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[218] 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[219] 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[220] 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[221] 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[222] 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.
[223]
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.
[224]
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,[225] 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[226] 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[227] 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[228] 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.
[229]
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[230] 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[231] 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,[232] 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[233] 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[234] 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,[235] 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[236] 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[237] 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[238] 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[239] 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[240] 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.
[241]
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[242] 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.
[243]
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[244] 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,[245] 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,[246] 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[247] 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[248] 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[249] 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,[250] 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[251] 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.
[252]
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[253] 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.[254] 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[255] 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[256] 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.
