by J. Wallace Anderson, M.D.
Volume 10, 1899, pg. 760-771
Given to the Glasgow Branch of the P.N.E.U.
There is, perhaps, nothing that more reconciles the believer in the good old times to his unhappy lot in being the creature of to-day than the fact that he has at least his book and his morning newspaper. Take these away, and he, and all of us most likely, will decide that life is not worth living. But there is a book of to-day and of yesterday, and of a day that is older than the most ancient papyrus, a book infinitely older than man himself, whose pages are ever open to us if we would but stop and read. I mean the book of Nature; and it is to some of its pages that I wish for a little to direct your attention. The book is large enough. It requires not the world, but the universe to contain it; for it is of universal Nature that we would speak; of Nature all around us, everywhere, whose forces are continually acting upon all created things. It is in this sense that we should attempt a definition of the term we might say it is just the recurring events or condition of things around us which are spontaneous, i.e., which are uninfluenced by the interference or art of man.
Keeping before myself the fact that I am addressing you as members of the Parent's Educational Union, I should like to preface my remarks with some words that have been suggested by thinking of you as in the company of your children. First of all, then, I think we may very profitably direct the attention of our children from their earliest years to the observation of Nature, to this great picture book abounding in illustration; and we can tell them that Augustine said that "Nature is the will of God." And we can give them this great fundamental principle or truth, that for every natural condition or order of things there is a reason, whether we have discovered it or not. I do not suppose anything has puzzled you and me when we were children more than this, why in the wide world should nettles sting? But now that we are older we can insist upon this, that for a phenomenon so very general in Nature there must be some very good reason, or at least some explanation that will evidence Nature's mighty methods; we may be sure that it is not a freak or an accident. It is recognized now that nettles sting for protection, protection against the tinier members of the animal kingdom. This is known from analogy; for while some plants have only sharp spines without the poisonous secretion of the nettle, others have fine hairs which actually seize the insect and destroy it. From this we learn also that a certain amount of self-defence is permissible if, like plants, we are unable to run away.
Let us take another general illustration, this time from the animal world. Walking through the Park on a wet morning we must all have remarked the fine winding streaks on the pathway, as if someone had had nothing else to do than peddle about with a pointed stick. If we tell our children that these tortuous, wavy lines are made by worms, and that there is a great principle underlying this which they are to ascertain for themselves, they will probably conclude that they, too, are to run round and round on the roadway, particularly if it begins to rain, and more particularly if they have been sent on an errand. But we must tell our children that the worms are not playing at all; they are working; they are tilling the ground. We may be quite certain that if a worm had to go on an errand it would do so--well, not exactly expeditiously, but promptly. But they are working; they are working out intricate and subtle changes in the ground. Of course, we must be prepared for awkward questions. Why does the worm not do one bit of ground at a time, like the gardener, in place of wandering about so? I suppose our answer would be in effect that creatures so low in the animal scale are not endowed with so high a degree of intelligence; that again not being necessary, because to use a commercial phrase, worm labour is cheap. And once more, on a summer day, as we pass by the long-deserted, grass-grown ruins of a highland clachan [village or hamlet], we can tell them that it was the worms that carried the earth over the low-lying stones, that it might be ready for the seed of grass or fern that the autumn wind would commit to its fostering care till the return of spring. We are bound, then, to believe from all analogy and experience, apart from any higher belief in the primary fitness of things, that for every process in Nature there must be a reason; that, in other words, everything in Nature has a purpose.
But I excluded from my definition of what is natural every condition which is the result of man's interference. We know that man by his art can change the face of Nature, and by his interference he can greatly disturb the course of Nature. I shall give you an illustration of this interference that I think will interest most children. We all know what a tumbler pigeon is, and, probably, when we ourselves were children we just supposed they tumbled for amusement or because it was their nature. The latter alternative would be the complete and final solution of the difficulty if every other explanation failed. But it happens that occasionally these pigeons tumble so many somersaults at a time that they fall to the ground. Now let us so train our own and our childrens' minds by the observation of Nature that we shall at once perceive a difficulty here, something that requires to be cleared up. How can an act which is known by experts to be confusing to the pigeon, an act which slightly in excess become absolutely destructive of the natural action, namely, flying, in process at the moment--I say, how can such an act as that somersault possibly be natural? There it is awaiting solution. I can only give you Darwin's explanation. I should say, first of all, that it is well known that injuries to certain parts of the brain produce certain effects at certain parts of the body, and of these injuries some will cause the animal to fall backwards, others forwards, or to one or other side, as the case may be. Well, Darwin says that originally we may suppose that a particular pigeon was born with some disease or defect of the brain which caused it to make somersaults in the air, and that a pigeon fancier, being taken with the peculiarity, bred a new variety from that origin. [All the varieties of pigeons are believed to have sprung from the blue rock pigeon.] But it must have been long ago, at least more than 300 years ago, for previous to that time pigeons with such variations in flight were held in high estimation by the people of India.
This, then, is an example of how man can interfere with Nature, and produce a state of things that we can only adequately explain when we come to know that it is not natural. But, before taking up our subject proper, I must ask you to note a still more limited meaning that I am going to give to the word natural. I am going to use it in the sense of primitive, simple; and, therefore, by a natural existence I shall mean one that is comparatively undeveloped, one that is little affected by the art of man. I shall say that such a thing is not natural in the sense that cities are not natural because they need miles and miles of water piping, and the expenditure of thousands of pounds on many other sanitary arrangements, in order that they may be tolerable for a single day. For example, if it is doubtful, as I have read, if more than three generations of pure Londoners are possible, then in the sense in which I am using the word existence in London cannot be natural. If it were, then not three, but 100 or 1,000 generations of pure Londoners would be possible. I am going to exclude from the scope of the word natural the condition of a man who does absolutely no kind of work so long as he can, notwithstanding his idleness, get enough of the best of food, and every facility for what is called "killing time." Because, though it is correct in a sense to say that man is naturally idle, I shall use the word in the truer sense that it is natural for man to earn his bread by the sweat of his brow. Taking up this position, then, let us proceed to the first part of our subject and consider:--The methods of Nature in relation to the preservation of health.
And first her methods in relation to food. Under the conditions I have assumed, Nature tells us instinctively what is the proper food for us to take. There can be no doubt that the healthy man living a country life in a cottage, farm, or manse, has an instinctive desire for the food that is best for him. He will select oatmeal in one or other form, flour in the form of bread, with milk prepared in different ways; and his animal food will be obtained from the surrounding country. He will not accept from you a dish of curry. If that were suited for the inhabitant of this country, it or its equivalent would be provided for him naturally. Ox palate will want the stimulus that the healthy countryman needs; and as for a meringue, he will say it is for women and children. Let the absurdity of the examples pass for the moment; I merely want to impress upon you certain principles. Another thing to be noted about our countryman is that he will never take anything out of season. His thoughts will never turn to forced rhubarb, not to speak of strawberries of summer, and they will supply his need of juicy fruit until the autumn berries and the later and larger fruits are ready to take their place. I remember one day in early spring, it is not so many years ago, that I thought what a treat a little bit of chickweed would be to my bullfinch at this season of the year, for he had none for months. With great difficulty I got a small piece, but he only took a leaflet or two just to please me. I know he thought I ought to have known better. But in summer, when that commonplace little weed is obtruding itself everywhere, where as we think it is not wanted, it is welcomed with the greatest relish by the greatest number of birds.
Now if you note such things and reflect upon them, I believe you will come to the following conclusion:--that in respect of food man will select, as I have said, the things that are best for him, and they will be most abundant, as things in season are; he will select what is of the simplest kind, and they will be the things of which he is least likely to tire. Is that not a wonderful combination? It is one of those grand harmonies of Nature that are sounding all around us, but which we seldom or never hear; or if we hear them we ignore them. For in civilized life we reverse all that, and yet we wonder why we are not always well. But we must listen to what Nature is saying; we must understand that all natural phenonema or states have a distinct purpose and meaning, and we should endeavour to discover this purpose, endeavour to get at the meaning, and learn the lesson that it teaches. Let us try then.
Everyone knows that children are fond of sweets. There must be a reason for this. It will not do to say that they like them simply because they are bad for them. There must be some good reason, and we should endeavour to discover it. It is just this. Childhood, as we all know, is characterized by constant activity; not a great degree of exertion, not a high tension, but constant restlessness. Now in all forms of animal life where this occurs we find rapid respiration and high temperature (the indication of rapid tissue change), and sugar is particularly a respiratory food. Animal food, again, is more adapted for steady hard work as befits the adult. That is the reason. And let it be observed that sugar does not necessarily spoil the teeth, for Negroes, who are very fond of it, have splendid teeth; though, given the impaired teeth of civilized life, I admit sugar does not improve them.
There is another common food to which I wish to refer, one particular form of food rather which is admittedly very nourishing, and yet a food to which children as a rule are by no means partial. I refer to oatmeal porridge. Here again it is not so much the fact to which I would direct your attention, as to the question it suggests. If oatmeal is preeminently nourishing, as proved not merely by chemical analysis, but by actual experience under the most suitable conditions, leading for example the great military hygienist, [Edmund Alexander] Parkes, to maintain that it was one of the very best foods for soldiers on the march, I say, if it is pre-eminently nourishing, why does the child with its still pure nature-given appetite, so generally dislike its oatmeal porridge? There must be a reason somewhere, perhaps there are several minor reasons. I am only certain of two. (1) Oatmeal porridge as usually prepared is a rather stimulating diet; it exerts a healthy stimulus upon the healthy stomach and bowel wall of the adult; but such a stimulus is to the child an irritant, and the younger the child the greater the irritant. And Nature is only true to herself in thus guiding the child meantime away from it. (2) It is an article of food which is apt to be carelessly prepared, almost certainly so if our cook is a superior person, and considers porridge vulgar; and if it has been the custom to send it to the table insufficiently boiled, or with the dispersion of a few knots in it morning after morning, the older child who might now be taking it with advantage has already turned from it with an only too persistent aversion. There are other minor reasons, but I have said enough to indicate what I imagine are in this case the how and the why of Nature's teaching. On the other hand, I believe if children were given from the first porridge made from the finest and best oatmeal, well boiled and carefully cooked, perhaps made with milk for a time, they would never tire of it. We all know that children are very fond of bread, and that they never really tire of it. Now bread is just carefully prepared from wheaten flour, and this again is just the product of a less stimulating variety of the great group of cereals than that which gives us the oatmeal with which we make our porridge. Further, as a matter of experience, I am convinced that, contrary to general opinion, this is a most suitable diet for invalids. This is not the place for me to express a decided opinion upon any particular treatment of disease; I would only assure you that without conscious bias my experience, acquired first of all in hospital, has led me to the conclusion that this food can be made one of the lightest, as it is beyond all doubt one of the most nourishing articles of diet.
But there is still another point relating to the selection of food to which I must refer in illustration of Nature's methods in the preservation of health. Let me first of all, however, state a general principle. Nature very markedly follows the common-sense plan of guarding against the entrance of mischief. She endeavours to catch the evil at the beginning and so keep it out. We are therefore fashioned like a walled city. The skin is our protector; it is a very material protection to the deeper structures of the body, but in man especially, it is a very vital protection also in respect of its highly sensitive surface. In other words, it is there that the watchmen are most abundant and most careful. Perhaps some of us as children may have argued, "If this little cut which I have on my finger is so painful, what must the poor man be suffering who is run over by a wagon?" But the inference is incorrect, because based on a fallacy. The skin presents a vastly greater degree of sensitiveness to pain than the deeper structures do, in order that we may shun the beginning of evil, i.e., the small cut. And so the sensitiveness of the windpipe at its commencement is far greater than it is at any lower part, so that even a drop of water or milk which begins to go down the wrong way sets up such an irritation, or causes such a tickling, that the most tiny and otherwise most inoffensive intruder is instantly expelled. We see something of this law in Nature's method of dealing with the food of children. We know that the whole alimentary canal of the child is very sensitive to the slightest irritant; in other words, that food which is a wholesome stimulus to the adult, may deleteriously affect the stomach and bowels of the child. This may result in the speedy expulsion of the offending food, if to either adult or child. Particularly is this so in the case of the child, as if Nature specially guarded the little one at the beginning of life; though to keep strictly to our simile of the walled city, it is rather that here neither the city nor its walls are complete, and so Nature is specially prompt in casting forth the mischief-maker out of the camp. The obvious lesson is not to put Nature needlessly to the test. Milk for babes and strong meat for men. But under our first head I have only time for a passing reference to one or two other points to which Nature directs our attention. I have said that, in a sense, city life is not natural; children dislike it. We are all children of Nature for a time, and those of us who were born in a city remember our longing for the country as the realization of all that makes life joyous. It is not the hard, flat pavement that will satisfy the child, or even the demure walk out with nurse in the city park or garden. Your little boy wants the green fields, the woods and streams that were the delight and support of his forefathers long ago. He has seen the lambs "fiskin," as he says, with their mothers; perhaps he has even noticed that these games are played by preference just before the lambs go to sleep, and he wants you to take him back there again to play like them. For a child must have exercise. I have spoken of respiratory food and the more rapid respiration itself of childhood. These find their counterpart in the lightness of the body, the elasticity of limb, and the whole unceasing restlessness of the young child. Care sits lightly upon him, he dances it off. Long may he do so, until each little tissue atom of his body gets shaken into its proper place, and settles down into the well-knit frame fitted for the burden and the struggle of the coming years. And here we have an example of the fitness of Nature's methods. The mother herself will reap a direct benefit from the exercise in the open air. Whatever inequality there may seem to be in Nature between the sexes, it is only the highly civilized woman who has so very unequal privileges as regards out-door exercise.
But we must now turn to the second part of our subject:--The methods of Nature in relation to the Healing of Disease. If exercise or work of some kind is the natural expression or consequence of health, rest is as truly Nature's first essential in her conflict with disease. It may seem somewhat of a paradox to say that rest is an essential part of a conflict, but it is really so, for in a conflict we must rest or cease from all ordinary or every-day work. So in disease we must rest from ordinary conscious work, that Nature may carry out all unconsciously on our part, those processes within us that are calculated to overcome the malady. Now, rest, or at least sufficient rest, is just what few people, if any, would take if left to the freedom of their will. There is a certain number, who by reason of their particular temperament, cannot or will not take even ordinary rest; there is a large number who will not rest because they are ambitious or hasten to be rich, and a still larger number who cannot rest or they would starve. And practically there is no one who would take sufficiently long and careful rest for Nature's purpose in the healing of disease or injury. For even the rich man does not rest. "Loafing" is not resting. But I am addressing you who are active, and have important duties to fulfil. If your doctor said to each of you here, "You must for your health's sake take a week's complete rest in bed, beginning to-morrow morning," I know there is not one of you but would begin to make excuses, and a large proportion of you would say, "Quite impossible." And yet, I repeat, rest is absolutely essential to healing, i.e., to the return to health. What is Nature to do? Will she wring her hands in despair? Not she. She places her finger of pain upon us, and the thing is settled.
I am not going to discourse to you on pain in the abstract, nor attempt to analyse the innumerable protests that every day are made upon its various forms. The conclusion of the whole matter is that pain, i.e., physical pain, enforces rest. Let me illustrate this by examples; we shall begin with the simplest. Suppose we cut our finger. The first thing that occurs is a sharp pain to direct our attention to the part; then it bleeds, and that is Nature's way of washing out any impurity. For some hours the parts are feeling the shock or fright, as we might say (this occurs and continues for a longer or shorter period after every accident); but sooner or later the parts recover themselves, and then there begins that marvelous process which is expressed by the simple-looking and familiar word "healing." Each of the thousand and one little muscle-fibres unite again, artery joins with artery and vein with vein, and new nerves grow and take the place of the old. Each layer of tissue unites with its corresponding layer on the other side of the wound, and with none else, while, finally, the skin grows over the surface again, not just exactly as before, but gradually contracting somewhat, binding the parts together and leaving only the tiniest scar. Was ever the finest lace or cambric repaired like that; and it is but sorry work this lace or cambric compared with even a little bit of skin. And in all this, we, so far as deliberate intention is concerned, do nothing. Nature says, "Only leave the finger to me; let me have rest for it, and I shall do the healing." But even that rest we would deny her were it not for pain. There is the collar stud that can only be cajoled into its place with the cut finger, and we are late for breakfast as it is; there is the letter that must catch the mid-day mail, the bit of sewing that has to be done before we can go out in the afternoon. But Nature draws the line at that, and oh, how the finger is throbbing! How cross we get. We rage and storm, which relieves our temper somewhat, but our finger not at all; till at length, repenting, we take the injured hand up gently with the other and fold it on our breast, or, better still, support it on a sling, and that is all that Nature asks or wants.
Take another example. I have often put the question at an ambulance examination, "Why are splints applied to the limb of which a bone is broken?" "To set it," some say, or "To keep the bone in position," say others. Partly true, but not the primary or most essential reason. It is to keep the broken ends at rest--at rest until the mortar-like material thrown out around and between those ends shall harden, and so bind them solidly together. A simple fracture such as we are supposing is not very painful. Bone is a deeper structure, and, therefore, not very sensitive to pain. I imagine Nature has judged that the undue mobility and the loss of power which the fracture occasions will always be sufficient to alarm us without the addition of much pain. At any rate, even the lower animals know that some mechanical support is required to give fixity to the parts for a time, and the sense of helplessness, rather than the sensation of pain, is the impelling power; but the object to be obtained, consciously or unconsciously, is to get for a time complete rest.
Again, in many other instances, while it is one of the innumerable forms of pain that enforces rest, it is of such a character as would rather be described as a sense of discomfort. Yet it is practically pain. We are attacked, let us suppose, by some infectious fever. At once there begins a struggle between the infecting germ and our own organism. It is a struggle for very life. Either they or we must win, and the first thing Nature tell us, and she tells us peremptorily, is to lay up. She sends us, if not acute pain, the aching head and limbs, and says to us, "You keep quiet there in bed. I cannot concern myself with your ordinary wants just now till the extraordinary demand which this contest imposes upon me is past." This is unquestionably the meaning of pain or discomfort--malaise as the French term it, and now adopted by physicians all over the world--the malaise set up at the beginning of every acute fever.
But we are always more impressed by special manifestations of this healing power of Nature, and I shall, therefore, instance one which was first referred to by the great Scottish physician, [William] Cullin, who flourished during the latter half of last century. It is in connection with the disease called rickets, so common amongst the children of the working classes of our city. It will be sufficient to say here that the well-known features of the disease depend upon an irregularity of bone growth, so that there is excess of the animal or softer constituents of bone, and a diminution in the mineral or lime material, which gives to the bone its required hardness. And if the child continues to walk the legs will bend more or less under the child's weight. Now the interesting point is this, that before any bending takes place, posibly before even the skilled surgeon could detect any local indication of the disease, Nature will make the limb or limbs painful, so that the child will be unwilling to walk--nay, even cry if forced, as it often is, to do so. And so if Nature and the child are only let alone the deformity may be prevented. Such an example as this more particularly impresses us on account of the early anticipation of the danger which may not as yet be even suspected by the most skilled observer. There are many examples of this foresight on Nature's part in relation to our affected organism no less interesting, but they are not well adapted for general illustration, as they require a special acquaintance with medical science; and as I am endeavouring to present to you examples that carry with them a practical lesson, I must note for a moment another method of Nature as a healing agent. In place of using pain as a means of securing rest, she may take away all the inclination for the exercise of a particular function. We see this in the loss of appetite in acute disease. The conflict is desperate; there is no time for food. This is all very good if the conflict is sharp and short. But what if it is not only sharp but dangerous because of its long duration. Before answering this question, let us first of all suppose a case in which there is no danger; for example, the so-called bilious attack [nausea]. There is the splitting headache, with, probably, some giddiness and sense of cold. By these means Nature makes the patient take rest and keep himself warm. There is, therefore, the very smallest expenditure of force taking place; the very smallest amount of tissue change going on. Why press food upon the patient when Nature has so evidently said "No?" The attack will be over in two or three days at most, and the patient will be up again to work with an appetite for food that will quickly make good the few days' loss. Here I have gone at once to the lesson. Don't worry the patient with, "Oh, do take something; here is a little nice so-and-so." Give him time; give Nature her time, and she will soon make him eat with a relish that he may not have had for months before.
But in the case of the ordinary fever it is very different. It may be dangerous, not only at the moment, but dangerous on account of its prolongation perhaps for many weeks. Here Nature is fighting desperately with foes invisible to us, immediately recognized by her. The loss of appetite clearly expresses her dilemma. She must continue the fight within us, and there is no time for food. We are like the soldier who cannot lay down his arms even to take bread, or at least to make it ready.
And here it is that art comes in; here it is that the physician finds his place, How he is then to act, how he is by his art to further and guide the efforts of Nature, nay sometimes restrain those efforts, is a matter not now before us. Our subject is too wide as it is for one address, and I can only venture to hope that in directing your attention to a page here and there, I may have suggested to you a renewed study of the book of Nature itself.
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