DR. CALVERT HOLLAND ON CONSUMPTION, INDIGES- TION, SCROFULA, AND NERVOUS
AFFECTIONS.* THE mein object of this work is to trace the origin of disease to the nervous system,—meaning by origin, not the "first cause," which the human mind cannot in its present state comprehend, but that which is generally understood as the origin of anything: The argument runs somewhat in this way. The great source of nutrition and health is the blood.; but its condition depends upon the circulation, and this on the nervous energy. Depress the nervous energy, and the circulation becomes proportionately feeble ; the general health, tone, or whatever else you may call the state of the individual, is proportionately- depressed ; the func- tions of the various organs are imperfectly discharged, the actions of the weaker become torpid or depraved, and particular disease ensues. When this disease is merely one of deranged function, or of injured structure, such as accompanies inflammation, the theory is coherent. It does not seem to satisfy the requirements of an original cause, when structural change, an alteration as it were of substance, takes place,—as ossification of vessels. Neither is the difficulty quite met, we think, by Dr. Calvert Holland's further theory of predisposing cause, thus explained, in reference to con- sumption.
"Every individual, from the innate endowments of his constitution, is predisposed to some particular disease. In one the tendency is to consump- tion in another to scrofula, in a third to nervous affections, in a fourth to infhlmmation, gout, or apoplexy. By predisposition is to be understood such a state of the vital powers as requires only the presence of certain exciting causes to. develop the morbid effect in harmony with them. The proximate cause in all these instances is to be traced to the peculiar influence exercised by the nervous system. Whether the body be robust or weak, or whatever may be its prevailing characteristics—whether the blood be superabundant or deficient, too stimulating or inadequately charged with vital properties— these different conditions are to be referred to nervous agency. It is this which confers on the various tissues their susceptibility of action. The sto- mach, according to the amount" distributed to it, whether agreeably to the laws of its organization or to temporary circumstances, is vigorous or feeble in the performance of its functions ; and hence the quantity and quality of the circulating fluid, though apparently to superficial observation to be as- cribed to the ingests, are, nevertheless, an exact representation of the pre- vailing influence of the-nervous system. The powers by which the blood is maintained in motion, as the heart, the arteries, and the capillaries, are • The Nature and Cure of Consumption, Indigestion, Scrofula, and Nervous Af- fections. By G. Calvert Holland, M.D., lately Physician to the Sheffield General Infirmary, Sc. Sc. Published by Orr and Co. similarly dependent on the same nervous principle, and are modified in their operations in the ratio of the quantity which they receive.
" It may therefore be shown, that a predisposition to disease has for its foundation a peculiar state of the nervous system ; the consideration of which, in reference to phthisis, is worthy of our most patient examination ; as it is in fact on the justness of the views formed on this subject that all preventive or counteracting means can possibly be based."
Logically speaking, much of this is conclusive enough ; but logic is not sufficient to establish truth, or to discover natural laws,—as we may learn from the blunderings of those masterly logicians the schoolmen of the middle ages. But Dr. Calvert Hol- land's logic is not quite conclusive, still less satisfying. If we ad- mit that " predisposition " suffices to Recount for morbid changes of struoture, the nervous energy seems at once reduced to a second cause—a mere means of developing a first cause of disease—a something behind, of superior power. Neither do we get much beyond compendious (and no doubt convenient) phrases to express a reference to some general cause, about which we really know no- thing. We could change our author's terms for other terms com- monly used,.—calling "predisposition" tendency, and "nervous energy" inherent or constitutional vigour or power,—and still be where we were. Nor does anything of much practical importance seem to flow from it. Grant (which may be readily done) that a de- ficient nervous energy causes a feeble circulation—that this affects the vessels and nerves, say of the stomach, inducing indigestion. This indigestion in time produces local derangement, which reacts on the general system, and that again on the local disease. In prac- tice, it is Anus. to regard both in the course of oure ; first to treat the local derangement, and when that is corrected, to improve the tone, to strengthen the system to invigorate the constitution,— terms by which is meant, we fancy, pretty much what Dr. Calvert Holland means by nervous enegy. It may be true that some practitioners attend too much to mere symptoms, and that few con- sider the central power, or whatever it may be called, so much as our author would havethem ; because they may not ascribe to the theory the same importance that he does, and may doubt whether they can in practice directly act upon it. Indeed, Dr. Calvert Hol- land's suggestions for improved and systematic treatment show this. His remedies only act like the remedies of other phy- sicians, and they have by no means the novelty in all oases which the Doctor supposes. The systematic use of the flesh-brush, and a general attention to the skin, are recommended in all popular compendiums since the late Dr. Combo so forcibly pointed out its importance, nearly twenty years ago. The same may be said of the connexion be- tween the skin and the great internal organs ; as well as of the injurious effects of sedentary or mental occupation on the ner- vous energy, and the impropriety of pushing bodily exercise to an undue extent. We do not even know that Dr. Calvert Holland draws a more systematic attention to these things than Dr. Combo; but as he treats of them in relation to specific dis- eases, he may seem to do so.
Upon the whole, we do not see that the author has succeeded in establishing his theory, much further than would have been gene- rally admitted on its broad statement. This book is certainly not the most successful of Dr. Calvert Holland's medical treatises. The author seems to us to deal too much in assumptions, and to be de- ficient in logical connexion even granting his assumptions. The book is pervaded by a quiet dogmatism, and somewhat disfigured by a spirit of attack upon the profession. But it is the work of an able man, who even when travelling on a wrong road will pick up much that is useful by the way. His exhortations on the import- ance of looking to broad physiological principles are well worth at- tending to ; the general, perhaps the inevitable tendency of many practitioners, being to confine their thoughts too much to symp- toms. The importance of strengthening the constitution, and of endeavouring to prevent the development of consumption lull scrofula, instead of trying to cure them when established, if not a new view of the subject, cannot be too often repeated. And there are frequent hints on the management of patients or the treatment of disease, that are well worth attention. The following remarks on the use of stimulants are sound and discriminating.
"The causes of indigestion may be divided into two great classes ; first, those which act immediately on the stomach or bowels, and secondly, those which, by exciting or depressing other parts of the body, indirectly disturb the conditions of these organs. Among the first is the wide class of ingests, which, either from their quality or quantity, are constant sources of de- rangement. They sometimes at once give rise to distressing symptoms from their indigestibility or irritating properties : they more frequently, how- ever, slowly and imperceptibly produce their injurious effects, which may be generally traced to the baneful habit of pampering or stimulating the ap- petite, giving the stomach a greater amount of food than it can properly act upon, or in other ways making an undue demand on its vital energies. Wine, spirits, tea, and coffee, taken immoderately, or under circumstances unfavourable to their grateful and beneficial influence, belong also to this class of disturbing causes. Each is fraught with good, if discretion as to quantity and occasion regulate its use. The existing state of society, the excessive mental and bodily exertion by which it is characterized, and the severe and almost unceasing drains upon the vital energies, impart at times to these articles, regarded as luxuries, an influence as potent and as impera- tively required as that which is exercised by the most nutritious food, to resuscitate the flagging and exhausted powers of life. The benefit they con- fer does not consist in furnishing to the system materials essential to com- pensate for its waste, but in placing the digestive organs, and indeed the en- tire animal economy in a condition to appropriate efficiently the ingesta calved. Their relation to the body is as that of the water to the wheel which it puts in motion. Viewed in this light, they are among the neces- saries of 14 and to a far greater extent than is usually imagined.
"It must not be supposed from the foregoing remarks that these articles are indispensable to all. We speak of them as having a use in reference to certain bodily conditions; and numerous instances are daily occurring where the pertinacious abstinence from generous stimulants allows debility or
functional derangement to pars into catenate and incurable structural changes."
We 'would gladly have quoted the entire passage relating to constipation of the bowels, and to caution in the use of purgatives, in the chapter on Indigestion ; but it would run to too great length. The following views on one branch of the subject de- serve consideration at all events.
"In reference to constipation, arising from an insufficient amount of ela- borated food in the bowels, the circumstance is replete with interest, and de- mands en attentive consideration. It has never been considered in all its importemt physiological relations to the digestive organs; and to this is to be ascribed the baneful and unphilosophical character of the measures usually employed to correct their disordered action. All things being equal, the contractions of the heart are strong or weak acccoording to the quantity and stimulating qualities of the blood. The same doctrine will apply also to the motions of the bowels. In order that these shall be able to act with regularity, or agreeably to the necessities of nature it is clear that they must be supplied not only with a properianramt of food; but with such as is fitted to stimulate them. The quantity 2S the important condition. In the majority of the caseaof dyspepsia, occurringin delicate, exhausted, or debilitated constitutions, characterized by the want of appetite, or which is not gratified from the fear of taking food of a substantial kind, but more frequently from the injurious habit of living largely on liquids, the digestive organs, independently of the causes already considered, are insufficien y sup- plied with the means indispensable to their healthy and vigorous operations. To expect the bowels to perform efficiently their functions under such cir- cumstances, would be as absurd as to calculate on the rapid and continued motions of the water-wheel when deprived of the fluid by which it is No- pelted. They must have a due amount of nutritive matter ; and further, they tenet be allowed within certain limits, and these must be liberal, to take their own time in acting upon what they receive, as well as in rejecting the residue of their vital actions.
"Constipation is not only a symptom of indigestion, of the debili- tated power of the body, but is a means which Nature frequently employs to conserve her energies. It is regarded as an evil, obstructing the harmomous play of the properties of life. Nature indicates by it, in the cases under consideration, an inability to discharge her duties,—a faltering in her actions, a struggling in her efforts to accomplish the end assigned to her. Our noninter- ference with her operations, save mildly and judiciously to solicit, not force, is the office -we are called upon to exercise. • "The remote intervals at which the bowels act, or the remarkable torpor which they occasionally exhibit, is a period of rest, during which they are gradually accumulating the vital energies essential to their normal functions ; and if not injudiciously disturbed during the slow Form of restoration, which may occupy months, they at length are sufficiently aroused and in- vigorated to perform with regularity their important duties. "During this nursing or economical conservation of the powers of life, the whole animal economy participates in the advantage. The nervous and the einiulatory systems acquire additional resources, the pulse becomes stronger and less frequent, the muscles are increased in tone, and the countenance is faller or less haggard in its expression. "If these remarks, founded not less on extensive experience than on phy- siological considerations, possess the importance which is here insisted upon, it will at once be evident, that the practice of drugging the system with alternating purgatives, tonics, and alteratives—at one time prostrating the digestive org,ans, at another studying to restore them—is a procedure calcu- lated to do immense injury to the finely-balanced powers of life. It may produce the desired result, may compel the torpid bowels to act; but it is urging them beyond their strength, and ultimately they will do nothing-for themselves, always waiting to be assisted. Purgatives do not rouse- their unexcited energies alone into play; those which are awakened and deter- mined to the alimentary canal are drawn from remote parts, from the sys- tem at large ; and hence the debility and the variety of nervous affections consequent on the freqtiont action of such remedies."
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