A treatise on the causes and consequences of habitual constipation

Preface

The object of this Treatise is to direct attention to ha¬ bitual constipation as a very frequent cause of general and of local disorder and disease ; a subject but partially considered and investigated hitherto.

For some interesting cases illustrative of parts of this work I am indebted to Dr. Williams, Dr. Stroud, Mr. Cal¬ laway, Mr. Morgan, Mr. Taunton, Dr. Roots, Sir Astley Cooper, Sir Benjamin Brodid*, Mr. Tupper, Mr. Bailer, Dr. Paris, Mr. Dendy, Dr. Hen. U. Thomson; to all of whom I return my grateful thanks.

To the late Mr. Jukes of Stourport, Worcestershire, I am under great obligation not only for the valuable cases supplied by him, but for personal kindness shown to me on many occasions. I gladly avail myself of this opportunity to express my respect and regard for the virtues and abili¬ ties of that estimable man.

24, Lower Brook Street, February 1, 1840.

J. B.

Contents

INTRODUCTION . P. 13

Chapter I

OF THE DISPOSITION, RELATIONS, ORGANIZATION, AND FUNCTIONS OF THE LARGE INTESTINE . . 16

Chapter II. General Remarks Upon, And Various Consequences Of Habitual

CONSTIPATION.

Inconvenience of Constipation. — Habitual Constipation a Source of general Dis¬ order and of local disease. — Tumours of the Breast dissipated. — Loaded Colon mistaken for Disease of the Liver. — Congestion of the Portal System and Disease of the Liver. — Hypochondriasis. — Neuralgia. — Epilepsy. — Spasmodic Contrac¬ tions of Muscles. — Duration of Constipation . 21

Chapter XII

ON THE INFLUENCE OF CONSTIPATION, AND OF THE ACCUMULATION OF MORBID SECRETIONS AND FECAL MATTERS IN THE LARGE BOWELS IN PREDISPOSING TO AND EXCITING THE MORE PREVALENT

diseases of india : namely, CONGESTION, inflammation, and ABSCESS OF THE LIVER, DIARRHOEA, DYSENTERY, AND ORGANIC DISEASES OF THE LARGE INTESTINE .... 154

THE CAUSES AND CONSEfllUENCES

OF

HABITUAL CONSTIPATION.

Introduction

Upwards of twenty years have now elapsed since my attention was directed to the influence of disorders of the digestive organs upon the general health by the admirable lectures of Mr. Abernethy. From the hour I first listened to the doctrines of that distinguished teacher, my mind has been so impressed with their importance, that I have taken advantage of every opportunity to test their general accuracy, and to investigate, in a more special manner, the sources of the numerous derangements comprised in disorders of the digestive organs.

I had pursued this inquiry but a short time, W'hen I wras struck with the frequency of one particular cause, which could be traced as the only one in operation from the period of health to the esta¬ blishment of the disorders the subjects of investigation. I found, moreover, that these disorders ceased on the removal of this the presumptive cause; and thence concluded that they stood in the relation of effect to such cause.

Next I discovered that this same cause had existed through a long period in diseases apparently only remotely connected with it; and then proceeded to ascertain its relation to these diseases, by tracing back, step by step, the manner of their formation : and the evidence which has resulted authorises me to attribute the origin and establishment of these diseases to the continued operation of the cause in question ; namely, Habitual Constipation.

Arrived at the belief that habitual constipation is capable of pro-

BURNE ON HABITUAL CONSTIPATION.

during very many disorders, I have devoted much time and atten¬ tion to discover the range of its influence and to inquire into its more immediate and remote effects : and the information obtained enables me to particularise a list of complaints which may reasonably, I think, be regarded as the consequences of habitual constipation. Nor have I presumed to reach this conclusion without having seen disease on an extensive scale at a dispensary and at a general hos¬ pital, independent of private practice, on a scale which has afforded an ample field for the observation and experience requisite to justify new views, and to form sound opinions.

Of the disorders alluded to, some are the result of universal sym¬ pathy ; some of contiguous, others of remote, sympathy ; and some of physical irritation, and of direct mechanical operation.

As the result of universal sympathy, may be enumerated those disordered conditions of the general health which predispose to any inveterate, or even malignant, disease, the local development of which, accident or other cause, may determine.

Of contiguous sympathy are irritation of the sexual organs in men ; and many very serious affections of the sexual organs in women, as irritation, tenderness, and hypertrophy of the uterus ; irregular menstruation ; abortion ; leucorrhoea. Of remote sym¬ pathy are indigestion ; sick-headach; pyrosis; erysipelas; neuralgia; and spasmodic contraction of muscles, as of the jaw producing trismus, and of the extremities producing deformity. Of physical irritation are spasmodic colic ; rigidity of the sphincter ani ; fistula ani; stricture of the rectum or other part of the large intestine ; tenesmus ; dysentery ; and symptoms simulating strangulated her¬ nia. Of direct mechanical operation are dilatation of the rectum ; haemorrhoids ; and prolapsus ani.

It gratifies me to find in the elaborate work of Dr. Good, that constipation is regarded as a cause of various complaints. “ The effects of constipation when long continued, are,” he says, “ pains in the head, nausea and sickness at the stomach, febrile irritation, general uneasiness in the abdominal region, congestion in the ab¬ dominal organs ; and hence an impeded circulation of the blood, piles, varices in the lower limbs, and, as we have already seen, colic. Many hysterical affections, chlorosis, and chorea or St. Vitus’s dance, formerly supposed to be unconnected with the state of the bowels, are now proved to be very prejudicially influenced, if not excited, by constipation. Even symptoms, bad enough to cause the case to be set down as phthisis, and the patient to be sent to Madeira, were ascertained by Dr. Borthwick to arise from habitual costiveness, and to yield to purgatives.”*

The practical and much valued “ Observations” of Dr. Hamilton on Purgative Medicines have not occupied the ground, or antici¬ pated the subject, of the present work. He remarks, “ This con-

* Study of Medicine: by John Mason Good, M.D. Fourth edition. By Samuel Cooper, vol. i. p. 192, 193.

INTRODUCTION.

stitutional costiveness is of dangerous tendency, and however desir¬ able it may be to rectify it, the consideration of it is not compre¬ hended in my present plan, which embraces only a few diseases, of which I consider costiveness to be the cause, or in which I appre¬ hend it to be a leading or permanent symptom.”* * * §

The extensive experience and acute observation of this excellent physician impressed him with the conviction, that “ the constipated and loaded state of the intestinal canal is a common cause of general bad health.”f Further, he says, that “ in mature age, and in the decline of life, symptoms, which are attributed to previous irregularities, to idiosyncrasy, to hereditary disposition, to disease, and to approaching old age, frequently arise from constipation of the bowels, or are intimately connected with it. The consideration, however, of these is but partly comprehended in my present under¬ taking.”

“ Thus I have learned, that a knowledge how to regulate the alvine evacuation, constitutes much of the prophylactic part of medicine ; and hence how necessary it is to advise those, who either wish to preserve good health, or who are in quest of the lost treasure, to attend to this circumstance.”;);

The acknowledged valuable principles established by Mr. Abernethy, of the influence of disorders of the digestive organs upon local disease, and of the reciprocal influence of local disease upon the digestive organs, wrere deduced from an extensive general observation of external disease. Assured of the principles, he did not engage himself in the analysis requisite to distinguish the special characters and sources of these disorders : but, with the candour of a great mind and with a view to encourage further inquiry, he remarked that “ accurate attention to the subject, especially in medical cases, may lead to important sub-divisions, which I haye not yet been able to make that “ The subject is so important, that the public would be highly indebted to any practitioner who would point out the varieties of these diseases, and the appropriate modes of cure.”§ It is this task which I propose to myself ; in so far at least as relates to all those affections which, in my belief, arise from habitual constipation.

Among these affections it will be seen that I have not included chorea or chlorosis, for the reason that experience has not satisfied me of the propriety of ranking these disorders among the conse¬ quences of habitual constipation, though unquestionably they are aggravated and protracted by it ; and for the reason also, that their connexion with a deranged state of the alimentary canal, and the beneficial influence which purgatives exercise upon them, have been so ably pointed out and illustrated by Dr. Hamilton.

* Observations on the Utility and Administration of Purgative Medicines in several Diseases. By James Hamilton, M.D. Second edition. Edinburgh, f Op. cit. p. 6. £ Op. cit. p. 7.

§ Abernethy on Diseases of the Digestive Organs, p. 42. 61.

BURNE ON HABITUAL CONSTIPATION.

Chapter I. Of The Disposition, Relations, Organization, And Functions Of

♦ THE LARGE INTESTINE.

Disposition. — The large intestine, consisting of the caecum, colon, and rectum, is more spacious, though less long, than the small in¬ testine. The caecum is situated in the right iliac fossa, and the colon, directing itself upwards, takes a circuitous course around the abdominal cavity ; and, after forming the sigmoid flexure on the left side, gains the pelvis, into which it dips to terminate continu¬ ously in the rectum.

In this course the ascending colon passes in front of the right kidney, and continuing along the anterior edge and under surface of the liver, in contact with it and with the gall bladder, traverses the upper part of the abdomen in a line with, and rather below, the large curvature of the stomach; and now, having, gained the left side, descends in front of the corresponding kidney as far as the spine of the ilium, where its tortuous course forms the sigmoid flex¬ ure, which, proceeding across the ilio-sacral articulation, dips into the pelvis to form the rectum, as has been stated.

Relations. — In thus performing the extensive circle of the abdo¬ men, the colon places itself in contiguous relation with all the viscera of that cavity ; with the liver, stomach and spleen on its outer line of circumference ; with the duodenum and convolutions of the small intestine on its inner line; and with the kidneys and hepatic and pancreatic ducts on its posterior. The rectum also, in its course through the pelvis, lies in a similar relation with the prostate gland, vesiculse seminales, bladder, and urethra in the male; and with the uterus and vagina in the female.

How varied and great, then, are the sympathies that may yesult from this extensive and multiplied relation of contiguity between the large intestine and so many important organs of the abdomen and pelvis; and how worthy of research and elucidation are the disor¬ ders not only of this intestine itself, but of all those other organs which are connected with it by the relation of sympath}'.

Organization. — The peculiar organization of the large intestine consists in its longitudinal muscular fibres being collected into three ribbon-like bands, which, being of less length than the intestine it¬ self, cause it to be wrinkled across, and thus to form bulgings or cellules separated by corresponding depressions or furrows. These ribbon-like bands, commencing at the caecum, extend along the whole tract of the colon ; and, converging as they gain the rectum, surround this bowel with an exceedingly thick and strong muscular tunic.

The interior of the large intestine is lined by a mucous mem¬ brane, the villosities of which are much less apparent than in the

OF THE LARGE INTESTINE.

small intestine. It has scarcely any valvulse conniventes, but is fur¬ nished with a great number of muciparous glands, large and soli¬ tary. Its supply of blood from the mesenteric arteries is less abun¬ dant than the supply to the small intestine. Its veins concur to form the vena portae.

The organization of the rectum presents several marked peculia¬ rities. Its lower portion is destitute of a peritoneal tunic, while its upper is furnished with one which even forms a meso-rectum. Its muscular coat is composed of two planes of fibres; the internal cir¬ cular, the external longitudinal: and O’Beirne states that the longi¬ tudinal fleshy fibres are set closely together, so as to completely sur¬ round and cover the internal plane ; and that, in addition, each of the three longitudinal bands of the sigmoid flexure sends down strong fleshy fibres to be expanded upon and intermixed with those of the proper external plane. The longitudinal fibres predominate in the upper two-thirds of the rectum ; the circular exist chiefly in the up¬ per third, and near the anus. “ It is therefore both an anatomical and a physiological fact, that this intestine exceeds every other part of the intestinal canal in the number and strength of its muscular coats, and consequently in muscular power.”* Its mucous mem¬ brane is described as thicker, redder, and more spongy than in the other parts of the intestinal canal ; and by Houston as exhibiting se¬ veral valvular projections. Its vascularity is very great, no intes¬ tine receiving so many blood-vessels as the rectum in proportion to its volume. Its nerves are derived not only from the ganglionic system, but also from the cerebro-spinal ; and it is therefore endowed not only with organic sensibility in common with the rest of the in¬ testinal canal, but with animal sensibility also.

Functions. — The large intestine may be considered a reservoir in¬ tended to contain, for a certain time, the excrementitial residue of the alimentary matter, which, as soon as it is introduced into the caecum, takes the name of feculent matter, feces, excrement, &c. Until the excrementitial residue has arrived in the large intestine, it is said to be free from the fetid odour peculiar to human excrement — an assumed fact, which has given rise to the opinion that there is a power of fecification inherent in this intestine. This change, how¬ ever, is to be attributed more properly to the decomposition of the excrementitial matter from its abode in the intestine, than to any power of fecification inherent in it, as may be shown by a reference to pathanatomy. In cases of stricture of the upper part of the rec¬ tum, for example, there takes place in the colon a gradual though immense accumulation of feculent matter, soft, homogeneous, fetid, and deeply tinged with bile; and precisely the same thing happens where the obstruction is seated in the caecum, when a similar accu¬ mulation forms in the small intestine, distending it for a considerable distance upwards, and presenting the same appearance and charac-

* New views of the Process of Defecation. By James O’Beirne. Dublin 1833, p. 9.

2*

BURNE ON HABITUAL CONSTIPATION.

ter in every respect as the accumulation in the colon, being like it soft, homogeneous, naturally tinged with bile, and emitting the cha¬ racteristic fetid odour.*

These facts prove that fecification is not limited to the large intestine, but will be accomplished in any part of the intestinal canal, where the excrementitial residue is retained sufficiently long to go through the usual process of decomposition.

The decomposition of the contents of the large intestine gives rise to the evolution of gas, which, by the stimulus of distension, excites the peristaltic action of the intestine, and is expelled by the additional conjoint aid of the diaphragm and abdominal muscles. When, however, the expulsion of the gas is opposed by the sphinc¬ ter, called into action by the will, it returns immediately into the colon, but is prevented passing into the smaller intesiines by the ilio-caecal valve. The gas, thus confined in the large intestine, distends it, excites its contractions, and is driven, first in one direc¬ tion than in another, with a force sufficient to produce the disa¬ greeable rumbling noise, borborygmus.

The use of the ilio-cascal valve is here conspicuous; for without it, the gas opposed in its natural passage downwards, would ascend into the small intestine and be discharged by the mouth — a horrible alternative. The chief use of this valve would seem to be to oppose the passage upwards of the fetid gas of the large intestine, because its construction is little adapted to oppose solid matter or even fluids, and because some reports authorise the belief that clysters, injected with great force, have overcome the resistance of this valve, and have been thrown up by vomiting. Besides, an anti-peristaltic action of the large intestine, powerful enough to propel its solid contents in this unnatural direction, is so rare as scarcely to admit of belief, and consequently not to need the obstacle of a valve.

The quantity of gas in the colon is often considerable, and its change of place indispensable; for, was it confined to one part, the prolonged distension of this part would strain and paralyse its muscular fibres, and so impair the function of the gut. The ca¬ pacity of the colon, then, may be regarded not merely as a reser¬ voir for the fecal matter — for, except in states of disease, its great capacity would be altogether superfluous — but more especially for the gases evolved from that matter, which, when not allowed to escape, require space for motion to and fro; an essential provision, adequately supplied by the capacious colon.

The functions of the colon are supposed by some not to be limited to the offices of a reservoir and of simple transference, but to be in part digestive and emunctory.

Schultz entertains some very extraordinary notions of the func¬ tions of the caecum and colon, suggested to him in the first instance

* See Case 4, in the author’s paper on the Caecum and Appendix, published in the Trans, of the Royal Med. and Chir. Society, vol. xx. p.213.

OF THE LARGE INTESTINE.

oy his own sensations of what goes on within the intestinal canal. He speaks of having felt a palpitating agitation in the motion of the colon fro'm right to left: of having felt, after aperient medicine, bile flow abundantly into the duodenum, and traverse swiftly the whole small intestine to the caecum, there to collect, and then to move with the food slowly along the large intestine. He is of opinion that an acid digestion goes on in the caecum; that the bile passes along the intestine to join the food in the caecum after it has been digested there; that the ilio-csecal valve is closed like the pylorus, to prevent bile passing while caecal digestion is going on ; that digestion in the caecum and stomach have their periods — the stomach by day, the caecum by night.* For these opinions I do not discover any sufficient foundation.

Sir Everard Home has adduced some facts on which he grounds an opinion that fat is formed in the large intestine: but, on perusal of his observations, I do not find they establish any other point than that lumps or masses of fat have been found in the alimentary canal of living animals. The remarkable difference in the short length and small dimensions of the colon and caeca of the casuary of Java — the colon one foot long, and each of the caeca only six inches long and a quarter of an inch in diameter — and in the great length and large dimensions of the colon and caeca of the African ostrich, — the colon forty-five feet long, and each of the caeca two feet nine inches long and three inches in diameter, — as associated with and adapted to the luxuriancy of Java and the dearth of Africa, struck Sir Everard forcibly, and suggested to him the opinion, that the colon and caeca were not unimportant in the office of assimilation.t

The opinion that the large intestine is concerned in the digestion of the vegetable part of food, derives no support from the pheno¬ mena of its functions observed during health. The residual matter voided presents characters in no way different from that found in the caecum, except its greater consistency, its fluids having been in part absorbed.

In the healthy condition of the digestive organs, the residuum of food having reached the large intestine, is already homogeneous and feculent, and offers no appreciable evidence of incomplete digestion, which it certainly would do if the vegetable part had not yet been assimilated. Nor is there any better reason to believe that this intestine acts as an emunctory for the purpose of remov¬ ing other excrementitious or hurtful parts from the system.

It is important, for the clear understanding of this subject, that we contemplate the functions of the large intestine in its healthy state, otherwise our judgment may be misled ; for because we find secretions from the colon, when diseased, form part of the egesta, we may erroneously conclude that therefore they do in the normal

-f- On the Formation of Fat in the Intestines of living Animals. By Sir Ever¬ ard Home, hart. Philosophical Transactions, vol. ciii. 1813.

BURNE ON HABITUAL CONSTIPATION.

state. In the healthy action of the large intestine we are not able to recognise any difference of character in, or addition of substance to, the fecal matter during its transference. All those anormal excretions, — whether melanotic, sanguineous, mucous, or purulent, derived from the large intestine, are products of a pathological state of the mucous membrane. They are heterogeneously mixed or smeared over, or intimately and uniformly combined with, the proper feculent matter. Did any excrementitious secretions take place as the normal function of the large intestine, they certainly would be apparent, from the want of intimate combination with the residuum of food ; whereas the feculent matter voided is perfectly homogeneous.

Besides, if the large intestine were an organ of excretory disassimilation, it would, in common with other organs of secretion, be richly supplied with blood ; but the contrary is the case.

There is comparatively less blood furnished to the colon than to the small intestine ; while to the rectum the supply is most abun¬ dant: yet the rectum is not supposed by any to perform the office of excrementitious secretion. I do not hold with the opinion, that the large intestine, in health, supplies any considerable part of the excrementitious matter voided ; or that, from its lining membrane, there takes place any other secretion than mucus to lubricate its surface and facilitate the transference of the feces. In Adynamic fevers, and many other disorders, one cannot hesitate to believe that a large portion of the foul alvine evacuations proceeds from the mucous membrane of the bowels itself ; but this is the result of disease.

The alimentary matter, deprived almost wholly of its nutritive properties, passes from the ileon into the caecum, whence it is transmitted along the colon, and, when arrived at the commence¬ ment of the rectum, excites a sensation which calls for its expulsion. The exoneration of this intestine once in twenty-four hours, although consistent with health, would appear to be less frequent than the uninfluenced order of nature requires.

There can be little doubt that the large intestine, like the bladder, admits of a certain accumulation of its contents before it is stimu¬ lated to expel them; but I should be disposed to limit this accumu¬ lation to the residuary matter of an ordinary meal, and attribute any addition to the influence of habit. By reverting to the healthy action of the bowels in infancy — the only condition in life uninflu¬ enced by the will — we find evacuations take place pretty nearly in the same ratio as the number of meals ; and that the residuary matter of one or two meals is sufficient to provoke an expulsory movement : but as soon as the development of the mind admits impressions which influence the will, then do the dejections become less frequent, and eventually occur only at convenient periods, once or twice in the day, with an extraordinary regularity. Even thus early does the will influence the action of the bowels.

In accordance with the laws of the animal economy, the protracted

CONSEQUENCES OF HABITUAL CONSTIPATION.

presence of the feculent matter so obtunds the organic sensibility of the intestine, that a considerable accumulation is required to provoke its action, which therefore generally happens only once in twenty-four hours. In this time the feculent matter does not undergo any unfavourable change; but, when delayed for a longer period, it becomes, first, solid, then hard, friable, and knotty; a preternatural state, which renders its evacuation difficult, and which soon excites a morbid irritation of the bowel itself. In persons who have one evacuation daily, it occurs usually when the organic sensibility of the alimentary canal is heightened, as on getting up in the morning, or on rising from the breakfast table. Here the excrementitial residue of one day’s food has accumulated in the large intestine during the night without exciting an expulsory movement of the bowel, the perceptive power of the nervous system being less quick during sleep ; but the state of sleep having passed away, the nervous sen¬ sibility is revived, or, from the excitement of breakfast, heightened, and the bowel stimulated to the act of exoneration.

Chapter II. General Remarks Upon, And Various Consequences Op Habitual

CONSTIPATION.

Inconvenience of Constipation. — Habitual Constipation a Source of general Dis¬ order and of local disease. — Tumours of the Breast dissipated. — Loaded Colon mistaken for Disease of the Liver. — Congestion of the Portal System and Disease of the Liver. — Hypochondriasis. — Neuralgia. — Epilepsy. — Spasmodic Contrac¬ tions of Muscles. — Duration of Constipation.

There are few persons who have not themselves experienced, at some period, the inconvenience of constipated bowels. Those in whom this inconvenience has been only occasional, will not be prepared to attach so much importance to the subject as it is the object of this work to point out; while all who have suffered from constipation habitually, will agree in regarding it one of the greatest troubles of life. Not only does it indispose the mind to exertion and the body to exercise, but it casts a gloom over the spirits, and is productive of that general discomfort which ruffles the temper and embitters the ordinary enjoyments of life.

It is true that Nature has designedly provided for the retardation of the excrementitious matter in the large intestine by furnishing the extremity of the bowel with a muscular mechanism subject to the will; a controlling power, which, duly exercised, is essential to our comfort and convenience ; but which, abused to set aside the calls of nature and so to retain the fecal matter within the bowel, is sure to be productive, sooner or later, of very formidable and disastrous consequences.

BURNE ON HABITUAL CONSTIPATION.

If we contemplate, for a moment, the processes and changes which take place in our food during its passage through the alimentary canal, and compare the characters of the excrementitious matter voided in the ordinary course of nature with the characters of that which has been unduly retained, we shall experience no difficulty in coming to the conclusion, that much injury, not only to the bowel but to the constitution, must, of necessity, result. The excrementitial residue in its natural state is consistent, soft, homogeneous, cohe¬ sive; but retained in the bowel, it becomes hard, knotty, dry, and friable: changes produced by the absorption of its fluids, which being necessarily conveyed into the blood, adulterate and corrupt it. Hence then an abundant source of impurity to the blood.

Feculent matter, even in its natural state, irritates the intestine if retained beyond the usual period ; and how much more irritating must it prove, when its characters have become altered as above. Irritation of the large intestine, so induced, extends by sympathy to the liver and stomach, and by disturbing their functions, impairs digestion. From impaired digestion, there must proceed impure chyle, from impure chyle impure blood ; and if impaired digestion, produced and prolonged by habitual constipation, should endure, not for months only but for years, how can we wonder that the whole mass of the blood should become corrupt, or that the solids derived from that blood should be corrupt also ? How can we won¬ der that eruptions should disfigure the body, or that untractable or malignant disease should break forth and shorten life ? Can we hesitate then to believe that habitual constipation may be and is one frequent source of genera] disorder and of local disease?

Although, in all treatises on disorders of the digestive organs, at¬ tention is recommended to the due evacuation of the intestinal ca¬ nal, and, since the promulgation of the doctrines of Mr. Abernethy, the same attention has been extended to other complaints, yet the influence of habitual constipation in the production of disease by di¬ rect and indirect agency has been in nowise appreciated ; the con¬ stipation having been regarded rather as an incidental circumstance than as a definite and original cause. Nor are we, on this account, aware of the vast power which an unremitting attention to the ac¬ tion of the bowels has in curing many disorders, and may have in ameliorating the character of many intractable diseases. “ Many morbid states,” says Dr. Holland, “ attributed, with the too frequent vagueness of medical language, to the stomach and liver, are chiefly, as I believe, connected with the colon as their seat and source.”* Believing, indeed, that the cachectic diathesis which gives rise to some malignant diseases may be generated by habitual constipation, I look forward with some degree of hope that, by keeping this prin¬ ciple steadily in view, the progress of the more chronic forms of these diseases may eventually be checked, and the morbid diathesis so amended, as to diminish their hitherto invariably fatal tendency,