On the Influence of Vitality upon Secretion

T. Inman
1859 BMJ (Clinical Research Edition)  
0-previous occasions, I have ventured to call the attention of the profession to what seemed to be fallacious principles of dia,nosis and treatment in respect to somue diseases generally considered to be of nervous origin; I propose, at the present time, to call attention to some points connected with secretion, into which we have not so clear an insight as is desirable. As far as I can ascertain the general notion about secretion, it is, that it is essentially an active process; and that
more » ... ess; and that increased secretion, as a necessary consequence, implies the idea of increased action in the secreting organ. Thus we speak of perspiration as increased action of the skin, diarrlioea as increased action of the bowels, diuresis of the kidney, and the like. Still farther, we consider that various organs can be stimulated or goaded inito increased action, and we find such ideas constantly put into formulas in the following manner: diaphoretics, diuretics, aperienits, etc., are given to increase the action of the sLin, the kidneys, the bowels, and the like. Under other circumstances, we have the idea of increased action put in another form; thus, in rheumatic fever we are told that perspiration is an " effort of nature" to throw off or eliminate a certain poison; in the diarrhea accompanying many cases of Bright's disease, we are told that the bowels talke on " iniereased action" to relieve the kidneys; that in scarlatina, the kidneys talke on increased action so as to suppletinen-t the deficient action of the skin, etc. In all these instauces, and many others we might name, there is a steady idea apparent, that increased secretion implies increased action, and that increased action implies increased power. This idea receives corroboration from the constancy with which in-,creased secretion from the niostrils, bronchi, urethra, and vagina, are spoken of as produced by "inflammation"of the Schneiderian membrane, of the mucous membrane of the bronclhi, etc. Now I am not going to makle the startling assertion that all OUe-ideas on this point are wrong; but I wish to group a number of ell knlown facts in suich a nmanner that it must be apparent to every one, that another interpretation may be given of the phienomenon of increased secretion, besides that of "i2icreased action ;" and I wish to poinlt out some of the very practical colnclusions wxlich a reconsideration of the subject in olves. h'lie first fact to which I would call attention is, that during the short period of life which elapses between an apoplectic stroke and its fatal termination, 'we have, in a vast majority of instances, if not universally, an abundant perspiration upon the skin, and a copious secretion (I use the word for want of a better) of mucus in the traclhea and the larger bronchi. Cold claimmy perspiration, and the " death rattle" in the throat, have long beeni recognise(d in many diseases as immediate harbingers of death. WNitlh the dying condition of the patient before our eyes, it is impossible to attribute these phenomena to iiicreased power, or iniereased action; we must, on the contrary, allow that they are due to a failing condition of the vital powers. Now copious perspiration and abundatnt bronchial secretion do not always come togetler, and we may therefore advantaceously follow upj) each sMniptom separately, and ascertain how far the preceding inference is correct. WVe ask, in wlhat classes of persons perspiration is most commron, constant, and severe? The answer is, it is an almost 'habitual attenidanit on consumption; it is nearly constant in riheumatic fever; it comes on partially in the later stages of typhus fever; it is frequent in cases of psoas abscess and st-unmous disease of the bones; it attends simple debility, whether arising from accidental or constitutional cause; it is commoIn in delicate children; and it is frequently produced by fright or otlher depressing mental emotion. It often accompanies bronchitis; and one of the most severe cases of colliquative perspiration I have seen, arose fiom sexual excesses. In nione of these instances can we suppose that there is increased action and au.gmented power. 3Z0 With regard to the causes influencing the amount of the bronchial secretion, we may aaain ask, In what persons is it most abundant? We find it far more copious in old age, when the powers are low, than in youth, when they are vigorous, and it augments in quantity every year as the patient grows older and is more enfeebled; it is increased by all depressing agencies, by the action of cold upon the surface which checks the circulation, by the abstinence of food which poverty too often enjoins, and by the use of such drugs as mercury and antimony. It is increased by even trifling exercise, and I have known in many cases a short walk to prove fatal. The bronchial secretion is unusually abundant in strumous children, in those who have a tendency to decline, or are already in consumption. I have known an inordinate amount of secretion induced by fasting, and almost magically cured by a very generous diet. Nor is it without interest, the fact, that of all the popular remedies for profuse bronchitic secretion, those are the most successful which are practically the most stimulating, e. g., ammonia, polygala, myrrh, ammoniacum, tinctures, balsams, etc. We now extend our inquiry into other secretions, and what do we find? That struma is very generally attended with increased secretion from the nostrils, the bronchi, the bowels, the skin, and in females from the vaaina. That a weak old age is attended with, and often fatally ended by, hydrothorax and hydropericardium, i. e., increased secretion from the pleura and pericardium; that ascites is common under the same circumstances; and that general dropsy frequently occurs, even when there is neither renal or cardiac disease. We know that large losses of blood occasionially eventuate in the same phenomena. We know that the children of consumptive parents are unusually liable to increased secretion from the lining membrane of the cerebral ventricle, i. e., to watery effusion. I have had many patients under my own eye, in which hydropericardium and hydrothoraxlhave been traceable to no other cause than cold, privation, misery, and hard usage at sea. I have had others, in which large effusions into the knee and elbow-joints have been due to a similar cause, and where the produqts of the increased secretion of the synovial membranes have been taken up aaain under the influence of strong stimulation, e. g., blisters and iodine paint. Still farther, we know that diarrhea, i. e., irncreased secretion from the bowels, is a frequent cause of infantile death in the miserable dwellings of the wretched poor, where starvation is more common than profusion, and a low vitality than a flush of strength. The same complaint is common in struma, phthisis, typhus, and other exhaustina diseases; it often attends sea scurvy, and is almost habitually produced by fear. If we turn to the female sex, we find that the secretion of the catamenia is increased by debility; that in the consumptive or strumous, it is not only excessive in quantity, but that it is brought on at irregular intervals by an amount of exertion an(d fatigue totally inadequate to produce similar effects on the healthy. We find, too, that the vaginal secretion is wonderfully increased in the delicate female; and that leucorrhcea is at once the evidence of debility and the cause of its continuance or increase. In man, we find that the quantity of semen is augmented by various depressing agencies, such as excessive heat, excessive fatigue, and sexual excess; the quality of the secretion is deteriorated, but the amount formed in any given period, say for a week or a month, is amazingly increased, i. e., in spermatorrhcea the amount of the discharge will reach an ounce in three weeks or thereabouts, whereas in health the same amount would not be discharged spontaneously in as many months. Nor does our experience of gonorrha'a militate against the preceding facts, as we have had repeated opportunities of noticing that the discharge is always most excessive in those of a strumous habit or debilitated frame; and that it may in them be diminished more surely by the use of steel or other tonic, than by a rigidly meagre diet and total abstinence from stimuli. And I would call attention to the well-known fact, that the most popular medicines in that complaint are such excitants as cubebs and copaiba, which stimulate the parts to decreased action. Nor is such increased secretion confined to cases of venereal origin; for I have the following account from a well-known physiologist. "In my most feeble state," he writes, " I observed the secretion from the glans penis to be unusually abundant, so much so that, having omitted for three days to take my cold bath in a morning, I found stains on my shirt." I have myself repeatedly noticed that the glans is far more moist, and the sebaceous secretion around the corona far more abundant, in delicate or strumous young men, than in I =
doi:10.1136/bmj.s4-1.122.350 fatcat:44kkkq5lwbbjlgc5yeqh3xj2xi