We have hitherto considered the effects of ardent spirits upon individuals, and the means of preventing them. I shall close this head of our inquiry, by a few remarks on their effects upon the population and welfare of our country, and the means of obviating them.
It is highly probable, not less than 4000 people die annually, from the use of ardent spirits, in the United States. Should they continue to exert this deadly influence upon our population, where will their evils terminate? This question may be answered, by asking, where are all the Indian tribes, whose numbers and arms formerly spread terror among their civilized neighbours? I answer, in the words of the famous Mingo chief, “the blood of many of them flows not in the veins of any human creature.” They have perished, not by pestilence, nor war, but by a greater foe to human life than either of them—ardent spirits. The loss of 4000 American citizens, by the yellow fever, in a single year, awakened general sympathyand terror, and called forth all the strength and ingenuity of laws, to prevent its recurrence. Why is not the same zeal manifested in protecting our citizens from the more general and consuming ravages of distilled spirits? Should the customs of civilized life, preserve our nation from extinction, and even from an increase of mortality, by those liquors; they cannot prevent our country being governed by men, chosen by intemperate and corrupted voters. From such legislators, the republic would soon be in danger. To avert this evil, let good men of every class unite and besiege the general and state governments, with petitions to limit the number of taverns; to impose heavy duties upon ardent spirits; to inflict a mark of disgrace, or a temporary abridgment of some civil right, upon every man convicted of drunkenness; and finally to secure the property of habitual drunkards, for the benefit of their families, by placing it in the hands of trustees, appointed for that purpose, by a court of justice.
To aid the operation of these laws, would it not be extremely useful for the rulers of the different denominations of christian churches to unite, and render the sale and consumption of ardent spirits, a subject of ecclesiastical jurisdiction? The methodists, and society of friends, have, forsome time past, viewed them as contraband articles, to the pure laws of the gospel, and have borne many public and private testimonies, against making them the objects of commerce. Their success in this benevolent enterprise, affords ample encouragement for all other religious societies to follow their example.
We come now to the third part of this inquiry, that is, to mention the remedies for the evils which are brought on by the excessive use of distilled spirits.
These remedies divide themselves into two kinds.
I. Such as are proper to cure a fit of drunkenness, and
II. Such as are proper to prevent its recurrence, and to destroy a desire for ardent spirits.
I. I am aware that the efforts of science and humanity, in applying their resources to the cure of a disease, induced by an act of vice, will meet with a cold reception from many people. But let such people remember, the subjects of our remedies, are their fellow creatures, and that the miseries brought upon human nature, by its crimes, are as much the objects of divine compassion (which we are bound to imitate), as the distresses which are brought upon men, by the crimes of other people, or which they bring upon themselves, by ignorance or accidents. Let us not then, pass by the prostrate sufferer from strong drink, but administer to him the same relief, we would afford to a fellow creature, in a similar state, from an accidental, and innocent cause.
1. The first thing to be done to cure a fit of drunkenness, is to open the collar, if in a man, and remove all tight ligatures from every other part of the body. The head and shoulders should at the same time be elevated, so as to favour a more feeble determination of the blood to the brain.
2. The contents of the stomach should be discharged, by thrusting a feather down the throat. It often restores the patient immediately to his senses and feet. Should it fail of exciting a puking,
3. A napkin should be wrapped round the head, and wetted for an hour or two with cold water, or cold water should be poured in a stream upon the head. In the latter way, I have sometimes seen it used, when a boy, in the city of Philadelphia. It was applied, by dragging the patient, when found drunk in the street, to a pump, and pumping water upon his head for ten or fifteen minutes. The patient generally rose, and walked off, sober and sullen, after the use of this remedy.
Other remedies, less common, but not less effectual for a fit of drunkenness, are,
4. Plunging the whole body into cold water. A number of gentlemen who had drunken to intoxication, on board a ship in the stream, near Fell's point, at Baltimore, in consequence of their reeling in a small boat, on their way to the shore, in the evening, overset it, and fell into the water. Several boats from the shore hurried to their relief. They were all picked up, and went home, perfectly sober, to their families.
5. Terror. A number of young merchants, who had drunken together, in a compting-house, on James river, above thirty years ago, until they were intoxicated, were carried away by a sudden rise ofthe river, from an immense fall of rain. They floated several miles with the current, in their little cabin, half filled with water. An island in the river arrested it. When they reached the shore that saved their lives, they were all sober. It is probable terror assisted in the cure of the persons who fell into the water at Baltimore.
6. The excitement of a fit of anger. The late Dr. Witherspoon used to tell a story of a man in Scotland, who was always cured of a fit of drunkenness, by being made angry. The means chosen for that purpose, was a singular one. It was talking against religion.
7. A severe whipping. This remedy acts by exciting a revulsion of the blood from the brain, to the external parts of the body.
8. Profuse sweats. By means of this evacuation, nature sometimes cures a fit of drunkenness. Their good effects are obvious in labourers, whom quarts of spirits taken in a day, will seldom intoxicate, while they sweat freely. If the patient be unable to swallow warm drinks, in order to produce sweats, they may be excited by putting him in a warm bath, or wrapping his body in blankets, underwhich should be placed half a dozen hot bricks, or bottles filled with hot water.
9. Bleeding. This remedy should always be used, when the former ones have been prescribed to no purpose, or where there is reason to fear from the long duration of the disease, a material injury may be done to the brain.
It is hardly necessary to add, that each of the above remedies, should be regulated by the grade of drunkenness, and the greater or less degree, in which the intellects are affected in it.
II. The remedies which are proper to prevent the recurrence of fits of drunkenness, and to destroy the desire for ardent spirits, are religious, metaphysical, and medical. I shall briefly mention them.
1. Many hundred drunkards have been cured of their desire for ardent spirits, by a practical belief in the doctrines of the christian religion. Examples of the divine efficacy of christianity for this purpose, have lately occurred in many parts of the United States.
2. A sudden sense of the guilt contracted by drunkenness, and of its punishment in a futureworld. It once cured a gentleman in Philadelphia, who, in a fit of drunkenness, attempted to murder a wife whom he loved. Upon being told of it when he was sober, he was so struck with the enormity of the crime he had nearly committed, that he never tasted spiritous liquors afterwards.
3. A sudden sense of shame. Of the efficacy of this deep seated principle in the human bosom, in curing drunkenness, I shall relate three remarkable instances.
A farmer in England, who had been many years in the practice of coming home intoxicated, from a market town, one day observed appearances of rain, while he was in market. His hay was cut, and ready to be housed. To save it, he returned in haste to his farm, before he had taken his customary dose of grog. Upon coming into his house, one of his children, a boy of six years old, ran to his mother, and cried out, “O, mother! father is come home, and he is not drunk.” The father, who heard this exclamation, was so severely rebuked by it, that he suddenly became a sober man.
A noted drunkard was once followed by a favourite goat, to a tavern, into which he was invited byhis master, and drenched with some of his liquor. The poor animal staggered home with his master, a good deal intoxicated. The next day he followed him to his accustomed tavern. When the goat came to the door, he paused: his master made signs to him to follow him into the house. The goat stood still. An attempt was made to thrust him into the tavern. He resisted, as if struck with the recollection of what he suffered from being intoxicated the night before. His master was so much affected by a sense of shame in observing the conduct of his goat to be so much more rational than his own, that he ceased from that time to drink spiritous liquors.
A gentleman, in one of the southern states, who had nearly destroyed himself by strong drink, was remarkable for exhibiting the grossest marks of folly in his fits of intoxication. One evening, sitting in his parlour, he heard an uncommon noise in his kitchen. He went to the door, and peeped through the key hole, from whence he saw one of his negroes diverting his fellow servants, by mimicking his master's gestures and conversation when he was drunk. The sight overwhelmed him with shame and distress, and instantly became the means of his reformation.
4. The association of the idea of ardent spirits, with a painful or disagreeable impression upon some part of the body, has sometimes cured the love of strong drink. I once tempted a negro man, who was habitually fond of ardent spirits, to drink some rum (which I placed in his way), and in which I had put a few grains of tartar emetic. The tartar sickened and puked him to such a degree, that he supposed himself to be poisoned. I was much gratified by observing he could not bear the sight, nor smell of spirits, for two years afterwards.
I have heard of a man, who was cured of the love of spirits, by working off a puke, by large draughts of brandy and water, and I know a gentleman, who in consequence of being affected with a rheumatism, immediately after drinking some toddy, when overcome with fatigue and exposure to the rain, has ever since loathed that liquor, only because it was accidentally associated in his memory with the recollection of the pain he suffered from his disease.
This appeal to that operation of the human mind, which obliges it to associate ideas, accidentally or otherwise combined, for the cure of vice, is very ancient. It was resorted to by Moses, when he compelled the children of Israel to drink the solution of the golden calf (which they had idolized) inwater. This solution, if made, as it most probably was, by means of what is called hepar sulphuris, was extremely bitter, and nauseous, and could never be recollected afterwards, without bringing into equal detestation, the sin which subjected them to the necessity of drinking it. Our knowledge of this principle of association upon the minds and conduct of men, should lead us to destroy, by means of other impressions, the influence of all those circumstances, with which the recollection and desire of spirits are combined. Some men drink only in themorning, some atnoon, and some only atnight. Some men drink only on amarket day, some atonetavern only, and some only inone kindof company. Now by finding a new and interesting employment, or subject of conversation for drunkards at the usual times in which they have been accustomed to drink, and by restraining them by the same means from those places and companions, which suggested to them the idea of ardent spirits, their habits of intemperance may be completely destroyed. In the same way the periodical returns of appetite, and a desire of sleep have been destroyed in a hundred instances. The desire for strong drink differs from each of them, in being of an artificial nature, and therefore not disposed to return, after being chased for a few weeks from the system.
5. The love of ardent spirits has sometimes been subdued, by exciting a counter passion in the mind. A citizen of Philadelphia had made many unsuccessful attempts to cure his wife of drunkenness. At length, despairing of her reformation, he purchased a hogshead of rum, and, after tapping it, left the key in the door of the room in which it was placed, as if he had forgotten it. His design was to give his wife an opportunity of drinking herself to death. She suspected this to be his motive, in what he had done, and suddenly left off drinking. Resentment here became the antidote to intemperance.
6. A diet consisting wholly of vegetables cured a physician in Maryland, of drunkenness, probably by lessening that thirst, which is always more or less excited by animal food.
7. Blisters to the ankles, which were followed by an unusual degree of inflammation, once suspended the love of ardent spirits, for one month, in a lady in this city. The degrees of her intemperance may be conceived of, when I add, that her grocer's account for brandy alone amounted, annually, to one hundred pounds, Pennsylvania currency, for several years.
8. A violent attack of an acute disease, has sometimes destroyed a habit of drinking distilled liquors. I attended a notorious drunkard, in the yellow fever, in the year 1798, who recovered with the loss of his relish for spirits, which has, I believe, continued ever since.
9. A salivation has lately performed a cure of drunkenness, in a person of Virginia. The new disease excited in the mouth and throat, while it rendered the action of the smallest quantity of spirits upon them painful, was happily calculated to destroy the disease in the stomach which prompts to drinking, as well as to render the recollection of them disagreeable, by the laws of association formerly mentioned.
10. I have known an oath, taken before a magistrate, to drink no more spirits, produce a perfect cure of drunkenness. It is sometimes cured in this way in Ireland. Persons who take oaths for this purpose are called affidavit men.
11. An advantage would probably arise from frequent representations being made to drunkards, not only of the certainty, but of thesuddennessof death, from habits of intemperance. I have heard of two persons being cured of the love of ardentspirits, by seeing death suddenly induced by fits of intoxication; in the one case, in a stranger, and in the other, in an intimate friend.
12. It has been said, that the disuse of spirits should be gradual, but my observations authorize me to say, that persons who have been addicted to them, should abstain from themsuddenly, andentirely. “Taste not, handle not, touch not,” should be inscribed upon every vessel that contains spirits, in the house of a man who wishes to be cured of habits of intemperance. To obviate, for a while, the debility which arises from the sudden abstraction of the stimulus of spirits, laudanum, or bitters infused in water, should be taken, and perhaps a larger quantity of beer or wine, that is consistent with the strict rules of temperate living. By the temporary use of these substitutes for spirits, I have never known the transition to sober habits to be attended with any bad effects, but often with permanent health of body, and peace of mind.
Footnotes:[63]Inquiry into the causes which produce, and the means of preventing diseases among British officers, soldiers, and others in the West-Indies.[64]Treatise on Tropical Diseases.
Footnotes:
[63]Inquiry into the causes which produce, and the means of preventing diseases among British officers, soldiers, and others in the West-Indies.
[63]Inquiry into the causes which produce, and the means of preventing diseases among British officers, soldiers, and others in the West-Indies.
[64]Treatise on Tropical Diseases.
[64]Treatise on Tropical Diseases.
GENTLEMEN,
I Shall conclude our course of lectures, by delivering to you a few directions for the regulation of your future conduct and studies, in the line of your profession.
I shall,first, suggest the most probable means of establishing yourselves in business, and of becoming acceptable to your patients, and respectable in life.
Secondly, I shall mention a few thoughts which have occurred to me on the mode to be pursued, in the further prosecution of your studies, and for the improvement of medicine.
I. Permit me, in the first place, to recommend to such of you as intend to settle in the country, to establish yourselves as early as possible uponfarms. My reasons for this advice are as follow:
1. It will reconcile the country people to the liberality and dignity of your profession, by showing them that you assume no superiority over them from your education, and that you intend to share with them in those toils, which were imposed upon man in consequence of the loss of his innocence. This will prevent envy, and render you acceptable to your patients as men, as well as physicians.
2. By living on a farm you may serve your country, by promoting improvements in agriculture. Chemistry (which is now an important branch of a medical education) and agriculture are closely allied to each other. Hence some of the most useful books upon agriculture have been written by physicians. Witness the essays of Dr. Home of Edinburgh, and of Dr. Hunter of Yorkshire, in England.
3. The business of a farm will furnish you with employment in the healthy seasons of the year, and thereby deliver you from the tædium vitæ, or what is worse, from retreating to low or improper company.Perhaps one cause of the prevalence of dram or grog drinking, with which country practitioners are sometimes charged, is owing to their having no regular or profitable business to employ them, in the intervals of their attendance upon their patients.
4. The resources of a farm will create such an independence as will enable you to practice with more dignity, and at the same time screen you from the trouble of performing unnecessary services to your patients. It will change the nature of the obligation between you and them. Whilemoneyis the only means of your subsistence, your patients will feel that they are the channels of your daily bread; but while your farm furnishes you with the necessaries of life, your patients will feel more sensibly, that the obligation is on their side, for health and life.
5. The exigencies and wants of a farm instockandlabourof all kinds, will enable you to obtain from your patients a compensation for your services in those articles. They all possess them, and men part with that of which money is only the sign, much more readily than they do with money itself.
6. The resources of a farm will prevent your cherishing, for a moment, an impious wish for the prevalence of sickness in your neighbourhood. A healthy season will enable you to add to the produce of your farm, while the rewards of an unhealthy season will enable you to repair the inconvenience of your necessary absence from it. By these means your pursuits will be marked by thatvarietyandintegrity, in which true happiness is said to consist.
7. Let your farms be small, and let yourprincipalattention be directed to grass and horticulture. These afford most amusement, require only moderate labour, and will interfere least with your duties to your profession.
II. Avoid singularities of every kind in your manners, dress, and general conduct. Sir Isaac Newton, it is said, could not be distinguished in company, by any peculiarity, from a common well-bred gentleman. Singularity in any thing, is a substitute for such great or useful qualities as command respect; and hence we find it chiefly in little minds. The profane and indelicate combination of extravagant ideas, improperly called wit, and the formal and pompous manner, whether accompanied by a wig, a cane, or a ring, should be allavoided, as incompatible with the simplicity of science, and the real dignity of physic. There is more than one way of playing the quack. It is not necessary, for this purpose, that a man should advertise his skill, or his cures, or that he should mount a phaeton and display his dexterity in operating, to an ignorant and gaping multitude. A physician acts the same part in a different way, who assumes the character of a madman or a brute in his manners, or who conceals his fallibility by an affected gravity and taciturnity in his intercourse with his patients. Both characters, like the quack, impose upon the public. It is true, they deceive different ranks of people; but we must remember that there are two kinds of vulgar, viz. the rich and the poor; and that the rich vulgar are often upon a footing with the poor, in ignorance and credulity.
III. It has been objected to our profession, that many eminent physicians have been unfriendly to christianity. If this be true, I cannot help ascribing it in part to that neglect of public worship with which the duties of our profession are often incompatible; for it has been justly observed, that the neglect of this religious and social duty, generally produces a relaxation, either in principles or morals. Let this fact lead you, in setting out inbusiness, to acquire such habits of punctuality in visiting your patients, as shall not interfere with acts of public homage to the Supreme Being. Dr. Gregory has observed, that a cold heart is the most frequent cause of deism. Where this occurs in a physician, it affords a presumption that he is deficient in humanity. But I cannot admit that infidelity is peculiar to our profession. On the contrary, I believe christianity places among its friends more men of extensive abilities and learning in medicine, than in any other secular employment. Stahl, Hoffman, Boerhaave, Sydenham, Haller, and Fothergill, were all christians. These enlightened physicians were considered as the ornaments of the ages in which they lived, and posterity has justly ranked them among the greatest benefactors of mankind.
IV. Permit me to recommend to you a regard to all the interests of your country. The education of a physician gives him a peculiar insight in the principles of many useful arts, and the practice of physic favours his opportunities of doing good, by diffusing knowledge of all kinds. It was in Rome, when medicine was practised only by slaves, that physicians were condemned by their profession “mutam exercere artem.” But in modern times, and in free governments, they shoulddisdain an ignoble silence upon public subjects. The American revolution has rescued physic from its former slavish rank in society. For the honour of our profession it should be recorded, that some of the most intelligent and useful characters, both in the cabinet and the field, during the late war, have been physicians. The illustrious Dr. Fothergill opposed faction and tyranny, and took the lead in all public improvements in his native country, without suffering thereby the least diminution of that reputation, or business, in which, for forty years, he flourished almost without a rival in the city of London.
V. Let me advise you, in your visits to the sick,neverto appear in a hurry, nor to talk of indifferent matters before you have made the necessary inquiries into the symptoms of your patient's disease.
VI. Avoid making light of any case. “Respice finem” should be the motto of every indisposition. There is scarcely a disease so trifling, that has not, directly or indirectly, proved an outlet to human life. This consideration should make you anxious and punctual in your attendance upon every acute disease, and keep you from risking your reputation by an improper or hasty prognosis.
VII. Do not condemn, or oppose, unnecessarily, the simple prescriptions of your patients. Yield to them in matters of little consequence, but maintain an inflexible authority over them in matters that are essential to life.
VIII. Preserve, upon all occasions, a composed or cheerful countenance in the room of your patients, and inspire as much hope of a recovery as you can, consistent with truth, especially in acute diseases. The extent of the influence of the will over the human body, has not yet been fully ascertained. I reject the futile pretensions of Mr. Mesmer to the cure of diseases, by what he has absurdly called animal magnetism. But I am willing to derive the same advantages from his deceptions, which the chemists have derived from the delusions of the alchemists. The facts which he has established, clearly prove the influence of the imagination, and will, upon diseases. Let us avail ourselves of the handle which those faculties of the mind present to us, in the strife between life and death. I have frequently prescribed remedies of doubtful efficacy in the critical stage of acute diseases, but never till I had worked up my patients into a confidence, bordering upon certainty, of their probable good effects. The success of this measure has much oftener answered, than disappointedmy expectations; and while my patients have commended the vomit, the purge, or the blister which was prescribed, I have been disposed to attribute their recovery to the vigorous concurrence of thewillin the action of the medicine. Does the will beget insensibility to cold, heat, hunger, and danger? Does it suspend pain, and raise the body above feeling the pangs of Indian tortures? Let us not then be surprised that it should enable the system to resolve a spasm, to open an obstruction, or to discharge an offending humour. I have only time to hint at this subject. Perhaps it would lead us, if we could trace it fully, to some very important discoveries in the cure of diseases.
IX. Permit me to advise you in your intercourse with your patients, to attend to that principle in the human mind, which constitutes the association of ideas. A chamber, a chair, a curtain, or even a cup, all belong to the means of life or death, accordingly as they are associated with cheerful or distressing ideas, in the mind of a patient. But this principle is of more immediate application in those chronic diseases which affect the mind. Nothing can be accomplished here, till we produce a new association of ideas. For this purpose a change of place and company are absolutely necessary.But we must sometimes proceed much further. I have heard of a gentleman in South-Carolina who cured his fits of low spirits by changing his clothes. The remedy was a rational one. It produced at once a new train of ideas, and thus removed the paroxysm of his disease.
X. Make it a rule never to be angry at any thing a sick man says or does to you. Sickness often adds to the natural irritability of the temper. We are, therefore, to bear the reproaches of our patients with meekness and silence. It is folly to resent injuries at any time, but it is cowardice to resent an injury from a sick man, since, from his weakness and dependence upon us, he is unable to contend with us upon equal terms. You will find it difficult to attach your patients to you by the obligations of friendship or gratitude. You will sometimes have the mortification of being deserted by those patients who owe most to your skill and humanity. This led Dr. Turner to advise physicians never to chuse their friends from among their patients. But this advice can never be followed by a heart that has been taught to love true excellency, wherever it finds it. I would rather advise you to give the benevolent feelings of your hearts full scope, and to forget the unkind returnsthey will often meet with, by giving to human nature—— a tear.
XI. Avoid giving a patient over in an acute disease. It is impossible to tell in such cases where life ends, and where death begins. Hundreds of patients have recovered, who have been pronounced incurable, to the great disgrace of our profession. I know that the practice of predicting danger and death upon every occasion, is sometimes made use of by physicians, in order to enhance the credit of their prescriptions if their patients recover, and to secure a retreat from blame, if they should die. But this mode of acting is mean and illiberal. It is not necessary that we should decide with confidence at any time, upon the issue of a disease.
XII. A physician in sickness is always a welcome visitor in a family; hence he is often solicited to partake of the usual sign of hospitality in this country, by taking a draught of some strong liquor, every time he enters into the house of a patient. Let me charge you to lay an early restraint upon yourselves, by refusing to yield to this practice, especially in theforenoon. Many physicians have been innocently led by it into habits of drunkenness. You will be in the more dangerof falling into this vice, from the great fatigue and inclemency of the weather to which you will be exposed in country practice. But you have been taught that strong drink affords only a temporary relief from those evils, and that it afterwards renders the body more sensible of them.
XIII. I shall now give some directions with respect to the method of charging for your services to your patients.
When we consider the expence of a medical education, and the sacrifices a physician is obliged to make of ease, society, and even health, to his profession; and when we add to these, the constant and painful anxiety which is connected with the important charge of the lives of our fellow-creatures, and above all, the inestimable value of that blessing which is the object of his services, I hardly know how it is possible for a patient sufficiently and justly to reward his physician. But when we consider, on the other hand, that sickness deprives men of the means of acquiring money; that it increases all the expenses of living; and that high charges often drive patients from regular-bred physicians to quacks; I say, when we attend to these considerations, we should makeour charges as moderate as possible, and conform them to the following state of things.
Avoid measuring your services to your patients by scruples, drachms, and ounces. It is an illiberal mode of charging. On the contrary, let the number andtimeof your visits, the nature of your patient's disease, and his rank in his family or society, determine the figures in your accounts. It is certainly just to charge more for curing an apoplexy, than an intermitting fever. It is equally just, to demand more for risking your life by visiting a patient in a contagious fever, than for curing a pleurisy. You have likewise a right to be paid for your anxiety. Charge the same services, therefore, higher, to the master or mistress of a family, or to an only son or daughter, who call forth all your feelings and industry, than to less important members of a family and of society. If a rich man demand more frequent visits than are necessary, and if he impose the restraints of keeping to hours, by calling in other physicians to consult with you upon every trifling occasion, it will be just to make him pay accordingly for it. As this mode of charging is strictly agreeable to reason and equity, it seldom fails of according with the reason and sense of equity of our patients. Accounts made out upon these principles, are seldom complainedof by them. I shall only remark further upon this subject, that the sooner you send in your accounts after your patients recover, the better. It is the duty of a physician to inform his patient of the amount of his obligation to him at leastoncea year. But there are times when a departure from this rule may be necessary. An unexpected misfortune in business, and a variety of other accidents, may deprive a patient of the money he had allotted to pay his physician. In this case, delicacy and humanity require, that he should not know the amount of his debt to his physician, till time had bettered his circumstances.
I shall only add, under this head, that the poor of every description should be the objects of your peculiar care. Dr. Boerhaave used to say, “they were his best patients, because God was their paymaster.” The first physicians that I have known, have found the poor the steps by which they have ascended to business and reputation. Diseases among the lower class of people are generally simple, and exhibit to a physician the best cases of all epidemics, which cannot fail of adding to his ability of curing the complicated diseases of the rich and intemperate. There is an inseparable connection between a man's duty and his interest. Whenever you are called, therefore, to visit a poorpatient, imagine you hear the voice of the good Samaritan sounding in your ears, “Take care of him, and I will repay thee.”
I come now to the second part of this address, which was to point out the best mode to be pursued, in the further prosecution of your studies, and the improvement of medicine.
I. Give me leave to recommend to you, to open all the dead bodies you can, without doing violence to the feelings of your patients, or the prejudices of the common people. Preserve a register of the weather, and of its influence upon the vegetable productions of the year. Above all, record the epidemics of every season; their times of appearing and disappearing, and the connection of the weather with each of them. Such records, if published, will be useful to foreigners, and a treasure to posterity. Preserve, likewise, an account of chronic cases. Record the name, age, and occupation of your patient; describe his disease accurately, and the changes produced in it by your remedies; mention the doses of every medicine you administer to him. It is impossible to tell how much improvement and facility in practice you will find from following these directions. It has been remarked, that physicians seldom remembermore than the two or three last years of their practice. The records which have been mentioned, will supply this deficiency of memory, especially in that advanced stage of life when the advice of physicians is supposed to be most valuable.
II. Permit me to recommend to you further, the study of the anatomy (if I may be allowed the expression) of the human mind, commonly called metaphysics. The reciprocal influence of the body and mind upon each other, can only be ascertained by an accurate knowledge of the faculties of the mind, and of their various modes of combination and action. It is the duty of physicians to assert their prerogative, and to rescue the mental science from the usurpations of schoolmen and divines. It can only be perfected by the aid and discoveries of medicine. The authors I would recommend to you upon metaphysics, are, Butler, Locke, Hartley, Reid, and Beattie. These ingenious writers have cleared this sublime science of its technical rubbish, and rendered it both intelligible and useful.
III. Let me remind you, that improvement in medicine is not to be derived only from colleges and universities. Systems of physic are the productions of men of genius and learning; but those facts which constitute real knowledge, are to bemet with in every walk of life. Remember how many of our most useful remedies have been discovered by quacks. Do not be afraid, therefore, of conversing with them, and of profiting by their ignorance and temerity in the practice of physic. Medicine has its Pharisees, as well as religion. But the spirit of this sect is as unfriendly to the advancement of medicine, as it is to christian charity. By conversing with quacks, we may convey instruction to them, and thereby lessen the mischief they might otherwise do to society. But further. In the pursuit of medical knowledge, let me advise you to converse with nurses and old women. They will often suggest facts in the history and cure of diseases, which have escaped the most sagacious observers of nature. Even negroes and Indians have sometimes stumbled upon discoveries in medicine. Be not ashamed to inquire into them. There is yet one more means of information in medicine which should not be neglected, and that is, to converse with persons who have recovered from indispositions without the aid of physicians. Examine the strength and exertions of nature in these cases, and mark the plain and home-made remedy to which they ascribe their recovery. I have found this to be a fruitful source of instruction, and have been led to conclude, that if every man in a city, or a district, couldbe called upon to relate to persons appointed to receive and publish his narrative, an exact account of the effects of those remedies which accident or whim has suggested to him, it would furnish a very useful book in medicine. To preserve the facts thus obtained, let me advise you to record them in a book to be kept for that purpose. There is one more advantage that will probably attend the inquiries that have been mentioned: you may discover diseases, or symptoms of diseases, or even laws of the animal economy, which have no place in our systems of nosology, or in our theories of physic.
IV. Study simplicity in the preparation of your medicines. My reasons for this advice are as follow:
1. Active medicines produce the most certain effects in a simple state.
2. Medicines when mixed frequently destroy the efficacy of each other. I do not include chemical medicines alone in this remark. It applies likewise to Galenical medicines. I do not say, that all these medicines are impaired by mixture, but we can only determine when they are not, by actual experiments and observations.
3. When medicines of the same class, or even of different classes, are given together, thestrongestonly produces an effect. But what are we to say to a compound of two medicines which give exactly the same impression to the system? Probably, if we are to judge from analogy, the effect of them will be such as would have been produced by neither, in a simple state.
4. By observing simplicity in your prescriptions, you will always have the command of a greater number of medicines of thesameclass, which may be used in succession to each other, in proportion as habit renders the system insensible of their action.
5. By using medicines in a simple state you will obtain an exact knowledge of their virtues and doses, and thereby be able to decide upon the numerous and contradictory accounts which exist in our books, of the character of thesamemedicines.
Under this head, I cannot help adding two more directions.
1. Avoid sacrificing too much to thetasteof your patients in the preparation of your medicines. The nature of a medicine may be wholly changed by being mixed with sweet substances. The Authorof Nature seems to have had a design, in rendering medicines unpalatable. Had they been more agreeable to the taste, they would probably have yielded long ago to the unbounded appetite of man, and by becoming articles of diet, or condiments, have lost their efficacy in diseases.
2. Give as few medicines as possible in tinctures made with distilled spirits. Perhaps there are few cases in which it is safe to exhibit medicines prepared in spirits, in any other form than indrops. Many people have been innocently seduced into a love of strong drink, from taking large or frequent doses of bitters, infused in spirits. Let not our profession be reproached in a single instance, with adding to the calamities that have been entailed upon mankind by this dreadful species of intemperance.
V. Let me recommend to your particular attention, the indigenous medicines of our country. Cultivate or prepare as many of them as possible, and endeavour to enlarge the materia medica, by exploring the untrodden fields and forests of the United States. The ipecacuanha, the Seneka and Virginia snake-roots, the Carolina pink-root, the spice-wood, the sassafras, the butter-nut, the thoroughwort, the poke, and the stramonium, arebut a small part of the medicinal productions of America. I have no doubt but there are many hundred other plants which now exhale invaluable medicinal virtues in the desert air. Examine, likewise, the mineral waters, which are so various in their impregnation, and so common in all parts of our country. Let not the properties of the insects of America escape your investigation. We have already discovered among some of them, a fly equal in its blistering qualities to the famous fly of Spain. Who knows but it may be reserved for America to furnish the world, from her productions, with cures for some of those diseases which now elude the power of medicine? Who knows but that, at the foot of the Allegany mountain, there blooms a flower that is an infallible cure for the epilepsy? Perhaps on the Monongahela, or the Potomac, there may grow a root that shall supply, by its tonic powers, the invigorating effects of the savage or military life in the cure of consumptions. Human misery of every kind is evidently on the decline. Happiness, like truth, is a unit. While the world, from the progress of intellectual, moral, and political truth, is becoming a more safe and agreeable abode for man, the votaries of medicine should not be idle. All the doors and windows of the temple of nature have been thrown open by the convulsions of the lateAmerican revolution. This is the time, therefore, to press upon her altars. We have already drawn from them discoveries in morals, philosophy, and government; all of which have human happiness for their object. Let us preserve the unity of truth and happiness, by drawing from the same source, in the present critical moment, a knowledge of antidotes to those diseases which are supposed to be incurable.
I have now, gentlemen, only to thank you for the attention with which you have honoured the course of lectures which has been delivered to you, and to assure you, that I shall be happy in rendering you all the services that lie in my power, in any way you are pleased to command me. Accept of my best wishes for your happiness, and may the blessings of hundreds and thousands that were ready to perish, be your portion in life, your comfort in death, and your reward in the world to come.
However trifling these complaints may appear, they compose a large class of the diseases of a numerous body of people. Hitherto, the persons afflicted by them have been too generally abandoned to the care of empirics, either because the disease was considered as beneath the notice of physicians, or because they were unable to cure it. I would rather ascribe it to the latter, than to the former cause, for pride has no natural fellowship with the profession of medicine.
The difficulty of curing sore legs has been confessed by physicians in every country. As far as my observations have extended, I am disposed to ascribe this difficulty to the uniform and indiscriminate mode of treating them, occasioned by the want of a theory which shall explain their proximatecause. I shall attempt in a few pages to deliver one, which, however imperfect, will, I hope, lay a foundation for more successful inquiries upon this subject hereafter.
I shall begin my observations upon this disease, by delivering and supporting the following propositions.
I.Sore legsare induced by general debility. This I infer from the occupations and habits of the persons who are most subject to them. They are day-labourers, and sailors, who are in the habit of lifting great weights; also washer-women, and all other persons, who pass the greatest part of their time upon their feet. The blood-vessels and muscular fibres of the legs are thus overstretched, by which means either a rupture, or such a languid action in the vessels is induced, as that an accidental wound from any cause, even from the scratch of a pin, or the bite of a mosquito, will not easily heal. But labourers, sailors, and washer-women are not the only persons who are afflicted with sore legs. Hard drinkers of every rank and description are likewise subject to them. Where strong drink, labour, and standing long on the feet are united, they more certainly dispose to sore legs, than when they act separately. In China, wherethe labour which is performed by brutes in other countries, is performed by men, varices on the legs are very common among the labouring people. Perhaps, the reason why the debility is induced in the legs produces varices instead of ulcers in these people, may be owing to their not adding the debilitating stimulus of strong drink to that of excessive labour.
It is not extraordinary that the debility produced by intemperance in drinking ardent spirits, should appear first in the lower extremities. The debility produced by intemperance in the use of wine, makes its first appearance in the form of gout, in the same part of the body. The gout, it is true, discovers itself most frequently in pain only, but there are cases in which it has terminated in ulcers, and even mortification on the legs.
II. Sore legs are connected with a morbid state of the whole system. This I infer,
1. From the causes which induce them, all of which act more or less upon every part of the body.
2. From their following or preceding diseases, which obviously belong to the whole system. Fevers and dysenteries often terminate critically inthis disease; and the pulmonary consumption and apoplexy have often been preceded by the suppression of a habitual discharge from a sore leg. The two latter diseases have been ascribed to the translation of a morbific matter to the lungs or brain: but it is more rational to ascribe them to a previous debility in those organs, by which means their vessels were more easily excited into action and effusion by the stimulus of the plethora, induced upon the system in consequence of the confinement of the fluids formerly discharged from the leg in the form of pus. This plethora can do harm only where there is previous debility; for I maintain that the system (when the solids are exactly toned) will always relieve itself of a sudden preternatural accumulation of fluids by means of some natural emunctory. This has been often observed in the menorrhagia, which accompanies plentiful living in women, and in the copious discharges from the bowels and kidneys, which follow a suppression of the perspiration.
3. I infer it, from their appearing almost universally in one disease, which is evidently a disease of the whole system, viz. the scurvy.
4. From their becoming in some cases the outlets of menstrual blood, which is discharged in consequenceof a plethora, which affects more or less every part of the female system.
5. I infer it from thesymptomsof sore legs, which are in some cases febrile, and affect the pulse in every part of the body with preternatural frequency or force. These symptoms were witnessed, in an eminent degree, in two of the patients who furnished subjects for clinical remarks in the Pennsylvania hospital some years ago.
6. I infer that sore legs are a disease of the whole system, from the manner in which they are sometimes cured by nature and art. They often prove the outlets of many general diseases, and all the remedies which cure them, act more or less upon the whole system.
In all cases of sore legs there is a tonic and atonic state of the whole system. The same state of excessive or weak morbid action takes place in the parts which are affected by the sores. The remedies to cure them, therefore, should begeneralandlocal.
In cases where the arterial system is affected by too much tone, the general remedies should be,
I.Blood-letting.Of the efficacy of this remedy in disposing ulcers suddenly to heal, the two clinical patients before-mentioned exhibited remarkable proofs, in the presence of all the students of medicine in the university. The blood drawn was sizy in both cases. I have not the merit of having introduced this remedy into practice in the cure of ulcers. I learned it from Sir John Pringle. I have known it to be used with equal success in a sore breast, attended by pain and inflammation, after all the usual remedies in that disease had been used to no purpose.
II.Gentle purges.
III.Nitre.From fifteen to twenty grains of this medicine should be given three times a-day.
IV. ATEMPERATE DIET, and a total abstinence from fermented and distilled liquors.
V.CoolandPURE AIR.
VI. Rest in a recumbent posture of the body.
Thelocalremedies in this state of the system should be,
I. Cold water. Dr. Rigby has written largely in favour of this remedy when applied to local inflammations. From its good effects in allaying the inflammation which sometimes follows the puncture which is made in the arm in communicating the small-pox, and from the sudden relief it affords in the inflammatory state of the ophthalmia and in the piles, no one can doubt of its efficacy in sore legs, accompanied by inflammation in those vessels, which are the immediate seat of the disease.
II. Soft poultices of bread and milk, or of bread moistened with lead water. Dr. Underwood's method of making a poultice of bread and milk should be preferred in this case. He directs us first to boil the milk, then to powder the bread, and throw it into the milk, and after they have been intimately mixed, by being well stirred and boiled together, they should be poured out and spread upon a rag, and a knife dipped in sweet oil or lard, should be run over them. The solidity and consistence of the poultice is hereby better preserved, than when the oil or lard is mixed with the bread and milk over the fire.
III. When the inflammation subsides, adhesive plasters so applied as to draw the sound edges of the sores together. This remedy has been usedwith great success by Dr. Physick, in the Pennsylvania hospital, and in his private practice.
IV. Above all, rest, and a horizontal posture of the leg. Too much cannot be said in favour of this remedy in this species of sore legs. Nannoni, the famous Italian surgeon, sums up the cure of sore legs in three words, viz. “Tempo, riposo, e pazienza;” that is, in time, rest, and patience. A friend of mine, who was cured by this surgeon of a sore leg, many years ago, informed me, that he confined him to his bed during the greatest part of the time that he was under his care.
In sore legs, attended by too little general and local action, the following remedies are proper.
I.Bark.It should be used plentifully, but with a constant reference to the state of the system; for the changes in the weather, and other accidental circumstances, often produce such changes in the system, as to render its disuse for a short time frequently necessary.
II.Mercury.This remedy has been supposed to act by altering the fluids, or by discharging a morbid matter from them, in curing sore legs. But this is by no means the case. It appears to act asa universal stimulant; and if it prove most useful when it excites a salivation, it is only because in this way it excites the most general action in the system.
III.Mineral tonics, such as the different preparations of iron, copper, and zinc.
IV.Gentle exercise.Rest, and a recumbent posture of the body, so proper in the tonic, are both hurtful in this species of sore legs. The efficacy of exercise, even of the active kind, in the cure of sore legs, accompanied by deficient action in the vessels, may easily be conceived from its good effects after gun-shot wounds which are mentioned by Dr. Jackson[65]. He tells us, that those British soldiers who had been wounded at the battle of Guilford, in North-Carolina, who were turned out of the military hospitals and followed the army, soonest recovered of their wounds. It was remarkable, that if they delayed only a few days on the road, their wounds grew worse, or ceased to heal.
In the use of the different species of exercise, the same regard should be had to the state ofthe system, which has been recommended in other diseases.
V. A nutritious and moderately stimulating diet, consisting of milk, saccharine vegetables, animal food, malt liquors, and wine.
Wort has done great service in sore legs. The manner in which I have directed it to be prepared and taken is as follows: To three or four heaped table-spoonsful of the malt, finely powdered and sifted, add two table-spoonsful of brown sugar, and three or four of Madeira, sherry, or Lisbon wine, and a quart of boiling water. After they have stood a few hours, it may be drunken liberally by the patient, stirring it each time before he takes it, so that the whole substance of the malt may be conveyed into the stomach. A little lime-juice may be added, if the patient requires it, to make it more pleasant. The above quantity may be taken once, twice, or three times a-day at the pleasure of the patient, or according to the indication of his disease.
VI.Opium.This remedy is not only useful in easing the pain of a sore leg, but co-operates with other cordial medicines in invigorating the whole system.
Thelocalapplications should consist of such substances as are gently escarotic, and which excite an action in the torpid vessels of the affected part. Arsenic, precipitate, and blue vitriol, have all been employed with success for this purpose. Dr. Griffitts informed me, that he has frequently accomplished the same thing in the Dispensary by applications of tartar emetic. They should all be used, if necessary, in succession to each other; for there is often the same idiosyncrasy in a sore leg to certain topical applications, that there is in the stomach to certain aliments. After the use of these remedies, astringents and tonics should be applied, such as an infusion of Peruvian, or white-oak bark; the water in which the smiths extinguish their irons, lime-water, bread dipped in a weak solution of green vitriol (so much commended by Dr. Underwood), compresses wetted with brandy, or ardent spirits of any kind, and, above all, the adhesive plasters formerly mentioned.
Tight bandages are likewise highly proper here. The laced stocking has been much used. It is made of strong coarse linen. Dr. Underwood gives several good reasons for preferring a flannel roller to the linen stocking. It sets easier on the leg, and yields to the swelling of the muscles in walking.
In scorbutic sores on the legs, navy surgeons have spoken in high terms of an application of a mixture of lime-juice and molasses. Mr. Gillespie commends the use of lime or lemon-juice alone, and ascribes many cures to it in the British navy during the late war, after every common application had been used to no purpose[66].
It is of the utmost consequence in the treatment of sore legs, to keep them clean, by frequent dressings and washings. The success of old women is oftener derived from their great attention to cleanliness, in the management of sore legs, than to any specifics they possess which are unknown to physicians.
When sore legs are kept from healing by affections of the bone, the treatment should be such as is recommended by practical writers on surgery.
I shall conclude this inquiry by four observations, which are naturally suggested by what has been delivered upon this disease.
1. If it has been proved that sore legs are connected with a morbid state of the whole system, isit not proper to inquire, whether many other diseases supposed to be local, are not in like manner connected with the whole system; and if sore legs have been cured by general remedies, is it not proper to use them more frequently in local diseases?
2. If there be two states of action in the arteries in sore legs, it becomes us to inquire, whether the same opposite states of action do not take place in many diseases in which they are not suspected. It would be easy to prove, that they exist in several other local diseases.
3. If the efficacy of the remedies for sore legs which have been mentioned, depend upon their being accommodated exactly to the state of the arterial system, and if this system be liable to frequent changes, does it not become us to be more attentive to the state of the pulse in this disease than is commonly supposed to be necessary by physicians?
4. It has been a misfortune in medicine, as well as in other sciences, for men to ascribe effects to one cause, which should be ascribed to many. Hence diseases have been attributed exclusively to morbid affections of the fluids by some, and of the muscles and nerves by others. Unfortunately themorbid states of the arterial system, and the influence of those states upon the brain, the nerves, the muscles, the lymphatics, the glands, the viscera, the alimentary canal, and the skin, as well as the reciprocal influence of the morbid states of each of those parts of the body upon the arteries, and upon each other, have been too much neglected in most of our systems of physic. I consider the pathology of the arterial system as a mine. It was first discovered by Dr. Cullen. The man who attempts to explore it, will probably impoverish himself by his researches; but the men who come after him, will certainly obtain from it a treasure which cannot fail of adding greatly to the riches of medicine.