1330
`
`SIR LAUDER BRUNTON : LONGEVITY AND THE MEANS OF ATTAINING I’I’.
`
`himself seen. How entirely different is the method of
`Sydenham.18
`The distinct begin with shivering and coldness, which is presently
`followed by excessive heat, and a violent pain in the head and back,
`vomiting, a great propensity to sweat (I mean in grown persons, for
`I never yet observed any such disposition in children, either before or
`after the rash came out,), a pain at the cavity of thp breast beneath the
`region of the heart, if it be pressed with the hand, dulness and sleepi-
`ness and sometimes convulsive fits ; and if these happen to those that
`have all their teeth, I reckon the Small-pox are at hand, which most
`commonly coming out a few hours after sufficiently answer the pro-
`gnostication.
`For instance, if the child hag a convulsive fit in the
`evening, as it usually happens, the small-pox appear next morning.
`His description of the severe neuralgia which sometimes is
`the last symptom of a malarial fever, and his determination
`of the fact that it really belongs to the disease and must be
`treated in the same way, is a remarkable example of his
`close observation.la
`But here it is to be noted that I have observed a certain sympt the
`sometimes like a nephritic pain. as to the intolerable pain of the loom,
`which being wont to follow ague, arises from a translation ofins,
`febrile matter upon the muscular parts of the body, but this symptom
`requires no other method of cure, than the ague whereon it depends,
`for it is heightened by frequent bleeding, or any other evacuation, and
`the patient’s life is endangered thereby.
`I thought good to mention
`this much of this symptom, that it might not impose on anyone.
`The neuralgia is sometimes so severe and so different from
`what has gone before and so remote from the beginning of
`the disease that it seems more like a separate morbid con-
`dition ; but Sydenham perceived its actual relation to the
`His description of gout and of hysterical diseases
`disease.
`and of chorea are further examples, too well known for me
`to quote, of the minuteness and precision of Sydenbam’s
`clinical observations. He scarcely considers morbid anatomy
`but endeavours to determine the species and ascertain the
`course and the treatment of diseases by clinical observation
`only.
`This is the general method of the Hippocratic writings
`and thus while Sydenham is often regarded as the originator
`of modern medicine his works might also be considered the
`culmination of the effects of the Renaissance.
`The writings of Thomas Willis contain many cases but it
`is clear that he only took a general view and did not make
`frequent precise observations.
`After a short account he
`generally proceeds to discuss the pathology, and this is so
`even in his accounts of saccharine diabetes of which he
`is generally regarded as the first describer.
`Willis, like
`Glisson, discusses the morbid anatomy of his cases. He
`often uses them to illustrate pathological doctrines rather
`than as studies in the natural history of disease.
`His
`interesting descriptions of the illness successively of five
`children in a family, cases, I think, of a scarlet fever with
`subsequent uraemia, are perhaps the best clinical reports to be
`found in his writings.
`His account of the case of Lord
`Shaftesbury, who had a hydatid cyst of the liver which was
`opened, when compared with the precise description of the
`same case by Locke,20 show that Willis often wrote from
`memory and not from notes made day by day.
`His works
`contain more hypotheses than minute observations.
`The cases mentioned by Martin Lister and those of some
`other writers of this period are too brief to deserve record
`as examples of clinical notes.
`A clinical observer whose works show the practice of
`generalisation from clinical observation as well as the
`careful records of the events of disease as observed at the
`bedside is Richard Morton who became a Fellow of this
`College in 1678 and died in 1698.
`His "Phthisiologia," a
`treatise on wasting diseases, contains numerous cases show-
`ing careful clinical note-taking and judicious deduction from
`his observations and so does his "Pyretologia,"a general
`He belongs to the school of
`treatise on febrile diseases.
`Sydenham but he makes a more general use of morbid
`anatomy and describes more cases.
`The physicians whom I have mentioned, Caius and Harvey,
`Mayerne and Glisson, Sydenham and Willis and Morton,
`were of course not the only clinical observers of their times.
`We may be certain, for example, that Lower who so acutely
`of dropsy followed the same
`reasoned on the causes
`Mayerne,
`Sydenham
`Glisson,
`method.
`the
`and
`are
`three clinical observers of the seventeenth century whose
`place ; Mayerne and Sydenham
`work deserves the first
`gave themselves up almost entirely to bedside observa-
`Glisson, while equally assiduous at the bedside,
`tion.
`Glisson’s mind most naturally
`was also a morbid anatomist.
`
`,
`
`.
`
`18 Of the Regular Small-pox.
`19 Of the Epidemic Diseases from the Year 1675 to the Year 1680.
`20 Shaftesbury Papers: Original note.
`
`turned towards the discovery of pathological laws and to
`Mayerne and Sydenham were most
`questions of etiology.
`occupied with the solution of problems of treatment and of
`prognosis.
`All three were close observers of nature. Glisson
`was a discoverer in anatomy, for he described the capsule of
`the liver, in physiology he first perceived the irritability of
`tissues, and in clinical medicine he first described completely
`a disease not known in the world of science before him.
`Sydenham had on the whole the greatest influence on times
`Mayerne was a less man than Glisson and
`after him.
`Sydenham in times to come but in his own day was a great
`and noble figure of vast attainments, of lifelong mental
`activity, and in his own time an influence to make all men
`All three observed carefully the general
`bedside observers.
`aspect of the patient and all the external features of his
`body. The breathing, the character of the pulse,
`the
`state of the tongue, the locality of pain, the indications of
`fever, the excreta, and the appearances of extracted blood
`were considered. Tumours were felt and the degree of dropsy
`estimated. Any impairment of the senses or of muscular
`power was noted. The liver and the spleen were examined
`The history was carefully considered and
`by palpation.
`facts bearing on heredity were recorded.
`This was the extent to which observation at the bedside
`was practised by these physicians.
`Mayerne seems most in
`personal relation to the patient, thoroughly investigating
`his mind and body ; Glisson is most considerate of the
`interpretation of
`well-observed symptoms given by the
`Sydenham had always before him the
`morbid anatomy.
`endeavour to establish general laws in relation to disease
`and hoped to do so by a precision of description such as that
`of the botanists in the description of plants.
`It is to
`Mayerne, Glisson, and Sydenham that the establishment of
`the study of clinical medicine in England is due.
`
`ON
`
`An Address
`LONGEVITY AND THE MEANS OF
`ATTAINING IT.
`Delivered at the Opening Meeting of the Manchester Medieal
`Society on Oct. 3rd, 1906,
`BY SIR LAUDER BRUNTON, M.D., D.Sc.,
`LL.D. EDIN., LL.D. (HON.) ABERD.,
`F.R C.P. LOND., V.-P. R.S.,
`CONSULTING PHYSICIAN TO ST. BARTHOLOMEW’S HOSPITAL.
`
`MR. PRESIDENT AND GENTLEMAN.—Long life has at all
`times been regarded as one of the greatest blessings that a
`man can possess and this feeling finds expression in the
`common acclamation " Let the King live"or "Long live
`the King."
`But long life is only to be desired when the
`faculties which render it a pleasure to its possessor or
`pleasing
`relatives and friends are retained in
`his
`to
`Although the Prayer-Book contains a
`sufficient measure.
`petition against sudden death, yet this is only to be regarded
`as a petition against unprepared-for death, for sudden
`death, though sad for those who are left behind, is really
`a great boon to the one who goes.
`But it does seem a
`very sad thing to
`see a man, whatever his age may
`be, cut down when his powers as yet show no signs
`of decay and when increasing age has brought with
`it increasing wisdom and power to direct and to help others.
`Less than six months ago I saw a gentleman who, despite
`his 76 years of age, was strong, erect, and to outward
`appearance healthy in body as well as vigorous in mind. He
`was a man of great influence in the commercial world,
`universally respected, his opinion deferred to, and at the
`time I saw him full
`of schemes as to what he was
`going to do.
`I found, however, that the tension in his
`vessels was so exceedingly high that I not only prescribed
`vascular dilators to lower the pressure within the vessels,
`but wrote to warn his medical man of the extremely pre-
`carious condition of his patient. In spite of the treatment,
`however, the fatal issue which I dreaded occurred in
`less than a week.
`This man’s life had exceeded the span
`of three score years and ten, yet he had all the mental
`energy of a man in the prime of life combined with the
`
`Human Power of N Company
`EX1033
`Page 1 of 6
`
`

`

`1330
`
`SIR LAUDER BRUNTON : LONGEVITY AND THE MEANS OF ATTAINING I’I’.
`
`turned towards the discovery of pathological laws and to
`questions of etiology. Mayerne and Sydenham were most
`occupied with the solution of problems of treatment and of
`prognosis. All three were close observers of nature. Glisson
`was a discoverer in anatomy, for he described the capsule of
`the liver, in physiology he first perceived the irritability of
`tissues, and in clinical medicine he first described completely
`a disease not known in the world of science before him.
`Sydenham had on the whole the greatest influence on times
`after him. Mayerne was a less man than Glisson and
`Sydenham in times to come but in his own day was a great
`and noble figure of vast attainments, of lifelong mental
`activity, and in his own time an influence to make all men
`bedside observers. All three observed carefully the general
`aspect of the patient and all the external features of his
`body. The breathing, the character of the pulse, the
`state of the tongue, the locality of pain, the indications of
`fever, the excreta, and the appearances of extracted blood
`were considered. Tumours were felt and the degree of dropsy
`estimated. Any impairment of the senses or of muscular
`power was noted. The liver and the spleen were examined
`by palpation. The history was carefully considered and
`facts bearing on heredity were recorded.
`This was the extent to which observation at the bedside
`was practised by these physicians. Mayerne seems most in
`personal relation to the patient, thoroughly investigating
`his mind and body ; Glisson is most considerate of the
`interpretation of well-observed symptoms given by the
`morbid anatomy. Sydenham had always before him the
`endeavour to establish general laws in relation to disease
`and hoped to do so by a precision of description such as that
`of the botanists in the description of plants. It is to
`Mayerne, Glisson, and Sydenham that the establishment of
`the study of clinical medicine in England is due.
`
`himself seen. How entirely different is the method of
`Sydenham.18
`The distinct begin with shivering and coldness, which is presently
`followed by excessive heat, and a violent pain in the head and back,
`vomiting, a great propensity to sweat (I mean in grown persons, for
`I never yet observed any such disposition in children, either before or
`after the rash came out,), a pain at the cavity of thp breast beneath the
`region of the heart, if it be pressed with the hand, dulness and sleepi-
`ness and sometimes convulsive fits ; and if these happen to those that
`have all their teeth, I reckon the Small-pox are at hand, which most
`commonly coming out a few hours after sufficiently answer the pro-
`gnostication. For instance, if the child hag a convulsive fit in the
`evening, as it usually happens, the small-pox appear next morning.
`His description of the severe neuralgia which sometimes is
`the last symptom of a malarial fever, and his determination
`of the fact that it really belongs to the disease and must be
`treated in the same way, is a remarkable example of his
`close observation.la
`But here it is to be noted that I have observed a certain sympt the
`sometimes like a nephritic pain. as to the intolerable pain of the loom,
`which being wont to follow ague, arises from a translation ofins,
`febrile matter upon the muscular parts of the body, but this symptom
`requires no other method of cure, than the ague whereon it depends,
`for it is heightened by frequent bleeding, or any other evacuation, and
`the patient’s life is endangered thereby. I thought good to mention
`this much of this symptom, that it might not impose on anyone.
`The neuralgia is sometimes so severe and so different from
`what has gone before and so remote from the beginning of
`the disease that it seems more like a separate morbid con-
`dition ; but Sydenham perceived its actual relation to the
`disease. His description of gout and of hysterical diseases
`and of chorea are further examples, too well known for me
`to quote, of the minuteness and precision of Sydenbam’s
`clinical observations. He scarcely considers morbid anatomy
`but endeavours to determine the species and ascertain the
`course and the treatment of diseases by clinical observation
`only.
`This is the general method of the Hippocratic writings
`and thus while Sydenham is often regarded as the originator
`of modern medicine his works might also be considered the
`culmination of the effects of the Renaissance.
`The writings of Thomas Willis contain many cases but it
`is clear that he only took a general view and did not make
`frequent precise observations. After a short account he
`generally proceeds to discuss the pathology, and this is so
`even in his accounts of saccharine diabetes of which he
`is generally regarded as the first describer. Willis, like
`Glisson, discusses the morbid anatomy of his cases. He
`often uses them to illustrate pathological doctrines rather
`than as studies in the natural history of disease. His
`interesting descriptions of the illness successively of five
`children in a family, cases, I think, of a scarlet fever with
`subsequent uraemia, are perhaps the best clinical reports to be
`found in his writings. His account of the case of Lord
`Shaftesbury, who had a hydatid cyst of the liver which was
`opened, when compared with the precise description of the
`same case by Locke,20 show that Willis often wrote from
`MR. PRESIDENT AND GENTLEMAN.—Long life has at all
`memory and not from notes made day by day. His works
`times been regarded as one of the greatest blessings that a
`contain more hypotheses than minute observations.
`man can possess and this feeling finds expression in the
`The cases mentioned by Martin Lister and those of some
`common acclamation " Let the King live" or "Long live
`other writers of this period are too brief to deserve record
`the King." But long life is only to be desired when the
`as examples of clinical notes.
`faculties which render it a pleasure to its possessor or
`A clinical observer whose works show the practice of
`pleasing to his relatives and friends are retained in
`generalisation from clinical observation as well as the
`sufficient measure. Although the Prayer-Book contains a
`careful records of the events of disease as observed at the
`petition against sudden death, yet this is only to be regarded
`bedside is Richard Morton who became a Fellow of this
`as a petition against unprepared-for death, for sudden
`College in 1678 and died in 1698. His "Phthisiologia," a
`death, though sad for those who are left behind, is really
`treatise on wasting diseases, contains numerous cases show-
`a great boon to the one who goes. But it does seem a
`ing careful clinical note-taking and judicious deduction from
`very sad thing to see a man, whatever his age may
`his observations and so does his "Pyretologia," a general
`be, cut down when his powers as yet show no signs
`treatise on febrile diseases. He belongs to the school of
`of decay and when increasing age has brought with
`Sydenham but he makes a more general use of morbid
`it increasing wisdom and power to direct and to help others.
`anatomy and describes more cases.
`Less than six months ago I saw a gentleman who, despite
`The physicians whom I have mentioned, Caius and Harvey,
`his 76 years of age, was strong, erect, and to outward
`Mayerne and Glisson, Sydenham and Willis and Morton,
`appearance healthy in body as well as vigorous in mind. He
`were of course not the only clinical observers of their times.
`was a man of great influence in the commercial world,
`We may be certain, for example, that Lower who so acutely
`universally respected, his opinion deferred to, and at the
`reasoned on the causes of dropsy followed the same
`time I saw him full of schemes as to what he was
`Mayerne, Glisson, and Sydenham are the
`method.
`going to do.
`I found, however, that the tension in his
`three clinical observers of the seventeenth century whose
`vessels was so exceedingly high that I not only prescribed
`work deserves the first place ; Mayerne and Sydenham
`vascular dilators to lower the pressure within the vessels,
`gave themselves up almost entirely to bedside observa-
`. but wrote to warn his medical man of the extremely pre-
`Glisson, while equally assiduous at the bedside,
`tion.
`carious condition of his patient. In spite of the treatment,
`was also a morbid anatomist. Glisson’s mind most naturally
`, however, the fatal issue which I dreaded occurred in
`less than a week. This man’s life had exceeded the span
`of three score years and ten, yet he had all the mental
`energy of a man in the prime of life combined with the
`
`ON
`
`An Address
`LONGEVITY AND THE MEANS OF
`ATTAINING IT.
`Delivered at the Opening Meeting of the Manchester Medieal
`Society on Oct. 3rd, 1906,
`BY SIR LAUDER BRUNTON, M.D., D.Sc.,
`LL.D. EDIN., LL.D. (HON.) ABERD.,
`F.R C.P. LOND., V.-P. R.S.,
`CONSULTING PHYSICIAN TO ST. BARTHOLOMEW’S HOSPITAL.
`
`18 Of the Regular Small-pox.
`19 Of the Epidemic Diseases from the Year 1675 to the Year 1680.
`20 Shaftesbury Papers: Original note.
`
`Page 1 of 6
`
`

`

`SIR LAUDER BRUNTON: LONGEVITY AND THE MEANS OF ATTAINING IT.
`
`1331
`
`long experience which enabled him to direct it to the best
`advantage. Although three score years and ten are generally
`regarded as the term of life, yet we see men who have
`exceeded it-such as the late Mr. Gladstone, the present
`Prime Minister, and the ex-Lord Chancellor-all doing work
`which would be severe for a man in the prime of life, and
`doing it well. The late Mr. Sidney Cooper painted up to the
`time of his death and almost rivalled in this respect Giovanni
`Bellini, who is said to have painted his best picture after
`the age of 90, and Titian, who painted up to the age of 99,
`when he died from plague. Aq even more striking example
`is that of the distinguished French chemist Monsieur
`Chevreuil, who, I believe, lectured at the College of France
`up to the age of 100, and a year and a half ago I had the
`pleasure of being present as a guest of Dr. W. Milligan at
`the dinner given to Senor Garcia on his hundredth birthday,
`a day on which the old gentleman went through an amount
`of fatigue that might have killed many a younger man.
`The object of my pper to-night is chiefly to consider the
`nature of the risks which old people run and how they may
`be best foreseen and averted so that great activity in
`advanced years such as appear in the examples I have just
`given may become the rule instead of the exception. These
`risks may apparently be divided into (a) those which arise
`from external influences ; and (b) those which originate in
`the body itself. Of course, the action of both classes of
`causes may be, and often is, combined. Thus infection from
`without, such as pneumonia or erysipelas, might often be
`successfully withstood even in advancing years were it not ’,
`for the presence of degeneration in the kidneys and athero-
`matous changes in the vessels, or enfeebled heart might
`continue for years were it not for a sudden fall or shock ’,
`which cuts short the thread of life.
`Through the kindness of the Registrar-General, Sir William
`Dunbar, and the able assistance of Mr. Finch, I have obtained
`some interesting tables showing the numbers living at ’,
`various ages for 70 years back. It is by no means easy to ’,
`read statistics aright, but, so far as I can see, these tables
`show a continuous increase in the expectation of life at
`birth, roughly speaking, from a little under 40 years in 1854
`to a little under 48 years in 1900. In the decades from 60
`to 90 years there is a slight diminution and this is also the
`case at the age of 100 for males. There is a little increase
`at this age for females. There is an increase in the number
`of survivors to the age of 80 both in men and women, but
`fewer men live to the age of 90, though more women do so
`than 60 years ago. The number of men living to 100 years
`per 100,000 of the population from 1891 to 1900 is only
`seven and of women 24, as compared with 15 men and 30 I
`women in 1838 to 1854. These figures are, however, ’’,
`vitiated by the fact that between the ages of 55 and 65
`there has always been a tendency to over-statement-a
`tendency that grows as age advances, so that very little
`reliance can be put on the data of extreme ages. During the
`last 50 years this tendency to over-statement has decreased
`slowly and irregularly in the age group 65 to 75. but rapidly
`and continuously at the higher age groups. The decrease
`has been so considerable that the numbers returned at the
`ages over 85 in 1901 were probably more nearly correct than
`those at ages over 75 in 1861 and 1871.
`One of the first points that naturally attract inquiry
`in regard to influences from without is that of septic
`infection and the benefit which is likely to have been
`produced by the introduction of antiseptic methods.
`The statistics of surgical operations show very clearly
`the good effect of antisepsis, but a still wider basis is
`afforded by the statistics of death-rates from childbirth,
`including puerperal aud septic diseases. These sank from
`335 per 1,000,000 in 1861-70 to 295 in 1891-1900, and in
`all probability as antiseptic methods become more widely
`diffused over the whole country the proportion of deaths will
`sink much lower still. The more rigid application of anti-
`septic methods to diseases of the bladder and the introduc-
`tion of prostatectomy are likely to increase longevity in males
`to a considerable extent, because even at present many men
`die much sooner than they otherwise would from septic
`infection of the bladder by non-sterile catheters. Despite
`antiseptics erysipelas is still a very common cause of death
`among the aged, and this disease also ought to be diminished
`greatly by proper antiseptic measures. Respiratory diseases,
`bronchitis and pneumonia, carry off a great number of aged
`people. Both of these are usually ascribed to the effect
`of cold, but iu should be borne in mind that while
`both are consequent upon exposure to cold, yet in both
`
`pathological organisms play a great part. Although
`Pasteur’s experiment with fowls is so well known that
`it may seem useless to repeat it, yet it is of such
`fundamental importance that I venture to remind you
`that the French savant discovered that fowls, the natural
`temperature of whose body is nearly 104° F., are immune
`from anthrax, but if they are made to stand with their feet
`in cold water until their temperature is sufficiently lowered
`they then become susceptible to the disease. In the same
`way many apparently healthy people carry about in their
`pharynx the germs of pneumonia but do not take the disease
`until their vitality is lowered by exposure to chill. Two
`factors are required to give rise to the disease-the lowered
`vitality of the patient and the infection from without, and
`neither will produce the disease without the presence of the
`other.
`To discuss fully the subject of infection from with-
`out would involve a consideration of infection generally.
`Time will not permit of this, but in regard to this subject
`it may be well to consider that many so-called
`common colds are very infectious and are readily
`One of the
`transmitted from one person to another.
`most violent attacks of bronchitis which I ever had
`originated very markedly in a local affection. I was travel-
`ling in the corner seat one day in a very dusty railway
`carriage. Some of the dust from the window appeared to
`get into the nostril nearest to it causing me to sneeze. This
`sneezing fit developed into a one-sided cold in my bead, the
`other nostril remaining quite free for more than a day. The
`catarrh then seemed to creep round the posterior nares and
`affect the other nostril. It then passed down into the trachea
`and finally into the bronchi. For many years I have been
`very firmly convinced that colds are very infectious and on
`one occasion I was going to call upon a friend of mine, a
`very old lady who was confined to the house and attended
`by her children with the utmost care. I had already driven
`about a mile or more on my way when I began to think that
`I had a cold in my head and that I might possibly com-
`municate it to her. I accordingly turned back and I think
`it was well that I did so, because about a couple of months
`afterwards I heard that she had remained perfectly well,
`living in two rooms, until some lady friends called, one of
`whom had a cold in the head. lmmediately afterwards my
`friend began to suffer from bronchitis and had a most severe
`attack. It seems to me that very often children convey
`infection from one to another, and often a child goes to
`school, comes back with a cold, and then, as the common
`saying is, "the cold goes through the house." This possi-
`bility of infection by children is naturally to be borne in
`mind in regard to the relations of very old people to them
`as well as to friends and visitors. It is to be remembered
`also that people who are apparently perfectly well may
`carry about disease germs and convey them to others, and
`that those who have been in constant attendance upon a
`case of pneumonia, diphtheria, or possibly bronchitis, may
`convey the germs to others without being apparently affected
`themselves. It might cause a little trouble but it would be
`an error on the right side if all those who had been in or
`near such cases were compelled to disinfect their throats by
`gargling with an antiseptic before visiting or attending upon
`old people.
`Another point which is worthy of consideration is the
`effect of dust in producing colds. I have already mentioned
`the effect of dust from a railway carriage in causing first
`inflammation in the nostril and then general bronchitis. I
`do not know whether any experiments have been made upon
`the specific gravity of microbes, but at the time when I used
`my consulting room as a library I found very frequently that
`if I had occasion to consult a book from one of the top
`shelves I was apt to get a cold in my head. This recurred
`with such regularity that at last I took to sponging the top
`of the book with a solution of carbolic acid before using it.
`Everyone knows what a great amount of dust can be
`seen in a room after anything has been moved about
`if the shutters are closed and a ray of sunshine streams
`through a chink. Some of the floating particles which
`are then seen in such abundance are probably patho-
`genic and protection of aged people from infection
`by dust is therefore I think very important. I have
`already quoted Pasteur’s experiments with fowls, and in
`guarding aged people from disease we have not only to pre-
`vent the access of microbes but also the incidence of depress-
`ing conditions. One of these, no doubt, is cold and one
`very frequently sees that after the occurrence of sudden and
`
`Page 2 of 6
`
`

`

`1332
`
`SIR LAUDER BRUNTON: LONGEVITY AND THE MEANS OF ATTAINING IT.
`
`severe cold weather not only is the column of deaths in the
`Zimces much longer than usual but it contains an unusual
`proportion of old people. In order to prevent the effect of
`such cold the clothing should not only be warm and the
`rooms of a proper temperature but care should be taken that
`old people do not go out of warm rooms into cold parts of
`the house. In many houses, although the rooms are warm
`the passages are very cold, and the most dangerous place of
`all is probably the water-closet, because here the old
`patient, who would never dream of going outside the
`house without being thoroughly wrapped up in the warmest
`of clothing and protected by rugs, will not only go with
`nothing on but a thin night-dress, but will remain
`sitting for many minutes although the closet is quite
`as cold as the air outside. I lay particular stress upon this
`point, not only because it is one that I have never seen
`mentioned but because it was particularly impressed upon me
`by the death of a patient and friend who had been perfectly
`well so long as he used a commode in his room but one day
`he went to the water-closet and caught a chill which was
`followed by a fatal attack of pneumonia.
`A chill of the whole body reduces vitality and renders
`patients more liable to disease but a local chill is particularly
`injurious. There is an old adage-
`" If wind blow at you through a hole
`Make your will and sain your soul."
`Wind which comes fairly in one’s face is little to be dreaded
`but if wind catches one at the back of the neck, behind the
`ear, or even at the side of the head, it is much more
`dangerous. Largely open windows are comparatively safe
`but a chink through which the air blows with force is to be
`carefully avoided. One reason of this probably is that wind
`blowing through a chink causes a more rapid current of
`air and thus chills the part of the body against which it
`impinges much more quickly than air moving slowly and
`still more than air which is not moving at all. Everyone
`knows how in the Alpine health resorts the temperature may
`be many degrees below zero and yet cold is not felt so long
`as the air is still, but whenever the wind begins to blow the
`cold becomes almost unendurable. There is one kind of
`draught that many people seem to forget, and that is the
`draught between the door and the fireplace. If one’s hand
`is placed at the lower edge of a door when a brisk fire is
`burning in the grate a considerable draught will be felt.
`This cold air spreads itself out over the floor of the room as
`it passes along but again collects into a narrower stream
`close to the fireplace, so that the feet of anyone sitting by
`the fireside are apt to be swept constantly by the cold air,
`and thus the body is chilled. To avoid this the chair in
`which an aged person sits should be placed so far away
`from the fireplace as to avoid this draught or else the feet
`should be kept raised by a somewhat high stool so as to be
`above the level of the draught.
`But while we take all due precautions to prevent injury
`from without we must not forget that one of the most
`important methods of securing health is to increase the
`patient’s power of resistance. Some years ago a governor-
`general of Canada asked an Indian, whose clothing was of
`the scantiest, although the weather was extremely cold, how
`it was that he was able to go about with so little clothing
`without apparently feeling chilled. The Indian said, " You
`do not cover your face, do you feel cold in the face ? " No,"
`said the governor-general. "Well then," said the Indian,
`" Indian all face." The scientific explanation of this power
`of resisting cold was given many years ago by Professor
`Rosenthal who showed that the peripheral vessels when
`subjected to a high temperature for a length of time lose
`their power of contraction when again exposed to cold. In
`consequence of this the blood continues to pour through the
`chilled skin and thus the temperature of the whole body is
`reduced. By training the vessels to alternate heat and cold as
`we do in our faces and as the Indian did in his whole body
`they react more quickly to changes of temperature and thus
`become more efficient regulators of the animal heat. This
`may be done to a certain extent by daily baths, care being
`taken, however, that the application of cold is not sufficiently
`great or sufficiently prolonged to depress the patient and I
`think one of the best ways is to apply hot water as hot as
`it can well be borne and then a little cold afterwards just
`enough to get the reaction. But it is not only the vessels of
`the skin which require exercise and training. The resistant
`power of the patient depends very greatly upon the power of
`his general circulation and the perfection of his respiratory
`movements. This has been very well pointed out in an
`
`i
`
`admirable lecture " On the Prolongation of Life," delivered
`by Sir Hermann Weber before the Royal College of
`Physicians of London three years ago. H