L. There is a certain delusion, that is very fortunate for the
apothecaries, and very fatal to the sick, that is derived from a
persuasion in many of these last, that their diseases would be eternal,
or incurable, without the help of medicine; although they see every day,
others cured of the same diseases, without this aid; and although the
disorder was of so slight a sort, that all those who did nothing but
leave nature to itself, recovered from it, he who called in a physician,
upon his getting well, thanked the doctor for his cure, when in reality,
he perhaps did nothing but delay it. I protest that when catarrhs have
been epidemical, I have in various instances observed, that they lasted
as long with those who took medicines, as they did with those who took
none; and the only difference that I could perceive between them was,
that the last recovered their natural state of robustness as soon as the
catarrh left them; and that those who had taken physic, did not recover
it till several days afterwards.
LI. There is another mistake said to be built upon experience, under the
deception of which, many shelter themselves, and pretend, in opposition
to those who differ from them in opinion, to justify the necessity of
plentiful evacuations. The rigid Helmonists, or sectaries of Van Helmont,
reprobate as prejudicial, purging and bleeding, in every case whatever;
and in opposition to this doctrine, is urged the common experience,
deduced from the cases of an infinite number of patients, who have
been purged and blooded, and have all done well; and that there have
been some weeks in sickly times, in which one physician has ordered a
hundred patients to be purged, and as many to be blooded, and that not
one of them has died. How then in opposition to this experience, say the
Galenists, can any one pretend to insist, that bleeding and purging do
harm?
LII. I do not undertake to defend the Helmonists, nor do I consider their
opinion, as more probable than the contrary one; but I say, that from
the experience alledged, nothing can be concluded to their prejudice. We
should suppose, that those who exclaim against purging and bleeding, do
not think them so pernicious, as to be fatal to all those who undergo
these operations; for even supposing them to be injurious, they are not
capable of destroying a man in perfect health, nor one that is visited by
a slight disorder. I believe, that although an intemperate use of them
kills many, they are chiefly those who are affected with some obstinate
disease; for in these cases, when nature is much weakened by struggling
with a powerful disorder, if you add a fresh enemy for her to encounter
in the imagined remedy, you compleat her overthrow, and lay her prostrate
on the earth. But those who are affected with a disease that is not
dangerous, (and there are many of this sort, which in appearance seem
violent ones,) generally preserve a sufficient degree of strength, to
resist both the distemper, and some unnecessary bleedings and purgings;
and although these may weaken the natural faculties, and retard the cure,
they very seldom are known to deprive the patient of life.
LIII. That the number of mild disorders, greatly exceeds that of the
dangerous ones, is very plain and certain; what then can we find
extraordinary, in those who are attacked with the first sort getting
well, notwithstanding they may have been injudiciously purged and
blooded? out of a hundred patients that a physician visits in a week,
seldom more than one or two of them labour under dangerous disorders.
It is customary with many people to send for the doctor, upon being
attacked with a slight inflammation, a catarrh, an ephemeris or fever of
a day, a fluxion of the eyes, a repletion of the stomach, and such kind
of indispositions; and if he happens to be one of the common or vulgar
sort, he seldom fails to purge and bleed. But admitting that the purging
and bleeding were never so improperly administered, does it follow from
thence, that the patient must die? Or why should this be an unavoidable
consequence, if in the same situation, he had been stabbed with a
poignard that had not penetrated very deep, or that had not wounded a
vital part, he would have escaped with his life?
LIV. As I observed before, I am neither a partizan of the Helmonists, nor
a favourer of the Galenists; but I look upon it as a thing certain, that
an intemperate use of purging and bleeding, has destroyed many men, and
especially, if administered when nature is much weakened; notwithstanding
which, I am persuaded that they are serviceable in many cases. Whether
they are absolutely necessary, and whether patients could not do well,
if other remedies were substituted in their places, is a point I will
not take upon me to determine; and especially, when I have fresh in
my memory, the declaration of a physician, whose authority has great
weight with me. This is Lucas Tozzi, a famous Italian physician, who in
his exposition of the third aphorism of the first book of Hippocrates,
_Habitus Athletarum, &c._ after combating and controverting the
usefulness of bleeding, with seemingly very efficacious and persuasive
reasoning, he asserts, and offers to prove, that it is not necessary
in any one of the diseases, in which the Galenists insist it cannot be
dispensed with; and in answer to the experience they alledge of its
utility, he quotes his own; and says, _if they appeal to experience, and
insist that it is evident from thence, that many people have been cured
of various disorders by blood-letting; I reply, that in the hospital of
the Anunciada at Naples, where I have officiated as physician many years,
I have cured in a short space of time, and without taking from them one
drop of blood, hundreds and thousands of patients, who have been attacked
with some one or other of the following disorders, frensies, pleurisies,
quinsies, inflammations of the liver, spitting of blood, erysipelases,
and all kinds of fevers_.
LV. What shall we say to this? Lucas Tozzi was not only a great theorist,
but also a most expert, successful, and much esteemed practitioner, and
as such, his advice was solicited with anxiety by people of the first
rank. If he without bleeding cured all those disorders, which in the
common opinion stand most in need of that evacuation, and not only cured
them, but did it in a short time, what diseases must they be which cannot
be cured without blood-letting?
LVI. And it is very remarkable, that in the same manner the Galenists
endeavour to deduce from experience the necessity of blood-letting
in many diseases, they endeavour also to establish the preference,
that should be given to drawing blood in particular disorders, from
particular veins, such as the hepatic, and cephalic. Anatomy however,
makes it as clear as the sun at noon-day, that this preference is not
grounded on any solid foundation, and that the cephalic vein bears no
more relation to, nor is any more connected with the head, than the
hepatic, nor the hepatic with the liver, than the cephalic; and that all
the veins of the same arm, communicate indifferently with all parts of
the body, as the laws of circulation demonstrate; and as that observation
which was pretended to be derived from experience, was founded in
mistake, it is not improbable, that that which is generally alledged in
favour of bleeding, may be so likewise.
LVII. What appears to me is, that the rule so much cried up by the
Galenists, and which establishes the necessity of bleeding, in
pleurisies, is liable to so many exceptions, that we ought not to
regard it as a general one; and we have observed in another part of
our works, that in some epidemical pleurisies, it has been found to be
evidently injurious. It is but a little while ago, that a learned French
physician, whose works are mentioned in the Memoirs of Trevoux, wrote
strongly against bleeding in winter pleurisies and peripneumonies; and
his reasoning had great weight with some eminent physicians of Paris. I
can certify, that in the last winter 1731, when many people were attacked
with pleurisies in this country, it was generally remarked, and we
received informations to the same effect from all quarters, that those
who were blooded died, and that those who were not did well.
LVIII. I would have it understood, that I wish all I have said, with
respect to the utility or inutility of purging and bleeding in general,
should be considered as the sentiments of a man, who takes no side in the
dispute, but who proposes what he advances problematically, and with a
view of convincing the world, that in order to avoid being misled, they
should examine with great attention and exactness, any observation that
is alledged to be founded on experience, for this is the principal object
I had in view, in writing this discourse.
LIX. It would argue weakness and want of judgment, for any one to
esteem a thing as a remedy for a particular disease, without reflecting
and making a remark, the propriety of which must stare every man in
the face, and that is, comparing the success of the practice of those
who use that medicine, with that of those who do not make use of it.
There have been physicians, who have declared themselves enemies to the
administration of the bark; but notwithstanding this, there is no body at
this day, who disputes its febrifuge efficacy in intermittent cases; for
experience shews, that it will stop the fit, although it may return again
afterwards, and although in the opinion of some people, the medicine
may leave some bad impression on the body. If purging and bleeding
would have the same effect, in some sort of fevers, we should all agree
in attributing to them a febrifuge virtue; notwithstanding that some
practitioners, might give the preference to other remedies, as more safe,
and better adapted. But this is so far from being the case with respect
to these evacuations, that their efficacy of removing fevers, is at this
day strongly contested, for experience has not yet manifested, that they
are remedies for these disorders, in any degree or manner, that is not
exceedingly doubtful or disputable.