Diseases of modern life

Front matter

I

MEDi !, i-

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Preface

Eleven years ago I published a series of essays on diseases of overworked men, in order to direct attention to the physical injuries of the body that are induced by excessive mental work and worry, and by excessive physical exertion. These essays were followed by others on disease from some occupations, from indulgence in alcohol, and from the use of tobacco.

At the time they were written, and long afterwards, the essays excited much public interest, and at the instance of Mr. Macmillan I undertook to republish them in a collected form.

In the work of revision many other subjects occurred to me as of similar order and interest, and I have been led, consequently, while retaining that which I have already published, to construct the volume that is herewith presented.

The book, medical in all its aspects, is avowedly written for the study of the intelligent public as well as for medical men ; but whoever opens it to find " domestic medicine/'

C PREFACE.

or revelations of the arcanum of medicine, will be deceived. I have written, feeling that the day of popular receipts has gone by, and that the arcanum is dissolved.

Avoiding every infringement on the art proper of curing disease, I have in these pages considered only the science of prevention, which many can understand, and which is a profitable science to all who condescend to learn it.

Chapter I. Natural Life To Natural Death — Euthanasia

By the strict law of Nature a man should die as unconscious of his death as of his birth. .

Subjected at birth to what would be, in the after conscious state, an ordeal to which the most cruel of deaths were not possibly more severe, he sleeps through the process, and only upon the subsequent awakening feels the impressions, painful or pleasant, of the world into which he is delivered. In this instance the perfect law is fulfilled, because the carrying of it out is retained by Nature herself : human free-will and the caprice that springs from it have no influence.

By the hand of Nature death were equally a painless portion. The cycle of life completed, the living being sleeps into death when Nature has her way.

This purely painless process, this descent by oblivious trance into oblivion, this natural physical death, is the true Euthanasia ; and it is the duty of those we call physicians to secure for man such good health as shall bear him in activity and happiness onwards in his course to this goal. For Euthanasia, though it be open to everyone born of every race, is not to be had by any save through obedience to those laws which it is the mission of the physician to learn, to teach, and to enforce. Euthanasia is the sequel of health, the happy death engrafted on the perfect life.

When the physician has taught the world how this benign

12 NATURAL LIFE TO NATURAL DEATH —

process of Nature may be secured, and the world has accepted the lesson, death itself will be practically banished; it will be divested equally of fear, of sorrow, of suffering. It will come as a sleep.

If you ask me what proof there is of the possibility of such a consummation, I point to our knowledge of the natural phenomena of one form of dissolution revealed to us even now in perfect, though exceptional, illustration. We have all seen Nature, in rare instances, vindicating herself despite the social opposition to her, and showing how tenderly, how soothingly, how like a mother with her foot on the cradle, she would, if she were permitted, rock us all gently out of the world. How, if the free-will with which she has armed us were brought into accord with her designs, she would give us the riches, the beauties, the wonders of the Universe for our portion so long as we could receive and enjoy them ; and at last would gently withdraw us from them, sense by sense, with such imperception that the pain of the withdrawal would be unfelt and indeed unknown.

Ten times in my own observation I remember witnessing, with attentive mind, these phenomena of natural Euthanasia. Without pain, anger, or sorrow, the intellectual faculties of the fated man lose their brightness. Ambition ceases, or sinks into desire for repose. Ideas of time, of space, of duty, lingeringly pass away. To sleep and not to dream is the pressing and, step by step, still pressing need ; until at length it whiles away nearly all the hours. The awakenings are short and shorter ; painless, careless, happy awakenings to the hum of a busy world, to the merry sounds of children at play, to the sounds of voices offering aid ; to the effort of talking on simple topics and recalling events that have dwelt longest on the memory; and then again the overpowering sleep. Thus on and on, until at length, the intellectual nature lost, the instinctive and merely animal functions, now no longer required to sustain the higher faculties, in their turn succumb and fall into the inertia.

This is death by Nature, and when mankind has learned the truth, when the time shall come — as come it will — that " there shall be no more an infant of days, nor an old man who hath not filled his days," this act of death, now, as a rule, so dreaded because so premature, shall, arriving only at its appointed hour, suggest no terror, inflict no agony.

The sharpness of death removed from those who die, the poignancy of grief would be almost equally removed from

EUTHANASIA.

those who survive, were natural Euthanasia the prevailing fact. Our sensibilities are governed by the observance of natural law and the breach of it. It is only when nature is vehemently interrupted that we either wonder or weep. Thus the old Greeks, fathers of true mirth, who looked on prolonged grief as an offence, and attached the word madness to melancholy, — even they were so far imbued with sorrow when the child or the youth died, that they bore the lifeless body to the pyre in the break of the morning, lest the sun should behold so sad a sight as the young dead ; while we, who court rather than seek to dismiss melancholy, who find poetry and piety in melancholic reverie, and who indulge too often in what, after a time, becomes the luxury of woe, experience a gradation of suffering as we witness the work of death. For the loss of the child and the youth we mourn in the perfect purity of sorrow; for the loss of the man in his activity we feel grief mingled with selfish regret that so much that was useful has ceased to be. In the loss of the aged, in their days of second childishness and mere oblivion, we sympathize for something that has passed away, and for a moment recall events saddening to the memory; but how soon this consoling thought succeeds and conquers —that the race of the life that has gone was run, and that for its own sake the dispensation of its removal was most merciful and most wise.

To the rule of natural death there are a few exceptions. Unswerving in her great purposes for the universal good, Nature has imposed on the world of life her storms, earthquakes, lightnings, and all those sublime manifestations of her supreme power which, in the infant days of the universe, cowed the boldest and implanted in the human heart fears and superstitions which in hereditary progression have passed down even to the present generations. Thus she has exposed us all to accidents of premature death, but, with infinite wisdom, and as if to tell us that her design is to provide for these inevitable calamities, she has given a preponderance of number at birth to those of her children who by reason of masculine strength and courage shall have most frequently to face her elements of destruction. Further, she has provided that death by her, by accidental collision with herself shall, from its very velocity, be freed of pain. For pain is a product of time. To experience pain the impression producing it must be transmitted from the injured part of the living body to the conscious centre, must be received

T4 NATURAL LIFK TO NATURAL DEATH —

at the conscious centre, and must be recognized by the m.nd as a reception; the last act being in truth the conscious act. In the great majority of deaths from natural accidents there is not sufficient time for the accomplishment of these progressive steps by which the consciousness is reached. The unconsciousness of existence is the first and last fact inflicted upon the stricken organism: the destruction is so mighty, that the sense of it is not revealed.

The duration of time intended by Nature to extend between the birth of the individual and his natural Euthanasia is undetermined, except in an approximative degree. From the first, the steady, stealthy attraction of the earth is ever telling upon the living body. Some force liberated from the body during life enables it, by self-controlled resistance, to overcome its own weight. For a given part of its cycle the force produced is so efficient, that the body grows as well as moves by its agency against weight; but this special stage is limited to an extreme say of thirty years. There is then another period, limited probably also to thirty years, during which the living structure in its full development maintains its resistance to its weight. Finally, there comes a time when this resistance begins, to fail, so that the earth, which never for a moment loses her grasp, commences and continues to prevail, and after a struggle, extended from twenty to thirty years, conquers, bringing, the exhausted organism which has daily approached nearer and nearer to her dead self, into her dead bosom.

Why the excess of power developed during growth or ascent of life should be limited as to time; why the power that maintains the developed body on the level plain should be limited as to time; why the power should decline so that the earth should be allowed to prevail and bring descent of life, are problems as yet unsolved. We call the force that resists the earth, Vital. We say it resists death,, we speak of it as stronger in the young than in the old; but we know nothing more of it really, from a physical point of view, than that while it exists it opposes terrestrial weight sufficiently to enable the body to move with freedom on the surface of the earth.

These facts we accept as ultimate facts. To say that the animal is at birth endowed with some reserved force, something over and above what it obtains from food and air, would seem a reasonable conclusion; but we have no proofs that it is true, save that the young resist better than the old. .

EUTHANASIA. 15

We must therefore rest content with our knowledge in its simple form, gathering from it the lesson that death, a part of the scheme of life, is ordained upon a natural term of life, is beneficently planned, " is rounded with a sleep."

Chapter II. The Phenomena Of Disease — Classification And Dis- Tribution

To that condition of man which leads to death before the completion of the natural cycle of life and the natural Euthanasia, we apply the term Disease.- But, as disease appears under various forms, each represented by phenomena so grouped together and so steadily reappearing in the same order as to be distinctive in character, a particular name has been applied to the several forms, which thus specified, have themselves been calleddiseases.

The Names Of Diseases. — The naming of these groups of phenomena has been unsystematic and fanciful. The movements of an animal, the dancing of fanatics at the shrine of a saint, the sensation of strangling or suffocation, the flowing of a stream or current, the burning of a fire, the effect of being stricken or knocked down, words or terms signifying these meanings, such as cancer, St. Vitus' dance, angina, catarrh, inflammation, apoplexy, and others equally fantastic, yet often forcible, have made up from the earliest times the nomenclature of disease — a nomenclature imperfect even for technical purposes of language, and inapplicable altogether for the higher developments of medical scientific research and practice.

In the course of time the whole subject of the naming of the phenomena of disease will have to be recast. The term disease will come to signify unity — a departure from an approximative standard of health, manifested by a series of definable phenomena, each traceable to some modification of a natural or physiological animal process. Then, to each series of defined phenomena a simple name will be given, indicating either the physiological disturbance upon which the unnatural symptoms that are presented depend, or upon the cause of the disturbance. Seventeen years ago I wrote l6 THE PHENOMENA OF DISEASE,

the same suggestion, hoping that the old and crude method of naming the special phenomena of disease, as if each group were an entity, would die out. Unfortunately such hope was too earnestly precipitate. In the last few years the ancient error has been greatly exaggerated; the figures of the old gods remain on their altars, and new ones have been added as infinitely grotesque as any that have preceded.

For the present I fear we must rest content with the names we possess of the varied classes of phenomena which make up the unity of disease, however foolish those names may be. It is probable that disease, as a whole, is not as yet understood with sufficient comprehensiveness to allow of a revised and simplified nomenclature. I shall nevertheless show, as I proceed, that the bases really exist on which to found a simple classification of diseases according to the causes by which they are induced.

Disease in Relation to Historical Time.— The so-called diseases, or specific phenomena of disease, which we in this day recognize as in active operation, though with different values of intensity, are fully two hundred and fifty in number. About one hundred of these help to make out the current and regular mortalities of civilized communities in our modern times.

In looking back at the history of disease in so far as it is written in parallel page with the history of man, we find how distinct the groupings of the phenomena have continued in relation to time and how remarkably fixed. From age to age and from one civilization to another they have retained their integrity of type, few becoming actually lost, and few springing forth as absolutely new. It is true that certain maladies to which definite characteristics and names have been assigned are of rarer occurrence in some periods than in others. Still, the maladies remain, and when they appear, even in the most isolated form, they are as they were when they were originally described. The malady known as ague was once so common in London that the metropolitan physician looked upon it as one of the most ordinary disorders he was called upon to treat; now it is so rare that a practitioner may live for years and never see an example of it; but when it is met with it is found to be made up of the same symptoms as when Sydenham so graphically depicted it. The sweating sickness which invaded England with the Earl of Richmond, and which, when he became the triumphant Henry the Seventh, obtained the second name of " the king

CLASSIFICATION AND DISTRIBUTION. 17

of England's sickness," has not appeared in the epidemic form since 1551. Yet in our time a typical, though, happily, isolated, example of it has been witnessed. The. black death is still represented in malignant typhus. The great plague ol Athens was neither more nor less than a terrible visitation of what we now call malignant scarlet fever. Smallpox has nhown no abatement of its fury, when it has had the opportunity of becoming fully developed, from that which it showed when Rhazes of the ninth century, following Aaron of the sixth, committed to parchment the description of its phenomena. Carcinoma — cancer — is the same intractable, painful, fatal malady to us as it was to Hippocrates, Galen, and Paulus ^Egineta. Gout, as we see it here, in this century, is the same as it was to Alexander of Tralles. Modern phthisis pulmonalis is identical with the description so faithfully rendered of it by Caelius Aurelianus. Inflammation is practically known to us by no better signs than the four distinguishing ones left us by Celsus — " redness, swelling, heat, and pain;" while in these days, as in his, the contest commenced by Erasistratus continues, as to whether there can be fever without inflammation; that is to say, whether, whenever there is general fever, there is not of necessity a local inflammation in some organ or structure of the affected body, or whether a general fever may exist independently of any such local disturbance.

In brief, the more deeply we study the past history of medicine the surer is the conviction that, throughout the whole of the known period o human existence on the earth, not one knew disease has been added, not one withdrawn. This is so true, that phenomena of disease which have been described by the ancients and have been ignored by subsequent writers, have reappeared to attest as truth what has passed for fable. The phenomenon called, in early times, " bloody sweat," has been disputed. But in our days this phenomenon has been seen. I have seen it myself, and although we now recognize, in observing it, that blood does not veritably exude from the skin when the red-colored perspiration breaks forth, as was originally supposed, we admit that the exuded fluid is nevertheless a product of the blood, and that the primitive definition is therefore substantially correct.

In like manner, the great plague which visited Constantinople in 543, and which Procopius and Euagrius described, the plague of hallucination, drowsiness, slumbering, distracl8 THE PHENOMENA OF DISEASE,

tion, and ardent fever, with eruption on the skin of black pimples the size of a lentil ; this plague — which usually killed in five days, and left many who recovered with withered limbs, wasted tongues, stammering speech, or such utterance of sound that their words could not be distinguished ; this plague, which had passed into mythical learning under the name of "cerebrospinal meningitis," has also in our time reappeared.

Disease in relation to Terrestrial Space.— The phenomena of disease, unlimited by time and almost unchecked by science, are nevertheless, to a certain extent, bounded by space. They are, I mean, confined by certain influences belonging to certain parts of the surface of the planet. The rules on this head are simple. Some phenomena of disease are developed in all parts of the earth. Some phenomena which could probably be developed in all parts, are actually developed only in certain parts. Some phenomena are capable of development in certain regions and in none other.

The phenomena of disease included under the first of these classes, and which may be called the universal, are many. TJiseases of nervous origin, such as epilepsy, paralysis, apoplexy, are of this kind : certain plagues, as smallpox and cholera, which spread wherever they are carried, are of this kind : those maladies which spring from the habits or social conditions of a community, whether they be acquired by imitation or by invention, — habits, for example, of uncleanliness, the use of intoxication fluids, or the mechanical restraints imposed upon the body — are also of this kind.

The phenomena included under the second class are those special to localities, such as pellagra — Lombardo- Venetian leprosy — goitre and cretinism. These, either from peculiarities of the locality or from the hereditary susceptibilities of its inhabitants, are as distinctive and local as the hills, rivers, woods, or monuments of the same locality.

The phenomena included under the third class are those which will not travel out of certain defined conditions that are obviously necessary for their existence. Of these the phenomena of disease known as yellow fever, which can only continue in parts of the earth where there is a mean temparature above 68° F., form a good illustration. The phenomena of the disease typhus fever, which flourish only in regions having a range of temperature lying between 40 and 62° F., form another illustration. The phenomena of the

CLASSIFICATION AND DISTRIBUTION. 19

disease phthisis pulmonalis, which are so limited by a given degree of cold that they cannot exist in the Hebrides, the Faroe Islands, Iceland, and the Arctic regions ; and the phenomena of catarrhs or colds, which are confined within a range of temperature extending from a mean of 41 F. to the extreme cold of the Arctic climate, are other and similar examples.

It would lead me too far away from my present object to use all the materials at my command in the detailed exposition of the facts I have thus cited in the history of disease. I have wished simply to indicate that the history of the phenomena of disease is coeval with the history of man ; that some of these phenomena are universal as man himself ; that others are limited by place and condition : but that all have old foundations, coexistent with man, so that man had only to be developed for them to be potential.

Disease in Relation to Race. — It is a question of great moment whether disease is modified by qualities of race. Until quite recently we had no evidence bearing upon this question that could at all elucidate it, and even now the trustworthy knowledge we possess is exceedingly small. Through the valuable labors of M M. Legoyt, Hoffman, Neufville and Mayer we have obtained, however, some curious facts relative to the most widely disseminated of all races on the earth, the Jewish. These facts show, that, from some cause or causes, this race presents an endurance against disease that does not belong to other portions of the civilized communities amongst which its members dwell. The distinctness of the Jews in the midst of other and mixed races singles them out specially for observation, and the history they present of vitality, or in other words, of the resistance to those influences which tend to shorten the natural cycle of life, is singularly instructive.

The resistance dates from the first to the last periods of life. Hoffmann finds that in Germany from 1823 to 1840 the number of still-born amongst the Jews was as^ in 39, and of the other races r in 40 Mayer finds that in Furth, children from one to five years die in the proportion of 10 per cent amongst the Jewish, and 14 per cent amongst the Christian population ; . and M. Neufville, dealing with the same subject from the statistics o Frankfurt, gives even a more favorable proportion of vitality to the Jewish child-population. Continuing his estimate from the age named into riper years, the value of life is still in favor of the Jews ; the average

20 THE PHENOMENA OF DISEASE,

duration of the life of the Jew being forty-eight years and nine months, and of the Christian thirty-six years and eleven months. In the total of all ages, half of the Jews born reach the age of fifty-three years and one month, whilst half the Christians born attain the age of thirty-six years only. A quarter of the Jewish population is found living beyond seventy-one years, but a quarter of the Christian population is found living beyond the age of fifty-nine years and ten months only. The Civil State extracts of Prussia give to the Jews a mortality of 1.61 per cent. ; to the whole kingdom 2.62 per cent. To the Jews they give an annual increase of 1.73 per cent; to the Christians, 1.36 per cent. The effectives of the Jews require a period of forty-one years and a half to double themselves; those of the other races fifty-one years. In 1849 Prussia returned one death for every forty of the Jews, and one for every thirty-two of the remaining population.

The Jews escape the great epidemics more readily than the other races with whom they live. Thus the the mortality from cholera amongst them is so small that the very fact of its occurrence has been disputed.

Lastly, that element of mortality, suicide, which we may look upon philosophically as a phenomenon of disease, is computed by Clatter from a proportion of one million of inhabitants of Prussia, Bavaria, Wurtemburg, Austria, Hungary, and Transylvania, to have been committed by rather less than one of the Jewish race to four of the members of the mixed races of the Christian populations.

Different causes have been assigned for this higher vitality of. the Jewish race, and it were indeed wise to seek for the causes, since that race which presents the strongest vitality, the greatest increase of life, and the longest resistance to death, must, in course of time, become, under the influences of civilization, dominant. We see this truth indeed actually exemplified in the Jews; for no other known race has ever endured so much or resisted so much. Persecuted, oppressed by every imaginable form of tyranny, they have held together and lived, carrying on intact their customs, their beliefs, their faith for centuries, until, set free at last, they flourish as if endowed with new force. They rule more potently than ever, far more potently than when Solomon in all his glory reigned in Jerusalem. They rule, and neither .fight nor waste.

Happily we have not far to go to find many causes for the

CLASSIFICATION AND DISTRIBUTION. 21

high vitality of a race which, by comparison with the Saxon and Celtic, is physically feeble. The causes are simply summed up in the term "Soberness of life." The Jew drinks less than his "even Christian;" he takes, as a rule, better food; he marries earlier; he rears the children he has brought into the world with greater personal care; he tends the aged more thoughtfully; he takes better care of the poor; and he takes better care of himself; He does not boast of to-morrow, but he .provides for it; and he holds tenaciously to all he gets. To our Saxon and Celtic eyes he carries these virtues too far; but thereby he wins, becomes powerful, and, scorning boisterous mirth and passion, is comparatively happy.

The special inroads on vitality made on other races by disease are not easily determined, because of the difficulties arising from temporary admixture of race I tried once to elicit some facts from a large experience of a particular disease, phithisis pulmonalis, and as the results of this attempt may be useful, I put them briefly on record.

At a public institution at which large numbers of persons afflicted with chest diseases applied for medical assistance, and at which I was for many years one of the physicians, I made notes, during a short portion of the time, of the connection that existed between race and the particular disease I have instanced — phthisis pulmonalis, or pulmonary consumption. The number of persons observed under the disease was three hundred, and no person was put on the record who was not suffering from the malady pure and simple, — I mean without complication with any other malady. They who were thus studied were of four classes: — (a) those who were by race distinctly Saxon; (i) those who were of mixed race, or whose race could not be determined; (c) those who were distinctly Celtic; (d) those who were distinctly Jewish.

The results were, that, of the three hundred patients, one hundred and thirty-three, 44.33 per cent, were Saxon ; one hundred and eighteen, 39.33 per cent., were of mixed or undeterminate race ; thirty-one, 10.33 P er cent., were Celtic ; and eighteen, 6 per cent., were Jewish.

It will be unfair to argue from these results that this proportion of Saxons suffering from pulmonary consumption, a proportion so extreme in comparison with the other races, is to be accepted as of general application. It may be conceded that of the persons who presented themselves before me the majority were Saxons, and that the numbers of them affected do but represent the relative proportions of the respective populations. Still the majority is large on the Saxon side, and to it ought to be added a considerable number of the class b, in which the precise fact of peculiarity or race could not be determined. Further, there was this noticeable feature, viz. — that amongst the Saxon patients three-fourths at least came with an hereditary or family history of consumption, while as regards the other distinct races the disease in every instance had apparently been acquired by the sufferer, and was independent of family proclivity.

In respect, therefore, to the particuliar malady named, I am led to infer that it is one to which persons of Saxon race are most susceptible. I am also led by other experience to think that the allies of this disease, struma, tabes mesenterica, and tubercular change generally are most commonly met with in members of this race.

Physiological peculiarities may account for dispositions to disease belonging to typical classes of the human family. What these peculiarities are we are as yet unable to determine. Whether they are primitively impressed on a race, or are acquired, is a question that can only be answered when the exact relationships of disease to race are discovered. My own view, is, that acquired and transmitted qualities, and specific existing social peculiarities, are sufficient agencies for the production of all the known variations of vitality belonging to particular races. This will be somewhat elucidated by that which follows in the next chapter.