The maintenance of health : a medical work for lay readers

Front matter

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A MEDICAL WORK FOR LAY READERS

1 Go, little book, from this my solitude :

Preface

This little work is written with, the intention of its being useful to the general public, or rather to such of them as are interested in the matter of health, and consists of a selection from the knowledge the writer has acquired in the study of his profession.

It is not a Family Practice of Medicine, but aims at the inculcation of those principles which ought to guide us in our search after health.

While essentially a popular work, the different subjects are handled with strict, indeed all attainable accuracy, and according to the most recent physiological teaching. As a consequence thereof, this little book may be found not altogether unworthy of the attention of those just entering the medical profession — or even of those older members of it whose lives have been spent in attention to the wants of others rather than in adding to their own stores of information.

vm

PREFACE.

Many of the chapters are original and novel, as for instance Chapter IX., on c Overwork, and Physiological Bankruptcy.’ Others have no such claims, as Chapter XI., on ‘ Hygiene,’ which is based on the standard work of Professor Parkes and the excellent handbook of Dr. George Wilson.

A brief recapitulation, in the shape of so many formulae or propositions, is appended to each Chapter, with the hope that such a plan will enable the reader to carry away the contents more thoroughly.

22 Lower Seymour Street, Porthan Square, W : July 21, 1874.

Chapter I

INTRODUCTION — HEALTH ! WHAT IS IT ? AND HOW IS IT MAINTAINED ?

PAGE

Ideal Health and practical Health — Types of Health — Chemical composition of Man — Renewal of Tissues — Indestructibility of Matter — The Body Temperature — Circulation of the Blood — Digestion — Secretion and Excretion- — Locomotion — Nervous action — The organic Nervous System — Sleep — The Sensations — Excitants to action — Acting Force and Vital Force — Bodily Health and Mental Health , . . 1

CHAPTER n.

IN YOUTH — THE PERIOD OP GROWTH.

The Baby — Effects of Cold — Pood — Baby’s Bottle — "Weaning, Precautions as to — Teething — Development of the Nervous System —

‘ Nerve-Storms ’ — Precocity — In Town and Country — ‘ Coddling ’ and ‘ Hardening ’ — Clothes — Food in Childhood — Importance of Fat — Regulation of the Bowels — Bathing — Sleep — Fresh Air — Change of Air — Exercise — Work — The Factory Act — Effects of Growth — Tubercle — Puberty — Effect on Health and Character — On the After Life . ...••o 27

X

Contents

CHAPTER in.

IN MATURITY — THE MAINTENANCE OP INTEGRITY.

Occupations of Man— Choice given by Education— Active and Sedern^^ tary— Effects of each— Habits requisite in each— Some special forms 0 ™^our —Emigration Travel, Requirements for Health— Change ot Climate— Causes of Disease— Excess— Privation — Decayed Teeth —Stout and Spare— Bantingism— Vinegar and Rice— Effects of Fashion— Foot Coverings— Effect of Soils— Female Dress— Habits —The Spinster, the Wife, and the Matron— Effect of Morality on

Conclusion

Climate Varieties of — Use of each — For the Consumptive — For the Gouty and Rheumatic— Spas— Telluric Influences— In America- Organic or Natural Laws— Infractions of Them— How occasioned— Fable of ‘ The Slater and the Law of Gravitation ’— Contrast of Natural and Moral Laws — General and Special Education, Quotation on— Neglect of Physical Education in Girls— Effects of Cultivation— Concluding Remarks . . , .

THE

MAINTENANCE OF HEALTH.

CHAPTER I.

INTRODUCTION — HEALTH ! WHAT IS IT ? AND HOW IS IT

MAINTAINED P

Health consists of a balance betwixt tbe various parts of tbe organism, in power as well as in function. Health is no more the endowment of the man whose brain, active and restless, tyrannises, in reiterated demands, over the body, its patient, enduring bondslave, than it is the possession of another person whose inefficient digestion leaves the system ill-fed and famished, the prey of depression or neuralgia. Neither can the idea of robust health, the full-fed, bright-eyed, glowingskinned, redundant health of writers and painters, be associated with the dweller in cities, the pale-faced spare handicraftsman of Southwark. You may as vainly look in the yard of a manufactory, for a group of oaks or elms, whose ring-recorded years go back to the days when Puritan rule had not yet modified therude mirth of England in the olden time, with merry groups of rustic urchins busily engaged in romp and', play under the spreading shade, regardless of the huim of machinery and the measured stroke of the engine — -

B you may as well, I say, indulge in this utterly impossible and wild outbreak of the imagination, as look for those •outward appearances which characterise the peasants of Cumberland and Northumberland amidst the pallid denizens of Spitalfields. And yet, because such is the case, it does not follow that the man of Spitalfields is not in health, in what is health to him. There are types of health, as there are the flesh of fishes and the flesh of beasts.

The one shows health under the most favourable circumstances, the rude health of primitive man, of man dwelling where the air is pure and uncontaminated; the other indicates the effects of aggregation, the consequences of centralisation and commerce, the results of the necessity for labour. Still, man is no more secure from disease under the first-mentioned circumstances than he is its victim under the latter. A neglected cold may prostrate the mountaineer, and gradually developing into tubercle, consumption may lay upon him its unrelenting grasp; or typhoid fever, the nemesis of outraged sanitary laws, may stretch him powerless, and threaten his existence ; while even in the most crowded localities the lean and anxious-looking dweller in cities may survive to the years of man’s allotted existence, comparatively free from infirmity or intercurrent disease. Much will depend upon the personal habits of each, of their accommodation to surroundings, of them obedience to the organic laws which rule over our existence. Neglect of these laws will blast the health or imperil the existence of the first-mentioned, while attention to them, and the availing himself of such sanitary arrangements as are within his power, will prolong the existence of the other in a state of comparative health.

Introduction

Wliat are the conditions necessary to the maintenance of health — not of ideal health, but the best health possible to the individual — will be detailed and manifested as the scheme of this work evolves itself in its various chapters : so far as it is possible in such a work to combine general rules with the exigencies of the individual. The first step, however, is the consideration of what man is, regarded physiologically. Looked at chemically he is a combination of oxygen, nitrogen, hydrogen, and carbon, with some inorganic matter, chiefly lime, soda, potash, sulphur, and iron. By various combinations are the different constituents, solid and fluid, arranged out of these primitive materials. His muscles, the red flesh of animals, consist of the four firstnamed, with traces of potash. The nerves do not differ chemically very widely, but the leading difference is in the presence of phosphorus, in the form of highly complex phosphoric compounds. As phosphate of lime phosphorus, however, is found in the greatest proportion in bone, which becomes a mere gelatinous mass, flexible but firm, when the lime has been chemically dissolved out. Blood contains quantities of iron, which is indispensable to the chemical interchanges carried on by it.

The other structures, as the skin, viscera, bloodvessels, &c., are built up in a similar manner ; while the fat, the stored-up fuel of the body, consists of hydrogen and carbon. But after all, water constitutes the great bulk of the individual, forming no less than 70 per cent, of the gross weight of the organism. For its repair, and to a greater extent for its growth, material is required chemically identical with itself, flesh, fat, saccharine and farinaceous matter, milk par excellence, and water. These are eliminated again, in the form of carbonic acid, the combination of the carbon with oxygen ; and water, the union of hydrogen and oxygen ; the nitrogen passing off in the solid constituents of urine and of sweat, accompanied by the eliminated lime, soda, &c. ; the products of the combustion of hydrogen and carbon, passing off chiefly by the lungs and skin.

Man, as an animal, is chemically an oxidising agent, reducing again to primitive forms the principles built up by the vegetable world, and taken in by him either directly as vegetables, or indirectly in the shape of the material of other animals. Without vegetable life, animals could not exist, and never could have existed ; side by side they grow and flourish, indispensable to each other’s existence ; the tree breaking up the exhaled carbonic acid of the animal, the carbon being stored up in its increasing mass, while the oxygen is returned again, free and uncombined, to the atmosphere for the respiratory needs of the animal world. Round and round go the elementary bodies in ceaseless change of form, nevertheless never more than they were at first, and will be at the last; the atomic material of this planetary sphere being ever absolutely the same in amount. The material of the bodies of Saul and his sons when burnt by the men of Israel after them ignominious exposure at Betlishan, in consequence of their defeat on Mount Gilboa, are circulating amongst us still ; it served others before them, and has formed part of thousands since. It is quite within the bounds of chemical possibility that some of the atoms contained in the fated apple of Eve may have lain in the material of the apple which revealed to Newton the law of gravitation ; and that atoms of the knife, long mouldered into dust, with which Abraham threatened the life of Isaac, may be circulating in the blood of the Bedouin,

INTRODUCTION.

aiding in bringing the free oxygen of the desert air to the tissues of the Arab rover. ‘ To what base uses we may return, Horatio ! Why may not imagination trace the noble dust of Alexander, till he find it stopping a bunghole ? ’ Hamlet, Act v. sc. 1.

To meet these constant chemical changes, material is taken in, in the form of food and drink, which is being constantly assimilated, and so nutrition and repair are conducted. The rapidity with which these changes are carried on is much greater than is usually supposed. Paley, in his £ Natural Theology,’ states that seven years are requisite for the perfect renewal of the body ; and this statement, owing partly to the mysticism associated with the number 7, partly to its constant reiteration from the pulpit, is generally accepted and believed. The time really is rather months than years ; but it is absurd to fix a time which must necessarily vary in different individuals, being much less in the infant than in the aged, in the active than the indolent ; widely different too in various tissues, from the epithelium lining of the glands of the stomach, renewed several times in each act of digestion, to the enamel of the tooth, which is probably never renewed during a lifetime.

In addition to the growth and maintenance of integrity in the different tissues of the body, it is by chemical combustion that the body-heat is maintained. No matter where found, whether on the blazing sand of the Sahara or on polar ice at midwinter, the temperature of man is much the same, not varying two degrees Pahrenheit. Of course the aid of clothes, especially in preventing the radiation off of the body-heat in cold climates, must not be undervalued. But food plays the essential part in the maintenance of this

G the maintenance of health.

balance, and the Esquimaux will consume in twentyour hours a gallon of whale oil, to say nothing of ot er food, chiefly fatty, to maintain his temperature, while a handful of dates and some succulent fruit will serve the Arab over an equal period of time. The body temperature of man is about 99° Fahrenheit (37 Centigrade), and a variation of a few degrees from this forms fever if higher, collapse if lower. The combustion goes on in the internal parts, chiefly in the muscles ; and by means of the blood circulating everywhere, the heat created in one part goes to maintain the temperature of another. The immense blood supply of the face permits of its being uncovered without risk when all other parts of the body are and must be warmly clad. A variation of 8° on either side of 100° is almost invariably fatal; a greater variation may occur ere actual death, but that is the limit compatible with life, and lesser variations are fraught with peril.

The circulation of the blood is a very interesting subject. This fluid contains not only the material for the nutrition of the body, for which purpose it is in close relation to the intestinal canal, but also the waste material, for the elimination of which it is in communication with the various emunctories of the body, as the skin, kidneys, and lungs. Not only so, but it bears with it millions of blood corpuscles, minute microscopic bodies by means of which oxygen is taken up and carbonic acid given off, i.e., the gaseous interchanges are effected by these means and through the instrumentality of the lungs. In the lowest animals there are no bloodvessels, the fluids merely permeating the tissues, aided by simple spaces ; but a little higher up these spaces have become pulsating sacs connected by tubes. In the higher animals there is a central heart, and from it

INTRODUCTION.

springs an elastic tube, tliG aorta ; this stibd.ivicl.6s into myriads of minute vessels by means of numerous intermediate elastic arteries, just as the trunk of a tree becomes ultimately, by means of tbe branches, divided into thousands of twigs ; and along this arterial system the blood flows. The vessels which return the blood to the heart are the veins, and between the minutest arteries and the smallest veins are the capillaries, so called from capillus, the Latin name for a hair. These extremely fine vessels permit, in some cases, of the blood-corpuscles only passing in single file; and yet they can contract and again become dilated. By this means the elastic arterial system is kept evenly filled, and the blood pumped in by the heart restrained from at once passing out again into the veins. By these minute capillaries go on the processes of nutrition, the absorption of waste, and the combustion which produces heat. When the internal capillaries are dilated there is an excessive production of heat, and an increase of waste material in the urine, as in fever; when the cutaneous vessels are dilated, the body temperature is rapidly cooled down by the warm blood being brought in contact with the cooler air, and this is aided powerfully by the perspiration, the evaporation of its watery constituents being a powerful cooling agent, as seen specially in warm climates. When the surrounding medium is of low temperature the skin is dry and cold, i.e. its vessels are contracted, and thus a small stream of blood only circulates through the skin, and so the heat is not drawn away from the internal parts ; were it not for this action in the vessels of the skin, man would be found only along a narrow strip of the temperate zone ; in colder regions he would rapidly freeze

TIIE MAINTENANCE OF HEALTH.

to death, in warmer climes he would quickly succumb to a body-heat too high to be compatible with life.

The veins gradually enlarge as they gather together, like rivulets uniting until a river is formed, and ultimately converge into one large stream from the upper half of the body, and another larger stream from the lower half; these two meet at the heart, opening into the right heart, from whence the blood passes into the lungs. In the lungs the gaseous interchanges go on, the little blood corpuscles, dark with carbonic acid’ becoming bright with oxygen, while the scarlet arterial blood rushes into the left heart to be rhythmically pumped out into the arteries. To enable the blood to come fieely in contact with the air, a minute subdivision of blood-vessels takes place in the lungs, and a network of tiny capillaries surrounds the vesicles, or pouches, in which the minute air-tubes terminate. A fine thin wall alone separates the blood and the respired air, and

by this means the chemical interchanges are carried on.

The heart is simply a hollow muscle which contracts rhythmically, and in doing so contracts upon its contents and expels them. Valves prevent the return of the blood, just as the valve of a pump jn’events the return of the water, and thus the oxygenised blood is distributed over the whole body. This respired oxygen fulfils several purposes : by it the waste material is made soluble, and so capable of being* removed ; by its union with the material of the body not only is the body-heat maintained, but all force is evolved.

There is also a subdivision of blood-vessels in the kidney. The artery going to the kidney, itself only a small organ, is large, and rapidly subdivides into capillaries ; these form balls by coiling up with the minute tubes in wliicli the urine is secreted. Here pass off -water and the products of tissue waste, the cinders of the body combustion; and the blood so depurated lejoins the general circulation by the renal veins. XJnne contains a number of substances in solution, and fiom the amount of these, especially the urea, can be calculated the amount of body combustion. It is as if one calculated the amount of fuel used by a furnace by collecting the incombustible ashes. Knowing how much coal was represented by so much ash, you weigh the ashes, and at once know the amount of coal consumed.

From the blood the tissues of the body are fed ; from the blood comes the material for growth and repair; and to the blood goes the material furnished by food. Speaking of food collectively, for it will be consideied more particularly in an ensuing chapter, it goes through the following processes in its progress in the organism: When offered to the mouth it is taken in by the lips, it is rolled over by the tongue, it is ground or masticated by the teeth, and moistened by the saliva, after which it is fit to be received into the stomach. Dyspepsia is the penalty for imperfect mastication, either from haste or from the want of teeth, and is the stomach’s protest against food but imperfectly prepared for it. After this preparation it is swallowed and rolled about in the stomach until thoroughly mixed with gastric juice and reduced to pulp, the ring at the intestinal orifice of the stomach only permitting the digested portions to pass : at last, however, the ring relaxes, and the contents of the stomach pass into the intestines, and the stomach is empty and ready against the next meal. Erroneous popular impressions exist as to the persistence of indigestible or unsuitable material in the stomach, and medical men are often told that a patient wants to get tiib maintenance of health.

something . off his stomach.’ In reality the stomach having received rmmasticated or indigestible food, passes it omn time usually several hours— into the bowels w lence it is removed by what we call purgation! Occasionally only is something seized by a fold of the stomach and retained for some time, months even, and then rejected by vomiting. I remember an elderly farmer suffering from cancer of the stomach who was reported to have vomited a mouse. On examination it turned out to be a piece of orange, the outside black trom the charcoal biscuits the poor man had been induced to swallow for ‘ indigestion; 5 but when opened up the peculiar cells of the orange pulp werp there, perfect and of natural colour. It was in the country in winter, and the orange was, and indeed must have been, swallowed the preceding season.

After passing the ring called the pylorus the food moves along the bowels or intestines, receiving the secretions of the liver and pancreas (sweetbread), bile and the pancreatic juice, after which it is called chyme, a pulpy fluid containing meat &c. in a semi-fluid condition, and fat emulsionised ; the starch of our food having been converted into sugar.

Along the intestines absorption goes on both into the veins and into the lymphatics, a series of canals in connection with the glands ; the blood carrying to the liver the material for combustion and for bile, the lymphatics passing into a congeries of glands from whence an elaborated fluid called chyle passes along a duct from the abdomen into the thorax, ultimately opening into the veins at the root of the neck and furnishing nutritive fluid to the blood. The unassimilable part of the food passes off by the bowels. In doing so it becomes of firmer consistency and acquires a disagreeable and

INTRODUCTION.

offensive odour from the secretion of the glands of the lower bowel. This is much more marked in the meateater, the stools of a young infant being usually almost odourless. The same is seen in the fseces of the meateating animals as compared to the herbivora ; compare

the cat and sheep for instance.

Man is also a locomotive animal, and possesses a bony skeleton, jointed and moved by his muscles. These joints or breaks in the bone are of course indispensable to movement. The connecting materials are the ligaments, tough bands admitting of movement. The muscles which pass from one bone to another contract, and so occasion movement; for instance, in walking the foot is flat upon the ground, and when the muscles of the calf contract the heel is drawn upwards and the weight of the body rests upon the toes only ; by the aid of the other muscles of the leg this movement is converted into a step forward. Under other circumstances the body can be raised and allowed to fall again, as when a person without moving away stands alternately upon all his foot or only upon his toes, producing a rhythmical up-and-down movement. Muscles do not always pass from one bone to another, as the muscles of expression in the face, the muscle which wags the ear of a dog &c. The tongue is also a muscle, and an active one.

Muscles can convert their force into certain external effects, for instance the potter uses his muscular force to modify the lump of clay into a hollow pot by turning a wheel ; the archer by means of a bow gives to an arrow the force of his contracted muscle which enables it to defy for so long a period the force of gravity. Thus a bow of fifty pounds pull will send an arrow much further than a bow of twenty-five pounds will send the

THE MAINTENANCE OF HEALTH.

same arrow. The ‘ puli’ means the amount of muscular effort required to draw the bow, and this counteracts the effect of gravity upon the arrow: the more the force the further it will fly, all things being equal.

But the muscular machinery does not go of itself; it lemains like a gun loaded and the hammer raised; an external force applied to the trigger is required to let it off. This force for the muscles is a nerve current. The nervous system of man is a wonderful matter, and nothing so excites our admiration or fixes us spellbound in wonder as the working of the nervous system. Its material is largely water, and in infancy the brain substance is merely a pulp. But what a marvellous pulp ! By it is the body set in motion ; thought has its residence in it, as also has memory ; it not only devises the plans of buildings, the schemes of commerce, the day-dreams of the visionary and the theories of philosophers, but evolves the force which is requisite to put them into execution when practicable. The great central mass is the brain, placed at the top of the organism, and enclosed in the bony skull ; from it proceeds the spinal marrow along a canal hewn out of the vertebra, as the bones of the spine are denominated, which sends off the nerves of the trunk and extremities. From the brain directly proceed the nerves of special sense — the nerves of smell, sight, taste, and hearing, nerves Which do not communicate the sense of feeling common to other sentient nerves. When the nerve of sight is severed a bright flash of light, not a shoot of pain, marks the act. Pain is the aggravation of a sensation, often not unpleasant in a minor degree, and feeling alone belongs to the trunk and limbs ; this pain attracts the attention of the brain, which then directs to it the light-carrying organ, the eye, for further explanation as to the cause of the sensation. By the brain are ah sensations received and registered, and when communication with the brain is cut off, as in paralysis, sensations are no longer felt, neither is motion practicable, the brain can no longer put in motion the muscles by inducing their contraction; they no longer obey the dictates of the will.

By experiment upon animals and observation of the effects of disease upon man, it has been found that the brain is not a mere homogeneous mass as regards function, but that different portions of it fulfil different functions. Thus disease in different parts will give correspondingly varying symptoms ; paralysis is the consequence of disease in one part, involuntary movements the result of it in another. One portion institutes movement, another gives it direction and co-ordinates the several movements into harmony, or regulates them in connection with the eye. More recently Prof. Perrier has demonstrated that centres for certain movements have a fixed locality, and has mapped out the brain; so that by the symptoms of a movement here and a paralysis there, the exact locality of disease of the brain, may and can be determined. His experiments also confirm the view that the brain, the centre of sensation, possesses no sensibility to pain itself, and that severe operations upon it are not accompanied by any signs of suffering.

The brain is a very active organ, and possesses an unusually large blood supply, upon which its activity depends ; indeed its activity is in direct proportion to. its blood supply. When the arteries going to the brain are compressed, as by the garrotter, unconsciousness follows. A diminution of the amount of blood circulating in the brain is indispensable to sleep ; conse-r

THE MAINTENANCE OF HEALTH.

quently the maniac, whose brain is flooded with blood cannot sleep often for many days together. Agents which prevent sleep or put it away achieve that end by filling the brain with blood ; such is the action of tea, coffee, and some medicinal remedies. Use of the brain directs more blood to it, and so men develop themselves by study, becoming actually cleverer than hitherto. By want of use and exercise the power of the brain becomes gradually enfeebled, and it loses its grasp, till a condition almost approaching idiocy results; as is frequently seen in persons who from inherited means have never been compelled to use their intellect. On the other hand, great and excessive demands upon it frequently lead to disease of a most serious character ; and the oncome of great age is usually accompanied by gradual impairment of the mental faculties called dotage; this psychical change going on hand-in-hand with physical changes in the brain substance or in its blood-vessels.

But there is also another nervous system than that of the brain, spinal cord, and their proper nerves. It would be extremely awkward if our digestion were to depend upon voluntary effort : if man had to direct his digestion at the risk of its stopping when his attention was withdrawn, humanity would present a curious spectacle for some time after the customary meal hours, and man’s activity would be marvellously crippled. If the heart’s action were dependent on attention and will, the first sleep would also be the last one for all animated creatures high enough up the scale of creation to possess a heart. Suppose the liver were to stop because it was forgotten, and the nerve orders for it to go on suspended by any engrossing matter, as speculation or love-making, humanity would be thrown out of its groove, and the progress of the race be arrested

INTRODUCTION.

beyond the powers of even antibilious pills to restore it. This second nervous system has its centres in the abdomen chiefly, but also in the chest and neck, and innumerable nerve filaments connect it with the cerebro-spinal system. Along these pass nerve currents which are stored up in the centres or ganglia of the organic nervous system, and from these centres they again pass off in a slow but continuous manner to maintain the action of the heart, stomach, liver, or intestines. The nerve force passed into this reservoir is regularly distributed without the action of the will to the different organs of organic life, that is, to the actions which belong to life, and not to motion or the other active manifestations of vitality. Thus a blow upon the head will knock a man senseless, but he still lives and survives ; a blow of like violence upon the pit of the stomach is followed by instant death, because the great centre of the organic nerves lies there, and the vital actions are suspended by the blow, so that the system never lives to recover, but abolition of function and of life at once follows.