Naples.
Your account of our Friend’s state of health gives me much concern; the
more, as I cannot approve the change he has made of a physician. You say,
the doctor, under whose care he is at present, has employed his mind so
entirely in medical researches, that he scarcely displays a grain of
common sense, when the conversation turns on any other subject; and that,
although he seems opinionative, vain, and ostentatious in his profession,
and full of false and absurd ideas in the common affairs of life, yet
he is a very able physician, and has performed many wonderful cures. Be
assured, my dear Sir, that this is impossible; for medical skill is not
like the rod of an inchanter, which may be found accidentally, and which
transfers its miraculous powers indiscriminately to a blockhead or a man
of sense. The number of weak, gossipping men, who have made fortunes by
this profession, do not prove the contrary. I do not say that men of that
kind cannot make fortunes; I only assert they are not the most likely to
cure diseases. An interest with apothecaries, nurses, and a few talkative
old ladies, will enable them to do the first; but a clear understanding,
and a considerable share of natural sagacity, are qualities essentially
necessary for the second, and for every business which requires
reflection. Without these, false inferences will be drawn from experience
itself; and learning will tend to confirm a man in his errors, and to
render him more completely a coxcomb.
The profession of physic is that, of all others, in which the generality
of mankind have the fewest lights, by which they can discern the
abilities of its professors; because the studies which lead to it are
more out of the road of usual education, and the practice more enveloped
in technical terms and hieroglyphical signs. But I imagine the safest
criterion by which men, who have not been bred to that profession,
can form a judgment of those who have, is, the degree of sagacity and
penetration they discover on subjects equally open to mankind in general,
and which ought to be understood by all who live in society. You do not
mention particularly what has been prescribed by either; only that the
former physician seemed to rely almost entirely on exercise and regimen,
whereas the present flatters our friend with a speedy cure, by the help
of the Pectoral and Balsamic medicines which he orders in such abundance,
and which he declares are so efficacious in _pulmonary consumptions_.
Having lamented with you the mournful events which render the name of
that disease peculiarly alarming to you, and knowing your friendly
solicitude about Mr. ——, I do not wonder at your earnest desire to know
something of the nature of a distemper with which he is threatened, and
which has proved fatal to so many of our friends. But I am surprised
that you have not chosen a more enlightened instructor, when you have so
many around you. Though conscious that I have no just claim to all the
obliging expressions which your partiality to my opinions has prompted
you to make use of, yet I am too much flattered by some of them, to
refuse complying with your request. My sentiments, such as they are, will
at least have the merit of being clearly understood. I shall observe your
prohibition, not to refer you to any medical book; and shall carefully
avoid all technical terms, which you so much abominate. With regard to
your shewing my Letter to any of the faculty; if you find yourself so
inclined, I have not the smallest objection; for those who have the
greatest knowledge in their profession, are best acquainted with its
uncertainty, and most indulgent to the mistakes or errors of others.
Alas, my friend! how is it possible that physicians should avoid
mistakes? If the ablest mechanic were to attempt to remedy the irregular
movements of a watch, while he remained ignorant of the structure and
manner of acting of some of the principal springs, would he not be in
danger of doing harm instead of good? Physicians are in the situation
of such a mechanic; for, although it is evident that the nerves are
the organs of motion and sensation, yet their structure is not known.
Some anatomists assert they are impervious cords; others, that they are
slender tubes, containing a fluid. But what the nature of this fluid is;
whether it serves only to nourish the nerves themselves, or is the medium
by which they convey feeling and the power of motion to other parts, is
not ascertained even by those who argue for its existence; far less
is it explained in what manner ideas, formed within the brain, can, by
the means of solid cords, or by a fluid contained in tubes, communicate
motion at pleasure to the legs and arms. We are ignorant why the will,
which has no influence over the motion of an animal’s heart, should find
the feet obedient to her dictates; and we can no more explain how a man
can move one leg over the other by volition, or the mere act of willing,
than how he could, by the same means, move Ossa on the top of Olympus.
The one happens every moment, the other would be considered as a miracle;
but they are equally unaccountable. While parts so infinitely essential
to life are not understood, instead of being surprised that so many
diseases baffle the skill of the physician, we have more reason to be
astonished that any can be alleviated or cured by his art.
The pen of the satirist, no doubt, may be fairly aimed against the
presumption and ignorance of many individuals of this, as of every other
profession; but cannot with justice be directed against the art itself:
since, in spite of the obscurity which still involves some parts of the
animal economy, many disorders are relieved, and some of the severest
and most disagreeable to which the human body is liable, are cured with
certainty by the art of medicine.
Unfortunately for mankind, and in a particular manner for the inhabitants
of Great Britain, the pulmonary consumption is not of the number.
This disease may originate from various causes:
1st. An external bruise or wound.
2d. The disease called pleurisy, including in that term an inflammation
of the lungs themselves, as well as the membrane which covers them.
3d. The bursting of some of the blood-vessels of the lungs, independent
of external injury, and owing to a faulty conformation of the chest, and
the slenderness of the vessels.
4th. Certain small tumours, called tubercles, in the lungs.
The first cause I have mentioned is an external bruise or wound.
An accident of that kind happening to the lungs, is more dangerous and
difficult to cure, than when the same takes place in most other parts
of the body; because the lungs are vital organs, essentially necessary
to life, and when their motion is impaired, other animal functions are
thereby injured; because they are of an uncommonly delicate texture, in
which a rupture having once taken place, will be apt to increase; because
they are in constant motion and exposed to the access of external air,
both of which circumstances are unfavourable to the healing of wounds,
and because the mass of blood distributed to the whole body passes
previously through the lungs, and consequently the blood-vessels of this
organ are more numerous than those of any other part of the body.
When we consider these peculiarities, it is natural to conclude, that
every wound of the lungs must necessarily prove mortal; but experience
has taught the contrary. Many wounds of the lungs heal of themselves, by
what is called, the first intention. The physician may prevent a fever,
by ordering the patient to lose blood in proper quantities, and he may
regulate the diet; but the cure must be left to nature, which she will
perform with greater certainty, if she is not disturbed by any of those
balsams which the wounded are sometimes directed to swallow on such
occasions. But when the wound, either from injudicious treatment, or from
its size, or from the bad habit of the patient, degenerates into an ulcer
attended with hectic symptoms, the disease must be treated as if it had
arisen from any of the other causes.
The pleurisy, or inflammation of the lungs, is a disease more frequent in
cold countries than in mild; in the spring than in the other seasons; and
more apt to seize people of a sanguine constitution than others.
Plentiful and repeated bleedings, fomentations, blisters near the
affected part, and a cooling, diluting regimen, generally remove it,
without its leaving any bad consequence. Sometimes, by the omission of
bleeding in due quantity at the beginning, and sometimes in spite of
all possible care, it terminates in an abscess, which, on bursting, may
suffocate the patient; or, if the matter is coughed up, becomes an open
ulcer, and produces the disease in question.
The third cause of the pulmonary consumption above mentioned, is,
a spitting of blood, from the bursting of vessels of the lungs,
independent of external wound or bruise. People of a fair complexion,
delicate skin, slender make, long neck, and narrow chest, are more
subject to this than others. Those who have a predisposition to this
complaint, by their form, are most apt to be attacked after their full
growth: women from fifteen to three-and-thirty; men two or three years
later. In Great Britain, a spitting of blood generally occurs to those
predisposed to it, in the spring, or beginning of summer, when the
weather suddenly changes from cold to excessive hot; and when the heat
is supposed to rarify the blood, before the solids are proportionably
relaxed from the contracted state they acquire during the cold of
winter. When a spitting of blood happens to a person who has actually
lost brothers or sisters, or other near relations, by the pulmonary
consumption, as that circumstance gives reason to suspect a family taint
or predisposition, the case will, on that account, be more dangerous.
Violent exercise may occasion the rupture of blood-vessels in the lungs,
even in those who have no hereditary disposition to such an accident;
it ought therefore to be carefully avoided by all who have. Violent
exercise, in the spring, is more dangerous than in other seasons; and,
when taken at the top of high mountains, by those who do not usually
reside there, it has been considered as more dangerous than in vallies.
The sudden diminution of the weight of the atmosphere, co-operating with
the exercise, renders the vessels more apt to break. Of all things the
most pernicious to people predisposed to a spitting of blood, is, playing
upon wind-instruments. Previous to the spitting of blood, some perceive
an uneasiness in the chest, an oppression on the breath, and a saltish
taste in the spittle; but these symptoms are not constant.
Nothing can be more insidious than the approaches of this disease
sometimes are. The substance of the lungs, which is so full of
blood-vessels, is not supplied so liberally with nerves; the lungs,
therefore, may be materially affected, before danger is indicated by
acute pain. And it sometimes happens, that people of the make above
described are, in the bloom of life, and generally in the spring of the
year, seized with a slight cough, which gradually increases, without
pain, soreness in the breast, difficulty of respiration, or spitting of
blood. A slow fever supervenes every night, which remits every morning,
with sweats. These symptoms augment daily; and, in spite of early
attention, and what is thought the best advice, the unsuspecting victims
gradually sink into their graves.
Those who by their make, or by the disease having in former instances
appeared in their family, are predisposed to this complaint, ought to
be peculiarly attentive in the article of diet. A spare and cooling
regimen is the best. They should avoid violent exercise, and every other
exciting cause; and use the precaution of losing blood in the spring.
If their circumstances permit, they ought to pass the cold months in a
mild climate; but, if they are obliged to remain during the winter in
Great Britain, let them wear flannel next the skin, and use every other
precaution against catching colds.
The fourth cause above enumerated is, tubercles in the lungs.
The moist, soggy, and changeable weather, which prevails in Great
Britain, renders its inhabitants more liable, than those of milder
and more uniform climates, to catarrhs, rheumatisms, pleurisies, and
other diseases proceeding from obstructed perspiration. The same cause
subjects the inhabitants of Great Britain to obstructions of the glands,
scrophulous complaints, and tubercles in the substance of the lungs.
The scrophulous disease is more frequent than is generally imagined.
For one person in whom it appears by swellings in the glands below the
chin, and other external marks, many have the internal glands affected
by it. This is well known to those who are accustomed to open dead
bodies. On examining the bodies of such as have died of the pulmonary
consumption, besides the open ulcers in the lungs, many little hard
tumours or tubercles are generally found; some, with matter; others, on
being cut open, discover a little blueish spot, of the size of a small
lead shot. Here the suppuration, or formation of matter, is just going
to begin; and in some the tubercle is perfectly hard, and the colour
whitish, throughout its whole substance. Tubercles may remain for a
considerable time in the lungs, in this indolent state, without much
inconveniency; but, when excited to inflammation by frequent catarrhs,
or other irritating causes, matter is formed, they break, and produce
an ulcer. Care and attention may prevent tubercles from inflammation,
or may prevent _that_ from terminating in the formation of matter; but
when matter is actually formed, and the tubercle has become an abscess,
no remedy can stop its progress. It must go on till it bursts. If this
happens near any of the large air-vessels, immediate suffocation may
ensue; but, for the most part, the matter is coughed up.
From the circumstances above enumerated of the delicate texture,
constant motion, and numerous blood-vessels of the lungs, it is natural
to imagine, that a breach of this nature in their substance will be
still more difficult to heal than a wound from an external cause. So
unquestionably it is; yet there are many instances of even this kind of
breach being repaired; the matter expectorated diminishing in quantity
every day, and the ulcer gradually healing; not, surely, by the power of
medicine, but by the constant disposition and tendency which exists in
nature, by inscrutable means of her own, to restore health to the human
body.
It may be proper to observe, that those persons whose formation of body
renders them most liable to a spitting of blood, have also a greater
predisposition than others to tubercles in the lungs. The disease, called
the spasmodic asthma, has been reckoned among the causes of the pulmonary
consumption. It would require a much greater degree of confidence in a
man’s own judgment, than I have in mine, to assert, that this complaint
has no tendency to produce tubercles in the lungs; but I may say, with
truth, that I have often known the spasmodic asthma, in the most violent
degree, attended with the most alarming symptoms, continue to harass the
patients for a long period of time, and at length suddenly disappear,
without ever returning; the persons who have been thus afflicted,
enjoying perfect health for many years after. It is not probable that
tubercles were formed in any of these cases; and it is certain they were
not in some, whose bodies were opened after their deaths, which happened
from other distempers, the asthma having disappeared several years before.
Certain eruptions of the skin, attended with fever, particularly the
small-pox, and still oftener the measles, leave after them a foundation
for the pulmonary consumption. From whichever of the causes above
enumerated this disease takes its origin, when once an ulcer, attended
with a hectic fever, is formed in the lungs, the case is, in the
highest degree, dangerous. When it ends fatally, the symptoms are, a
quick pulse, and a sensation of cold, while the patient’s skin, to the
feeling of every other person, is hot; irregular shiverings, a severe
cough, expectoration of matter streaked with blood, morning sweats, a
circumscribed spot of a crimson colour on the cheeks, heat of the palms
of the hands, excessive emaciation, crooking of the nails, swelling of
the legs, giddiness, delirium, soon followed by death.
These symptoms do not appear in every case. Although the emaciation is
greater in this disease than in any other, yet the appetite frequently
remains strong and unimpaired to the last; and although delirium
sometimes comes before death, yet in many cases the senses seem perfect
and intire; except in one particular, that in spite of all the foregoing
symptoms, the patient often entertains the fullest hopes of recovery to
the last moment.
Would to heaven it were as easy to point out the cure, as to describe the
symptoms of a disease of such a formidable nature, and against which the
powers of medicine have been directed with such bad success, that there
is reason to fear, its fatal termination has been oftener accelerated
than retarded by the means employed to remove it! To particularise the
drugs which have been long in use, and have been honoured with the
highest encomiums for their great efficacy in healing inward bruises,
ulcers of the lungs, and confirmed consumptions, would in many instances
be pointing out, what ought to be shunned as pernicious, and in others
what ought to be neglected as futile.
Salt water, and some of the mineral springs, which are unquestionably
beneficial in scrophulous and other distempers, have been found hurtful,
or at least inefficacious, in the consumption; there is no sufficient
reason to depend on a course of these, or any medicine at present known,
for preventing or dissolving tubercles in the lungs. Mercury, which has
been found so powerful in disposing other ulcers to heal, has no good
effect on ulcers of that organ;—though some physicians imagine it may be
of service in the beginning to dissolve tubercles, before they begin to
suppurate; but as there is no absolute evidence, during life, of indolent
tubercles being formed, there can be none that mercury cures them.
Various kinds of gums, with the natural and artificial balsams, were
long supposed to promote the healing of external wounds and ulcers,
and on that account were made the basis of a vast variety of ointments
and plaisters. It was afterwards imagined, that the same remedies,
administered internally, would have the same effect on internal ulcers;
and of course many of those gums and balsams were prescribed in various
forms for the pulmonary consumption. The reasoning on which this practice
was established, however, seems a little shallow, and is far from being
conclusive; for although it were granted, that these balsams contributed
to the cure of wounds, when applied directly to the part, it does not
follow that they could carry their healing powers, unimpaired, from the
stomach to the lungs, through the whole process of digestion. But more
accurate surgery having made it manifest, that the granulations which
spring up to supply the loss of substance in external wounds, and the
healing or skinning over of all kinds of sores, proceeds from no active
virtue in the plaisters or ointments with which they are dressed, but
is entirely the work of nature, and best performed when the mildest
substances, or even dry lint only is applied; and that heating gums,
resins, and balsams, rather retard than promote their cure; the internal
use of such remedies ought to be rejected now, on the same principles
they were adapted formerly.
No kind of reasoning ought to have weight, when opposed by fair
experience. But physicians have formed contrary and opposite conclusions,
with respect to the effect of the natural and artificial balsams, even
when they have laid all theory and reasoning aside, and decided on their
powers from practice and experiment only. This is sufficient to prove,
at least, that their efficacy is very problematical. For my own part,
after the fairest trials, and the most accurate observations I have been
able to make, I cannot say that I ever knew them of service in any hectic
complaint proceeding from an ulcer in the lungs; and I have generally
found those physicians, on whose judgment I have more reliance than on my
own, of the same opinion.
It is far from being uncommon to see a cure retarded, not to say any
thing stronger, by the means employed to hasten it; and physicians who
found their practice on theoretical reasonings, are not the only persons
to whom this misfortune may happen. Those who profess to take experience
for their sole guide, if it is not directed by candour, and enlightened
by natural sagacity, are liable to the same. A man may, for twenty years,
order a medicine, which has in every instance done a little harm, though
not always so much as to prevent nature from removing the complaint at
last; and if the reputation of this medicine should ever be attacked, he
may bring his twenty years experience in support of it. It ought to be
remembered, that as often as the animal constitution is put out of order,
by accident or distemper, nature endeavours to restore health. Happily
she has many resources, and various methods of accomplishing her purpose;
and very often she succeeds best without medical assistance. But medical
assistance being given, she frequently succeeds _notwithstanding_; and it
sometimes happens, that both physician and patient are convinced, that
the means which did not prevent have actually performed the cure.
A peasant is seized with a shivering, followed by feverishness, and
accompanied with a slight cough—he goes to bed, and excessive heat and
thirst prompt him to drink plentifully of plain water; on the second or
third day a copious sweat bursts from all his pores, and terminates the
disorder. A person of fortune is seized with the same symptoms, arising
from the same cause, and which would have been cured by the same means,
in the same space of time; but the apothecary is called, who immediately
sends pectoral linctuses to remove the cough, and afterwards gives a
vomit, to remove the nausea which the linctuses have occasioned: the heat
and fever augment; the physician is called; he orders the patient to be
blooded, to abate the violence of the fever, and gives a little physic
on some other account. All this prevents the natural crisis by sweat;
and the patient being farther teased by draughts or powders every two or
three hours, nature cannot shake off the fever so soon by six or seven
days, as she would have done had she been left to herself. She generally
does her business at last, however; and then the physician and apothecary
glory in the happy effects of their skill, and receive the grateful
thanks of their patient for having cured him of a dangerous fever.
Every body of common penetration, at all conversant in medical matters,
must have seen enough to convince them that the above description is not
exaggerated; but it is not to be inferred from this, that the art of
medicine is of no use to mankind. There are many diseases in which nature
sinks, without medical assistance. It is the part of the penetrating and
experienced physician to distinguish these from others, and leave it to
the knavish and weak to assume the merit of cures in cases where they
know, or ought to know, that medicine can do nothing.
Some physicians, who have abandoned the other resins and gums, as useless
or hurtful in hectic complaints, still adhere to myrrh as a beneficial
medicine; but from what I can learn, the cases in which this gum has
been thought serviceable, are hectic complaints, from debility, in
consequence of excessive evacuations of various kinds, and not proceeding
from ulcerated lungs. After it is fully established that myrrh is of use
in such instances, it will still be worthy of investigation, whether
it is of more or less than Jesuits bark. I have repeatedly mentioned
blood-letting, and a spare, diluting regimen, as the most powerful means
of preventing and curing all affections of the lungs that depend on
inflammation. In the case of external wounds, or bruises of the lungs,
this method facilitates the immediate cure by the first intention. It
is the chief thing to be depended on for the cure of pleurisies; and it
is often owing to a neglect, or too sparing an use of this evacuation,
that the complaint terminates in an abscess. In people predisposed by
the form of their bodies, or the nature of their constitutions, to a
spitting of blood, it may prevent the turgid vessels from bursting; and
in those who have tubercles in the lungs, it is of the greatest utility,
by preventing those tumours from inflaming, and becoming ulcers; but
after the ulcers are actually formed, I have great doubts with regard to
the propriety of attempting a cure by repeated bleedings, even in small
quantities. This method has been often tried; but I fear the success
with which it has been attended, gives no encouragement to continue the
practice. That symptoms may be such, in every period of this disease, as
to require this evacuation, is not to be denied; but there is a great
difference in the application of what is considered as an occasional
palliative, and that from which we expect a radical cure. In the one
case, it will only be used when some particular symptom strongly urges;
in the other, it will be used at stated intervals, whether the symptoms
press or not; and may tend to weaken the already debilitated patient,
without our having the consolation of knowing, with certainty, that it
has had any other effect.
Blisters do not weaken so much; they are of undoubted use in pleurisies;
perhaps, by exciting external inflammation, they may contribute to draw
off the inflammatory disposition within the breast: perhaps—But in
whatever way they act, I imagine I have frequently seen blisters and
setons, particularly the latter, of considerable service, even after the
symptoms indicated the existence of an ulcer in the lungs.
As for the numerous forms of electuaries, lohochs, and linctuses,
composed of oils, gums, and syrups, and by the courtesy of dispensatory
writers called _pectoral_; I am convinced they are of no manner of
service in this complaint, and seldom have any other effect than that
of loading the stomach, and impairing the digestion of salutary food.
So far from being of any permanent service to the disease, they cannot
be depended on for giving even a temporary relief to the cough; when
that symptom becomes troublesome, gentle opiates will be found the
best palliatives. Some practitioners object to these medicines, on a
supposition that they check expectoration; but they only seem to have
this effect, by lulling the irritation to cough; the same quantity
will be expectorated in the morning, after the influence of the opiate
is over. It is surely better that the matter should accumulate, and
the patient spit it up at once, than allow him to be kept from rest,
and teased with coughing and spitting through the whole night. These
palliatives, however, are to be managed with great caution; never
exhibited while the patient enjoys a tolerable share of _natural_ rest.
Small doses should be given at first, and not increased without absolute
necessity. Exhibited in this manner, they cannot do harm; and those who
reject the assistance of a class of medicines, which afford ease and
tranquillity in the most deplorable state of this disease, ought to give
better proofs than have hitherto appeared, that they are able to procure
their patients more valuable and lasting comforts than those they deprive
them of.
The known efficacy of the Peruvian bark, in many distempers, especially
in intermittent fevers; the remission of the symptoms, which happens
regularly every day at a particular stage of the pulmonary consumption,
and in some degree gives it the appearance of an intermittent, joined to
the failure of all other remedies, prompted physicians to make trial of
that noble medicine in this disease. In consequence of these trials, the
bark is now pretty generally acknowledged to be serviceable in hectical
complaints, proceeding from debility, and other causes, exclusive of
ulcerated lungs; but when the disease proceeds from this cause, the bark
is supposed, by some very respectable physicians, always to do harm. I
am most clearly of the first opinion, and perhaps it would not become me
to dispute the second. It may be permitted, however, to observe, that
the most discerning practitioners may be led into a notion, that a very
safe medicine does harm, when it is exhibited at the worst stage of a
disease, in which hardly any medicine whatever has been found to do good.
In every stage of this disease, elixir of vitriol may be used. It is a
pleasant and safe medicine, but particularly efficacious when the patient
is troubled with wasting sweats.
Having, in obedience to your request, delivered my sentiments freely,
you will perceive, that, besides the objections already mentioned to the
person under whose care our friend is at present, I cannot approve of his
being directed to take so many drugs, or of his being detained in town,
at a season when he may enjoy, in the country, what is preferable to all
medicine; I mean air, exercise, and, let me even add, diet.
Had I known of our friend’s complaints earlier, I should have advised
him to have met the advancing spring in the South of France; but at the
season in which you will receive this letter, the moderate warmth, and
refreshing verdure of England, are preferable to the sultry heats and
scorched fields of the South. From the view I have of his complaints, I
can have no hesitation in advising you to endeavour to prevail on him to
quit his drugs, and to leave London without delay. Since he bears riding
on horseback so well, let him enjoy that exercise in an atmosphere freed
from the smoke of the town, and impregnated with the flavour of rising
plants and green herbage; a flavour which may with more truth be called
_pectoral_, than any of the heating resins, or loathsome oils, on which
that term has been prostituted. Let him pass the summer in drinking the
waters, and riding around the environs of Bristol. It will be easy for
him to find a house in the free air of the country, at some distance
from that town; and it will be of use to have an additional reason for
rising early, and riding every morning. It is of the greatest importance
that he continue that exercise every day that the weather will permit: a
little cloudiness of the sky should not fright him from it; there is no
danger of catching cold during the continuation of that movement which
assists digestion, promotes the determination of blood from the lungs to
the surface of the body, and is more salutary in the morning than after
dinner.
With respect to diet, he should carefully observe the important rule of
taking food frequently, in small quantities, and never making a full
meal; that the digestive organs may not be overpowered, or the vessels
charged with too large a quantity of chyle at a time; which never fails
to bring on oppressive breathing, and augments the fever and flushing,
which in some degree succeeds every repast.
Since all kinds of milk are found to disagree with his constitution, that
nourishment, which is in general so well adapted to similar complaints,
must be omitted, and light broths, with vegetable food, particularly of
the farinaceous kind, substituted in its place.
Acids, especially the native acid of vegetables, are remarkably
agreeable and refreshing to all who labour under the heat, oppression,
and languor, which accompany hectic complaints. It is surprising what a
quantity of the juice of lemons the constitution will bear, without any
inconveniency, when it is accustomed to it by degrees; and in those cases
where it does not occasion pains in the stomach and bowels, or other
immediate inconveniencies, it has been thought to have a good effect in
abating the force of the hectic fever.
I have met with two cases, since I have been last abroad, in both of
which there seemed to be a quicker recovery than I ever saw, from the
same symptoms. The first was that of a young lady, of about seventeen
years of age, and apparently of a very healthy constitution. In bad
weather, during the spring, she caught cold: this being neglected in
the beginning, gradually grew worse. When physicians were at length
consulted, their prescriptions seemed to have as bad an effect as her own
neglect. By the middle of summer her cough was incessant, accompanied
with hectic fever and flushings, irregular shiverings, morning sweats,
emaciation, expectoration of purulent phlegm streaked with blood, and
every indication of an open ulcer in the lungs. In this desperate
state she was carried from the town to a finely situated village in
Switzerland, where, for several months, she lived in the middle of a
vineyard, on ripe grapes and bread. She had been directed to a milk and
vegetable diet in general. Her own taste inclined her to the grapes,
which she continued, on finding, that, with this diet only, she was less
languid, and of a more natural coolness, and that the cough, fever, and
all the other symptoms gradually abated. She seemed to be brought from
the jaws of death by the change of air, and this regimen only; and she
returned to her own home in high spirits, and with the look and vigour of
health. The ensuing winter, after being heated with dancing at the house
of a friend, she walked home in a cold night; the cough, spitting of
blood, and other symptoms immediately returned, and she died three months
after.
In the other case, there was not such a degree of fever, but there was
an expectoration of matter, frequently streaked with blood, and evident
signs of an ulcer in the lungs. The person who laboured under these
symptoms, had tried the usual remedies of pectorals, pills, linctuses,
&c. with the usual success. He grew daily worse. He had formerly found
much relief from bleeding, but had left it off for many months, on a
supposition that it had lost all effect; and he had allowed an issue to
be healed, on the same supposition; though he still persevered in a milk
regimen. I mentioned to him the case of the young lady, as it is above
recited. He immediately took the resolution to confine himself to bread
and grapes for almost his only food. I advised him at the same time to
have the issue opened, and to continue that drain for some time; but this
he did not comply with. He forsook, however, the town for the country,
and passed as much of the morning on horseback, as he could bear without
fatigue. He soon was able to bear more; and after about three weeks or
a month, his cough had greatly abated. When he had persisted in this
regimen between two and three months, he had very little cough; and what
he spit up was pure phlegm, unmixed with blood or matter. He has now been
well above a year; and although I understand that he occasionally takes
animal food, he has hitherto felt no inconveniency from it. He passed
the second autumn, as he had done the first, at a house in the country,
surrounded with vineyards. The greater part of his food consisted of ripe
grapes and bread. With such a diet, he had not occasion for much drink of
any kind; what he used was simple water, and he made an ample provision
of grapes for the succeeding winter.
Though I have no idea that there is any specific virtue in grapes,
for the cure of the pulmonary consumption, or that they are greatly
preferable to some other cooling, sub-acid, mild fruit, equally agreeable
to the taste, provided any such can be found; yet I thought it right to
particularize what was used on those two occasions; leaving it to others
to determine, what share of the happy consequences I have enumerated were
owing to the change of air, how much may have flowed from the exercise,
how much from the regimen, and whether there is reason to think, that
the favourable turn in both cases depended on other circumstances,
unobserved by me.
I have now, my dear Sir, complied with your request; and although I have
endeavoured to avoid technical verbosity, and all unnecessary detail,
yet I find my letter has swelled to a greater size than I expected. I
shall be exceedingly happy to hear that any hint I have given has been
serviceable to our friend. If the cough should still continue, after he
has passed two or three months at Bristol, I imagine the most effectual
thing he can do will be, to take a voyage to this place; he will by that
means escape the severity of a British winter. The voyage itself will be
of service, and at the end of it he will have the benefit of the mild
air of the Campagna Felice, be refreshed and nourished by the finest
grapes, and, when tired of riding, he will have continual opportunities
of sailing in this charming bay.