Popular Lectures on Zoonomia Part 18

Nervous complaints may therefore be divided, like all other diseases, into two cla.s.ses. First, those in which the excitement is increased, or in which it verges to, or has actually reached, the point of predisposition to sthenic disease; Secondly, those in which the excitement is diminished, or in which it verges towards asthenic disease. This last cla.s.s, as has been done before, may be subdivided into two orders. The first will comprise those diseases in which the excitability is sufficiently abundant, or even acc.u.mulated, but where the excitement is deficient from a want of energy in the exciting powers. In the second, there has been no deficiency in the action of the exciting powers; but on the contrary, probably for a considerable time, some of the diffusible stimuli not natural to life have been applied; in this case, the excitability has become exhausted, and a proper degree of excitement cannot be produced by the action of the common exciting powers.

No diseases show so clearly the fallacy of trusting to symptoms, as those of the former cla.s.s. I have met with innumerable cases of this kind, in which, if you were to trust to the patients own description, they laboured under considerable debility; and had it not been for the particular attention I paid to my own case, I should not probably have suspected that a directly opposite state of the system may produce these symptoms.

From inheriting a good const.i.tution, and being brought up in the country in a hardy manner, I am so much predisposed to the sthenic state, that I may consider the state of my excitement, as generally, indeed almost always, above the point of health: and unless I live in the most temperate, and even abstemious manner, the excitement is extremely liable to overstep the bounds of predisposition, and fall into sthenic disease. I have had several attacks of this kind of disease; and indeed, I never remember to have laboured under any disease of debility, or diminished excitement.

Health, according to the view we have taken of it, may be compared to a musical string, tuned to a certain pitch, or note; and though perhaps in the great bulk of mankind, either from the manner of living, or from other circ.u.mstances, the excitement is a little below, and requires to be screwed up to the healthy pitch, yet there are others where it is apt to get constantly above, and where it requires letting down to this pitch; my const.i.tution is one of these: but I have this consolation, that if I can for a few years ward off the fatal effects of some acute sthenic diseases, this tendency to sthenic diathesis will gradually wear off, and I may probably enjoy a state of good health, at a time, when most const.i.tutions of an opposite cast begin to give way. Whenever I have for some time lived rather fully, though by no means intemperately, after having for some days, or perhaps some weeks experienced an unusually good flow of spirits, and taken exercise with pleasure, I begin, first of all, to have disturbed sleep, I find myself inclined to sleep in the morning, as if I had not been refreshed by the night's sleep; my spirits become low, and I am apt to look upon the gloomy side of every thing I undertake or do. I feel a general sense of languor and debility, and am ready, as I have heard many patients labouring under the same state exclaim, to sink into the earth. From the slightest causes, I am apt to apprehend the most serious evils, and my temper becomes irritable, and scarcely to be pleased with any thing. If in this state, I take exercise, I soon feel myself fatigued; a disagreeable stupor comes on, without, however, the least degree of perspiration, and I feel an inability to move.

At first, I used to imagine these to be symptoms of debility, or diminished excitement, nor was it till after several ineffectual trials to relieve them by the tonic, or stimulant plan, that I was convinced of my mistake. This plan always caused an aggravation of every symptom, and if I persevered in it, an inflammatory disease was sure to be the consequence. Indeed, I might have suspected this, from considering, that these symptoms had been brought on by full living, and preceded by good spirits; but my mind had received such a prejudice from the writings of medical men, who had uniformly described these as a train of nervous symptoms, as they called them, depending on a debilitated state of the nervous system, that I was blind to conviction, till repeated disappointment from the stimulating plan, convinced me I must be wrong. The only alternative therefore, was a contrary plan, and the immediate relief I experienced, was a proof that I had detected the real nature of the complaint. Since that time, I can at any time prevent these unpleasant symptoms, by an abstemious course of life, and remove them, when they have come on, by the debilitating plan; which, instead of weakening, gives additional elasticity and strength to the fibres, and alacrity to the spirits. I have described the symptoms in one case, as this will serve as a general description. We may add, that persons labouring under this kind of predisposition, are particularly attentive to the state of their own health, and to every change of feeling in their bodies; and from every uneasy sensation, perhaps of the slightest kind, they apprehend great danger, and even death itself. In cases of this kind, the bowels are generally costive, and the spirits of the patient are very apt to be affected by changes in the weather, particularly by a fall of the barometer.

How the diminution of atmospheric pressure acts in increasing the symptoms, we perhaps do not know; but its effects are experienced almost universally.

It is evident, that the only mode of cure in cases of this kind is extreme temperance: animal food should be taken sparingly, and wine and spirits in general totally abstained from. The bowels should be kept open by any mild neutral salt. I have generally found magnesia and lemonade to agree remarkably well in such cases. Exercise on horseback, is also particularly useful; bark, bitters, and the fetid and antispasmodic medicines, which are generally prescribed in such cases, are extremely hurtful.

This view of nervous complaints is, I may venture to say, as new as it is just. It has never been imagined, that any of them depended upon too great excitement; on the contrary, they have been universally considered as originating in debility, and of course, tonics were prescribed, which, though they produced the greatest benefit in the other cla.s.s of nervous complaints, in these they occasioned the most serious evils, and often brought on real inflammatory diseases, or even diseases of indirect debility, as I have repeatedly seen.

These cases cannot at first sight, however, be easily distinguished from those of the opposite cla.s.s; the symptoms being nearly alike, and the patient complaining of languor, debility, and extreme depression of spirits in both. But by attending carefully to the effects produced by the exciting powers, they may in general be distinguished. A patient of this kind will tell you, that he does not feel pleasant effects from wine, or spirituous liquors; instead of exhilaration, his spirits become depressed by them; whereas, in the contrary state, he finds almost instant relief. By attending to circ.u.mstances of this kind, the nature of the complaint may in general be ascertained.

Highly seasoned, and strongly stimulant foods should in the sthenic hypochondriasis, if it may be so called, be avoided; but the most mischievous agent of all, and which contributes to bring on the greater number of these complaints, is wine. This, I believe, produces more diseases, than all other causes put together. Every person is ready to allow, that wine taken to excess is hurtful, because he sees immediate evils follow; but the distant effects, which require more attentive observation to perceive, very few see, and believe; and, judging from pleasant and agreeable feelings, they say that a little wine is wholesome, and good for every one; and accordingly take it every day, and even give it to their children; thus debauching their natural taste in the earliest infancy, and teaching them to relish what will injure their const.i.tutions; but which, if properly abstained from, would prove one of the most valuable cordial medicines we possess.

The idea that wine or spirituous liquors a.s.sist digestion, is false.

Those who are acquainted with chemistry, know that food is hardened, and rendered less digestible by these means; and the stimulus, which wine gives to the stomach, is not necessary, excepting to those who have exhausted the excitability of that organ, by the excessive use of strong liquors. In these, the stomach can scarcely be excited to action, without the a.s.sistance of such a stimulus. If the food wants diluting, water is the best diluent. Water is the only liquor that nature knows, or has provided for animals; and whatever nature gives us, is, we may depend upon it, the best, and safest for us. Wine ought to be reserved as a cordial in sickness, and in old age; and a most salutary remedy would it prove, did we not exhaust its power by daily use.

I am sensible that I am treading on delicate ground, but I am determined to speak my sentiments with plainness and sincerity, since the health and welfare of thousands are concerned. Most persons have so indulged themselves in this pernicious habit of drinking wine, that they imagine they cannot live without a little every day; they think that their very existence depends upon it, and that their stomachs require it. Similar arguments may be brought in favour of every other bad habit. Though, at first, the violence we do to nature makes her revolt; in a little time she submits, and is not only reconciled, but grows fond of the habit; and we think it necessary to our existence: neither the flavour of wine, of opium, of snuff, or of tobacco, are naturally agreeable to us: on the contrary, they are highly unpleasant at first; but by the force of habit they become pleasant.

It is, however, the business of rational beings to distinguish carefully, between the real wants of nature, and the artificial calls of habit; and when we find that the last begin to injure us, we ought to use the most persevering efforts to break the enchantment of bad customs; and though it cost us some uneasy sensations at first, we must learn to bear them patiently; a little time will reward us for our forbearance, by a reestablishment of health and spirits.

I shall now proceed to examine the opposite cla.s.s of nervous complaints: or such as do really depend on debility, or an asthenic state of the system. These may be divided into two orders; viz. those of direct, and those of indirect debility. I shall first consider those of direct debility.

Though these complaints originate from a deficiency of stimulus, yet it is very seldom from a deficiency of the common stimulant powers.

The only people, who in general labour under this deficiency of the common stimulants, are the poor; they are seldom troubled with nervous complaints; their daily exercise, and constant attention to procure common necessaries, prevent their feeling what so grievously afflicts the rich and luxurious. These complaints arise chiefly from a deficiency of mental stimuli. The most common cause of them, and whose effects are the most difficult to remove, is to be looked for in the mind.

The pa.s.sions and emotions, when exercised with moderation, and kept within proper bounds, are the sources of life and activity; without these precious affections, we should be reduced to a kind of vegetation, equally removed from pleasure and from pain. For want of these elastic springs, the animal spirits lose their regularity and play; life becomes a lethargic sleep, and we fall into indifference and languor.

If then the pa.s.sions are so necessary to the support of the health of the body, when in a proper degree, can we expect, that when they are inordinate or excessive, or even deficient, we shall escape with impunity? tumultuous pa.s.sions are like torrents, which overflow their bounds, and tear up every thing before them; and mournful experience convinces us, that these effects of the mind are easily communicated to the body. We ought, therefore, to be particularly on our guard against their seduction.

"'Tis the great art of life to manage well The restless mind."

It is particularly in their infancy, if it may be so called, that we ought to be upon our guard against their seduction; they are then soothing and insidious; but if we suffer them to gain strength, and establish their empire, reason, obscured and overcome, rests in a shameful dependence upon the senses; her light becomes too faint to be seen, and her voice too feeble to be heard; and the soul, hurried on by an impulse to which no obstacle is presented, communicates to the body its languor and debility. The pa.s.sions, by which the body is chiefly affected, are, joy, grief, hope, fear, love, hatred, and anger. Any others may be reduced to some of these, or are compounded of them. The pleasurable pa.s.sions produce strong excitement of the body, while the depressing pa.s.sions diminish the excitement; indeed it would seem that grief is only a diminution of joy, as cold is of heat; when this pa.s.sion exists in a proper degree, then we feel no particular exhilarating sensation, but our spirits and health are good: we cannot doubt, however, that we are excited by a pleasant sensation, though we are unable to perceive it. In the same manner, when heat acts moderately, or is about the degree we call temperate, we do not perceive its effects on the body, though there can be no doubt, that the body is under the influence of its stimulus, and powerfully excited by it; for when it is diminished, or cold applied, we feel a deficiency of excitement, and become afterwards more sensible of heat afterwards applied.

The same takes place with respect to joy and grief, and proves, I think, clearly, that the one is only a diminution of the other, and that they are not different pa.s.sions. When the body has been exposed to severe cold, the excitability becomes so much acc.u.mulated with respect to heat, that if it be afterwards applied too powerfully, a violent action, with a rapid exhaustion of the excitability, which ends in mortification, or death of the part, will take place. We should therefore apply heat in the gentlest manner possible, and gradually exhaust the morbidly acc.u.mulated excitability.

In the same manner, when the body has been under the influence of violent grief, any sudden joy has been known to overpower the system, and even produce instant death. We have an instance in history, of a mother being plunged into the extreme of grief, on being informed that her son was slain in battle; but when news was brought her, that he was alive, and well, the effect upon her spirits was such, as to bring on instant death. This event ought to have been unfolded to her in the most gradual manner; she should have been told, for instance, that he was severely wounded; but that it was not certain he was dead; then that there was a report he was living, which should have been gradually confirmed, as she could bear it. The same observations may be made, with respect to hope and fear, or despair; the former is an exciting pa.s.sion, the latter, a depressing one; but the one is only a lower degree of the other; for a moderate degree of hope produces a pleasant state of serenity of the mind, and contributes to the health of the body; but a diminution of it weakens; and a great degree of despair so acc.u.mulates the excitability of the system, as to render it liable to be overpowered by any sudden hope or joy afterwards applied. What proves that joy and hope act by stimulating, and grief and despair by withdrawing stimulant action from the body, is, that the former exhaust excitability, while the latter acc.u.mulate it. Joy, for instance, does not render the system more liable to be affected by hope, but the reverse; and the same may be said of hope.

In the same way, heat does not render the body more liable to be affected by food, but the reverse. Both these are stimulants, and exhaust the excitability. But after heat has been applied, if it be followed by cold, a great degree of languor or weakness will take place; because we have here a direct debility, added to indirect debility. In the same way, grief succeeding joy, or despair succeeding hope, produce a greater degree of dejection, both of mind and body, than if they had not been preceded by these stimulant pa.s.sions; because here, direct debility is added to indirect. The excitability is first exhausted, and then the stimulus is withdrawn.

We see then, that the pa.s.sions of the mind act as stimulants to the body, that, when in a proper degree, they tend to preserve it in health; but when their action is either too powerful, or too small, they produce the same effects as the other powers. We should therefore naturally expect, that when there is a deficient action of this kind of mental stimulus, or when the mind is under the influence of the depressing pa.s.sions, a predisposition to diseases of direct debility would take place, and even these diseases be produced.

Accordingly we find a numerous cla.s.s of nervous complaints originating from these causes. Indeed, the undue action of the mental stimulants, produces more quick alterations in the state of the excitement, than that of the other exciting powers. Violent grief, or vexation, will immediately suspend the powers of the stomach. If we suppose a person in the best health, and highest good humour, sitting down to dinner with his friends, if he suddenly receives any afflicting news, his appet.i.te is instantly gone, he cannot swallow a morsel. If the same thing happens after he has made a hearty dinner, the action of the stomach is suddenly suspended, and the whole process of digestion stopped, and what he has eaten, lies a most oppressive load. But this is not all: the whole circulation of the blood becomes disturbed; the contraction and dilatation of the heart become irregular; it flutters, and palpitates; hence all the secretions become irregular, some of the glands acting too powerfully, others not at all; hence the increased action of the kidneys, and hence a burst of tears; hysterical affections, epilepsy, and syncope, frequently succeed, in which every muscle of the body becomes convulsed. Indeed, many terrible diseases originate from this source, which were formerly ascribed to witchcraft, and the possession of devils.

In slower, more silent, but longer continued grief, the effects are similar, but not so violent. The functions of the stomach are more gently disturbed, its juices vitiated; and acidity, and other symptoms of indigestion, will show themselves. Hence no bland and nutritive chyle is conveyed into the blood; whence emaciation and general debility must follow; and the patient will at last die, as it is said, of a broken heart.

Besides the disturbed state of the stomach, and bad digestion, there can be no sleep in this state of mind; for,

"Sleep, like the world, his ready visit pays, Where fortune smiles; the wretched he forsakes; Swift on his downy pinion flies from woe, And lights on lids unsullied with a tear."

Hence the animal spirits will not be recruited, nor the worn out organs restored to vigour.

The minds of patients labouring under this division of nervous diseases, are likewise in general filled with over anxiety concerning their health; attentive to every feeling, they find, in trifles light as air, strong confirmations of their apprehensions.

It is evident, that in these cases, a state of direct debility prevails, attended with a morbidly acc.u.mulated excitability; hence, those remedies afford relief, which produce a quick exhaustion of this principle, and thus blunt the feelings, and lull the mind into some degree of forgetfulness of its woes. Hence opium, tobacco, and the fetid gums are often resorted to; and in the hands of a judicious pract.i.tioner, they will afford great relief, provided he carefully watch the patient, and prevent their abuse; for, if left to the discretion of the patient, he finds that kind of relief which he has long wished for; his moderation knows no bounds, and he is apt to take them in such a manner, as to add indirect debility, to direct, and thus bring on a state of exhausted excitability, while there is still a diminished state of mental stimulants. This will cause his spirits to be more depressed than ever; he will therefore increase the dose, whether it be of opium, tobacco, or spirituous liquors, and thus he will be hurried on, adding fuel to the flame, till his exhausted excitability becomes irrecoverable, and he ends his days in a miserable state of imbecility, if not by suicide. Hence, though some of these narcotic stimulants, which exhaust the excitability, and blunt the feelings, may be employed with advantage, in order to prepare the mind for those changes, which the physician wishes to produce, they should be used with the greatest caution, and never left in any degree to the discretion of the patient. The cure, however, depends chiefly on regulating the state of the mind, or interrupting the attention of the patient; and diverting it, if possible, to other objects than his own feeling.

Whatever aversion to application of any kind we may meet with in patients of this cla.s.s, we may be a.s.sured that nothing is more pernicious to them than absolute idleness, or a vacancy from all earnest pursuit.

The occupations of business suitable to their circ.u.mstances, and situations in life, if neither attended with emotion, anxiety, nor fatigue, are always to be advised to such patients; but occupations which are objects of anxiety, and more particularly such as are exposed to accidental interruptions, disappointments, and failures, are very improper for patients of this cla.s.s.

To such patients exercise in the open air is of the utmost consequence. Of all the various methods of preserving health and preventing diseases, which nature has suggested, there is none more efficacious than exercise. It puts the fluids all in motion, strengthens the solids, promotes digestion, and perspiration, and occasions the decomposition of a larger quant.i.ty of air in the lungs, and thus not only more heat, but more vital energy is supplied to the body; and of all the various modes of exercise, none conduces so much to the health of the body, as riding on horseback: it is not attended with the fatigue of walking, and the free air is more enjoyed in this way, than by any other mode of exercise. The system of the vena portarum, which collects the blood from the abdominal viscera, and circulates it through the liver, is likewise rendered more active, by this kind of exercise, than by any other, and thus a torpid state, not only of the bowels, but of this system of vessels, and the biliary system, is prevented.

When a patient of this cla.s.s, however, goes out for the sake of exercise only, it does not in general produce so good an effect, as might be expected; for he is continually brooding over the state of his health: there is no new object to arrest his attention, and he is constantly reminded of the cause of his riding. Exercise will therefore be most effectual when employed in the pursuit of a journey, where a succession of pleasant scenes are likely to present themselves, and new objects arise, which call forth his attention. A journey likewise withdraws the patient from many objects of uneasiness and care, which might present themselves at home.

With respect to medicines, costiveness, which often attends these diseases, ought to be carefully avoided, by some mild laxative.

Calcined magnesia, and lemonade, have always seemed to me to answer the purpose; but the most effectual method is to acquire a regular habit, which may be done by perseverance, and strict attention.

Chalybeate waters have been frequently tried, and may in general be recommended with success, particularly, as the amus.e.m.e.nt and exercise generally accompanying the use of these waters, aid the tonic powers of the iron. The bark may likewise be exhibited with advantage.

There is yet another cla.s.s of nervous diseases which we have to notice, which are by no means uncommon; yet they have, like the first cla.s.s, escaped the attention of writers on this subject, and of medical pract.i.tioners in general: I mean those where the system is in a state of torpor, or exhausted excitability.

This state of the system may be brought on by various causes, but princ.i.p.ally by the long continued use of opium, tobacco, or fermented liquors.

When these substances, which are powerful stimulants, have been taken for some time, they bring on a state of the system so torpid, that the usual exciting powers, and the usual occurrences, which in general produce pleasant sensations, do not occasion a sufficient degree of excitement, in those whose excitability is thus exhausted.

They therefore feel continual languor and listlessness, unless when under the influence of the stimulus which brought on the exhaustion.

Every scene, however beautiful, is beheld with indifference by such patients, and the degree of ennui they feel is insupportable: this makes them have recourse to the stimulus which has exhausted their excitability, which in some degree removes this languor for a time; but it returns with redoubled strength, and redoubled horror, when the stimulant effect is over: and as this repet.i.tion exhausts the excitability more and more, the stimulus is repeated in greater quant.i.ty, and thus the disease increases to a most alarming degree.

There is no way of curing this state of nervous torpor, but by leaving off the stimuli which caused the exhaustion; and if the patient have resolution to do this for a few weeks, though, at first, he will, no doubt, find his spirits a little depressed, he will ultimately overcome the habit, and will be rewarded by alacrity of spirits, such as he never experiences under the most powerful action of artificial stimulants.

I must not, however, forget to notice, that there is a nervous state, or ennui, originating from a wrong direction of mental exertion, which exhausts the excitability to a great degree, and brings on a state of depression scarcely to be born.

When a person has by habit made his mind constantly dependent on dissipation, on gaming, and on frivolous, but not inactive pursuits, in order to produce pleasurable sensations, and at the same time neglected that culture of the understanding which will enable him to retire into himself with pleasure, and receive more enjoyment from the exercise of this cultivated understanding than he does in the most noisy, or fas.h.i.+onable circle of dissipation: I say, when there is this vacancy of mind, whenever it is not engaged in such pursuits as I have mentioned, a languor and weariness is experienced, which is intolerable, and which prompts the person so circ.u.mstanced, to fly continually to the only scenes which interest his mind. Hence, the pa.s.sion for gaming, in which the anxiety attending it causes an interest in the mind, which takes off the dreadful languor experienced, when it is not thus employed.

It is owing to wealth, admitting of indolence, and yielding to the pursuit of transitory and unsatisfying amus.e.m.e.nts, or to that of exhausting pleasures only, that the present times exhibit to us so many instances of persons suffering under this state: it is a state totally unknown to the poor, who labour for their daily bread, and to those whose minds are actively employed in study or business. It can only be cured by cultivating the understanding, and applying to some art or science, which will engage and interest the attention. I have received the thanks of many for recommending the study of philosophy, and particularly of chemistry, to their attention. This affords a rational and interesting pursuit, which, if entered into with ardour, and if the person actually works, or makes experiments himself, he will soon experience an enjoyment and an interest, such as he never experienced at the gaming table, or at any other place of fas.h.i.+onable amus.e.m.e.nt. Nay, I will venture to say, that all elegant amus.e.m.e.nts will be enjoyed with much greater relish by one who employs himself in some rational pursuit, and only resorts to such amus.e.m.e.nts as a relaxation, than by one who makes these amus.e.m.e.nts a business.

From the view we have taken of these complaints, it is evident, that they are like other general diseases of the sthenic, or asthenic kind; they seem to const.i.tute a state of the body between predisposition and disease; and they differ from most diseases in this, that in most complaints the increase, or diminution of the excitement is unequal in different parts of the body, and this gives rise to the different forms of disease; but in nervous complaints the excitement seems much more equably affected in different parts. These complaints, as we have seen, may be divided into three cla.s.ses; sthenic; those of acc.u.mulated excitability; and those of exhausted excitability: but though they are evidently distinguishable in this manner, and require different modes of cure, I have never seen any account of more than one kind in any medical writer: the same remedies were prescribed for all, however different they might be.

Though medicines may relieve complaints of this kind, and particularly those of the second cla.s.s, yet from what has been said, it must be evident, that much more may be done by regulating the action of the common exciting powers. Indeed, this is the case in most chronic diseases. Exercise and temperance will do infinitely more than medicine. By their means, most diseases may be overcome; but without them we may administer drugs as long as we please.

Voltaire sets this advice, which I have frequently inculcated, in so strong a light, that it may perhaps carry more conviction than any thing I can say. Ogul was a voluptuary, ambitious of nothing but good living: he thought that G.o.d had sent him into the world for no other purpose than to eat and drink: his physician, who had but little credit with him, when he had a good digestion, governed him with despotic sway, when he had eaten too much.

On feeling himself much and seriously indisposed by indolence and intemperance, he requested to know what he was to do, and the doctor ordered him to eat a basilisk, stewed in rose water, which he a.s.serted would effect a complete cure. His slaves searched in vain for a basilisk; at last they met with Zadig, who was introduced to this mighty lord, and spoke to him in the following terms.

"May immortal health descend from Heaven to bless all thy days! I am a physician: at the report of thy indisposition, I flew to thy castle, and have now brought thee a basilisk, stewed in rose water.

But, my lord, the basilisk is not to be eaten; all its virtue must enter through thy pores. I have enclosed it in a little ball, blown up and covered with a fine skin. Thou must strike this ball, with all thy might, and I must strike it back for a considerable time: and by observing this regimen for a few days, thou wilt see the effects of my art." The first day Ogul was out of breath, and thought he should have died with fatigue; the second he was less fatigued, and slept better. In eight days he recovered all the strength, all the health, all the agility and cheerfulness of his most agreeable years. Zadig then said unto him, "there is no such thing in nature as a basilisk; but thou hast taken exercise, and been temperate, and hast recovered thy health." In the same manner I say, that temperance and exercise are the two great preservers of health, and restorers of it when it is lost; and that the art of reconciling intemperance and health is as chimerical, as was.h.i.+ng the Ethiopian white.