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