On Slight Ailments; their Nature and Treatment
- Author:
Lionel S. Beale, M.B., F.R.S., &c. London: J. & A.
Churchill. Philadelphia: Presley, Blackiston.
These valuable lectures by Dr Beale have supplied a great want in medical literature. The sum of human happiness is chiefly made up of small things, and small ailments go far to destroy the comfort of life; anyone, therefore, who can lessen these, does the public a service, and it is gratifying to find one of the most scientific physicians of the day giving us the results of his experience as to the treatment of many of the innumerable ills that flesh is heir to.
The author introduces the subject to his class with the following sound remarks :? ” It therefore follows, and this will be strongly impressed upon you when you come to work carefully at the important subject of diagnosis, the detection of disease, that many of the apparently slight disturbances or ailments may be due to some grave pathological change, which would be entirely passed over by one who had had little experience in medical observation, but would be full of significance to the well-informed practitioner, and that apparently serious illness may be due to temporary and functional derangement only. Do not, therefore, be too hasty in giving an opinion concerning the import of uncertain and indefinite symptoms. We should remember that the most perfect machines sometimes go wrong without a flaw being detected just before the occurrence, it may be, of a complete breakdown. The tissues and organs, and the marvellously minute and delicate structures of a living organism may fail in a hundred ways without giving any notice to its owner, while the most careful scrutiny and minute examination may fail to demonstrate any fault or flaw ; nay, even after the body has ceased to work, after its death, the changes resulting in its destruction may elude the most careful scrutiny.”
“Medical advisers of purely anatomical and pathological habits of mind are apt to offend unscientific patients, and, without deserving it, gain for themselves the unenviable repu- tation of being thoughtless and unkind?regardless of others’ suffering, and if not objectionable, very far from agreeable ministers of relief. People do strongly object to follow the advice of such advisers, however correct it may be; and perhaps the least unfriendly among the patients of such a doctor would, in confidence and in the most quiet manner, recommend him as soon as possible to change his vocation.”
” It has been my lot to study, on more than one occasion, the well-turned phrases and persuasive sentences by which popular prescribers of decillionths of grains, brimful of tact, managed to bring conviction to the minds of people of intelli- gence, and at the same time to impress them with their profound knowledge and intelligence, though all the time they were writing nonsense, and probably knew that they were doing so. But, as is well known, cleverly-stated nonsense often hits the mark, and will continue to do so for many a long year. Men high among the most intelligent and most learned?nay, men who have been looked up to as men of the world, have often been humbugged in matters medical, and even profound lawyers have failed to distinguish medical nonsense from medical sense, and mere sham from real scientific knowledge. Those who are always gauging the value of evidence, and devoting themselves to the extraction of truth, seem specially susceptible to medical and scientific imposition. But there is hardly a department of human endeavour in these days in which you will not find audacious humbugs influencing opinion, and gaining for a time notoriety and renown at the hands of their dupes. I know persons who would be easily influenced by what the quack says, who would go away from the honest, well-informed medical practitioner, with the idea that he knew nothing what- ever about his business, and was quite ignorant of the nature of the changes taking place in the organism, and of the method by which these changes might be modified when they were not properly performed. This is unfortunate, but there is no help for it. Every upright practitioner has been placed in this most unhappy position more than once in his life. Should you find yourselves so situated, the best thing is to say very little, and be as patient as possible, leaving matters to be set right by time. But, while doing our utmost to preserve and extend the high repute always enjoyed by medical practitioners, we must be careful not to play into the hands of pretenders, and this we shall certainly do if we needlessly offend fanciful and crotchety patients. By so doing we practically dismiss them to be preyed upon by quacks.”
It is not to the general practitioner only that this work will be found useful ; the psychologist, too, will meet with much to arrest his attention, especially what the author says on the sub- jects of hypochondriasis, hysteria, vertigo, wakefulness, and drowsiness, &c. The following extracts will show the author’s manner of dealing with some of these important symptoms:? ” In this way,” by constipation, ” that unpleasant condition known as hypochondriasis in the male, and as a form of hysteria in the female, very often commences. There is even the possi- bility that a condition of disease, bordering upon insanity, may be brought about by long-continued improper action of the bowels. Patients will often come to you complaining of very great discomfort. They tell you they feel more or less oppressed, and heavy and overwhelmed; some complain of an unpleasant sensation all over the surface of the abdomen : and when they have taken food, instead of gradually disappearing, it seems as if it went on accumulating and distending the stomach; the patient is blown up with wind; and many persons who suffer in this way soon lose their healthy complexion and become more or less sallow and pasty. Indeed, it is quite extraordinary how many different derangements of the health may result from im- perfect action or a torpid state of the secreting and expelling structures of the large bowel. Imperfect action of the descending colon may cause violent and persistent nerve pains, referred to the back or hip or groin. Certain forms of sciatica are due to this cause; violent lumbar pain is also not unfrequently caused by sluggish action of this part of the alimentary canal.” ” Vertigo, swimming in the head, or giddiness, is an indica- tion sometimes of disturbed action of the stomach and liver, and sometimes of deranged circulation and disturbed heart’s action. But this symptom may be also due to affections of the nerve structure of the brain or the small arteries which supply it. The exact seat of the lesion varies, but in animals injury to the crus cerebri, as well as certain injuries to the cerebellum are followed by vertigo. For one case, however, which is due to serious disease of the brain or its vessels, we shall meet with a large number which depend upon temporary derangement of the digestive organs.”
” Drowsiness.?Patients sometimes come to consult us in consequence of a persistent sleepy state. They will tell you that they could sleep all day as well as all night. If they sit on a chair for a few minutes they drop off to sleep ; if they take up a book or a paper, it soon falls from their hands in conse- quence of drowsiness coming on; even if they go out for a walk they soon begin to experience an almost irresistible tendency to lie down and yield themselves to sleep. Patients who suffer in this way sometimes come for help to their medical adviser. They may feel pretty well in health, with the exception of this irrepressible drowsy feeling, and they ask you what they can do to get rid of a tendency so very troublesome and disagreeable. ” In many cases this state seems to depend upon some imper- fect action of the digestive organs. Sometimes it may be traced to over-feeding. Sometimes to taking too large a meal in the middle of the day. Sometimes beer is the cause of it, or a too liberal allowance of wine. If you give mild purgatives, and mineral acids and saline medicines which act upon the intestinal canal, you will often get rid of the condition, and cure the patient. When the liver is at fault, as is not infre- quent^ the case, you will find the advantage of giving a small dose of calomel, blue pill, or gray powder every third or fourth night, for three or four courses.
” Cold bathing, also, is often useful. As soon as the patient rises in the morning he should have a cold shower bath. There is no need of a large quantity of water. A shower bath of two or three pints will be sufficient. If the drowsiness is very troublesome, two moderate shower baths a day should be tried? one at about eleven, the other at four o’clock?cold or tepid, according to the time of the year. In some cases, in addition to the cold bathing, a mild purgative every night for a week will be found useful.”
” Wakefulness and Restlessness.?The very opposite condition to drowsiness afflicts some patients. They come to you com- plaining that they cannot sit still or rest quietly for a time. They experience a strong desire to be continually walking about. They cannot stay for long in one place, and do not feel satisfied unless they get constant change of scene. You inquire if there is any cause for this restlessness, but, as a rule, the invalid assures you that everything is going on in its usual way. But he cannnot feel satisfied, quiescent, or composed. Some suffer from vague frights. When they go to bed at night, instead of dropping off to sleep in a natural way, they lie tossing about. The pillow is not comfortable, and soon gets too warm for the head. A most uncomfortable night is passed, and the patient only gets a little sleep towards morning, and wakes up from this, feeling tired, exhausted, and unrefreshed. The mental disturbance in these cases depends upon some temporary derangement which cannot be accurately defined. If upon inquiry you learn that the restless state has existed for any con- siderable time, you must tell the patient to thoroughly change his mode of life. If he is in business, you must recommend him to get away for a time. Send him to some place where he will get complete change of scene for a month or more. The diet should at the same time be carefully regulated, and in all probability the patient will return home well, and able to go on with his round of daily duty just as steadily as before the occurrence of the illness.”
The work is not only a guide for the management of slight ailments; it teems throughout with original physiological and pathological observations, which greatly enhance its value, and prove the profoundness of the microscopical researches of the author. It is impossible for us within the limits of a review to do more than indicate a few of the valuable medical aphorisms with which these lectures abound.
Disclaimer
The historical material in this project falls into one of three categories for clearances and permissions:
Material currently under copyright, made available with a Creative Commons license chosen by the publisher.
Material that is in the public domain
Material identified by the Welcome Trust as an Orphan Work, made available with a Creative Commons Attribution-NonCommercial 4.0 International License.
While we are in the process of adding metadata to the articles, please check the article at its original source for specific copyrights.