Remarks explanatory of certain Dietetic maxims, and established
notions or prejudices, illustrative of the physical
constitution and domestic habits of the Limenians.
In Lima there are certain opinions and rules, relating to the nature and
cure of diseases, so very popular and well received among the vulgar,
and at the same time so habitually countenanced by many of the native
practitioners, that, for any one who proposes to practise in that part of
the world, and hopes to be honourably acquitted by the jury of nurses and
attendants who are always numerous about the sick, it may be worth while
to consider the tenor of the following remarks:
I. _No conoce nuestro clima._—It is affirmed by native doctors, but
not always acceded to by the vulgar, that there is something occult
in the climate of Lima, which only a Limenian or Creole physician can
sufficiently comprehend. Hence the prejudiced objection, “No conoce
nuestro clima,”—that is, “he knows not our climate,”—is sanctioned by
high professional authority; and this much hackneyed caveat is usually
laid at the threshold of every European doctor who desires to make
himself professionally useful in Lima.
Every one, we think, will admit that the practice of medicine must be
modified, or considerably altered, according to the topography of any
particular country; for it is observed, that difference of locality
affects not only man, but plants and animals, in a striking degree as we
extend from the Equator towards latitudes far to the north or south of
it. Yet, if there be any who understand either the botany or zoology of
Peru, or who endeavour to illustrate these subjects by their science and
diligence, they are not Peruvians.
The only lover of natural history we have the honour to be acquainted
with in that country is Don Mariano Rivero of Arequipa; and, though their
tranquil sky might be imagined to allure Limenians of a philosophic turn
of mind to the contemplation and study of the heavenly bodies, yet to Dr.
Gregorio Paredes alone belongs, in the present day, the merit and high
distinction of keeping the sublime vigils of the astronomer. Now this
dearth of native science is not confined to these general branches of
natural history and philosophy, but affects very sensibly the practice
of medicine. The very manuals of primary medical instruction put into
the hands of medical students in the capital of Peru are foreign and
European. And thus it is plain that they have no peculiar and national
digest of medical knowledge—no local and partial medical code, such as
charlatans and public impostors would desire to insinuate when they talk
of their _own_ practice of physic, or what they call _Medicina del pais_.
It is indeed to be hoped that no respectable physician in Peru will
hereafter indulge in the folly of maintaining that Europeans are neither
fit to practise in that country, nor able to comprehend the peculiar
influences of the climate of Lima. This climate, like every other on
the known face of the globe, is open to the investigations of the
meteorological observer, whether he be a native of the Old or New World.
The laws of physiology, we may further observe, like those of
gravitation, are the same in Peru as in other parts of the world; and the
aphorisms of Hippocrates, generally founded on accurate observations made
more than two thousand years ago, are at this day equally true as when
first embodied, and applicable to man’s physical constitution all over
the globe. The medical treatment of diseases, whether conducted at home
or abroad, must be conducted in conformity with the common and immutable
laws of the animal economy, and with due attention to the constitution
and temperament of individuals. The locality of the patient’s birth or
residence, the influence of climate, diet, and habits, &c. are mere
accidental circumstances, secondary and subordinate considerations, which
every physician or medical officer of our fleets and armies, to whatever
clime he be transported, should be able to survey and to estimate, like
the skilful commander who, as he reconnoitres his ground, perceives the
local character of a new field of action.
II. _Tomar dulce para bever agua a las horas de la comida._—This is a
standing dietetic rule observed at the close of a meal or repast, which
means that sugar, or some sweet preserve, is to be taken to give relish
to the water that it is customary to drink at this time, whether one feel
thirsty or not: they therefore sweeten the palate to enjoy their simple
drink.
Should a Limenian in perfect health, who thus drinks water at stated
periods, feel thirsty shortly after a meal concluded, as usual,
with sugar or some sweet-meat and water, he is taught to endure the
inconvenience rather than bring on himself indisposition by indulging his
thirst. To understand this, it is requisite to know, that, until three
hours have elapsed after the taking of the last meal, no one is supposed
to drink even water, which is the most common beverage of the natives;
for to commit such an irregularity would, it is believed, be to occasion
a fit of indigestion or to hazard health.
This may appear a ridiculous prejudice to those who are accustomed to
quench their thirst, as often as it naturally arises, without regard to
rules; but, on the coast of Peru, the neglect of this prophylactic rule
of only drinking at stated periods, when it violates the established
habits of an individual trained up in the observance of it, may be
allowed to be injurious to the health, as it certainly disturbs the
digestive functions. This strict attention to measured periods of
drinking water is also countenanced in the hill-land of the interior,
where digestion is usually so vigorous as not to require such nice
precaution: but it is patronised by custom; and this, no doubt, the
majority hold as a sufficient reason for the continuance of the practice.
When a person suffers from acute febrile disease, and is only allowed
very spare and tenuous diet, such as chicken soup, panada, tapioca, or
arrow-root, &c.; then, from one meal to another, the regular interval is
five hours; three hours after each meal, water, or some medicated drink,
is given; and, two hours after this drink, the allotted aliment, of
whatever simple sort it may be, is again repeated. Thus food and drink
are regularly alternated till the patient is considered to be in a state
which requires the supply of solid food; and then, as when in ordinary
health, the interval from meal to meal is understood to be seven hours.
The solid food given to the convalescent generally consists of chicken,
which, of all the items in the list of Limenian dietary, is that in
most general requisition. Now, for the proper digestion of the chicken,
five hours are allowed before any medicated drink is ordered after it;
and the principle recognised in this method is, that drink, which too
much dilutes and weakens the gastric juice in the stomach, cannot with
propriety be taken before chymification is complete.
Nurses, and very kind and obliging friends, usually attend so strictly
to the above order in giving food and drink, that, though the poor
patient be burning with thirst, he can only have permission to quench
it at the fixed and assigned hours; and, through a feeling of pure
benevolence towards the sick, they interrupt a salutary sleep rather than
fail in punctually giving either drink, nutriment, or medicine at the
corresponding hours. Under the influence of an amiable sense of duty,
the anxious mother is often heard to assure the doctor that she herself
was attentive to give her child its drink or medicine at exact time, as
announced from the nearest church spire by the striking of the clock;
though it grieved her to interrupt its gentle slumber.
During the exacerbations of intermittent fevers, so prevalent in
Peru, the state of the stomach is usually much disturbed; and in such
circumstances, instead of alternating food and drink without regard to
the condition of the digestive functions, we have taken pains to persuade
the sick to deviate from the order established by custom, and allowed our
patients the inexpressible comfort of drinking as often as thirst urged
them, until there was obtained a solution of the febrile exacerbation.
III. _Prepararse para tomar purga._—Many practitioners of the venerable
Boerhaavian school have died in Lima in course of the last few years,
but several of this stock are yet remaining; and, in their professional
harangues at consultations, they are heard to talk learnedly of the
malignant, adust, crude, and corrosive, &c. state of the humours of the
human frame, without, as it always appeared to us, being able to affix
any precise and practical ideas to these hypothetical expressions. And
though the junior doctors of modernized opinions are generally found to
indulge in some theory of the abstract solidists, yet they are obliged to
respect the prejudices of the vulgar, and talk in a way that is agreeable
to those whom it is their business to persuade. Patients, blinded by
the received notions concerning the scorched blood, and displaced,
corrupt, or perturbed and jumbled humours, reckon the daily visit of the
physician indispensable under ordinary circumstances of indisposition.
They do not expect that, day after day, active drugs are required; but,
according to their own precognition of the case, they think it necessary
for their safety that their medical adviser make his regular visits and
observations, carefully examine the various excretions, and so be able to
judge accurately of the character of the case, and prepare the patient by
delay, diet, and diluents, &c. to take physic in due time, which is the
meaning of the vernacular expression, “Prepararse para tomar purga.”
IV. _Empacho._—This famous Limenian mischief-maker is supposed to lurk
concealed under almost every form of chronic or intractable disease, and
means, in the most usual acceptation of the word, a preternaturally
loaded and torpid condition of the bowels: but, on other occasions, the
same word is used to express the casual lodgement, in any part of the
digestive passages, of some such matter as the fresh rind of a fig,
grape, or date, keeping up local irritation and fever. Thus, at one time,
the term empacho signifies a confined and inactive state of the bowels;
and, at other times, indigestion of some foreign and adherent substance,
frequently giving rise to quite a contrary condition of gastric disorder:
the former is called simply empacho; the latter is called empacho
pegado,—for the removal of which, a table-spoonful, or two, of the liquid
fat of a fowl—the _enjundia de gallina_! is a _popular_ remedy.
In a large proportion of cases where this cause of mischief is supposed
to exist, it has, in fact, no place or existence except in the mind that
conceives the notion of it; and, in itself, the fallacy is harmless so
long as it is speculative: but the practice to which it leads is often
mischievous, and it is with the latter that the practitioner has most to
do.
It would, indeed, be a hopeless task for the regular practitioners in
Peru to reason a Limenian doctress out of her reveries on the subject
of empacho, which, when viewed by her as the exciting cause of disease,
assumes a Protean character, and is visible to her imagination in mostly
every case of ailment, which she, true to her favourite opinion, offers
to cure in her own way.
The evil effects of a farrago of nostrums, or untimely and inappropriate
medicaments applied by the help of the doctress, the educated physician
is often called, but sometimes too late, to correct; and the fatal
abuses thus arising have, on various occasions, called forth the public
and earnest remonstrances of the highest medical tribunal of the
country,—but all to no purpose, the practice being rooted in vulgar
favour and prejudice.
So universal, indeed, is the credit of the Limeña quacks, or curanderas,
of whom La Señora Dorotea is the chief, and so general is the use of the
instrument called jeringa, (through the medium of which the principal
ingredients of this señora’s materia medica are confidently applied,)
that it constitutes an essential and conspicuous article of domestic
utility. And the great consideration in which this auxiliary is held, as
a _sine quâ non_ in the treatment of empacho, and almost every disease,
renders it a topic of never-failing conversation.
As a familiar example of the abuse of the jeringa, may be mentioned the
vulgar practice of resorting to it in disorders attendant on dentition.
Sometimes the increased action of the bowels is indiscreetly stopped by
astringents thus adhibited, and a fatal determination of blood to the
head ensues; but it more frequently happens that the contrary practice
is pursued, and stimulant remedies are administered, which either
increase the existing disease, or transmute it into a dysentery. On such
occasions the skilful practitioner may endeavour in vain to convince
the mother that her child’s gastric ailment does not proceed from the
presence of the dire empacho. When, as often happens during the progress
of teething, children are suffered to eat all sorts of sweets, fruit,
and unwholesome diet, or permitted to partake of strong food used by
adults, and ill-suited to the more delicate organs of the tender child,
then, no doubt, empacho or indigestion may be traced, in many cases, as
a co-existing cause of the irritation and disturbance in the bowels, to
which the offspring of white parents are more particularly subject in
Lima. Complicated cases of this nature demand a prudent modification in
treatment. Yet such instances are not so frequent as others, independent
of indigestion, and in which a moderate bowel complaint is so far from
being injurious that it is most salutary, as a natural protection
against affections of the head during the process of teething. It is
a peculiarity connected with the religious belief and popular customs
of the country, that diseases of infancy and early childhood are too
lightly considered by the native physician. The reason assigned for this
is the devout one, that little innocents are exempted from the pangs of
Purgatory, which must be borne by adults for the purification of their
souls; and that therefore, for the child, it is happiness to die.
We have heard the physician offer this consolation to a weeping mother in
the higher ranks of society. He softly assured her that her pretty babe
would pass through Purgatory to Paradise without as much as scorching a
finger in the transit.
In the lower and middle ranks especially, this religious dogma seems
to stifle the natural emotions of the heart; for, evidently forgetting
that even “Jesus wept,” they celebrate with music and dancing the death
of the dearest object of a fond parent’s affection, who, as her child is
consigned to a niche in the Pantheon, bedecks her person, grown thin by
previous care and watching, and now she smiles in her robes of white, as
if these were indeed no emblems of torn affection!
V. _Sangria sobre el empacho._—To bleed a patient affected with
empacho is, by the common consent of the vulgar, declared to be a most
unpardonable blunder; and this is the meaning of the expression, “Sangria
sobre el empacho!” when ejaculated in the apartments of the sick.
It will be readily imagined that, in numerous instances coming under
the vulgar denomination of empacho, the subtraction of blood will be a
necessary measure before purgatives can be properly or safely resorted
to, with a view to remove from the bowels the irritating cause lodged
there, and affecting the general system.
But to avoid the unjust criticism of uncharitable members of the
profession, who are always ready to turn to their private advantage,
any popular prejudice which can be called in to humble the name of
fellow-practitioners more respectable than themselves, and also as a
mean either to acquire or to preserve the confidence of the sick, the
prudent physician will not overlook the natural effects of any known
prepossession regarding blood-letting. He will so far accommodate his
practice to the ideas of those who are most interested in the issue
of his treatment, as to order at least one enema, when the empacho is
firmly believed to exist, before he proceed to the further discharge of
his professional duty, and fulfilment of the indication of the case, by
ordering the lancet to be applied.
No time or advantage is lost by such a concession to the preconceived and
inflexible opinion, that bleeding is particularly hurtful in those cases
of illness connected with undue accumulations in the bowels: but one very
important end is gained by it; since, by agreeing with the sick and their
friends on an indifferent point of practice, they will more willingly
submit to the application of other remedies necessary for the safety of
the patient.
VI. _Cosas frias y calientes._—All articles of diet, and medicaments, are
by the Peruvians vulgarly divided into cold and hot; or, as the words on
which we are about to comment express it, into “cosas frias y calientes.”
When the physician prescribes any particular diet or physic to a patient
in Lima, he must be ready to answer many inquiries regarding the
qualities of the things prescribed.
Besides professed sick-tenders, zamba housekeepers or head-servants, some
women in the middle and humbler ranks, such as manteras, chocolateras,
tenderas, cigareras, picanteras, pulperas, changaneras,—that is, female
shopkeepers, chocolate and cigar venders, with a subordinate gradation
of publicans, &c.—are always ready to talk, with confounding fluency and
volubility, without knowledge, concerning qualities and temperaments; and
they display a natural acuteness of metaphysical capacity, with a truly
peripatetic nicety of discrimination, when, in a moment of oratorical
excitement, they assign to certain mixtures and drinks ideal measures and
degrees of the elementary qualities. Women skilled in such mysteries, and
omniscient charlatans, run over the various combinations of the cold and
hot, dry and humid, and all their resulting modifications of temperature
and temperament, with apparently unerring precision, and with a graduated
exactness which no chemist in Europe, with every advantage of science and
apparatus, can pretend to equal in his elaborate investigations into the
qualities and elements of bodies either living or inanimate.
The particular temperament of the patient his intimate friends are
supposed to know perfectly; and the doctor’s reply to any question that
may be proposed to him on this subject will be considered, in many
instances, as no bad test of his penetration and professional knowledge
in other matters with which they do not presume to be themselves so well
acquainted.
In conformity with such prevailing impressions, when nurses are to be
selected for the children of delicate mothers, preference is given to the
black women, as their blood and milk are believed to be cooler and more
refreshing than the same fluids are in women of a different race. The
Indian woman, on the other hand, is considered inferior to the negress as
a nurse, because she is believed to be of a comparatively hot temperament
and constitution. The effect of the quality of the nurse’s milk is
conceived to influence the future temperament of the infant that hangs on
her breast; and it is sometimes assigned as a reason why an individual
is of an ardent temperament, that when a child he had been weaned, or
deprived of the breast, by giving him wine,—_se desteto con vino_.
Colour is looked upon as an indication of constitutional temperament
even in the lower animals. Thus, when one in town labours under hectic
fever, or consumption, he is recommended to go to the country, and drink
warm milk from a black cow, because it is allowed to be more cooling and
febrifuge than the milk taken from a cow of any other colour.
In case of a rheumatic swelling of a joint,—the knee, for instance,—or
some tumefaction in any of the glands, it is taken for granted, that,
whatever other remedy be applied, the envelope for the limb or part
affected must be of a medicinal colour, and consist of black wool, or
something of a dark woollen texture. In short, so far has this general
idea concerning the antiphlogistic nature of black been carried, that
few natives dispute its accuracy: nor are we prepared to say that it
may not have some foundation in fact and observation (though often
laughed at by strangers as a puerile prejudice); for it is well known to
scientific men, that the free radiation of heat is much influenced by the
differences of colour in the radiating surfaces of bodies.
With respect to food and drink, the division into cold and hot is never
overlooked.
A “_traguito_,” or little dram of Italia, a colourless brandy made on
the coast, the old men consider as _fresco_, or cooling, when taken
immediately after dinner; and when they take the “_traguito_,” which
they do not every day, it will probably facilitate the digestion of
the greasy food which they are commonly accustomed to eat, and in this
manner deserve the name of a _fresco_. But, again, though at their
entertainments they allow wine to be a safe and good drink after the
“_helados_,” or ices, which they like exceedingly, still they use wine
sparingly on other occasions, as they consider it too heating for general
use. There are fruits after which the natives do not think it safe
to drink either wine or spirits; of this sort is the short plantain,
called “platano de guinea,” after which a mouthful of spirits would be
considered quite poisonous. Foreigners do not seem to attend to this
strict rule observed by the natives; nor is the violation of it, as far
as we know, attended with any serious consequence to them.
Various kinds of fruit and vegetable juices, which are considered cool in
their qualities, are not rarely most heating in their effects, according
to the condition of the system when taken. The melon is in reputation
for its cooling nature; but, though the impression made by it on our
alimentary organs is at first very refreshing, the muleteer who journeys
from the Cordillera to the coast, and has but once in his lifetime been
attacked with a gastric tertian, in consequence of cooling his parched
fauces by eating of the melon, can give a lively account of the internal
heat, agitation, and oppression experienced by him on the occasion. There
is no cooling fruit safer than the granadilla, which is most grateful and
refreshing to the feverish patient, or thirsty traveller in the scorched
and rock-bound ravines and narrow valleys of the interior, where this
fruit is often abundant, as it is also on the coast in its proper season.
Fowls are reckoned to be infinitely _cooler_ in their temperament than
sheep or oxen, and their flesh is also considered as very safe and
cooling; hence the almost universal use of the former, and prohibition
or disuse of the latter, in the dietary of a delicate invalid. This
distinction will appear still more strongly marked, when it is observed,
that to prescribe beef-tea in any acute disease would be deemed an act of
rashness and ignorance; but chicken-tea is held to be the most cooling of
diluents, and very eligible in the most inflammatory diseases and in the
warmest weather.
This chicken-tea, called “agua de pollo,” is commonly prepared in the
proportions of three cupsfull of water to one half of a little unfledged
chicken, with the addition of a mallow leaf or two, and the core of a
lettuce, (cogollo de lechuga,) by which latter in particular its cooling
properties are said to be exalted. After the ingredients are boiled
together for a proper length of time, the clear decoction is poured off
for use. The great efficacy of this drink is accredited by the undisputed
consent of doctors of all colours, and matrons as well as nurses of all
sorts and temperaments.
It is needless to remark that, in general, plain water or toast-water,
or a ptisan of barley decocted with some of the subacid fruits of the
country, would answer very agreeably the purpose of the agua de pollo;
but when the latter is preferred, it should be remembered that in warm
weather it decomposes rapidly, and then acquires irritating properties.
As a purgative, in gastric disorders, the old physicians in Lima extol
almond oil, which is often of inferior quality; and they take some pains
to arm the minds of the credulous against the use of the best castor-oil
of European preparation, by telling them that it is extracted from the
seeds of the “higuerilla,” or castor-oil shrub, everywhere indigenous in
the warm valleys of the interior; and these seeds are generally known to
be excessively drastic when taken as the peasants use them, in the dose
of two or three bruised, and then swallowed in substance. Now from the
seeds the native apothecaries prepare an impure oil, which is sold in the
shops under the name of “oil of higuerilla;” and as it is only used for
burning in lamps, when the vulgar learn that castor-oil is but another
name for the same, they naturally consider it as essentially hot, and
most heating and improper for internal use. The vulgar should be advised
by every ingenuous and intelligent member of the profession, that the
fault is not in the remedy, but in the way of preparing it: and this
remark may be extended to the delicate preparations from the mineral
kingdom, which acquire a bad name when badly prepared, as is necessarily
the case in Lima, where chemistry is so little cultivated or practised as
a science.
VII. _Los acidos son malos para el pecho._—No class of remedies is in
more general use in Lima than vegetable acids in the bilious disorders
of daily occurrence; but in affections of the chest, whether simply
catarrhal, or of the more serious forms of pneumonia or phthisis, it is
a generally received and settled opinion that acids of all sorts are
injurious, which they make known by such expressions as these: “Los
acidos son malos para el pecho,”—acids are bad for the breast; “Los
acidos cierran el pecho,”—acids shut up the breast.
This opinion seems to have partly originated from a notion, once
entertained by the doctors, that acids coagulate the animal fluids, and
so produce obstructions and disease. It is made evident to our senses,
that milk secreted from the blood is readily coagulated by acids; and
thus they seem to conceive that something of the same process takes place
in the circulating fluids of the body when acids are taken into the
system.
Not only the vulgar, but some of the professional characters, appear to
be impressed with the notion that the blood is thickened or curdled by
acids, whether mineral or vegetable; and that the delicate circulation
of the lungs is consequently impeded, and the respiratory pores clogged.
This opinion appears to be expressed in the very common remark, “El
enfermo tomo fresco de lemon, y con el acido se le ha tupido el pecho,”
which means that the patient drank cold lemonade, and with the acid the
breast was stopped up.
We are well persuaded that there are instances, especially among delicate
females, where the respiratory organs are so susceptible of impressions,
that the immediate refrigerating effects of cool acidulated drinks on the
stomach of such persons extend rapidly, by sympathy, from the stomach to
the surface of the body and lungs; and there produce a certain degree of
constriction on the exhaling vessels, which disturbs their healthy action.
It is only in this manner we can account for the fact, as frequently
stated to us by patients, that, as certainly as they did take anything
cool and acidulated, they were speedily affected with a tightness
about the chest, and felt as if they had actually caught cold. On such
occasions their usual observation was, “El acido me ha cerrado el
pecho,”—the acid has locked or closely shut the breast.
A complicated ailment which is vulgarly conceived to be seated in the
chest, is often met with in Lima during the sultry months of January,
February, and March. It is attended with a short and dry cough, a foul
tongue, and evening fever, or restlessness, that chases away sleep. The
patient becomes low-spirited and anxious; and dreads an approaching
attack of consumption, or spitting of blood.
In such disorders, the gastric and hepatic functions may be suspected
of some irregularity; and, when in any case this is explained to the
patient, the disease may be treated as one seated in the organs of
digestion, and _frescos_ or cooling acidulated drinks often do wonders.
Not only diluted in cold water, but with the addition of ice, the various
vegetable acids of the season are given with the best results. They break
up the whole chain of morbid symptoms; and the patient, thus encouraged
and refreshed, completes convalescence by cold sea-bathing, and a few
weeks’ residence at the neat village of Mira-flores, a few miles from the
capital.
Throughout the entire year, but more particularly during the warmer
months, great use, and no small abuse, is made of all sorts of _frescos_,
or cooling and acidulated drinks, with or without the addition of ice,
and other ingredients of a very opposite nature, as pimento and spices,
which latter render the same drink heating to the stomach, that, by ice,
is rendered cool on the lip.
There are no beverages which the vulgar misapply more than their
_frescos_. The most approved of these, as tamarinds and whey, or the
juice of the apple and quince, &c. diffused in water and sweetened
with sugar, are sometimes so long continued with a view of cooling and
purifying the blood, that they finally relax and weaken the stomach;
of which there are heard many complaints. Again, iced water, or iced
acidulated _frescos_, are frequently misapplied in the common acute
diseases of the country when the patients are in a free sweat; for, by
suddenly checking a salutary perspiration, very bad consequences may
follow: but this, though a well-known fact, is too often overlooked.
VIII. _Acido sobre la leche es malo._—It is particularly worthy of notice
that, shortly before or after milk happens to be taken pure as a drink,
or mixed up in some culinary form as an article of diet, it is believed
that no acid can be safely received into the stomach; it being thought
necessary that the interval between these incompatible ingredients should
be seven hours at least.
In illustration of the fact here stated, it may be mentioned that we
were once called to see a lady in Lima who had been ailing for about a
twelvemonth; and, on inquiring why she had delayed her cure so long, her
reply was,—
“A year ago, on my arrival from Valparaiso, I called in Dr. ——, a French
physician, who ordered me to confine myself to a rice and milk diet
alternated with lemonade. I felt so greatly shocked at this gentleman’s
extraordinary error in prescribing such treatment, which every one knows
to be most hurtful, not only to the infirm, but to the sound and healthy,
that I resolved at the time to leave my complaints to nature, rather than
expose my life to the greater indiscretion of some other doctor of less
fame.”
In this instance the error, for which the French physician was blamed,
consisted in his having overlooked the popular rule universal in Peru,
and probably not unknown in Chile, that “acido sobre la leche es malo,”
viz. that acid after milk is hurtful.
According to this rule in Peruvian dietetics, it would be considered
little short of poisonous to use milk or cream with any sort of fruit,
jam, or preserve containing the least quantity of acid. And here it may
be noticed, that in their own preserves, they completely destroy the rich
and distinguishing flavour of the fruit by an excess of sugar, just as
they annihilate, in very bad taste, the peculiar and natural fragrance
of their finest flowers by sprinkling upon them foreign and artificial
perfumes.
IX. _Los olores son malos para las recien paridas._—It is one of the
social customs of Peru, sometimes attended with great inconvenience,
that friends and visitors, moved by feelings of kindness, crowd into the
rooms of the sick, when not perhaps in a fit state to enjoy company or
conversation.
During their confinement ladies are not sufficiently exempted from this
friendly intrusion, or neighbourly attention. The only restraint imposed
upon those who visit a lady on such an occasion is, that they do not
enter her apartment with flowers or perfumes; nor are the attendants
permitted to introduce censers with the fumes of burning incense, as
is customary at other times. Thus, it is acknowledged that “Los olores
son malos para las recien paridas,” viz. that perfumes are injurious to
women during their confinement; and they certainly are so, for they are
frequently observed to give rise to fainting, convulsions, or other bad
consequences. These precautions all who visit or wait upon the sick are
strict in observing; and so much the more, as it is customary for females
in every rank to use perfumes on their dress, and to decorate their heads
with flowers for evening visits: a practice in which the woolly-haired
negress and mulatta greatly excel, as they love to adorn their stunted
curls with flowers of aroma and jessamine.
Parturient women are very subject to a sensation of languor and
exhaustion at stomach, attended with a feeling of faintness, which they
call “_fatiga_.” On ordinary occasions, when this feeling or sensation is
experienced by females not similarly situated, it is usual to resort to
cordials and odoriferous draughts containing lavender, hartshorn, &c. and
also to stimulating embrocations applied over the seat of the stomach,
which usually consist of a camphorated mixture, or perhaps Cologne water,
and other such remedies applied in common cases of weakness and faintness
referred to the stomach; but, under the circumstances to which our rule
refers, all applications of this sort are inadmissible.
When there is a feeling of sickness and faintness, with a disconsolate
sensation (called “un desconsuelo”) at the epigastrium or scrobiculus
cordis, they are allowed on all occasions to apply to the stomach, as a
popular remedy with the matrons, a bit of warm toast, or the breast of
a fowl sprinkled over with powdered cinnamon and moistened with wine,
or, as it is vernacularly expressed, “la pechuga de gallina con vino y
canela;” and they agree that this application, which possesses a great
deal of their confidence, commonly produces the best effects.
X. _Tomar agua fria encima de colera._—To drink cold water immediately
after a fit of anger, which is the meaning of the words in our text, is a
frequent cause of ailment, and one which the practitioner every day hears
of as the origin of the worst cases of visceral obstructions or hepatic
disease. Unfortunately, the occasions of such attacks are of ordinary
occurrence; for the temper of those who suffer from them is rarely under
proper control, and, as a necessary consequence of the existing state of
society, provocations to anger are common in every situation.
We were once consulted by a curate of an irritable disposition, and an
epicure in his taste, on account of an induration and very prominent
enlargement of the liver, which some time after ended in a fatal abscess.
This gentleman assigned, as the exciting cause of his malady, his having
drunk cold water when angry, or on occasion of a quarrel he had with his
cook, a Zamba girl, who we may suppose must have spoiled some favourite
sauce.
This was the first time we were consulted on an ailment said to arise
from drinking cold water when angry. But afterwards, as we had engaged
in more general practice, we were called upon to listen to very many
statements of the same sort; and, on such multiplied and independent
evidence, we are compelled to believe that this is indeed one of the
usual causes of hepatic derangement very prevalent in Peru.
During these fits of anger the brain appears to be greatly excited,
and the flow of blood to it increased; and the liver, which readily
sympathises with the brain in our mental states of angry emotion, seems
to be at the same time gorged with blood. Under these circumstances, we
think a draught of cold water operates injuriously, by creating a sudden
chill within, and inducing, through the channel of sympathy between the
stomach and liver, contraction of the biliary excretories, which lays
the foundation of more permanent congestion and consequent inflammation,
by preventing the natural relief which should arise from a free flow
of bile. That the ready flow or free outlet of bile is the natural and
proper medium of relief in such cases, every one has an opportunity to
judge; for fits of anger are so common in Lima, that a day never passes
without witnessing or hearing of their ill consequences; and the most
familiar and immediate effect is a bilious disorder of the bowels, or
indigestion and subsequent vomiting,—just as the stomach happens to be
occupied, or otherwise, during the period of mental perturbation.
We may remark, that ice and iced water are only considered safe (even
by the vulgar, who use them daily with a view to restrain the excessive
flow of bile consequent on an angry or choleric fit,) when they are given
after the violence of the commotion is over, and after the stomach, if it
happen to be loaded, has, by drinking warm water or otherwise, been freed
of its contents; but in hot weather, when the skin is more relaxed, and
the bilious secretion more plentiful and redundant than common, ices are
much used, and iced water forms the usual drink at the hour of meals.
We meet with persons who never experience the smallest annoyance or
approach to anger, without being affected by some corresponding movement
in the bowels; and others are never known to get warm in earnest
discussion without feeling some derangement at the stomach, or showing on
the following day a white or furred tongue. In truth, the delicacy of the
digestive organs, or that mobility by which their functions are so easily
affected by mental emotions, is quite extraordinary; and, as the daily
repair and due sustenance of the whole frame depends on the regular and
healthy discharge of the digestive functions, it is not to be wondered
at that, among a people by no means intellectual in their habits, the
sword should often be observed to wear out its scabbard,—in other words,
that the frequent agitations of passion should induce serious diseases,
and easily wear out the frame in a country where the sympathy between
the mind and chylopoetic organs is so very marked and influential. Hence
the anxiety which experienced natives feel at the hour of awakening
repentance, or the return of sober reflection, after a culpable
indulgence of anger; and hence, too, the rigid abstinence or tenuous diet
attended to after one has been fretful or out of temper, till the pulse
is again observed to be natural, and the organs of digestion sufficiently
composed: and to show how far these painful states of mind may affect the
secretion of milk, we have only to recollect that the Limeña will hear
her babe cry a whole day, rather than harm it by giving the breast till
her own agitation, which she knows vitiates her milk, is quieted after
one of those choleric movements which it has been either her fault or
misfortune to suffer.
XI. _Si se puede lavarse con agua fria._—In almost every case of
lingering illness in either sex, it is vexatious to witness the
reluctance to ablution that prevails in the capital; and this prejudice,
with the dread of shaving connected with it, is particularly cherished
among those who have been delicately nurtured; the male part of whom are
often heard to ask “si se puede lavarse con agua fria o afeytarse?”—if it
be safe to wash with cold water or to shave.
The Limenians are fond of seasonal bathing and the pleasures of a
watering-place, which they know how to enjoy for three months in the year.
Chorrillos, three leagues to the south of Lima, is the favourite
watering-place, much frequented during the sultry summer months by
gambling parties, and persons of rank and fashion from town. It is only
a small village of fishermen, and constructed of cane and mud. The
Indian owners of the shades, and neatly constructed houses or _ranchos_,
let them to the bathers at a high rate during the bathing season; and
some persons either take these for a term of years, or construct other
light summer houses for themselves, which they fit up very tastefully,
and pass the summer months in them in the midst of gaiety and mirth.
Chorrillos is sheltered from the south-western blast by an elevated
promontory, called the Moro-Solar, which rises like a gigantic guaca
overlooking the numerous monuments, or pagan temples, of this name, which
are scattered over the naturally rich, but now in a great measure waste
and desolate plain, that extends from Lima to Chorrillos.
During the raw, damp, and foggy months of July and August in Lima,
Chorrillos enjoys a clear sky and a genial air. The south-westers laden
with heavy clouds spend their strength on the friendly Moro-Solar, (on
which burst the only thunder-storm witnessed by the Limenians in the
memory of any one now living,) and divide into two currents: the one
pursues the direction of the village of Mira-flores, and the other the
hacienda of San Juan, leaving Chorrillos clear and serene between.
Thus protected, the village of Chorrillos feels not the chilly mists
of winter; and it is the great hospital of convalescence for agueish,
asthmatic, dysenteric, rheumatic, and various other sorts of invalids
from the capital during the misty season, when the clinking of dollars
and noise of the die no longer disturb the repose of the sickly.
The salutary practice of bathing in the sea was in former times confined
chiefly to those affected with cutaneous diseases; but within the last
forty or fifty years, as we are told, sea-bathing has been preferred to
river-bathing, or to the cold baths by the old Alameda, and fountain of
Piedra-lisa. The women are usually cleanly in their persons; but, however
congenial cleanliness may be to their sex, they, like the sick and
bearded men, seem to be greatly afraid of ablution in hectic fever, and
some thoracic diseases with which they are often visited.
Of the Indian in the interior we need not speak in the same breath
with his brother in the capital, or with the maritime Indian, whose
ordinary occupation in fishing, or more delicate engagement of safely
conducting the ladies over the surf during the bathing season, especially
at Chorrillos, necessarily leads to cleanliness. But the indigenous
mountaineers never perhaps in the whole course of life wash their bodies
thoroughly; and their skin (at least in the warm valleys) is habitually
covered with a thick coating of perspirable matter and extraneous dirt,
which it is not easy to wipe off.
In very many cases of acute disease, the warm bath is, with the natives
of the coast, a favourite and most valuable remedy, rarely neglected; but
its application is usually forbidden in affections of the chest.
It will be readily imagined that the frames of those who fly from
impressions of cool air and hazy weather, which, with all their care
to shun, they cannot entirely escape, easily become so sensitive as to
render them more susceptible in proportion to their self-indulgence, and
more liable to catarrhal affections, than those who, by free exposure of
their persons, train their constitutions to greater hardihood.
As evidence of the evil results arising from the vain endeavour to avoid
the impression of the common physical causes to which, through life,
every one must be occasionally exposed, we would particularly notice
the peculiar delicacy of the delicately reared Limenian. When somewhat
weakened by bad health, or a slight indisposition which confines him to
his apartments for a few days, should he happen to shave and wash the
face with cold water, he is thereby put in danger of being visited by a
spasmodic affection of one side of the mouth, or affected, as is more
likely to take place, with a cold in the head; so that the inflammation
thus induced in the nostrils and fauces may soon be observed to extend
itself along the continuous mucous membrane, and through the windpipe
into the cavity of the chest; and there it is hard to foretel what
ravages it may commit.
We need not therefore be surprised to hear the often reiterated query of
the convalescent in the words, “No me hara daño lavar y afeytarme?”—will
it not do me harm to shave and wash? Nor should we indulge in a smile
at his expense, as we see him gradually venture on the first degrees of
ablution, by rubbing over the hands and face with a cloth dipped in tepid
water sharpened with aguardiente, or the common spirits of the country.
XII.—_Morir en regla._ This expression, which means to die according to
rule, is one which all good Catholics are most solicitous to realize
for themselves and friends; and the custom it refers to is deemed of the
utmost importance in a religious and professional point of view.
When a physician visits a patient, and finds him in a doubtful or
critical state, he must never omit to warn the patient or his friends
of his real situation, with a view to enable them to call a medical
consultation, and allow time for testamentary preparations and spiritual
confession. The neglect of this precautionary measure would, in the event
of the disease terminating fatally, bring great blame on the physician;
but, after he has notified what he considers to be the patient’s real
condition, then, whether the parties interested in such communication
choose to act upon his advice or not, he has acquitted himself properly;
and when the patient, previously confessed and sacramented, dies with
the benefit of a consultation, or duly assisted by a medical junta, he is
said to die according to rule, that is, _morir en regla_.
The great medical juntas in Lima, by which we understand consultations
where more than four or five doctors are met together, are remarkable
occasions of oratorical display. The warmest discussion frequently turns
on the dose, composition, or medicinal operation of some common drug;
and all the learning, method, and criticism, sometimes discovered at
these solemn debates, terminate not unfrequently in the most simple
practice, by which the nurse is enjoined to have recourse to the jeringa,
and the patient told he must drink “agua de pollo,” or chicken-tea,
until the return of the junta. In former times such consultations were
called oftener than necessary, because a great junta became a sort of
ostentatious exhibition, in which all who could afford to cite a group
of doctors desired to imitate the great and the wealthy.
A sample, on a little scale, of such fashionable follies, is familiar
to the Limenian in the well-known local story of the two doctors,
who, for a month or more, daily met in consultation at the house of a
family in town, where, as they retired to the supposed privacy of a
consulting-room, the one would clear his throat, and ask the other,
“_Come el enfermo hoy?_”—May the patient eat to-day?—to which the second
doctor would reply, “_Como no? si, comera._”—Why not? yes, he shall eat.
Thus, day after day, began and ended the consultation, as far at least
as its topics of discussion concerned the patient; while the good old
doctors spun out a regular allowance of time before they rejoined the
patient, or his attendants, serenely to announce the well-matured result
of their conference. A man of _nous_, accustomed to listen behind the
scenes, at length broke in upon their consultation; and dismissed them
one day by paying to each his usual fee, and telling them both how happy
he was to find that he now knew as much as themselves, for that he could
repeat as well as anybody, “Come el enfermo hoy?—Como no? si, comera.”
A medical junta in Lima is commonly continued morning and evening, and
from day to day, till the patient is pronounced to be out of danger. As
the junta breaks up after each separate meeting, it is customary for
the president of the meeting, or one of the physicians, to say, as he
leaves his seat, “Vamos a consolar al enfermo,”—Let us go to console
the patient; and then all the doctors present re-enter the patient’s
apartment to soothe and to console him; and after this one of the number
steps forward to lay down the regimen—“a dar el regimen”—agreed upon in
consultation, and which one or more nurses and attendants are now ready
to receive from the mouth of the physician. After the formality of a
junta is thought no longer necessary, it often happens that, by wish of
the patient or his relatives, two or more of the medical advisers return
at separate hours, but by mutual agreement, for several days, by way
of further security to the sick, or as a source of satisfaction to his
family.
After all the care possible bestowed on the part of doctors, it often
happens that, when the patient recovers, San Antonio, or any other saint
after whom the individual is named, has all the credit of the cure; but,
when the case is unprosperous, then all the evil is ascribed to human
agency.
In Lima, as elsewhere, it will readily enough be admitted in general
terms that all must die; but regarding this proposition, when death
strikes any one in particular, difficulties at once suggest themselves;
for the surviving friends are ever ready to assign many reasons why they
are quite sure the deceased might have escaped, had it not been for this
or that physician that misunderstood his malady. Hence it may be said
that it is only in well-regulated juntas, and in public hospitals, that
the people of Lima are supposed to glide to their latter end by fair and
natural means. Upon this subject we heard it remarked by a sagacious
native, “Should a gambler lose at a cock-fight, he does not attribute the
loss to any fault in the cock, but to some trick done to him; if a horse
lose in a race, his owner never acknowledges the cause of the failure to
be in the animal, but assigns it to some accident thrown in his way: and
surely, when we know that on such comparatively trivial occasions men
thus talk and think, it is but natural for them, in an affair of such
moment and interest as life itself, never to believe that a friend or
relative loses his existence from any fault of his own, or any defect in
his organization, but rather that his demise should be charged, as we see
it is, though often unjustly, on the blind and stumbling ignorance, or
unpardonable carelessness and indifference of the physicians.”
One common consequence of this mode of thinking is, that, by a single
fatal case in practice, all the former success of the practitioner is
overlooked, at least for a time; from which it follows that various
medical advisers are sure to replace one another often in those families
where death is a frequent visitor.
We seldom meet in families that shyness or reserve in divulging bodily
ailments which can render them reluctant to change their family
physician; and no physician, though specially entrusted with a patient,
can be sure that others of the profession do not, at secret interviews,
tamper with his peculiar treatment. This baneful custom leads to
professional jealousies and mutual distrust. We believe many families
countenance it from motives of consideration for the doctor _ostensibly_
in trust, whose self-love they propose to spare by this clandestine
practice, when they think a more open manner of proceeding would be
repulsive to his feelings. There is, however, another very obvious reason
which lends its influence to this furtive system of visiting the sick;
and it is, that by this means the opinion of several advisers may be had
at comparatively little expense. Should only two individuals be called
to meet at the bedside of the patient at an appointed hour to consult
on his case, the meeting is a _bonâ fide_ junta, and each member of it
is entitled to his four or four and a half dollars; whereas the single
visits are only valued at one dollar each, and such detached visits
are in many instances not paid by the sick, but by the friends at whose
request the professional calls are made. Here then is great economy;
eight opinions (and if the patient be poor, so that he is only expected
to pay a half dollar fee for a detached visit, _sixteen opinions_) may be
procured for the standard price of two when given in consultation; and
custom, as well as reason and prudence, require that several opinions
should be taken in cases of hazard and difficulty.
Owing in a considerable degree to the comparative poverty of the present
times, medical juntas are by no means so frequent as they used to be;
but yet it is a common saying on serious occasions, where the assistance
of more than one medical adviser is thought necessary, that more is seen
by four eyes than by two.—“_Mas se ve con cuatro ojos que con dos._”
By multiplying skill according to this rule, a score of eyes may be
assembled in one junta to search into the patient’s obscure malady, so as
to point out the cause and the remedy; or, if there should be no other
alternative, let him die according to rule.