F. Royston Fairbank
1878 The Lancet  
436 become more powerful, act more readily, and thus lead to more efficient control of the feelings. At the command c the will the muscles are kept at rest, glandular and othe effects are less marked, and, finally, the emotion graduall, dies away. 2. Mark the attitude of an individual who expresses determination to carry out his plans. He clenches his fist stamps his foot, and says with emphasis " I will " simul taneously, and his muscles generally are in a state of con traction. And is there
more » ... t a muscular element in tha unflinching resolution to bear severe pain without outwar manifestation ? 3. Muscular exercise produces power and a readiness to ac in obedience to a wish which must of necessity engende confidence. This confidence in the ability to act is a menta process springing out of physical strength. What canno be accomplished by careful preparation ? Note the admirabl swim of Webb and the prolonged walk of Weston, both feat of prodigious and unexampled endurance. In each cas there was undoubtedly an intense feeling of fatigue amounting to severe pain, and yet they were enabled by a powerful exercise of the will, greatly aided by, if not actually arising out of muscular development, to bring their labour to a wonderfully successful termination. May not any o the emotions be fitly compared with the state of fatigue And is it not, moreover, true that they are all more or les: under the control of the will ? 4. But, further, systematic exercises assist in the contro of the feelings and appetites-(a) By exhaustion. It is clear that by expending a certain amount of nervous energy in a definite direction, which must be given off in some wa or other, the tendency to take any other direction is greatly diminished. (b) By habit. By degrees exercises become sc much a part of the individual that they are performed as a matter of course. Early rising, for instance, is usually ar act for many years of self-denial, but by frequent repetitior the effort is reduced to a minimum. Is it not reasonable tc suppose that an active vigorous condition of muscle is oj material assistance not only in taking the final leap, but in forming the resolution to do so. After a time, indeed, may there not be a certain amount of automatic action about it? 5. Of course, it is not by any means a universal fact, but it is a matter of observation that the woman is more emotional than the man. Has muscular development any share in the production of this difference ? 6. Almost every practitioner knows that an individual who has been suffering from acute disease has not that control of the feelings which is natural to him. Has the wasting of muscle anything to do with this ? Now, if excessive selfish indulgence has the morbific influence which I have ascribed to it, then it follows that an increased power of the will, and a more constant and regular exercise of it, must of necessity prevent much disease. It has been shown that some of the more important physical phenomena accompanying states of feeling are directly and powerfully, I do not say solely, influenced by the will; in other words, the muscular movements at any rate may be checked, or almost extinguished, by volitional control. This control is strengthened, facilitated, and made more efficient by systematic physical exercises. Following the same line of argument, I believe that mental exercises of a suitable kind are second only to physical exercises in importance. If this be so, there remains this question, which is one well worthy of the serious consideration, not only of each individual member of the medical profession, but of every reformer, statesman, and philanthropist. In what manner, when, and how long should these systematic exercises be employed? Without attempting to give even a sketch of a complete answer, I would merely venture to mention one or two points which have occurred to me :-1. That systematic physical exercises should take a very prominent place in the training of our youth, irrespective of rank, in both sexes, and they should form a very much larger share of the instruction given in our board schools than they do at the present time. '. That during the first ten years of life, systematic mental exercises over and above reading and writing should he of a moral nature. The beauties and advantages of truthfulness, temperance, and honesty should be impressed upon the youthful mind, and contrasted in their results with the hideousness and degradation of dishonesty, intemperance, and deceit. Without a shadow of a doubt, it is far more important during the first decade of human life to point out the difference between right and wrong, and see that there is a decided and proper appreciation of it, than to crowd the brain with facts and figures, or with anything else. It must not be forgotten that physical exercises lose much of their value apart from mental and moral ones, as far as control of the will is concerned, as may be witnessed over and over again in the persons of professional athletes, prize-fighters, and soldiers. The physique of a man may be ever so good, and he may have great volitional control, but it is of little use unless he knows when to exercise that control. As well might you expect a vessel classed Al, thoroughly well furnished with efficient machinery, able seamen, and judicious officers, but without helm, compass, or chart, to make a safe and rapid voyage to the antipodes. 3. That when children become capable of understanding them, a few simple facts relative to the laws of health should be presented to their minds. This would naturally include the results of non-observance of those laws, and thus the necessity of self-control would be forced upon their atten. tion. In conclusion, however unpalatable and nauseous the idea, disease appears to be in many instances an evil of our own creation ; and I cannot help thinking that the allotted term of threescore years and ten might be much more fre. quently attained, without of necessity entailing a life of rigid asceticism, by a constant persevering habit of self-denial, steadily and firmly maintained by systematic exercises. NOTES OF SURGEON TO THE DONCASTER GENERAL INFIRMARY. THE following cases illustrate two possible sequelae of operation for strangulated hernia, which are, I believe, very rare. I have not been able to find any notice of them in the books I have consulted. CASE 1. Strangulated femoral hernia; operation; subsequent ascitesfrom chronic _peritonitis; paracentesis ; reco. very. -Betsy M-, a married woman about forty-five years of age, came under my care with the following history. Had always been healthy and active until ten weeks ago, when she suffered from strangulated femoral hernia on the left side, the rupture being of quite recent origin. After the symptoms had existed two days she was seen by a surgeon, who at once operated. He informed me that he opened the sac and found a small knuckle of intestine, dark' but other. wise sound. Pain continued in the lower part of the body for a few days, but it was relieved by fomentations, and entirely passed away. The wound had not yet, after ten weeks, quite healed, and from it a clear fluid constantly oozed. From the date of operation the patient had noticed her body gradually enlarge, until it was at this time as large as at the ninth month of pregnancy. The enlargement was evidently caused by ascites. There was great oppression of the heart and lungs from the enlarged abdomen. She was ordered to take diuretics, and to remain under observation. A week later, distension of abdomen causing great distress, I performed paracentesis, and drew off about two gallons and a half of fluid, of a deep straw colour, which became perfectly solid with heat, and was of a sp. gr. 1025. The distressing symptoms were at once relieved. The wound in the groin healed completely in twenty-four hours. Three weeks after paracentesis her abdomen was again nearly as large as before, and she was greatly emaciated and anaemic. I prescribed tincture of the muriate of iron, with solution of acetate of ammonia. She rapidly regained her strength under this treatment, the ascites entirely disappeared, and her body was reduced to its previous ordinary dimensions. Two years later she remained in good health. I attribute the ascites to chronic peritonitis, the result of the operation. CASE 2. Old inguinal hernia; operation; return ; rupture of the sac with escape of the intestine externally; ; operation recovery.-Sophia T-, aged forty-two years, a tramp, was admitted as "a casual " to the Doncaster work.
doi:10.1016/s0140-6736(02)43570-2 fatcat:vc6z3yzxr5flpkjosuywfk2yly