John Coventry
1846 The Lancet  
523 susceptibility to inflammation and other disorders. This is ir some measure-attributable to the mechanical laxity whict follows the distention they have undergone ; but it is als( apparently augmented by an increased sensibility of thE nerves, and a diminished tone of the vessels. To these ac. quired peculiarities of the uterus and its appendages we musi doubtless look for the physical disposition of parts necessary to puerperal inflammation; for any cause of excitement, whether specific or
more » ... not, operating on this condition of parts, might be allowed as sufficient to produce the disease. Now disorders are said to fall most heavily upon those parts which have these acquired peculiarities; but perhaps it would be better to use more precise terms. Certainly they influence these parts the most, but, in the great majority of cases, they operate with equal force on the rest. In fact, that shock which other parts can sustain with impunity, here produces a great amount of mischief, just as any shock which a complicated piece of machinery may receive, is only evident in the more delicate parts of the mechanism. The whole, of course, feels the concussion; but that part which is the weakest alone shows any permanent indication of violence. The subject might be illustrated in various ways, if it were necessary, but it is sufficiently obvious on the smallest consideration. In concluding these observations on the subject of constitutional peculiarity, I may just notice what are called the temperaments of the body, because I omitted to mention the subject in my former paper. I conceive the word temperament, in its customary application, does not differ essentially from the term constitution; but perhaps the former may be regarded as not merely expressing the physical condition of the body, but also as comprehending the influence of this condition on the functions of the body generally, and on the brain in particular. In this view, temperament includes the consideration both of the constitution of the body and the effects of such constitution. The term has long been in use, and is now commonly, though somewhat vaguely, employed. It seems to owe its origin to an ancient doctrine, it having formerly been supposed that the various elements of the body were mixed in different proportions, producing a kind of tempering according to the admixture. The temperaments usually enumerated are, -1st, the sanguine ; 2nd, the phlegmatic ; 3rd, the choleric ; 4th, the melancholic ; and 5th, the nervous ; but with regard to the last, Dr. Prichard* remarks, that it is not sufficiently definite to deserve a place in the scale. The characteristics of the several temperaments are pretty generally known. The sanguine is denoted by the florid complexion, light hair, blue eyes, large bloodvessels, soft skin, and full and frequent pulse; the phlegmatic, by the light hair, grey eyes, pallid skin, small bloodvessels, slow pulse, deficient energy, and cold surface; the choleric, by the dark hair and eyes, with the swarthy and ruddy complexion. The melancholic temperament differs from the last, in the lank hair, slow pulse, and unhealthy hue of the complexion. -These various peculiarities of constitution certainly deserve a consideration; but it is to be regretted that the division is not more precise and scientific. Long ago, Sir Gilbert Blane remarked on the want of a good classification of temperaments, and I think the subject would well repay any one who would bestow on it the requisite attention. The common classification is indeed extremely difficult of application, nor is it always possible to say whether the case in point can be fairly expressed by any of the customary designations. It cannot be denied, however, that there are in reality a great many ,palpable varieties of constitution which we all recognise at once, and yet have no names to represent them. Were they to be fairly described and properly denominated, it would be of much assistance in the consideration of disease; though were too much nicety of discrimination attempted, I fear it would only still further perplex this interesting and important inquiry. With these remarks I shall, for the present, take my leave of the readers of THE LANCET. In concluding these essays on general pathology, I have to regret many imperfections, and some errors, which have arisen in the condensation of the matter for the pages of THE LANCET; I have also to regret that arrangements have not permitted their publication in a more consecutive form. My object has been, as I stated at the commencement, " to insist on the importance of a philosophical analysis of morbid phenomena, with a view to a just estimation of the various elementary conditions of disease; and more especially to direct a proper attention to the laws of association by which these conditions are united, and to the modifications produced by their co-existence and complications." IN common, doubtless, with no small share of the readers of THE LANCET, I have frequently observed the very meagre con-tributions of medical men to the subject of hygiene, and regretted, that whilst every species of therapeutic enginery has been most diligently plied, the philosophy of health-preservation should have remained at so heavy a discount. The ancient, venerated shrines of the " Dea Hygea," melancholily indeed contrast with the rampant Morrisonian lion crowning the New-road establishment, whose imposing externality so admirably conceals the ignoramus enclosed in his hide; Asinum latere sub leonis specie." The application of the fasces to quackery's thrice-contemptible carcase I leave to other and abler lictors; my present purpose is to excite attention to a most important but neglected section of hygiene-ablution, and to elucidate the various evils of dirtiness as deduced from the structure and functions of the skin. Professing no new discovery, nor the instruction of the practitioner, I have presumed (and on that presumption ground my claims for admission into your columns) that I am placing, in a striking and useful light a subject of the utmost interest to the lay readers of THE LANCET,—a numerous and influential class, including, more especially, members of the clerical and scholastic professions, managers of unions, prisons, insane asylums, and the like. In other words, I throw myself more upon the exoteric than the esoteric sphere of your periodical, for I hold it a great detriment to the community at large, to ostracize topics relative to our sanatory condition as a people from the medical periodical press, or, at best, very grudgingly, admit them. The principal hygienic agents are, diet, climate, exercise, sleep, mental regulation, and ablution. In a state of unsophisticated nature, man's instinctual tendencies doubtless form his best hygienic guides; he eats when hungry, drinks when athirst, reposes when tired, shelters and defends himself by clothing against summer-heat and wintercold, in common, to a great extent, with the lower animals, and all this in virtue of the most cogent instincts, his reason being little concerned in the matter. How different with man in a high state of social economy and artificial existence, when his complicated physical and moral relations render a rational code of hygiene a desideratum of no slight value. Of the above-named hygienic agents, one, be it observed, labours under many disadvantages; it partakes less of the instinctive character than its fellows, asserts its claims to observance in vocables less peremptory, and possesses less selfevident, sensible recommendations. The infringements of its laws are not followed by such immediate chastisement, still, though the dart so long shaken over the culprit's head delays its stroke, the blow when struck is not the less severe. Hunger, thirst, raiment, labour and rest successive,-the timely dews of sleep, the tired muscle and the heavy eyelid, assert their rights in far too urgent a tone for refusal. Not so with uncleanliness, the mischiefs of whose long-continued, silent operation are only at length recognised in their final issue in some formidable disease. The clearest perception will be obtained of the uses and advantages of ablution, from a concise glance at the elaborate construction and manifold offices of the skin, that much-abused member of the body corporate, a covering dearer to a man than even the tailor's,-says the poet, alas, too often, how infinitely less attended to ! and to which ablution, neglected ablution, forms as natural a food as sleep to the drooping eyelid, or diet to the craving stomach. The basis of the human skin is gelatine; in the language of organic chemistry, composed of fibrine or animal flesh plus ammonia and oxygen, and familiarly recognised by the two insoluble compounds it forms with tannic acid and boiling water,-leather or tanno-gelatine and animal jelly, hydrogelatine. Into this gelatine foundation-corium or true skin --shoot countless bundlets of nerves, absorbents, and bloodvessels. constituting the papillary layer of the corium, textus papillaris. Common sensation and the special sense, touch, are given by the nerves, whilst the vascular elements of the corium secrete the remaining proper cutaneous structures,-to wit, the colour-cells, rete mucosum, and superficial stratum of the skin, (epidermis, or cuticle.) A fundamental organic distinction exists between the corium and the superincumbent cutaneous structures. The former is a
doi:10.1016/s0140-6736(02)70190-6 fatcat:o37cphrebrcrhdsyixrc6b6eia