely covered, the young lady speeds, in the carriage, to the house of enter- tainment. She enters the ball-room, dances until she is in a glow, and from that temporary tropical atmosphere is sud- denly led, that she may become cool, into the corridor or refreshment saloon, or picture-gallery, or supper room, pas- sing at once, from a temperature say of 65° or 70° Fahren- heit to 35° or lower, perhaps to some degree below freezing- point. The intensity of the risk is equalled only by the folly of it. Common cold, sore-throat, bronchitis, rheuma- tism, or the first development of tubercle, is thus engen- dered. With the advance of spring the dangers increase. A few bright days in March make winter clothing feel heavy and uncomfortable. The warm under-flannel is left off or is replaced by a cotton garment, and the overcoat or woolen shawl is thrown aside. Suddenly there comes a rapid fall in the temperature and a biting east wind. The thoughtless are now literally entrapped. The penalty is the infliction of recurrent disease in those who have been recovering from winter illness, and the prostration of many who, throughout DISEASE FROM ERRORS OF DRESS. 247 the winter, have held on free of all disease other than that sense of dificient vital power which the long trial of winter cold inflicts even on the most robust. While speaking of the warmth of clothing for inclement weather, it would be incorrect not to speak of weight in relation to warmth. Many persons mistake weight for warmth, and thus feeble people are actually borne down and weakened by the excess of heavy clothing which is piled on them. This is an unnecessary evil and one to be avoided. Good woolen or fur fabrics retain the heat, and yet are light. It is when fabrics intended for sustaining warmth are made up of cotton that the mistake of accepting weight for warmth is made. The error in dress during the summer is, chiefly, that of wearing dark clothes. The oppression that is felt in tropical weather from carrying black garments, which so readily absorb the heat, is most severe. Women who feel themselves obliged to wear heavy crape mourning, in order to indicate late bereavement, are subjected during the sum- mer heat to nervous headache and severe exhaustion. The same errors are often made, in different seasons of the year, in respect to bed-clothes as in respect to ordinary every-day clothes, and with the some results. Weight ot bed-clothes is constantly mistaken for warmth, and the chest is loaded with layers of heavy material when a German cov- erlet of one-fourth the weight would ensure double the warmth, and leave the respiration unembarrassed. From Errors in Yentilation of Dress.— The body in order to be properly clothed must be covered so as to be protected, by its covering, from rain and ext&rnal moisture. At the same time the clothing should be so ventilated that the fluid and gaseous excretions of the skin may not accu- mulate. If this precaution be not taken some disease, local or general, i.'^ all but sure to manifest itself. The wearing of the unventilated beaver hat is a ready method of sup- pressing the natural growth of hair, and of causing to be retained in the hair that effete, epithelial scale vulgarly called scurf. The long leathern boot is another unventi- lated, unwholesome receptacle of the exhalations of the body. The most dangerous of them all is the tight water- proof coat ; this garment, retaining the secretions from the larger portion of the surface of the body, suppresses gase- ous transpiration, locks up, in the saturated under-clothing, the acid fluids excreted by the skin, promotes indigestion by 248 DISEASE FROM ERRORS OF DRESS. interfering with transpiration, and induces more quickly tlian by any arrangement, — short of one that might be pur- posely devised for the sake of experiment, — rheumatic disease. AVhen waterproofs were first worn the number of rheumatical patients who suffered through using them was quite phenomenal. The larger and looser impermeable covering now sold, and usually adopted, has met the danger partially, but, in a limited degree, it still exists. From Errors in the Dyeing of Dress. — The intro- duction of wearing apparel, socks, stockings, and flannels which have been made, by new processes of dyeing, to assume a rich red or yellow color, has led to a local disease of the skin, attended, in rare cases, with slight constitutional symptoms. This disease is due to the dye-stuffs. The chief poisonous dyes are the red and yellow coralline, sub- stances derived from that series of chemical bodies which have been obtained of late years from coal tar, and com- monly known as the aniline series. The coloring principle is extremely active as a local poison. It induces on the skin a reddish, slightly raised eruption of minute round pimples, which stud the reddened surface, and which, if the irritation be severe and long-con- tinued, pass iutp vesicles discharging a thin watery ichor, and producing a superficial sore. The disease is readily curable if the cause of it be removed, and, as a general rule, it is purely local in character. I have, however, once seen it pass beyond the local stage. A young gentleman consulted me for what he considered was a rapidly developed attack of erysipelas on the chest and back. He was, indeed, covered with an intensely red rash, and he was affected with nervous symptoms, with faintness and depression of pulse, of a sing- ular and severe kind. I traced both the local eruption and the general malady to the effect of the organic dye in one of those red woollen chest and back "comforters," which are commonly worn in cold weather. On removing the " com- forter " all the symptoms at once ceased. Happily the insolubility of the dye-stuff in water and in the natural secretions of the skin prevents its ready absorp- tion into the body ; for if it were easily absorbed it would actually prove fatal. Tardieu and Roussin found that coral- line, dissolved in alcohol and introduced, in doses of a few grains, into the bodies of the lower animals, destroyed life, and that the liver of an animal which had been a few days under its influence passed into a fatty degeneration. The DISEASE FROM ERRORS OF DRESS. 249 lungs of animals subjected to the poison assumed a peculiar color as though they too had been dyed. Roussin dyed skein of silk from the coloring stuff extracted from the liver and lungs of poisoned animals, and suggested this process as a mode of detecting the poison in suspected cases of death from its action. From Uucleailliness of Dress. — Uncleanliness of attire leads to disease, or more correctly speaking, creates condi- tions favorable to the invasion of disease. Clothing worn too long a time becomes saturated with the excretions and exhalations from the body, and, by preventing the free trans- spiration from the surface of the skin, induces oppression of the physical powers and mental inactivity This observation will be accepted by most persons as true in respect to linen and woollen garments worn as under- clothing ; it is equally true in regard to those outer garments which are often worn, unremittingly, until the linings, torn and soiled, are unfit altogether for contact with the cleaner garments beneath them. Health will not be clothed in dirty raiment. They who wear such raiment suffer from trains of minor complaints ; from oppression, dulness, headache, nausea, which, though trifling in themselves, taken one by one, when put together greatly reduce that standard of per- fect health by which the value of life is correctly and effect- ively maintained. Unclean clothing is sometimes a direct means of convey- ance of disease. The unclean fabric becomes saturated with poisonous substances, with the fumes of tobacco for instance, and holds its wearer in a persistent atmosphere charged with unwholesome vapor. Still more seriously it becomes the medium of the poisons of the spreading diseases. I could cull from my note-books many examples of this last-named danger, but must be satisfied to mention one or two striking and brief illustrative facts. I have known scarlet fever carried by the clothing of a nurse into a healthy family, and communicate the disease to every member of the family. I have known cholera to be communicated by the clothes of the affected person to the women engaged in washing the clothes. I have known small-pox conveyed by clothes that had been made in a room where the tailor had by his side sufferers from the terrible malady. I have seen the new cloth out of which was to come the riding habit for some innocent child to rejoice in as she first wore it, undergo the preliminary duty of forming part of the bedclothing of 250 DISEASE FROM IMITATION AND MORAL CONTAGION. another child stricken down with fever. Lastly, I have known scarlet fever, small-pox, typhus, and cholera, com- municated by clothing contaminated in the laundry. Thus the uncleanly garments on the bodies of the unclean, the workrooms of the makers of garments, the very laun- dries in which cleanliness is sought, are all liable to become sources of those scourges which, " still as the breeze but dreadful as the storm," baffle yet our finest art, and imprint on our fair country the fields of pestilence which blacken as with national mourning, the map of . the geographer of disease. CHAPTER XX. DISEASE FROM IMITATION AND MORAL CONTAGION. Under the names of imitation, moral contagion, sympathy, and allied terms, there have been recognized siiice the time of Esquirol a series of phenomena of disease which are of singular interest and importance. The phenomena are of nervous type, and, happily, are often transitory in their course; but they are apt to become permanent, and when they do it is hard to distinguish them from symptoms which result from true organic disease. The phenomena of which I am about to treat are never, as far as we know, truly organic. They are functional derange- ments of nervous centres, the effects of which simulate those irremediable derangements which spring from positive organic changes of the same centres. They are imitative diseases as well as diseases of imitation. Except for this difference in relation to organic root, the diseases of imitation and moral contagion are singularly akin to true physical diseases. When they are seen in isolated instances they are often the same to the letter. When they spread, they spread precisely after the manner of an ordi- nary spreading disease of the actual physical order. Now they assume a more sporadic form, that is to say, are con- fined to a limited number of persons in a limited area; again, they widen into great epidemics, attack multitudes of per- sons, and exhibit their seasons of origin, intensity, and decline. DISEASE FROM IMITATION AND MORAL CONTAGION. 25 1 The analogies go further. The common contagious dis- ease is often traceable to an imported case or to a spontane- ously originated case. In the moral epidemics the same ori- gins are always to be found. In the common epidemic the prevailing disease reigns, and, for a time, supersedes every other. The same rule extends to the moral epidemic. Sometimes a moral epidemic succeeds and as it were super- sedes a physical; as when the dancing mania of the middle ages, one of the purest of moral epidemics, succeeded and superseded the great physical epidemic of Black Death. In physical epidemics all persons are not alike susceptible to the influence of the contagion; some are extrefhely sus- ceptible, others are unsusceptible, and some, indeed, seem pre- disposed to the contagion as if by hereditary disposition. The same is characteristic of the moral contagious maladies. Physical contagious diseases recur in cycles which present a remarkable regularity, and certain of them are special to certain seasons. The like order of progression and of selec- tion of season has characterized the great moral epidemics. Thus an epidemic of the moral type, marked by symptoms of convulsion, which appeared and reappeared in the Shetland Islands, and which has been described by the Rev. Mr. Archibald, was always a disease of the summer season. The similarity of physical and moral contagious disease is most marked in examples where the moral contagion appears at periods when true physical diseases are prevalent, and when the imitative systems are of the same character as the real. Physicians themselves are often sorely perplexed under these circumstances. During epidemics of cholera I have seen patients of whom it was impossible to say, for a time, whether they were su^ering from the real or the imita- tive malady. To complete the analogy between the physical and the imitative or moral diseases, there remains the fact, that both classes are most easily suppressed by the plan of separating the diseased from the healthy. The dynamics of the two forms of disease are the same; they go forth on and by the same conditions; they progress on the same plan; they are brought to rest by the same means. Possibly, one may run into the other, the moral into the physical. Dr. Baker, in a recent report on an epidemic of '* tetanoid fever " or *' cere- bro-spinal meningitis " occurring in Michigan State, relates, that in several instances the intense fear of the malady 252 DISEASE FROM IMITATION AND MORAL CONTAGION. seemed to be the immediate excitant of it. I believe I have witnessed the same fact in examples of cholera. When from the general we descend to the particular facts relating to diseases of imitation and moral contagion, we discover that they assume definable forms, and, to a certain extent, are classifiable. One class is purely motional and at first volitional, — that is to say, is either intentionally or unconsciously voluntary. A second class is emotional. A third class is ideational. A fourth class is compounded of the others. Tlie Motional Type. — The pure motional type of the imitative disease is confined, as a rule, to individual exam- ples, or, at most, is limited in its range. In this type the phenomena that are seen are muscular; their origin is nerv- ous, but they appear as perverted action, as over action or as paralysis, of muscular fibre. Some of the purest and, if I may so say, most elementary types of disease of this kind are seen in perversions of mus- cular movement. A child born with the most perfect posi- tion of the eyeballs was permitted, when in her third year, to be taken out daily by a good-natured servant, who with many excellent mental qualities, had one great physical defect, namely a double strabismus, or squint. In a few weeks it was seen that the child could easily imitate the aberration, and at first, such slight importance was attached to the fact, she would be asked, in play, to squint like her attendant. A little later on the parents were amazed to find that the distortion of the eyeballs in their child was present when it was not called for, and that at last it settled into permanent strabismus. The distortion has continued ever since, and will never be remedied, except by surgical opera- tion. I have seen a still more painful illustration of disease, induced in the manner now being considered, in a girl who was occasionally taken to visit a connection of her family suffering from chronic chorea, — Chorea Sancti Viti or, Saint A^itus' dance. The patient was constantly moving her hands and arms, adding, at intervals, which could almost be timed to the minute they were so regular, a peculiar grimace in which the angles of the mouth were extended, the nostrils dilated, the eyes widely opened and the skin of the forehead uplifted into folds. The child soon began to imitate certain of these movements, especially the movements of the limbs and the corrugation of the forehead. At the same time she DISEASE FROM IMITATION AND MORAL CONTAGION. 253 acquired a fondness, which amounted even to a fascination, for the company of the afflicted person. After a few months it was observed, whenever the child returned from one of her visits, that she exhibited for several days the same ner- vous phenomena as those she had witnessed and although the intercourse was soon afterwards stopped for ever by the death of the elder sufferer, she contracted the disease so definitely that she never recovered. A little unusual physi- cal fatigue, an excitement, or any other influence that would leave depression of mind or body in its train, was sufficient to bring on a return of the symptoms and to give them uncontrollable sway for many hours, sometimes for many days. One of our representative men of science described to me an outbreak of imitative chorea which occurred in his own family. A woman suffering from chorea, — St. Vitus' dance, — came to his house, and was seen by one of his children. The child spontaneously commenced to make imitative mus- cular movements, not in mockery of the patient, but as if governed by some uncontrollable impulse received through the sense of sight. From this child the disease spread to another, and so on to a third. It assumed a most decided form in those affected, and would have spread through the whole of the family but for the prompt measures that were taken to suppress it. The affected were all placed in sepa- rate rooms, and the unaffected were entirely withdrawn from them. In this way the disease was limited at the commence- ment, and those who were seized were in a few weeks restored to health. To muscular movements imitated from diseased persons may be added other symptoms, so that the role of a disease presenting mixed phenomena may be presented. I was on one occasion consulted about a young woman, who, having been for some weeks in close communion with a patient suffering from pulmonary consumption, com- menced gradually to imitate the movements of breathing and the cough of the consumptive sufferer. Gradually, other symptoms were acquired, including the most perfect repre- sentation of the voice of the real patient. The paroxysm of cough increased, and the symptoms altogether seemed so real, there was, on the part of the friends of the uncon- sciously imitative girl, no doubt as to her ultimate fate. The stethoscope and the other objective means for detection of disease yielded, however, no evidence of the actual existence 254 DISEASE FROM IMITATION AND MORAL CONTAGION. of the graver malady, and after two year of symptoms, dur- ing which time the patient went the usual round of dispen- sary and hospital for advice, she suddenly recovered, as I and many of my learned brethren had foretold. There have been many assumed recoveries of this kind from consumption, and sometimes the recovery has been perfected while the patient was undergoing a particular form of treatment. Then the grand discovery of a cure for con- sumption has been blazoned forth, some worthy son of Escu- lapius has been unduly praised, or some quack has reaped false credit and dishonorable gain. In the type of imitative disease we have now under con- sideration, the simulation of true paralysis, in one or other of its forms, is often presented. A lady I attended heard the details of an attack of paralysis in one of her friends, whereupon she began to present the same symptoms herself. She lost, day by day, the power of her lower limbs and, later still, the voluntary command over the whole of the lower half of her body. For many weeks this condition was pre- sent, the patient remaining so helpless that she could not, even in bed, raise her lower limbs, much less more on them. The extremest and the most varied opinion prevailed amongst the medical men, who from time to time visited her, as to. the precise nature of her illness. At last, during a great crisis in her family circle, when one of the circle was expected to die, a sudden scream from an adjoining room roused her apparently dead members into life. She rose from her bed unassisted, walked rapidly into the room where the other patient was lying, and from that moment recovered the entire use of the previously and, as they seemed, hopelessly palsied limbs. The new mental condition that was aroused constituted the cure. I have known a marked paralytic seizure occur from moral contagion after a railway accident. In all such instances, which are not assumed, — and there is no necessity in such cases to suppose that as a matter of course the symp- toms are assumed,-^there occurs, under the mental shock originally induced, what may be called latency of the will over those nervous centres which are in communication, by the nervous cords, with the paralyzed muscles. There is an opposite condition of nervous tension induced by imitation, in which the whole force of the will is directed to the persistent performance of one particular muscular act. In such examples a particular muscular contraction is main- DISEASE FROM IMITATION AND MORAL CONTAGION. 255 tained for long periods of time. Few phenomena are more singular than these. A young girl, who was living in India, witnessed some native feats and shows at a religious festi- val. Amongst other sights that she saw was that of a native, whose lower limbs were drawn up to his body and were there permanently fixed. The girl was morbidly impressed by this sight and next morning was found in bed unable to rise, because one of her own lower limbs was drawn up closely and rigidly to her body. This imitative condition remained for many months, and neither by persua- sion nor by force could the patient be got to straighten out the limb. She was submitted to the action of chloroform, and when her volitional power was entirely overcome by the action of the narcotic vapor, and the whole of the muscles were rendered flaccid, the limb could readily be brought down. But so soon as the narcotic effect passed away, so soon as the will regained its dominion, so soon as the mus- cles regained their stimulus, so soon was the limb drawn again into its contracted and rigid position. The young lady, with the limb in the contracted state, was ultimately brought to England, where she remained for many weeks without change. One day, while her attention was entirely absorbed in a game of chess, her leg was gently straightened without the slightest opposition on her part; and, the moment she was conscious of the fact, she undertook to walk up stairs. To the wonder of all her friends she accom- plished the feat without demur or difficulty, and from that time onwards has remained unaffected. Interrogated after- wards as to the reason why her limb was distorted in the manner described, she expressed her entire inability to assign any reason. She was of opinion that, although she never willed the contraction, nor by any act of will main- tained the resistance, yet that the idea of it was never off her mind, during her waking hours, until the moment when she was entirely devoted to the simple object of winning the game of chess. Then it seemed to her that in the excite- ment she had altogether forgotten the contraction, as well as the varied forcible attempts that had been made to overcome it, every one of which, she was convinced, served only to aggravate the evil. When she discovered that the limb had been brought down, the fact gave her no surprise. The Emotional and Ideational Types.— Hitherto I have detailed instances in which the imitative disease has been purely motional and has presented itself in isolated 256 DISEASE FROM IMITATION AND MORAL CONTAGION. cases, or, at most, in limited circles. In an intenser form it is presented with emotional outbreaks, and is then, to the public mind, far more striking as a phenomenon. The grandest illustration of this type of moral contagious disease is afforded in the epidemic of the middle ages known as the dancing mania. Under the names of " Tarantism," '* Secourism," " Con- vulsionairism," and *' Sympathy," many other outbreaks of disease, similar to the dancing mania but of a less exalted intensity, have broken out since the fifteenth century. The study of the ideational class of moral contagious diseases would lead me too far away from the purpose of this book, which treats only of theph)'sical man, and is con- fined to the phenomena of the earth, earthy. The scholar who would pursue the study into the region of metaphysics will find in the history of the witch mania, the devil mania, and the angel mania of past times much food for contempla- tion. He may also possibly detect in the modern phases of spiritualism, clairvoyance, shakerism, and in the New Forest jumping, much that is analogous to phases that have long since passed away, and marked evidence of the influence of moral contagion, He will find the phenomena confined to no particular creed, community, place, or time, They may appear in a convulsionary outbreak at Montmartre, when out of a hundred and fifty girls preparing for communion, forty are attacked in five days, fifteen at the precise moment when the archbishop is holding up his hands. They may be developed in a camp-meeting of revivalists in American prairie-land. Of this, however, the student may be quite sure, that, in whatever way he meets them, they are the same phenomena, and are due to a disturbance, through the senses, of those centres of the nervous system which govern the muscular motion. Comlbilied Types. — An emotional contagion combined with an imitative impulse leads to certain phenomena of mental disease, the results of which are exceedingly disas- trous. The distinguished Despine, of Marseilles, whose admirable works on natural psychology lift him into the front rank of mental philosophers of the physical school, records that during the first empire a soldier hanged himself in his sentry-box. Very soon afterwards a number of other soldiers, acting on the impulse of imitation, did the same, and so the influence of the contagion remained active until the sentry-boxes were destroyed, when the miscliief was DISEASE FROM IMITATION AND MORAL CONTAGION. 257 entirely stayed. The same admirable observer has pointed out that duelling assumes the epidemic imitative character, and that as the duel contagion goes on its course it is inten- sified ; that a truly serious quarrel is required to lead to the first duel, while the most trifling pretext will bring about a later. Our own laws so completely command the duellest that in modern English life we are too fortunate to be able to glean a similar knowledge to that of Despine ; but in the matter of the suicide our experience is parallel. Our monu- ment in the city, our Duke of York's Column, our Suspension Bridge at Clifton, are so many equivalent sentry-boxes that have tempted the suicidal to imitate the suicide. Physical Nature of Moral Contagon. — As we review the various facts that may be marshalled forth bearing on disease from imitative and moral contagion we are driven to the inevitable conclusion, that though the phenomena are derived from what are called moral causes, they must, after all, have a true physical origin. We see, by their personality, that they are due to some stimulus acting upon each individual bedy, and therefore to some influence as common to us as the air we breathe. We learn that the modifications to which the affected body is subjected are like the motions which can be excited by heat, electricity, or chemical action , and when we analyse the unnatural movements we can determine, by physiological reasoning the veritable parts of the nervous organism that are placed under excitation. In the purely motional class, the spinal and cerebellar and superior ganglionic centres of the cerebrum are the centres excited. In the emotional class^ the organic nervous chain is subjected to the excitation. In the ideational and com- pound classes, the centres of thought as well as of motion and emotion are the scenes of disturbed functional activity. But what is the mechanism of disturbance ? An external miasmatic influence, says Bouchut. A moral influence, says Despine. My own explanation is that phenomena are con- nected with. disturbance, — i.e. with modified motion, — in th»<« ethereal matter which, according to my theory of the existence of a nervous ether or atmosphere in the living body, charge^j the nervous organism throughout its entire extent, and is the medium of communication between ourselves and the outer universe which surrounds us. In some individuals this ethereal medium is, I think, itself modified in respect to its tension and perhaps in respect to its purity, by which 17 258 AUTOMATIC DISEASE AND HYPOCHONDRIASIS. varying degrees of susceptibility to motion are obtained. Through it different centres of the nervous organism can be excited by external forces as readily as they can be by direct organic central injuries. Thus touched, through the senses, the results will be the same in phenomena of disturbance as when the disturbed centre is organically damaged, but with this important distinction, that the simple disturbance from outward vibration, unless it be kept up until central mischief be entailed and a casual be changed into a permanent derangement, is temporary in its action, and is curable if the influence that excites it be removed. CHAPTER XXI. AUTOMATIC DISEASE AND HYPOCHONDRIASIS. There are certain automatic phenomena of the body which, exaggerated in character, pas^ into phenomena of disease. Many of these phenomena have been described by different authors, from Hippocrates downwards, under the term hyp- ochondriasis. Hypochondriasis is, in fact, strictly automatic in many of its phases, and by including it, in disease, as one of the examples of automatism, we may classify its symptoms with others of the same order. Extreme automatic phenomena are daily witnessed and felt without exciting any wonder or suggesting the idea of disease. We call them habits, and we treat them, in many instances, as valuable acquisitions. Some of them come down hereditarily, others are acquired. It is when the auto- matic act or expression is repeated without meaning or object, and so frequently as to become a plague, that it lapses in,to disease. The automatism of disease is sometimes seen in the form of motion of some 'particular part of the body. When we reach the close of the present year (1875), numbers of per- sons will, for several days in 1876, continue to write, auto- matically, the 5 instead of the 6. Many married women, especially if they have married late in life, continue, auto- matically, to write their maiden names. Some persons acquire a habit of saying one particular sentence or word AUTOMATIC DISEASE AND HYPOCHONDRIASIS. 259 which comes up, repeatedly, in almost every conversation. Persons who for a few months enter a room of a house on the right hand, perform that act at last with automatic reg- ularity; and, if they change to a room on the left hand, are for years afterwards guilty of mistake whenever they approach the old door. The automatic act extends even to sensations. If a cer- tain impression affecting sensation be made daily on the body for a considerable number of times the sensation will recur for a period, even when the cause that first excited it is withdrawn. In very susceptible people the sensation of a draught of air is thus experienced, even when no current of air, to cause a draught, is present. These simple phenomena are perfectly familiar to all, and so long as they are under the control of the individual they are perfectly natural. When they appear grossly exagger- ated, and when they occur independently of the will of the person through whom they are manifested, they constitute automatic disease. Automatic movement amounting to disease is exhibited in varied ways. I have known it shown, in the writings of the affected, by the repetition of some sentence or argument, in the same words, in every letter or other communication which the writer undertook to indite. This one sentence will be introduced, it may be, more than once in the same letter, and if it be omitted in the body of the letter will be added in the postscript. The automatic affection shows itself in other motions. I have seen it to take the direction of a movement to a certain point every day at a certain time, by the person affected. Thus one gentleman would, in defiance of all reason, walk daily to a wayside pillar or post, touch it three times with his walking cane o-r umbrella, and then return home. It was hopeless to argue with this automatic, for he could not argue with himself. Had he been physically resisted in his design he would probably not have made any defence, neither would he have been long annoyed at the obstacle put in his way; but, let alone to follow his own course, he would as certainly strike the post as a clock would strike the hour. Again, the automatic movement may be that of some par- ticular muscles, as those of the hand when it is engaged in holding a pen, or casting up money; or of the occipito- frontalis muscle, so that the hair on the fore part of the head 26o AUTOMATIC DISEASE AND HYPOCHONDRIASIS. is drawn forcibly back ; or of the diaphragm, causing a long- drawn, deep and sorrowing sigh. In one extremely painful example I saw automatic phenomena of eructation and choke, followed by a spasmodic jerk as if the head were being half dislocated. Automatic movements of expression in speech are equally striking phenomena. The illustrious Thomas Willis, he who gave the world of science the first true light on the functions of the different parts of the brain, relates a remarkable instance of this character. Willis considered sleep to be an automatic act, and including under the name of the " sensi- tive soul " that part of the mental organism which is " void of all science and proper direction," argued that the action of this part is determinated by outward accidents and cir- cumstances. Wherefore, he adds, "the animal spirits in what path they are once led, unless they be hindered, will repeat to a hair their former tracts." Hence it is that we both sleep and also awake at set and wonted hours ; also we expect and hardly pass by the same times of dinner and supper, " so solemn the manner of nature is to do the same thing which it did before, and till being taught new things, it is the manner of its government constantly and exactly to observe the old." He gives an example of this kind of " assiduity," which, says he, "is admirable." A youth living for some years in his neighborhood, "though he were silly and foolish, yet did he know exactly, without any sign, the interspaces of the hours, and as often as the space of a whole hour was elapsed, as if he had been a living clock, he would presently person- ate the like number of the hour, with so many hoarse sounds, and no business or employ about any other occupation could make him omit this task. He at the beginning was wont to imitate aloud, by making a noise, every stroke of the sound- ing clock ; and as often as he heard the sounding of the bell of the clock, presently he cried one, two, three, &c., repeating successively the several pulsations. Hence, it hap- pened afterwards that the animal spirits, by daily imitation, being accustomed to be stirred up by such a motion, accord- ing to the set spaces of time, at length they were able to distinguish the same periods of their own accord, nothing directing, as if the sliding spaces of time had been measured out by the wheels of a clock." In persons suffering from hysterical excitement, various symptoms present themselves automatically, with singular AUTOMATIC DISEASE AND HYPOCHONDRIASIS. 26 1 exactness as to time. In this manner pain in the form of neuralgia, or tic, will recur with the precisest exactitude ; and, I am of opinion, that in most cases periodical neuralgia is of this automatic nature. The most striking instances, however, of automatism in disease are exhibited in the hypochondriacal. Hypochon- driasis is a malady almost as exclusively confined to the male sex as hysteria is to the female. It occurs commonly in men of middle life, and it is presented, as a rule, in two classes of men, — in those who, either from neglected edu- cation or natural weakness, are of feeble intellectual power, or in those who, by great mental struggles, have worn out their reasoning faculties. In these persons, to whichever of the two classes they may belong, the controlling, reasoning intellectual faculty is lost, and the automatic action or expres- sion is allowed to take its own course. Thus, without rea- son, some automatic act recurs with clock-like regularity and is persistently the theme of the sufferer's conversation. The words and terms in which he describes his ailments, the processes of feeling his own pulse, and otherwise investi- gating his own symptoms, become automatic. In this variety of disease the physician meets with the sin- gular phenomenon of a patient, who may exhibit the most perfect subjective train of symptoms, with not a single objec- tive symptom to indicate any form of organic derangement or deterioration. He hears the symptoms described month after month in the same words, and yet he sees no physical change. One patient will fix on one particular organ as a seat of pain, and will exclaim every two or three minutes during a visit, " Oh ! the agony, the agony ;" yet his face shall be free of all evidence of suffering, and, if his attention can be for a moment diverted to other subjects the idea of the pain will, for that moment, disappear. Another patient will go to bed every night declaring he shall not sleep ; he will compose himself naturally to sleep and will sleep per- fectly during the whole night ; yet his first morning state- ment will be a solemn declaration, which he will repeat, in the same words, many times an hour the whole day through, that he has never closed his eyes. A third representative of this class of sufferers will affirm that he distinguishes a tumor or swelling in some part of his body, which tumor is imperceptible to every one else. The sensation has become to him like a reality which he describes automati- cally 262 AUTOMATIC DISEASE AND HYPOCHONDRIASIS. I need not tender further illustrations of these forms of automatic disease, but one word more may be said respect- ing them. It is, that when the automatism is fairly estab- lished, the reasoning belief of the patient is so far in abey- ance that no real importance need be attached to the repeated statement. This knowledge is a source of great relief to those who have to watch the progress of the auto- matic hypochondriac who sometimes goes so far as to declare, with periodical exactitude and persistent repetition, that he will commit suicide or do some other desperate deed. The fact of this repetition proves, mostly, the mere automatic character of the assertion, indicates that there is no reason- ing intention at the bottom of the threat, and removes, con- sequently, much of the anxiety which might otherwise pre- vail. In conclusion : many ordinary acts of life which become dangerous to life, or which induce symptoms of disease more or less important, are often purely automatic. I am con- vinced that great numbers of alcoholics indulge, to a fatal extent, in the vice of intemperance from the automatic con- dition into which they are trained by frequent repetition of the same act. We hear people say, significantly, of some hard drinker who is going wrong, that '* he lifts his hand too often to his mouth." The description is perfect of an auto- matic movement. In a minor way the smoker or snuff -taker disturbs his digestion by automatic action. He is daily absorbed at cer- tain hours in some particular pursuit, and, if he could be watched, it would be detected that, at regular moments which could be measured as to time, he will take a pinch of snuff or light a pipe or cigar. The automatism is so perfect, that left free the automatic act will be carried out, without dis- turbing the reasoning faculty for a moment ; but if the act be hindered, the reason may be at once abruptly arrested. The most inscrutable feature of automatism is, after all its hereditary feature. That pure amtomatic acts descend in line from parent to child, and that the tendencies, tastes, pleasures, passions, diseases, descend automatically, are facts as clear as any that science has revealed. All acts that are essentially motor such as sporting and fighting, — over which the reason exerts so little control, even in this day of advanced thought, are automatic. No wonder then, that actions of disease, which always by their existence imply some reduction of reasoning power, should^also be automatic. INTERMARRIAGE OF DISEASE. 263 CHAPTER XXII. INTERMARRIAGE OF DISEASE. The induced diseases of modern life cannot justly be con- sidered without a brief, — and it shall be a brief, — reference to one of the most solemn of their predisposing causes. I mean the inter-marriage of disease by the union of persons who are strongly tainted with fatal maladies which must in the ordinary course of events, appear in their offspring. It is the common impression that injuries of this class are only affected through marriage of consanguinity. Hence mar- riage between cousins is objected to; but in plain truth the question of consanguinity is secondary. There is no doubt that if cousins each possessing an original family taint marry, the result may be doubly disastrous to the offspring. This however, is not on account of the consanguinity, but because both persons are similariy infected with the taint. I mean by this that if they had not been related, and had been similarly infected, the results to their offspring would be the same. We ought therefore to take a much wider view of the sub- ject than that which is bounded by consanguinity. The worst intermarriages of disease are those in which both parents are the inheritors of the same disease, as where both are disposed to consumption, to cancer, or to insanity. Under these circumstances it is all but inpossible for the majority of the offspring to escape the inherited disease. Intermarriages of distinct diseases are hardly less dan- gerous. The intermarriage of cancer and consumption is a combination specially fraught with danger. Let one typical illustration of this suffice. A young man of marked cancer- our proclivity married a woman whose parents had both died of pulmonary consumption. This married couple had a family of five children, all of whom grew up to adolescence, sustaining at their best but delicate and feeble existences. The first of these children died from a disease allied to can- cer, called lupus; the second of simple pulmonary consump- tion; the third, owing to tubercular deposit in the brain, suc- cumbed from epileptiform convulsions; the fourth, with symp- toms of tubercular brain disease, sank from diabetes, the result of the nervous injury; and the last, living longer than any of the rest, viz., to thirty-six years, died of cancer. The 264 INTERMARRIAGE OF DISEASE. parents, in this instance, survived three of the children, but they both died comparatively early in life; the father from cancerous disease of the liver, the mother from heart disease and bronchitis. The intermarriage of rheumatic with consumptive disease is productive of intermediate maladies in which the bony frame- work of the body is readily implicated. Children suffering from hip-joint disease, — morbus coxarius, — are common examples of this combination. Hydro-cephalic children are frequent results of the same combination. The whole of this subject is a modern study in the natural history of disease. Some day it will be so formularized that the learned physican will be able to predict the results of combinations of disease from marriage, with arithmetical accuracy. Whether such knowledge will control the results is a question difficult to answer at this point of time. In the present state of our civilization rank and position are considered all-important elements in the marriage con- tract. Wealth is considered. Relative age is sometimes taken into account. Religion and race are often made sub- jects of serious moment. Hereditary health as an element of the marriage contract, of what import is that ? Who are so lightly studied as the unborn ? PART THE THIRD, SUMMARY OF PRACTICAL APPLICATIONS. The first step towards the reduction of disease is, begin- ning at the beginning, to provide for the heaUh of the unborn. The error, commonly entertained, that marriagea- able men and women have nothing to consider except wealth, station, or social relationships, demands correction. The offspring of marriage, the most precious of all fortunes, deserves surely as much forethought as is bestowed on the offspring of the lower animals. If the intermarriage of dis- ease were considered in the same light as the intermarriage of poverty, the hereditary transmission of disease, the basis of so much misery in the world, would be at an end in three or at most four generations. II. Greater care than is at present manifested ought to be taken with women who are about to become mothers. Wealthy women in this condition are often too much indulged in rest and are too richly fed. Poor women in this condition are commonly underfed and made to toil too severely. The poor, as we have seen, fare the best, but both, practically, are badly cared for. Nothing that is extraordinary is required for the woman during the condi- tion named. She needs only to live by natural rule. She should retire to rest early; take nine hours sleep; perform walking or similar exercise, to an extent short of actual fatigue, during the day; partake moderately of lood, and of animal food not oftener than twice in the day; avoid all alcoholic drinks; take tea in limited quantities; forego all scenes that excite the passions; hear no violence of lan- guage; be clothed in warm, light, loose garments; and shun, with scrupulous care, every exposure to infectious disease. 265 266 SUMMARY OF PRACTICAL APPLICATIONS. III. In meeting the uncontrollable causes of disease the special influence of season deserves particular regard. It should always be remembered that, other things being equal, during winter the body loses, during summer gains in weight. Further, it should be remembered that these changes are abrupt: that, in England, the loss commences, shajply, in September and lasts until April, and that the gain comr mences in April and lasts until September, In September, though the weather even be warm, it is right, therefore, to add to the clothing and to commervce a littLe excess of food. In summer it is right not only to reduce the clothing, but to eat less food than in winter IV. The best means of preventing the spread of the commu- nicable diseases is perfect and instant isolation of the affected, and removal and thorough purifying of all clothing and bedding with which the affected have come in contact. It is a vulgar error to suppose that every child must neces- sarily suffer from the contagious maladies, and that the risk of exposure to infection is, therefore, of little moment. The chance of infection lessens, with advance of life, and that person is strongest who has never passed through a con- tagious malady. Against small-pox vaccination is the grand safeguard, but even vaccination ought never to prevent the isolation of those who suffer from small-pox. V. The mortality trom the uncontrollable causes of disease amongst persons of advanced life, is best prevented by pro- viding against sudden vicissitudes of heat and cold. The primary care is to guard against sudden change of vascular tension from exposure to heat when the blood-vessels are weakened by cold. Such exposure- is the cause of nearly all the congestions which occur during winter, and which carry off the enfeebled. The sound practice is to maintain the body, at all hours and seasons, but especially during the hours of sleep, at an equable temperature. The tempera- ture of 60° Fah. may be considered a safe standard. VI. The true danger of every form of mental exercise is the addition of worry. Laborious mental exercise is healthy SUMMARY OF PRACTICAL APPLICATIONS. 267 unless it be made anxious by necessary or unnecessary diffi- culties. Regular mental labor is best carried on by intro- ducing into it some variety. New work gives time for repair better than attempt at complete rest, since the active mind finds it impossible to evade its particular work unless its activity be diverted into some new channel. During the new work a fresh portion of brain comes into play and the over- wrought seat of mental faculty is secured repose and recov- ery. Excessive competition in mental labor is ruinous at all ages of life. VII. The idea that excessive physical exercise is a sound means of promoting health is erron^eous. Man is not constructed to be a running or a leaping animal like a deer or a cat, and to raise the physical above the mental culture were to return to the shortness and misery of savage life. Physical training while it should be moderately encouraged should be refined and made secondary to mental training. Every rash and violent feat of competitive prowess should be discountenanced. VIII. The combination of mental and physical fatigue, as it is practised in many pursuits at this time, is exceedingly injur- ious. Long journeys, each day, to and from the sphere of profession or business, are hurtful. The idea that mental labor may be advantageously supplemented by violent rnus- cular exercise, such as is implied in volunteering, long and fatiguing walks, or laborious excercise on horseback, is an error. Moderate and regular exercise, at the same time, favors mental work. The practical point is to regulate the physical labor that it shall not induce fatigue. IX. One of the surest means for keeping the body and mind in perfect health consists in learning to hold the passions in subservience to the reasoning faculties. This rule applies to every passion. Man, distinguished from all other animals by the peculiarity that his reason is placed above his pas- sions to be the director of his will, can protect himself from every mere animal degradation resulting from passionate excitement. The education of the man should be directed not to suppress such passions as are ennobling, but to bring all under governance, and ^especially to subdue those most destructive passions, anger, hate, and fear. 268 SUMMARY OF PRACTICAL APPLICATIONS. X. * To escape the evils arising from the use of alcohol there is only one perfect course, namely, to abstain from alcohol alto- gether. No fear need be entertained of any physical or mental harm from such abstinence. Every good may be expected from it. True, a certain very qualified temperance, a temperance that keeps, the adult to a strict allowance of one ounce and a half of alcohol in each twenty-four hours may, possibly, be compatible with a healthy life; but such indulgence is unnecessary and encourages the dangerous desire to further indulgence. A man or woman who abstains is healthy and safe. A man or woman who indulges at all is unsafe. A man or woman who relies on alcohol for sup- port is lost. XI. Smoking tobacco, and the use of tobacco in every form, is a habit better not acquired, and when acquired is better abandoned. The young should especially avoid the habit. It gives a doubtful pleasure for a certain penalty. Less destructive than alcohol, it induces various nervous changes, some of w^hich pass into organic modifications of function. So long as the practice of smoking is continued the smoker is temporarly out of health. AVhen the odor of tobacco hangs long on the breath and other secretions of the smoker, that smoker is in danger. Excessive smoking has proved directly fatal. XII. Indulgence in narcotics, opium, chloral, chlorodyne, ether, absinthe and all others of the class is an entire departure from natural law. Except under the direction of skilled opinion and for the cure of disease, the use of these agents is subversive of the animal functions, and is a certain means of embittering and shortening life. It is doubtful whether the freedom of the subject ought to be permitted to extend to the uncontrolled self-indulgence in these poisons. The indulgence indicates an unsound reason which requires to be governed by sound reason, temperately enforced. XIII. The food on which the man who would be healthy should live, should be selected so as to ensure variety without excess. Animal food should not be taken oftener than twice daily. The amount of animal and vegetable food com- SUMMARY OF PRACTICAL APPLICATIONS. 269 bined should not exceed thirty ounces in the twenty-four hours and for the majority of persons an average of twenty-four ounces of mixed solid food, a third only of which should be animal, is sufficient. All animal foods should be eaten while they are fresh and after they are well cooked. The habit of eating underdone flesh is an almost certain cause of parasitic disease. The amount of fluid taken, in any form, should not exceed the average of twenty-four ounces daily. Water is the only natural beverage. xrv. To escape the injuries arising from impure air it is neces- sary to attend, to the following* rules. To avoid the admis- sion into closed apartments of air charged with any sub- stance that offends the sense of smell. To avoid surcharg- ing the air with vapor of water. To keep the temperature in every room as nearly as possible at the safe standard of 60^ Fah. To take ample means for allowing air to escape from the room by every available outward draught, by the chimney flue especially. To admit air freely at all times, and, when a room is not in use and the external air is not charged with moisture, to allow the entrance of air from without through every window and door XV. Occupations of every kind, however varied they may be, require to be alternated, fairly, with rest and recreation. It is the worst mistake to suppose that most and best work can be done when these aids are omitted. Strictly, no occupation that calls forth special mental and physical work should fill more than one third of the daily life. The minds of men of all classes ought now to be devoted to the pro- motion of a systematic method by which the productive labor of every life should be carried on within the limited term of eight hours in the twenty-four. The body of man is not constructed to run its completed cycle under a heavier burden of labor. XVI. Enforced idleness, by those who have acquired wealth, is always an error so' long as the health is good. Men of busi- ness should never actually retire while they retain fair bodily and physical faculty. It is one of the gravest of errors to attempt to enforce idleness on others from the mistaken sentiment of wishing to place them beyond the necessity for 270 SUMMARY OF PRACTICAL APPLICATIONS. work. This is against nature. The earth, which is itself ever in motion, demands ever the motion of cultivation from its inhabitants that it may be a garden properly- arranged from age to age. Those, therefore, who have idle- ness thrust upon them, by their progenitors, should throw it off as if some necessity for work *were equally theirs. By this plan they will live longest to enjoy the greatest hap- pinesss. XVII. The natural duration of sleep is eight liours out of the twenty-four, and those who can secure this lead the sound- est lives. It is best taken from ten o'clock till six, and it is most readily obtained by cultivating it as an automatic pro- cedure. All stimulants, all excitements, all excessive fatigues, all exhaustions pervert sleep even if they do not prevent it. The room in which sleep is taken should be the best ventilated and the most equably warmed room in the house. The air 01 the room should be maintained at the natural standard of 60° Fah., and the body of the sleeper should always be kept completely warm. The bed should be soft and yielding. A regular tendency to sleep at other hours than the natural is a sure sign of error of habit or of nervous derangement. XVIII. Dress, to be perfectly compatible with healthy life, should fit loosely, should be light, warm, and porous, should be adapted to the season as to color, should be throughout every part of the clothing, upper as well as under, fre- quently changed, and should be, at all times, scrupulously clean. The wearing of clothes until they are threadbaie, is an invariable error in all that respects the health, to say nothing of the comfort of the wearer. All bands or corsets which in any way restrict the course of the blood in any part of the body are directly injurious. Dresses dyed with irritating dyestuffs, ought to be carefully avoided. XIX. Connected with cleanliness of clothing, as a means of health, is personal cleanliness. Perfected action of the skin, so essential to the perfect life, can only be obtained by thorough ablution of the whole body. The ablution ought, strictly, to be performed once in every twenty-four hours. It is best to train the body to the use of cold water through all seasons, so that the requirement for water of raised tem- SUMMARY OF PRACTICAL APPLICATIONS. 27 1 perature may not become a necessity. The simplest and best bath is the ordinary sponge-bath. Plungings, splash- ings, showers and the like are mere pastimes. The occa- sional use of the hot air or Turkish bath is* an important adjunct to the means of maintaining health. XX. The diseases arising from imitation and moral contagion are best avoided by taking care that the young and impres- sionable are removed from the sources of danger. They who are sources of danger should be isolated as much as possible. It behoves parents, especially, to check, at once, all dangerous imitative acts and performances, and as far as possible to protect the young from all .sights which sug- gest extravagant gestures and deformities. Education of the masses is required to remove those psychological influ- ences leading to diseases of imitation, which spring from ignorance and superstition. The physician may point out the dangers of those moral contagions * he is powerless to prevent them. XXI. The automatic phenomena of disease when they appear are best removed by introducing into the daily life of the sufferer such refined tastes and amusements as will keep him from thinking too much of himself and of the pecu- liarities of his organic nature. The grand preventive remedy for the automatic malady is to stop it in its hereditary course by the exercise of stricter care against that intermarriage of disease which was specially considered in the first section of this brief summary. INDEX. Absence of mind, 84 Absinthe, disease from, 187 Accidents, all groups of diseases viewed as, 31 Acidity from food, 201 Actors, diseases incident to, 224 Acute pleurisy in alcoholic phthisis, 143 Acute rheumatism, correlative ef- fects of the seasons on, 39-40 yEsop's fable of " the belly and the members," 78 Agricultural occupations, diseases incident to, 232 Ague, paroxysm of, in unborn children ; rarity of, at the present time, 16-17 Air, causes of impurity of, in houses 211 ; disease from impurity of, 206 ; impurity of, from damp, 215 deterioration, 210 ; metallic poisons, 216 ; organic poisons, 208 ; sewer gas, 213 ; stoves, 214 Air of large towns and country air, 211 Air, precautions against impurity of 269 Albumen, 145 Alcohol, abstinence from, 268 Alcohol, action of, on the blood 127 ; bowels, 135 ; cerebro-spinal system, 123 ; colloidal structures, 127, 146 ; emotions, 135 ; heart, 120, 123, 130 ; membranes, 127, 129 ; muscles, 124 ; muscular force, 132 ; urine, 135 ; vital functions, 119 Alcohol, calculus from, 145 ; catar- act from, 146 ; collapse of the nervous centres from, 126 ; death from, 126 ; diabetes from, 144 Alcohol, disease from, physiological proem, 118 Alcohol, disease of the blood-vessels from, 140 ; eye from, 146 ; heart from, 139 ; kidney from, 145 ; liver from, 144 ; lungs from, 141 Alcohol, effects of, on the brain, 141 : epilepsy from, 148; ethylic, 119 ; failure of speech from, 149 ; fall of animal temperature, from, 124-130 ; functional dis- ease from, 133 ; insanity from, 150 ; loss of memory from, 149 ; mental alienation from, 150 ; nnisc(S volitantes from, 137 ; a narcotic, 130, 131 ; nervous diseases from, 147 ; organic disease from, 140; paralysis from, 149 ; physiological changes from, 127 ; physiological deductions from the actions of ; sesory dis- turbance from, 135; not a stimu- lant, 131 ; stone in the bladder from, 145 ; symptoms of systemic failure from, 138; vascular changes in the skin from, 137 ; vascular nervous excitement from, 119 Alcoholic disease, her'^.ditary trans- mission of, 152; symptoms of, 138 Alcoholic dispepsia, 135 ; insomnia, 147 . Alcoholic phthisis, 14 ; fatality of,, 143 : haemorrhage in, 143 Alcoholic sleeplessness, 147; thirst, 137 Alcoholism from automatism, 262 Ammonia in impure air, 207 Ammonia-sulphur compounds, 208 Analysis of deaths from bronchitis, 38 ; carbuncle, 39 ; catarrh, 39 ; croup, 39 ; erysipelas, 39 ; in- fluenza, 39 ; pleurisy, 39 ; pneu- monia, 38 ; quinsey, 39 Analysis of the Registrar-General's returns, 38 274 INDEX. Aneurism, Morgagni's observations on, 102 ; from physical strain, loi Anger, effects of, iii ■'Angina pectoris," 79 Aniline dyes, disease from, 24S Animal food, regulation of, 268 Animal secretion and puerperal fever, 56 Animal temperature, fall of, from alcohol. 124, 130 Animals, effects of tobacco on, 208 Antiquity of various diseases, 16 Apoplexy and smoking, 174 "Apnoea, cardiac," 79 Archibald (Rev. Mr.), on epidemic of diseases in Shetland Islands, 251 Arrested development of important organs in unborn children, 26 Arsenic wall papers, disease from, 216, 217 Arterial relaxation from alcohol, 134 Artilleryman, aneurism in an, 102 Artists, diseases incident to, 223 Ascarides found in unborn children, 25 . Ascaris lumbricoides , 192 Ascaris my s tax, 195 Atmospheric change a cause of disease, 36 Atmospheric chemical changes, moisture, and winds, effects of, 47 Atmospheric pressure, effects of, 45 Atmospheric temperature, effects of, 43 Automatic disease, 258 ; precautions agamst, 271 Automatism, phenomena of, 258 Avarice, effects on the health, no Baker (Dr. H. B.), report on teta- noid fever, 199, 252 Baldness frooi unventilated hats, 247 Balls, diseases contracted at, 246 Barker (Dr. H.), researches on sewer glass, 213 Barometrical pressure and the pre- valence of disease, 40 Bath, the best, 270 Beaver hat, cause of baldness and scurf, 247 Bedroom, temperature of, 270 Belts, disease from wearing tight, 244 Bichromate of potassa, ulceration from, 233 Birds, effect of tobacco on, 155 Birth, diseases antecedent to, 22 ; unconsciousness during, 11 Black death, modern cases of, 17 Black Hole of Calcutta, 207 Bladder, stone in the, from alcohol, 145 Blood, action of alcohol on the, 127 ; arrest of the circulation of, 65 ; changes of quality in the, 30 ; disease of the, from tobacco, 159 ; effects of tobacco smoke on the, 156 ; separation of parts of the, in old age, 65; the supposed seat of hereditary disease, 30 Blood-vessels, disease of the, from alcohol, 140 Bloody sweat, 17 Body, duration of the growth of, 14; effects of the constituents of .to- bacco smoke on the, 154 ; effects of the seasons on the weight of, 37, 266; primary action of tobacco smoke on the, 155 ; secondary action of tobacco smoke on the, Boots, disease from wearing tight, 244 ; long leathern, 248. Bouchut on imitation in suicide, etc. 257 Bowels, action of alcohol on the, 135 Boy, diabetes induced in a, by fright, 89 Brain, dementia from failure of, 82 ; disorganization of, 86 ; Dr. Thomas Willis on the functions of the, 260 ; effects of alcohol on the 147 ; effects of fear upon the, T14 ; effects of tobacco smoke on the, 156, 174 ; paralysis of, from rage, 113 ; vascular engorgement of, from alcohol, 122 Breath of smokers, 158 Bright's disease from alcohol, 145 INDEX. ^75 British Association, report on '.ftloral-hydrate, 183 Broken heart from mental strain, 73 Broken sleep, disease from, 237 Bronchitis, analysis of dealhsfrom, 38 ; and smoking, statistics of, 170 ; and tobacco, 171 Business, evil effects of traveling to and from, 107 Business men, disease incident to, 227 ; efiects of overwork on, 85 Caffeine, 200 " Caissons," health of men em- ployed in, 45 Calculus among the diseases of the unborn, 25 ; from alcohol, 145 Cancer, 17 ; and consumption, intermarriage of, 263 ; early pre- valence of, 166 ; epithelial, 167 ; from a fish-bone in the throat, 167 ; of the lower lip, 167 ; in the pike, 166 ; from smoking, lbs Carbonic acid in tobacco smoke, effects of, 154 Carbonic oxide in tobacco smoke, effects of, 154 Carbuncle, analysis of deaths from, 40 " Cardiac apncea," 7g Cataract from alcohol, 146 ; Dr. Weir Mitchell on, 147 Catarrh, analysis of deaths from. Catarrh and colds, limits of, 8g Causes of disease, 31 Causes of induced diseases, 71 Cavendish tobacco, effects of 162 Celsus on inflammation, 17 " Cerebro-spinal meningitis," 18, 198 Cerebro-soinal system, action of alcohol on, 123. Cerebrum, action of alcohol on the, 124 Cestode, 193. T95 Chemical basis of tobacco smoke, 153 Chemical change?, effects of atmos- pheric, 47 Chest, diseases of the. nnd lobacco, 169 Chewing tobacco, effects k>\. 162 Childbirth, effects of over-eating in, 205 Children, diseases incident to. from overwork, 229 Clili^ral hydrate, disease from, 183 Chloralis>?i, increase of, 184 Chlorodyne, disease from. 186 Chloroform, disease from, 185 Choleraic disease, 137 Chore I, caught by imitation, 252; 253. Chronic bronchitis and tobacco, 171 Cigars, effects of, 162 Circulation of the blood, arrest of, Clarionet-pl lying, case of vertigo from. 226 Classification of causes of disease. Classification and distribution of the phenomena of disease, 15 Cleanliness, necessity of personal, 271 " Clergyman's sore throat," 220 Clergymen, diseases incident 10 220 Clock, automatic imitation of a, example of, 260 Clothes, odor of lobacco on, 158 Clothes, threadbare, 270 Clothing, disea-;e from improper, 245 ; during changes of season, 265 ; precautions in, 270 C bbold (Dr.). his woik on the Entozoi, 195 Coffee, effects of, 200 Cold, action of. on persons of d.f ferent ages, 43 ; on aged people. 66 Cold and hea', danger of sudden, changes of. 266 Colds and caiairhs, limits of ig Colic from exposure to lead, 233 Colloidal food, proper proporiion of, 202 Colloidal matter, change of, in ad- vanced age. 63 Colloidal structures, action of alco- hol on the. 127. 146 " Comforter." disea-e from wearing a icd, 24S 276 INDEX. Commercial occupations, diseases incident to, 227 Communicable disease, 50 ; poisons of the, 51 Composers, diseases incident to, 227 Composition of tobacco smoke, 153 Congestion from physical strain, 103 Congestion, vascular, 67 Congestive diseases, influence of aimo^pheric pressure in, 46 Consai guinity, marriages of, 263 Conservation, the, of disease, 17 Constantinople, the great plague at, in, 17 Consumption, from alcohol, 141 ; and cancer intermarriage of, 263; caused by sleeping in a van, 2og; is it contagious ? 20g ; correlative effects of the season on, 39 ; pul- monary, symptoms of, acquired by imitation, 253 ; and smokers, statistics of, i6g; and tobacco, 171 . Contagious diseases conveyed by clothing, 249 Contagious diseases, prevention of, 266 Contagious ophthalmia, 20S Controllable diseases, 34, 35 61 Convict prison at Wakefield, effects of the season on the inmates of, 37 " Convulsionairism,'" 256 Convulsion, unborn children at- tacked by, 26 Convulsionary ou break among girls, 256 Convulsions, epidemic of, :"n the Shetland Islands, 251 Convulsions from indigestibles, 201 Coralline dyes; disease from, 248 Corpuscles, action of alcohol on the, 127 Correlative effects of the season on disease, 38 Corsets, disease from wearing, 243 Countrymen, effects of physical overwork on, lOO Cov^pox, 60 Crape, effects of vi-earing, in sum- mer 247 Cravats, disease from wearing tight, 244 Craving for work, a stage of de- mentia, 84 Crenated corpuscles, 127 Cretinism and goitre, 18 Cromwell on his son's death, 75 Croup, analysis of deaths irom, 39 . Cutaneous disease from impure air, 208 Cyanosis, case of, recorded by Dr. Mayne, 28 ; in children 26, 27 ; from flute -playing, case of, 226 ; mode of death during, 27 Cysticerci, 193 Cyslicej'cus celluloses, 195 Damp, impurity of air from, 215 Dancing mania of the Middle Ages, 256 Death from alcohol, 126 ; from failure of digestive power, 69 ; from intermittent action of the heart, 65; modern sentiments on, 13 ; by nature, 12 ; painlessness of a natural, 1 1 ; painlessness of sudden, 14 ; from paralysis through smoking, 177; practically banished, 11 ; from vascular con- gestion, 67 ; view of, at various stages of life, 69 Delirmm tremens, 151 De Marmon (Dr.), observations on the action of alcohol, 125 DemenXia, absence of mind a Ftage towards, 84 ; craving for work, a stage of, 84 ; from failure of brain and mental power, 82; loss of memory, a stage of, 85 ; of overwork, 82 ; poetic ' ' frenzy " a stage of, 84. De Quincey's "Confessions of an English Opium Eater," iSo Descent of disease, 32 Despine on imitation in suicide, &c. 256 Diabetes, first symptoms of, 91 ; from alcohol, 144 ; from mental strain, 89 ; induced by sudden fright, 90 ; a well-known states- man attacked by, go Digestion, the process of, 128 INDEX. 277 Digestive organs, disease of, from opium, J 81 ; disease of, from tobacco, 160 Digestive power, deatli from failure of, 69 Dilation of the eye in smokers, 172 Diphtheria, correlative effects of the seasons on, 39 Disease antecedent to birth, 22 ; classification and distribution of the phenomena of, 15; correlative effects of the seasons on, 38 ; definition of, 15 ; from communic- able causes, 50 ; external origins and causes of, 31 ; from external causes, 50; hereditariness of. 29 ; incidental to old age, 34, 35, 62; "incubation" of, 57; induced and special, 71 ; locality of, 19 ; long existence of various types of, 16 ; the names of, 15 ; and ozone, connection between, 41 ; proctss of " incubation " of, 58 ; in rela- tion to race, 19 ; in relation to terrestiial space, 18; supposed supernalural origin of, 32; uncon- trollable causes of, 36 Diseases beyond human control, 34, 35 ; causes of induced, 71 ; of descent, 32 ; developed in the unborn, 23 ; most common to the unborn, 23 ; number of specific. 16 ; in relation to historic lime, 16 ; under human control, 34. 35, 61 ; viewed as accidental, 43 Distribution and classification of the phenomena of disease, 15 Distribution of poisonous particles, 53 Diuresis in hysteria from mental .93 Dizziness from railway traveling, 109 Domestic occupations, diseases in- cident to, 231 Dractmctihis medinensis, 193 Dramatic artists, diseases incident to, 224 Dreams and overwork, 77 Dress, disease from dyes in, 24S ; disease from errors of, 243 l pre- cautions in, 270 ; ventilation of, 247 " Drop wrist," 233 Drunkards, occasional, 150 Duelling from imitation, 256 Duration of life, 14 J^ust, disease from inorganic, 216 Duties of physicians. 1 1 Dyeing of dress, disease from. 248 Dypsomania, 150 Dysentery, correlative effects of the seasons on, 39 Dyspepsia, alcoholic, 135; and heart disease, 78 Ear, effect of tobacco on the, 173 Ears, ringing sounds in, in hysteria from mental strain, 93 Ecchinococciis hominis, 196 Eczematous eruption from alcohol. 137 Education, results of overwork in children, 230 Effects of alcohol on the brain, 147 Effects of atmospheric pressure 45; atmospheric temperature, 43; iiie constituents of tobacco smoke on the body, 154 ; electrified air or ozone, 40; 1 ghning stroke and sun-stroke, 48 ; moisture, winds, and atmospheric chemical chan- ges, 47 ; the seasons on life, 36 ; tobacco on the brain, 173 ; to- bacco on the ear, 173 ; tobacco on the organs of sense, 172 ; to- bacco on the sense of smell, 174; tobacco on the volitional and organic nerves, 176 Effervescing drinks, 201 Electrified air, effects of, 40 " Entity " of disease, 32 Emotions, actions of alcohol on the, 135 Enthozootic diseases, 193 Epidemic visitations of disease, 33 Epidemics of diseases, recurrence of, 34 Epilepsy from absinthe, 1S7; from alcohol, 14S ; herditary trans- mission of, 30 ; and insanity, suposed supernatural origin of, 32 Epithelial cancer, 167 Erasistratus on inflamma;ion and fever, ] 7 278 INDEX. Eruptions on the skin from alcoho], 137 Eruptive disease from food, 189 p>ysipclas, analysis of deaths from, 39 Ether, disease from, 186 EJiylic alcohol, 119 lOua^rius and Procopius on the gYL-iit plague of Constantinople n Eulenberg on the composion of tobacco smoke, 153 Euthanasia, II Euthanasia, examples of natural, 12 ; phenomena of natural, 12 ; the true, 12 Evening parties, diseases contracted at, 246 Exceptions to sudden death, 13 Excitement, diseases from excess of, 71 Expectoration in smoking, 163 External origins and causes of dis- ease, 31 Exudation, symptoms of, in glan- dular diseases, 59 Eye, disease of the, from alcohol, 146 ; effects of tobacco on the, 172 Failure, from alcohol, symptoms of, 138 ; of brain ancl mental power, 82 ; of digestive power, death from, 69 Failure of the heart, in old age, 64; subjects of, 76 ; symptoms or, 77 Failure of speech from alcohol, 149 " Faint-hearted " men, 74 Family tendency of susceptibility to certain diseases, 57 " Famine fever," 56, 203 Farm laborers, disease incident to, 232 Fascicola hepatica, 193. 197 Fashion in narcotics, 180 Fasting body, effects of smoking on the, 160 Fatal diseases of old age, 64 Fatality of alcoholic phthisis, 143 Fatigue, physical and mental, 267 Fear, effects of, 113; effects of <^\\ the brain, I14 ; example ot in- sanity from, 114 ; intermittent heart from, 114 Febrile diseases and ozone, 40 Fever and inflammation, 17 Fever, remittent, correlative effects of tne seasons on, 39 Fever wards, ammonia in the air of, 208 Fibrine, sepaiation of, in the blood. Fine arts, diseases incident to work- ers in the, 223 Fishbone, cancer from a, in the throat, 167 Fishes, poisonous in hot Climates, I go Flatulency in hysterical disease, 93 Fluke w^orms, 193, 197 Flute playing, cyanosis from, 226 Foetus, arrested aud imperfect de- velopment of organs in the, 26 diseases developed in the, 23 ; diseases most common to the, 24; tumors and schirrus developed in the, 25 Food, diseases from, 188; regula- tion of, 268 Force, supposed endowment of animals at birth with reserved, 14 Fordyce (Dr.) and inoculation, 52. " Frenzy," poetic, a stage toward dementia, 84 Functional disease from alcohol, 133. Functional disease of the heart fiom tobacco, 168 Functional disease from tobacco, 159 Functional influences of tobacco, 159 Functional nervous derangements, 199 Funeral custom of the Greeks, 13 Gambling, physical effects of , 11 7 Garters, disease from wearing tight, 244 " Germ," the, theory, 54 Giddiness from railway traveling, 109 Glands, effects of smoking on the, 177 INDEX. 279 Glandular diseases, 58. Globules, the red, effects of tobac- co on, 160. Gluttony, disease from, 188, 204. Goats, effects of tobacco on, 155. Goitre and cretinism, 18. Goitre from impulse of grief, 115, Gout, correlative effects of the sea- sons on, 39, Greek definiiion of melancholy, 13. Greek funeral custom, 13. Grief, effects of, 115. Grief, intermittent heart from im- pulse of, 115. Grief, numbness and coldness from impulse, 116. Grotto del Cane, air of, 47. Growth of body, duration of, 14. Gums,effects of tobacco on the, 165. HEMOPTYSIS from impulse of grief, 115. Haemorrhage in alcoholic phthisis, 143. Haemorrhoids from over eating, 205. Habit of automatism, 25S. Hamlet, 75. Hare lip in unborn children, 26. Harp players, disease incident to, 226. Haschish, 179, 187. Hatred, effects of, 113. Hearing, effect of tobacco on the sense of, 173. Heart, the, 74. Heart, action of alcohol on the, 120, 123, 130. Heart, action of the, in physical overw^ork, 100; under alcohol, 126, 130. Heart, broken, from mental strain, 73- Heart disease from alcohol, 139; boy born with, 26; and dyspep- sia, 78; and indigestion, 78; irri- tability in, 80; melacholy in, 80; and moisture, 47; parox- ysms of pain in, 80; the secre- tions in, 79; sleeplessness and, 77; sudden death from, 82; from tobacco, 167; from undue exertion, 102. Heart, effects of physical overwork on the, loi ; effects of rage and anger on the, 112; effects of tobacco smoke on the, 157; ex- ample of intermittent, from fear, 114; failure of the, in old age, 64; hereditariness of intermit- tent action of the, 29; hyper- trophy of the, 104: intermittent action of, 64; intermittent action of the, fiom broken sleep, 241; intermittent, from impulse of grief, 115; mode of death from intermittent action of the, 65; subjects of failure of the, 76; symptoms of failure of the, 77; the, and thought and emotion, 75 ; undue muscular development of the, 104; wearing out of, from undue exertion, 102; work of the, 73- Heat and cold, danger of sudden change of, 266. Heat, increment of, in glandular diseases, 59. Heated stove, case of illness from use of, 214. Heels, disease from wearing high, 244-. Hereditarine'ss of automatic pheno- mena, 258, 262. Hereditarniess of intermittent action of the heart, 29, Hereditary diseases, 23, 29. Hereditary, health as an element of marriage. 264, 265, maladies, 29; physical qualities, 29; pro- clivities, physical seat of, 30; transmission of alcoholic disease, 152; transmissions of injuries to nervous matter, 31. Hewson (Dr. Addinell) on mortal- ity from surgical fever. 46. "High" game and meat disease from eating, 191. Hip-joint disease, 264. Hoffman (M.), disease in relation to the Jewish race, 19. " Housemaid's knee," 232. Houses, disease of living in damp, 215; impurity of air in. 211. Hurry of railway traveling, evil effects of, 107. 2«0 INDEX. Hydatids^ 193. Hydrate of chloral, disease from, 183. Hydro-cephalus, 264. Hypertrophy of the heart, 104. Hypochondriasis, 258. Hysteria from mental strain, 92. Hysterical disease, 91. Iceland, Morbus ecchinococci in, 197. Idiopathic cases of scarlet and sur- gical fevers, 55. Idiosyncrasies of families, 57. Idleness, ill effects of, 269. Idleness and sloth, disease from, 234. Illusions, physical origin of, 84. Imitation and moral contagion, disease from, 250. Imitation, physical nature of, 257; precautions against diseases from, 271. Imperfect development of impor- tant organs in unborn children, 26. Impurity of air by deterioration, 210; disease from, 206; precau- tions against, 269. Increment of heat in glandular diseases, 59. "Incubation" of disease, 57, 58. Indian hemp-seed, 179, 187. Indigestion and heart disease, 78. Induced diseases, 35, 36, 71. Induced diseases, causes of, 71; definition and classification of, 71; from excess of excitement, 71; from excess of labor, 71; from physical strain, 95. Industrial occupations, diseases in- cidental to, 233. Inflammation, 17. Inflammation and fever, 17. Influence of smoking on the men- tal faculties, 175, Influenza, analysis of deaths from, 39-. Injuries to nervous matter, hered- itariness of, 31. Inoculation, Dr. Fordyce and, 52. Inorganic dust, disease from, 215. Insanity, from alcohol, 150; and epilepsy, supposed supernatural origin of, 32; example of, from fear, 114; and tobacco, 176. Insomnia, alcoholic, 147 ; and in- cipient heart disease, 77; from overwork, 241; from remorse, 241; a stage of dementia, 84. Intellectual v. physical develop- ment, 95. Intermarriage of disease, 263, 265. Intermittent action of the heart, 64. Intermittent action of the heart, from broken sleep, 241 ; hered- itariness of, 29; from fear, 114; from impulse of grief, 115. Intra-uterine life, diseases devel- oped during, 24. Irritability in heart disease, 80. Irritation from indigestibles, 201, Jaundice from the use of chloral hydrate, 185. Jewish race, causes of ths higher vitality, 20. Jews, never athletes, 98; death- rate among the, 20; their endu- rance against disease, 19. Kidney, disease of the, from alco- hol, 145. Labor, diseases from excess of, 71- Xatakia tobacco, effects of, 162. Late hours, disease from, 237. Laundresses, diseases incident to, 232. Lawyers, diseases incident to, 221. Lemonade, effects of, 201. Liebreich (Dr.) and chloral- hydrate, 183. Life, duration of, 14. Lightning-stroke, case of, 48; locality of injury, 50; pheno- mena of, 50; and sun- stroke, effects of, 48. Limits of phenomena of disease, 18. " Lion hearted " men, 74. Lip, cancer of the, 167, 1 literary profession, diseases inci- dent to the, 219. INDEX. 281 Lithotomy, scale of mortality from, 63. Liver, disease of the, from alco- hol, 144. Lobster, siguatera from eating, 190. Local paralysis from mental strain, 87. Locality of disease, 18. Lombardo-Venetian leprosy, iS. Longevity and the development of physical power, 97, Loss of memory, from alcohol, 149; symptom of dementia, 85. Lungs, disease of the, from alco- hol, 141; disease of the, from tobacco, 168; effects of tobacco smoke on the, 157; vascular en- gorgement of ihe, from alcohol, 122. Luxuries, diseases from, 72. Malarial fevers and moisture, 47. Malformations in the foetu^, 26. Mania a poiu, 1 50. Marriage between persons heredit- arily diseased, 263, 265; hered itary health as an element of, 264 265. Marriages of consanguinity, 263, Mayer (M.), disease in relation to the Jewish race, 19. Mayne (Dr.), case of cyanosis re- corded by, 28. Measly pork, 195. Mechanical derangements in un- born children, 25. Medical men and necessitarianism, 222. Medical profession, diseases inci- dent to the, 222. Melancholy in heart disease, 80. Membranes, action of alcohol on the, 127, 129. Membranes, use of the, 128. Memory of, loss of, from alcohol, 149; loss of, in heart disease, 78; loss of, a symptom of dementia, 85; results of excessive develop- ment of, in children, 230. Men, reason for preponderance of, 14. Menander on sleep, 242. Meningitis, 19S. Men'al, alienations from alcohol, 150; faculties, effects of smok- ing on the. 175; impressions, communication of, from mother to her unborn child, 28; labor and tobacco, 175; and physical fatigue, 267; and physical strain, 106; power, dementia from fail- ure of, 82; strain, diabetes from, 89; strain, diseases from, 71, 73; strain, paralysis from, 86; work, necessity of variety in, 266. Mercaptan, 208. Metallic poisons, disease from, 216. Meteorological causes of disease, 36; changes on the body, exam- ple of , 37; conditions, action of, on the body, 39. Meteorology and inflammatory diseases. 42. Milner (Mr.), discovery of the effects of the seasons on health, 37. Mnid. action of alcohol on the, 124. Mitchell (Dr. Weir), researches on the synthesis of cataract, ;47. Mites and tobacco smoke, 155. Mode of death from intermittent action of the heart, 65, Modern Sentiments on death, 13. Moffatt (Dr.), researches on ozone, 40. Moisture, winds, and atmospheric chemical changes, effects of, 47. Monstrosities, 28. Mon martre, convuhionary out- break among girls, 256. Moial contagion and imitation, disease from, 250. Moral contagion, physical nature of, 257. Moral contagion, precautions against disease from, 271. ATorlnis coxaritis, 264, Ahvbiis ecchmococci, treatment of, in Iceland, 197. Morgagni's observations on aneur- ism, 102. Mortality from cold among persons of different ages, 43. 282 INDEX. Mother and unborn child, connec- tion existing between, 28. Mouth, effects of tobacco on the, 162. Mucous membrane, the, 128. 163. MusccE volitantes from alcohol, 137- Muscles, action of alcohol on the, 124, Muscular, action, perturbed, in hysteria fromjnental strain, 94; force, action of alcohol on, 132; paralysis from mental strain, 87. Musicians, diseases incident to, 226. Narcotic, alcohol a, 130, 131. Narcotics, diseases from the use of, 179. Narcotics, effects of, 268. Natural death, exceptions to, 13. Natural decay, disease incidental to, 62; symptoms of, 62. Natural euthanasia, examples of, 12. Necessitarianism and doctors, 222. JVeffiatode yforras, 193. Nerves, effect of tobacco on the volitional and organic, 176. Nervous centres, collapse of, from alcohol, 126; hereditary trans- mission of injury to, 31. Nervous disease from alcohol, 147; from tobacco, 172. Nervous matter, hereditariness of injuries to, 31. Nervous power, failure of, from opium, 181. Nettle-rash, 189. Neufville (M.), disease in relation to the Jewish race, 20. Neuralgia, causes of. 45. Neuralgia or tic from alcohol, 129. Nicotine, action of, on tiJie stom- ach, 160; effects of, 155; effects of, on the eye, 173. Nitrous oxide, phenomena of dis- ease fiom use of, 181. Nomenclature of disease, 15. Nose, cause of the bloom on the, in topers, 123. Number of specific diseases, 16. Numbness and coldness from im- pulse of grief, 116. Numbness in hysteria from mental strain, 94. Occasional drunkards, 150. Occupations, disease incident to some, 217, Old age, diseases incidental to, 34, 35, 62; fatal diseases of, 64; separation of part of the heart in, 65; symptoms of, 62. Ophthalmia, contagious, 208. Opium, disease from, 180; disease of digestive organs from, 182; smoking, 183. Organic disease from alcohol, 139. Organic nerves, effects of tobacco on the, 176; nervous system, the, 91. Organic poison, diseases produc- ing, 52; in air, 208; distribution of. 53; phenomena of disease in- duced by, 57. Organs of sense, effects of tobacco on the, 172. Origin, external, of disease, 31. Origin of poisonous particles, 54, 55, 56. Othello, strain on the actor of, 225. Overwork, dementia of, 82; dis- eases from, 71; and dreams, 77; effects of, on men of business, 85; paralysis from, 86; resuks of, in children and students, 230; suicide from, 81. Oxygen and disease, 43. Oxyuris vertidcularis, 193. Ozone, connection between, and disease, 41 ; distribution of, 42 ; Drs. MoffattandB. W. Richard- son's researches on, 40 ; effects of, 40 ; and febrile disease, 40 ; localization of, 42 ; modified by temperature, 42; physiological action of, 41. Pain, paroxysms of, in heart dis- ease, 80. Painless death, 12. Painters, diseases incident to, 223 Papers, disease from arsenical wall, 2t6. Paralysis, from alcohol, 149 ; of the brain from rage, 113 ; instance of INDEX. 283 death from, through smoking, 177; local, from playing the violoncello, 226 ; symptoms of, acquired by imitation, 254 ; from wony and mental strain, 86 Parasitic disease, ig2 Paikes (Dr.), observations on vas- cular excitement from alcohol, 120 Passions, control of the, necessary to health, 267 Tassions, disease from the influence of the, no Passions, the reel of the, 117 Pellagra, 18 Peritoneal secretion, " septine " obtained from, 55 Peritoneum, the, 128 Perversions of nutrition from improperly-selected food, 202 Phenomena of disease — classifica- tion and distribution, 15 ; from communicable causes, 50 ; from external causes, 50 ; incidental to old age and natural decay, 62 ; induced by organic poisons, 57 ; induced and special, 71 ; from tobacco, 159 Phenomena of diseases beyond human control, 34, 35 ; of func- tional ( isease from alcohol, 133 ; of natural euthanasia, 12 ; of jeduced vascular tension, 91 Philip V. of Spain, death of, from broken heart, 74 'Phthisis, Alcoholic, 141 ; fatality of, 143 ; haemorrhage in, 143 Phthisis pulmonalis, 17 ; compara- tive immunity of Jews from, 21 ; and moisture, 47 ; statistics of, 21 ; susceptibility of Saxon race to, 22 Physical, courage and the heart 74 ; culture, value of, 96 ; design of disease, 32 ; effects of gamb- ling, 117 ; effects of political excitement, 117 ; exercise, danger of excessive, 267 ; v. intellectual development, 96 ; labor, the natural bounds of, 95 ; and mental fatigue, 267 ; and mental strain, 106 ; and mental strain, fatal case of 106 ; origin of spectra, illusions, &c., Physical overwork, effects of, on countrymen, 100 ; effects on the heart, loi ; mode of death from, 99 ; symptoms of, 98 Physical power, development of. and longevity, 97 ; high estima- tion of, 95 ; value of, 96 Physical seat of hereditary pro- clivities, 30 Physical strain, diseases from, 71,95 Physicians, the duties of, 1 1 Physiological, action of alcohol. 119; action of ozone, 41; changes from alcohol, 127 ; deductions from the action of alcohol. 130 ; peculiarities and susceptibility to certain diseases, 22 ; phenomena of disease from tobacco, 205 Pigtail tobacco, effects of, 162 Pike, cancer in the, 166 Pipes, effects of foul, 162 Pipes, short, epithelial cancer from. 167 Pleurisy, acute, in alcoholic phthisis, 143 ; analysis of deaths from, 39 . Pneumonia, analysis of deaths from, 38 Poetic " frenzy," a stage towards dementia, 84 Poets and their sufferings, 224 Poisons, of the communicable diseases, 51 ; diseases occurring form organic, 34 ; metalic, in wall papers, 216 Poisonous particles, distribution of, 53 ; origin of, 54, 56 ; sponta- neous origin of, 55 ; and tem- perature, 53 Poisonous secretions, 56 Political excitement, physical effects of, 117 " Poor smell," cause of, 211 Pork, measly, 195 Prediction of the recurrence of certain diseases, 34 Pregnancy, precautions and rules during, 265 Premature decay from deficient sleep, case of, 240 284 INDEX. Preponderance of men, reason for, 14 Pressure, atmospheric, effects of. Primary action of tobacco smoke on the body, 155 Process of the *' incubation " of diseases, 58 Professional classes, diseases incident to, 218 Proposed nomenclature of disease, | Puerperal fever communicated by animal secretion, 56 Pulmonary consumption, symp- toms of, acquired by imitation, 1 253 ; in unborn children, 25 Quinsy, analysis of deaths from 39 Rabies in dogs, 56 Rage, effects of, II2 : effects of, on the heart, ii2 ; example of the effects of, on the heart, 112; paralysis of the brain from, 113 Railway traveling, effects of, 107 Railway traveling, giddiness from, 109 Reade (Rev, J. B.), discovery of ammonia in impure air, 207 Recreation and rest, necessity of, 269 Recurrence of epidemics of dis- eases, 34 Red globules, effect of tobacco on the, 160 Reduced vascular tension, 91 Reel, the, of the passions, 117 Registrar-General's classification of causes of disease, 53 ; returns, analysis of, 38 "Rejuvenescence," 36 Religious "revivals," physical effects of, 117 Remittent fever, correlative effects of the seasons on, 40 Remorse, insomnia from, 242 Renal secretion, 89 ; action of alcohol on the, 135 Resei-ved force, supposed endow- ment of animals at birth with, 14 Rest and recreation, necessity of, 269 " Retired" men, diseases incident to, 235 " Revivals," physical effects of, 118 Rheumatic disease and moisture, 47 Rheumatism, acute, correlative effect of the seasons on, 39 ; causes of, 45 ; and consumption, inter-marriage of, 264 Richardson (Dr. B. W.), researches on ozone, 40 Ringing in the ear from tobacco, 173 Robertson (Mr.), on over-eating in childbirth, 205 St. Vitus dance* caught by imita- tion, 252, 253 Saline purpura, 197 Salivary secretion, effect of tobacco of the, 162 Scarlet fever, correlative effects of the seasons on, 40 Scarlet fever, malignant, 17 Schirrus developed in the foetus. Schoolroom, diseases caused by polluted air of a, 209. Sciatica from alcohol, 129. " Scrivener's palsy," 228. "Scruf," 248. Scurvy, 197. Seasons, correlative effects of the, on disease, 38; and disease, 266; effects of, on life, 36; liability to disease at change of, 245. Seat of hereditary proclivities to disease, 30. Secondary action of tobacco smoke on the body, 157. " Secotirism," 256, Secretions, the, in heart disease, 79- Secretions, poisonous, 56. Senile gangrene, 65. Sensations and automatism, 259. Sense, effects of tobacco on the organs of, 172, Sensory disturbance of alcohol, 135. INDEX. 285 " Septine," 55. Seplinous diseases, 192; poisoning, case of, 192. Servants, diseases incident to, 231. Sewer emanation, impurity of air from, 213, Sewer gas, 213. Shag tobacco, effects of, 214. Shakespeare onsleeplessness, 242. Shetland Islands, ep demic of convulsions in, 251. Shoes, disease from wearing tight, 244. Short pipes, epithelial cancer from, 167. Sight, failure of, from impulse of grief, 115. Sigualera, 160. Singers, diseases incident to, 226. Singing in the ear from tobacco, 173- Skin, eruptions on the, from alco- hol, 137; vascular changes in the, from alcohol, 137. Sleep, automatism of, 260; broken, disease from, 257; proper dura- tion of, 270. Sleeplessness, alcoholic, 147; dis- ease from, 237; and incipient heart disease, 77; from remoise, 241; a stage of dementia, 84. Sloth and idleness, disease from, 234. Small pox, 17; developed in the unborn, 24; the virus of, 52. Smell, effects of tobacco on the sense of, 174. Smoke, composition of tobacco, ^53. Smokers, breath of, 15S; dilation of the eye in, 173. Smoker's sore throat, 164. Smoking, and apoplexy, 174 ; automatism in, 262; and bron- chitis, statistics of, 170; cancer from, 165; and consumption, statistics of, 169; diseases from, 152; effects of, on the fasting body, 160; effects of, on the mental faculties, 175; effects of, on the volitional and organic nerves, 176; influence of, on communities, 17S; and insanity. 176; instance of death from par- alysis from, 177; summary of diseases from, 178; vertigo from, 175. Snakes, venomous, the virus of, 52. Snuff-taking, effects of. 162; effects of, on the sense of smell, 174; sore throat from, 165. Sore throat, smoker's, 164 Sore throat, from snuff-taking, 165. Specific communicable disease, 60. Specific poisons, nature of, 51. Spectra, illusions, etc., physical origin of, 84. Spectra in vision induced by men- tal strain, case of, 83. " Speculators," diseases incident to, 230. Speech, failure of, from alcohol, 149- Spina bifida in unborn children*, 26. Spinal column affected by railway traveling, 109. Spinal cord, effects of tobacco on the, 176. Spontaneous origin of poisonous particles, 55. "Stage struck," symptoms of, 224. Statesman, a well-kown, attacked by diabetes, 90. Statistics of consumption and smoking, 169. Stays, disease from wearing, 243. Still-born infants, proportion among the Jews, iq. Stimulant, alcohol as a, 131. " Stitch " in the side in alcoholic phthisis, 143. Stokes (Dr. U. S.), report on effects of political excitement, 117- Stomach, action of nicotine on the, 160; effects of chewing tobacco on the, 162; effects of snuff- taking on the, 162; effects of tobacco smoke on the, 156, 160. Stomach, in heart disease, 78. Stone in the bladder from alcohol, 145- 286 INDEX. Stoves, impurity of air from, 214. Strabismus, caught by imitaiiuii, 252. StrongyLiis bronchialis, 195. Sirongylus micruitis, igS- Students, diseases incident to, 229. Subjects of failure of the heart, 76. Sudden death from heart disease, 82; painlessness of, I4. Suicide, fiom alcoholic delirium, 122; from imitation, 256; from overwork, 81. Sulphur-alcohol, 208. Sulphurous odor in lightning- stroke, 49. Sun-stroke, effects of, 49; and lightning- stroke, effects of, 48; locality of injury, 50. Supernatural, supposed, origin of epilepsy and insanity, 32. Surgical fever, " Septine " ob- tained during, 55. Susceptibility of families to certain diseases, 57. Sweating sickness, the last epi- demic of, 16, Swede, the, and alcohol, 133. " Syjnpathy ,'' 256. Symptoms of failure of the heart, 77- Symptoms of glandular diseases, 58; old age, 62; systemic fail- ure from alcohol, 138, Syncope, death from, through fear, 114. Synthesis of cataract, Dr. Weir Mitchell's researches on the, 147,. Syphilis, 60. Syphilis developed in the unborn, 24. Systemic failure from alcohol, 138. Tccnia solium, 195. Tape worms, 193, 195. " Ta7'a7ttisf}i," 256. Tartar of the teeth from smoking, 163. Taste, effects of tobacco on the sense of, 174. Tea-drinking, effects of, 199. " Tea- tasters," effects of tea on. 200. Teeth, effects of tobacco on the 165. Teeth, tartar of the, from smoking, 163. Temperature best average, 2t)6, 270; of body during glandular diseases, 59; fall of animal, from alcohol, 124, 130; and poison- ous particles, 53, 56. Tenice, 193, 196. Terrestrial space, disease in rela- tion to, 18. Tetanoid fever, 198. Tetanoid fever, epidemic of in Michigan, U. S., 252. Theine in tea, 199. Thirst, alcoholic, 137. Thread worms, 194. Throat, effects of tobacco on the, 162. Tobacco, and apoplexy, 174; and bronchitis, 171; cancer from, 165; cavendish. 162; and con- sumption, 171; disease from, 152, 159. . Tobacco, disease of the blood from, 159; digestive organs from, 160; heart from, 167; lungs from, 168. Tobacco, effects of, 268; on ani- mals, 155; birds, 155; the brain, 174; the ear, 173; the glands, 177; on goats, 155; the mental faculties, 174; the organs of sense, 172; the red globules, 160; the salivary secretion, 162; the sense of smell, 174; the sense of taste, 174; the tongue, gums and teeth, 165; the vision, 172; the volitional and organic nerves, 176. Tobacco, functional ii fluenc es of, 159; influence? of, on communi- ties, 178; and insanity, 176; an irritant, 157: Latakia 162; ner- vous disease from, 172; pigtail, i6c; shag. 162: summary of diseases trom, 178; Turkish, 162; and vertigo, 175. Tobacco smoke, composition of, 153. INDEX. 387 Tobacco smoke, effects of, on ^he blood, 156; on the brain, 156; carbonic acid in, 154; carbonic oxide in, 154, the constituents of, on the body, 154; on the heart, 157; on the lungs, 157; on the stomach, 156; volatile empyreumatic substance in, 155, Tobacco smoke and mites, 155; primary action of, on the body, 155; secondary action of , on the body, 157. Tobaccoes, effects of various, 162. Tongue, effects of tobacco on the, 165. Toothache from alcohol, 129. Training effects of, on the consti- tution, 104. Transmission, hereditary, of alco- holic disease, 152, Traveling to and from business, evil effects of, 107. Trematode, 193, Trichina spiralis, 193. Trichiniasis, 193. Tubercular consumption from damp house, case of, 215. Tubercular matter discovered in the lungs of the unborn, 25. Tumors developed in the foetus, 25- Turkish baths, 270. Turkish tobacco; effects of, 162. Typhus fever, limits of, ig. Typhus, malignant, 17. Unborn, arrested and imperfect development of organs in the, 26; diseases developed in the, 23; diseases most common to the, 24. Unborn child and the mother, con- nection existing between, 28. Unclean clothing a medium of dis- ease. 249. Uncleanliness of dress, disease from, 249. Unconsciousness during birth, 11. Uncontrollable causes of disease, 36. Urine, action of alcohol on the, 135. Urticaria, 189. Vaccination, 54. Vaccination, process of, 58. Van, consumption caused by sleep- ing in a traveling, 209^ Vascular, changes iu tlic skin from alcohol, 137; congtsiion, 67; engorgement of the brain from alcohol, 122; engorgement of the lungs from alcohol, 122; ner- vous excitement from alcohol, 119; tension phenomena of re- duced, 91. Venomous snakes, the virus of, 52. Ventilation of dress, 247. Ventricles of the heart, 103. Vertigo, from clarionet-playing, case of, 226; from smokiug, 175; and tobacco, 175. Violincello, paralysis from play- ing, 226. Virus of small pox, 52, of venom- ous snakes, 52. Virion, effects of tobacco on the, 172. "Visitation" and "entity" of disease, 32. Vital force, duration of, 14. Vital functions, action of alcohol on, 119, Vitality at various ages, 44. Vocalists, diseases incident to, 226. Vohl on the composition of tobacco smoke, 153. Volatile empyreumatic substance in tobacco smoke, effects of, 155. Volitional nerves, effects of tobacco on the, 176. Volitional nervous centres, collapse of, from alcohol, 126. Volunteer system, effects of the, 106. Volunteering, effects of, 106. Vomiting under alcohol, 124. Waistband, disease from tight, 243 Waiters, diseases incident to, 232. Wakefield Convict Establishment, effects of the seasons on the in- mates, 37. War mania. Dr. Stokes (U. S.) on effects of, 117. 288 INDEX, Water in food, proper proportion of, 204. Water, poison of cholera in, 191. Waterproof coats, disease from, 248. Wave of heat, effects of, 67 . Weight of body, effect of the sea- sons upon, 37, Willis (Dr. Thomas), researches on the brain, 260. Wind instruments, diseases inci- dent to players on, 226. Winds, and disease, 47; effects of certain, 213; moisture, and atmospheric chemical changes, effects of, 47. Wollowicz (Count), observations on vascular excitement from alcohol, 120, Wood (Dr. Thos.) experiments on ozone, 41. Work, craving for, a stage of de- mentia, 84, Workhouse, diseases caused in a, by polluted air, 209. Worms, fluke, 193, 197; tape, 193, 195, Worry, danger from 266; diseases from, 63 ; paralysis from, 86. "Writer's cramp," 228. Yellow fever, limits of, 19. Yerba de Nuaca, the, 179. COLUMBIA UNIVERSITY LIBRARIES This book is due on the date indicated below, or at the expiration of a definite period after the date of borrowing, as provided by the rules of the Library or by special ar- rangement with the Librarian in charge. 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