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It is not, however, of the accidental occurrence of this disease of which we speak; but of that description which follows us from the cradle to the grave. It seizes upon every organ and tissue of the body, assumes the shape of sciatica or lumbago, which Andral thinks takes its rise in the investing membranes of the spinal marrow. It attacks the diaphragm, where it acts upon the muscles; the great toe, in the form of gout; operating upon the muscles and investing membrane of the liver and heart, which are likewise muscular; and the joints and muscles themselves.
The only difference between the acute and chronic rheumatism, as Dr. Stokes justly observes, is in the degree and not in the nature. The gout, which generally fastens on a small spot, is only a variety of inflammatory rheumatism; and the tic doloureux is only the chronic form of it, seizing on a nerve or tendon. There is, doubtless, something peculiar in the organization of a person subject to this diathesis; and on a superficial examination, we should say that a proneness to perspire is one cause of its appearance, though only an obvious one.
There are others more remote, which we should endeavor to detect; for instance, in long-continued rheuinatism of the chronic kind, the tissues thicken in various parts, and a hard, bony substance is formed under them. May not this arise from a deficiency of that part of the organic pabulum called gelatine? Supposing this surmise to be true, it becomes a matter of deep interest to discover what particular diet, climate and avocation are best suited to repair this deficiency. We may be allowed to throw out another hint, which is certainly of value. It is, that cold, damp weather not only aggravates the paroxysm when present, but brings it on when it has been some time absent.
It is a singular feature in this diathesis that an injury done to any organ or part is rendered more difficult of cure than in any other. When there is a strain, sprain, or fracture,oreven a slight bruise or blow, the investing membrane of the injured part continues for a long time in a sluggish state, unless inflammation is immediately set up, which is sometimes a preventive of greater evil. Instead of allowing the secretions to circulate freely, they are arrested at that spot, and this accumulation forms a sort of spurious tissue, gland, or bone—more frequently bone. We constantly see instances of an osseous formation on the bones of the hand, called by medical men a disease of the periosteum, for which there seems to be no
other cure, in extreme cases, than to remove the excrescen
Medical men, in forming their diagnosis of a disease of this kind, will inevitably trace a predisposition to a rheumatic affection—if not in the patient himself
, certainly in his parents and of course they will shape their treatment accordingly. In six cases out of ten of diseased periosteum, a rheumatic diathesis could be traced, either incipiently or in well-marked paroxysms, perhaps occurring years before.
But it is not so much our purpose to speak of the alleviation or cure of a rheumatic diathesis, as to point out its effect upon temper and habits. Of all diseases, excepting scrofula, this one most frequently engenders selfishness and uncharitableness. A man of this diathesis, even when the paroxysm has long passed off, looks out for the best corner of the room, the best seat in a coach, and the best bed in an inn. All this is
very well in a general way, for every one should endeavor to do this when no one else is to suffer by it; but our rheumatic subject is too apt to displace others who are as much entitled to be screened from draughts of air and damp sheels as himself.
It may be said that a person whose limbs are twisted and distorted by pain is not a fit subject for advice or reproof, and that he should be allowed to consult his ease on all occasions. This is well enough in the abstract; but there is such a thing as carrying the matter too far. No amount of suffering can justify a man in appropriating all the time and thoughts of those around him. To give up the whole life of a wife or child, a relative, friend or servant, to a capricious, selfish sufferer, is much more cruel than to give him a salutary check,-a check by which he would be less exacting and annoying to others, and of greater benefit to bimself.
That a person is in great pain, is a poor excuse for knocking down a child or servant who has not been sufficiently quick in attending to his wishes or whims. This the
gouty, the neuralgic and rheumatic often do. A paroxysm of pain produces in them a paroxysm of rage.
If there were no instances where a thoughtful and kind consideration for others accompanied the severest cases of neuralgia and rheumatism, we might suppose that an irritable temper, churlish manners and selfishness are as inseparable from the disease as pain itself; but having before us at this moment bright examples of long suffering from neuralgia, with unaltered goodness of temper and the kindest consideration for the comfort and feelings of others, we are led to believe that the cruelty and selfishness so frequently displayed in rheumatic persons are owing to a want of moral training and to injudicious indulgence in childhood.
People of rheumatic diathesis are very apt to become sedentary in their habits and occupations. Some cultivate the exact sciences; others write invectives of the same character as those of Junius; others again take to conchology and entomology. Flamstead, the first astronomer royal, was a great mathematician and observer. He was a martyr to rheumatism and neuralgia; but having no false indulgence when young, he was exempt from selfishness and churlishness.
Having observed that this diathesis disposes men to sedentary habits, we need not be surprised that they either keep themselves aloof from public life, or withdraw from it early, even when their faculties are in full vigor. This arises from pure selfishness—from love of ease-and, we may add, from parsimony. To be in public life, there must necessarily be frequent calls on the purse, and this the selfish man cannot endure. Pitt is one of the rare examples to the contrary. Whatever view may be taken of his conduct and his public acts, he must be allowed by all to have been disinterested, and to have given up personal comfort to the claims of others.
Dr. Stokes, in his lecture on scrofula, throws out a hint which may be of service to the rheumatic sufferer, or rather to his physician. He observes of the white and red tissues, that the former are of a lower degree of vitality, and of course that remedies which are of service in dispersing diseases of the red tissues have very little power over the white ones. But that this only refers to chronic disease ; for when turning to those which are acute, he observes that we arrive at a very curious fact, and this fact, we think, may be closely allied to rheumatism. “Serous membranes, although belonging to the white tissues, are nevertheless very liable to acute and violent diseases."
It is not our province to go deeper into this curative and speculative part of the subject; but the temper, habits, and general character of those who possess the rheumatic diathesis are so strongly affected by it that we felt it a duty to refer to this remark respecting the acuteness of pain in rheumatism. If we suppose that the disease is principally attached to the serous membranes, we have gained something at least which may assist us in our inquiries concerning its origin. We recommend both the lecture on rheumatism and on scrofula to the attention of any one who is interested in the cure of these diseases.
6. The scrofulous diathesis.- We come now to speak of scrofulous or phlegmatic diathesis; and here we enter at once into a wide field, with startling facts to meet us at every turn. But our limits will prevent us from dwelling too minutely on particulars. We expect, however, that the masterly manner in which Dr. Stokes, in his lectures, has discussed the subject of scrofula, will induce other physiologists to look still deeper into the matter; for the class possessing this diathesis is more numerous than has hitherto been supposed.
We wish it to be understood that the term scrofula is used by us in a more comprehensive sense than usual. Under this head we class all cutaneous affections and all swellings of the glands-ulcers, cancers, psoriasis, erythema, erysipelas - and, in short, every morbid action of the glands and cuticle. Tarsal ophthalmia often arises from a scrofulous diathesis. When this is the case, there is no permanent cure; for whenever there is a debilitating or irregular action going on in the system, the edges of the eyelids are affected by it immediately.
Scrofula, in the common acceptation of the word, “is a disease principally characterized by a chronic swelling of the absorbent glands, which tends very slowly to imperfect suppuration. It has also been called struma. By the French, it is known as ecrouelles, which is corrupted in Scotland into the cruels. The Germans call it der kropf, from the swelling under the chin; and the English, the king's eril. In horses, this affection is called farcy."
According to Dr. Stokes and Broussais, who held the same doctrine,
"Scrofula implies nothing specific, but simply that there is an undue preponderance of the white over the red tissues, and that in such persons there is of course a greater liability to diseases of the lymphatic system. Where there is this undue preponderance of the white over the red tissues, there we have the scrofulous constitution, and the liability to its accompanying disease. Observe, there is nothing specific in this. An individual, originally free from scrofula, may afterwards be subject to it, and it may, under certain circumstances, occur in all constitutions.
“The characteristics of what has been termed the strumous habit are known since the time of Galen. The skin is white, the complexion
NO. XV.-VOL. VIII.
delicate and transparent, the hair fair, in general, but sometimes dark, the features delicate, the upper lip thick, the alae of the nose large, the head fully developed, the chest rather narrow, [and Dr. Bell adds, that the thorax is narrow and arched in front - pigeon or chicken-breast, as it is termed — the shoulders are raised, and the abdomen large,] the joints are large, a great tendency to sanguinéous congestion, internal and external, which is very little under the influence of antiphlogistic means, the intellectual faculties early developed and of a higher order, great refinement and delicacy of taste. In such persons, there is generally a considerable preponderance of the white tissues, and they are much disposed to scrofulous diseases, which is nothing more than a chronic irritation of the white parts and the organs immediately connected with them.
“We may look on the scrofulous diathesis as a condition of the human body which is to a certain degree imperfect, and which is to be attributed to arrest of development."
In proportion as the animal rises in the scale, the proportion of the red to the white tissues is increased; and the lowest animals, which possess only a white circulation, enjoy a degree of vitality not far removed from that of the vegetable kingdom. Red blood, then, is the pabulum vita — the characteristic of superior organization and vitality — the rich stream by which the nobler parts of our system are nourished. Applying this to the different states of our bodies in health and disease, we find that the predominance of red blood and red tissues is a proof of health and vigor ; and white tissues show the feeble and unhealthy individual."
Dr. Stokes proceeds in the clearest manner to carry out this beautiful theory, and we regret that we have not room for more copious extracts from his book. In support of this theory, he observes that in women, in whom the white tissues are more prevalent than in men, the skin is fairer, the vessels carrying red blood smaller, and the muscular system less developed, and that as they have also more white blood, their strength is less and their constitution more delicate ; that in albinos, in whom there is a like preponderance of white tissue, the muscular fibres are lax. He remarks, further, that, as persons advance in life, there is an increase of white tissues, and that when animals are kept in a starving condition, their tissues become blanched in a remarkable degree. Bacon's aphorism is, that white is the color of defect.
It appears, therefore, that the red tissues are more highly animalized or vitalized than the white ones. In consequence, the latter are less able to resist death or diseases. " White tissues are most liable to morbid affections of an intractable character, frequently terminating in the total destruction of the diseased part. Cancers, tubercles, ulceration in the carti