SECTION X.

_The AUTHOR’s PRACTICE._

There are some diseases of which it is difficult to discover exactly the

cause, and consequently it must be so to determine the indication, and to

regulate the method of cure; and yet such diseases are easily cured when

those points are once ascertained. It is not so of the _Tabes dorsalis_.

That disease is known, its cause is known: (it is, as M. LEWIS observes,

a particular sort of consumption, _of which the proximate cause is a

general debility of the nerves_:) the indication is easily formed, and

there can be no great differing in opinions about the essential method of

cure: and yet even the best methods often fail; this is a reason the more

for fixing the particulars with exactness.

A general relaxation of the fibres, a weakness of the nervous system, a

depravation of the fluids, are the causes of this evil. It depends on the

weakening of all the parts; the great requisite is to restore strength

to them; this is the sole indication, which has again its respective

subdivisions, derived from the different parts that are weakened; but

as the same remedies are of service in them all, it is needless to

particularise those subdivisions here, which has been already done in

the course of this work.

Those who are totally ignorant of physic, and who nevertheless talk more

of it than those who understand it, will probably think it very easy

to accomplish this indication; and that with good aliments, and the

cordials with which pharmacy abounds, it is a matter of great facility to

restore strength; while, on the contrary, sad experiences have taught our

greatest physicians that nothing could be more difficult.

“_It is easy_ (says M. GORTER) _to diminish the vital forces, but we

have hardly any thing capable to repair them_[103].” This may easily be

conceived, on reflecting, that aliments and remedies are nothing but

the instruments of which Nature makes use to support itself, to repair

her losses, and to remedy the disorders which happen to the body. And

what is Nature? _The aggregate of the forces of the body harmoniously

distributed._ It is the vital force respectively distributed into the

different parts. When those forces are exhausted, Nature it is that

consequently fails; she is the working architect that no longer executes

her functions; furnish her with materials, as long as you please, she

is in no condition to employ them. You may bury an architect, with

all his building, under stone, wood, and mortar, without an inch of

a wall being thereby repaired. Just so it is with diseases dependent

on the destruction of the vital forces: the aliments repair nothing,

the remedies operate nothing. I have seen stomachs so weakened, that

aliments received from it no more preparation than in a vessel of wood:

sometimes they take place in it according to the laws of their specific

gravities, and when, at length, a new ingestion has, by its weight,

irritated the stomach, they have been known, on a slight effort, to come

away, successively, clearly separate one from another. At other times,

through a long stay in the stomach, they corrupt in it, and are vomited

up just as if they had been suffered to putrify in a vessel of silver

or porcelain. What good can be hoped from aliments of this sort? The

exhaustion of strength is not, indeed, so considerable in all: there are

some in whom the vital forces are only weakened without being totally

destroyed; for these there remains some resource in aliments, and even

in remedies. What remains unperished of Nature draws some benefit from

aliments: as to the remedies, they are to be sought for among those which

have been observed to be fittest for re-animating that principle of the

vital action which is verging to extinction: these are the adventitious

aids, with which the architect is to be enabled to work at his task at

the least expence possible of the strength that is left him: sometimes,

too, they serve, as a spur to a weak horse, that may oblige him to make

an effort to get out of a plunge in a slough; but what expertness, what

prudence are not required, to be able at one cast of the eye, to judge

comparatively the depth of the slough, and the strength of the animal? If

the attempt is beyond his strength, that spur will, it is true, oblige

him to make an effort; but if that effort is not sufficient to disengage

him, and bring him into the good road again, it will only serve to

totally exhaust him.

The weakness which is produced by self-pollution, is attended with such

a difficulty in the choice of restorative remedies, as does not occur in

other cases; which is, that those articles must, with the greatest care,

be avoided, that, bringing with them any irritation, might awaken the

sensual passion. In the animal mechanism, that mechanism so different

from the inanimate, and so little subjected to the same rules, there

is a law, that, when the motions augment, the augmentation is the most

considerable in the parts the most susceptible. In self-polluters those

parts are the generative ones. It is in these parts that the effect of

the irritating remedies will the most sensibly manifest itself; and the

dangerous consequences of this effect cannot be too circumstantially

guarded against in the choice of the means of cure. What then are they

to be? This is what I shall examine, after having particularised the

regimen. In this particularisation, I shall follow the common division of

the six non-naturals, as they are termed, Air, Aliments, Rest, Motion,

the natural Evacuations, and the Passions.

_AIR._

Air has the influence over us, that water has over fish, and even a much

more considerable one. Those who know how great a power the air has, and

who also know that there have been Epicures who could, by the taste,

discover not only the river, but even the part of the river out of which

the fish had been taken;

——_lupus hic Tiberinus an alto_

_Captus hiet, pontesne inter jactatus an amnis_

_Ostia sub Tusci?_

HOR.

such, I say, will easily be sensible of the importance it is of to the

sick, their breathing one air preferable to another. Such as may have

once entered into a room inhabited without being aired; such as may have

kept walking on the side of a marsh in the heats; or have resided in low

places, surrounded, on all sides, with eminences; such as have made a

transition from a populous town to the country; who have breathed the air

at sun-rise or at mid-day, before or after a shower of rain; all these, I

say, will conceive how great an influence the air has over health.

_Temperie cœli corpusque, animusque juvatur._

OVID.

The sick or weakly have, more than others, need of a good air; it is a

remedy that acts, and perhaps the only one that does so, without the

concurrence of our nature’s vital forces, to which it gives no trouble,

and is no draught upon them: and for that very reason, it is of the

greatest importance not to neglect it. That air which is the properest

for a general atony or relaxation, is a dry, temperate air: too moist, or

too hot an air are pernicious. I know one labouring under a disorder of

this kind, whom great heats throw into a total faintness or exhaustion

of strength, and whose state of health varies in summer, according to

the vicissitudes of days less hot or less cold. A cold air is much less

to be dreaded; and it is necessarily, and according to Nature, that

it should be so. Heat relaxes still more the fibres which are already

but too relaxed, and dissolves still more the humors already too much

dissolved: Cold, on the contrary, is a remedy against these two evils.

When the Caribes are attacked with the palsy, after, and in consequence

of those dreadful convulsions of the cholic, to which they are subject,

when they cannot be sent to the warm-baths in the north of Jamaica, the

other expedient is to send them to some place of a colder air than that

of their country; and this bare change of air has always manifestly a

favorable effect.

Another essential quality of the air, is, that it should not be

impregnated with noxious particles: that it should not have lost, by its

stay or stagnation in inhabited places, that kind of reviving quality

which constitutes all its efficacy, and which might be called its vital

spirit as necessary to plants as to animals; and such is the air one

breathes in a country, open, airy, interspersed with the verdure of

herbs, bushes, and trees.

“Let the sick, says ARETÆUS[104], live near meadows, fountains, rivulets;

the freshness they exhale, and the gaiety which those objects inspire,

fortify the mind, restore strength to the body, and give new life.”

The air of the town, continually sucked in and let out again, continually

crouded with foul vapors or infected exhalations, combines at once the

two inconveniences of possessing less of that vital spirit, and of being

big with noxious particles.

On the other hand, the air of the country is enriched with the two

opposite qualities. It is a pure virgin air, an air impregnated with all

that is the most volatile, the most agreeable, the most cordial, in the

effluvia of the plants, and in the vapor of the earth, which is itself

very salubrious.

But it would be of no use to fix on a place with a good air to live in,

if one does not chuse to breathe it. The air of rooms, or chambers, if it

is not continually renewed, is nearly the same in all. It can hardly be

called a change of air, from a close room in town to a close room in the

country. There is no enjoying the benefits of a healthy atmosphere but

in the open fields. If infirmities, or weakness, hinder the procurement

of that benefit, by the going or the being carried thither, at least the

air of the room, or chamber, should be renewed several times in a day;

not simply by opening a door or a window, which renews it only a little,

but in letting into the chamber a torrent of fresh air, by opening, all

at once, two or three different and opposite inlets. There is no disorder

that does not require this precaution; but it is requisite not to expose

the sick person to the force of the current of air, and it is always

very easy to place him out of the power of it.

It is also extremely important to breathe the morning air. Those who

deprive themselves of it, for the sake of remaining in a stifling

atmosphere between four curtains, voluntarily renounce the most

agreeable, and perhaps the most strengthening of all remedies. The

freshness of the night will, by morning, have restored to the air all

its vivifying principle; and the dew which evaporates, by degrees, after

having loaded itself with all the balm of the flowers on which it will

have dwelt, renders the air truly medicinal; you solace yourself in a

vaporous bath of the essence of plants, the air of which you continually

draw in, and of which nothing can be equivalently substituted to the good

effect. The ease, the refreshment, the strength, the appetite, which we

may feel procured by it, for the rest of the day, are a proof in every

one’s power, and a stronger one than all that I could add.

I have, very recently, seen the most sensible effects of it on some

valetudinarians, and especially on such as were hypochondriacs: these

experienced, in the clearest manner, that if they indulged themselves in

breathing the morning air, they were always the more chearful, the more

lively, for the rest of the day; and those who passed that rest of the

day with them, could not, by that mark, be mistaken as to the hour of

their rising.

It is easy then to conceive, how important this effect is for those who

are affected, in any degree, with the _Tabes dorsalis_, who are so often

hypochondriacal; and in whom a return of chearfulness is alone sufficient

to furnish an unquestionable sign of a general amendment of health.

_ALIMENTS._

In the choice of Aliments I would recommend the two following rules:

_First_, To take no aliments, but what, under a small volume, contain

a great deal of nourishment, and are of easy digestion. This is an

aphorism of SANCTORIUS: _Coïtus immoderatus postulat cibos paucos et boni

nutrimenti_[105].

_Secondly_, To avoid all that have any acridity.

It is of great importance to restore to the stomach all its strength; and

nothing is more destructive of the forces of the animal fibres than an

over-stretch; so that the dilatation of the stomach by an over-abundance

of aliments would daily weaken it: besides, if it is too full, weak

persons feel a state of uneasiness, of anguish, of debility, and

melancholy, that augments all their disorders. Both these inconveniences

are prevented by the choice of aliments, such as I have recommended, by

taking of them a little at a time, and frequently. It is essential that

they should afford an easy nutrition: the stomach is in no condition

with persons in their state, to conquer any thing hard of digestion: its

action, which is extremely faint and languid, would be totally destroyed

by aliments too indigest, or of a nature to diminish its strength.

Upon these principles may be formed a catalogue of such as are proper

in this case, and of those which should be excluded. In this last class

are all flesh-meats naturally hard and indigestible; such as pork; all

flesh of old animals; all that has been hardened by salt or smoak, a

preparation which, at the same time, renders them acrid: all that are

too fat, or greasy; a quality which, in any other subject of aliment

whatever, relaxes the fibres of the stomach, diminishes the action,

already too weak, of the digestive juices; they remain indigested,

dispose to obstructions, and acquire, by their stay in the stomach, an

acridity, which, breeding a continual irritation, gives inquietude,

pains, want of rest, anguish, feverishness. In short, there is nothing

which persons of a weak digestion ought more carefully to avoid, than

fat or greasy food. Unfermented pastry-ware, especially when kneaded up

with fat, is another sort of aliment much above the strength of a weak

stomach. Flatulent garden-stuff is also very noxious, by producing a

turgescence that distends it, and at the same time cramps the circulation

in the neighbouring parts; such, in general, are all forts of cabbage, of

leguminous pulse, and such plants as have a taste and smell remarkably

acrid, which last quality renders them noxious, independently of their

flatulency.

Fruits, which are so salutary in acute and inflammatory distempers,

in obstructions, especially those of the liver, and in several other

disorders, are never proper in this case; they weaken, relax, and

enervate the strength of the stomach; they augment the attenuation of the

blood, already too aqueous; and ill digested, they ferment in the stomach

and intestines, and this fermentation sets free an astonishing quantity

of air, which produces enormous distensions, that absolutely disturb

the course of the circulation. I have, in a woman, seen this effect: so

considerable, for her having eaten too many cherries and currants, four

and twenty hours after a very easy delivery, that her belly was stretched

to such a degree as to become livid; she appeared lethargically dozing,

and her pulse was almost imperceptible. Fruits also leave, in the first

passages, a principle of acidity, apt to occasion several dangerous

symptoms, so that it is necessary to abstain almost totally from them.

Crude garden-stuff, vinegar, verjuice, have the like inconveniences, and

deserve the like exclusion.

But though the catalogue of prohibited articles of food be a long one,

that of the allowable ones is still longer. It comprehends the flesh

of all young animals, fed in healthy places, and wholesomely fed; such

especially is that of veal, lamb, or young mutton, young beef, fowl,

pigeon, turkey, partridge. Lark, thrushes, quails, and other wild fowl,

without being absolutely forbidden, are, however, attended with such

inconveniences, as not to allow of their entering into daily food. Fish

is under the same restriction.

But it is not enough only to chuse your flesh-meats with due discernment,

but they must also be properly prepared. The best way is to roast them

by a gentle fire, so as to preserve their gravy, and not dry them up

too much; or to stew them slowly in their own juices. The flesh-meats

that are boiled in too much water, give out to it all that they have of

juiciness, and remain incapable of nourishing: thus they often become

nothing but fleshy fibres deprived of their nutritious juice, and equally

insipid to the taste, and indigestible to the stomach. It is common

for weak persons, and even for such of them as are above all suspicions

of being too nice, not to be able to eat of them without their stomach

being disordered by them. The more tender flesh meats are, the less they

can bear this preparation, which, in the case of sick people, ought

to be reserved for extracting by it from hard or tough meats whatever

nourishment they may contain.

Yet whatever preparation may be carefully employed upon the flesh meats,

there are persons who cannot digest them: and to them it becomes as

necessary to give them the broth, extracted by a gentle boiling; but as

that has too great a tendency to putrefaction, it must be accompanied

with some bread, and a dash of lemon juice, or a little wine: such a

mixture is of the most desirable, in that case, for nourishment. Some

lobsters boiled, and crushed in the broth, heighten its relish, and make

it perhaps more strengthening; but they have the double inconvenience, of

being somewhat heating, and of rendering the broth more susceptible of a

quick corruption; so that on these two accounts it is good to be on one’s

guard.

Bread and garden-stuff have not the advantage of containing at once a

great deal of nourishment in a small quantity; but the use of them,

especially of bread, is indispensably necessary, to prevent, not only

the distaste which the use of a regimen consisting totally of animal

meats would not fail of producing, but also that putridity which would

be the consequence of them, if not mixed with vegetables. Without this

precaution, there would soon a spontaneous alkali disclose itself in the

first passages, with all the disorders consequential thereto. I have

seen terrible accidents produced by this regimen, in weak persons, to

whom it had been prescribed. One of the commonest symptoms is, thirst;

they are obliged to drink, and drink weakens them: besides, the liquid

they drink does not easily mix with the humors of the body, as that

mixture depends on the action of the vessels, which is very languid; and

if, unfortunately, as is not unfrequent with those who do not use much

motion, the action of the kidneys diminishes, the liquids pass into the

cellular membrane, and immediately form œdematous swellings there, and,

at length, dropsies of all kinds.

These dangers are prevented by a due alliance of the vegetable regimen

with the animal. The best garden-ware are, the tender roots, herbs of the

endive kind, artichoaks, asparagus. There are some others, which, though

tender, are of disservice; being too cooling, they deaden the strength of

the stomach.

Farinaceous grains, prepared and boiled in cream, with flesh broth,

are an aliment not to be slighted, as it combines every thing that is

nourishing in the two kingdoms animal and vegetable, while their mixture

prevents the danger from each aliment given single; the broth hinders

the meal from turning sour, the meat the broth from putrefying. By

reading, with a little reflexion, observant Naturalists, it may easily be

perceived, that distempers are more malignant in the north of Europe than

in its middle regions: may not that be owing to more flesh meats being

eaten in proportion than vegetables?

What I have above said of fruits, need not, however, hinder, where the

stomach still preserves something of its strength, one’s indulging one’s

self, now and then, with a small quantity of the best chosen for the

sort, and for ripeness; the most watery are those which are the least

proper.

Eggs are an aliment of the animal kind, and an aliment extremely useful;

they strengthen greatly, and are easy of digestion, provided that they

have but little or even no preparation by fire, for if the white is

once hardened it does not dissolve again; it becomes heavy, indigest,

and unnutritious: it might then be the aliment of those who digest too

quickly, and not of those who have rather no digestion. The best way of

eating them, is just as they are new laid from the fowl, without any

preparation, or in the shell, after only three or four dips in boiling

water, or stirred into warm, and not boiling broth.

Conclusively; there remains to mention the aliment from milk; which

unites all the qualities that can be desired, without having any of the

inconveniences that are to be dreaded. It is the most simple, the most

easily assimilable, and the quickest restorative: all prepared as it is

by nature, it needs no risk of spoiling it by an artificial preparation:

like the broth of flesh meats it nourishes, but is not susceptible of

putridity; it prevents thirst, it supplies the place of meat and drink;

it keeps up all the secretions; it disposes for tranquil sleep; in short,

it fulfils all the indications that present themselves in this case. M.

LEWIS attests its having produced the best effects[106]. Why then is not

it always employed, always substituted to the other aliments? Answer. For

a reason which is peculiar to it, which unnaturalises its effect, and

which makes it sometimes produce a very different one, from that which

might be hoped from it, or reasonably expected.

This reason is, that sort of decomposition to which it is subject. If the

digestion of it is not very quick, if it stays too long in the stomach,

or if, without too long a stay there, it meets in it with matters of a

nature to hasten that decomposition, it undergoes in the stomach all

the changes, which fall under our observation, out of it. The butyrous,

the caseous, the serous parts separate; the whey sometimes occasions a

quick diarrhœa; sometimes it passes off by the urinary passages, or by

perspiration without nourishing; the other parts, if they stay in the

stomach, are not long before they trouble it, cause uneasy sensations,

bloatedness, loathings, cholics; and if one is not immediately affected

by them, it is because they will have passed into the intestines, where

they may, it is true, remain some time without a sensible prejudice,

but they acquire there a singular acridity, and after a certain time

they produce mischiefs which the delay will not have rendered the less

dangerous; and, indeed, it may be established for a law, that should

render one extremely circumspect in the prescription of it in dangerous

cases, that if it is an aliment of which the digestion is the easiest,

it is also that of which the indigestion is the most noxious. We have

already mentioned the difficulties that BOERHAAVE found in the use of

it; but however great they may be, the advantages to be drawn from it are

so considerable, that it is worth while to study all possible means for

surmounting them, and happily such means there are. They may be ranged

under two classes; attentions to the regimen, and the medicines. Of these

last I shall refer the discussion to one of the following articles.

The attentions to the regimen are, first, the choice of the milk. From

whatever species it may be determined to procure it, the female that

furnishes it should be healthy, and live regular: Secondly, during the

time of taking it, all aliments should be avoided that can turn it sour;

such are all fruits, raw or prepared, and in general every thing that

is acid: Thirdly, it must be taken at times very distant from other

aliments; it not taking kindly any mixture: Fourthly to take only a

little of it at a time: Fifthly, all the while to take care of keeping

the breast, the abdominal region, and the legs extremely warm: and,

above all, Sixthly, (for without this precaution all the others would be

useless,) to be very moderate as to the quantity of even the best chosen

aliments. During this recourse to milk, there should be no trouble given

to the stomach; the smallest over-load, the slightest indigestion, leaves

in it a principle of corruption, which presently turns the milk, and

may, of the most wholesome of aliments, make a poison sometimes very

violent, and, at least, almost always infallibly one, in a greater or

less degree.

Another question occurs: What is the milk that merits preference? In

answer to this, I will not enter into an examination of the various

sorts of milk; this would be over-lengthening my work by an adventitious

subject; for satisfaction in which there are many recourses extant, and

perhaps none better than a dissertation, now indeed out of print, of the

late Mons. d’APPLES, M. D. and Professor of Greek and Morality in this

College[107].

Now-a-days there are hardly any kinds of milk used but of the female

breast, or of asses milk, the goat’s, or the cow’s. Each has its

different qualities: it is the comparison of these qualities, and of

the indication presented by the disorder, that should determine the

choice from among them. There are few cases in which milk from the cow

may not be succedaneously used for all the others. That from the female

breast is generally believed the most strengthening: it is the notion

of the greatest masters in the art, and yet this opinion bears upon a

ruinous foundation, which is, the women’s making use of animal food,

without considering at the same time that the preference is constantly

given to the milk of a hale robust nurse from the country, who eats no

flesh-meats, or, at least, very little, and who lives only upon bread and

vegetables. I believe, however, that there are cases in which it may be

tried with success. The noble cures operated by the use of it, leave no

doubt of its efficacy; but there is one inconvenience which is peculiar

to it, which is, that it must be taken immediately from the breast that

furnishes it: this is a precaution, of which GALEN has already taken

notice of the necessity, and, in ridicule of those who would not care to

confine themselves to it, he refers them “_like asses, to asses milk_.”

But in the case of recourse to the female breast for lactation, might not

the vessel of conveyance excite those desires which the main point is to

keep under? Might it not expose the patient to the temptation of renewing

the adventure of that Prince, the story of whom CAPIVACCIO has preserved

to us? He had two nurses given him, whose milk produced so good an

effect, that he put them both into a condition of supplying him, at the

end of some months, with new milk on a fresh account, if he should happen

to need it.

It is thought that asses milk has the nearest analogy to that of the

female breast; but, if I may be allowed to say it, this assertion is

rather matter of opinion than of experience. It is the most serous, and,

from that very quality, the most laxative. It is a most pernicious error

the imagining it the most strengthening. Daily observations demonstrate

the contrary, and prove not only that it is not the most efficacious,

but that it is, perhaps, the least so. I have rarely seen any good

effects from it; sometimes I have seen bad ones, and am not the only

one that has seen them. M. DE HALLER, writing to me, says, “It appears

to me, that this same asses milk rarely does what it is desired to do.”

Now, the inutility of a pretended remedy, in disorders where the hopes

of a cure are founded on it, is one of the most grievous defects. M.

HOFFMAN advised it in cases where there were at once an exhaustion and a

desire[108].

Before I quit this subject of Aliments, I ought to conclude with the

counsel of HORACE, to avoid mixtures.

——_nam variæ res_

_Ut noceant homini credas, memor illius escæ_

_Quæ simplex olim sederit, at, simul assis_

_Miscueris elixa: simul conchylia turdis;_

_Dulcia se in bilem vertent; stomachoque tumultum_

_Lenta feret pituita._

To sense it is obvious enough, without any need to insist on this advice,

how impossible it is for very different aliments to undergo, within the

same time, a perfect digestion: this mixture it is which is one of the

causes that ruin the healthiest constitutions, and is mortal to weak

ones: it cannot be too carefully avoided.

Another attention equally necessary, and almost equally neglected, is,

a thorough mastication. This is a help to digestion, of which even the

most vigorous stomachs cannot be long deprived, without a notable decline

or diminution; and without which the digestion in weak ones is extremely

imperfect. Nothing but a long and attentive observation could satisfy one

of the infinite importance to health of a careful mastication. I have

seen the most stubborn diseases of the stomach, and the most inveterate

languors, dissipated singly by this attention. On the other hand, I have

seen persons in good health fall into infirmities, when their teeth,

being damaged, no longer suffered them to employ any but an imperfect

mastication; nor recovered they their health, till, after a total loss of

their teeth, their gums acquired such a hardness as to enable them to

supply their function.

So many particulars, so many precautions, so many self-denying

privations, will seem very fit to verify this line of M. PROCOPE,

_Vivre selon nos loix c’est vivre miserable._

_By physic’s laws to live ’s a wretched life._

But is there any paying too dear for health? How amply are you satisfied

for the sacrifices you make, by the enjoyment of it, and by the pleasures

it throws into all the moments of your life? “Without health (says

HIPPOCRATES) there can be no enjoyment of any earthly good; honors,

riches, and all other advantages are of no avail[109].”

Besides, these sacrifices are much less than it is commonly imagined they

are. I could quote many witnesses, to whom, after just the first days,

it no longer cost them any pain to renounce the variety and savoriness

of rich viands, for the sake of a simplicity of regimen: which is what

nature points out, and is the most pleasing to well constituted organs.

A healthy palate, which has all the sensibility that it ought to have,

can have no relish but for plain meats; made dishes and high sauces are

insupportable to it, while, in the least savory aliments, it finds a

relish, and a variety of relish, which escape the depraved, worn out,

or furred organs of taste: so that those who return to the simplicity

of nature in their aliments, whether it is for their health, or from

convinced reason, or from a contracted distaste to high eating, may be

assured, that so fast as they shall recover their health, they will find

in plain aliments a delight of the palate which they did not suspect

in them. A fine ear discerns the slight difference between two notes,

which will have escaped a less sensible ear: just so it is with the

nerves of the organs of taste; when they are in exquisite order, they

perceive the slightest varieties of savors, and are sensible to them;

the water-drinkers meet with waters as flattering to their taste as the

most exquisite Falernian could be to drinkers of wine, and others as

disagreeable to them, as to those the pricked wines of Brie.

But even were there not rational hopes of pleasure in the plain regimen,

and I am sure it is not hard to accommodate one’s self to that which I

have indicated, the satisfaction one must feel, the consideration that,

in submitting to it, one is fulfilling a duty to one’s self, must be a

greatly pressing motive, as well as a justly flattering reward, for those

who can know all the value of the being well with one’s self.

The liquid part of aliments, or the drink, is an article of the regimen

almost as important as the solid, or eating.

All liquids should be forbidden that can augment the weakness or

relaxation, that can diminish the little that remains of the digestive

powers, that can convey any acridity into the humors, or dispose the

nervous system, already too irritable, to a greater mobility. All hot

waters have the first defect, of weakening or relaxing. Tea, with that,

has also all the others: coffee has the two last; so that one ought

rigorously to abstain from them. The author of a work superior to all

encomiums, and of which those who interest themselves in the progress of

the medical art, wait with the greatest impatience for the continuation,

has presented such an account of the danger of these two liquids, as

might very well disgust or deter from the use of them those who find the

greatest pleasure in them[110].

Spirituous liquors, which, at the first view might appear serviceable,

for that they operate precisely the contrary of hot water, of which

they really diminish the danger, if added to it in a small quantity,

are, however, attended with other inconveniences that authorise their

rejection, or at least restrain them to an extremely rare recourse.

Their action is too violent, too transient; they irritate more than

they strengthen, and if they sometimes strengthen, the weakness which

succeeds is greater than before a recourse to them: besides, they give

to the _papillæ_ of the stomach a hardness that robs them of that degree

of sensibility necessary to the creation of an appetite, and take from

the liquids that degree of fluidity which they ought to have in aid of

that sensation; and, indeed, the great drinkers of spirituous liquors are

strangers to it. “Those (says the illustrious author whom I have just

now quoted) who every day drink strong liquors after their meals, by way

of remedying the defects of digestion, could hardly find a more likely

method for accomplishing just the contrary to what they propose, and to

destroy the powers of digestion.”

The best drink is water from the purest spring, mixed, equal parts, with

a wine neither too heady nor too acid: the heady kinds sensibly irritate

the nervous system, and produce in the humors a transient rarefaction,

of which the effect is an extension of the vessels, that leaves them

afterwards the laxer for it, and to augment the dissolution of the

humors: the acid kinds weaken the digestions, irritate, and procure

over-copious urines, which exhaust the patients. The best are those

which have the least of spirit and of salt, the most of terrestrial and

oily, which constitutes what is called racy, generous wines: such are

the red wines of Burgundy, of the Rhône, of Neufchâtel, and a few kinds

in this country, (Lausanne,) the old white wines of Grave, the choice

ones of Pontac, the wines of Spain, Portugal, the Canaries, and, where

procurable, those of Tockay, superior perhaps to those of all the world

besides, both for salubrity and deliciousness to the taste. As to common

use there are none preferable to those of Neufchâtel.

In places where good water is not to be come at, it may be corrected by

filtration, by a hot iron, or an infusion of some agreeable aromatics,

such as cinnamon, aniseed, lemon-peel.

Common beer is noxious. Mum which is properly an extract from grain, both

nourishing and strengthening, may be of great use: rich of spirit, it

enlivens as much as wine, and is more nutritious; it may serve for meat

and drink.

Among the useful drinks, may be ranked chocolate, which belongs perhaps

more properly to the class of solid aliments; the cocoa contains a great

deal of nutritious substance, and the mixture with it of sugar and

aromatics corrects any detriment from its oiliness. “Chocolate made with

milk (says M. LEWIS) in such quantities as to pass easy off the stomach,

is an excellent breakfast for a tabid constitution. I knew a child twelve

years old who was in the last stage of a consumption, when given over

by a Physician, recovered by the mother’s giving her chocolate only,

in small quantities, often repeated. Indeed it is an aliment that for

weak constitutions cannot be too much recommended[111].” Be it, however,

remarked, that there are some to whom it might prove very pernicious.

One general attention to be observed is, that too great a quantity of any

drink whatever should be avoided: it weakens the digestions by relaxing

the stomach; by drowning the digestive juices, and by precipitating the

aliments before they are well digested; it relaxes all the parts, it

dissolves the humors; it disposes to urines and to sweats that exhaust

the patients. I have seen disorders produced by an atony, considerably

lessened, by no other means of assistence, than by a retrenchment of a

part of the liquids for drinking.

_SLEEP._

What is to be said of sleep, may be reduced to three points; its

duration, the time of taking it, and the precaution necessary for a quiet

undisturbed enjoyment of it.

In grown persons seven hours of sleep, or at the most eight, are

sufficient for any one: there is even a danger in sleeping longer, and

in remaining longer a bed, which throws one into the same disorders as

an excess of rest. If any could wish to indulge it longer, it might be

those who give themselves a great deal of motion, and of violent motion,

during the day time; but it is not those who practise such indulgence;

on the contrary, it is those who lead the most sedentary life. Thus that

term ought never to be exceeded, unless one should be fallen into such

a degree of weakness as not to have the strength necessary left for the

being long up; in which case, however, one should try to keep so as long

as possible. “The more moderate the quantity of his sleep (says Mr.

LEWIS) the sweeter and more invigorating will it be.”

It stands demonstrated, that the air of the night is less healthy than

that of the day, and that the weakly sick are more susceptible of its

influences in the evening than the morning; as then, during our sleep,

we are confined to a small part of the atmosphere, which our bodies also

would not fail of corrupting; it is to sleep that that time should be

appropriated, in which the air is the least healthy, and in which the

being up in it would be the most pernicious; so that it is best to go

to bed early, and rise early. This is a precept so commonly known, that

it may appear trivial to recall it to mind; but it is actually so much

neglected, the consequence of it seems to be so little felt, though

infinitely greater than it is believed to be, that it is very allowable

to suppose it unknown, and to re-inculcate it by an insistence on its

importance, especially to valetudinarians.

Mr. LEWIS gives it for his opinion, “That if a patient lies down at

ten o’ clock, which hour he should never exceed, he ought to rise in

the summer-time at four or five, in the winter at six or seven, under

an absolute prohibition of an indulgence in bed in the morning.” He

recommends even the forming a habit of getting up after one’s first

sleep, and avers, that uneasy as this custom might be at the first, it

would soon become easy and agreeable[112]. A number of examples attest

the salutariness of this advice: there are many valetudinarians who

feel themselves light and well on waking out of their first sleep, and

who experience a laborious restlessness on yielding to the temptation of

going to sleep again: they are as sure of passing a good day of it, if,

at whatever the hour be of their waking out of their first sleep they

immediately get up, as of passing it disagreeably, if they give way to

the second.

Sleep is not tranquil but where there are no causes of irritation: which

ought therefore to be carefully prevented. Three of the most important

attentions are;

_First_, Not to be in a hot air, and to be neither too much nor too

little covered.

_Secondly_, Not to have the feet cold at lying down; an accident common

to weak persons, and which is, for many reasons, hurtful to them. The

rule of HIPPOCRATES should be scrupulously observed, _To sleep in a cool

place, taking care to cover one’s self_[113].

_Thirdly_, And what is yet more important, not to lie down upon a full

stomach: nothing disturbs more the sleep, nor contributes more to render

it disquieting, painful, heavy, or overwhelming, than a laborious

digestion in the night. Depression of spirits, weakness, disgust,

weariness, incapacity of thought or of application to any thing the next

day, are the inevitable consequences.

——_vides ut pallidus omnis_

_Cœna desurgat dubia? Quin corpus onustum,_

_Hesternis vitiis animum quoque prægravat una_

_Atque affligit humo divinæ particulam auræ._

HOR.

On the contrary, nothing is more efficacious toward procuring a sweet,

calm, uninterrupted, refreshing sleep, than a light supper. Freshness,

agility, gaiety, are, the ensuing day, its necessary consequences.

_Alter, ubi dicto citius curata sopori_

_Membra dedit, vegetus præscripta ad munia surgit._

Ibid.

“The time of sleep (says Mr. LEWIS, with great reason) is that of

nutrition, and not of digestion.” Accordingly he requires of his patients

the greatest severity as to their supper: he prohibits to them, and

never was a juster prohibition, all flesh-meats at that meal; he allows

them nothing but a little milk, and some bread sippets, and that two

hours before they go to bed that the first digestion may be over before

they lie down to sleep. The Atlantics, who were strangers to an animal

diet, and who never ate any thing that had life, were famous for the

tranquillity of their sleep, and hardly so much as knew what dreams were.

_MOTION._

Exercise is a point of absolute necessity. To the weak it is a pain to

take it; and if they have any inclination to melancholy or dejection

of spirit, it is not easy to determine them to motion; and yet nothing

is more apt to augment all the evils that proceed from weakness, than

inactivity; the fibres of the stomach, of the intestines, of the vessels,

are lax; the humors every where stagnate, because the solids have no

longer the strength to impress on them the necessary motion: thence

are generated lodgments of matter, choaked up passages, obstructions,

extravasations; coction, nutrition, the secretions, do not proceed; the

blood remains aqueous, the strength diminishes, and all the symptoms of

the disorder increase. Exercise prevents all these evils, by augmenting

the force of the circulation; all the functions execute themselves as if

there existed in the body a real strength for it, and this regularity

of the functions does not fail soon to give it, so that the effect of

motion is to supplement the vital forces, and to restore them. Another

of its advantages, independent of the augmentation of circulation, is

its enabling one to enjoy an air always new. A person that does not stir,

soon corrupts the air which surrounds him, and becomes noxious to him:

whereas a person in action is continually changing it. Motion may often

supply the place of remedies, but all the remedies in the world cannot

supply the place of motion.

The fatigue of the first days of attempting it, is a rock against which

the faint heart of many of the sick is apt to split; but if they had the

courage to conquer this first obstacle, they would soon be experimentally

sensible, that to this case especially it is that that proverbial saying

is truly applicable, _Il n’y a que les premiers pas qui coûtent_: “It

is only the first steps that are hard to take.” I have been myself

astonished at seeing to what a degree those who had not been disheartened

at the first, acquired strength by exercise. I have seen persons fatigued

with one turn in a garden, arrive, in a few weeks, at being able to take

a walk two leagues, and be the better after it.

The exercise of walking on foot is not the only favorable one. For

persons extremely weak, for such as have a complaint of their bowels

or breast, riding on horseback is even better: but in a still greater

weakness, the motion of a carriage, if not too easy an one, is

preferable. When the weather does not allow of going out, some means

of motions should be contrived, in the house, some not too laborious

occupation, or some exercise of play; such, for example, as the

battledore and shuttle-cock, which diffuses through the whole body an

equable motion.

A return of appetite, of sleep, of chearfulness, are the necessary

consequences of motion; but the precaution should be observed, of not

taking any thing of a violent motion immediately after a meal, and not to

eat while warm from exercise; which should be taken before a meal, with

allowance of some moments of rest before the sitting down to it.

_EVACUATIONS._

The evacuations are apt to be disordered along with the other functions,

and their disorder increases that of the whole machine; it is then of

importance to give attention thereto, in order to the earliest remedy.

The evacuations which principally require observation are, the stools,

the urines, the perspiration, and the saliva. The best way to keep them

in due order, or to bring them to the point at which they ought to be

at, is to govern one’s self by those precepts which I have laid down on

the other objects of regimen: when those are heedfully attended to in

practice, the evacuations, whose greater or the less regularity is the

barometer of the better or worse state of digestions, proceed regularly

enough. That evacuation which it is of the most importance to favor, as

being the most considerable, is perspiration, which very easily goes

out of order, in weak persons. It may be aided by having the skin very

regularly rubbed with a flesh-brush, or a flannel; but when it is very

languishing indeed, there is not a surer way to restore it, than to put

the whole body immediately into woollen covering. And yet care should be

taken to avoid too warm a dress, for fear of sweating, which is always

detrimental to perspiration; the forced strainers remain the weaker,

and perform their functions the worse: too cool a dress is also to be

shunned, as that is an enemy equally to all cutaneous evacuations. The

part which every person, and especially the weak, ought to keep the

warmest, is the feet. This easy precaution would never be neglected,

if the importance of it to the preservation of the whole machine was

sufficiently known. Frequent catching cold of the feet disposes to the

most terrible chronical diseases. There are many on whom it immediately

produces bad effects. But those especially who are subject to disorders

of the breast, to cholics, or to obstructions, cannot too much guard

against these dangers. Those priests who used to walk bare-footed on the

pavement of the temples were often attacked with violent cholics.

The _saliva_ often is an over abundant secretion in weak persons; which

is owing to a relaxation of the salivary organs. Now if the patients

spit out continually this saliva, thence result two evils; the one,

that they exhaust themselves by this evacuation; the other, that this

humor, so necessary to the work of digestion, which without it operates

but imperfectly, fails, and thereby renders it laborious and defective.

I have already sufficiently explained myself on the dangers of a bad

digestion, not to need here much insistence on those incident to an

evacuation, on which the digestion so essentially depends. For this

reason it is that Mr. LEWIS forbids smoaking to his patients. Smoaking,

among its other inconveniences, disposes to an abundant salivation, by

the irritation it produces on the glands which furnish this secretion.

Might not the inhalation from one person to another, which I have

precedently mentioned, be here recalled to mind as one of the means of

cure? CAPIVACCIO had judged it of use to the person under his care,

that should lie between the two nurses that suckled him; and it is very

probable that the inhalation of their atmosphere contributed perhaps as

much as their milk to restore his strength.

ELIDÆUS, cotemporary with CAPIVACCIO, and preceptor to FORRESTUS, who has

preserved to us this observation[114], advised a young man, who was in

a _marasmus_, to asses milk, and to have his nurse lie in the same bed

with him, who was a woman extremely healthy, and in the flower of her

age: this advice had the greatest success; nor was the compliance with

it discontinued till the patient owned he could no longer resist the

inclination grown upon him, to make an illicit use of the strength that

was returned to him. A remedy, on the foot of this utility by inhalation

might be preserved, and yet the danger be prevented by not mixing the

sexes.

_The PASSIONS._

The intimate union of the soul and body has been precedently mentioned;

how great the influence is of the well-being of the first, over the last,

cannot have escaped comprehension; the sinister effects of melancholy

have been pointed out; so that it is almost needless here to add, that

too great care cannot be taken to avoid the unpleasant sensations of the

soul, and that it is of the highest consequence to procure for it none

but the most agreeable ones; indeed in all distempers, but especially

in those, which, like the _tabes dorsalis_, of themselves dispose to

sadness, a sadness which, by a vitious circle, considerably augments

those distempers. But (and this makes one of the difficulties of the

cure) it often happens that the patients take a kind of pleasure in

this symptom of their disorder, and there is no prevailing on them to

determine upon making any efforts to get the better of it. Besides, not

to deceive ourselves, we must not imagine that it is enough to prescribe

to a person to be chearful, for him to be so. Mirth is voluntary.

Laughing is no more to be commanded than it is to be forbidden. A man can

no more help his being sad, than having a fit of a fever, or the torture

of a tooth-ach. All that can be required or expected of the patients

is, that they will no more refuse their yielding to accept or try the

remedies prescribed to them against their melancholy, than they refuse

yielding to other remedies. Now the remedies are not so much, in this

case, company, (we have already observed that it was displeasing to them,

for particular reasons) as a variety of situations. A continual change

of objects for a succession of ideas that diverts them, and this is what

they need.

Nothing can be more pernicious to persons inclined to deliver themselves

up to one idea, than inaction, or want of occupation. But, above all,

nothing is worse than that for the case here treated of: the patients

cannot too much avoid idleness, and the being too much left or abandoned

to themselves. Rural exercises, or employment, comprehend the most

powerful diversion. M. LEWIS advises, “that the sick should, if possible,

see none but those of their own sex;

“_Nam non ulla magis vires industria firmat_

_Quam Venerem et cæci stimulos avertere amoris._

VIRG.

“that they should never be absolutely alone; that they should be kept

from giving themselves up to their own reflexions; that they should be

diverted or kept from reading, or any occupation of the mind; all these,

(as he observes,) being so many causes that exhaust the spirits and

retard the cure.” I should not, however, be for totally debarring them

from all reading. It might be enough to forbid their reading for too long

a time at once, if it were but on account of the weakness of their eyes;

or all reading that should require too much application, but especially

and severely any kind of reading that might recall to their mind ideas,

or to their imagination objects, of which it were to be wished they

should lose the remembrance: but there are subjects which, without much

fixing the attention, and without recalling dangerous images, might

agreeably divert, entertain, and prevent the terrible dangers of a

wearisome idleness.

_REMEDIES._

I shall follow the same order as in the preceding article. I shall point

out the pretended remedies, which are to be avoided, before I enter

on the mention of those which are the eligible ones. I have already

taken notice of a first class of those which should be excluded, the

irritating, the heating, the volatile medicines. There is a second one,

of a very opposite nature, and equally noxious, and that is evacuatives.

I have already observed, that sweats, an over-secretion of the _saliva_,

and too copious urines, exhausted the patient. I shall not then repeat

my premonition against those evacuations: it is consequentially clear

enough, that all the medicines which excite them, should be banished. It

remains then to examine the propriety of bleeding, and of the evacuations

of the _primæ viæ_. The curative indications being to restore strength,

now, in order to judge whether they are proper, it is but to know whether

they can be expected to answer that indication. I shall not be long

on this head. There are two cases in which bleeding restores strength;

in all others, it diminishes it. The first is, when there is too great

an abundance of blood; this is not the case in consumptions; or when

the blood has acquired an inflammatory inspissation, which, rendering

it unfit for its uses, quickly destroys the vital forces; this is the

disorder of the vigorous, of those who have rigid fibres, and a strong

circulation: our sick are in precisely the contrary case; bleeding then

cannot but be hurtful to them. “Every drop of blood, (according to M.

GILCHRIST,) is precious to persons in a consumption: the assimilating

power that repairs it being destroyed, they have not more than barely

sufficient to keep up the circulation, and that but a languid one[115].”

M. LOBB, who has very justly calculated the effects of evacuations, is

positive in this sense. He observes, “that in bodies, which have no more

than the necessary quantity of blood, if that is diminished by bleeding

or other evacuations, the vital forces are at the same time diminished,

the secretions disturbed, and various disorders produced[116].”

The manner in which M. SENAC speaks of bleeding gives it yet more

precisely the exclusion in this case. “If (says he) the thick or red

globules of the blood be deficient, bleeding is useless or rather

pernicious: it ought then to be forbidden in extenuated bodies, where

the blood is in small quantity, or not of due consistence, as when there

comes from the vessels but a liquid that can scarce color linnen or

water[117].” It has been observed, that such is the state of the blood

in those who have hurt themselves by self-pollution; and such it is

generally in the weak and in valetudinarians. Let those who attempt the

cure, in this case, by bleeding, compare that method with this precept

founded on the most enlightened theory, and on numerous practical

observations, well digested by reflection; these constitute the basis of

the work from which I draw it, and then let them judge of the success

they ought to expect.

Those medicines which evacuate the first passages, conduce to the

restoration of strength, when, in those parts, there is formed a lodgment

of matters so considerable by their mass, as to cramp or obstruct the

functions of all the _viscera_, or when there are in the stomach, or in

the first intestines, putrid matters, of which the common effect is a

prodigious weakness. In those cases evacuatives may be prescribed, if

nothing contra-indicates them, if there are no other means of freeing

the first passages, or if there should be any danger in not evacuating

them quickly enough. These three conditions have rarely place in

persons who are in a state of consumption, and in whom the weakness and

atony of the first passages is a counter-indication, ever present, to

purgatives or emetics. There is oftenest another method of procuring

a successive evacuation, which is, the employing the non-astringent

tonics; such are a great number of bitters, which, by restoring play

to the organs, produce the double good effect of digesting what is not

indigestible, and of evacuating the superfluities. In short, there is

rarely any danger in not evacuating them quickly enough. This danger,

indeed, sometimes exists in acute diseases; the acridity of the matters

which the heat augments, and the prodigious re-action of the fibres, may

occasion violent symptoms, which are never seen in chronical disorders or

distempers of languor, in which the evacuatives, properly so called, are,

from that very quality, never, by much, so necessary, and are, as I have

before observed, often contra-indicated. Atony, and the want of action,

are the cause of those gatherings when there are any formed; when they

are evacuated by a purgative, the effect is dissipated, but the cause

which will have produced them is considerably augmented: there remain

to be repaired both the evil that actually exists, and that which the

remedy will have done; if for these a remedy is not quickly provided,

the effect re-produces itself faster than before; and if way is given

to the employing purgatives a-new, the evil is a second time augmented;

besides that the intestines are made thereby to contract indisposition

to stools, which hinders their functions, till at length they arrive at

such a point that there is no obtaining evacuations from them but by

physic. In short, purgatives, in the case of obstructions in the first

passages of weak persons, can produce no diminution of the effect but by

augmenting the causes, nor give a momentary relief but as they make the

disease worse. And yet this method is but too much followed; the sick

generally like it, to them it has an air of quickness or dispatch; and,

indeed, provided that the failure of strength be not too considerable,

they find themselves relieved for a few days. The evil, it is true,

returns, but they had rather impute it to the insufficiency than to the

operation of that remedy, to which they have taken a liking. Besides, the

sick are ever for the present relief, and few physicians have the courage

to oppose this weakness. Yet is it important, as well in physic as in

morality, to know when to sacrifice the present to the future: a neglect

of this law peoples the world with wretches and with valetudinarians.

It were much to be wished, that there should be inculcated to many

physicians, as well as to many patients, that fine passage to be found

in the _Pathologia_ of M. GAUBIUS, upon all the evils which are the

consequence of the abuse of purgatives[118].

Are not there, will it be said, some cases, in which emetics and

purgatives may be admitted for the sick of whom I am treating? Doubtless,

some there are, but they are very rare; and great attention is requisite

not to be mistaken as to the signs which seem to indicate evacuatives,

and which often depend on a cause that is to be attacked by remedies

of quite another nature. I will not enter into a discussion of these

distinctions; that would be quite out of place here; it is enough for me

to observe, that evacuatives are rarely advisable in this disorder. M.

LEWIS is of opinion, “that a gentle emetic may serviceably prepare the

first passages for the other remedies, but would not have that exceeded;”

a multitude of cases have taught me, that even that might and often ought

to be omitted; and I have precedently adduced two observations of M.

HOFFMAN, which prove all the danger for that remedy. But even, without

recourse to experience, common sense alone may suffice to persuade

one, that a remedy which gives convulsions, cannot be very proper for a

disorder which are the effects of repeated convulsions.

It is by combating the cause that the evil is to be destroyed; for as

little as may every day be removed, of that cause, one may be pretty sure

that the effect will disappear, without the danger of a return. If it

is against the effect only that the procedure of the cure is levelled,

the work of each day is not only of no service to the following one, but

almost always detrimental.

After having indicated what is to be avoided, there remains to examine

what can be done. I have precedently specified the character that the

remedies ought to have; to strengthen without irritating; there are some

that can answer those indications; indeed the catalogue of them is not a

long one, and the two most efficacious are, doubtless, _the bark and the

cold bath_. The first of these medicines has been looked upon, for more

than a century past, independently of its febrifuge virtue, as one of

the most powerful strengtheners, and as an anodyne. The most celebrated

of the modern physicians look on it as a specific in the disorders of

the nerves. I have already shewn, that it was an ingredient in the

prescription above quoted from BOERHAAVE; and M. VANDERMONDE employed

it with great success in the case of a young man under his care, whom

debauches with women had thrown into a deplorable condition[119]. M.

LEWIS prefers it to all the other remedies; and M. STEHELIN, in that

letter of his which I have more than once mentioned, says, he holds it

the most efficacious of any.

Twenty ages of exact and well considered experiences have demonstrated

that the cold baths possess the same qualities. Dr. BAYNARD has more

particularly proved the virtue of them in the disorders produced by

self-pollution, and by excesses of venery; especially in a case, where,

independently of the impotency and of the simple _gonorrhœa_, there was

so great a weakness, augmented, indeed, by bleeding and by purgations,

that the patient was considered as at the gates of death[120].

M. LEWIS does not scruple affirming yet more positively their efficacy.

“Among all the medicines (says he,) whether external or internal, there

is nothing can equal the virtue of the cold bath.... It cools the body

more, strengthens the nerves better, and promotes perspiration more

effectually, than any medicine taken down the throat can do, and will do

as much service in the _tabes dorsalis_, prudently used, as every thing

else put together[121].” It ought even to be remarked, that the cold bath

has, as I have already said of the air, a particular advantage, which is,

that its action depends less on the reaction, which is as much as to say

on the vital forces of nature, than the action of the other remedies:

these only act upon the quick, but the cold bath gives a spring even to

the dead fibres.

The conjunction of the bark with the cold bath stands indicated by the

purity of their virtues; they operated the same effects, and being

combined, they cure those disorders which all the other remedies only

serve to make worse. In their qualities of strengthening, of anodynes,

of febrifuges, they re-invigorate, they lessen the feverish and nervous

heat, they calm the irregular motions produced by the spasmodic

disposition of the nervous system. They remedy the weakness of the

stomach, and very quickly dissipate the pains which are the consequences

of it. They restore appetite, facilitate the digestion and nutrition,

they re-establish all the secretions, and especially perspiration, which

renders them so efficacious in all the catarrhal and cutaneous disorders;

in short, they are remedies for all the diseases caused by weakness,

provided that the patient does not labor under indissoluble obstructions,

inflammations, abscesses, or internal ulcers, conditions which even do

not necessarily or almost necessarily exclude, any thing more than the

cold baths, but which often allow of the bark.

I saw, some years ago, a foreigner, who might be of the age of about

twenty-three or twenty-four, and who, from his tenderest infancy, had

been subject to the torture of the cruellest head-achs, and almost

continual ones considering the frequency and the length of the fits,

which were almost always accompanied with a total loss of appetite.

The evil had been considerably made worse by the use of bleeding, of

evacuatives, of purgative waters, of warm baths, of broths, and a

multitude of other remedies. I prescribed for him the cold bath and the

bark. In a few days, the fits became weaker and weaker, and much less

frequent; the patient, at a month’s end, thought himself almost radically

cured; the cessation of the remedies and the bad weather renewed the

fits, but incomparably less violent than before. He recommenced the same

process of cure the spring following, and his disorder came to be so

slight, that he judged he should need no more of any application; I am

persuaded that the same recourse, once or twice repeated, will radically

cure him.

A man of eight and twenty years old, had, for many years, been cruelly

tormented with an irregular gout, which seized constantly his head, and

occasioned dreadful distortions of his face; he had consulted a number of

physicians, and tried remedies of various kinds, and lately a medicinal

wine composed of the most penetrative aromatics, infused in Spanish

wine; all, and especially the last, had increased his disorder; blisters

had been applied to his legs which brought on violent symptoms; at this

epoch it was that I was consulted. I advised for him, a strong decoction

of bark and of camomile, which he continued for six weeks, and which

restored him to more health, than he had enjoyed for many years. It would

be needless here to adduce a great number of examples, especially foreign

to the case, to prove the strengthening quality of these remedies, which

has been so long demonstrated, and of which every thing in this disorder

indicates the use; an use of which the happiest successes have confirmed

the virtue.

When I employed the bark in a liquid form, I ordered the decoction of

one ounce in twelve ounces of water, or, according to the indication,

of red wine, boiled for two hours in a close vessel, to be taken, at

three ounces a time, three times a day. I time the cold bath in the

evening, when the digestion of the dinner is intirely completed; it

contributes much to procure a quiet sleep. I knew a young man, accustomed

to self-pollution, who used to pass the night in the most sleepless

disquiet, and who was every morning bathed in his own colliquative

sweats; the night that followed the sixth cold bath he slept five hours,

and got up in the morning without sweats, and much refreshed.

Martials are a third remedy, so often used in all cases of weakness,

as not to need any insistence here on their efficacy in quality of

strengtheners; as they contain nothing of an irritating nature, they are

extremely proper in this disorder. They are given in substance or in

infusion; but the best preparation is the chalybeate waters prepared by

nature, and especially the spaw-waters, one of the most powerful tonics

that are known, and a tonic, so far from irritative, that it softens any

acridity that may be in the humors. The gums, myrrh, the bitters, the

mildest aromatics may also be of use. It must be the circumstances that

must decide the choice from among these different remedies. The first of

those that I have indicated, merit, for the most times, the preference;

but there may cases occur which require others; they should, in general,

be selected from the class of the nervous medicines, taking for a guide

of choice, the precautions I have above specified. It is a disorder

of the nerves, and ought to be treated as such; and treated so it has

often been with success, without the cause of it having been known. It

is a truth, and a truth demonstrated by incontestable observations, that

the ignorance of this cause, and a neglect thereto consequential of the

precautions which it exacts, has sometimes frustrated prescriptions to

all appearances the best indicated, without the physicians being able to

penetrate the cause of their failure of success.

I prescribed for the young man, whose case is described in a fragment of

his letters (p. 34.) pills of which mirrh was the basis, with a decoction

of the bark; and this was attended with the happiest success[122]. “I

am every day (as he wrote me sixteen days after his beginning these

remedies) more and more sensible of the great good they do me; my

head-achs are no longer either so frequent or so violent: I have not them

now any more, unless when I apply close; my stomach grows better; I have

now but rarely pains in my limbs.” At the end of a month his cure was

complete, except in this, that he had not, nor perhaps ever will have,

the strength it is probable he would have had but for his misconduct. The

check, which the machine receives in its growing season, has consequences

which are irreparable. Oh, that this truth were but strongly imprinted on

the minds of youth! It has been lately urged with great energy. “Youth”

(says M. LINNÆUS) “is the most important season for forming a robust

constitution. Nothing is more to be dreaded than a premature or excessive

use of the pleasures of venery: thence proceed weaknesses of the eyes,

vertigos, diminution of appetite, and even an enfeeblement of the mental

powers. Bodies enervated in youth never recover their original vigor:

their old age is accelerated and infirm, and their life short[123].”

Sixteen hundred years before the times of this great Naturalist,

PLUTARCH, in his valuable work on the education of children, had

recommended the formation of their constitution as a point of the highest

importance. “No care (says he) should be neglected that can contribute to

the elegance and vigor of the body:” (the excesses of which I am treating

are detrimental to both the one and the other;) “for” (adds he) “the

foundation for a healthy old age is to be laid in youth: temperance and

moderation at this early time of life, are a passport to a happy latter

season[124].”

To the account of the preceding case, in which the success appears due

to the bark, I shall subjoin another, in which the cold bath was the

principal remedy.

A young man of a bilious constitution, seduced to libidinous practices

from the age of ten years, had always been, from that time, weak,

languishing, and of an ill habit of body: he had had some bilious

disorders, which it had been very difficult to cure; he was extremely

lean, pale, feeble, melancholic. I prescribed for him the cold bath, and

a powder of cream of tartar, martials, and a very little cinnamon. In

less than six weeks he acquired such a strength as he had never before

known.

One great advantage of the Spaw-waters and of the bark is, that the use

of them agrees with milk, and suffers it to pass. The Spaw-waters are

not the only ones that have this property. HOFFMAN prescribed asses

milk, with a third of Seltzer-water. M. DE LA METTRIE has preserved to

us a curious observation of M. BOERHAAVE; speaking of the Duke of ——,

“This amiable Duke (I translate literally) had thrown himself out of the

nuptial paradise; I brought him into it again by the use of Spaw-waters

with milk[125].”

A weakness of the stomach which causes the digestion to be too slow;

acids; the want of activity in the bile; the obstructions in the

intestines of the abdominal region, are the principal causes that hinder

the digestion of the milk, and counter-indicate its use. The waters which

remedy all these causes cannot but facilitate the digestion; and the

bark, which fulfils the same indications, may also be very well combined

with the milk. These remedies may be employed, either precedently, to

prepare the passages, which is almost always necessary, or at the same

time.

In 1753 I restored, perfectly, a foreigner, who had so exhausted himself

with a woman of the town, that he was grown incapable of any act of

virility; his stomach was also extremely weakened, and the want of

nutrition and sleep had quite emaciated him. At six in the morning he

took six ounces of the bark-decoction, to which he added a spoonfull of

Canary-wine: an hour afterwards he took ten ounces of goats milk, fresh

drawn, with a little sugar, and an ounce of orange-flower-water. He dined

on a cold roast fowl, with a glass of excellent Burgundy, diluted with

an equal part of water. At six in the evening he took a second dose of

the bark; at half an hour after six he went into the cold bath, in which

he staid ten minutes, and immediately on coming out of it, went to bed.

At eight in the evening he took again the same quantity of milk, and got

up from nine till ten. Such was the effect of these remedies, that at

the end of eight days, on seeing me come into his room, he cried out to

me, in a transport of joy, that he had recovered _the external sign of

virility_, if I may make use of M. BUFFON’S expression. In a month, he

had almost intirely retrieved his original vigor.

Some absorbent powders; some spoonfulls of mint-water, often the

addition of only a little sugar; some pills of the extract of the bark

with mastic, which is itself an useful remedy in this case, may also

contribute to prevent the disagreement of the milk. To the mastic, or

to the gum-dragon, might be substituted that gum newly introduced in

some parts of England, under the name of _Gumm. rubrum Gambiense_, upon

which there may be seen a small dissertation in that excellent collection

published by the new Society of Physicians formed at London[126]. It

strengthens, it sweetens: which are the two great indications in the

diseases of which I am treating.

However, if with all the care that may be taken, it should be found

impossible to bear the milk, I should advise trying butter-milk. I

prescribed it with success for a young man, in whom certain symptoms of

vergency to the hypochondriac disorder deterred me from a recourse to

milk itself. The bilious drink the butter-milk with pleasure, and are

always the better for it; and indeed it ought always to be preferred

to milk, where there is a great deal of heat, a feverishness, an

eresipelatous disposition; but it is especially of very great service

when the venereal excesses produce an acute fever, such as was that of

which RAPHAEL died. Notwithstanding the weakness in these erotic fevers,

the tonics would be hurtful; bleeding is dangerous: the famous JOHNSTON,

who died Baron of Ziebendorff, above fourscore years ago, positively

forbad it in this case[127]. Too cooling a method of cure does not

succeed, as the observation of M. VANDERMONDE proves, and as I have

myself seen; but the butter-milk is of service, provided it is not too

unctuous. It calms, it dilutes, it sweetens, it assuages the thirst, it

refreshes, and at the same time nourishes and strengthens, which is of

great importance in this case; one symptom of which is, that strength

melts away in it with an inconceivable quickness. M. GILCHRIST, who does

not lay any great stress on milk in a hectic, commends greatly the use of

butter-milk in that very disorder[128].

Since my last edition of this work, published about four years ago, (it

being now 1764,) I have been consulted by several persons in a state of

enervity or debility. Some have been intirely cured. Many have received

considerable relief; others none at all. When the disease is got to

a certain head, the most that can be hoped for is, that the remedies

will stop the progress of the disorder. Of the successes of some of my

patients I have remained unacquainted.

In almost all my treatment of these cases, milk has been the principal

aliment; while the bark, martials, chalybeate waters, and the cold bath

have been the remedies. Some patients I put intirely into a milk diet;

others only took it once or twice a day.

The patient of whom I particularised the case in the fifth Section,

where I promised an account of my method of management of his disorder,

lived for three months upon nothing but milk, upon bread well-baked,

upon one or two quite new laid eggs, a day, and fair water, just drawn

from the fountain. His milk he took four times a day, twice warm from

the cow without bread, twice warmed on the fire with some bread. The

remedies were an electuary composed of bark, of conserve of orange-peel,

and syrup of mint. His breast was covered with an aromatic strengthening

plaister. His whole body was every morning rubbed down with flannel. He

took as much exercise as he could bear, both on horseback and foot, and

especially he kept much in the open air. His weakness, and his complaints

of his breast, hindered me from advising him the cold bath at that

epoch. The success, however, of the remedies was such, that his strength

returned to him, and his stomach was restored. In a month’s time he was

able to walk a league on foot. His vomitings ceased intirely; the pains

of his breast were considerably diminished, and for these three years

last past he continues in a very tolerable state of health. Little by

little he returned to his usual aliments, having taken a distaste to milk.

The parts of generation are always those that recover their vigor the

slowest. Often too they never regain it, even though the rest of the body

appear to have recovered its natural strength. In this case, it may be

literally prophesied, that the part which has sinned, will be the part

that shall die.

I have always found more facility in curing those who, in the age

of maturity, had exhausted themselves by excesses, in a short time,

than those who, in a longer space of it, had enervated themselves by

pollutions, more rarely practised, but which having been begun in their

tenderest youth, had hindered their growth, and had never allowed them

to come to all their natural strength. The first may be considered as

having had a violent illness, which has consumed all their strength, but

whose organs having acquired all their perfection, however they may have

much suffered, yet, the cessation of the cause of their illness, time, a

good regimen, and proper remedies, may restore them. Whereas the others,

having never let their constitution come to good, how should they be

restored to what they never had? How could they expect that art should

operate in the age of maturity, what they have hindered nature from

operating in the tender season of youth and of puberty? Common sense must

tell one how chimerical such a hope must be; and, indeed, my observations

every day prove to me, that young persons, who have delivered themselves

up to this pollution, in their childhood, in their earliest youth, and

in the epoch of the unfolding of puberty, an epoch which is a crisis

of Nature, for which its whole strength is necessary to her; daily

observation, I say, proves to me, that such young persons must never

expect to be vigorous and robust: they may think themselves very well

off, if they can compass the enjoying a moderate state of health, exempt

from great disorders or great pains.

Those who trust to a tardy repentance, having delayed it to an age, in

which the machine may preserve itself, when it is in good order, but is

not to be repaired without great difficulty, ought not either to have

great hopes. After forty it is rare to grow young again.

When I order the bark with wine, I do not restrict the patient intirely

to a milk diet; but make him take the bark in the morning and the milk

at night. For some patients, however, I have been obliged to invert that

order; the wine taken in the morning not agreeing with their stomach, and

constantly making them vomit.

When I employ mineral waters, I make them drink first some bottles pure,

before I proceed to have them mixed with milk.

When the disorder is inveterate it commonly degenerates into a

_cacochymia_, a general depravation of the humors, or ill habit

of the body; the cure of which must be proceeded upon before you

attempt to restore strength. In this case it is that evacuants are

sometimes indispensably necessary, and prove of great service. Whereas

restoratives, nutritious aliments, milk, ordered in these circumstances,

may throw the patient into a slow fever, and he will rather find his

strength diminish in proportion to the use he makes of them.

When violent excesses shall have thrown one suddenly into such a

considerable weakness as to give room of fear for the patient’s life,

recourse should be had to active cordials. Spanish wines may be given him

with a little bread, or some good broths with new laid eggs: he should

be put to bed directly, and have some flannels applied to his breast,

steeped in wine, warmed with Theriaca.

As to those cases, in which venereal excesses have occasioned an acute

fever, bleeding should not be used, unless indicated by the fullness and

hardness of the pulse; and it is better to take the quantity of blood

at two different times bleeding, than all at once. The white decoction,

barley water with a little milk, some doses of nitre, some glisters with

a decoction of mullein flowers, some warm bathings for the feet; and as

to aliments, some veal-broth, thickened with barley or the like grain;

these are the remedies indicated by right practice, and such as I have

seen succeed very happily and quickly, in those cases in which I have

employed them.

The symptoms rarely require any particular method of cure, and yield to

the general one. You may sometimes, however, join external corroboratives

to the internal ones, where it may be proper to strengthen any particular

part. I have myself often advised, with success, epithems or aromatic

plaisters for the breast. Nor is it sometimes unserviceable to wrap the

testicles in a soft flannel, steeped in some corroborative liquid, and to

support them by means of a suspensory.

Here also may be placed what M. GOTTER says: “I have sometimes cured the

_gutta serena_, occasioned by venereal excesses, by employing internal

corroboratives, and errhines, or nasal cephalic powders, which, by the

slight irritation they produced, determined a greater afflux of the

animal spirits to the optic nerve[129].”

It would be needless here to enter on greater particularities of the

method of cure; whatever extension I might give them, they would never be

sufficient to guide the sick without the assistence of a physician, to

whom they would be superfluous. I have, indeed, treated the more largely

of the regimen, because that, when the disorder has as yet made no great

progress, that alone, joined to the cessation of the cause, might operate

a cure, and that any one might confine himself to it without any danger.

There appears then nothing more for me to say, before I terminate this

part, but to add the preservative cautions. I was sensible that this

article was wanting to the first edition of this work, and that it was

an unjustifiable defect, from the importance of the matter. A gentleman,

celebrated in the Republic of Literature for his works, and yet more

respectable for his talents, his knowledge, and his personal qualities,

than for his name, and for the employments of which he so worthily

acquits himself, in one of the first towns in Switzerland, M. ISELIN, (I

hope he will forgive my naming him,) made me sensible of that my omission

in a very polite manner. I shall quote here an extract of his letter with

the more pleasure, for its pointing out exactly what there remained for

me to do.

“I could wish (says he) to see a work from your hand, in which you would

explain the means the most secure and the least dangerous, by which

parents, during the time of education, and young persons, when they are

left to their own conduct, might the best preserve themselves from that

violence of desires which urges them to those excesses, whence arise such

dreadful diseases, or to disorders that disturb the happiness of society

and their own. I do not doubt of there being a diet that particularly

favors continency. I should think that a work that should teach it us,

combined with a description of the diseases produced by impurity, would

be equivalent to the best treatises of morality on this subject.”

M. ISELIN is doubtless in the right; nothing would be more important than

the combination of the two points he desires; but then nothing would be

more difficult than the detaching them from the other parts not only of

moral but medicinal education. To treat of this article apart, that is

to say, to treat of it well, it would be necessary to establish a great

number of principles, which would swell too much this little work, and

which would, besides, be very foreign to it. Some general precepts,

unconnected with the necessary principles and divisions, would not only

be of little use, but might even become dangerous; so that it is better

to refer such a treatise to the making part of a more considerable one,

upon the means of forming a good constitution, and of giving a youth a

firmly established health; a matter which, though it has been handled

by very able authors, is, hitherto, far, very far from being exhausted;

and upon which there remain a multitude of extremely important things

to be added, as well as upon the disorders incident to that season of

life. So that, though it be against my inclination, I will not here touch

upon this article. All that I can say is, that idleness, inactivity,

too long lying a-bed, too soft a bed, a rich, aromatic, salt, or vinous

diet, dangerous or suspicious acquaintance, licentious works, being

the likeliest causes of seduction into those excesses, they cannot be

too carefully avoided. Diet especially is of extreme importance, and

there is not attention enough had to that particular. Those who educate

youth, ought to have ever present to them that pathetic observation of

St. JEROM: “The forges of Vulcan, the internals of the Vesuvius and the

Mount Olympus do not burn with more flames, than youth pampered with high

meats, and drenched with wines.”

MENJOT, one of LEWIS the XIVth’s Physicians, from about the middle

to the end of the last century, mentions women, that an excess of

_hippocras_ (spiced wine) threw into a venereal extasy. The use of wine

and flesh-meats is so much the more pernicious, for that while they

augment the force of the stimulations of loose desires, they weaken at

the same time that of reason, which ought to resist them. “Wine and

animal food dull the soul,” says PLUTARCH, in his treatise _On the eating

of flesh-meats_, a work which ought to be generally perused. The most

ancient Physicians had already known the influence of regimen over the

morals; they had the idea of a moral medicinal-course; and GALEN has

left us upon that matter a small work, which is, perhaps, the best upon

that subject hitherto extant. Conviction of the reality of his promise

cannot but follow its perusal.

“Let those (says he) who deny that the difference of aliments can render

some temperate, others dissolute; some chaste, others incontinent; some

courageous, others cowardly; some meek, others quarrelsome; some modest,

others overbearing; let those, I say, who deny this truth, come to me;

let them follow my counsels as to eating and drinking, and I promise

them, that they will find great helps therefrom towards moral philosophy;

they will especially feel the faculties of their soul gather greater

strength; they will improve their natural genius, they will acquire more

memory, more prudence, more diligence. I will also tell them what kind of

liquors, what winds, what state of the air, what climates they ought to

shun or chuse[130].”

HIPPOCRATES, PLATO, ARISTOTLE, PLUTARCH, had already left us some very

good things on this important matter, and among the works which remain to

us of the Pythagorean PORPHYRY, that zealous anti-christian of the third

century, there is one, _upon the abstinence of the animal food_, in

which he reproaches FIRMUS CASTRICIUS, to whom he addresses it, for his

having quitted the vegetable diet, though he himself had owned it was the

fittest to preserve health, and to facilitate the study of philosophy;

and he adds, “Since you have taken to the eating of flesh-meat, your

own experience has taught you, that that confession of yours was well

grounded.” There are some very good things in that work.

The most efficacious preservative, the most infallible one is, doubtless,

that which is pointed out by that great man, who, of all men has the

best known his fellow creatures, and all their ways; who has not only

seen what they actually are, but what they have been, what they ought to

be, and what they are capable of becoming; who has the most truly loved

them; who has made the greatest efforts in their favor, and who has been

the most cruelly persecuted by them. “Watch with care (says he) over the

young man. Do not leave him alone either by day or by night. Sleep, at

least, in the same room with him. From the instant that he shall have

contracted that habit, the most fatal one that a young man can inslave

himself to, he will carry to the grave the melancholic effects of it. He

will have his body and his heart for ever enervated by it.” I refer to

the work itself for a perusal of all the excellent things he has said on

this matter[131].

The description of the danger, upon the abandoning one’s self to such

vitious practices, is perhaps one of the most powerful motives of

correcting one’s self of them: it is a dreadful picture, and fit to

make one start back with horror and affright. Let us assemble in one

point of view the principal features of it. A general wasting of the

whole machine; an enfeeblement of all the corporal senses and of all

the faculties of the soul; loss of imagination and memory; imbecillity;

contempt; shame; the ignominy such viciousness drags after it; all the

functions of life disturbed, suspended, or painfully executed; long,

vexatious, unaccountable, disgustful diseases; acute and constantly

regenerating pains; all the infirmities or evils of old age, in the age

of youth and vigor; an unaptitude for all those occupations for which man

is born; the vile character to act of being an useless burthen to the

earth; the mortifications to which such a character is daily exposed; a

distaste for all worthy pleasures; a dull melancholy; an aversion for

society and consequently for one’s self; a horror of life, the dread

of temptations every moment to suicide; an anguish worse than pain; a

remorse worse than anguish, a remorse which daily increasing, and which

doubtless taking a new force, when the soul is no longer weakened by its

ties to the body, will perhaps serve for a torment to all eternity, for

an unextinguishable fire. See here the sketch of the fate reserved for

those who proceed as if they had not it to dread!

Before I quit this article of the method of cure, I ought to observe to

the patients, and it is an observation equally extensible to all who

labor under chronical disorders, especially when they are accompanied

with weakness; that they ought not to hope that, in a few days, those

evils can be repaired or removed, which are the produce of the errors

of years. They must lay their account with being obliged to endure the

tediousness of a long cure, and to confine themselves scrupulously to all

the rules laid down for their regimen. If sometimes they appear trifling

or minute to them, it is because they themselves are not fit judges of

the degree of their importance; it would be better for them constantly

to repeat to themselves, that the irksome tediousness of the most rigid

method of cure is still preferable to a state of any the slightest

disease. Be it allowed me to observe, that for one disorder that remains

uncured through improper treatment, there are a number, which the

indocility of the patients renders incurable, notwithstanding the most

well judged assistance given on the part of the physician.

For the securing success, HIPPOCRATES required that the patient, the

physician, the attendants, should all equally do their duty; if this

concurrence was less rare, the happy issues of disorders would be more

frequent. “Let the patient (says ARIDÆUS) have a good heart, and join

forces with the physician against the disease[132].” I have seen the

most stubborn ones yield to the establishment of this harmony; and

recent observations have demonstrated to me, that the virulence of even

cancerous disorders has submitted to methods of cure, directed perhaps

with some skill, but especially executed with a docility and a regularity

of which the successes constituted the best praise.

ARTICLE IV.

_Accessory, or Relative DISEASES._