Popular Science Monthly/Volume 1/May 1872/Miscellany
THE NATURE OF DISEASE.
BY SIR WM. W. GULL, BART., M. D., F. R. S.
In addressing you this evening, gentlemen, I have in some sort to throw myself on the forbearance of the Society, for, though I have been able to bring certain ideas together on the subject on which I desire to speak, I have not, for want of time, been able to adopt a form of words such as I would have liked. In some sense I am the spokesman of the Society as its President, in especial when laying before the public the objects of the Society as I would now do.
We, in our calling, differ from some theologians in one important respect: they look on this world as a decaying world, as much worse than it once was; we, as students of Nature, are opposed to this view, for, if we look to the history of Nature, we see we are ever advancing toward perfection, even if we are not likely to reach it. This is an improving world, and we are met to advance that idea. We believe that this world has something better in store for all than any thing which has yet been seen, and are like to the convalescent, whose last day should always be the very best he has ever spent. Some men are apt to think that science has certain limits set to it, beyond which no man may go; but we believe that knowledge extends far beyond the strictly scientific limit. Doubtless, were the early lower animals assembled together in conclave, they would conceive it quite impossible to transcend their status; that when the world came to megatheriums, let us say, then it must stop. They could not conceive the possibility of such a being as man. But at this point we join the theologians again in accepting a metaphysical element, in forming conceptions of things of which we can have no positive knowledge. In this way we may be said to worship Nature, but only in a very limited sense. We look upon our being, not as perfect, but as becoming perfect, and we are here to-night—and at all times have it as our object—to improve these defects of Nature, and to endeavor to perfect the human frame.
Respecting the object we work for—this living organism of ours—one great advance has of late been made. We are acquiring a physiological notion of disease. Disease is no entity; it is but a modification of health—a perverted physiological process; and this must at all times be insisted upon. Were it not that we fear death, and dislike pain, we should not look upon disease as any thing abnormal in the life-process, but to be as part and parcel of it. Few would now venture on a definition of disease; for in reality it is but the course of Nature in a living thing which is not health. In health the balance of function is even; incline it to either side, and there is disease. That being so, just as the life-process constitutes an individual and puts him apart from his fellows, so must any alteration in it be individual, and not general. But to the ignorant disease is an entity—an evil spirit which attacks us and seizes us. Hence arises the word "seizure," which, though in a somewhat different way, we still use, but with a protest. To the charlatan, disease is a set of symptoms to be attacked by a variety of drugs—a drug for each symptom. To us, disease is a life-process of a perverted kind.
Many states are not now called diseases which used to be, and there are still some to be expunged. Some people are always ailing. Some have feeble stability, and to them it is as natural to be ill as it is to others to be well; but this is not disease. So, too, aged persons get ill; but this is not disease—in reality, it is natural change simulating disease, and, when we try to cure such, we use all the farrago of the chemist's shop to prevent the sun setting. So syphilis at last ceases in the system to be syphilis, and becomes an early decay.
It is curious to consider the various morbific agents at work within our bodies, the lines in which they work, and their seats of action. These as yet have been but little studied, and deserve attention. Thus, it is very doubtful if scarlatina begins in the blood, as we should all be apt to say, rather than in any other tissue or fluid. Let it be our object to find out where all these begin within the body, and how they enter the body. In future, I hope, comparative pathology, which is just beginning to be studied, will teach us much; for in our bodies we men have many organs which are of little or no use to us, and are only relics of a former state of being. What, for instance, is the comparative anatomy of tonsils? Were I to make a man, I do not think I would put tonsils in him. Yet these, and such like organs, in accordance with the general law, are more prone to disease than are the others which are of real use in the system. I remember the case of a man who had a permanent vitelline duct. He had been out on a cold day, and the motion of the intestines twisted them in a mass round this persistent duct, and he died. I made a preparation of the duct, and wrote under it, "Cui vitam atque mortem dedit diverticulum." Every part of the body is alive, and has its own individual life and pathology, whether it be immediately required or not; only, if not required, it is more prone to disease than if it were. I could, for instance, suppose a fœtus of four months going to the doctor and saying: "I am going all wrong; my Wolffian bodies are disappearing, and kidneys are coming in their stead." Yet that is as much a condition of disease as some of those conditions of which I speak.
It is of the utmost possible importance, then, to be able to tell what we have and what we have not to cure. How often do we find people trying to do what is impossible! Some women have no more vital capacity than a canary-bird; they are constantly ill, and it is useless to attempt to make them well. A man came to me, and said: "I don't know what to do with So-and-so. I have given her every thing I could think of, and she will not get strong." "Why," I said. "you have been trying to put a quart into a pint pot. You cannot make her strong, and never will."
So, when a new instrument or mechanical means of diagnosis is introduced, we must try to make ourselves masters of it, so as to be able to use it aright, even though this is troublesome to ourselves; only we must beware of applying the knowledge thus acquired too early to practice. Thus, as regards the thermometer, doubtless it yields us most valuable information, but we must beware of using it as a guide to our treatment until we have a more complete knowledge of the condition of bodily temperature.
But after the physical comes the vital diagnosis. It is well to know exactly what is the condition of each part of the system; but to what is the wrong due? That no weighing or measuring can give you—only experience. A man has pneumonia—that is a too vague fact; what are the dynamics of the disease? One man with a pneumonia will get rapidly well and be right again in a few days, whereas another man will not get well at all. So, in different individuals, a form of disease apparently the same may be different from the beginning, and this we cannot always make out in our diagnosis, especially in internal disease. In skin-diseases we can do better.
During the last week I had been called on, as most of you know, to form a diagnosis of the workings of the mind. Here the break-down may be the first sign of the diseased condition, just as it may be in heart-disease, peritonitis, and a score of other diseases. A man, after racing up a hill, finds himself breathless and spitting blood. He comes to you, and you find heart-disease. It does not mean that the heart-disease was produced by running up the hill; it only means that an organ, equal to its ordinary duties, failed when unusual stress came to be laid upon it. So is peritonitis often the result of disease previously latent, but brought on by exposure to cold, or some such agency. Some men say that such cases as those of doubtful sanity should not be taken up by us—that ordinary men are quite as well fitted for finding out the truth as we are, with all our training. If so, all I say is, that it is no honor to us that it is so. Now, therapeutics is the end, though the study of diseased conditions might be pleasant enough by itself. We are sometimes twitted with letting Nature alone to do her work. We do not. And here, again, we join issue with the theologians. They say, "If it is God's will that a man die, so be it." But, say we, "God's will is to be found out; it is not a mere fate." We are not ignorant worshippers of Nature, and, whether a man is doomed to die or no, we know only by the result. We are connective agents. We have to adjust and correct. We know the tendency to recurrence to the equilibrium—that is, health—and we endeavor to assist in adjusting this balance in each individual.
In fever, for instance, two things are promptly at work—destructive changes, and changes tending to recovery. In such diseases there are certain superficial accidents which we are apt to notice. In fever there are often complications; but these are really part of the fever-process, and are not to be interfered with by themselves. Our study must be, how best to bring the condition to a safe ending; for a patient in fever may get well of the fever, and yet die of a bedsore.
In conclusion, if I have spoken more as regards medicine than as regards surgery, I think the surgeons ought to be indebted to me for hints toward the extirpation of superfluous organs—a grand prospect for the surgeons of the future.—British Medical Journal.
The following statements are from a paper entitled "Medical Notes on Alaska," by W. T. Wythe, M. D., read before the Sacramento Society for Medical Improvement, and published in the Pacific Medical Journal:
The country is very mountainous; lofty peaks, clad with snow throughout the year, being everywhere visible. One mountain-chain, identical with the Sierra Nevada and Coast Range of California, extends along the coast, through the Alaskan Peninsula and the Aleutian Islands; another chain, the continuation of the Rocky Mountain system, extends across the country to Behring's Strait, and, passing under the sea, is said to reappear in Asia. Between these two mountain-chains lies an immense valley, drained by the Youkon, a river nearly as large as the Mississippi, and which Dr. Dall has well described in his work on Alaska. These mountains, with their numerous branching chains and foot-hills, cover the whole country with impassable barriers. Among them lie many valleys, where, during the few days of summer, some vegetation can be seen, and it is here that the natives live; sometimes, however, a glacier will encroach upon the valley, or an avalanche of snow and rocks from the neighboring hills fill it up, or in spring a flood overflow it. In these inhabitable spots there is but little soil; all the vegetation seems to spring up in the peat-bogs, which are found everywhere except on the mountains. In these bogs, when sheltered from the winds, many kinds of trees will grow, but they are almost totally worthless. Grass grows very rapidly during the warmer days of summer, and sometimes attains a height of five feet. For agricultural purposes the territory is worthless.
The climate of the interior of Alaska is very different from that of the coast. Along the coast the average temperature is about 40° Fahr. during the year, while on the other side of the mountains it is many degrees lower. The coast is very foggy and damp. The rainfalls are very frequent, and it is subject to very severe storms of wind. At Sitka, it is said that for a number of years past the number of days during the year when it did not rain or snow, has been thirty-five. In the interior the climate is very cold in winter, and in summer somewhat warmer than on the coast. There is but little rain or fog. Snow falls to a great depth, and I have seen the ground frozen thirteen inches below the surface in midsummer. The cause of this peculiar climate, and of the difference of average temperature on the coast and the interior, is the same that modifies the whole Pacific coast. The Japan current, which brings the warm waters of the southeast shores of Asia, is undoubtedly the principal agent in controlling the climate of the northwest coast of America. From the Aleutian Islands to Sitka the whole coast is bathed by this "Pacific Gulf Stream." In addition to this current, the winds have a share in influencing the climate. Along the coast the prevailing winds are from the southwest, and are decidedly warmer than from any other quarter, having been warmed in passing over the Japan current.
There are four principal tribes in Alaska, each having distinct manners and customs: 1. The Koloshians, who dwell along the south coast, and are found as far north as Cook's Inlet. They are tall and powerful men, very savage and warlike; during the Russian government they were very troublesome, and even now are the terror of the northwest coast. 2. The Aleutians, who live on the islands, are short of stature; their almond eyes and peculiar features proclaim their Mongolian origin. They are fishermen, and travel long distances in their skin bydarks or canoes. Among the many facts which prove their Tartar descent, is the remarkable one that the inhabitants of Attou, the most westerly of the Aleutian Islands, speak a language so nearly like that of the Corrile Islands on the Asiatic coast, that they need no interpreter between them. 3. The Kenaians, who live on the mainland, are tall and powerful men, nearly as white as Europeans. They are hunters, and live by trading. They are peaceful, but not cowardly, as the Alutes are, and are able to defend themselves from the Koloshians. 4. The Esquimaux are found on the north coast. Many of the Aleutians, who have been partially civilized by the Russians, live in log huts, and clothe themselves as white people do; the majority, however, dress in skins, and live in holes which they dig in the ground, and cover with a sort of hut of logs. Civilized and uncivilized, all display great ingenuity in making their houses air-tight; every crevice through which the cold wind could enter is closed, and the walls are lined with moss. In these huts, not more than ten feet long and ten wide, half a dozen people will live; day and night they keep up a large fire, until the heat and odor are more than a white man can endure. The filth of these houses is indescribable. During the Russian administration the natives were obliged to bathe once a week in the steam-bath, which was erected in every village. Uncle Sam's advent put an end to this tyranny, and now each man is free, and remains as dirty as he pleases. The food consists of fish dried in the sun, and, when they can get it, black bread and tea. The diseases of the northwest coast are modified by, and in many cases owe their origin to, the peculiar topography of the place and its climate, whether it is that of the coast or interior. In the damp, cold climate along the ocean, where the winds blow the greater portion of the time with great violence directly from the sea, disorders of the respiratory organs are the most frequent. Bronchitis is never absent; catarrh is seen at every change of weather. Sudden changes, when they are severe, often produce a catarrhal fever or influenza, with more or less bronchitis. Pneumonia often occurs, and seemed in sporadic cases to assume a typhoid type. During a few days of unusually warm weather, an epidemic of bilious pneumonia made its appearance at Kodiak, attacking about fifty of the natives. The treatment consisted in opening their doors and windows so as to admit air, attention to the police of their houses, and quinine. Rheumatism is very obstinate, and occurs very often, and generally takes the articular form. Tuberculous diseases are very common among both natives and whites, and occur most frequently among the half-breeds. Phthisis pulmonalis runs a fearfully rapid course. Skin-diseases are much more frequent than in the interior; eczema, especially, is often seen, but yields readily to treatment. Syphilis, in all its forms, seems to be found everywhere on the coast, and, most of all, in places where the whites have traded longest; it is slowly but surely killing all the natives of the northwest coast.
In the interior, rheumatism and bronchitis seem to be the prevailing diseases. On Cook's Inlet I met with a number of cases of intermittent fever: all occurred on a bluff several hundred feet above the sea, and where the houses were exposed to a strong breeze directly from the inlet. These cases were among white people, and might have been contracted elsewhere; but, happening after a sea-voyage of forty days, and in persons previously in good health, I attributed it to the locality. Scurvy also appears frequently in the interior, caused by lack of vegetables and fresh meat, and faulty hygiene. The long nights of that high latitude, the excessive cold and deep snow, and the lack of antiscorbutics, render it difficult to keep large bodies of men entirely free from this disease.
The value of the country may be summed up thus: Its fur-bearing animals are numerous and valuable. There are large and valuable banks of codfish among the islands, and St. Paul and St. George Islands contain fur-seals enough to give to the monopoly having possession the control of the market for that article throughout the world. Beyond this, nothing valuable has been found as yet.
HINTS ON HOUSE-BUILDING.
The great object of sanitary legislation is to secure for each individual the greatest amount of fresh air, pure water, sunshine, and dryness of soil Public sanitation in towns should provide for width of streets, paving, the removal of fluid and solid nuisances, open places for the circulation of air, and recreative resorts for the inhabitants. The width of streets is important in relation to the height of the houses. The width should never be less than the height. The healthiest sites for dwelling-houses are known to be those on trap, granite, and metamorphic rocks, where water readily escapes, and the soil, and consequently the air, is dry. Cholera is rare in houses on such sites. Permeable sandstone, gravel, and chalk, if unmixed with clay, are also healthy. Sands which contain organic matter, clay, and alluvial soils, are always to be suspected. Thorough draining, both subsoil and surface, is a necessary preliminary to building. Dampness of ground necessitates dampness of air and of the walls. This causes chemical alteration in the organic materials in the houses, with absorption of oxygen and discharge of other gases; it favors, too, the growth of low animal and vegetable organisms, which poison the air of the dwellings, and produce disease. The decomposition of the organic contents of the soil is hastened by its dampness, and especially by rapid alterations of its hygrometric state. Calcareous stone is best; some sandstone is so porous that, though dry to-day, it may be soaked with damp to-morrow. Houses should never be built on ground filled up with ashes and other débris. The large amount of organic matter contained in it, which is freely exposed to the action of the air and moisture, becoming decomposed, must cause poisonous emanations, destructive to those who, living above, must breathe it. The drainage and other pipes laid in this soil are extremely liable to be entered by these poisons, and thus they are conducted into houses directly. Frequent sweeping and washing are necessary in every house. Dust is not alone unpleasant, but it is a fruitful source of disease—perhaps the most so. The dust of curtains, carpets, papers, and other colored substances, consisting of organic and coloring matter, being swallowed with the food and inhaled, causes many a doctor's visit. Every house should have a kitchen and wash-room distinct from the dwelling-rooms. The latter should be large enough to allow of each inhabitant obtaining 10 ½ cubic feet of fresh air per hour, when doors and windows are shut. Each house should have abundance of good water for drinking, cooking, and washing, including bathing: five to six pints per day should be allowed for drinking, at least 18 gallons for washing, and eight to 10 should be used daily to flush the sewers. Sick people require more: from 40 to 50 gallons daily. Water-closets consume various quantities, according to their construction. The nature of the closet and the method of removing the contents have become one of the most important questions which advancing civilization has created. The dry-earth system is quite inapplicable to large towns; it suits private houses of the rich or jails well. The Goux system is equally unsuitable. The water system, where there is a plentiful supply of water, is infinitely the best and the cheapest. A sufficient fall of ground can nearly always be obtained. The improvement of the dwelling-house and the establishment of comfortable homes, worthy of human beings, is a necessary duty of the state, and a noble work for the philanthropist. These necessary conditions may be advantageously supplemented by a little comfort and elegance. A little garden is a civilizer of great power.—The Builder
As relates to the claims of this man as a scientific discoverer, a writer in the Engineering and Mining Journal says:
"Mr. Crookes, whose accounts of experiments with the 'Psychic Force' have been severely criticised at home and in this country, replies to a personal attack by Dr. Carpenter in a pamphlet which is attached to the last number of the Quarterly Journal of Science of which Mr. Crookes is editor. Dr. Carpenter's article (published in the Quarterly Review) was certainly a savage assault; and the style of Mr. Crookes's reply is calculated to win the sympathy of the reader. We have not entered the debate upon Psychic Force, and we do not care to express an opinion concerning the furious personalities into which it has degenerated. But we lost confidence in Mr. Crookes a good while ago; and in this last vindication of himself he has repeated the offence which dishonored him then in the eyes of all who were familiar with the facts. These we shall briefly recapitulate:
"1. The discovery of sodium-amalgam and its uses by Prof. Henry Wurtz, of this city, and his application for a patent for the invention was swiftly followed by a similar invention by Mr. Crookes, in London, which led to a discussion of the question of priority and originality.
"2. In this discussion, all the dates of announcement, application, issuance of patent—in fact, the whole of the circumstantial evidence—were in favor of the American chemist. Mr. Crookes was on the defensive throughout; he never breathed the suggestion that Prof. Wurtz got the idea from him; on the contrary, he attempted to remove the very natural suspicion that he received the hint of it, at least, from the American Patent-Office, through some one of the spies, who, it is well known, make a business of sending to England information of new discoveries to be patented there (according to the lovely British law) by the 'introducer' without reference to original authorship. We repeat that Mr. Crookes rested on his own solemn declaration that this was not the case with the sodium-amalgam patent; that the instance was one of independent, simultaneous discovery, not unknown in the history of science. This declaration of Mr. Crookes was accepted, in view of his respectable standing, as conclusive; and certain curious coincidences between his specifications and the earliest papers filed at Washington, by Prof. Wurtz, were ranked as accidental.
"3. A year or two later, Mr. Crookes published a translation of Kerl's 'Metallurgy,' and in the chapter on silver introduced a flattering description of Crookes's Sodium-Amalgamation Process. No allusion whatever is made to Prof. Wurtz in the book. This is brazen enough; but worse remains behind. A letter in the San Francisco Mining and Scientific Press; an address by Prof. Silliman before the National Academy of Science at Washington; an account of experiments at Tulare County, California, published in a San Francisco paper; and an account of experiments in Colorado, given in this paper (then the American Journal of Mining), are all quoted as referring to Crookes's process, whereas they all referred to the process patented in this country by Prof. Wurtz. Some of these documents, indeed, contained his name, which Mr. Crookes deliberately avoided quoting.
"4. We branded this piece of dishonesty as it deserved, more than three years ago; and we have never seen or heard of any 'vindication' from Mr. Crookes. And now, in his reply to Dr. Carpenter, he proudly alludes to his discovery of sodium-amalgam, extensively used in Australia, California, etc., as one of his claims to the respect of scientific men. The psychic force of 'a lie, well stuck to,' is proverbial; but it will not work in this case, across the Atlantic Ocean. We do not accept any statements whatever, on the authority of Mr. Crookes, until he has confessed and atoned for the outrage we have now for the second time exposed.
"It is quite immaterial whether he did really discover sodium-amalgam; it is immaterial that the discovery is of no great practical value, and that the process is not in general use anywhere, and has long been abandoned in this country. Our charge is not against the originality or the value of Mr. Crookes's 'invention;' it affects directly his conception of truthfulness and honor, his claims to belief as a witness and to respect as a man. According to our notions of the brotherhood of science, its members always confide in one another's sincerity and good faith. A person who cannot be trusted so far is, ipso facto, not a member."
- Remarks before the Clinical Society of London.