Part 10

I shall follow the same order as in the preceding article. I shall point out the pretended remedies, which are to be avoided, before I enter on the mention of those which are the eligible ones. I have already taken notice of a first class of those which should be excluded, the irritating, the heating, the volatile medicines. There is a second one, of a very opposite nature, and equally noxious, and that is evacuatives. I have already observed, that sweats, an over-secretion of the _saliva_, and too copious urines, exhausted the patient. I shall not then repeat my premonition against those evacuations: it is consequentially clear enough, that all the medicines which excite them, should be banished. It remains then to examine the propriety of bleeding, and of the evacuations of the _primæ viæ_. The curative indications being to restore strength, now, in order to judge whether they are proper, it is but to know whether they can be expected to answer that indication. I shall not be long on this head. There are two cases in which bleeding restores strength; in all others, it diminishes it. The first is, when there is too great an abundance of blood; this is not the case in consumptions; or when the blood has acquired an inflammatory inspissation, which, rendering it unfit for its uses, quickly destroys the vital forces; this is the disorder of the vigorous, of those who have rigid fibres, and a strong circulation: our sick are in precisely the contrary case; bleeding then cannot but be hurtful to them. “Every drop of blood, (according to M. GILCHRIST,) is precious to persons in a consumption: the assimilating power that repairs it being destroyed, they have not more than barely sufficient to keep up the circulation, and that but a languid one[115].” M. LOBB, who has very justly calculated the effects of evacuations, is positive in this sense. He observes, “that in bodies, which have no more than the necessary quantity of blood, if that is diminished by bleeding or other evacuations, the vital forces are at the same time diminished, the secretions disturbed, and various disorders produced[116].”

The manner in which M. SENAC speaks of bleeding gives it yet more precisely the exclusion in this case. “If (says he) the thick or red globules of the blood be deficient, bleeding is useless or rather pernicious: it ought then to be forbidden in extenuated bodies, where the blood is in small quantity, or not of due consistence, as when there comes from the vessels but a liquid that can scarce color linnen or water[117].” It has been observed, that such is the state of the blood in those who have hurt themselves by self-pollution; and such it is generally in the weak and in valetudinarians. Let those who attempt the cure, in this case, by bleeding, compare that method with this precept founded on the most enlightened theory, and on numerous practical observations, well digested by reflection; these constitute the basis of the work from which I draw it, and then let them judge of the success they ought to expect.

Those medicines which evacuate the first passages, conduce to the restoration of strength, when, in those parts, there is formed a lodgment of matters so considerable by their mass, as to cramp or obstruct the functions of all the _viscera_, or when there are in the stomach, or in the first intestines, putrid matters, of which the common effect is a prodigious weakness. In those cases evacuatives may be prescribed, if nothing contra-indicates them, if there are no other means of freeing the first passages, or if there should be any danger in not evacuating them quickly enough. These three conditions have rarely place in persons who are in a state of consumption, and in whom the weakness and atony of the first passages is a counter-indication, ever present, to purgatives or emetics. There is oftenest another method of procuring a successive evacuation, which is, the employing the non-astringent tonics; such are a great number of bitters, which, by restoring play to the organs, produce the double good effect of digesting what is not indigestible, and of evacuating the superfluities. In short, there is rarely any danger in not evacuating them quickly enough. This danger, indeed, sometimes exists in acute diseases; the acridity of the matters which the heat augments, and the prodigious re-action of the fibres, may occasion violent symptoms, which are never seen in chronical disorders or distempers of languor, in which the evacuatives, properly so called, are, from that very quality, never, by much, so necessary, and are, as I have before observed, often contra-indicated. Atony, and the want of action, are the cause of those gatherings when there are any formed; when they are evacuated by a purgative, the effect is dissipated, but the cause which will have produced them is considerably augmented: there remain to be repaired both the evil that actually exists, and that which the remedy will have done; if for these a remedy is not quickly provided, the effect re-produces itself faster than before; and if way is given to the employing purgatives a-new, the evil is a second time augmented; besides that the intestines are made thereby to contract indisposition to stools, which hinders their functions, till at length they arrive at such a point that there is no obtaining evacuations from them but by physic. In short, purgatives, in the case of obstructions in the first passages of weak persons, can produce no diminution of the effect but by augmenting the causes, nor give a momentary relief but as they make the disease worse. And yet this method is but too much followed; the sick generally like it, to them it has an air of quickness or dispatch; and, indeed, provided that the failure of strength be not too considerable, they find themselves relieved for a few days. The evil, it is true, returns, but they had rather impute it to the insufficiency than to the operation of that remedy, to which they have taken a liking. Besides, the sick are ever for the present relief, and few physicians have the courage to oppose this weakness. Yet is it important, as well in physic as in morality, to know when to sacrifice the present to the future: a neglect of this law peoples the world with wretches and with valetudinarians. It were much to be wished, that there should be inculcated to many physicians, as well as to many patients, that fine passage to be found in the _Pathologia_ of M. GAUBIUS, upon all the evils which are the consequence of the abuse of purgatives[118].

Are not there, will it be said, some cases, in which emetics and purgatives may be admitted for the sick of whom I am treating? Doubtless, some there are, but they are very rare; and great attention is requisite not to be mistaken as to the signs which seem to indicate evacuatives, and which often depend on a cause that is to be attacked by remedies of quite another nature. I will not enter into a discussion of these distinctions; that would be quite out of place here; it is enough for me to observe, that evacuatives are rarely advisable in this disorder. M. LEWIS is of opinion, “that a gentle emetic may serviceably prepare the first passages for the other remedies, but would not have that exceeded;” a multitude of cases have taught me, that even that might and often ought to be omitted; and I have precedently adduced two observations of M. HOFFMAN, which prove all the danger for that remedy. But even, without recourse to experience, common sense alone may suffice to persuade one, that a remedy which gives convulsions, cannot be very proper for a disorder which are the effects of repeated convulsions.

It is by combating the cause that the evil is to be destroyed; for as little as may every day be removed, of that cause, one may be pretty sure that the effect will disappear, without the danger of a return. If it is against the effect only that the procedure of the cure is levelled, the work of each day is not only of no service to the following one, but almost always detrimental.

After having indicated what is to be avoided, there remains to examine what can be done. I have precedently specified the character that the remedies ought to have; to strengthen without irritating; there are some that can answer those indications; indeed the catalogue of them is not a long one, and the two most efficacious are, doubtless, _the bark and the cold bath_. The first of these medicines has been looked upon, for more than a century past, independently of its febrifuge virtue, as one of the most powerful strengtheners, and as an anodyne. The most celebrated of the modern physicians look on it as a specific in the disorders of the nerves. I have already shewn, that it was an ingredient in the prescription above quoted from BOERHAAVE; and M. VANDERMONDE employed it with great success in the case of a young man under his care, whom debauches with women had thrown into a deplorable condition[119]. M. LEWIS prefers it to all the other remedies; and M. STEHELIN, in that letter of his which I have more than once mentioned, says, he holds it the most efficacious of any.

Twenty ages of exact and well considered experiences have demonstrated that the cold baths possess the same qualities. Dr. BAYNARD has more particularly proved the virtue of them in the disorders produced by self-pollution, and by excesses of venery; especially in a case, where, independently of the impotency and of the simple _gonorrhœa_, there was so great a weakness, augmented, indeed, by bleeding and by purgations, that the patient was considered as at the gates of death[120].

M. LEWIS does not scruple affirming yet more positively their efficacy. “Among all the medicines (says he,) whether external or internal, there is nothing can equal the virtue of the cold bath.... It cools the body more, strengthens the nerves better, and promotes perspiration more effectually, than any medicine taken down the throat can do, and will do as much service in the _tabes dorsalis_, prudently used, as every thing else put together[121].” It ought even to be remarked, that the cold bath has, as I have already said of the air, a particular advantage, which is, that its action depends less on the reaction, which is as much as to say on the vital forces of nature, than the action of the other remedies: these only act upon the quick, but the cold bath gives a spring even to the dead fibres.

The conjunction of the bark with the cold bath stands indicated by the purity of their virtues; they operated the same effects, and being combined, they cure those disorders which all the other remedies only serve to make worse. In their qualities of strengthening, of anodynes, of febrifuges, they re-invigorate, they lessen the feverish and nervous heat, they calm the irregular motions produced by the spasmodic disposition of the nervous system. They remedy the weakness of the stomach, and very quickly dissipate the pains which are the consequences of it. They restore appetite, facilitate the digestion and nutrition, they re-establish all the secretions, and especially perspiration, which renders them so efficacious in all the catarrhal and cutaneous disorders; in short, they are remedies for all the diseases caused by weakness, provided that the patient does not labor under indissoluble obstructions, inflammations, abscesses, or internal ulcers, conditions which even do not necessarily or almost necessarily exclude, any thing more than the cold baths, but which often allow of the bark.

I saw, some years ago, a foreigner, who might be of the age of about twenty-three or twenty-four, and who, from his tenderest infancy, had been subject to the torture of the cruellest head-achs, and almost continual ones considering the frequency and the length of the fits, which were almost always accompanied with a total loss of appetite. The evil had been considerably made worse by the use of bleeding, of evacuatives, of purgative waters, of warm baths, of broths, and a multitude of other remedies. I prescribed for him the cold bath and the bark. In a few days, the fits became weaker and weaker, and much less frequent; the patient, at a month’s end, thought himself almost radically cured; the cessation of the remedies and the bad weather renewed the fits, but incomparably less violent than before. He recommenced the same process of cure the spring following, and his disorder came to be so slight, that he judged he should need no more of any application; I am persuaded that the same recourse, once or twice repeated, will radically cure him.

A man of eight and twenty years old, had, for many years, been cruelly tormented with an irregular gout, which seized constantly his head, and occasioned dreadful distortions of his face; he had consulted a number of physicians, and tried remedies of various kinds, and lately a medicinal wine composed of the most penetrative aromatics, infused in Spanish wine; all, and especially the last, had increased his disorder; blisters had been applied to his legs which brought on violent symptoms; at this epoch it was that I was consulted. I advised for him, a strong decoction of bark and of camomile, which he continued for six weeks, and which restored him to more health, than he had enjoyed for many years. It would be needless here to adduce a great number of examples, especially foreign to the case, to prove the strengthening quality of these remedies, which has been so long demonstrated, and of which every thing in this disorder indicates the use; an use of which the happiest successes have confirmed the virtue.

When I employed the bark in a liquid form, I ordered the decoction of one ounce in twelve ounces of water, or, according to the indication, of red wine, boiled for two hours in a close vessel, to be taken, at three ounces a time, three times a day. I time the cold bath in the evening, when the digestion of the dinner is intirely completed; it contributes much to procure a quiet sleep. I knew a young man, accustomed to self-pollution, who used to pass the night in the most sleepless disquiet, and who was every morning bathed in his own colliquative sweats; the night that followed the sixth cold bath he slept five hours, and got up in the morning without sweats, and much refreshed.

Martials are a third remedy, so often used in all cases of weakness, as not to need any insistence here on their efficacy in quality of strengtheners; as they contain nothing of an irritating nature, they are extremely proper in this disorder. They are given in substance or in infusion; but the best preparation is the chalybeate waters prepared by nature, and especially the spaw-waters, one of the most powerful tonics that are known, and a tonic, so far from irritative, that it softens any acridity that may be in the humors. The gums, myrrh, the bitters, the mildest aromatics may also be of use. It must be the circumstances that must decide the choice from among these different remedies. The first of those that I have indicated, merit, for the most times, the preference; but there may cases occur which require others; they should, in general, be selected from the class of the nervous medicines, taking for a guide of choice, the precautions I have above specified. It is a disorder of the nerves, and ought to be treated as such; and treated so it has often been with success, without the cause of it having been known. It is a truth, and a truth demonstrated by incontestable observations, that the ignorance of this cause, and a neglect thereto consequential of the precautions which it exacts, has sometimes frustrated prescriptions to all appearances the best indicated, without the physicians being able to penetrate the cause of their failure of success.

I prescribed for the young man, whose case is described in a fragment of his letters (p. 34.) pills of which mirrh was the basis, with a decoction of the bark; and this was attended with the happiest success[122]. “I am every day (as he wrote me sixteen days after his beginning these remedies) more and more sensible of the great good they do me; my head-achs are no longer either so frequent or so violent: I have not them now any more, unless when I apply close; my stomach grows better; I have now but rarely pains in my limbs.” At the end of a month his cure was complete, except in this, that he had not, nor perhaps ever will have, the strength it is probable he would have had but for his misconduct. The check, which the machine receives in its growing season, has consequences which are irreparable. Oh, that this truth were but strongly imprinted on the minds of youth! It has been lately urged with great energy. “Youth” (says M. LINNÆUS) “is the most important season for forming a robust constitution. Nothing is more to be dreaded than a premature or excessive use of the pleasures of venery: thence proceed weaknesses of the eyes, vertigos, diminution of appetite, and even an enfeeblement of the mental powers. Bodies enervated in youth never recover their original vigor: their old age is accelerated and infirm, and their life short[123].”

Sixteen hundred years before the times of this great Naturalist, PLUTARCH, in his valuable work on the education of children, had recommended the formation of their constitution as a point of the highest importance. “No care (says he) should be neglected that can contribute to the elegance and vigor of the body:” (the excesses of which I am treating are detrimental to both the one and the other;) “for” (adds he) “the foundation for a healthy old age is to be laid in youth: temperance and moderation at this early time of life, are a passport to a happy latter season[124].”

To the account of the preceding case, in which the success appears due to the bark, I shall subjoin another, in which the cold bath was the principal remedy.

A young man of a bilious constitution, seduced to libidinous practices from the age of ten years, had always been, from that time, weak, languishing, and of an ill habit of body: he had had some bilious disorders, which it had been very difficult to cure; he was extremely lean, pale, feeble, melancholic. I prescribed for him the cold bath, and a powder of cream of tartar, martials, and a very little cinnamon. In less than six weeks he acquired such a strength as he had never before known.

One great advantage of the Spaw-waters and of the bark is, that the use of them agrees with milk, and suffers it to pass. The Spaw-waters are not the only ones that have this property. HOFFMAN prescribed asses milk, with a third of Seltzer-water. M. DE LA METTRIE has preserved to us a curious observation of M. BOERHAAVE; speaking of the Duke of ——, “This amiable Duke (I translate literally) had thrown himself out of the nuptial paradise; I brought him into it again by the use of Spaw-waters with milk[125].”

A weakness of the stomach which causes the digestion to be too slow; acids; the want of activity in the bile; the obstructions in the intestines of the abdominal region, are the principal causes that hinder the digestion of the milk, and counter-indicate its use. The waters which remedy all these causes cannot but facilitate the digestion; and the bark, which fulfils the same indications, may also be very well combined with the milk. These remedies may be employed, either precedently, to prepare the passages, which is almost always necessary, or at the same time.

In 1753 I restored, perfectly, a foreigner, who had so exhausted himself with a woman of the town, that he was grown incapable of any act of virility; his stomach was also extremely weakened, and the want of nutrition and sleep had quite emaciated him. At six in the morning he took six ounces of the bark-decoction, to which he added a spoonfull of Canary-wine: an hour afterwards he took ten ounces of goats milk, fresh drawn, with a little sugar, and an ounce of orange-flower-water. He dined on a cold roast fowl, with a glass of excellent Burgundy, diluted with an equal part of water. At six in the evening he took a second dose of the bark; at half an hour after six he went into the cold bath, in which he staid ten minutes, and immediately on coming out of it, went to bed. At eight in the evening he took again the same quantity of milk, and got up from nine till ten. Such was the effect of these remedies, that at the end of eight days, on seeing me come into his room, he cried out to me, in a transport of joy, that he had recovered _the external sign of virility_, if I may make use of M. BUFFON’S expression. In a month, he had almost intirely retrieved his original vigor.

Some absorbent powders; some spoonfulls of mint-water, often the addition of only a little sugar; some pills of the extract of the bark with mastic, which is itself an useful remedy in this case, may also contribute to prevent the disagreement of the milk. To the mastic, or to the gum-dragon, might be substituted that gum newly introduced in some parts of England, under the name of _Gumm. rubrum Gambiense_, upon which there may be seen a small dissertation in that excellent collection published by the new Society of Physicians formed at London[126]. It strengthens, it sweetens: which are the two great indications in the diseases of which I am treating.

However, if with all the care that may be taken, it should be found impossible to bear the milk, I should advise trying butter-milk. I prescribed it with success for a young man, in whom certain symptoms of vergency to the hypochondriac disorder deterred me from a recourse to milk itself. The bilious drink the butter-milk with pleasure, and are always the better for it; and indeed it ought always to be preferred to milk, where there is a great deal of heat, a feverishness, an eresipelatous disposition; but it is especially of very great service when the venereal excesses produce an acute fever, such as was that of which RAPHAEL died. Notwithstanding the weakness in these erotic fevers, the tonics would be hurtful; bleeding is dangerous: the famous JOHNSTON, who died Baron of Ziebendorff, above fourscore years ago, positively forbad it in this case[127]. Too cooling a method of cure does not succeed, as the observation of M. VANDERMONDE proves, and as I have myself seen; but the butter-milk is of service, provided it is not too unctuous. It calms, it dilutes, it sweetens, it assuages the thirst, it refreshes, and at the same time nourishes and strengthens, which is of great importance in this case; one symptom of which is, that strength melts away in it with an inconceivable quickness. M. GILCHRIST, who does not lay any great stress on milk in a hectic, commends greatly the use of butter-milk in that very disorder[128].

Since my last edition of this work, published about four years ago, (it being now 1764,) I have been consulted by several persons in a state of enervity or debility. Some have been intirely cured. Many have received considerable relief; others none at all. When the disease is got to a certain head, the most that can be hoped for is, that the remedies will stop the progress of the disorder. Of the successes of some of my patients I have remained unacquainted.

In almost all my treatment of these cases, milk has been the principal aliment; while the bark, martials, chalybeate waters, and the cold bath have been the remedies. Some patients I put intirely into a milk diet; others only took it once or twice a day.