DR. GULLY'S WATER CUBE IN CHRONIC DISEASE. THE medical works
of Dr. Gully that have fallen in our way have been generally distinguished by literary ability, ingenuity of hypothesis, and considerable plausibility of exposition and argument in advancing his views. Those views, however, have been dogmatic rather than capable of proof, or at least than proved ; and Dr. Gully seems, like the Atheni- ans of old, to be smitten with a taste for new things. In his Simple Treatment of Disease, he pointed out the evils that arise from active practice, and advanced some very sensible views as to the propriety of watching the intentions of Nature, but not interfering with her till those intentions are indicated. In carrying out this principle, however, he seemed to us to push his practice to an extent which Nature did not re- quire and patients would not submit to. He gave ample credit to the powers of Nature in expelling the disease, but too little in bearing the remedies.
Although there is no apparent resemblance between The Water Cure in Chronic Disease and the Simple Treatment, the " Cure" is in reality a corollary from the "Treatment" In both cases Dr. Gully conceives that the cure emanates from Nature, and that the physician's business is only to assist or "fillip" her. In both, Dr. Gully makes time, and rest or relaxa- tion, main elements of the curative means ; and demands from patients more of time and submissive attention than the majority, we suspect, will choose to render. The steps in advance in the present work consist in throwing physic to the dogs,—prescribing water, both externally and inter- nally, in immense quantities, under certain regulations ; and in a theory or hypothesis of the origin of all disease, and of the mode in which the water cure operates (and physic, as we understand, cannot operate at all) in cur- ing it. In presenting this hypothesis, Dr. Gully speaks with his wonted dog- matism; and any one would suppose that he was enunciating a series of established mathematical truths, rather than advancing views that may be disputed. To give a full account of Dr. Gully's exposition of the causes of chronic or rather of all diseases, cannot be done in our limited space; but we will convey an outline of it as well as we can. It has some re- semblance to Dr. Searle's theory of the capillaries, which we mentioned last week; but The Water Cure in Chronic Disease excels The Why and the Wherefore in system, comprehensiveness, and literary exposition. In every part of the body, blood-vessels exist in such numbers that the point of the finest instrument cannot be introduced without touching some of them • and those vessels are ever accompanied by ganglionic nerves,—though Dr. Gully prefers the term " nutritive," as they regulate the action of nutrition. The central seat of these important nerves is the organs of respiration and digestion (the stomach and the lungs); and in these two, but chiefly in the stomach, most disease originates, and in the stomach ;11 of it must be cured. Even a surgical case depends upon the condition of the nutritive nerves and blood-vessels of the stomach. If they form healthy blood from the food ingested, the injury is readily re- paired ; if not, it is repaired slowly, or not at all. These ganglionic or nutritive nerves have irritability, which is ever in action, but not sensi- bility, which arises from the nerves of the brain and spinal cord. Hence, a great deal of mischief may be going on without the patient being cogni- zant of the extent of the injury, or even his medical adviser, if the latter relies upon the evidence of pain : which, however, he does not; nor do Dr. Gully's illustrations of the mode in which disease is induced negative the absence of pain, or at least of sensation, because injury cannot take place without involving more than the nerves of irritation.
" The first effect, therefore, of causes of disease—excessive cold or heat, in- fectious matter, &c.—is upon that nervous system which presides over the capil- lary or nutritive blood-vessels, and whose central portions are in the viscera of the chest and abdomen—the ganglionic system.
"It is ascertained by numerous experiments, that the first effect of all kinds of agents upon the nervously-endowed capillaries is to produce contraction of them; a diminution of their calibre by the fact of their contraction. In other words, all agents are stimulants to them, and bring them into action, and that action is con- traction. But as all action is effort, such effort must, in a living body, be suc- ceeded by lassitude and exhaustion; and in the case of these small blood-vessels, relaxation and increase of calibre is the evidence of this secondary state; and fur- ther, it follows that the amount of relaxation will be in exact proportion to the amount of the previous contraction.
"Of course the condition of the blood as to quantity is affected by these two op- posite states of the vessels that contain it. When the vessels contract on the ap- plication of the morbid stimulus, they drive their contained blood from them; and when relaxation ensues, the blood rushes into their increased calibre; and the amount of blood thus brought into a part will be, of course, in exact proportion with the relaxation, and this with the contraction, of the containing blood-vessels.
" To illustrate all this. I apply water at 35° of Fahrenheit to the back of the hand when it is warm: it first of all drives the blood from the skin, and renders it pale; this is because the cold has stimulated the nutritive nerves of the blood- vessels, and caused them to contract and drive the blood from them: but in a very ehort time the skin becomes more than usually red, and, if friction be used, hot too; this is because the vessels have been exhausted by the contracting effort, have relaxed, and admitted more blood into them. This is an approach to in- flammation of the skin of the hand.
"Or take a piece of frozen mercury, the temperature of which is 38° below the zero of Fahrenheit, and apply it on the hand. The stimulus is so violent, the con- traction so excessive, as to be instantaneously followed by excessive relaxation and total loss of vital power of the blood-vessels, and inflammation of the most de- structive kind is produced. The part is burnt, in fact, as effectually as if the opposite stimulus of red-hot iron had been applied. " Between these two instances the shades of stimulation and relaxation are in- finite, according to the morbific agent applied. The more stimulating the agent, the more rapid and extreme the amount of blood brought to the part, whether that part be the skin of the hand or the mucous lining of the stomach or lungs."
Dr. Gully next proceeds to inquire into the changes in the blood ; and then illustrates the progress of the local injury upon the general system.
"A man ingests highly-seasoned meats and alcoholic drinks, and begets in the mucous lining of his stomach a patch of such disorder as I have minutely described. Now, though that disorder is, as regards the patch itself, one of depressed vital power, it becomes to other parts a source of exalted vital action,—as if the very that of the existence of a diseased point roused the system to efforts for its relief; an opinion that was held by Hippocrates, and has prevailed with some of the soundest physicians since his time. The sympathy thus excited in other organs of the body is in proportion to the amount and kind of nervous matter they con- tain. Thus, in the case before us, the ganglionic nervous matter of the mucous membrane of the stomach excites the same matter distributed to the heart; whose beats are, in consequence, increased in frequency and force; the pulse becomes rapid and hard; as a result of this quickened pulse, the breathings also quicken. Then comes the sympathy with the spinal cord and the brain, whose functions are rendered irregular or are oppressed: hence the lassitude of mind and limb, the prostration of strength, the somnolence first, and then the sleeplessness, &c. Then there are the sympathies with the mucous surfaces of all the other organs roused, causing the diminution and vitiation of their secretions: hence the heavi- ness and the aching of the forehead, the suffused eyes, the fevered and dry tongue, the thirst, the stoppage of the bile, the constipation of the bowels, the scantiness of the secretion from the kidneys, all of them are dependent on mucous mem- branes. And as this mucous surface extends to the outer part of the body, form- ing the true skin, the same morbid sympathy extends thither, accompanied with the same diminution and vitiation of sensation and secretion: hence the dry and hot akin called 'feverish heat.'
"In fact, here is a case of what is called 'simple inflammatory fever,' a general disease traceable to a small point of acute inflammation in the stomach. Some- times the same general result follows on the application of cold air to the outer mucous surface—the skin, whereby the blood is thrown on an extensive portion of the inner mucous membrane of the nose, throat, and lungs; and then nearly the same phwoomena are present, and a feverish cold' is said to exist. But in either case, and indeed in all cases of general aymptoms, there is one organ, and sometimes only one spot of an organ, that originates the whole series, and which must be overcome, as the cause, before we can vanquish the symptoms, which are the effects."
If this disease goes on, it may induce death or serious illness ; but if not so violent, it terminates in a chronic state of disorder, that may extend from the stomach to the other organs of the body. But the stomach still remains the key of the position; because not only must a better nutrition originate there, but it is by means of the stomach that all internal reuse- dies must be administered and reach the other parts—you cannot, for instance, act upon the liver without first digesting the medicines and stimulating the stomach. These medicines, however, as usually adminis- tered, Dr. Gully, with his cold-water lights, has decided are rather mis- chievous than otherwise. They temporarily relieve the earlier stage of the acute disorder, only to advance it into the chronic, which they gra- dually aggravate instead of care. It is probable that there is much truth in this ; that abstinence and repose after indulgence—that a strict system of diet on the first appearance of indigestion, coupled with atten- tion to the skin, and to air and exercise—would cure all the lighter pre- liminary acute derangements which subsequently run into the chronic. " But men are men,' as lago says. If they never indulged there would be no occasion for abstinence ; if they made a habit of temper- ance, cleanliness, and exercise in the open air, they would enjoy health as good as their constitution permits. But " nemo mortalium omnibus horis sapit " ; and the constitution of many persons is so delicate nata- rally, or through their occupation, that they, are constantly subject to external influences. And what are all such people to do? The neces- sities of life will not allow them to give weeks to Dr. Gully's simple treat- ment, still less months to his water cure. They take, and we suspect they must continue to take, physic—not as a good, but a necessary evil. Whether they may not take too much, just as they eat too much, indulge too much, and in bodily matters do and risk too little, is another question.
The brief summary we have given of Dr. Gully's views of the causes of chronic disease ; must only be regarded as an outline yet his exposition of the subject forms but a small portion of a bulky volume. The second part applies his theory to various diseases of the digestive organs, lungs, nerves, limbs, and skin ; each disorder being illustrated by cases, some of a very mond:erful character ; but the whole containing various passages well worth consideration, though rather for their critical censure of the systems of over-dosing and active practice, or for their pathological re- marks, than for their enforcement of Dr. Gully's own theory. The third part contains the author's exposition of the rationale of the cold water cure; in which the skin is represented as a great curative medium, but the direct curative agents are the blood-vessels, relieved by an improved action of the skin and stimulated by the various applications of the water. There is in this, as in many other parts, a dogmatism of manner, which savours rather of the unscrupulously positive empiric than the cautious physician, who knows the uncertainties of things ; but the matter is for the most part reasonable enough. Dr. Gully very properly exposes the promises and mechanical practices of many so-called professors of the cold water cure, and the lucubrations of amateurs. He also fairly admits, that in all the commoner cases, the water merely saves time ; that regimen, relaxation, air, and exercise, if properly persevered in, would work the same results, but by a slower process.
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