ARTICLE III. Curative Indication.

SECTION IX. Means of Cure proposed by other Physicians.

There are some diseases against which the success of remedies is next to sure. Those which are the consequences of venereal exhaustion, and, a fortiori, of self-pollution, do not enter into this class; and the prognostic which is to be made of them, when they shall have arrived at a certain degree, has nothing in it but what is desperately terrible.

Hippocrates has, in such case, denounced Death. “It is a deplorable disorder, says Boerhaave; I have often seen it, but could never cure it.”[92]

M. Van Swieten had, for three years, a patient whom he mentions for it, under his hands, without success. I have seen some perish miserably of this disorder. There were even others of those patients, to whom I could not so much as give relief. Yet these examples should not intirely discourage: there are not wanting instances of a happier issue. Some may be found in the collection of the Onania, and in the Observations of Physicians; my own practice has furnished me some. In the same place where Hippocrates gives a description of this disease, he points out means of cure.

“When, (says he,) the patient is in this condition, let there be fomentations made for him, over his whole body; then give him a medicine that may provoke a puke; after that, another to purge his head, and then a cathartic by stool. After the purgatives, give whey or asses milk; after that, cows milk for forty days. While he drinks milk, he must abstain from flesh meats, and in the evening he may have some boiled wheat. After his milk diet is over, he should be nourished with the most tender meats, beginning with a small quantity, and by this means he will recover afresh. For a whole twelvemonth he must avoid all kind of debauchery, all venereal indulgence, and all immoderate exercise; he must confine himself to walks, in which he will do well to avoid the cold, or the sun.”

It is remarkable here, that Hippocrates begins the method of cure by an emetic, and by purging. Now there is a danger of such an authority’s obtaining the force of a law, and yet the observation of this law would, in a number of cases, be pernicious. But it is easy to get rid of this perplexity, by observing, that he only ordered purgatives in a view to divert the fluxion which he supposed threw itself from the head on the spine of the back; and that, in another place, he puts those who are sick, after venereal excesses, in the catalogue of those to whom no purgatives should be given, “because not only they can do no good, but, on the contrary, they may do a great deal of harm[93].” So that it is this last rule which must be considered as the general one: the first constitutes an exception, and an exception which appears founded on a theory, of which the error is now discovered, and which especially therefore ought to have no force.

In Hoffman’s dissertation, which I have already often quoted, there are to be found two observations, that should recommend great circumspection as to the use of emetics. They are as follow:

A man of fifty years of age, having, for a long time, indulged himself in excesses with women, fell into a state of languor, emaciation, and consumptiveness. His sight grew dim, so that at length objects appeared to him as if he saw them through a cloud. It was at this epoch that he took an emetic by way of preventing a fever, which he apprehended, after a long use of eating ham. This medicine made his head swell, and totally deprived him of his eye-sight.

A common prostitute, who, every time that she had commerce with a man, felt a dimness in her eyes come upon her, having taken an emetic, lost her eye-sight intirely[94].

M. Boerhaave seems to have rather meant to establish the difficulties of the cure, than to point out the means of obtaining it.

“There are (says he) little hopes of cure; the milk passes too easily; the exercise of riding does no good to this kind of patients; they complain that these remedies weaken them; and, in fact, exercise encreases the waste of their seed, in the course of their nocturnal pollutions by dreams, and at the same time diminishes their strength. When the day re-appears, they quit their beds, all bathed in their own sweat, and but the weaker for even their sleep; they cannot bear aromatics, of which the effects are also dangerous. The only resource, in these cases, is that of aliments, a moderate exercise of the body, bathing the feet, and frictions used with precaution[95].”

Among the consultations of this great man, which M. de Haller has added to the edition which he has procured to us of them, there is one for a man, who had rendered himself totally impotent for the joys of love.

“A man (as the case is stated) has so much weakened the organs of generation, that the seed comes away of itself, every time that he has any beginning of erection, for that is never a complete one[96], and the seed never spurts forth with any force, but dribbles away, drop by drop, which renders him impotent; his memory, stomach, loins, legs, are totally weakened.”

M. Boerhaave answered: “These disorders are always extremely hard to cure: they hardly ever declare themselves, but when the body has lost so much of its vital forces, that the remedies remain without efficacy. However, it may not be amiss to try what the following ones will produce.

“First, A dry and temperate regimen, composed of fowls, of beef, of mutton, of kid, all rather roasted than boiled, a small quantity of ale, but excellent in its kind, of a very little wine, but then that wine must be of a very generous restorative sort.

“Secondly, A great deal of exercise, augmented, by due degrees; it should only border upon weariness, and always be taken fasting.

“Thirdly, Frictions, with a flannel perfumed with the smoke of incense, to be used to the loins, the abdominal region, the pubis, the groin, the scrotum, and regularly repeated night and morning.

“Fourthly, He should take, every two hours, half a drachm of the following kind of electuary:

“℞. Terr. Japon. dr. iv. Opoponac. dr. v. Cort. Peruv. dr. vi. Conserv. rosar. rub. unc. i. Olib. dr. ii. Succ. acac. unc. ß. Sir. Kerm. q. s. f. l. a. cond.

“Immediately after which he should drink half an ounce of the following medicinal wine:

“℞. Rad. cariophil. mont. Pœn. mar. ana unc. i. Cort. rad. capp. tamarisc. ana unc. iß. Lign. agalloch. ver. unc. i. Vin. Gall. alb. lib. vi. f. l. a. vin. med.

“I hope (added Boerhaave) that the patient will be cured, after having employed this regimen for two months.”

But he would not make use of it, and died, in a few weeks, of a malignant flux. What would have been the effect of this remedy? That can be only conjectured.

M. Zimmermann wrote to me, that he had made a patient try it for two months, but without any success.

M. Hoffman sets forth the precautions which he conceived ought to be taken, and the methods to be employed.

“We must (says he) avoid all the remedies which do not agree with weak habits of body, or that may weaken still more those who are already enervated: such are all astringents, all over-refrigerants, all saturnines, nitrous, acid, and especially narcotic medicines: all these are pernicious in cases of this kind, and unfortunately there is, however, too much use made of them.

“The end to be proposed is to re-establish the vital forces, and to restore to the fibres the tension they have lost. Heating remedies, volatiles, aromatics, those that have an agreeable but strong odor, are not proper here: nothing but the mildest aliments should be allowed, such as are the fittest to repair that nutritious gelatinous substance, which immoderate evacuations will have destroyed: such are strong broths of beef, of veal, of capon, with a little of wine, of lemon-juice, of salt, of nutmeg, and cloves. To the use of this diet may beneficially be joined, those remedies which favor perspiration, and which reanimate the languishing tone of the fibres.”

In another consultation for a self-pollutor, he ordered the taking, every morning, a certain measure of asses milk mixed with a third of the quantity of Selter-water.

It would be useless here to quote the precepts, or observations of other authors. I shall content myself with relating here a very instructive case, such as it stands in a thesis of M. Wespremi, which thesis includes fourteen observations, all interesting ones[97].

“W. Conybeare, about thirty-six years old, had had, for six years past, his eyes so dimmed, without any apparent blemish in them, that he saw all objects as it were through a thick cloud. He had been successively in the three most celebrated hospitals in London, St. Thomas’s, St. Bartholomew’s, and St. George’s; at length, about two years ago, he came to ours. In all the others, after other remedies, it had been tried whether a mercurial salivation might not cure this kind of gutta serena. The physicians were tired out, and the patient quite discouraged. On my interrogating him very particularly, and very carefully, upon his illness, he told me, that, from time to time, he felt a pain all along the spine of his back, especially when he stooped to take up any thing; that his legs were so weak, that he could scarce stand a minute upright, without leaning, which if he did not, his legs would tremble, and he had then a vertigo and dizziness; that his memory was so weakened, that he sometimes appeared stupid; and I could myself observe, that he was greatly emaciated. All this made me suspect, that his gutta serena might be no other than the symptom of a more dreadful disorder, and that the patient was attacked with a real tabes dorsalis.

“I pathetically urged him to own to me, whether he had not polluted himself with the abominable crime of Onan, which intirely destroys the balsamic parts of the nervous fluid. After much hesitation, and blushing, he confessed it. I ordered him to take, over night, two mercurial pills, containing six grains each, of mercurius dulcis, and the next day an ounce of purgative salts, and to repeat that four times in the space of fifteen days. On the expiration of that term, I made him, according to the prescription of Hippocrates, live forty days intirely upon a milk-diet, during which time he used to have himself, two or three times a week, rubbed, as he went to bed. At the end of this method of treatment, he returned from the country, in a much better condition than he had gone thither. I advised him, afterwards the cold-bath for three weeks. For two months together he took, twice a day, the mineral electuary and volatile julep, to which he joined frictions, and the bathing his feet. These remedies so far restored his health, that he wanted to resume the exercise of his trade, which was that of a baker; but I advised him to betake himself to some other business, being afraid that his inhaling the flower, that rises in the kneading, might form in his as yet weak stomach and breast, a paste, of which the effects might be dangerous.”

M. Stehelin gave some relief to the youth mentioned towards the end of the second Section, by strengthening baths, by Tinct. Mart. Ludovic. and by aperitive broths.

The principal remedies mentioned in the Onania consist of nostrums, which the author reserved to himself. It may be observed on it, in general, and the observation is important, that he employed no evacuants, and that only corroboratives constituted the basis of them, under the names of The strengthening tincture, and The prolific powder. They act, without that action’s producing any sensible effect, but, as the author says, they inrich, strengthen, and nourish the parts of generation in both sexes. According then to him, they give them new vigor; they favor the generation of seed, and powerfully restore oppressed nature: in a word, like all nostrums, they do every thing that is required of them. There is a third secret remedy mentioned, under the name of The restorative draught, which operates very efficaciously, and, in fact, if any faith may be given to the testimonies adduced in favor of these remedies, they have doubtless great virtue. Besides these three nostrums, he gives some formularies: One is a draught, composed of amber, aromatics, and of some other remedies of that class: A second is a liniment, composed of essential oils, of balsams, of acrid tinctures. Both, these compositions appear to me too stimulative, and as they have not any experience in their favor, I omit the particularising them. He specifies two others, which seem more proper.

Decoction.

℞. Flor. siccat. lamii[98] mpl. vi. Rad. cyper. et galangal. ana unc. ii. Rad. bist. unc. i. Rad. osmund. reg. unc. ii. Flor. ros. rub. mpl. iv. Icthiocoll unc. iii. Scissa tus mixt. cum aquæ quart. viii. ad quartæ partis evaporat. coquantur.

Take a quart of this every day.

Injection.

℞. Sacchari Saturn. Vitriol, alb. Alum. rup. ana drachm. i. Aq. chalyb. fabr. ℔ i ß. per dies decem igne arenæ digerantur. Add. Spir. vin. camphorat. cochl. iii.

Before I go on to the next Section, I think myself bound to mention, that very sensible views, applicable to the disease of which I am treating, may be found in a book lately published, intitled, Precis de Medecine pratique, a work of M. Lieutaud, physician to the young royal family of France, who, after having got to himself a distinguished name among the Anatomists and Physiologists, has moreover secured to himself one of the first ranks among the practitioners, by his excellent treatise on intermittent and remittent fevers.

The chapters of his last work relative to the tabes dorsalis, are those which have for their title calor morbosus, morbific heat, at disease, be it here parenthetically remarked, very frequent, of which no one had before treated, and which has been often subjected to improper methods of cure, as I have elsewhere lamented, and of which M. Lieutaud has been the first to unfold the symptoms, the nature, and curative indication. Vires exhaustæ, and anæmia, or deficiency of blood, a very interesting chapter, which is intirely and originally that author’s.

M. Lewis, whose work I could not procure for myself before the impression of the first edition of mine, is one who has the most of any enlarged upon the method of cure. I had the pleasure of finding that we agreed perfectly in our ideas, and that we employed the same remedies, especially the bark, and the cold bath; a conformity which appears to me a proof in favor of the practice we have, in this case, both followed. I shall only quote here the two aphorisms that comprehend the substance of his doctrine: I shall avail myself of some passages in the explanation which he gives to them, to confirm, in the following Section, my own practice.

“The cure of this disease (says that able physician) depends as much on knowing what to avoid as what to do. Without a nice regularity of the non-naturals, therefore, medicine will have little or no effect. Thus the salubrity of the air is or great importance; the diet should be analeptic and cooling; sleep little, and in due season; moderate exercise must be used, especially riding on horseback. The secretions of the body are to be regulated if out of order, and the patient should be entertained with chearful company and mirthful diversions. All the remedies that are necessary, are derived from the two classes of balsamics and astringents[99].”

He recommends strongly, in the place of tea, which, he observes, is always prejudicial to the nerves, the infusion of mint, or balm, in every dish of which is to be put a tea-spoonful of the balsamic mixture of cream and yolks of eggs beat together, with two or three drops of oil of cinnamon, which he says give a very agreeable flavor, and is highly grateful to the stomach[100]. This indeed I have had occasion to remark myself, of its being both balsamic and strengthening; but I shall place here a remark that may have its use: It is, that M. Lewis specifies among the corroboratives, medicines from lead, Tinct. faturnia[101]; and I think it my duty to give this caution, without offence to his authority and to that of other respectable physicians, that the internal use of all preparations of lead is a real poison, according to the almost unanimous confession of all the faculty. I have seen the most tragical effects from it; and the shameless rashness of quacks, furnishes but too many occasions of observing such. But if the use of it is to be preserved, like that of some other poisons, let the administration of it at least be reserved for those who are able to discern its dangers and its virtues, and not indicated without due precaution in works designed for the public.

I shall conclude this Section with the method employed by M. Storck in the cure of these disorders: it is a very simple and a very efficacious one. And by comparing all these methods, it will be seen, that they are all founded on the same principles, all tend to the same end, and all employ means nearly similar, a conformity which forms a recommendation of the method, and inspires confidence.

“I begin (says M. Storck) by trying to restore the patient with nourishing broths. Rice, oatmeal, barley boiled with broth, or milk, or milk itself, are all very serviceable; but it must be observed, to let him eat but little at a time, and often. Should the stomach be so weakened, which is sometimes the case when the disorder is far advanced, that it cannot bear even these light aliments without great anguish, the patient should be put to the female breast of milk, a recourse which has retrieved many out of the most desperate condition. To restore strength and activity to the relaxed fibres, I would recommend the use of wine heated with a hot iron, bark, and cinnamon. As soon as the patient has strength enough to walk, it will be of infinite service to him, his going into the purest air of the country, or mountains[102].”

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;

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.

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.

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,

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.

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.

“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;

“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].