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A Plea for a Simpler Life
Chapter II

I have endeavoured in the former chapter to show how little can be done by drugs and stimulants and food to combat disease, and I have mentioned some cases where their use is positively injurious. Is there any general rule that can guide us as to when we are justified in not interfering at all, and in leaving the case to the simple methods followed by nature?

Perhaps no absolute rule can be given, but our action should be guided mainly by this consideration, that diseases, as we are called to treat them, or, in other words, the abnormal phenomena presented to us by the sick, are not the essential elements' of the case, but are signs of processes set up in the body in order to relieve itself of some disturbing influence threatening to interfere with its functions, or (it may bej to destroy them altogether.

In a large number of cases there is no difficulty. The cause of the illness may be obvious, or may be readily discovered, and any needful treatment may be at once had recourse to in order to remove the disturbing cause. But the disturbing cause may be doubtful, and. any ‘ remedies' that may be thought of being (as we have seen) also doubtful, we have a double reason for exercising a wise forbearance, and for leaving the case alone so far as any other means are concerned than those demanded by nature.

I think I will best serve my purpose by restricting this chapter mainly to cases which illustrate the evils that arise from interference with nature in carrying out her own methods, and the benefits which accrue to the sick from leaving them alone, or from using oniy the simplest means to aid nature in her work of reparation.

The science of surgery is a very different one from that of medicine, and its advance during the last fifty years has been enormous. The practice of surgery has kept pace with the .science. The surgeon in a great majority of cases knows what he is about, and the patient knows what he is suffering from. An injury is manifest to the eye or to the trained touch in far the larger number of cases, and any doubt as to the cause or the nature of the ailment is excluded. In a certain number of cases, even in surgery, this does not hold, and in these the prudent surgeon may have to act on the principle of letting alone, as in doubtful medical cases. But the advance in the means of diagnosis renders even these cases much less common than formerly. Also in the methods used the surgeon has great advantage over the physician. He can much more easily discover if he is doing good to his patient or the reverse and can at once alter his treatment; and he can also know much more certainly if the case be hopeless and any treatment unnecessary. It is well to notice that in most cases, even in surgery, the best measures are those which ensure rest to the injured part, and this kept up till time is given for the restorative process of nature to effect a cure.

Many cases of internal injuries must be included in the common domain of the surgeon and the physician, as in injuries to the head, where there may be fracture of the base of the skull, with rupture of blood-vessels and internal haemorrhage. As a physician, I have had more to do w'th cases of apoplexy from rupture of an artery in the substance of the brain. Here all we can do is to prevent if possible the further escape of blood, and to encourage if we can its absorption. The old method was of course to bleed the patient with the view of lessening the pressure on the cerebral vessels, and perhaps there was some sense in this, though much might be said on the subject perhaps to little purpose. Now, various medicines are often given, administered by the mouth if swallowing is possible, or by the bowel, and very soon the attempt is made by food and stimulants ‘ to support the system.’ I am very sure my success has been greater since I have trusted entirely to rest and time, and have given neither food nor medicine. If the lower bowel is loaded, it may be right to remove what is there mechanically or by a mild enema, and emptying the bladder may have to be seen to if necessary. But beyond this rest should be absolute. The straining caused by the simplest aperient may make to the patient the difference of life or death; abstinence from food and mostly from drink of any kind will soon diminish the volume of the blood, and if continued will help to absorb the clot of blood, which may be looked upon as an addition to the store of nutriment we have spoken of as laid up in the system to meet such a contingency as now presents itself. Thirst, if it by and by comes on. may be relieved by frequent minute sips of cold water better than by a large draught of any liquid; and later, if there be signs of exhaustion or of failure of the heart’s action, my experience is that hot water will be of far more use than any alcoholic stimulant, or. if this cannot be taken in any quantity, some small doses of carbonate of ammonia. There are, of course, cases where the escape of blood is so large that there is no chance of recovery from the first; but I have seen many cases apparently hopeless, and where for many days there has been no sign of consciousness, that have been pulled through, not by the physician, but by nature left entirely to her own resources. In a large proportion of very severe cases which I have been allowed to treat in my own way, the patients, even though well up in years, and in one remarkable case very old. have afterwards enjoyed excellent health for many years without one sign of paralysis of any sort; and some have done a large amount of head-work, and have died from diseases of quite a different character, or from simple old age.

One case, treated in a very different way, caused me perhaps more worry and anxiety than any other I ever attended. A gentleman of middle life, whose family I had long looked after, had an attack of apoplexy in the north of England, where the family had gone for the summer. He was a strong, healthy man, and I do not remember that he ever required from me any medical advice; but he was certainly too well fed. After some months he was brought back to Edinburgh by the medical man who had attended him through his illness, and whom I was asked to meet along with one of our consulting physicians. The patient was still a great invalid and much paralysed. He was quite helpless, and the English doctor, who was well pleased with the improvement so far, seemed most anxious to impress upon us the necessity of keeping up his strength.

He was taking as much ‘good' food as he could, and also stimulants. On leaving, the consultant told me he had been much amused at the way the English doctor, a young man, had laid down the law to me, a much older man. ‘ But,’ he said, ‘ you can now take your own way,’ which he knew very well. But I could not get my own way, and had not the patient been an old and intimate friend I would have given up the case, the more readily that I got no help from my consulting friend. At last most marked gouty symptoms appeared, and then I succeeded better in getting my own way. It was too late and the patient died. I succeeded in getting an examination of the brain made by the then pathologist of the Infirmary. We found, besides a quantity of clear fluid on the surface and in the ventricles of the brain, what looked like a small tumour embedded in the substance of the cerebrum, where it might have given but little trouble. But it proved to be the remains of a clot of blood, partially organised, and with vessels through its substance. The full feeding had given no chance to its being absorbed, and the continued irritation kept up by it had led to effusion ; and the pressure of the fluid on different parts of the brain accounted to us for the curious changing symptoms which the case had shown all through its course.

It has often been to me a sad reflection that wealth, which here was in abundance, and the kindliest of feelings—for my friend was blessed with one of the best of wives— should, from want of a little knowledge of the laws of nature, be turned into true causes of suffering being aggravated and death brought on prematurely; and that the acquisition of that knowledge is hindered by the varying fashions of the day, as they affect the teaching and practice of medicine. I have myself suffered in many ways from my heterodoxy. A few of my good patients have left me—a very few, and as I have good reason to know, not always to their own advantage. Servants in families in which I attended frequently would have none of me and demanded another; and I have even been threatened with the terrors of the law. My worthy friend, then Police Surgeon of Edinburgh, will, I think, forgive my giving a short story which afforded us both a good laugh the last time I had the pleasure of seeing him. Some twenty-five years ago, meeting him in the street, he told me most seriously that I must take care what I was about, or I would certainly come within the clutches of the law. This coming from him rather startled me, and I asked what he meant. ‘Oh,' said he. 'there is old General C., next door to me, ill in bed. getting no food, and nothing being done for him.’ I felt relieved and answered that I would take the risk. The old gentleman soon got well: no doubt he has occasionally gone through the same experience since, but he is still alive, and the last time I saw him very much so; and now, at the good age of ninety-five, he is,

I am told, the oldest officer of Her Majesty’s Service. If ‘something had been done for him.’ as my friend suggested, then and on other occasions, he might have lived as long, but I doubt it.

There is another set of cases where great mischief is done by a free use of food and stimulants, viz. in haemorrhages from some other internal organ, as the stomach, lungs, or kidneys. The old idea was to remove the cause of the haemorrhage by lessening the pressure of the blood ; and this by reducing its quantity by bleeding, or by putting leeches on a distant part of the body, with the view of drawing the blood into another direction. The idea now almost always acted on is to keep up the strength by stimulants, and to make up the loss as quickly as possible by giving good food; while also a variety of so-called styptic medicines are used, with, in some cases, the local application of cold. The sceptical physician who does not pursue these methods runs a considerable risk of getting into trouble; but I have often run the risk during the last forty years, and I have never, so far as I know, had cause to regret it. I will give a few cases which I choose out of many as perhaps the most illustrative of my heterodoxy both in theory and in practice.

A gentleman about middle age and of a healthy constitution was long addicted to turns of deep drinking. He was absolute master in his own house, and he never allowed me to be sent for till he was just on the verge of delirium tremens. In a previous attack he had some haemorrhage from the stomach, owing evidently to a cirrhotic liver. This alarmed him, and for a much longer period than usual he had kept off all stimulants. At length, however, he had to allow me to be sent for. and from his fears of haemorrhage somewhat earlier than usual. I found that for ten cays he had taken no food whatever ; but was drinking largely strong wines and spirits. He was not yet in the state that I could stop this and give him some mild food, but every day he promised me that he would take no more, and next day he expressed great regret that he had found it impossible to do so. This went on for three or four days, when one morning I got an urgent message to see him. I found that all of a sudden he had vomited an enormous quantity of blood. I guessed it at ten or twelve pounds at least. I certainly never saw such a quantity of vomited blood before, nor anything like it. No pulse could be felt in any of his extremities, which were cold, and his heart could scarcely be heard to beat. He had some consciousness ; he seemed to wish to speak to me, and putting my ear close to his mouth, I heard, in the faintest whisper, ‘ a big drink.' My first thought was to gratify him, as he seemed in a quite hopeless condition ; but I knew that to continue the stimulants was to give him no chance at all, and that if there was any doubt he should get the benefit of it. His great want now was evidently fluid, and some safe stimulant, if there was such, to keep up the heart's action. I got a tumbler of quite hot water, with a teaspoonful of Liebig’s Extract dissolved in it, and I poured gently on the surface of this a single teaspoonful of whisky, the fumes and taste of which might deceive him into the belief that I had yielded to his wish ; and he swallowed this with some effort. The same dose was repeated in some twenty or thirty minutes, and these two teaspoonfuls of whisky were all the stimulant he got; but the hot water and Liebig were continued at frequent intervals and were well taken. By evening some reaction came on, and to the astonishment of every one he made a steady recovery. He lived carefully for some years, had no return of haemorrhage, and he died from the effects of a severe chill from Tong exposure to rain and cold.

A young married lady, an old patient, came to Edinburgh to consult me for a severe chest affection of some standing. I had gone to the south of France, so she consulted one of the ablest physicians of London, now deceased. He gave her mother, who accompanied her, such a hopeless opinion, and, at the same time, ordered so very different a diet from what she knew I would approve of that she followed me south, hoping that I would take a less desperate view of the case. I found that it was a very serious one indeed. The upper part of both lungs was inflamed and congested, one much more than the other, about one half of the lung being affected, and in it there was at least one considerable cavity already formed. There had been repeated attacks of haemoptysis to rather an alarming extent. The London physician, who had been extremely kind and sympathetic, told them not to be alarmed at this, as it must occur from time to time. He recommended some drugs, I forget what, but his great anxiety was that she should be well nourished, and he wrote out a diet for her which she was to follow as far as possible. Her mother had tried to keep her up to the mark, but she herself complained to me strongly that the attempt to do so only made her more miserable. Her coated tongue at once proved to me that she could not digest such a diet, and she was delighted when I told her I would not ask her to take more food than she wished or could enjoy. I recommended a very moderate quantity of milk and an egg or two as her only animal diet, and I ordered no drugs. I also told the mother that I took a much more serious view of the haemorrhage; that had she been able to take and to digest the quantity of nourishment ordered in London, an occasional bleeding might relieve the congested and now evidently inflamed lungs; and that had the blood come from some external part of the body little mischief might result, but that a portion of it would most probably remain in the lungs, and would certainly set up further irritation. The old lady saw the common sense of this, and no longer urged food on her daughter. Next day I found good milk was not to be procured. The cows of the hotel were fed more or less on oranges, and the milk had a peculiar flavour which rendered it undrinkable. Nor were fresh eggs to be got. The friends I was living with close by had, fortunately, a cow properly fed, and had also a number of fowls, and they kindly supplied my patient with one pint of milk and a couple of eggs every morning. On these and on nothing else the invalid lived for several weeks; and though the weather was such that she could get but little out of doors, the change on her was really marvellous. She lost her pinched, pallid, suffering look, slept better, was able to move about, her cough improved, and she had no more haemoptysis. But the great change was in the lungs. The congestion in the best lung almost disappeared ; and in the bad one the local signs were so much modified that, but for the undoubted presence of a cavity, I might have hoped that there was no phthisis at all. Had the London physician seen her tour weeks later he could not possibly have given so hopeless a prognosis. I never saw her again, arid she died of phthisis two years afterwards.

Some years ago I spent a few weeks near Rio. I was there asked to meet the late Dr. F. of Rio to consult about an English gentleman living in the hotel. The case was one of severe haematuria. He had suffered for years from dyspepsia. A sea voyage was recommended ; but after a short remission the stomach ailment returned, accompanied with haematuria, and he arrived in Rio much exhausted. After some weeks’ rest in a delightful climate he was no better, and Dr. F. advised him to get home as long as it was possible for him to travel. H is general health was wretched, and the mair. object of the doctor and of his nephew, who was with him, was to get him to take any tempting food he could, to make up for the loss of blood, which was considerable and constant, and to keep up his strength. Every possible remedy had been tried, the doctor told me, except turpentine, which he proposed we should give him; but he considered the case hopeless, and wished to get him home if. possible; as he was unfit to travel the ten miles to Rio and get on board the steamer in one day, he kindly offered to take him to his own house for the night. It looked very much as if some organic change of the bladder was present. I suggested that possibly the cause might be a simpler one, and that, as the bleeding had come on when he was living, as he told me, on fuller diet than usual, on board ship, and during very hot weather, it might at first have been an effort of nature to relieve a congested organ, and that the weak part had not had a chance to heal from the constant use of as full a diet as was possible. This was quite a new view of the case both to the patient and to the doctor, and the former was most willing to change his mode of living. It was agreed not to try the turpentine nor any medicine whatever, and to adopt at once and for the future a very simple and restricted diet. He left next day, and on my return home I found a letter from the nephew, dated six weeks after I had seen the invalid. He writes: ‘My uncle’s haematuria ceased without any assistance from medicine as soon as we got fairly through the tropics, and he began to mend slowly, and by the time he arrived at Liverpool he had regained some of his strength. The change of air on getting home did him good, and, on the whole. I think he has very nearly recovered what he lost on the voyage. I attribute his recovery greatly to your advice.’ How often I have known a simple case converted into a complicated and hopeless one by exactly the same treatment!

I will give one other case, perhaps the worst case of haemorrhage from a fibroid tumour I ever met with. A lady, from Glasgow, where she kept house for a brother, came to see me several times and lived with a sister in Edinburgh. I advised rest and light food. She was rather of the full plethoric type. She got worse and worse, and at last finding she could not take rest at home I insisted that she should stop with her sister, remain absolutely in bed, and, though she was now very weak and bloodless, that she should live on a very restricted, almost starvation diet. I had given her freely the favourite styptic remedies, especially Ruspini's Styptic, which then enjoyed a very high reputation. The surgical methods now used in such cases, and electricity as now practised with often the best results, were not then thought of. At once she began to improve, and at the end of three or four months, during which she rested, and I may say more or less starved, the attacks left her and did not return. She soon gained strength and went home. The end was rather a sad one. Some three years after I was called to see her in Glasgow. She had kept quite well, and got strong and full as before.

Whether I had not enjoined her strongly enough to avoid getting too full and plethoric now that she had not her previous relief, or that she had not considered it necessary to be any longer so careful. I do not know; but I found her suffering from a very severe attack of pleuro-pneumoria, to which she succumbed a day or two after. Twenty years earlier she would have been bled and bled again, and the result might have been different.

In such a case as the last, I have all along occasionally ventured to bleed, and my successor has done the same. Fortunately the result was always favourable. We know from such cases as I have given the details of, that one can lose a vast amount of blood and be ultimately not one whit the worse for it. Above all, in a case of congestion of the lungs the remedy seems the natural one. The whole mass of the blood must circulate through the lungs, as well as through the rest of the body. If the lungs are swollen and congested this becomes impossible, and surely it is a more rational method to relieve them of a portion of their load, rather than to try to force the whole of it through by stimulating the heart’s action, as is the method universally adopted nowadays. I heard and knew little or nothing of the complaint in my younger days, perhaps because by early bleeding it was rarely allowed to get ahead, but was checked at the commencement.

I find that the same mode of treating congestion of the lungs now prevails in France as in this country. The change from the old to the new treatment, and the usual results, was told me very graphically some years ago by a fine old French gentleman whom I had seen from time to time near Antibes, where he was the neighbour of friends I frequently visited. I heard he had been ill, and went to see him. He told me he had been very ill, and that the wonder was he was alive. He had had congestion of the lungs. ‘In my young days,’ he said, ‘when any one got congestion of the lungs, he was bled, and he was cured. But now, if you take congestion of the lungs, the doctor will not bleed you, and there is nothing to do but to send for the padre.'

As I wish to notice the evils that result from full feeding in asylums, I may here give some account of my experience in treating cases of insanity, and give one or two illustrative cases. I may be tola that I can have but little knowledge of this extensive subject, as I have never been attached to any establishment dealing with it. This is true; but I have had much experience outside, where I was not bound very much by rules, and could treat each case as it arose. As proof that I was considered by experts as knowing something about the insane, my advice has more than once been asked by them when their own relatives were threatened. There is no harm in stating that an old friend, who was long held, and justly so. as the head of his specialty in Scotland, when he feared that a very near relation was becoming insane, put her under my care, and let me- have a free hand in her treatment. On stopping her stimulants and good food, we found that the insomnia and other more suspicious symptoms soon went off, and our anxiety about her was speedily relieved. More recently another medical man, who occupied a high position in connection with lunacy, asked me to look after a friend, an old lady who had still more advanced symptoms than the last-mentioned. In his letter to me he said he knew nobody but myself who could be of any use to her.

I could give numerous cases of good results from, as I think, a rational mode of treatment.

An old lady, long a patient of mine, lived undoubtedly too well. She was a robust, healthy woman with a good stomach, and she took advantage of it. About once a year she had a severe attack of erysipelas of the head, which cleared her out for a time. One year the erysipelas did not come on, and instead of it she had an attack of acute mania. She was making a slow recovery after the acute symptoms were over, and for a change she went to the country. There her friends put her on a better diet. She did not improve, and they called in the physician of the county asylum. He wrote me that the case was a hopeless one of senile insanity, and told me what would be the course it would certainly run. He also said that it was not safe to leave her at large, as in such cases there was a tendency to suicide. Of course he approved of good living. If his views had been carried out, I have no doubt his prognosis would have proved correct. But I managed to get her home, put her again on a restricted diet, and though not quite sound she lived for years with her daughters in town, and never showed signs of senile insanity nor of any other form of it.

A much younger lady I kept out of an asylum for twenty years. She had occasional attacks of insane excitement during all that time, but she had an excellent maid, and little was needed except an occasional quiet change to a lodging in the country. She was getting past her change of life, and I quite expected she would have a comfortable and calm old age. At one time she asked me if she should not adopt vegetarianism pure and simple. I had put her at least halfway towards it; and I afterwards regretted that I had not let her follow her wish. But I pointed out to her that she was doing very well as she was, and thought it would be better that she did not change. She was now living by herself in her own house, in a fine healthy locality. By and by she was so well that she went to pay a visit to friends at some distance. There one of her excited tarns came upon her, I know not from what cause. Her friends got alarmed and sent for their doctor, a valued friend of mine, long since dead. He at once said she was too low, and changed entirely her mode of living. Ere long I was asked to send a professional nurse to bring her back to Edinburgh. She was boon much in her usual again. At the desire of the friends I got an excellent lady attendant for her, and hoped all would go well. But now the friends, who had left me quite alone hitherto, interfered with the lady attendant, and she had to give up her place. Seeing I could do no more good. I had also to give up my patient, very much to her sorrow, and my own. All along she had dreaded being sent to an asylum, and made me promise that I would never allow it. It was soon resolved however to send her there, the chief reason given being as before, that there was risk of her committing suicide. She was sent to what are justly considered most comfortable quarters; but very soon the physician of the establishment came to tell me that on one of the first opportunities she had committed the act the fear of which had led to her seclusion. I was not astonished, though I had never seen the slightest tendency H her to injure herself during the twenty years I had the care of her.

In cases where it is possible, and these are not a few, my desire has been, especially in recent years, to keep my patients out of any asylum ; and I have not had cause to regret it. Simple feeding does more than make up for all the advantages—and these are very great—of the best regulated establishment. Happily there are already some signs of a coming change.

I shall now give a few purely medical cases, illustrating the two opposite modes of treatment, and extending over a period of more than quarter of a century.

In November 1869 I was called to Helensburgh to see Mrs. S., an old lady who was supposed to be dying from cancer of the stomach. The patient was well on to eighty years of age. She had enjoyed good health, had been well fed, took a moderate amount of wine, but for some years had attacks of disordered stomach, accompanied with vomiting, which was the chief symptom. These attacks had been getting more frequent and severe, but the present one was much the worst she had ever had. For twelve days nothing had remained on her stomach ; she had got very thin; her colour was very bad ; but the vomiting now was more from irritation of the stomach than from bile. After the vomiting fits, which were very distressing and exhausting, she had a desire for something to drink, and this was freely supplied in the varied forms of champagne, soda and brandy, beef-tea. and turtle-soup. For a few minutes she was relieved, but the distress and vomiting soon returned. Her strength was rapidly failing, and it looked as if one or at the most two days more would bring the end. From being full and plump, she had got so thin that the edge of the liver could be felt a little below the ribs, and this had led to the idea that she might be suffering from cancer of the stomach. After finding out all I could about the case I withdrew to consult with the doctor and a semi-medical friend of the family. I was able to assure them that the case was not one of cancer; that the old lady had still some life in her ; and that if only we could give the stomach a rest it might recover its functions and she might yet get well. I pointed out that the desire for drink or such fluid food as she was taking so freely was not a true call of nature for nourishment, but a crave for something to dilute the acrid mass which soon formed again after each fresh supply, aggravating the irritation of the nerves of the stomach, and bringing back the misery which, for a short time, had been relieved. She had of course been taking a variety of medicines. I recommended that all these should be stopped, as also the stimulants and food, and that the old lady should have nothing whatever but hot water, and of this just as much as she cared to take; that this should be continued at least for twelve or twenty-four hours, when, if it seemed to suit. a very small quantity of milk could be added to it, and gradually, as it could be done without the least discomfort, a very little mild food, as gruel, or weak chicken soup, might be given occasionally. This was all agreed to most readily, as it was clear to every one that on the present lines of treatment the case was utterly hopeless. As we were talking, a message came that Mrs. S. had been sick again, and would she take soda and brandy, or what? She had had a bad fit of sickness. I said that now was the time to begin the hot water, the stomach being well emptied ; and I sent her up a full tumbler, about as hot as one could drink it. to be taken at once in whole or in part, just as she felt inclined. In about half an hour, before leaving, I went to her room and found her in a much more satisfactory condition. She had taken the whole tumbler greedily, and it was. she said, the only thing that had done her good. She felt soothed and comfortable. I did not see her again, but from this turning-point she made a steady though necessarily a slow recovery, only somewhat retarded on one or two occasions by the desire of the doctor to get up her strength a little faster. She quite recovered her health and her former plumpness, and she lived for I do not know how many years.

The two following cases I met with in London, where I spent two winters some ten or twelve years ago :—

I had heard of the illness of a young married lady, a friend of my family, and one day her mother came to ask if I would see her as a friend. She told me her daughter had been gradually getting into bad health, and that now they were very anxious about her. Her stomach had got so weak that it could retain next to nothing; on the previous day all her food was five oysters, and they were pleased that these had not been vomited. One of the first physicians had seen her in consultation, and ordered wine and a tonic. On a second visit he had ordered stronger wine and a stronger tonic. These were so manifestly injurious that the mother, who well knew my methods though she did not follow them, in despair about her daughter, begged that I would see her. I told her I could not do so in the way she wished; that no good could come of it, as I certainly would advise a very different treatment; that I would stop all medicines and stimulants, and would give little or no food until the stomach had rest and could digest it. I asked her tc tell the doctor what I said, and if then he was willing to see me I would be glad to meet him. I heard nothing for five days, and was then informed that the doctor had at once adopted my suggestions, and that the patient had showed so much improvement that they did not think a consultation necessary. After another week, however, I got a request to meet the doctor, as the patient, on being tried with stronger food, had at once gone back to her old condition. I found her terribly emaciated; lying on a water-bed to prevent bed-sores which had threatened. There were some symptoms of pelvic irritation, but she was not pregnant. Her family, consisting of two fine healthy boys, quite young, took up much of her time ; she was much in society; and she had continued her duties to both long after she was quite unfit for the exertion. Her exhaustion was now extreme, and both doctor and friends were afraid to continue the only treatment which had in the least degree done her good. Though by no means sure of the result, I strongly urged as the only chance of preserving life that the stomach must have rest; that in its present condition any stimulating food or medicine could only do mischief; and that if time could not be given it to recover its tone the patient must die. As the only food I recommended a few sips from time to time of well-diluted milk, lime-water, and white of egg, and, as the only stimulant, hot water as she could take it. This was agreed to.

I think I also recommended a large sinapism over the stomach at bed-time, kept on only so long as it was pleasant. This I have long found to allay irritation and miseries when the stomach is irritable, and very often it produces a quiet sleep. At once she rallied, the sickness stopped, and she even gained in strength. The process of recovery was very slow, but pretty steady, even when she began to take a little more simple food, such as well-boiled gruel, soup of young chicken or of young lamb. I had several meetings with the doctor, who was astonished and delighted with the result of a mode of treatment which was absolutely new to him. He told me that he could only account for the condition of his patient when I first saw her on the idea that she was falling into acute phthisis, although the chest signs were as yet very trifling. By and by the signs of pelvic irritation became more marked and had to be attended to; but it was years before she was fit for much exertion. She is now in excellent health.

My next case is a sad contrast to the former. A nervous Scotchman of a decidedly gouty type, a resident of Edinburgh, suffered so frequently in our irritating climate from bronchitis and stomach attacks that I had advised him many years previously to go to London. The change was advantageous for him as to his business, and he found the climate much more suitable. He came down from time to time to Edinburgh, when I usually saw him, as the return to the North often, as I have seen in others, brought back something of his old ailments. But altogether he enjoyed very fair health, and, as he lived very carefully, I expected for him a long life. I did not see him for some years, when, happening to be in London, I called for him as usual. I was astonished at the change in his appearance. He had got stout and full, a great contrast to his ordinary condition. He told me that a year ago he consulted a doctor who told him that his was poor man’s gout, and he put him on a full diet both of food and stimulants. He soon got into robust health, ‘ but,’ he said,. ‘ I had a terrible winter.’ He was attacked with eczema over his whole body, and had to be in bed, I think he said for six months, with a wire cover over him to prevent the clothes from touching his body. He was of course dosed and dieted, and as the weather got warmer he got free of the eczema. That was three months before I saw him. He had resumed his full living, and he was again strong and stout. Though he did not exactly say it, I saw that he thought I had been too strict with him. I had not the heart to frighten him, and only remarked that it was lucky for him that the gout had taken an outward direction. Three months later I went up to London for the winter, and one of my first visits was to my old friend. I was told he was very ill and could see no one. I was admitted, however, and his wife told me his history since I had seen him. He had kept in excellent health all the summer: but when on a visit to the country three weeks before he got a chill, and one of his old bronchitic turns came on. He got home, and had gradually got worse. On going to his room I found him in a very suffering condition. He seemed still a large strong man compared to what he used to be; but, in addition to the bronchitis, his stomach had now gone wrong, and he was so wretched he could scarcely speak to me. He told me that his wife, by the doctor’s orders, was always urging him to take food and stimulants, and he was sure they did him no good. He did not vomit much, if at all, but his uneasiness and misery were unceasing. I saw that his stomach was full of acridity, and happening to have some liquorice in my pocket I gave him a good piece of it. It at once relieved him, and he was able to talk more comfortably. After a little he suddenly took up a tumbler of rich London milk, and before I could stop him swallowed some mouthfuls. In a few minutes his intense uneasiness returned; the milk had at once soured and formed a hard curd in his stomach. This accident confirmed me in the belief that his suffering was mainly from a grievous error in diet. I gave the wife a strong message to the doctor: that I had known his patient much longer than he, and that a very different diet would be much to his advantage. Three days later I called to see him, and found him much the same, still taking too much food, etc., but his wife was not now so urgent for him to take it. I also got a message from the doctor that the patient was a strong man, that there was no fear of him, but that I must have forgotten how old he was—he was perhaps a little older than myself,—and that it was absolutely necessary to keep up his strength ; I was sorry, but could say no more. Twice again I called to ask for him at intervals of three days, and the last time was told the doctor was getting rather anxious about him. and would be glad to meet me. I agreed of course to meet him at any time he fixed. I heard nothing for two days, and then a black-bordered letter intimated his death.

I know that it is the prevailing opinion that old people require more ‘keeping up' than younger persons. My experience tells me that this is a great mistake, both in health and in disease. I am perfectly sure that the old bear stimulants much worse than the younger. I have often seen a new lease of life follow the giving up of even a very moderate use of wine which had been indulged in for the greater part of a lifetime, and had thus become a habit. That the same holds in the case of disease will perhaps be better illustrated by the following case, one of the latest of the very few I now have occasion to treat. An old lady of eighty-seven had a year ago a severe attack of influenza then epidemic in Edinburgh. She usually enjoyed fair health for her age, and she rarely if ever took any stimulants, but I could not get her off what I consider the bad habit of taking aperient medicine. For some years she had suffered much from chronic rheumatism, which had at last rendered her quite helpless, and she could not turn in bed without great pain. Massage more than once relieved her considerably, but finding that the relief was only temporary she got discouraged and gave it up. Having a fair stomach and no exercise she got full and unwieldy. and it looked as if soon she would be unable to leave her bed. When 1 saw her she was evidently in for a severe attack; I advised that she should take no medicine, as much hot water as she pleased, and little or no food. The state of the tongue was proof enough to me that she could digest nothing, and she had an abundant store of nutriment in her body to last for weeks if necessary. I tried to comfort her two anxious daughters by saying that I hoped she would weather the influenza : and that if she got fair play, she would almost certainly be cured of her rheumatism, and possibly of her habit of taking medicine.

Almost from the first the head was affected, and the old lady at the end had lost all that had occurred during at least two weeks. On the fourth night of her illness she remembered that her bowels had not been opened for four days, and she insisted that the nurse should give her a dose of castor oil; the effect was rather severe, and that, with the necessary movement, so exhausted her, that in the morning I found her in a state of collapse, and feared she was to die. By evening, however, she rallied without any stimulant but some doses of carbonate of ammonia in camphor mixture, a stimulant much preferable to wine or brandy when the stomach is disordered. She now forgot all about her bowels and they moved of themselves twelve days later, when everything was so perfectly natural that the nurse, to whom this treatment was altogether new, and the daughters also acknowledged that I had been right. The case went on with no improvement, but fortunately no chest symptoms supervened except a troublesome cough. One night, about a fortnight after the commencement, the daughters feared she was lower, and sent for the neighbouring doctor. He at once ordered brandy, but it was not given till I should see her next morning. I found her much in the same condition, and the brandy was not given. She did not show any sign of improvement till the end of three weeks, when a copious erythematous rash came out on the lower part of the body, and we had much trouble to prevent bed-sores. She was now however round the corner, her tongue cleared, and she could take a little simple food. She made a steady if slow recovery. She has had no rheumatism since, and though, from the bad summer and worse winter, she has got but little out of doors, and has not yet much power of walking, she now enjoys better health than she has had for years. She lost at least a stone and a half in weight, which is a great advantage to her. and which I advised her not to try to make up. She lives well on considerably less food than she took before her illness, and she is quite resolved to do so for the future; and she requires no aperients. I tell her that I hope she will now live out her hundred years.

I could give other cases of influenza quite as illustrative as the above. I have known the disease since 1837, when there was an epidemic which few escaped in Aberdeen, where I was a medical student. I have had my share of cases in most epidemics since. I have never treated them on the keeping-up plan, and I have had no occasion to regret it. The orthodox treatment has run the whole extent of the gamut since 1837.

There are no doubt great differences both in the epidemics and in individual cases; but I have failed as yet to meet with any case for which I would consider an alcoholic stimulant necessary, unless it be where such an accident occurred as happened to the old lady whose case I have given somewhat in detail, and where I gave some doses of carbonate of ammonia. In such a condition it is possible that a temporary fillip may help to bring the patient round a corner, but even for this I consider the ammonia preferable to alcohol. In this case too the collapse was undoubtedly brought on by an error in treatment. There is in most cases of influenza of the recent type a great and sudden depression and a feeling of intense weakness. But this is caused by the unknown poison. It is not of short duration, but may remain for many days, and a mere fillip is not what is required. Surely this depression cannot be relieved either by alcoholic stimulants, which notoriously lower all the chemical actions of the body, and are much more likely to prevent the elimination of the poison than to aid it, nor by food of any kind, which must use up some nervous energy in its digestion, and which, under the circumstances, it is not likely to get. Anyhow I have used neither, but have trusted to hot water alone during the earlier days, and I have given little or no food till, from the state of the tongue, I could judge that its digestion was possible, and then in very small quantity. With this treatment I have not met with any case of an influenza patient suffering from ill-health for months or years from what is called the dregs of the disease. These are common enough, but I believe they are mostly or entirely due to giving any food in the early, and too much in the later stages and afterwards.

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