IN the pathological and symptomatic make-up of sick humanity, fever and inflammation cut such an important figure as to be practically present everywhere in all the forms of disorder that afflict the rage. These so uniformly go hand in hand that we rarely witness one without the other in any given case of disease. No well-marked case of established fever will long prevail without sings of a local inflammation.
In exceptional cases, where the local inflammatory manifestation is very circumscribed and involves only a limited amount of anatomical structure, the febrile manifestation may be so slight as to form apparent exception to the rule, that fever and inflammation are practically constant in symptomatic and pathological association.
The celebrated French physician and scientist, Broussais, spent much time and literary effort to establish his theory that every case of fever is attended by its local phlegmasia. With equal propriety might he have spent time and effort to establish the proposition that every local phlegmasia has its associate febrile condition. Of the two conditions, interest is concentrated in the phlogistic or inflammatory state, both in a pathological and therapeutic point of view. In a pneumonia we have an eye to the lung involvement as a mode of relief for the pulmonary fever; in rheumatism, to get rid of the fever by a relief to the articular surfaces; and so on in gastritis, enteritis, cerebritis, carditis, cystitis, etc.
Practically, the successful management of inflammation constitutes the summum bonum of professional effort.
From the times of Hippocrates and Galen down to the early years of the present century, the best lights in the profession taxed ingenuity and thought to arrive at a correct theory as to the nature and cause of inflammation, partly as matter of scientific interest and practically to institute modes of treatment. These various theories, with the names of the authors annexed, have been stated, re-stated, discussed, and re-discussed so often and so amply that a rehash here would seem tedious and unnecessary. The leading ones have been the vitalists, humoralists, super-excitationalists, mechanical and chemical.
We think it safe to affirm that in every well-marked inflammation there are qualities and conditions involving the main element in each of these theories. It is a wise provision of nature, in the direction of human experience and activity, that as we grow gracefully old we become more simple, modest, and less pretentious; so that, as a profession and as individuals, we have come to esteem and define inflammation as an association of appearances known as heat, pain, swelling, tenderness, and redness. Of course, this association of conditions becomes in the future of matters fruitful in such superadded conditions as suppuration, ulceration, gangrene, atrophy, hypertrophy, and the various dyscrasias.
Having disposed of the various theories above so summarily as of little value scientifically or practically, we are in some sort stopped from much privilege or latitude in this line ourselves. But we think it entirely safe to affirm, as a conclusion drawn from observation and experience, that every case of inflammation consists essentially and primarily in a capillary blood stasis of the part. Physiologist teach us that that innumerable mesh-work known as the capillaries stands as the half-way place between the veins and arteries. Whether the motion in these little radicals is a vis a tergo from the heart, or by capillary attraction, or by a sort of successive vermicular contraction, is still matter sub judice.
We know, however, that upon the successful transition of the blood through these little tubules depends the suitable performance of that covert, mysterious performance known as assimilation and disassimilation- the repair after waste and wear and the removal of physiological debris. Now, any hurt or adverse agency, whether traumatic or toxic, which interferes with the capillary motion is at once announced by inflammatory manifestations-heat, pain, tenderness, swelling, and redness.
I believe the theory or idea has been generally conceded that the excess of blood in a part under inflammation depends an invitation of the circulation to take direction to the particular locality of the part under affection. I confuse I have never been able to see either fact or sense in such explanation. Of course, there is an excess of blood in the part. How does it occur? I should say it depends upon a failure of the capillaries to send it along. They have received a hurt, either traumatic or toxic, and fail of the part of their function. At first it may be slight; stasis adds to the obstruction; until, after a short while, obstruction and capillary failure become so complete as to arrest all motion, to be followed by extravasation, death of tissue, suppuration, ulceration, gangrene.
Common-sense would seem to say or indicate that whatever helps the disabled capillaries in an effort to send the blood along must be palliative,curative, helpful. Leeches, blisters, cupping, blood-letting have heretofore been supposed to be the means to this desirable end.
As the result of observation and experience, I have pleasure in stating that moist heat has a range of power and opportunity for such a purpose unequalled by any therapeutic agent in the whole resource of the curative art, whether we consider it in reference to power of action or wide range of applicability. It is an easy matter for the busy, enthusiastic practitioner to get himself under the banners of a fad or a hobby-things which I formerly held in much odium and dislike.
Lately I have fallen into much favor with such modes of thought and action. A good hobby or a good fad, if pushed with reasonable discretion, will certainly enable in the premises. Any excess or mistake may be safely left to the corrective help of experience and conservative observation. In a presentation of the claims of moist heat as a therapeutic agent I can hardly expect to present anything specially new. I simply desire, in a systematic way to gather together the various details and modes of its uses and activities.
I opine some of my auditors will feel surprise at the conclusion of my contention, at the great range of activity of this simple, everyday agent. Precisely how it quickens capillary action and sends the blood along the normal modes and channels, I do not pretend to explain. That it brings relief in curable cases and palliation in others not curable, is beyond contention or controversy.
In the management of nervous disorders, insomnia, rheumatism and cutaneous affection, the vapor bath is of the very first importance. Submerging the entire body i hot water is in the same line and of very great value. In the early part of the present century an ignorant, illiterate new York well nigh revolutionized the then prevalent modes of treating disease by the introduction of what soon came to be known as the “Thompsonian Practice,” Thompson being the author of the plan.
He came upon the stage of professional action at a time when poor sick humanity was in agony and despair from the heroical uses of the lancet, the scarificator, the blister, plaster, salivation, purging and vomiting. Taking advantage of the odium attaching to these modes, Thompson and his coadjutors had for a time a wonderful run of success. His treatment consisted almost exclusively in the use of the vapor bath coupled with the abundant ingestion of hot plizans; so that the patient had moist heat galore internally and externally. He made abundant cures, but the system gradually fell into disuse from certain crudities and excesses attending its administration.
The great success of the celebrated hot springs in various parts of the world, of which “Hot Springs” Arkansas is a reliable example, is simply attributable to free bathing in hot water and the free drinking of the same on an empty stomach. Precisely the same results might be attained in the private family home if method and persistency could be accomplished in the use of the hot water internally and externally, with exemption from worry and business cares. The “Turkish Bath,” now so popular as a luxury as well as in the cure of disease, has its chief resource in the moisture and heat, together with certain manipulations incident to the administration.
The hot “size-bath,” so useful in various pelvic disorders, has a marked influence upon the condition of the patient generally, while acting well upon parts locally. Much the same may be said of a hot “foot bath,” I doubt if the same amount of hot water could be applied to the same amount of external bodily space elsewhere with the same good result. In a violent acute brain disorders a protracted hot head douche will sometimes act like magic. In the thirst, nausea and vomiting attending many cases of strong fever, nothing so quickly allays the symptoms as constant sips of hot water repeated for ten or fifteen minutes. Hot irrigations of the intestines, with hot abdominal fomentations, bring great relief in acute dysentery.
