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urges; in the other, it will be used at stated intervals, whether the symptoms press or not; and may tend to weaken the already debilitated patient, without our hav. ing the consolation of knowing, with certainty, that it has had any other effect.
Blisters do not weaken so much; they are of undoubted use in pleurisies; perhaps, by exciting external inflammation, they may contribute to draw off the inflammatory disposition within the breast; perhaps-But in whatever way they act, I imagine I have frequently seen blisters and setons, particularly the latter, of considerable service, even after the symptoms indicated the existence of an ulcer in the lungs.
As for the numerous forms of electuaries, lohochs, and linctuses, composed of oils, gums, and syrups, and by the courtesy of dispensatory writers called pectoral ; I am convinced they are of no manner of service in this complaint, and seldom have any other effect than that of loading the stomach, and impairing the digestion of salutary food. So far from being of any permanent service to the disease, they cannot be depended on for giving even a temporary relief to the cough; when that symptom becomes troublesome, gentle opiates will be found the best palliatives. Some practitioners object to these medicines, on a supposition that they check expectoration ; but they only seem to have this effect, by lulling the irritation to cough ; the same quantity will be expectorated in the morning, after the influence of the 'opiate is over. It is surely better that the matter should accumulate, and the patient spit it up at once, than allow him to be kept from rest, and teased with coughing and spitting through the whole night. These palliatives, however, are to be managed with great caution; never exhibited while the patient enjoys a tolerable share of natural
Small doses should be given at first, and not increased without absolute necessity. Exbibited in this manner, they cannot do harm; and those who reject the assistance of a class of medicines, which afford ease and
tranquillity in the most deplorable state of this disease, ought to give better proofs than have hitherto appeared, that they are able to procure their patients more valuable and lasting comforts than those they deprive them of.
The known efficacy of the Peruvian bark, in many distempers, especially in intermittent fevers ; the remission of the symptoms, which happens regularly every day at a particular stage of the pulmonary consumption, and in some degree gives it the appearance of an intermittent, joined to the failure of all other remedies, prompted physicians to make trial of that noble medicine in this disease.
consequence of these trials, the bark is now pretty generally acknowledged to be serviceable in hectical complaints, proceeding from debility, and other causes, exclusive of ulcerated lungs; but when the disease proeeeds from this cause, the bark is supposed, by some very respectable physicians, always to do harm. I am most clearly of the first opinion, and perhaps it would not become me to dispute the second. It may be permitted, however, to observe, that the most discerning practitioners may be led into a notion, that a very safe medicine does harm, when it is exhibited at the worst stage of a disease, in which hardly any medicine whatever has been found to do good. In every stage of this disease, elixir of vitriol may be used. It is a pleasant and safe medicine, but particularly efficacious when the patient is troubled with wasting sweats.
Having, in obedience to your request, delivered my sentiments freely, you will perceive, that, besides the objections already mentioned to the person under whose care our friend is at present, I cannot approve of his being directed to take so many drugs, or of his being detained in town, at a season when he may enjoy, in the country, what is preferable to all medicine; I mean air, exercise, and, let me even add, diet.
Had I known of our friend's complaints earlier, I should have advised him to have met the advancing
spring in the south of France; but at the season in which you will receive this letter, the moderate warmth, and refreshing verdure of England, are preferable to the sultry heats and scorched fields of the south. From the view I have of his complaints, I can have no hesitation in advising you to endeavour to prevail on him to quit his drugs, and to leave London without delay. Since he bears riding on horseback so well, let him enjoy that exercise in an atmosphere freed from the smoke of the town, and impregnated with the flavour of rising plants and green herbage; a flavour which may with more truth be called pectoral, than any of the heating resins, or loathsome oils, on which that term has been prostituted. Let him pass the summer in drinking the waters, and riding around the environs of Bristol. It will be easy for bim to find a house in the free air of the country, at some distance from that town; and it will be of use to have an additional reason for rising early, and riding every morn, ing. It is of the greatest importance that he continue that exercise every day that the weather will permit: a little cloudiness of the sky should not fright him from it; there is no danger of catching cold during the continua, tion of that movement which assists digestion, promotes the determination of blood from the lungs to the surface of the body, and is more salutary in the morning than af ter dinner,
With respect to diet, he should carefully observe the important rule of taking food frequently in small quantities, and never making a full meal; that the digestive organs may not be overpowered, or the vessels charged with too large a quantity of chyle at a time; which never fails to bring on oppressive breathing, and augments the fever and flushing, which in some degree succeeds every repast,
Since all kinds of milk are found to disagree with his constitution, that nourishment, which is in general so well adapted to similar complaints, must be omitted, and light broths, with vegetable food, particularly of the farinaçe. ous kind, substituted in its place.
Acids, especially the native acid of vegetables, are remarkably agreeable and refreshing to all who labour under the heat, oppression, and languor, which accompany hectic complaints. It is surprising what a quantity of the juice of lemons the constitution will bear, without any inconveniency, when it is accustomed to it by degrees ; and in those cases where it does not occasion pains in the stomach and bowels, or other immediate inconveniences, it has been thought to have a good effect in abating the force of the hectic fever.
I have met with two cases, since I have been last abroad, in both of which there seemed to be a quicker recovery than I ever saw, from the same symptoms. The first was that of a young lady, of about seventeen years of age, and apparently of a very healthy constitution. In bad weather, during the spring, she caught cold: this being neglected in the beginning, gradually grew worse. When physicians were at length consulted, their prescriptions seemed to have as bad an effect as her own neglect. By the middle of summer her cough was incessant, accompanied with hectic fever and flushings, irregular shiverings, morning sweats, emaciation, expectoration of purulent phlegm streaked with blood, and every indication of an open ulcer in the lungs. In this desperate state she was carried from the town to a finely situated village in Switzerland, where, for several months, she lived in the middle of a vineyard, on ripe grapes and bread. She had been directed to a milk and vegetable diet in general. Her own taste inclined her to the grapes, which she continued, on finding, that, with this diet only, she was less languid, and of a more natural coolness, and that the cough, fever, and all the other symptoms gradually abated. She seemed to be brought from the jaws of death by the change of air, and this regimen only; and she returned to her own home in high spirits, and with the look and vigour of bealth. The ensuing winter, after being heated with dancing at the house of a friend, she walked home in a cold night; the cough, spitting of blood, and
other symptoms immediately returned, and she died three months after.
In the other case, there was not such a degree of fever, but there was an expectoration of matter, frequently streaked with blood, and evident signs of an ulcer in the lungs. The person who laboured under these symptoms had tried the usual remedies of pectorals, pills, linctuses, &c. with the usual success. He grew daily
He had formerly found much relief from bleeding, but had left it off for many months, on a supposition that it had lost all effect; and he had allowed an issue to be healed, on the same supposition ; though he still persevered in a milk regimen. I mentioned to him the case of the young lady, as it is above recited. He immediately took the resolution to confine himself to bread and grapes for almost his only food. I advised him at the same time to have the issue opened, and to continue that drain for some time; but this he did not comply with. He forsook, however, the town for the country, and passed as much of the morning on horseback, as he could bear without fatigue. He soon was able to bear more ; and after about three weeks or a month, his cough had greatly abated. When he had persisted in this regimen between two and three months, he had very little cough ; and what he spit up was pure phlegm, unmixed with blood or matter. He has now been well above a year; and although I understand that he occasionally takes ani. mal food, he has hitherto felt no inconveniency from it. He passed the second autumn, as he had done the first, at a house in the country, surrounded with vineyards. The greater part of his food consisted of ripe grapes and bread. With such a diet, he had not occasion for much drink of any kind; what he used was simple water, and he made an ample provision of grapes for the succeeding winter.
Though I have no idea that there is any specific virtue in grapes, for the cure of the pulmonary consumption, or
, that they are greatly preferable to some other cooling, sub