We come now to the third part of this inquiry, that is, to mention the
remedies for the evils which are brought on by the excessive use of
distilled spirits.
These remedies divide themselves into two kinds.
I. Such as are proper to cure a fit of drunkenness, and
II. Such as are proper to prevent its recurrence, and to destroy a
desire for ardent spirits.
I. I am aware that the efforts of science and humanity, in applying
their resources to the cure of a disease, induced by an act of vice,
will meet with a cold reception from many people. But let such people
remember, the subjects of our remedies, are their fellow creatures, and
that the miseries brought upon human nature, by its crimes, are as much
the objects of divine compassion (which we are bound to imitate), as the
distresses which are brought upon men, by the crimes of other people, or
which they bring upon themselves, by ignorance or accidents. Let us not
then, pass by the prostrate sufferer from strong drink, but administer
to him the same relief, we would afford to a fellow creature, in a
similar state, from an accidental, and innocent cause.
1. The first thing to be done to cure a fit of drunkenness, is to open
the collar, if in a man, and remove all tight ligatures from every other
part of the body. The head and shoulders should at the same time be
elevated, so as to favour a more feeble determination of the blood to
the brain.
2. The contents of the stomach should be discharged, by thrusting a
feather down the throat. It often restores the patient immediately to
his senses and feet. Should it fail of exciting a puking,
3. A napkin should be wrapped round the head, and wetted for an hour or
two with cold water, or cold water should be poured in a stream upon the
head. In the latter way, I have sometimes seen it used, when a boy, in
the city of Philadelphia. It was applied, by dragging the patient, when
found drunk in the street, to a pump, and pumping water upon his head
for ten or fifteen minutes. The patient generally rose, and walked off,
sober and sullen, after the use of this remedy.
Other remedies, less common, but not less effectual for a fit of
drunkenness, are,
4. Plunging the whole body into cold water. A number of gentlemen who
had drunken to intoxication, on board a ship in the stream, near Fell's
point, at Baltimore, in consequence of their reeling in a small boat, on
their way to the shore, in the evening, overset it, and fell into the
water. Several boats from the shore hurried to their relief. They were
all picked up, and went home, perfectly sober, to their families.
5. Terror. A number of young merchants, who had drunken together, in a
compting-house, on James river, above thirty years ago, until they were
intoxicated, were carried away by a sudden rise of the river, from
an immense fall of rain. They floated several miles with the current,
in their little cabin, half filled with water. An island in the river
arrested it. When they reached the shore that saved their lives, they
were all sober. It is probable terror assisted in the cure of the
persons who fell into the water at Baltimore.
6. The excitement of a fit of anger. The late Dr. Witherspoon used to
tell a story of a man in Scotland, who was always cured of a fit of
drunkenness, by being made angry. The means chosen for that purpose, was
a singular one. It was talking against religion.
7. A severe whipping. This remedy acts by exciting a revulsion of the
blood from the brain, to the external parts of the body.
8. Profuse sweats. By means of this evacuation, nature sometimes cures
a fit of drunkenness. Their good effects are obvious in labourers, whom
quarts of spirits taken in a day, will seldom intoxicate, while they
sweat freely. If the patient be unable to swallow warm drinks, in order
to produce sweats, they may be excited by putting him in a warm bath,
or wrapping his body in blankets, under which should be placed half a
dozen hot bricks, or bottles filled with hot water.
9. Bleeding. This remedy should always be used, when the former ones
have been prescribed to no purpose, or where there is reason to fear
from the long duration of the disease, a material injury may be done to
the brain.
It is hardly necessary to add, that each of the above remedies, should
be regulated by the grade of drunkenness, and the greater or less
degree, in which the intellects are affected in it.
II. The remedies which are proper to prevent the recurrence of fits
of drunkenness, and to destroy the desire for ardent spirits, are
religious, metaphysical, and medical. I shall briefly mention them.
1. Many hundred drunkards have been cured of their desire for ardent
spirits, by a practical belief in the doctrines of the christian
religion. Examples of the divine efficacy of christianity for this
purpose, have lately occurred in many parts of the United States.
2. A sudden sense of the guilt contracted by drunkenness, and of
its punishment in a future world. It once cured a gentleman in
Philadelphia, who, in a fit of drunkenness, attempted to murder a wife
whom he loved. Upon being told of it when he was sober, he was so struck
with the enormity of the crime he had nearly committed, that he never
tasted spiritous liquors afterwards.
3. A sudden sense of shame. Of the efficacy of this deep seated
principle in the human bosom, in curing drunkenness, I shall relate
three remarkable instances.
A farmer in England, who had been many years in the practice of coming
home intoxicated, from a market town, one day observed appearances of
rain, while he was in market. His hay was cut, and ready to be housed.
To save it, he returned in haste to his farm, before he had taken his
customary dose of grog. Upon coming into his house, one of his children,
a boy of six years old, ran to his mother, and cried out, "O, mother!
father is come home, and he is not drunk." The father, who heard this
exclamation, was so severely rebuked by it, that he suddenly became a
sober man.
A noted drunkard was once followed by a favourite goat, to a tavern,
into which he was invited by his master, and drenched with some of his
liquor. The poor animal staggered home with his master, a good deal
intoxicated. The next day he followed him to his accustomed tavern.
When the goat came to the door, he paused: his master made signs to
him to follow him into the house. The goat stood still. An attempt was
made to thrust him into the tavern. He resisted, as if struck with
the recollection of what he suffered from being intoxicated the night
before. His master was so much affected by a sense of shame in observing
the conduct of his goat to be so much more rational than his own, that
he ceased from that time to drink spiritous liquors.
A gentleman, in one of the southern states, who had nearly destroyed
himself by strong drink, was remarkable for exhibiting the grossest
marks of folly in his fits of intoxication. One evening, sitting in his
parlour, he heard an uncommon noise in his kitchen. He went to the door,
and peeped through the key hole, from whence he saw one of his negroes
diverting his fellow servants, by mimicking his master's gestures and
conversation when he was drunk. The sight overwhelmed him with shame and
distress, and instantly became the means of his reformation.
4. The association of the idea of ardent spirits, with a painful or
disagreeable impression upon some part of the body, has sometimes cured
the love of strong drink. I once tempted a negro man, who was habitually
fond of ardent spirits, to drink some rum (which I placed in his way),
and in which I had put a few grains of tartar emetic. The tartar
sickened and puked him to such a degree, that he supposed himself to be
poisoned. I was much gratified by observing he could not bear the sight,
nor smell of spirits, for two years afterwards.
I have heard of a man, who was cured of the love of spirits, by
working off a puke, by large draughts of brandy and water, and I know
a gentleman, who in consequence of being affected with a rheumatism,
immediately after drinking some toddy, when overcome with fatigue and
exposure to the rain, has ever since loathed that liquor, only because
it was accidentally associated in his memory with the recollection of
the pain he suffered from his disease.
This appeal to that operation of the human mind, which obliges it to
associate ideas, accidentally or otherwise combined, for the cure of
vice, is very ancient. It was resorted to by Moses, when he compelled
the children of Israel to drink the solution of the golden calf (which
they had idolized) in water. This solution, if made, as it most
probably was, by means of what is called hepar sulphuris, was extremely
bitter, and nauseous, and could never be recollected afterwards, without
bringing into equal detestation, the sin which subjected them to the
necessity of drinking it. Our knowledge of this principle of association
upon the minds and conduct of men, should lead us to destroy, by means
of other impressions, the influence of all those circumstances, with
which the recollection and desire of spirits are combined. Some men
drink only in the _morning_, some at _noon_, and some only at _night_.
Some men drink only on a _market day_, some at _one_ tavern only, and
some only in _one kind_ of company. Now by finding a new and interesting
employment, or subject of conversation for drunkards at the usual times
in which they have been accustomed to drink, and by restraining them
by the same means from those places and companions, which suggested
to them the idea of ardent spirits, their habits of intemperance
may be completely destroyed. In the same way the periodical returns
of appetite, and a desire of sleep have been destroyed in a hundred
instances. The desire for strong drink differs from each of them, in
being of an artificial nature, and therefore not disposed to return,
after being chased for a few weeks from the system.
5. The love of ardent spirits has sometimes been subdued, by exciting
a counter passion in the mind. A citizen of Philadelphia had made many
unsuccessful attempts to cure his wife of drunkenness. At length,
despairing of her reformation, he purchased a hogshead of rum, and,
after tapping it, left the key in the door of the room in which it was
placed, as if he had forgotten it. His design was to give his wife an
opportunity of drinking herself to death. She suspected this to be his
motive, in what he had done, and suddenly left off drinking. Resentment
here became the antidote to intemperance.
6. A diet consisting wholly of vegetables cured a physician in Maryland,
of drunkenness, probably by lessening that thirst, which is always more
or less excited by animal food.
7. Blisters to the ankles, which were followed by an unusual degree of
inflammation, once suspended the love of ardent spirits, for one month,
in a lady in this city. The degrees of her intemperance may be conceived
of, when I add, that her grocer's account for brandy alone amounted,
annually, to one hundred pounds, Pennsylvania currency, for several
years.
8. A violent attack of an acute disease, has sometimes destroyed a habit
of drinking distilled liquors. I attended a notorious drunkard, in the
yellow fever, in the year 1798, who recovered with the loss of his
relish for spirits, which has, I believe, continued ever since.
9. A salivation has lately performed a cure of drunkenness, in a person
of Virginia. The new disease excited in the mouth and throat, while
it rendered the action of the smallest quantity of spirits upon them
painful, was happily calculated to destroy the disease in the stomach
which prompts to drinking, as well as to render the recollection of them
disagreeable, by the laws of association formerly mentioned.
10. I have known an oath, taken before a magistrate, to drink no more
spirits, produce a perfect cure of drunkenness. It is sometimes cured in
this way in Ireland. Persons who take oaths for this purpose are called
affidavit men.
11. An advantage would probably arise from frequent representations
being made to drunkards, not only of the certainty, but of the
_suddenness_ of death, from habits of intemperance. I have heard of
two persons being cured of the love of ardent spirits, by seeing
death suddenly induced by fits of intoxication; in the one case, in a
stranger, and in the other, in an intimate friend.
12. It has been said, that the disuse of spirits should be gradual, but
my observations authorize me to say, that persons who have been addicted
to them, should abstain from them _suddenly_, and _entirely_. "Taste
not, handle not, touch not," should be inscribed upon every vessel that
contains spirits, in the house of a man who wishes to be cured of habits
of intemperance. To obviate, for a while, the debility which arises
from the sudden abstraction of the stimulus of spirits, laudanum, or
bitters infused in water, should be taken, and perhaps a larger quantity
of beer or wine, that is consistent with the strict rules of temperate
living. By the temporary use of these substitutes for spirits, I have
never known the transition to sober habits to be attended with any bad
effects, but often with permanent health of body, and peace of mind.
OBSERVATIONS
ON THE
_DUTIES OF A PHYSICIAN_,
AND THE METHODS OF
IMPROVING MEDICINE.
ACCOMMODATED TO THE PRESENT STATE OF SOCIETY
AND MANNERS IN THE UNITED STATES.
Delivered in the University of Pennsylvania, February 7, 1789, at the
conclusion of a course of lectures upon chemistry and the practice of
physic.
_PUBLISHED AT THE REQUEST OF THE CLASS._
GENTLEMEN,
I Shall conclude our course of lectures, by delivering to you a few
directions for the regulation of your future conduct and studies, in the
line of your profession.
I shall, _first_, suggest the most probable means of establishing
yourselves in business, and of becoming acceptable to your patients, and
respectable in life.
_Secondly_, I shall mention a few thoughts which have occurred to me on
the mode to be pursued, in the further prosecution of your studies, and
for the improvement of medicine.
I. Permit me, in the first place, to recommend to such of you as intend
to settle in the country, to establish yourselves as early as possible
upon _farms_. My reasons for this advice are as follow:
1. It will reconcile the country people to the liberality and dignity
of your profession, by showing them that you assume no superiority over
them from your education, and that you intend to share with them in
those toils, which were imposed upon man in consequence of the loss of
his innocence. This will prevent envy, and render you acceptable to your
patients as men, as well as physicians.
2. By living on a farm you may serve your country, by promoting
improvements in agriculture. Chemistry (which is now an important branch
of a medical education) and agriculture are closely allied to each
other. Hence some of the most useful books upon agriculture have been
written by physicians. Witness the essays of Dr. Home of Edinburgh, and
of Dr. Hunter of Yorkshire, in England.
3. The business of a farm will furnish you with employment in the
healthy seasons of the year, and thereby deliver you from the tædium
vitæ, or what is worse, from retreating to low or improper company.
Perhaps one cause of the prevalence of dram or grog drinking, with which
country practitioners are sometimes charged, is owing to their having no
regular or profitable business to employ them, in the intervals of their
attendance upon their patients.
4. The resources of a farm will create such an independence as will
enable you to practice with more dignity, and at the same time screen
you from the trouble of performing unnecessary services to your
patients. It will change the nature of the obligation between you and
them. While _money_ is the only means of your subsistence, your patients
will feel that they are the channels of your daily bread; but while your
farm furnishes you with the necessaries of life, your patients will feel
more sensibly, that the obligation is on their side, for health and life.
5. The exigencies and wants of a farm in _stock_ and _labour_ of all
kinds, will enable you to obtain from your patients a compensation for
your services in those articles. They all possess them, and men part
with that of which money is only the sign, much more readily than they
do with money itself.
6. The resources of a farm will prevent your cherishing, for a moment,
an impious wish for the prevalence of sickness in your neighbourhood.
A healthy season will enable you to add to the produce of your farm,
while the rewards of an unhealthy season will enable you to repair the
inconvenience of your necessary absence from it. By these means your
pursuits will be marked by that _variety_ and _integrity_, in which true
happiness is said to consist.
7. Let your farms be small, and let your _principal_ attention be
directed to grass and horticulture. These afford most amusement, require
only moderate labour, and will interfere least with your duties to your
profession.
II. Avoid singularities of every kind in your manners, dress,
and general conduct. Sir Isaac Newton, it is said, could not be
distinguished in company, by any peculiarity, from a common well-bred
gentleman. Singularity in any thing, is a substitute for such great or
useful qualities as command respect; and hence we find it chiefly in
little minds. The profane and indelicate combination of extravagant
ideas, improperly called wit, and the formal and pompous manner, whether
accompanied by a wig, a cane, or a ring, should be all avoided, as
incompatible with the simplicity of science, and the real dignity of
physic. There is more than one way of playing the quack. It is not
necessary, for this purpose, that a man should advertise his skill, or
his cures, or that he should mount a phaeton and display his dexterity
in operating, to an ignorant and gaping multitude. A physician acts the
same part in a different way, who assumes the character of a madman or
a brute in his manners, or who conceals his fallibility by an affected
gravity and taciturnity in his intercourse with his patients. Both
characters, like the quack, impose upon the public. It is true, they
deceive different ranks of people; but we must remember that there
are two kinds of vulgar, viz. the rich and the poor; and that the
rich vulgar are often upon a footing with the poor, in ignorance and
credulity.
III. It has been objected to our profession, that many eminent
physicians have been unfriendly to christianity. If this be true, I
cannot help ascribing it in part to that neglect of public worship
with which the duties of our profession are often incompatible; for
it has been justly observed, that the neglect of this religious and
social duty, generally produces a relaxation, either in principles or
morals. Let this fact lead you, in setting out in business, to acquire
such habits of punctuality in visiting your patients, as shall not
interfere with acts of public homage to the Supreme Being. Dr. Gregory
has observed, that a cold heart is the most frequent cause of deism.
Where this occurs in a physician, it affords a presumption that he is
deficient in humanity. But I cannot admit that infidelity is peculiar
to our profession. On the contrary, I believe christianity places among
its friends more men of extensive abilities and learning in medicine,
than in any other secular employment. Stahl, Hoffman, Boerhaave,
Sydenham, Haller, and Fothergill, were all christians. These enlightened
physicians were considered as the ornaments of the ages in which
they lived, and posterity has justly ranked them among the greatest
benefactors of mankind.
IV. Permit me to recommend to you a regard to all the interests of your
country. The education of a physician gives him a peculiar insight in
the principles of many useful arts, and the practice of physic favours
his opportunities of doing good, by diffusing knowledge of all kinds. It
was in Rome, when medicine was practised only by slaves, that physicians
were condemned by their profession "mutam exercere artem." But in modern
times, and in free governments, they should disdain an ignoble silence
upon public subjects. The American revolution has rescued physic from
its former slavish rank in society. For the honour of our profession
it should be recorded, that some of the most intelligent and useful
characters, both in the cabinet and the field, during the late war,
have been physicians. The illustrious Dr. Fothergill opposed faction
and tyranny, and took the lead in all public improvements in his
native country, without suffering thereby the least diminution of that
reputation, or business, in which, for forty years, he flourished almost
without a rival in the city of London.
V. Let me advise you, in your visits to the sick, _never_ to appear in
a hurry, nor to talk of indifferent matters before you have made the
necessary inquiries into the symptoms of your patient's disease.
VI. Avoid making light of any case. "Respice finem" should be the motto
of every indisposition. There is scarcely a disease so trifling, that
has not, directly or indirectly, proved an outlet to human life. This
consideration should make you anxious and punctual in your attendance
upon every acute disease, and keep you from risking your reputation by
an improper or hasty prognosis.
VII. Do not condemn, or oppose, unnecessarily, the simple prescriptions
of your patients. Yield to them in matters of little consequence, but
maintain an inflexible authority over them in matters that are essential
to life.
VIII. Preserve, upon all occasions, a composed or cheerful countenance
in the room of your patients, and inspire as much hope of a recovery
as you can, consistent with truth, especially in acute diseases. The
extent of the influence of the will over the human body, has not yet
been fully ascertained. I reject the futile pretensions of Mr. Mesmer to
the cure of diseases, by what he has absurdly called animal magnetism.
But I am willing to derive the same advantages from his deceptions,
which the chemists have derived from the delusions of the alchemists.
The facts which he has established, clearly prove the influence of
the imagination, and will, upon diseases. Let us avail ourselves of
the handle which those faculties of the mind present to us, in the
strife between life and death. I have frequently prescribed remedies of
doubtful efficacy in the critical stage of acute diseases, but never
till I had worked up my patients into a confidence, bordering upon
certainty, of their probable good effects. The success of this measure
has much oftener answered, than disappointed my expectations; and while
my patients have commended the vomit, the purge, or the blister which
was prescribed, I have been disposed to attribute their recovery to the
vigorous concurrence of the _will_ in the action of the medicine. Does
the will beget insensibility to cold, heat, hunger, and danger? Does
it suspend pain, and raise the body above feeling the pangs of Indian
tortures? Let us not then be surprised that it should enable the system
to resolve a spasm, to open an obstruction, or to discharge an offending
humour. I have only time to hint at this subject. Perhaps it would lead
us, if we could trace it fully, to some very important discoveries in
the cure of diseases.
IX. Permit me to advise you in your intercourse with your patients,
to attend to that principle in the human mind, which constitutes the
association of ideas. A chamber, a chair, a curtain, or even a cup, all
belong to the means of life or death, accordingly as they are associated
with cheerful or distressing ideas, in the mind of a patient. But this
principle is of more immediate application in those chronic diseases
which affect the mind. Nothing can be accomplished here, till we produce
a new association of ideas. For this purpose a change of place and
company are absolutely necessary. But we must sometimes proceed much
further. I have heard of a gentleman in South-Carolina who cured his
fits of low spirits by changing his clothes. The remedy was a rational
one. It produced at once a new train of ideas, and thus removed the
paroxysm of his disease.
X. Make it a rule never to be angry at any thing a sick man says or does
to you. Sickness often adds to the natural irritability of the temper.
We are, therefore, to bear the reproaches of our patients with meekness
and silence. It is folly to resent injuries at any time, but it is
cowardice to resent an injury from a sick man, since, from his weakness
and dependence upon us, he is unable to contend with us upon equal
terms. You will find it difficult to attach your patients to you by the
obligations of friendship or gratitude. You will sometimes have the
mortification of being deserted by those patients who owe most to your
skill and humanity. This led Dr. Turner to advise physicians never to
chuse their friends from among their patients. But this advice can never
be followed by a heart that has been taught to love true excellency,
wherever it finds it. I would rather advise you to give the benevolent
feelings of your hearts full scope, and to forget the unkind returns
they will often meet with, by giving to human nature----a tear.
XI. Avoid giving a patient over in an acute disease. It is impossible
to tell in such cases where life ends, and where death begins. Hundreds
of patients have recovered, who have been pronounced incurable, to the
great disgrace of our profession. I know that the practice of predicting
danger and death upon every occasion, is sometimes made use of by
physicians, in order to enhance the credit of their prescriptions if
their patients recover, and to secure a retreat from blame, if they
should die. But this mode of acting is mean and illiberal. It is not
necessary that we should decide with confidence at any time, upon the
issue of a disease.
XII. A physician in sickness is always a welcome visitor in a family;
hence he is often solicited to partake of the usual sign of hospitality
in this country, by taking a draught of some strong liquor, every time
he enters into the house of a patient. Let me charge you to lay an
early restraint upon yourselves, by refusing to yield to this practice,
especially in the _forenoon_. Many physicians have been innocently led
by it into habits of drunkenness. You will be in the more danger of
falling into this vice, from the great fatigue and inclemency of the
weather to which you will be exposed in country practice. But you have
been taught that strong drink affords only a temporary relief from those
evils, and that it afterwards renders the body more sensible of them.
XIII. I shall now give some directions with respect to the method of
charging for your services to your patients.
When we consider the expence of a medical education, and the sacrifices
a physician is obliged to make of ease, society, and even health, to
his profession; and when we add to these, the constant and painful
anxiety which is connected with the important charge of the lives of our
fellow-creatures, and above all, the inestimable value of that blessing
which is the object of his services, I hardly know how it is possible
for a patient sufficiently and justly to reward his physician. But when
we consider, on the other hand, that sickness deprives men of the means
of acquiring money; that it increases all the expenses of living; and
that high charges often drive patients from regular-bred physicians to
quacks; I say, when we attend to these considerations, we should make
our charges as moderate as possible, and conform them to the following
state of things.
Avoid measuring your services to your patients by scruples, drachms, and
ounces. It is an illiberal mode of charging. On the contrary, let the
number and _time_ of your visits, the nature of your patient's disease,
and his rank in his family or society, determine the figures in your
accounts. It is certainly just to charge more for curing an apoplexy,
than an intermitting fever. It is equally just, to demand more for
risking your life by visiting a patient in a contagious fever, than
for curing a pleurisy. You have likewise a right to be paid for your
anxiety. Charge the same services, therefore, higher, to the master or
mistress of a family, or to an only son or daughter, who call forth
all your feelings and industry, than to less important members of a
family and of society. If a rich man demand more frequent visits than
are necessary, and if he impose the restraints of keeping to hours, by
calling in other physicians to consult with you upon every trifling
occasion, it will be just to make him pay accordingly for it. As this
mode of charging is strictly agreeable to reason and equity, it seldom
fails of according with the reason and sense of equity of our patients.
Accounts made out upon these principles, are seldom complained of by
them. I shall only remark further upon this subject, that the sooner
you send in your accounts after your patients recover, the better. It
is the duty of a physician to inform his patient of the amount of his
obligation to him at least _once_ a year. But there are times when a
departure from this rule may be necessary. An unexpected misfortune in
business, and a variety of other accidents, may deprive a patient of the
money he had allotted to pay his physician. In this case, delicacy and
humanity require, that he should not know the amount of his debt to his
physician, till time had bettered his circumstances.
I shall only add, under this head, that the poor of every description
should be the objects of your peculiar care. Dr. Boerhaave used to say,
"they were his best patients, because God was their paymaster." The
first physicians that I have known, have found the poor the steps by
which they have ascended to business and reputation. Diseases among the
lower class of people are generally simple, and exhibit to a physician
the best cases of all epidemics, which cannot fail of adding to his
ability of curing the complicated diseases of the rich and intemperate.
There is an inseparable connection between a man's duty and his
interest. Whenever you are called, therefore, to visit a poor patient,
imagine you hear the voice of the good Samaritan sounding in your ears,
"Take care of him, and I will repay thee."
I come now to the second part of this address, which was to point out
the best mode to be pursued, in the further prosecution of your studies,
and the improvement of medicine.
I. Give me leave to recommend to you, to open all the dead bodies you
can, without doing violence to the feelings of your patients, or the
prejudices of the common people. Preserve a register of the weather,
and of its influence upon the vegetable productions of the year. Above
all, record the epidemics of every season; their times of appearing and
disappearing, and the connection of the weather with each of them. Such
records, if published, will be useful to foreigners, and a treasure
to posterity. Preserve, likewise, an account of chronic cases. Record
the name, age, and occupation of your patient; describe his disease
accurately, and the changes produced in it by your remedies; mention
the doses of every medicine you administer to him. It is impossible to
tell how much improvement and facility in practice you will find from
following these directions. It has been remarked, that physicians seldom
remember more than the two or three last years of their practice.
The records which have been mentioned, will supply this deficiency of
memory, especially in that advanced stage of life when the advice of
physicians is supposed to be most valuable.
II. Permit me to recommend to you further, the study of the anatomy (if
I may be allowed the expression) of the human mind, commonly called
metaphysics. The reciprocal influence of the body and mind upon each
other, can only be ascertained by an accurate knowledge of the faculties
of the mind, and of their various modes of combination and action. It is
the duty of physicians to assert their prerogative, and to rescue the
mental science from the usurpations of schoolmen and divines. It can
only be perfected by the aid and discoveries of medicine. The authors I
would recommend to you upon metaphysics, are, Butler, Locke, Hartley,
Reid, and Beattie. These ingenious writers have cleared this sublime
science of its technical rubbish, and rendered it both intelligible and
useful.
III. Let me remind you, that improvement in medicine is not to be
derived only from colleges and universities. Systems of physic are
the productions of men of genius and learning; but those facts which
constitute real knowledge, are to be met with in every walk of life.
Remember how many of our most useful remedies have been discovered by
quacks. Do not be afraid, therefore, of conversing with them, and of
profiting by their ignorance and temerity in the practice of physic.
Medicine has its Pharisees, as well as religion. But the spirit of
this sect is as unfriendly to the advancement of medicine, as it is to
christian charity. By conversing with quacks, we may convey instruction
to them, and thereby lessen the mischief they might otherwise do to
society. But further. In the pursuit of medical knowledge, let me advise
you to converse with nurses and old women. They will often suggest
facts in the history and cure of diseases, which have escaped the most
sagacious observers of nature. Even negroes and Indians have sometimes
stumbled upon discoveries in medicine. Be not ashamed to inquire into
them. There is yet one more means of information in medicine which
should not be neglected, and that is, to converse with persons who have
recovered from indispositions without the aid of physicians. Examine the
strength and exertions of nature in these cases, and mark the plain and
home-made remedy to which they ascribe their recovery. I have found this
to be a fruitful source of instruction, and have been led to conclude,
that if every man in a city, or a district, could be called upon to
relate to persons appointed to receive and publish his narrative, an
exact account of the effects of those remedies which accident or whim
has suggested to him, it would furnish a very useful book in medicine.
To preserve the facts thus obtained, let me advise you to record them
in a book to be kept for that purpose. There is one more advantage that
will probably attend the inquiries that have been mentioned: you may
discover diseases, or symptoms of diseases, or even laws of the animal
economy, which have no place in our systems of nosology, or in our
theories of physic.
IV. Study simplicity in the preparation of your medicines. My reasons
for this advice are as follow:
1. Active medicines produce the most certain effects in a simple state.
2. Medicines when mixed frequently destroy the efficacy of each other.
I do not include chemical medicines alone in this remark. It applies
likewise to Galenical medicines. I do not say, that all these medicines
are impaired by mixture, but we can only determine when they are not, by
actual experiments and observations.
3. When medicines of the same class, or even of different classes, are
given together, the _strongest_ only produces an effect. But what are
we to say to a compound of two medicines which give exactly the same
impression to the system? Probably, if we are to judge from analogy, the
effect of them will be such as would have been produced by neither, in a
simple state.
4. By observing simplicity in your prescriptions, you will always have
the command of a greater number of medicines of the _same_ class, which
may be used in succession to each other, in proportion as habit renders
the system insensible of their action.
5. By using medicines in a simple state you will obtain an exact
knowledge of their virtues and doses, and thereby be able to decide upon
the numerous and contradictory accounts which exist in our books, of the
character of the _same_ medicines.
Under this head, I cannot help adding two more directions.
1. Avoid sacrificing too much to the _taste_ of your patients in the
preparation of your medicines. The nature of a medicine may be wholly
changed by being mixed with sweet substances. The Author of Nature
seems to have had a design, in rendering medicines unpalatable. Had they
been more agreeable to the taste, they would probably have yielded long
ago to the unbounded appetite of man, and by becoming articles of diet,
or condiments, have lost their efficacy in diseases.
2. Give as few medicines as possible in tinctures made with distilled
spirits. Perhaps there are few cases in which it is safe to exhibit
medicines prepared in spirits, in any other form than in _drops_. Many
people have been innocently seduced into a love of strong drink, from
taking large or frequent doses of bitters, infused in spirits. Let not
our profession be reproached in a single instance, with adding to the
calamities that have been entailed upon mankind by this dreadful species
of intemperance.
V. Let me recommend to your particular attention, the indigenous
medicines of our country. Cultivate or prepare as many of them as
possible, and endeavour to enlarge the materia medica, by exploring the
untrodden fields and forests of the United States. The ipecacuanha,
the Seneka and Virginia snake-roots, the Carolina pink-root, the
spice-wood, the sassafras, the butter-nut, the thoroughwort, the poke,
and the stramonium, are but a small part of the medicinal productions
of America. I have no doubt but there are many hundred other plants
which now exhale invaluable medicinal virtues in the desert air.
Examine, likewise, the mineral waters, which are so various in their
impregnation, and so common in all parts of our country. Let not the
properties of the insects of America escape your investigation. We have
already discovered among some of them, a fly equal in its blistering
qualities to the famous fly of Spain. Who knows but it may be reserved
for America to furnish the world, from her productions, with cures for
some of those diseases which now elude the power of medicine? Who knows
but that, at the foot of the Allegany mountain, there blooms a flower
that is an infallible cure for the epilepsy? Perhaps on the Monongahela,
or the Potomac, there may grow a root that shall supply, by its tonic
powers, the invigorating effects of the savage or military life in the
cure of consumptions. Human misery of every kind is evidently on the
decline. Happiness, like truth, is a unit. While the world, from the
progress of intellectual, moral, and political truth, is becoming a more
safe and agreeable abode for man, the votaries of medicine should not
be idle. All the doors and windows of the temple of nature have been
thrown open by the convulsions of the late American revolution. This
is the time, therefore, to press upon her altars. We have already drawn
from them discoveries in morals, philosophy, and government; all of
which have human happiness for their object. Let us preserve the unity
of truth and happiness, by drawing from the same source, in the present
critical moment, a knowledge of antidotes to those diseases which are
supposed to be incurable.
I have now, gentlemen, only to thank you for the attention with which
you have honoured the course of lectures which has been delivered to
you, and to assure you, that I shall be happy in rendering you all the
services that lie in my power, in any way you are pleased to command
me. Accept of my best wishes for your happiness, and may the blessings
of hundreds and thousands that were ready to perish, be your portion in
life, your comfort in death, and your reward in the world to come.
AN
INQUIRY INTO THE CAUSE AND CURE
OF
_SORE LEGS_.
However trifling these complaints may appear, they compose a large
class of the diseases of a numerous body of people. Hitherto, the
persons afflicted by them have been too generally abandoned to the care
of empirics, either because the disease was considered as beneath the
notice of physicians, or because they were unable to cure it. I would
rather ascribe it to the latter, than to the former cause, for pride has
no natural fellowship with the profession of medicine.
The difficulty of curing sore legs has been confessed by physicians in
every country. As far as my observations have extended, I am disposed
to ascribe this difficulty to the uniform and indiscriminate mode of
treating them, occasioned by the want of a theory which shall explain
their proximate cause. I shall attempt in a few pages to deliver one,
which, however imperfect, will, I hope, lay a foundation for more
successful inquiries upon this subject hereafter.
I shall begin my observations upon this disease, by delivering and
supporting the following propositions.
I. SORE LEGS are induced by general debility. This I infer from the
occupations and habits of the persons who are most subject to them. They
are day-labourers, and sailors, who are in the habit of lifting great
weights; also washer-women, and all other persons, who pass the greatest
part of their time upon their feet. The blood-vessels and muscular
fibres of the legs are thus overstretched, by which means either a
rupture, or such a languid action in the vessels is induced, as that
an accidental wound from any cause, even from the scratch of a pin, or
the bite of a mosquito, will not easily heal. But labourers, sailors,
and washer-women are not the only persons who are afflicted with sore
legs. Hard drinkers of every rank and description are likewise subject
to them. Where strong drink, labour, and standing long on the feet are
united, they more certainly dispose to sore legs, than when they act
separately. In China, where the labour which is performed by brutes
in other countries, is performed by men, varices on the legs are very
common among the labouring people. Perhaps, the reason why the debility
is induced in the legs produces varices instead of ulcers in these
people, may be owing to their not adding the debilitating stimulus of
strong drink to that of excessive labour.
It is not extraordinary that the debility produced by intemperance in
drinking ardent spirits, should appear first in the lower extremities.
The debility produced by intemperance in the use of wine, makes its
first appearance in the form of gout, in the same part of the body.
The gout, it is true, discovers itself most frequently in pain only,
but there are cases in which it has terminated in ulcers, and even
mortification on the legs.
II. Sore legs are connected with a morbid state of the whole system.
This I infer,
1. From the causes which induce them, all of which act more or less upon
every part of the body.
2. From their following or preceding diseases, which obviously belong
to the whole system. Fevers and dysenteries often terminate critically
in this disease; and the pulmonary consumption and apoplexy have often
been preceded by the suppression of a habitual discharge from a sore
leg. The two latter diseases have been ascribed to the translation of
a morbific matter to the lungs or brain: but it is more rational to
ascribe them to a previous debility in those organs, by which means
their vessels were more easily excited into action and effusion by the
stimulus of the plethora, induced upon the system in consequence of the
confinement of the fluids formerly discharged from the leg in the form
of pus. This plethora can do harm only where there is previous debility;
for I maintain that the system (when the solids are exactly toned)
will always relieve itself of a sudden preternatural accumulation of
fluids by means of some natural emunctory. This has been often observed
in the menorrhagia, which accompanies plentiful living in women, and
in the copious discharges from the bowels and kidneys, which follow a
suppression of the perspiration.
3. I infer it, from their appearing almost universally in one disease,
which is evidently a disease of the whole system, viz. the scurvy.
4. From their becoming in some cases the outlets of menstrual blood,
which is discharged in consequence of a plethora, which affects more or
less every part of the female system.
5. I infer it from the _symptoms_ of sore legs, which are in some
cases febrile, and affect the pulse in every part of the body with
preternatural frequency or force. These symptoms were witnessed, in
an eminent degree, in two of the patients who furnished subjects for
clinical remarks in the Pennsylvania hospital some years ago.
6. I infer that sore legs are a disease of the whole system, from the
manner in which they are sometimes cured by nature and art. They often
prove the outlets of many general diseases, and all the remedies which
cure them, act more or less upon the whole system.
In all cases of sore legs there is a tonic and atonic state of the whole
system. The same state of excessive or weak morbid action takes place in
the parts which are affected by the sores. The remedies to cure them,
therefore, should be _general_ and _local_.
In cases where the arterial system is affected by too much tone, the
general remedies should be,
I. BLOOD-LETTING. Of the efficacy of this remedy in disposing ulcers
suddenly to heal, the two clinical patients before-mentioned exhibited
remarkable proofs, in the presence of all the students of medicine in
the university. The blood drawn was sizy in both cases. I have not the
merit of having introduced this remedy into practice in the cure of
ulcers. I learned it from Sir John Pringle. I have known it to be used
with equal success in a sore breast, attended by pain and inflammation,
after all the usual remedies in that disease had been used to no purpose.
II. GENTLE PURGES.
III. NITRE. From fifteen to twenty grains of this medicine should be
given three times a-day.
IV. A TEMPERATE DIET, and a total abstinence from fermented and
distilled liquors.
V. COOL and PURE AIR.
VI. Rest in a recumbent posture of the body.
The _local_ remedies in this state of the system should be,
I. Cold water. Dr. Rigby has written largely in favour of this remedy
when applied to local inflammations. From its good effects in allaying
the inflammation which sometimes follows the puncture which is made in
the arm in communicating the small-pox, and from the sudden relief it
affords in the inflammatory state of the ophthalmia and in the piles, no
one can doubt of its efficacy in sore legs, accompanied by inflammation
in those vessels, which are the immediate seat of the disease.
II. Soft poultices of bread and milk, or of bread moistened with lead
water. Dr. Underwood's method of making a poultice of bread and milk
should be preferred in this case. He directs us first to boil the milk,
then to powder the bread, and throw it into the milk, and after they
have been intimately mixed, by being well stirred and boiled together,
they should be poured out and spread upon a rag, and a knife dipped in
sweet oil or lard, should be run over them. The solidity and consistence
of the poultice is hereby better preserved, than when the oil or lard is
mixed with the bread and milk over the fire.
III. When the inflammation subsides, adhesive plasters so applied as to
draw the sound edges of the sores together. This remedy has been used
with great success by Dr. Physick, in the Pennsylvania hospital, and in
his private practice.
IV. Above all, rest, and a horizontal posture of the leg. Too much
cannot be said in favour of this remedy in this species of sore legs.
Nannoni, the famous Italian surgeon, sums up the cure of sore legs in
three words, viz. "Tempo, riposo, e pazienza;" that is, in time, rest,
and patience. A friend of mine, who was cured by this surgeon of a sore
leg, many years ago, informed me, that he confined him to his bed during
the greatest part of the time that he was under his care.
In sore legs, attended by too little general and local action, the
following remedies are proper.
I. BARK. It should be used plentifully, but with a constant reference
to the state of the system; for the changes in the weather, and other
accidental circumstances, often produce such changes in the system, as
to render its disuse for a short time frequently necessary.
II. MERCURY. This remedy has been supposed to act by altering the
fluids, or by discharging a morbid matter from them, in curing sore
legs. But this is by no means the case. It appears to act as a
universal stimulant; and if it prove most useful when it excites a
salivation, it is only because in this way it excites the most general
action in the system.
III. MINERAL TONICS, such as the different preparations of iron, copper,
and zinc.
IV. GENTLE EXERCISE. Rest, and a recumbent posture of the body, so
proper in the tonic, are both hurtful in this species of sore legs. The
efficacy of exercise, even of the active kind, in the cure of sore legs,
accompanied by deficient action in the vessels, may easily be conceived
from its good effects after gun-shot wounds which are mentioned by Dr.
Jackson[65]. He tells us, that those British soldiers who had been
wounded at the battle of Guilford, in North-Carolina, who were turned
out of the military hospitals and followed the army, soonest recovered
of their wounds. It was remarkable, that if they delayed only a few days
on the road, their wounds grew worse, or ceased to heal.
[65] Medical Journal, 1790.
In the use of the different species of exercise, the same regard should
be had to the state of the system, which has been recommended in other
diseases.
V. A nutritious and moderately stimulating diet, consisting of milk,
saccharine vegetables, animal food, malt liquors, and wine.
Wort has done great service in sore legs. The manner in which I have
directed it to be prepared and taken is as follows: To three or four
heaped table-spoonsful of the malt, finely powdered and sifted, add two
table-spoonsful of brown sugar, and three or four of Madeira, sherry,
or Lisbon wine, and a quart of boiling water. After they have stood a
few hours, it may be drunken liberally by the patient, stirring it each
time before he takes it, so that the whole substance of the malt may
be conveyed into the stomach. A little lime-juice may be added, if the
patient requires it, to make it more pleasant. The above quantity may be
taken once, twice, or three times a-day at the pleasure of the patient,
or according to the indication of his disease.
VI. OPIUM. This remedy is not only useful in easing the pain of a sore
leg, but co-operates with other cordial medicines in invigorating the
whole system.
The _local_ applications should consist of such substances as are
gently escarotic, and which excite an action in the torpid vessels of
the affected part. Arsenic, precipitate, and blue vitriol, have all
been employed with success for this purpose. Dr. Griffitts informed me,
that he has frequently accomplished the same thing in the Dispensary by
applications of tartar emetic. They should all be used, if necessary, in
succession to each other; for there is often the same idiosyncrasy in a
sore leg to certain topical applications, that there is in the stomach
to certain aliments. After the use of these remedies, astringents and
tonics should be applied, such as an infusion of Peruvian, or white-oak
bark; the water in which the smiths extinguish their irons, lime-water,
bread dipped in a weak solution of green vitriol (so much commended by
Dr. Underwood), compresses wetted with brandy, or ardent spirits of any
kind, and, above all, the adhesive plasters formerly mentioned.
Tight bandages are likewise highly proper here. The laced stocking
has been much used. It is made of strong coarse linen. Dr. Underwood
gives several good reasons for preferring a flannel roller to the linen
stocking. It sets easier on the leg, and yields to the swelling of the
muscles in walking.
In scorbutic sores on the legs, navy surgeons have spoken in high terms
of an application of a mixture of lime-juice and molasses. Mr. Gillespie
commends the use of lime or lemon-juice alone, and ascribes many cures
to it in the British navy during the late war, after every common
application had been used to no purpose[66].
[66] Medical Journal, Vol. VI.
It is of the utmost consequence in the treatment of sore legs, to keep
them clean, by frequent dressings and washings. The success of old women
is oftener derived from their great attention to cleanliness, in the
management of sore legs, than to any specifics they possess which are
unknown to physicians.
When sore legs are kept from healing by affections of the bone, the
treatment should be such as is recommended by practical writers on
surgery.
I shall conclude this inquiry by four observations, which are naturally
suggested by what has been delivered upon this disease.
1. If it has been proved that sore legs are connected with a morbid
state of the whole system, is it not proper to inquire, whether many
other diseases supposed to be local, are not in like manner connected
with the whole system; and if sore legs have been cured by general
remedies, is it not proper to use them more frequently in local diseases?
2. If there be two states of action in the arteries in sore legs, it
becomes us to inquire, whether the same opposite states of action do not
take place in many diseases in which they are not suspected. It would be
easy to prove, that they exist in several other local diseases.
3. If the efficacy of the remedies for sore legs which have been
mentioned, depend upon their being accommodated exactly to the state of
the arterial system, and if this system be liable to frequent changes,
does it not become us to be more attentive to the state of the pulse in
this disease than is commonly supposed to be necessary by physicians?
4. It has been a misfortune in medicine, as well as in other sciences,
for men to ascribe effects to one cause, which should be ascribed
to many. Hence diseases have been attributed exclusively to morbid
affections of the fluids by some, and of the muscles and nerves by
others. Unfortunately the morbid states of the arterial system, and
the influence of those states upon the brain, the nerves, the muscles,
the lymphatics, the glands, the viscera, the alimentary canal, and the
skin, as well as the reciprocal influence of the morbid states of each
of those parts of the body upon the arteries, and upon each other, have
been too much neglected in most of our systems of physic. I consider the
pathology of the arterial system as a mine. It was first discovered by
Dr. Cullen. The man who attempts to explore it, will probably impoverish
himself by his researches; but the men who come after him, will
certainly obtain from it a treasure which cannot fail of adding greatly
to the riches of medicine.
AN ACCOUNT
OF THE
_STATE OF THE BODY AND MIND_
IN OLD AGE;
WITH
_OBSERVATIONS ON ITS DISEASES_,
AND THEIR REMEDIES.
Most of the facts which I shall deliver upon this subject, are the
result of observations made during the term of five years, upon persons
of both sexes, who had passed the 80th year of their lives. I intended
to have given a detail of the names, manner of life, occupations, and
other circumstances of each of them; but, upon a review of my notes,
I found so great a sameness in the history of most of them, that I
despaired, by detailing them, of answering the intention which I have
purposed in the following essay. I shall, therefore, only deliver
the facts and principles which are the result of the inquiries and
observations I have made upon this subject.
I. I shall mention the circumstances which favour the attainment of
longevity.
II. I shall mention the phenomena of body and mind which attend it; and,
III. I shall enumerate its peculiar diseases, and the remedies which are
most proper to remove, or moderate them.
I. The circumstances which favour longevity, are,
1. _Descent from long-lived ancestors._ I have not found a single
instance of a person, who has lived to be 80 years old, in whom this was
not the case. In some instances I found the descent was only from one,
but, in general, it was from both parents. The knowledge of this fact
may serve, not only to assist in calculating what are called the chances
of lives, but it may be made useful to a physician. He may learn from it
to cherish hopes of his patients in chronic, and in some acute diseases,
in proportion to the capacity of life they have derived from their
ancestors[67].
[67] Dr. Franklin, who died in his 84th year, was descended from
long-lived parents. His father died at 89, and his mother at 87.
His father had 17 children by two wives. The doctor informed
me, that he once sat down as one of 11 adult sons and daughters
at his father's table. In an excursion he once made to that
part of England from whence his family migrated to America, he
discovered, in a grave-yard, the tomb-stones of several persons
of his name, who had lived to be very old. These persons he
supposed to have been his ancestors.
2. _Temperance in eating and drinking._ To this remark I found several
exceptions. I met with one man of 84 years of age, who had been
intemperate in eating; and four or five persons who had been intemperate
in drinking ardent spirits. They had all been day-labourers, or had
deferred drinking until they began to feel the languor of old age. I did
not meet with a single person who had not, for the last forty or fifty
years of their lives, used tea, coffee, and bread and butter twice a day
as part of their diet. I am disposed to believe that those articles of
diet do not materially affect the duration of human life, although they
evidently impair the strength of the system. The duration of life does
not appear to depend so much upon the strength of the body, or upon the
quantity of its excitability, as upon an exact accommodation of stimuli
to each of them. A watch spring will last as long as an anchor, provided
the forces which are capable of destroying both, are always in an exact
ratio to their strength. The use of tea and coffee in diet seems to be
happily suited to the change which has taken place in the human body, by
sedentary occupations, by which means less nourishment and stimulus are
required than formerly, to support animal life.
3. The _moderate exercise of the understanding_. It has long been an
established truth, that literary men (other circumstances being equal)
are longer lived than other people. But it is not necessary that the
understanding should be employed upon philosophical subjects to produce
this influence upon human life. Business, politics, and religion, which
are the objects of attention of men of all classes, impart a vigour to
the understanding, which, by being conveyed to every part of the body,
tends to produce health and long life.
4. _Equanimity of temper._ The violent and irregular action of the
passions tends to wear away the springs of life.
Persons who live upon annuities in Europe have been observed to be
longer lived, in equal circumstances, than other people. This is
probably occasioned by their being exempted, by the certainty of their
subsistence, from those fears of want which so frequently distract the
minds, and thereby weaken the bodies of old people. Life-rents have been
supposed to have the same influence in prolonging life. Perhaps the
_desire of life_, in order to enjoy for as long a time as possible,
that property which cannot be enjoyed a second time by a child or
relation, may be another cause of the longevity of persons who live
upon certain incomes. It is a fact, that the desire of life is a very
powerful stimulus in prolonging it, especially when that desire is
supported by hope. This is obvious to physicians every day. Despair of
recovery, is the beginning of death in all diseases.
But obvious and reasonable as the effects of equanimity of temper are
upon human life, there are some exceptions in favour of passionate men
and women having attained to a great age. The morbid stimulus of anger,
in these cases, was probably obviated by less degrees, or less active
exercises of the understanding, or by the defect or weakness of some of
the other stimuli which keep up the motions of life.
5. _Matrimony._ In the course of my inquiries I met with only one person
beyond eighty years of age who had never been married. I met with
several women who had borne from ten to twenty children, and suckled
them all. I met with one woman, a native of Herefordshire, in England,
who was in the 100th year of her age, who had borne a child at 60,
menstruated till 80, and frequently suckled two of her children (though
born in succession to each other) at the same time. She had passed the
greatest part of her life over a washing-tub.
6. _Emigration._ I have observed many instances of Europeans who have
arrived in America in the decline of life, who have acquired fresh
vigour from the impression of our climate, and of new objects upon their
bodies and minds; and whose lives, in consequence thereof, appeared
to have been prolonged for many years. This influence of climate
upon longevity is not confined to the United States. Of 100 European
Spaniards, who emigrate to South-America in early life, 18 live to be
above 50, whereas but 8 or 9 native Spaniards, and but 7 Indians of the
same number, exceed the 50th year of human life.
7. I have not found _sedentary employments_ to prevent long life, where
they are not accompanied by intemperance in eating or drinking. This
observation is not confined to literary men, nor to women only, in whom
longevity, without much exercise of body, has been frequently observed.
I met with one instance of a weaver; a second of a silver-smith; and a
third of a shoe-maker, among the number of old people, whose histories
have suggested these observations.
8. I have not found that _acute_, nor that all _chronic_ diseases
shorten human life. Dr. Franklin had two successive vomicas in his
lungs before he was 40 years old. I met with one man beyond 80, who had
survived a most violent attack of the yellow fever; a second who had had
several of his bones fractured by falls, and in frays; and many who had
been frequently affected by intermittents. I met with one man of 86, who
had all his life been subject to syncope; another who had for 50 years
been occasionally affected by a cough[68]; and two instances of men who
had been afflicted for forty years with obstinate head-achs[69]. I met
with only one person beyond 80, who had ever been affected by a disease
in the _stomach_; and in him it arose from an occasional rupture. Mr.
John Strangeways Hutton, of this city, who died in 1793, in the 109th
year of his age, informed me, that he had never puked in his life. This
circumstance is the more remarkable, as he passed several years at sea
when a young man[70]. These facts may serve to extend our ideas of the
importance of a healthy state of the stomach in the animal economy; and
thereby to add to our knowledge in the prognosis of diseases, and in the
chances of human life.
[68] This man's only remedy for his cough was the fine powder of dry
Indian turnip and honey.
[69] Dr. Thiery says, that he did not find the itch, or slight degrees
of the leprosy, to prevent longevity. Observations de Physique,
et de Medecine faites en differens lieux de L'Espagne. Vol II.
p. 17 i.
[70] The venerable old man, whose history first suggested this remark,
was born in New-York in the year 1684. His grandfather lived
to be 101, but was unable to walk for thirty years before he
died, from an excessive quantity of fat. His mother died at 91.
His constant drinks were water, beer, and cyder. He had a fixed
dislike to spirits of all kinds. His appetite was good, and he
ate plentifully during the last years of his life. He seldom
drank any thing between his meals. He was never intoxicated but
twice in his life, and that was when a boy, and at sea, where he
remembers perfectly well to have celebrated, by a feu de joye,
the birth-day of queen Anne. He was formerly afflicted with the
head-ach and giddiness, but never had a fever, except from the
small-pox, in the course of his life. His pulse was slow, but
regular. He had been twice married. By his first wife he had
eight, and by his second seventeen children. One of them lived to
be 83 years of age. He was about five feet nine inches in height,
of a slender make, and carried an erect head to the last year of
his life.
9. I have not found the _loss of teeth_ to affect the duration of human
life, so much as might be expected. Edward Drinker, who lived to be 103
years old, lost his teeth thirty years before he died, from drawing the
hot smoke of tobacco into his mouth through a short pipe.
Dr. Sayre of New-Jersey, to whom I am indebted for several very valuable
histories of old persons, mentions one man aged 81, whose teeth began to
decay at 16, and another of 90, who lost his teeth, thirty years before
he saw him. The gums, by becoming hard, perform, in part, the office of
teeth. But may not the gastric juice of the stomach, like the tears and
urine, become acrid by age, and thereby supply, by a more dissolving
power, the defect of mastication from the loss of teeth? Analogies might
easily be adduced from several operations of nature, which go forward in
the animal economy, which render this supposition highly probable.
10. I have not observed _baldness_, or _grey hairs_, occurring in early
or middle life, to prevent old age. In one of the histories furnished
me by Dr. Sayre, I find an account of a man of 81, whose hair began to
assume a silver colour when he was but one and twenty years of age.
11. More women live to be old than men, but more men live to be _very_
old, than women.
I shall conclude this head by the following remark:
Notwithstanding there appears in the human body a certain capacity of
long life, which seems to dispose it to preserve its existence in every
situation; yet this capacity does not always protect it from premature
destruction; for among the old people whom I examined, I scarcely met
with one who had not lost brothers or sisters, in early and middle life,
and who were born under circumstances equally favourable to longevity
with themselves.
II. I now come to mention some of the phenomena of the body and mind
which occur in old age.
1. There is a great sensibility to _cold_ in all old people. I met
with an old woman of 84, who slept constantly under three blankets and
a coverlet during the hottest summer months. The servant of prince de
Beaufremont, who came from Mount Jura to Paris, at the age of 121, to
pay his respects to the first national assembly of France, shivered with
cold in the middle of the dog days, when he was not near a good fire.
The national assembly directed him to sit with his hat on, in order to
defend his head from the cold.
2. Impressions made upon the _ears_ of old people, excite sensation
and reflection much quicker than when they are made upon their eyes.
Mr. Hutton informed me, that he had frequently met his sons in the
street without knowing them, until they had spoken to him. Dr. Franklin
informed me, that he recognized his friends, after a long absence from
them, first by their voices. This fact does not contradict the common
opinion, upon the subject of memory, for the recollection, in these
instances, is the effect of what is called reminiscence, which differs
from memory in being excited only by the renewal of the impression which
at first produced the idea which is revived.
3. The _appetite_ for food is generally increased in old age. The
famous Parr, who died at 152, ate heartily in the last week of his
life. The kindness of nature, in providing this last portion of earthly
enjoyments for old people, deserves to be noticed. It is remarkable,
that they have, like children, a frequent recurrence of appetite, and
sustain with great uneasiness the intervals of regular meals. The
observation, therefore, made by Hippocrates, that middle-aged people
are more affected by abstinence than those who are old, is not true.
This might easily be proved by many appeals to the records of medicine;
but old people differ from children, in preferring _solid_ to liquid
aliment. From inattention to this fact, Dr. Mead has done great mischief
by advising old people, as their teeth decayed or perished, to lessen
the quantity of their solid, and to increase the quantity of their
liquid food. This advice is contrary to nature and experience, and I
have heard of two old persons who destroyed themselves by following it.
The circulation of the blood is supported in old people chiefly by the
stimulus of aliment. The action of liquids of all kinds upon the system
is weak, and of short continuance, compared with the durable stimulus
of solid food. There is a gradation in the action of this food upon the
body. Animal matters are preferred to vegetable; the fat of meat to the
lean, and salted meat to fresh, by most old people. I have met with but
few old people who retained an appetite for milk. It is remarkable, that
a less quantity of _strong drink_ produces intoxication in old people
than in persons in the middle of life. This depends upon the recurrence
of the same state of the system, with respect to excitability, which
takes place in childhood. Many old people, from an ignorance of this
fact, have made shipwreck of characters which have commanded respect in
every previous stage of their lives. From the same recurrence of the
excitability of childhood in their systems, they commonly drink their
tea and coffee much weaker than in early or middle life.
4. The _pulse_ is generally full, and frequently affected by pauses in
its pulsations when felt in the wrists of old people. A regular pulse in
such persons indicates a disease, as it shows the system to be under the
impression of a preternatural stimulus of some kind. This observation
was suggested to me above thirty years ago by Morgagni, and I have often
profited by it in attending old people. The pulse in such patients is an
uncertain mark of the nature, or degree of an acute disease. It seldom
partakes of the quickness or convulsive action of the arterial system,
which attends fever in young or middle-aged people. I once attended a
man of 77 in a fever of the bilious kind, which confined him for eight
days to his bed, in whom I could not perceive the least quickness or
morbid action in his pulse until four and twenty hours before he died.
5. The marks of old age appear earlier, and are more numerous in persons
who have combined with hard labour, a vegetable or scanty diet, than
in persons who have lived under opposite circumstances. I think I have
observed these marks of old age to occur sooner, and to be more numerous
in the German, than in the English or Irish citizens of Pennsylvania.
They are likewise more common among the inhabitants of country places,
than of cities, and still more so among the Indians of North-America,
than among the inhabitants of civilized countries.
6. Old men tread upon the _whole base_ of their feet at once in
_walking_. This is perhaps one reason why they wear out fewer shoes,
under the same circumstances of constant use, than young people, who,
by treading on the posterior, and rising on the anterior part of
their feet, expose their shoes to more unequal pressure and friction.
The advantage derived to old people from this mode of walking is
very obvious. It lessens that disposition to totter, which is always
connected with weakness: hence we find the same mode of walking is
adopted by habitual drunkards, and is sometimes from habit practised by
them, when they are not under the influence of strong drink.
7. The breath and perspiration of old people have a peculiar acrimony,
and their urine, in some instances, emits a f[oe]tor of an offensive
nature.
8. The eyes of very old people sometimes change from a dark and blue, to
a light colour.
9. The _memory_ is the first faculty of the mind which fails in the
decline of life. While recent events pass through the mind without
leaving an impression upon it, it is remarkable that the long forgotten
events of childhood and youth are recalled and distinctly remembered.
I met with a singular instance of a German woman, who had learned to
speak the language of our country after she was forty years of age, who
had forgotten every word of it after she had passed her 80th year, but
spoke the German language as fluently as ever she had done. The memory
decays soonest in hard drinkers. I have observed some studious men to
suffer a decay of their memories, but never of their understandings.
Among these was the late Anthony Benezet of this city. But even this
infirmity did not abate the cheerfulness, nor lessen the happiness of
this pious philosopher, for he once told me, when I was a young man,
that he had a consolation in the decay of his memory, which gave him
a great advantage over me. "You can read a good book (said he) with
pleasure but _once_, but when I read a good book, I so soon forget
the contents of it, that I have the pleasure of reading it over and
over; and every time I read it, it is alike new and delightful to me."
The celebrated Dr. Swift was one of those few studious men, who have
exhibited marks of a decay of understanding in old age; but it is
judiciously ascribed by Dr. Johnson to two causes which rescue books,
and the exercise of the thinking faculties from having had any share
in inducing that disease upon his mind. These causes were, a rash vow
which he made when a young man, never to use spectacles, and a sordid
seclusion of himself from company, by which means he was cut off from
the use of books, and the benefits of conversation, the absence of
which left his mind without its usual stimulus: hence it collapsed
into a state of fatuity. It is probably owing to the constant exercise
of the understanding, that literary men possess that faculty of the
mind in a vigorous state in extreme old age. The same cause accounts
for old people preserving their intellects longer in cities, than in
country places. They enjoy society upon such easy terms in the former
situation, that their minds are kept more constantly in an excited state
by the acquisition of new, or the renovation of old ideas, by means of
conversation.
10. I did not meet with a single instance in which the moral or
religious faculties were impaired in old people. I do not believe, that
these faculties of the mind are preserved by any supernatural power, but
wholly by the constant and increasing exercise of them in the evening
of life. In the course of my inquiries, I heard of a man of 101 years of
age, who declared that he had forgotten every thing he had ever known,
except his GOD. I found the moral faculty, or a disposition to do kind
offices to be exquisitely sensible in several old people, in whom there
was scarcely a trace left of memory or understanding.
11. Dreaming is universal among old people. It appears to be brought on
by their imperfect sleep, of which I shall say more hereafter.
12. I mentioned formerly the sign of a _second childhood_ in the state
of the appetite in old people. It appears further, 1. In the marks
which slight contusions or impressions leave upon their skins. 2. In
their being soon fatigued by walking or exercise, and in being as soon
refreshed by rest. 3. In their disposition, like children, to detail
immediately every thing they see and hear. And, 4. In their aptitude to
shed tears; hence they are unable to tell a story that is in any degree
distressing without weeping. Dr. Moore takes notice of this peculiarity
in Voltaire, after he had passed his 80th year. He wept constantly at
the recital of his own tragedies. This feature in old age, did not
escape Homer. Old Menelaus wept ten years after he returned from the
destruction of Troy, when he spoke of the death of the heroes who
perished before that city.
13. It would be sufficiently humbling to human nature, if our bodies
exhibited in old age the marks only of a second childhood; but human
weakness descends still lower. I met with an instance of a woman between
80 and 90, who exhibited the marks of a _second infancy_, by such a
total decay of her mental faculties, as to lose all consciousness in
discharging her alvine and urinary excretions. In this state of the
body, a disposition to sleep, succeeds the wakefulness of the first
stages of old age. Dr. Haller mentions an instance of a very old man who
slept twenty, out of every twenty-four hours during the few last years
of his life.
14. The disposition in the system to _renew_ certain parts in extreme
old age, has been mentioned by several authors. Many instances are to be
met with in the records of medicine of the sight[71] and hearing having
been restored, and even of the teeth having been renewed in old people a
few years before death. These phenomena have led me to suspect that the
antediluvian age was attained by the frequent renovation of different
parts of the body, and that when they occur, they are an effort of the
causes which support animal life, to produce antediluvian longevity, by
acting upon the revived excitability of the system.
[71] There is a remarkable instance of the sight having been restored
after it had been totally destroyed in an old man near Reading,
in Pennsylvania. My brother, Judge Rush, furnished me with the
following account of him in a letter from Reading, dated June 23,
1792.
"An old man, of 84 years of age, of the name of Adam Riffle, near
this town, gradually lost his sight in the 68th year of his age,
and continued entirely blind for the space of twelve years.
About four years ago his sight returned, without making use of
any means for the purpose, and without any visible change in the
appearance of the eyes, and he now sees as well as ever he did. I
have seen the man, and have no doubt of the fact. He is at this
time so hearty, as to be able to walk from his house to Reading
(about three miles), which he frequently does in order to attend
church. I should observe, that during both the gradual loss, and
recovery of his sight, he was no ways affected by sickness, but,
on the contrary, enjoyed his usual health. I have this account
from his daughter and son-in-law, who live within a few doors of
me."
15. The _fear_ of death appears to be much less in old age, than in
early, or middle life. I met with many old people who spoke of their
dissolution with composure, and with some who expressed earnest
desires to lie down in the grave. This indifference to life, and desire
for death (whether they arise from a satiety in worldly pursuits and
pleasures, or from a desire of being relieved from pain) appear to be a
wise law in the animal economy, and worthy of being classed with those
laws which accommodate the body and mind of man to all the natural
evils, to which, in the common order of things, they are necessarily
exposed.
III. I come now briefly to enumerate the diseases of old age, and the
remedies which are most proper to remove, or to mitigate them.
The diseases are chronic and acute. The CHRONIC are,
1. _Weakness_ of the _knees_ and _ancles_, a lessened ability to walk,
and tremors in the head and limbs.
2. _Pains in the bones_, known among nosological writers by the name of
rheumatalgia.
3. _Involuntary flow of tears_, and of mucus from the nose.
4. _Difficulty of breathing_, and a short _cough_, with copious
expectoration. A weak, or hoarse voice generally attends this cough.
5. _Costiveness._
6. An _inability to retain the urine_ as long as in early or middle
life. Few persons beyond 60 pass a whole night without being obliged
to discharge their urine[72]. Perhaps the stimulus of this liquor in
the bladder may be one cause of the universality of dreaming among old
people. It is certainly a frequent cause of dreaming in persons in early
and middle life: this I infer, from its occuring chiefly in the morning
when the bladder is most distended with urine. There is likewise an
inability in old people to discharge their urine as quickly as in early
life. I think I have observed this to be among the first symptoms of the
declension of the strength of the body by age.
[72] I met with an old man, who informed me, that if from any accident
he retained his urine after he felt an inclination to discharge
it, he was affected by a numbness, accompanied by an uneasy
sensation in the palms of his hands.
7. _Wakefulness._ This is probably produced in part by the action of the
urine upon the bladder; but such is the excitability of the system in
the first stages of old age, that there is no pain so light, no anxiety
so trifling, and no sound so small, as not to produce wakefulness in old
people. It is owing to their imperfect sleep, that they are sometimes
as unconscious of the moment of their passing from a sleeping to a
waking state, as young and middle-aged people are of the moment in which
they pass from the waking to a sleeping state. Hence we so often hear
them complain of passing sleepless nights. This is no doubt frequently
the case, but I am satisfied, from the result of an inquiry made upon
this subject, that they often sleep without knowing it, and that their
complaints in the morning, of the want of sleep, arise from ignorance,
without the least intention to deceive.
8. _Giddiness._
9. _Deafness._
10. _Imperfect vision._
The acute diseases most common among old people, are,
1. _Inflammation of the eyes._
2. The _pneumonia notha_, or bastard peripneumony.
3. The _colic_.
4. _Palsy_ and _apoplexy_.
5. The _piles_.
6. A _difficulty in making water_.
7. _Quartan fever._
All the diseases of old people, both chronic and acute, originate in
predisposing debility. The remedies for the former, where a feeble
morbid action takes place in the system, are stimulants. The first of
these is,
I. HEAT. The ancient Romans prolonged life by retiring to Naples, as
soon as they felt the infirmities of age coming upon them. The aged
Portuguese imitate them, by approaching the warm sun of Brazil, in
South-America. But heat may be applied to the torpid bodies of old
people artificially. 1st. By means of the _warm bath_. Dr. Franklin
owed much of the cheerfulness and general vigour of body and mind
which characterised his old age, to his regular use of this remedy. It
disposed him to sleep, and even produced a respite from the pain of the
stone, with which he was afflicted during the last years of his life.
2. Heat may be applied to the bodies of old people by means of
_stove-rooms_. The late Dr. Dewit, of Germantown, who lived to be near
100 years of age, seldom breathed an air below 72°, after he became an
old man. He lived constantly in a stove-room.
3. WARM CLOTHING, more especially warm bed-clothes, are proper to
preserve or increase the heat of old people. From the neglect of the
latter, they are often found dead in their beds in the morning, after a
cold night, in all cold countries. The late Dr. Chovet, of this city,
who lived to be 85, slept in a baize night-gown, under eight blankets,
and a coverlet, in a stove-room, many years before he died. The head
should be defended in old people, by means of woollen, or fur caps, in
the night, and by wigs and hats during the day, in cold weather. These
artificial coverings will be the more necessary, where the head has been
deprived of its natural covering. Great pains should be taken likewise
to keep the feet dry and warm, by means of thick shoes[73]. To these
modes of applying and confining heat to the bodies of old people, a
young bed-fellow has been added; but I conceive the three artificial
modes which have been recommended, will be sufficient without the use of
one, which cannot be successfully employed without a breach of delicacy
or humanity.
[73] I met with one man above 80, who defended his feet from moisture
by covering his shoes in wet weather with melted wax; and
another who, for the same purpose, covered his shoes every
morning with a mixture composed of the following ingredients
melted together: lintseed oil a pound, mutton suet eight ounces,
bees-wax six ounces, and rosin four ounces. The mixture should
be moderately warmed, and then applied not only to the upper
leather, but to the soles of the shoes. This composition, the
old gentleman informed me, was extracted from a book entitled,
"The Complete Fisherman," published in England, in the reign of
queen Elizabeth. He had used it for twenty years in cold and wet
weather, with great benefit, and several of his friends, who had
tried it, spoke of its efficacy in keeping the feet dry, in high
terms.
II. To keep up the action of the system, GENEROUS DIET and DRINKS should
be given to old people. For a reason mentioned formerly, they should be
indulged in eating between the ordinary meals of families. Wine should
be given to them in moderation. It has been emphatically called the milk
of old age.
III. YOUNG COMPANY should be preferred by old people to the company of
persons of their own age. I think I have observed old people to enjoy
better health and spirits, when they have passed the evening of their
lives in the families of their children, where they have been surrounded
by grand-children, than when they lived by themselves. Even the
solicitude they feel for the welfare of their descendants, contributes
to invigorate the circulation of the blood, and thereby to add fuel to
the lamp of life.
IV. GENTLE EXERCISE. This is of great consequence in promoting the
health of old people. It should be moderate, regular, and always in fair
weather.
V. CLEANLINESS. This should by no means be neglected. The dress of old
people should not only be clean, but more elegant than in youth or
middle life. It serves to divert the eye of spectators from observing
the decay and deformity of the body, to view and admire that which is
always agreeable to it.
VI. To abate the pains of the chronic rheumatism, and the uneasiness of
the old man's cough (as it is called); also to remove wakefulness, and
to restrain, during the night, a troublesome inclination to make water,
OPIUM may be given with great advantage. Chardin informs us, that this
medicine is frequently used in the eastern countries to abate the pains
and weaknesses of old age, by those people who are debarred the use of
wine by the religion of Mahomet.
I have nothing to say upon the acute diseases of old people, but what
is to be found in most of our books of medicine, except to recommend
BLEEDING in those of them which are attended with plethora, and an
inflammatory action in the pulse. The degrees of appetite which belong
to old age, the quality of the food taken, and the sedentary life which
is generally connected with it, all concur to produce that state of the
system, which requires the above evacuation. I am sure that I have seen
many of the chronic complaints of old people mitigated by it, and I have
more than once seen it used with obvious advantage in their inflammatory
diseases. These affections I have observed to be more fatal among
old people than is generally supposed. An inflammation of the lungs,
which terminated in an abscess, deprived the world of Dr. Franklin.
Dr. Chovet died of an inflammation in his liver. The blood drawn from
him a few days before his death was sizy, and such was the heat of
his body, produced by his fever, that he could not bear more covering
(notwithstanding his former habits of warm clothing) than a sheet in the
month of January.
Death from old age is the effect of a gradual palsy. It shows itself
first in the eyes and ears, in the decay of sight and hearing; it
appears next in the urinary bladder, in the limbs and trunk of the
body; then in the sphincters of the bladder and rectum; and finally in
the nerves and brain, destroying in the last, the exercise of all the
faculties of the mind.
Few persons appear to die of old age. Some one of the diseases which
have been mentioned, generally cuts the last thread of life.
END OF VOLUME I.
* * * * *
Transcriber's note:
The original spelling and minor inconsistencies in the spelling and
formatting have been maintained.
Obvious misprints have been corrected.
Partly repeated chapter headings have been deleted.
The table on page 107 has been split to match the page size.