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Lippincott's Magazine of Popular Literature and Science, Vol. 15, by Various

V >> Various >> Lippincott\'s Magazine of Popular Literature and Science, Vol. 15,




Dr. Lauder Brunton of England has performed a series of experiments upon
the circulation parallel to those just narrated. Anaesthetizing animals
and exposing the heart, he has found that the action of that organ is
accelerated and weakened by the local application of heat, precisely as
occurs in fever.

In order to test the effect of the withdrawal of heat, I have taken a
rabbit out of the hot chamber, in which it lay upon its side totally
unconscious, and plunged it into a bucket of cold water. The temperature
of the water rose rapidly, whilst that of the rabbit fell even more
rapidly. As soon as the bodily heat approached its normal intensity
consciousness returned, and in a few moments the animal, which had just
before been at the point of death, was running about the grass.

Some months since I had an opportunity of repeating this experiment upon
a human being.

In acute inflammatory rheumatism it sometimes happens that the swelling
and pain of the joints suddenly disappear, and the patient becomes
comatose or wildly delirious. It has been customary to explain these
symptoms as the result of the rheumatism leaving the joints and
attacking the brain. Evidently, this being the case, the proper thing to
do was to irritate the joints so as to draw the rheumatism back to them.
This method was formerly practiced, and the almost invariable result was
death in a few hours.

In most if not all of these frightful cases of sudden accession of
severe nervous symptoms in rheumatism the temperature will be found, on
testing it, to be exceedingly high--108 deg., 109 deg. or even 110 deg.
Fahrenheit. If the views advocated in this paper be correct, it is not
the rheumatism, but the intense bodily heat, which causes the severe
symptoms, and finally death. The joints lose their sensitiveness, not
because the disease has left them, but because the heat so overpowers the
brain that it has lost its power of perception: the patient's leg might
be cut off without his feeling it. In such a case the proper treatment is
to take away the heat by plunging the patient into a cold bath. But can
there be anything more shocking to the universal belief and prejudices
than to put a patient dying of acute rheumatism into an almost ice-cold
bath?

Last spring there was in my ward in the Philadelphia Hospital a stout
young Irishman who had passed through an acute attack of inflammatory
rheumatism, and was suffering from a sharp relapse. Entering the ward
one day, I saw at once that the man was unconscious, and turning to the
resident physician asked, "What is the matter with James?" "Nothing,"
was the reply: "I saw him an hour and a half ago, and he was doing very
well, except that the fever was very high." "He is dying now, at any
rate," was my rejoinder. On going to the bedside the patient was found
perfectly unconscious, the skin dry and intensely hot, the affected
joints pale and devoid of sensibility, the breathing irregular and
jerking, the pulse 170 and scarcely perceptible, every muscle relaxed as
in death, every power of perception abolished. A thermometer placed in
the armpit registered 108-4/5 deg. Fahrenheit.

Believing that the symptoms were due simply to this excessive
temperature, I ordered the man to be at once stripped and put in a full
bath drawn from the cold-water spigot. The temperature of this bath
was found to be 60 deg. Fahrenheit. In one minute and a half after
the patient had been placed in the tub he recovered consciousness
sufficiently to put out his tongue when told to do so in a loud,
commanding tone. In three minutes he began to struggle to get out and
to complain of the cold. In six minutes and a half he had become quite
rational. He was now taken out, only partially wiped, laid upon an
India-rubber blanket and covered with a single sheet, the temperature of
the room being between 65 deg. and 70 deg. Three minutes after this the
temperature in the armpit was 94 deg., in the mouth 105-3/5 deg.; five
minutes later the mouth-thermometer marked 103 deg., and the pain and
tenderness had reappeared in the affected joints. It would be out of
place here to give further details as to his treatment. It is enough to
state that, although owing to a misunderstanding of my orders, the man
was left in a cool room for twelve hours upon the gum blanket, wet and
covered only with a sheet--or possibly because he was so left--he
recovered without a relapse or any bad symptoms.

The first case in which the cold-water treatment was practiced in the
Philadelphia Hospital was that of a woman suffering from a desperate
relapse of typhoid fever. She was semi-comatose, with a pulse of 150 and
a temperature of 107 deg. Fahrenheit: death was seemingly inevitable and
imminent. As the bath-tubs were not convenient, the order was given that
the woman be laid upon an India-rubber cloth, and be wrapped simply in a
sheet constantly wet with water at a temperature as near 32 deg. as
practicable. The nurses, aghast, refused at first to carry out the
order, but the physician's power being despotic, obedience was enforced.
About three pints of whisky were given in the twenty-four hours, besides
drugs, the whole treatment being successful.

It has been shown that excessive bodily heat is capable of producing the
various symptoms of fever, and that its withdrawal is followed by the
immediate relief of these symptoms; and since excessive heat is always
present in fever, it is a logical deduction that it is the cause of
fever symptoms; or, in other words, that it is the essential part of
fever.

It must be borne in mind, however, that the term fever is here used in
an abstract sense, to express a general diseased process, a bodily
condition. _A_ fever is a very different thing from fever. We may have
_a_ fever, such as typhoid, without the existence of fever. In a fever,
the fever--_i.e._, the elevation of temperature--is only part of the
disease, and great judgment and experience are often required to decide
how much of the general symptoms is caused by the fever, and how much by
the disease which is the cause of the fever.

The importance of high temperature having been recognized, it becomes a
matter of the gravest scientific and practical interest to determine the
method in which it is produced.

There are only two systems which bind the body together--namely, the
circulation and the nervous system. As fever is usually a universal
phenomenon, occurring simultaneously in every part of the body, it must
be produced either through the nervous system or by a poison in the
blood acting simultaneously on every tissue. Every physician knows,
however, that there are cases of fever in which there has been no
introduction of a poison into the blood: hence it follows that at least
sometimes fever must be produced by the nervous system.

This being so, the study of the influence of the nervous system upon
animal heat is naturally the next step in our investigation. Before
making this step it may be well to call to mind the fact that chemical
processes are usually accompanied either by the giving out or the
withdrawal of heat. Thus, the chemical actions which result when ice and
salt are mixed cause a withdrawal of heat, and a "freezing mixture" is
formed. When a candle is burnt, the oxidation of its constituents, a
chemical process, evolves heat. Oxidation is the great source of
artificial heat, and animal heat is chiefly generated by the same
process; in other words, animal heat is always the product of the
chemical movements of the body, and these movements are almost
exclusively of the character of oxidation. In the animal tissues a
lessened oxidation is equivalent to a lessened heat-production, and
_vise versa_.

If a large nerve be exposed in one of the lower animals, and a galvanic
current be sent through it for half a minute or more, the temperature of
the animal falls very decidedly; and if the irritation be repeated
several times at intervals, the diminution of the animal heat may amount
to several degrees. Galvanization of a nerve affects very powerfully the
circulation, and it has been believed that this derangement was the
cause of the lessened chemical movements. But the alteration of the
circulation is immediate, and ceases almost at once when the current is
broken, whereas the fall of temperature comes on only after several
minutes, then progressively increases, and persists for many minutes--it
may be hours. The two phenomena being thus differently developed, it is
impossible that they should have the relation of cause and effect, and
the fall of temperature must be traced to a direct influence of the
nervous system upon the chemical processes of the body.

This lowering of temperature under the influence of a powerful
irritation of a nerve-trunk or of its minute branches, which everywhere
pervade the tissues and spread out in the skin, is common to all species
of mammals. If a rabbit be merely tied down tightly upon a table, the
fall is perceptible, and if it be severely wounded, the temperature
diminishes very greatly. It has long been known that severe burns are
followed by a very great depression of the animal heat. Redard, a French
physician, made during the late siege of Paris a most interesting series
of observations upon the influence of severe gunshot wounds. He found
that, entirely independent of any haemorrhage which might have occurred,
the temperature fell enormously, and in direct proportion to the gravity
of the wound; so that by the aid of the thermometer he was able to
predict whether a fatal issue would or would not occur in the course of
a few hours.

We have found that both in man and the lower animals the nervous system
is able to check the chemical movements of the body, but before we can
decide how it does so facts not yet noticed must be looked at.

If the spinal cord of an animal be cut just below the origin of the
nerves of respiration, an immediate fall of temperature occurs, and, if
the animal be left in a cool room, persists until death ensues. If,
however, the victim be put in a warm place, after a time the temperature
begins to rise, and finally a most intense fever is developed. Parallel
phenomena follow division of the spinal cord in man. Indeed, Sir
Benjamin Brodie was first led to experiment upon animals by observing in
1837 an excessive fever follow in a patient a wound of the spinal cord.

I have already explained, in a former number of this Magazine,[2] the
nature of the so-called vaso-motor nerves, which preside over the little
circular muscles that run round and round in the coats of the
blood-vessels. When they are excited, these muscles contract and the
size of the arteries is diminished: when they are paralyzed, the
arterial inner muscles relax and the vessels dilate. The vaso-motor
nerves have their governing centre in that upper portion of the spinal
cord which is within the skull, the so-called medulla oblongata. When
the spinal cord is divided, the vessels are cut off from the influence
of this vaso-motor centre, and at once dilate, profoundly affecting the
blood-current by doing so.

The first fall of temperature which follows division of the cord is
believed by most physiologists to be due to this dilatation of the
vessels. Very probably the blood-stream, flowing sluggishly, does not
give the normal amount of stimulus to the tissues, so that at first
their chemical actions are lessened, and consequently less caloric than
usual is generated in the body. Further, the blood moving slowly through
the dilated vessels of the lungs and of the surface of the body, is
cooled more completely than it should be; hence, unless the body is
protected by being surrounded with warm air, no excessive accumulation
of heat in it can occur, and therefore no fever can appear.

Assuming that this explanation of the primary lowering of the
temperature after division of the cord be correct--and no better one has
as yet been offered--what is the cause of the fever which afterward
develops itself? As it occurs only when the animal is exposed to a
somewhat elevated temperature, it has been thought by some to be due to
the absorption of this external heat. This, however, is certainly not
true, as is shown, to omit less decisive proofs, by the experiments of
Naunyn and Quincke, who exposed animals for two days to a temperature of
90 deg., and at the end of that time, their bodily temperature not having
risen, cut their spinal cords, after which intense fever was developed
in a few hours without any change of atmosphere.

Section of the cord must therefore give rise to an increased chemical
movement and heat-production in the body. As already stated, this
section affects very greatly the circulation, but the fever is
independent of such action. The upper end of the medulla oblongata is
continuous with a nervous mass which joins the two brain hemispheres
together, and hence is known as the _pons_ or bridge. If, instead of
cutting the spinal cord, we separate the medulla oblongata from the
pons, an _immediate_ rise of temperature occurs, and continues until
death, whether the operation be performed in a cold or heated room.[3]

Cutting the medulla at its junction with the pons causes, then, an
immediate and direct elevation of temperature, without disturbance of
the circulation. What can this mean? Evidently, only one thing--namely,
that by the division of the medulla there has been separated from the
general tissues of the body a repressive force--a something which
normally controls their chemical activity and the production in them of
animal heat.

The existence of nerves whose function is to repress action is no new
discovery in physiology. Readers of _Lippincott's Magazine_ may remember
my description of the pneumogastrics or brake-nerves of the heart, whose
duty it is to control the action of that viscus. Nerves which repress or
inhibit action are spoken of in modern physiology as inhibitory. The
experiments which have been adduced prove that there are nerves whose
function it is to control the general vital chemical actions, and that
the governing centre of these nerves is situated above the medulla
oblongata. To this centre, whose exact location is unknown, the name of
the _inhibitory heat-centre_ has been given.

The way in which galvanization of a nerve, violent injuries and
excessive pain depress the temperature, independently of any action upon
the circulation, is now evident. An impulse simply passes up the
irritated or wounded nerve, and excites this inhibitory heat-centre to
increased action, and the temperature falls because the chemical
movements of the body are repressed.

The method in which fever is produced also becomes very evident when
once the existence of an inhibitory heat-centre has been established.
Any poison having the power to depress, and finally paralyze, this
centre must, if it find entrance to the blood, produce fever. If the
poison, from its inherent properties, or from its being in very small
quantity, only diminishes the activity of the inhibitory heat-centre,
the controlling influence is not entirely removed from the chemical
movements of the body, and only slight fever results; but if the poison
actually paralyzes the inhibitory nerves, a very great rise of
temperature must rapidly follow the complete removal of the brake-power.

As an illustration we may consider the intense rheumatic fever, or the
so-called "cerebral rheumatism," such as affected the young Irishman
whose case has been narrated in the present article. Without any
apparent reason the poison of rheumatism habitually attacks one joint on
one day, and another joint on another day, and with as little apparent
reason it occasionally falls of a sudden upon the inhibitory
heat-centre, and actually paralyzes it. In a few minutes intense fever
is developed, and the bodily temperature rapidly approaches nearer and
nearer that line on the other side of which is death.

In many cases of fever, however, there is no poison in the blood; thus,
the local irritation of a boil or other inflammation may cause what is
well termed "irritative fever." The way in which this is produced is by
an indirect, and not a direct, action upon the inhibitory heat-centre.

The casualties of the late war proved but too abundantly that a man may
be wounded in one part of the body and suffer from paralysis of
voluntary motion in another part. Thus, a soldier struck in the neck
fell unconscious, and on awaking was astonished to find his right arm
powerless at his side. This is the so-called "reflex paralysis." Very
commonly the irritation of a nerve will give rise to an impulse which
will travel up the nerve to a motor-centre, and so excite it that it
shall send in turn an impulse down a second nerve to a distant muscle,
and a spasm result. Sometimes, however, the impulse which travels to the
nerve-centre is of such a character that, instead of exciting it to
action, it deprives it of the power of action. In the former instance
reflex motion, in the latter reflex paralysis, results.

We have seen that galvanization of a nerve may excite the inhibitory
centre to activity, and the peculiar persistent irritation of a local
inflammation may deprive the same centre of its power of action: in the
one instance a reflex inhibitory heat-centre spasm--_i.e._, lowering of
temperature--is produced, and in the other a reflex inhibitory
heat-centre paralysis--_i.e._, fever--results.

It would be going too far at present to assert that all fever is
produced in the way spoken of. There are certain drugs which lower the
temperature in the fever that follows division of the cord and
consequent paralysis of the heat-centre, and which must therefore act
either upon the blood, or universally upon the tissues so as to diminish
their-chemical movements. It is most probable, although not yet
absolutely proved, that there are other substances which act directly
upon the blood and tissues in such a way as to increase their chemical
activities, and thereby cause fever.

The practical considerations in regard to the treatment of disease which
naturally flow from the recent investigations of fever are very
important and very obvious. This is especially true since it has been
shown in Germany that under the influence of a continuous high bodily
temperature, not intense enough at any time to compromise life, all the
muscular tissues of the body undergo a peculiar granular degeneration.
Many a typhoid-fever patient has undoubtedly died from the heart-muscle
having undergone this change, when, if by artificial cooling the
temperature of the body had been kept down, the alteration of the
heart-structure would have been prevented, and death averted. It is
obvious, also, that the old plan of thwarting the intentions of Nature,
and depriving the fever-patient of the free use of cooling drinks, was
practically a baneful cruelty. As the body is burning up in fever, it is
also evident that to deprive it of sustenance is to aid in the
production of fatal exhaustion. The burning will go on, whether food is
given or not, so long as the tissues can serve as fuel. Of course no
more food should be taken than the patient can digest, but every grain
of digested food is so much added to the resources of the system, which
is engaged, it may be, in a close and doubtful conflict with disease.

If it were possible, of course the best treatment for fever would be
that which lessened the production of heat. Fortunately, we have some
drugs--notably, quinine and alcohol--which do exert a decided influence
upon the vital chemical movements, but, unfortunately, their power is
limited. As we are therefore often unable to control heat-production,
the best we can do is to abstract the caloric from the body whenever it
becomes so excessive as to threaten serious results. To do this, all
that is necessary is to put the patient in a cold bath, or wrap him in a
sheet wet with ice-cold water, or lay him upon an ice-mattress, or
surround him with coils of tubing through which cold water runs, or use
some similar efficacious device. I do not wish to be misunderstood.
External cold is not to be lightly employed: it is a powerful two-edged
weapon, capable of cutting both ways--a weapon as injurious and
destructive in the hands of the ignorant and inexperienced as it is
efficient in the hands of those to whom study and experience have taught
its skillful use.

To illustrate what cold water may effect when employed by intelligent
and skillful physicians, I may be permitted to cite a few hospital
statistics from Germany and Switzerland, the only countries where the
so-called antipyretic treatment of continued fever has been efficiently
carried out on a large scale. From 1850 to 1861 there were treated
without cold water, at the hospital at Kiel, 330 cases of typhoid fever,
with 51 deaths--a mortality of about 15-1/2 per cent.; from 1863 to
1866, 160 cases were treated with cold baths, with 5 deaths--a mortality
of only 3-1/10 per cent. In the hospital of Bale, from 1843 to 1864,
there were 1718 cases without antipyretic treatment, with 469 deaths--a
mortality of about 27-1/2 per cent; from September, 1866, to 1873, 1121
cases were treated antipyretically, with 92 deaths--a mortality of a
little over 8 per cent. Assuredly, we may claim that this
water-treatment in typhoid fever is one of the greatest gains of modern
medicine since the discovery of anaesthesia.

Some of my readers may here say to themselves, "Why, this is
hydropathy!" Not so. It is the legitimate, not the illegitimate, use of
cold water. It is the use of it as a single weapon, not as the only
weapon of the armory. It is the employment of it in a single affection,
not as a cure for all diseases.

Perhaps, in concluding this essay, I may be pardoned one word of counsel
to my lay audience. Any physician who proclaims himself a follower of
any special doctrine, be he a hydropath, an electropath, an allopath, a
homoeopath, or any other _path_, should be viewed with suspicion. Water,
cold, heat, electricity, drugs, are all agents capable of being used
advantageously in the treatment of disease. Above all men, the physician
ought to have that teachable spirit which is the offspring of true
humility. Knowing the grave responsibilities which he assumes, living
almost beneath the shadow of that past whose life-imperiling mistakes
are so plainly visible in the light of the present, he, of all men,
should be ever seeking for new knowledge, gathering with equal zest the
seeds of healing in the waste as well as in the cultivated places,
amongst the lowest and most ignorant of the populace, as well as in
far-famed schools of medicine.

H.C. WOOD, JR., M.D.




SONNET.


Young bride, that findest not a single star
Shining to-night with longed for prophecy,
Though snowy drifts are swelling near and far,
They need not chill thy happy hope and thee.
If blue had overarched the earth all day,
And heaven were brilliant with its stars to-night,
"A happy omen!" many a guest would say,
And think that Fortune blessed the sacred rite.
Be superstition far from thee, sweet soul:
This snowy robe, in unison with thine,
Nature will doff to-morrow, and the whole
Of this white waste in spring-like freshness shine.
If love be strong, then all adversity
Will melt like snow, and life the greener be.

CHARLOTTE F. BATES.




SOME RECOLLECTIONS OF HIRAM POWERS.


There are--or were--many at Florence whose recollections of Hiram Powers
stretch over the best part of a quarter of a century; and there are few
men of whom it could with equal truth and accuracy be said that such
recollections are wholly pleasant in their character to the survivors
and honorable to the subject of them. He was in truth universally
respected by people of all classes, and by Americans and English, as
well as Italians, in the city of his adoption, and personally liked and
esteemed by all who had the good fortune to be among his friends.
Recollections such as these are, I say, the property of very many at
Florence. But there is no one in that city--there _was_ during his
life no one in that city, not even she who during a long life was a
companion, friend, partner and helpmeet in every sense admirable for
him--whose recollections went back to so early a period as mine did.

When I came to Florence with my mother in 1841, intending to make a home
there for a few years, we found, with some surprise and much pleasure,
Hiram Powers, with a wife and children, settled there as a sculptor. It
was long since, in the course of the changes and chances of life, we had
lost sight of him, but the meeting was none the less pleasurable to, I
think I may say, both parties. It was at Cincinnati in 1829 that my
mother and myself first knew him. My mother, who had long been an
acquaintance of General La Fayette, became thus the intimate friend of
his ward, Frances Wright. Fascinated by the talent, the brilliancy and
the singular eloquence of that remarkable and highly-gifted woman, and
at the same time anxious to find a career for one of her sons (not the
well-known author of the present day, but another brother, long since
dead), whose wishes and proclivities adapted him for a life of more
activity and adventure than that of one of our home-abiding professions,
my mother was persuaded by her to join her in a scheme which at that
time was engaging all her singularly large powers of energy and
enthusiasm, the object of which was to found at New Harmony--I think,
though I am not sure whether Frances Wright's colony was not another,
separate from that of New Harmony--an establishment which was in some
way or other to contribute to the emancipation of the slaves, mainly, I
imagine, by showing that under proper management they were not unfitted
for freedom. The fate of that philanthropic scheme is too well known to
make it necessary for me to rehearse the story of it here, imperfectly
known to me as it is. The upshot was, that my mother and brother were
induced to go to Cincinnati and attempt other plans, the final result of
which was also a failure. I had had no share in these Transatlantic
projects, being at the time a scholar at Winchester in the college of
William of Wykeham. But between quitting Winchester, at the age of
eighteen, and going to Oxford, I had a period of liberty of nearly a
twelvemonth, the greater part of which I devoted to accompanying my
father on a visit to Cincinnati. And there I became acquainted with
Powers, a very few years only my senior, whom I found already the valued
friend of my mother and brother.

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