274 CHANGES PREPARATORY TO OCCURRENCE OF disease.

So, too, with regard to acute inflammations and various diseases of a non-contagious character, what seems to be a sudden illness is probably but the climax of a series of changes which have been going on for a considerable time, although the patient may not have been aware that anything was wrong. An attack of acute rheumatism is always referred to exposure to wet and cold, or to sleeping in a damp bed, or to a long drive or walk in the rain, or to some single unfortunate circumstance or want of caution on the part of the patient. But how many of us are exposed, over and over again, to adverse conditions of precisely the same kind with perfect impunity. The peculiar state of the blood which precedes the attack of illness, and which alone renders the attack possible, has been produced after a prolonged course of pathological changes. But if this special state of blood exists not, instead of the person exposed to the adverse influences being attacked by acute rheumatism or pneumonia, or pleurisy, or some other acute inflammation, he experiences, perhaps, a sharp rigor, accompanied possibly by local pain and general discomfort, succeeded in two or three hours by profuse sweating, probably diarrhoea, and the secretion of urine rich in urates, uric acid, and other matters. In the course of a day or two, except feeling a little weak, the patient regains his normal state of health. Perhaps, indeed, for some time afterwards he may even feel exceptionally well and vigorous. He has, in fact, been relieved by the removal of various substances which had been for some time accumulating in his blood to his detriment, and which at any moment might have been instrumental in the development of local disease in some important organ. These considerations, supported by many more to which I might advert, suggest the general conclusion that the maintenance of each individual organism in a good state of health, the careful attention on the part of the practitioner to slight ailments, and the recognition by him of any symptoms that may indicate slight derangement of function or action, are of far greater consequence than the hunting after and extermination of various species of hypothetical pathological organisms, even though it were actually possible to catch and exterminate legions.

I believe that if the organism be in a proper state, almost all disease germs coming in contact with it, or entering it, will certainly die, instead of growing and multiplying and deranging or destroying important constituents of the blood and tissues. Many of the poisons in question are round about us-in the food we eat-in the water we drink. The foot of a fly will carry enough poisonous matter to infect a household. It is, therefore, vain to be always seeking to annihilate contagion which you can only destroy to a most limited and probably useless extent. On the other hand, it seems exceedingly reasonable, and especially on the part of nurses and ourselves, who must be continually exposed to the assaults of, disease germs, to do all that is possible to promote and improve the resisting power of the body. We always notice that of those exposed to the

SLIGHT DERangements PREVENTING serious DISEASE. 275

same adverse conditions, but a very small percentage will be seriously ill. A moderate number only after suffering exposure will catch cold or experience some slight derangement. The majority will entirely escape. No doubt such facts.may, in part, be explained on the supposition of the existence of difference in constitution in the different individuals. Allowing amply for this, however, there is good ground for concluding that it is possible to preserve the body in such a state of health as would enable it to resist attacks of contagious poisons, to any one of which, in a different condition, it would certainly succumb. In other words, there is good reason for the conclusion that it is possible to resist the onslaught of contagious poisons, and, therefore, that it is possible to still increase the health of the community. By detecting and treating slight derangements, I have no doubt whatever that we frequently succeed in establishing a state of the system which renders the supervention of serious disease almost impossible.

The comparative immunity of those who are frequently troubled with various slight derangements of health has been frequently noticed. Perhaps it is to be explained by the existence, in particular individuals, of a highly sensitive and exceptionally active state of those nerve-fibres, and that part of the nervous system which is intimately connected with the healthy action of the circulating and digestive systems. In some persons these nerves respond to the slighest stimulus, and the least departure from the ordinary state at once occasions inconvenience or discomfort; while in others, considerable variation, as regards temperature, quality and quantity of food, make little or no impression, and occasion no immediate disturbance or derangement. But, in the latter case, pathological changes may take place, and may result in grave structural alteration, without the patient having experienced the least discomfort, or even being made aware that any departure from health had occurred in his system before the supervention of the serious illness which you are asked to investigate and treat. Perhaps, in some such manner, we may attempt to account for the fact that certain individuals are suddenly struck down by terrible disease while they seem to be in good health, and others, who never feel well, or look well, reach old age without experiencing one single attack of any illness so serious as to endanger life. Such persons, it must be noted, are often obliged to be very careful, as regards diet, and the feeling of tiredness, after great exertion, is in them so distinct that it must be yielded to. Thus they are forced to take rest before any damage whatever has been done to their organs. It is not probable that careful attention to the process of excretion, as well as to the quality and quantity of food that is taken, brings about and preserves a state of blood in which disease germs, instead of growing and multiplying, would die? How many ailments may not be prevented by judicious starving, or by living for a day or two now and then on low diet? How thoroughly may not the blood be depurated by a sharp purge given,

perhaps, just before liquor sanguinis was about to escape from the vessels, to be poured, perhaps, into the air-cells of the lung? Might not the purgation be fairly considered to have prevented an impending attack of acute Pneumonia or Inflammation of the Lung, and thus to have really "cut. short" the disease? May not moderate doses of Bicarbonate of Potash or Soda, taken in solution twice or three times a day for a week or two, avert an attack of acute rheumatism? Will not a small dose of certain preparations of Mercury, now and then, prevent attacks of gout or rheumatism or sick headache or dyspepsia or biliousness? Is it not reasonable to conclude that certain salts, by their action on the bowels and kidneys, by promoting free elimination, establish a general state of the tissues, which may for the time render it impossible that certain morbid changes of serious consequence should occur?

I have endeavored, in these few lectures, to show you why we should not fail to devote some attention to the study of those slight departures from the normal state which possibly, in these days, are sometimes passed over by the practitioner, although, on the one hand, their import may be strangely exaggerated, or, on the other, hardly noticed by the patient himself. As I have tried to impress upon you many times, slight derangements sometimes afford the first and only indications of commencing disease of a serious character. There is good reason for thinking that by judicious management, not only may some troublesome though slight ailments be entirely relieved, but further and progressive morbid changes may be prevented or retarded.

The principles upon which the treatment of many slight ailments may be successfully conducted, are the same as those upon which the management of more marked developments of morbid phenomena is based. have given illustrations of the simplest and slightest ailments, and have endeavored to show how their treatment may be most simply and successfully carried out, and I have attempted to lead you on by degrees to consider more highly complex pathological changes, and to explain the principles upon which more complex methods of treatment are based. In no way, I believe, can you so quickly acquire that sound knowledge of pathological processes, and of the means of checking or modifying them, which are daily required in practice, as by adopting the course I have advocated. Let me, therefore, conclude by again impressing upon you the importance of not neglecting the study of the nature and treatment of "Slight Ailments" now, or at any period of your professional

career.

INDEX.

ABSORPTION of fluid in constipation, Bat's wine tonized, 1333.

278

Catarrh, 214.

INDEX.

Catarrhal inflammation of stomach, 266.
Catching cold, 202.

Catechu, 151.

Cayenne pepper in nausea, 86.

Contagion, 275.

Contagious disease, 46.

Contractile power of bowel, loss of, 116.
Contraction of minute arteries, 228.
Co-ordinating power in vertigo, 156.

Cells, changes in epithelial, in a flea-bite, Corpuscles, mucus, 250.

blood, passage through vascular
walls, 241.

outside capillaries in inflammation,

Diagnosis, importance of being cautious
in making, 217.
Diapedesis, 240, 243.

Diarrhoea, 144.

treatment of, 151.

Diathesis, 76.

Diet in constipation, 127.

in rheumatism, 211.

in diarrhoea, 150.

in hot and cold climates, 98.

in indigestion, 93.

Digestion, artificial, 109.

in jaundice, 167.

non-nutritious matters in, 113.

in rheumatism, 205.

Digestion in sick headache, 169.

Dilatation of capillary vessels in fever and
inflammation, 222, 232.

Diluents in a cold, 218.
Diphtheria, 261.

Disease germs, 275.

Disks for hypodermic injection, 192.
Dispensaries, self-supporting, 35.

Dissection of nerves of intestines, 87.
Diuretics in a cold, 215.
Dorsum of tongue, 43.

Douche, eye, 260.
Dover's powder, 191.

Dried apples in constipation, 129.
Drowsiness, 184.

Dry mouth and fauces, 67.