r*WW' ^uioL vv^y \ DR. HAYWARD'S LECTURE. -nvs'jw J (/ LECTURE SOME OF THE DISEASES A LITERARY LIFE DELIVERED BEFORE THE AMERICAN INSTITUTE, AUGUST33, 1832. \f BY GEORGE HAYWARD, M. D. --"^ r 4 A. &Z)Us< :J BOSTON: ^J ---~--- CARTER, HENDEE AND CO. 1833. PRINTED BY I. R. BUTT! DISEASES OF A LITERARY LIFE. The subject of education is of the deepest importance to our countrymen. The government under which we live is strictly a government of popular opinion, and if great and untiring efforts be not made to keep the public mind duly enlightened, all our valua- ble institutions will be swept away. If our citizens should become indifferent to the cause of popular education, the tone of public morals would be lowered, the reverence for religion would decay, and our country would soon be distracted with lawless anarchy, or fall an easy prey to some ambitious and popular leader. No one therefore who loves his country, and duly appreciates the inestima- ble privileges we now enjoy can be indifferent on this point. The deep interest which I feel in the subject, and my readiness to co-operate with you in this great cause, have induced me to ac- cept the invitation with which I have been honored by your com- mittee ; at the same time I can declare with the utmost sincerity, that it is with extreme diffidence that 1 appear in this place on this occasion. No one will be surprised at this, who calls to mind the learning and acquirements of the * two individuals who have addressed you on the former occasions on physical education, the character of the audience before whom I appear, and the extent and importance of the topic on which I am to speak. But I have yielded my own opinion to that of others whom I am accustomed to respect, and have been induced to comply with the request to offer some observations on physical education be- * John C. Warren, M. D., and James Jackson, M. D. 4 cause I was anxious to show the interest 1 felt in your institution, though I was at the same time confident that there were many oth- ers better qualified for the task. It has been truly said that man is the creature of education. His moral, intellectual and physical powers are all susceptible of a high degree of improvement. At birth he is the most feeble and helpless of animals, and at a period when the lower orders of the creation, by the development of their bodily powers and that pecu- liar faculty which we call instinct, are enabled to provide for their wants, man is dependent on those around him ; but by a proper cultivation of his faculties he becomes associated with a higher or- der of beings. It is the province of others to speak of his moral and intellectual culture ; my remarks will be confined to his physi- cal education, and I shall occupy the time allotted to me in saying something of those diseases of the body which are the most likely to be induced by the exertion of the intellectual faculties. I wish not to have it understood that any diseases necessarily follow the cultivation of the mind ; on the contrary I am convinced that this cultivation, if judiciously managed, promotes the health of the body. But it cannot be concealed, that in our country at least, literary men rarely attain a great age, and that not unfrequently during the greater part of their lives, they are subjected to severe and distress- ing disease. This is not a necessary consequence of their pursuits ; there must therefore be either no regard to system in their mode ol life, or there must be some radical error in the system which they »* adopt. I shall probably be better understood in what I am going to say, if I offer a kw general explanations in relation to the animal economy. The human body is composed of many distinct parts, which are destined to perform functions, all of which are more or less import- ant to the preservation of life, and which have an intimate relation with and dependence on each other. These parts are called systems; a few of which I shall briefly notice. One of the most important is the nervous system. This is com- posed of the brain, the spinal marrow and the nerves. The brain occupies the whole cavity of the skull; the spinal marrow, which is a continuation of the brain, is situated in a canal in the spinal 6 column, and the nerves go out from the brain and the spinal marrow to all parts of the body. The brain is the seat of perception, and the nerves are the agents by which it is connected with external objects. How this communication is effected is totally inexplicable; but physiology abounds with theories sufficiently wild and visionary on this subject. But our business is only with facts. The nerves have not all the same functions. Some are nerves of sense, others of sensation, others again of motion, and another class is destined to endow particular organs with the power of executing certaiu functions. The nerves of sense, with the exception of those of feeling, which are spread throughout the body, arise from the brain and are carefully protected from injury by passing through bony ca- nals. But though these nerves are exquisitely sensible to their own peculiar stimulus, as the optic nerve to light, &c, they have not the power of imparting motion or ordinary sensibility to the organs to which they are distributed. If the gustatory nerve should be divided, the tongue would retain its power of motion and sensa- tion, though the sense of taste would be lost; and it is well known that all the motions of the eye are independent of the optic nerve, and in a recent surgical operation, in which I had occasion to divide that nerve itself, the patient afterwards informed me that it gave him no severe or peculiar pain. There are no less than twelve pairs of nerves sent off from the brain and thirty pairs from the spinal marrow. Those of the brain are distributed to the organs of sense, respiration and digestion, and two small nervous filaments go out from this organ, which seem to be the rudiment of a system of nerves which supplies nearly all those organs over whose action the will has no control. The brain is evidently the instrument of the mind, and its de- rangement is followed by a disturbance of the intellectual facul- ties. If its functions are interrupted, either by injury done direct- ly to the brain or through the medium of the nerves, the mind ceases to act. A slight compression or a powerful jar are fre- quently sufficient to suspend for a time the operations of the men- tal powers. So dependent are these powers on the organization of the brain for their healthy exercise, that many have supposed that the mind was nothing but matter exquisitely organized; and it 6 seems to be on this foundation that has been reared, the whole superstructure of what is familiarly known under the name of Phre- nology. The teachers of this doctrine, as far as 1 understand them, maintain not only that the brain is the seat of the mind, but that the intellectual faculties, the moral powers and the animal propen- sities reside in different parts of it, and that these parts are more or less developed in proportion to the degree in which these properties are enjoyed by individuals, with a corresponding development of the skull, and that it is easy to discover by an examination of the skull, the extent to which these properties are possessed. The intellectual faculties are said to reside in the forepart of the brain, the moral powers are placed in the upper part of the centre, and the animal propensities at the base. And then we have charts of the skull on which are marked the precise situation of each of the various faculties and powers, though it must be confessed that the professors have not till of late been agreed as to the exact spot in which these different faculties reside. Too many distinguished men however, have been the advocates of phrenology to allow me to speak lightly of it. But if it be maintained, that mind is the result of organization, and that its vari- ous faculties and powers are placed in different parts of the brain, which are exclusively assigned to them, I must say that the doc- trine is not only fraught with dangerous consequences, but that it is at variance with facts familiar to almost every physician. A belief that the intellectual character of men can be determin- ed by an examination of the skull, will often lead to very erroneous and unjust conclusions, and may tend to discourage individuals, who may not happen to possess the external characters of great mental powers, from all efforts at improvement. But this would not be a substantial objection if the theory were well founded. Is the brain anything more than the instrument by which the mind operates? We know, that the brain may be wounded, exten- sively lacerated, and large portions of it, amounting to a quarter of the whole, actually removed, without impairing in the slightest degree the intellectual faculties. Abcesses and tumours of large size have often been found in the brains of individuals after death who retained during life the full possession of their mental powers. 7 It has not unfrequently happened in wounds of the head, that the very organs of certain faculties, according to the phrenologi- cal system, have been removed, without impairing these faculties. Though the mind is affected in most diseases of the brain, it does not necessarily decay with the decay of the body. It is not unfrequent, a few hours before dissolution, when the tongue is hard- ly able to give utterance, and the whole animal frame is wasted and worn out, to witness displays of intellectual power that would astonish at any time. The mind, acting with more freedom, soars higher, as if in anticipation of the disenthralled state on which it is about to enter. It is true that the brain is the instrument by which the mind operates, and the more perfect the instrument, the more perfect will be the mental operations. But we know not in what this per- fection consists. It cannot be in the mere size of the organ, as is frequently supposed ; for this is contradicted by what we see in other animals. Nor is it in its resemblance to the human brain, for some of those animals in whom this organ resembles that of man most closely, are surpassed in sagacity by others in whom the re- semblance is much less complete. We had better admit then with Buffon that " the soul, thought, and speech do not depend on the form or the organization of the body." It may ba thought humili- ating by some to acknowledge our ignorance, but it is better to do this than to fall into dangerous error. I have however, already digressed too long to pursue this sub- ject farther, and I will now proceed to notice some other parts of the animal economy, which are important, both from their connection with the vital functions and their liability to disease. Among these the digestive apparatus holds an important place. The food during mastication becomes intimately mix ul with the saliva, and is then conveyed by a powerful muscular action into the stomach. It is brought in this organ, by the agency chiefly of the gastric juice, a peculiar fluid which is secreted by the stomach, into a homogeneous mass. As soon as this mass enters the first intestine it comes in contact with a set of absorbent vessels, which, from the milky appearance of the fluid they contain are called lacteals. These vessels take up all that part which is adapted to nourish the 8 body, they then unite in a common trunk, which conveys this nutri- tious fluid into the blood vessels. But this fluid is not yet sufficiently assimilated to the blood to form a part of the circulating fluid, which is destined to convey nourishment to the whole body. How this purpose is effected will be seen by attending to the circulating and respiratory functions. The fluid received from the lacteals is poured into a vein, and is thence carried to the right side of the heart. In man the heart is a double organ, each part of which is the centre of a distinct circulation. That of the right side circu- lates the dark colored blood, which is returned by the veins from all parts of the body, after having parted with a portion of its nu- tritive principles; and with this blood, just before it enters the heart, is mixed the fluid which is furnished by digestion. This dark colored blood is sent by the right side of the heart to the lungs, and it there undergoes a change, either by parting with some noxious principle which it contains, or by absorbing something from the air, and it then becomes of a bright scarlet color. It is then returned to the left side of the heart by what are called the pulmonary veins, adapted to all the purposes of life, provided the lungs be in a healthy state. The instant it enters the left side of the heart, it is sent by that organ with great force through the arteries to all parts of the body. It has been calculated that two ounces of blood are thrown out at each contraction of the heart, and as there are about seventy of these in a minute, nearly ten pounds of blood must consequently pass through the heart in that time ; and as the whole blood in a male adult is estimated at twentyfive pounds, it follows that the whole blood of the body is circulated, in less than three minutes. This action of the heart continues during life; it cannot cease for a moment without producing death ; so necessary is the stimulus of the red blood for the support of the vital functions. The heart does not move with the same rapidity at all periods of life. In infancy its pulsations are more than one hundred in a min- ute, these gradually become less frequent, till in old age they rarely exceed sixty. During the early periods of life the body is contin- ually increasing, and the circulation is more rapid to supply the demands which are made by the growth of the various organs. 9 A principle of decay seems to be implanted in the structure of the animal machine at birth. The circulating system, which is so essential to the continuance of life, is from its very activity doomed to destruction. So long as all the systems act in perfect harmony, the circulation goes on well; but the least interruption in one is sure to produce embarrassment in the others. In the early periods of life this is not sensibly felt, because the machine can at that time accommodate itself to great irregularities ; but as we advance in age, the case is different. If the respiratory or digestive func- tions are disturbed, the circulation labors, the blood accumulates in some organs or vessels, producing immediately serious effects or laying the foundation for incurable disease. But even without this, the heart and arteries cannot carry on the circulation for any length of time beyond the term of years usually allotted to man. The brain becomes gradually less sensible, the nervous energy is of course diminished, the heart consequently acts with less power in distributing the blood, and nutrition is less perfectly performed. The valves of the heart and the great vessels become thickened, and finally converted into a bony substance, and the vessels themselves lose their strength and power of resistance. The circulation is languid and carried on with great labor, nutrition in the different parts is not perfectly effected, and the whole func- tions of the animal body finally cease, without the occurrence of any disease. We see then in what light we should regard the pretensions of those who boast of discoveries, which will confer perpetual youth and immortality on man's bodily frame. Should not the strong marks of dissolution, which are impressed on it by its Creator, and the evidence which we have of the imperishable nature of the human mind, rather teach us to consider the present state as the beginning only of existence ? The functions of respiration are intimately connected with those of the circulation. These are performed by the windpipe and the lungs. The lungs are large organs, divided into three parts or lobes on the right side and into two on the left, and occupy the principal part of the cavity of the chest. They are composed almost en- tirely of air tubes and cells and blood-vessels. The blood in an impure state is brought from the right side of the heart and distributed 2 10 in numberless vessels throughout the lungs. In the act of inspira- tion the air is brought into the air cells and the blood is separated from the air by a delicate membrane only. The blood in health is immediately changed in color and properties, though it is not deter- mined precisely how this change is effected or in what it consists. The air we breathe is composed of two different constituent princi- ples, with a small mixture of a third. Soon after this discovery was made, and it is of modern date, it was thought that in the pro- cess of respiration the blood absorbed the oxygen or vital part of the air, and hence this red blood received the name of oxygenated blood. It is very certain that the air thrown out from the lungs is very different from that which is taken in, containing a much greater quantity of fixed air or carbonic acid gas. Some chemists have undertaken to show that all the oxygen, which is taken from the atmospheric air in respiration, is no more than what is contained in the fixed air which is discharged by the lungs, and that this air is formed in the process of respiration by the union of the oxygen of the air and the carbon which is given off by the blood in a volatile state. They assert therefore that the blood in respiration does not absorb oxygen from the air, but that it parts with a portion of its carbon, and that it would be more proper to say, that in this pro- cess the blood is decarbonized and not that it is oxygenated. Without stopping to discuss the comparative merits of these theories, it must be acknowledged that the change produced in the blood in its passage through the lungs is essential to life. If it be completely suspended, even for a moment, death follows. When the air is prevented from entering the lungs, the circulation continues in them, but the blood undergoes no change, and is returned to the heart with the same color and qualities as before it entered the lungs. The instant this black blood is thrown by the left side of the heart to the brain, life ceases. Hence we understand the manner in which death is produced in drowning, hanging, and in entering places in which the air is unfit for respiration, as in wells and cisterns. In these cases death is not instantaneous, because some air finds access to the lungs, and in some cases of hanging, life is destroyed by a fracture of the spine and a consequent pressure on the spinal mar- row. The Turkish punishment by the bow-string, which consists 11 in drawing a cord so tightly around the wind-pipe, as completely to prevent the entrance of the air to the lungs, produces instanta- neous death. It is evident I trust from what has been said, that the functions of the brain, stomach, heart and lungs, are essential to life, and it fol- lows that when they are deranged or imperfectly performed, disease is the consequence. It is true also that they are the organs which are in most cases primarily affected in the disorders of literary men. In speaking of the diseases most likely to occur in connexion with a cultivation of the intellectual faculties, the only order which I shall observe will be that of time, that is, I shall describe them in the different periods in which they are the most liable to occur. Till the body has attained its full size, all its powers seem to be directed to its nutrition and growth. These powers bear a different relation therefore to each other at the different periods of life. Be- fore the adult age, all the nutritive powers are in excess; the brain and nervous system, which give energy to the whole, are more developed in proportion in the child than in after life, and in con- sequence children are more liable to affections of the brain and nerves. Even cutting the teeth or overloading the stomach will not unfrequently produce in them violent and sometimes fatal con- vulsions, and there is a strong tendency in many of the diseases of childhood to terminate in dropsy of the brain. These facts should teach us, that the minds of children should be gradually developed, and that there is danger that the brain will suffer if they are early excited to action. Epilepsy and other affections of the brain, are known to be often the melancholy attendants on precocious childhood. The minds of children, underordinary circumstances, are developed spontaneously at a period as early as is consistent With health, and it may well be doubted whether the premature display of intellect, which is sometimes witnessed in them, can compensate for the hazard which must necessarily accompany it. A derangement of the digestive functions, in some of its forms, is among the most frequent and troublesome diseases which afflict literary men. It is most likely to occur between the ages of fif- teen and thirtyfive, though no period of life is wholly exempt from it. There is, as we have already seen, a direct connection by means 12 of nerves between the brain and the stomach, and we know that a blow on the head is often followed by vomiting, and that a disorder- ed stomach usually produces pain in the head. Various affections of the mind have a powerful influence over the digestive functions. Grief will not only destroy for a time the appetite for food, but will also interrupt and suspend the power of digesting it. Under the name of Indigestion, or the more popular one of Dys- pepsia, is included a great variety of morbid affections, which all agree in one particular, viz. that the stomach, whatever may be the cause, does not readily and with ease digest the food taken into it. This sometimes proceeds from the state of the brain, at others from that of the muscular coat of the stomach ; at one time the secre- tion by which digestion is effected, is imperfect, deficient in quantity or of a quality not adapted to the purpose for which it was intend- ed. It not unfrequently happens that the lining coat of the stomach is in a state of low inflammation, which sometimes terminates in serious and incurable affections of the organ; and again all the symptoms of dyspepsia may arise from a disordered state of the liver, which acts sympathetically on the stomach. If this view of the subject be correct, it must be perceived, that the same means cannot be adapted to all cases of dyspepsia, and that those who pretend that they possess a remedy suited to every individual labor- ing under the disease, must either deceive themselves or be willing to deceive others. It is not necessary to be acquainted with medi- cal science to know, that what would be beneficial in inflammation would do mischief in debility and want of action. But though this enfeebled state of the stomach is often an atten- dent on a literary life, it is by no means a necessary consequence of it. Few men, certainly in this country, are injured by too much study • there are none among us who devote more hours to mental labor than is compatible with health. The difficulty arises rather from a sudden change of habits, and a neglect of those means which are essential to a sound state of the body. Our students, the moment they become so, are too apt to abandon exercise ; confine them- selves too long in hot and perhaps ill-ventilated apartments ; place no restraint on their appetite for food, which is usually as °reat in those who lead a sedentary life, as in those who labor daily many 13 hours in the open air, and in addition to all this, indulge themselves not unfrequently both in smoking and chewing tobacco, and then if the stomach should flag and seem unable to accomplish the task that is required of it, the w hole difficulty is referred to studious habits and mental labor, while all the other circumstances which have been named, and which no doubt are the real cause, are entirely overlooked. Another trouble, and one which is intimately connected with the derangements of which 1 have just been speaking, is frequently met with in professional men, I allude to a disturbance in the functions of the liver. This most frequently occurs in those individuals, who in addition to intellectual labor, are in situations of great res- ponsibility, and the disease is perhaps more often seen among the clergy than any other class of society. The liver, whose office it is to secrete the bile, is the largest gland in the body. But unlike other glands, it is not supplied with the arterial or pure blood for this secretion ; on the contrary, the bile is secreted from the venous or dark-colored blood, which is re- turning to the heart for the purpose of undergoing the change which is effected in it by the lungs. One of the objects of this secretion therefore seems to be to rid the blood of a portion of its impurity, and the bile may be regarded as an excrementitious fluid. If the liver fail to perform its office or if thc/e be any obstruction in the passage of the bile to the intestines, the blood is impure, and the effect of this is felt by no part of the system more sensibly than the brain ; and it is perhaps fair to conclude that the brain may have some influence in producing this state of the liver. At any rate we know, that in all those morbid affections, which arise from a disordered state of the liver, whether it be only a derangement of its functions, or whether the organ itself be actually diseased, the mind is sensibly affected. This remarkable sympathy did not escape the observation of the ancients; they attributed nearly all cases of mental disease to a derangement of the abdominal organs, and the term which is employed to denote one species of this dis- ease, melancholy, is derived from two Greek words meaning black bile. This disordered state of the liver is usually attended with a tor- 14 pid state of the whole alimentary canal, a great depression of spirits, a general lassitude and an indisposition to bodily and mental effort. It must be overcome at an early period, or it will prove almost un- manageable. It sometimes requires great sacrifices on the part of the paiient for its removal. Change of scene, change of habit, change of diet and sometimes even change of occupation, must be made before it can be cured. The next in frequency to the diseases of the digestive organs are those of the lungs, and they are unfortunately for the most part of a more severe and alarming character. Though the respiratory appar- atus is often deranged, the only wonder with those who are acquaint- ed with its structure and functions is, that it is able to keep in order aslongas it does. The lungs are of the most delicate organization, composed almost entirely of air vessels and cells and blood-vessels, and covered by a membrane of the finest and most attenuated tex- ture, and this membrane is every moment of our lives, in contact with the atmospheric air, which is not unfrequently loaded with foreign substances of a highly acrid and deleterious nature. Hence the lungs are oftentimes disturbed and irritated ; but if the rest of the system be healthy, the equilibrium is soon restored, and the organs regain their wonted activity. If on the other hand the functions of the other parts are imperfectly performed, if there be a general torpor and want of action throughout the system, an accumulation of blood takes place in the respiratory organs, and it sometimes lays the foundation for incurable disease, though it is frequently thrown off by that conservative principle which seems to preside over the animal economy. But if instead of being removed by the efforts of nature or the interference of art, this derangement is suf- fered to continue, it increases on every slight occasion, till a violent haemorrhage ensues to relieve the crowded organs. And this bleed- ing at the lungs is one of the most common diseases of literary men. Their habits of life are well calculated to produce this. Their want of active exercise, which prevents the circulation from having that vigor so essential to its well being ; their long confine- ment in close rooms, breathing an atmosphere not the best calcula- ted to impart energy to the system, and the quantity of food which they take, usually much more than they require with their limited 15 exercise, all seem to predispose them to the disease in question. The irregularity of their habits too, both as to sleep and exercise, is not to be overlooked in estimating the influence of the causes which produce haemorrhage of the lungs. This disease, though alarm- ing, is by no means always necessarily fatal. If it be properly treated at the lime of its occurrence, and the patient afterwards adopt an entire change as to diet, regime and exercise, if there had been any error