Part 7

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;

——_lupus hic Tiberinus an alto_ _Captus hiet, pontesne inter jactatus an amnis_ _Ostia sub Tusci?_ HOR.