Domestic Encyclopædia (1802)/Chronical Diseases
CHRONICAL DISEASES are, in general, neither attended with fever, nor any other symptoms portending a speedy termination of the complaint; and, in this sense, they are opposed to acute, or inflammatory disorders. Physicians find no small difficulty in drawing a precise line of distinction between these affections; as the latter often change into those of a chronic nature.
Tissot derives the origin of inveterate diseases from the following sources: 1. Debility of the solid parts of the body, either hereditary, or induced by adventitious causes; 2. Defective digestion, and weakness in the stomach; 3. improper treatment, and imperfect resolution, of acute diseases; and 4. Too great irritability, and other affections, of the nervous system.
From this view of the causes, and the corresponding evidence of medical practitioners, it cannot be doubted that chronic maladies are not only the most complicated, but also the most difficult to be removed: Proteus-like, they appear under a thousand different forms, often exhaust the fortitude of the most patient, baffle the united efforts of the Faculty, throw the unhappy person into a state of despair, and deliver him over to all the artifices, and cunning of ignorant pretenders, who impose upon the credulous victim, and close the of his delusion!
On the contrary, in acute diseases, Nature, though violent in all her efforts, generally points out the way, in which she may be assisted: in short, the cautious physician, who has had a moderate share of experience, will here seldom fail to procure the desired relief. If his prescriptions be scrupulously attended to, a few appropriate doses, in a vigorous constitution, will produce all the good effects which may be attained by art.—But, in chronic affections, medicines generally operate slowly, and often in a manner very different from what experience entitles us to expect. Hence the precarious nature of drugs has become almost proverbial; not because they are in themselves inert (which would involve a contradiction); but because they were improperly, or injudiciously, applied.
Such being the case in all those inveterate affections, which torment mankind, it is matter of just surprize, that the attention of the afflicted, as well as the scientific, has not been more generally directed towards discovering effectual means of relieving the unhappy, instead of such as have but too often eluded the most sanguine hopes of the patient, and detracted from the reputation of the physician.—If it be admitted that, in chronic distempers, the whole animal frame is under a slow, though certain, influence of disease; that the system, in all its functions, requires a very different action, or stimulus, from that generally produced by medicines, on particular organs; and that so favourable a change can be effected only by operating on the different processes of digestion, assimilation, absorption, and respiration, not separately, but conjointly; then we may venture to affirm, that the prevailing plan of treating those obstinate maladies is established upon a very precarious basis.
Novel as this assertion may appear to many of our readers, it is nevertheless true; and though it may, at first, meet with opposition, like most of those general truths which all acknowledge, but few will defend or practise, there is every reason to trust to the good sense of mankind, that empiricism and knavery will gradually vanish from the tablets of history.
In order to approach with our labours towards a plan of so beneficial a tendency, we have, on all proper occasions, inculcated the necessity of attending to that most important department of medicine, which treats of diet and regimen. From these alone, the most essential advantages may be derived in all chronic diseases, especially such as cannot be traced to their sources, or the predisposing causes of which cannot be discovered, either from an intentional concealment of the patient, his want of resolution and capacity to disclose them, or other reasons, chiefly arising from the present imperfect state of the healing art. Hence, the writer of this article has, for many years, been sedulously employed in collecting and arranging facts, towards a new work, in which he proposes to lay before the public an outline of the treatment to be adopted in a diseased state of the body; and which will form a counterpart to his former "Lectures on Diet and Regimen."—At present, it will be sufficient to point out the principal rules, by which the conduct of such persons, as are the victims of inveterate afflictions, ought in general to be guided.
1. When the patient is not confined to his bed, gentle and frequent exercise will be salutary; but all violent commotions, whether of mind or body, are extremely prejudicial, and cannot fail to retard his recovery.
2. The sick-room ought to be lofty and capacious, frequently ventilated by opening the door or windows, without admitting a draught of air; and, in damp weather, the apartment cleared of foul, mephitic vapours, either by mild aromatic fumigations, or more effectually, by the steam of vinegar. For the same reason, all soiled linen, as well as the night-chair, &c. should be immediately removed; the bed frequently made; and an assemblage of persons never suffered to vitiate the atmosphere of a patient's room.
3. Let the temperature of the air be cool rather than warm; yet this general rule may admit of exceptions in particular cases: only a moderate degree of warmth should, likewise, be allowed with respect to the bed-clothes, and especially the covering, which ought to be soft and light. When the strength of the patient permits, he should be encouraged to rise, and spend part of the day, sitting either in bed or on a chair; but carefully avoiding a draught of air, or taking cold: hence he should not too suddenly venture to leave the house.
4. In regard to food, he must abstain from crude and heating animal flesh, such as bacon, ham, boiled beef, hard eggs, &c. from dry, flatulent, acrid, salted, and such provisions as increase the bulk of feculent excretions. Thus, white meat in the most frugal portions, blended with vegetables of a mucilaginous and nutritive kind, such as cauliflower, asparagus, parsnips, scorzonera, &c. as well as light dishes of rice, barley, or oatmeal, in a liquid rather than solid form, and particularly baked or roasted apples, will be found the most conducive to health. In certain cases, however, raw fruit may be abundantly allowed; but the patient must never eat any food against his appetite; and if, during the crisis of a disease, he should express a strong desire for a particular dish, no prudent physician will object to the gratifying of this natural inclination, unless the substance claimed be obviously possessed of hurtful qualities.
5. In the article of drink, a chronic patient cannot be too cautious. In general, he ought to give the preference to simple, pure water, or ptisan made of pearl-barley and currants; or whey; toast and water; or this fluid acidulated with the juice of lemons or vinegar, and sweetened with sugar or honey. All spirituous liquors are, in general, unnecessary and detrimental, unless required from particular circumstances.
6. The important process of perspiration also deserves to be duly regulated: every time the patient has profusely perspired, he ought to change his linen, which should be previously warmed; and, if there prevail no peculiar irritability in the system, flannel will always be found the most beneficial dress next the skin.
In short, every object, tending to alarm or disturb the patient, should be carefully removed; his sleep rendered as quiet and comfortable as possible; and, if his strength and appetite begin to improve, he ought to redouble his attention, both as to the time and manner of taking muscular exercise, not less than to his mental exertions, as well as with regard to the gradual change of the quantity and quality of his aliment.