NATIONAL LIBRARY OF MEDICINE Washington Founded 1836 U. S. Department of Health, Education, and Welfare Public Health Serrice X^fe^edk: ^l-f-title ±*d. )*«* Uaf L»&fc !«-»-+ -fv*e~v cops 7 ; kw^.^ V ' i A DISSERTATION C ... >' O N T'H E G ,o " u^ T* it ar o ai CHROMIC DISEASES. r CAJ>OCjAA^NW^J DISSERTATION \>. */: O M X H t ,Vl-G-0 U-.Tvjjjjv" CHRONIC DISEASES, JOINTLY. CONSIDERED,. o a As proceeding from the fame Causes *' * a * What TOofe C^k u s e s are ; • •« * - -.. AND , 'v, O 6 . . A rational and rproroj Method .of Ccjrf propofed. AddreiTed to all Inv-Uids, By WILLI AM CAD OGAN, Fallow of the College of Physician^' THE TENTH E D J t r i *o n. '■€* tod petis in tc e/l. LONDON, Printed: BOSTON : Re-printed for Hsnry Knox, ia Cor/ibill, mdccubcii* - , 7f^ .hfl ! PREFACE. TO enjoy good health is better than to command the world, fays a celebrated practical philofo- pher*, who underftood the ufe and value of life and health better than moft men ; for in exile,with afmall income, and no very good conftitution, he cultivated an uncommon length of days into a rational feries of pleafures 5 and ^rhat is much more, an uninter- rupted courfe of happineft. But, as far as I can find, he was almoft the only man that did fo. The generality of men feem to me not to beftow a tho't .tipon either, till it be too late to reap the benefit of ttheir conviction ; fo that health, like time, becomes Valuable only when it is loft; and we can no longer think of it but with retrofpect and regret. That men in good health, the young and gay in their career, mould be negligent of it, or abufe it, J' refufing to flop and liften to, or take warning from .others, is no great wonder; but it ir very furpriz:r\g that mankind in general mould be miftaken and miflead forever in the fame perpetual rourjd of fruit- lefs attempts to repair and eftablifh it •, not the ig« norant vulgar only, but the fenfible the judicious, men of parts, and knowledge in other things, in this cafe equally blind, ihould purfue, with the fame vain hope, after repeated dilappointments, the thoufand and ten thoufand idle arts and tricks of medication and quackery j never once lifting their eyes up t confirmed, from conviction of their neceflity* in fuch good and falutary habits, as cannot fail to eftablifli his health for life. Poflibly, if men were better informed of the real caufes of their difeafes, they might be lefs unreafona- ble in their demands, and learn to be contented withprefent relief; fubmitting with patience to that plan of life which alone can lead them to, and pre- ferve them in, permanent health. With this view of engaging men's attention to their own happinefs, and undeceiving them in their vain and groundlefs hopes of remedy, and diverting them from the de- lufions of art to the*.realitfes of nature, I have ven- tured to publifh the following DiHVrtation ; which vffi PREFACE. I niuftbeg the reader to confider as, what it really is, a hafty extrad ot a much larger work, intended to take in the whole circle of Chronic Difeafes, here comprehended only in their reprefentative the Gou/. If what I have faid may feem to want far- ther illuftration, or more demonftrative proof, he will look upon it only as a fketch to furnilh hints for his own thoughts and reflections, either to improve mine or reject them entirely, as may feem good un- to him. If he thinks, from what I have faid here, or in the brochure itfelf, that I mean to impeach the practice of phyfic in general; I fay, that it is not my intention. I would decry all quacks, from iEfcula- pius to the prefent, either as ignorant fools, or felf- convicted impoftors, advertifmg daily lies ; whether mounted on ftages, or riding in chariots. But the art of phyfic fairly and honeftly pra&ifed I honour as the firft of profeflions, comprehending the moft ufeful, the moft extenfive and univerfal knowledge of nature. I think a real Phyfieian the moft liberal of characters upon earth -, by which I do not mean every Doctor that goes about taking guineas, but him who will neither flatter the great nor deceive the ignorant, and who would prefer the fatisfadtion of making one invalid a healthy man, to the wealth j of Radcliff or the vogue oilVard. But there is an evil fpirit of quackery gone forth, that has poflfeffed all orden. of men among us. I would lay it if I could, together with every demon of fuperftition, fraud, and error, and reftore the world to truth and nature. George-Street, Hanover-Square^ Nov. 20. 1771^ A DISSERTATION ON THE G O U T, &c. Fy>HW% OWEVER common it may be. for Jp u *£. men that fufFer to complain of the •^t ^ evils of life, as the unavoidable lot of l^^^v^^jj[ humanity ; would they ftop but for a moment to confider them iu the light of reafon and philofophy, they would find little or no foundation for them in nature ; but that every man was the real author of all or mod of his own miferies. Whatever' doubts may be entertained of moral evils, the natural, for the moft part, fuch as bodily infirmity, ficknefs, and pain ; all that clafs of complaints which the learned call chronic difeafes, we moft undoubtedly bring upon ourfelves by our own indigencies, excefTes, or miftaken habits of life ; or by fuffering our ill-conducted paffions to' lead us aftray or difturb our peace of mind. What- ever notions men have been taught or hive received h [ 10 j of other caufes, fuch as accidental colds, or particu- larities of conftitution, this or that thing difagree- ing or furfeiting, &c. thefe are too trifling to pro- duce difeafes that commonly laft for lite: there muft be fcmething more fubftantial, fomething more conftant and parmanent in our daily ha- bks, to produce fuch inveterate evils. Though if you read authors or confult practitioners, what do you find, but that you have taken cold, though you know not how, or that your complaints are gouty, rheumatic, bilious, nervous, &c. ? words that fatisfy, though they give no kind of idea, and feem to have gained credit and afifent only by the pohteneTs of phyficfans, who, while they are taking their patients money, are too well bred to tell them difagreeable truths, and that it is by there own faults they are ill. To enquire a little further into this matter may be well worth our trouble •, the talk feems to have been left for me, and I will per- form it moft fincerely. I have long had it in my mind to write upon chronic difeafes in general, in the hope of giving mankind, what moft afluredly they have never yet had, a few rational ideas about them ; thinking that, if the true original caufes of them were fully and fairly fet forth, men could not be fo capitally miftaken to impute them, as they do, to the falfe and imaginary, and therefore apply falfe and ima- ginary remedies ; nor think that the general health of mankind were to be overfet by every trifle, and the recovery of it lay hid in a few drops or pow- ders of any kind. Did they better "underftand the L " J nature of chronic difeafes in general, and whence they proceed, they could not be fo unreafonable to think they might live as they lift with impunity, expecting repeated remedy from art; or, did they know any thing of the nature of medicine, they would find that, though fits of pain have been re- lieved, or ficknefs cured by it for a time, the eftab- lifhment of health is a very different thing, depend- ing upon other powers and principles : the firft may be and often is doqe by medicine,the other ne. ver. That their opinion of medicine is vain and ridiculous muft appear, I think, very evidently to any one who recollects that the art of phyfic has now been practifed, more or lefs regularly, above two thoufand years ; and moft afluredly there is hoc yet difcovered any one certain remedy lor any dif- eafe. Ought not this to make us fufpect that there is no fuch thing ? How can it be, when different degrees of the very fame difeafe require various means and methods, and the fame thing that in one degree would relieve, or perhaps cure, in another might kill ? It is by plan, by regimen, and fuccefliv-j intention, that difeafes muft be cured, when they are curable •, or relieved and palliated when they are not. The fkilful in medicine, and learned in nature, know well that health is not to be efcablifh- ed by medicine ; for it's effects are but momentary, and the frequent repetition of it deftructive to the ftrongeftframes ;that if it is to be reftored, it muft be by gently calling forth the powers of the body to act for themfelves, introducing gradually a littles more and more activity, chofen diet, and, above all, peace jf mind, changing intirely tha: courle cf lifs t ** 7 which firft brought on tfye difeafe : medicine co-ope^ rating a little. That this is the truth, all whp know any thing of nature or art muft know : and I may fafely take upon me to fay, that, though I firmr ly believe health may be reftored in moft cafes that are not abfolutely mortal, I am very fure that no in- valid was ever made a healthy man by the mere power of medicine. If this be the cafe, how muft the initiated, according as their humanity is touched., either laugh at or pity the poor foolifh world, lur- rendering at difcretion to the moft ignorant of quacks, pretending to infallible remedies which are not in nature. But what is ftill more ridiculous, the patients themfelves are often io afhamed to own they have been deluded, that they favor the cheat, by pretending to relief which they never felt. I have collected a few materials for this work, which I intend to put in order, as foon as I can find time and induftry enough to fet about it in earneft ; and, if I can finifli it %o my own fatisfaction, perhaps J may fome time or other trouh'e the world with it, At prefent I think myfelf particularly called upon to fay fomething of the gout, as that difeafe was to make a confiderable part of my plan ; and, as I fee now fo many, and hear of more, wh'o are throwing away, not only their money very foolifhly, but, as I vprily believe, the future health of their lives alfo, in hopes of a medical cure for it, to fhew that fuch Jiopes are chimerical, and contradictory to everv ide*» of true philofophy and common fenfe. L *3 3 1 fhall therefore take, a few extracts from this % and* •• [ 1/ ] he is relieved for that time ; (he might be fo much fooner, and very fafely too, by the affiftance of art judicioufly employed): he recovers however, and in a few months is taken again. Why ? Not from any thing inherent in his conftitution, but becaufe he returned to his former habic of life that produ- ced it at firft, and will for ever produce it, while the ftrength o," his body lafts. The truth is, we breed it at firft, we renew it again and again, and bring it on ourfelves by our own miftakes or faults, which we would fain excufe by throwing them back upon our parents, that our complaints may be more juftly founded. And as bankrupts, undone by idlenefs and extravagance, for ever plead lofles and misfortunes ; (o do we in- heritance, to exculpate ourfelves. It is natural enough for thofe who believe t;~ gout hereditary to think it alfo periodical, as if Something innate and inherent in our conftkutions produced it at certain times ; but this is a gr.-at miftake ■> for, if it were periodical, ic muft be regu- larly fo. The only periodical difeafe I know is the intermittent fever, which, till it be diftruhed by the bark or any other febrifuge, is as regular as a good clock. The returns of the gout are always very un- certain, according to the quantity or quality of ao cumulated indigeftion within, and the strength of our bodies. C [ i8 ] I come now to Ihew that the gout is not incura- ble. If by the cure of it be meant the adminifter- ing a pill or a powder, or medicine of any kind to do it, 1 fear it is and ever will be incurable. It has b-en long and often attempted in vain, from the origin of phyfic to this day, from the firft quack to the prefent. Indeed there is a moft glaring abfur- dity at firft fight, that muft ftop any man of conv mon fenfe, who has the leaft infight into nature, or knowledge of the human frame : for, if the gout be the neceflary effect of intemperance, as I hope to ihew very evidently that it is, a medicine to cure it muft be fomething that will enable a man to bear the daily intemperance of his future life unhurt by the gout or any other difeafe ; that is, fomething given now that will take away the effect of a future « caufe. As well might a medicine be given now to prevent a man's breaking his leg or his neck feven years hence. One would think the utmoft that any rational man could expect from medicine was, that it fhould have power to relieve and remove prefent diforder.% Jeaying the body quite free, without pre- . tending to infure it from future injuries. Hee lies the error : men think the gout to be fomething la- tent in the body now, which, once well eradicated, would never return •, not fyfpecting it to be no more than each day's indigeftion accumulated to a certain pitch, that, as long as the vigor of life lafts, always brings on every fit, which once well over, the man a .has no more gout, nor feeds of gout in him, than i he who never had it ; and, if he did not breed it a- £iin, moft certainly would never have it again. A proof of this is that the gout has b:en often cured L *9 J by a milk diet, which, as long as it lafted, has ge- nerally kept the patient free. But this method of cure I cannot approve, becaufe it relaxes and ener- vates the man, and does not fufficiently fupport the health and vigour of his body. Though I think the gout incurable by medicine, it is fo far frO:n being incurable in its nature, that 1 am firmly perfuaded it may be more eafily and more perfedly cured than almoft any other chronic difeafe ; and this i& another ftrong argument that proves it not hereditary. My reafon is, that it is confeffedly a difeafe of theftrongeft and beft confli- tution relieving itfelf by throwing off* harfn and bad humors from the vitals, and out of the blood upon the extremities, where they do leaft harm to the powers and principles of life and health •, and as thefe humors can be nothing more than the daily accumulations of indigeftion, if a man can live with- out breeding conftantly this indigefted acrimony, he may moft undoubtedly live free, not only from the gout, but every other chronic difeafe alfo. And that he may live fo, not in a perpetual ftatc of mor- tification and felf-denial, but with great eafe and comfort to himfelf, in the trueft, moft philosophic Luxury, I fhall endeavour to prove, I hope to the Satisfaction of all thinking, reafonable men, I have faid, that Indolence, Inteirpcrcnce, and "vexation, are the original caufes of all or moft of our chronic difeafes : perhaps a few accidents muft fee excepted, to which the ftrongeft and heakhiri* t 20 ] are moft liable ; and the effects of fevers not hap- pily ended; and which I except, to obviate all cavil and difpute with the men of art. I believe, to every confiderate man, whofe eyes have been opened fo as to give the leaft infight into nature, the truth of this propofition will be fo felf-evident, that he muft inftantly perceive it •, and every invalid that will be candid enough to do it, may fairly trace all his com- plaints up to one or other of thefe caufes. But it may require fome explanation to the generality of men, who a»-e fo fhort-fighted as never to look back or forward far beyond the ken of their nofe, and therefore never fee either diftant caufes or effects ; and when they are fick feldom enquire more than for fome cold or furfeit of yefterday, and to fome fuch trifling caufe impute difeafes that laft for life. An accidental cold or even debauch that happens but feldom can have no fuch effect; and men otherwife healthly, living in good habits, foon get rid of both. It is the conftant courfe of life we lead, what we do, or neglect to do, habitualy every day, that if right eftablifhes our health, if wrong, makes us invalids for life. Men ignorant of the ways of nature in the pro- duction and fupport of animals, not knowing what fhe requires to preferve them in health and vigour to their utmoft period, have conceived very ftrano-e itnd moft aifuredly very falfe ideas of difeafes in general, and kern to thin k every difeafe a diftinct kind of being or thing, and that there are medicines oppof-d t.q each, that will certainly remove and cure L 2« 3 it. This makes thern lo felicitous to know the name of their complaint, which once afcertained, they think the remedy not far off. Poor men ! Is not the gout furhciently diftinguifhed ? But where is the re- medy ? Certainly not in the precarious fkill of pre- fcribing doctors, or the fecre.t of ignorant and enter- prizing quacks. They fancy too that there is great variety of conftitution, with difeafes unavoidable peculiar to each : that certain times of life muft pro- duce many, and that it is impoflible to grow old without ficknefs of fome kind or other. There is certainly no foundation in nature for any of thefe opinions, nor is there any real eflTential difference of conftitution, but of ftrong or weak, and this is pro- duced more by habit than nature. The ftrong by bad habits will become weaker, and by good the weak ftronger. But the moft delicate frames may be as healthy as the ftrongeft, for the fame reafon that a fquirrel may be as healthy as an elephant. There is no difeafe neceflarily peculiar to any time of life, however the changes into the different ftages of it may effect the valetudinary. And it is poflible for men to live to great age without any dileafe at all, for many have lived to upwards of an hundred widi uninterrupted health. < Not from the natural defects of our confti tut ions therefore, but the abufe of them, proceed all our chronic difeafes. That is, from Indolence, Intem- perance, or Vexation. Let us now proceed to en- quire what muft be the neceflary effect of one or more of thefe caufes acting daily upon the body i [ 22 ] whether in the ftrongeft and moft vigorous frames it muft not be the gout; in weaker, rheumatifm, dolic, ftone, palfy, &c. or any, or all of the nervous and hyfterical clafs, Firft, of Indolence, by which I do riot mean in- fenfibility, but an inactive habit of life, taking the word in the general common fenfe it is now ufed. Of Indolence. IT feems to have been the defigh of Providence that all men fhould labor, every one for himfelf. That fome are rich enough to purchafe the ftrength and activity of others is a mere accident with regard to individuals, in which the care of Providence appears1 to be no otherwife concerned, than having unequal- ly distributed thofe powers and abilities by which ac- tive and fiery fpirits rife uppermoft to preferve the harmony of fubordination, without which fociety could never exift. The rich and great have fo far forgot this firft principle ofnature, that they renounce all bodily labor as unworthy their Condition, and fcre tither too lazy or too inattentive to fubftitute exercife inftead of it: thus facrificing health to indulgence. and dignity^ they do not enjoy thofe advantages their fuperior ftations and fortunes give them ; but in happinefs fall often below the laboring hind. I remember to have feen a very ingenious little book upon the origin of evil, in which labor is confi* ideredasagreat evil. The agreeableauthot muft furely i. L 23 J mean when it*s exceflive, and urged on the wearing and wafting the body ; for in general it is the firft principle of good to mankind, and to none more than the laborious themfelves. Does he mean that it "woudd be better for us all, did the earth fpontane- oufly bring forth .her fruits in fuch abundance, that we fhould no more labor or contend for them than we do for the air, and have nothing to do but baflc in eafe, and riot in enjoyment ? Jf fo I can b,y no means agree with him ; for foon, very foon, in fxich a ftate of things, there would not be one healthy man upon the earth, and the whole race muft quickly perifh. Indeed I am afraid, notwithstanding alj our unreafonable and unphilofophical complainings, the utmoft wit of man cannot remove the leaft evil out of nature, without taking with it all the good. But begging pardon for this little digrefiion, and to come back to my own purpofe, 1 think he had been nearer the truth, had he put indolence in its (lead, which is a fource of great evil. Nothing under- mines the foundation of all our happinefs, the health and vigor of the body, like it, or lays fuch a train X)f difeafes to come. But I muft endeavor to fhew in what irjanner. It is upon the minuteft and almoft invrfible parts of the body our beft health, ftrength, and fpirits de? pend : thefe fine parts, commonly called capillaries, are little pipes or tubes, the extended continuations of the larger blood vefleh, through which the fineft parts of the blood muft conftantly pafs, not only to keep thefe very fmall .channels always free and open, but alfo that the particles of the blood may in their. [ n ] paflage be attenuated, broken, and rubbed into- jglobules perfectly fmooth and round, and eafily di- vifible in ftill lefs and lefs, till they efcape the fight afiifted even* by the microfcope ; which gives ocular demonftration of this moft amazingly minute circula- tion. I have obferved myfelf, and any curious pa- tient man may fee with a good microfcope, in the pellucid membrane of any living animal, this fur- prizing minutenefs. He may felect and obferve one fingle veflel, the fmalleft of thofe that convey red blood, many of which would not equal the fmalleft hair in fize, through which the blood may be feen! pafling, not like a fluid,but a number of little red fo* lid balls pufhing one another on till they come to the extremity or ramification ofthevelTel where it divides into two ftill lefs. There the firft globule, flopping a little, and recoiling, is pufhed on again till it divides into two, and, lofing its red colour, paflfes on in the fmaller pipes fitted only to receive the ferum; which undergoes the fame circulation till it be refined into lymph, and this into flill finer flu- ids ; which, being thus prepared, efcape into a fub- tility beyond all fsofftble obfervation. Now the .ftrength of the heart and arteries alone, in a feden- tary courfe of life, is by no means fufficient to keep up and perpetuate this motion through thefe capila- ries, but requires the afliftance and joint force of aU the mufcles of the body to act by intervals, cotnprefs the veins, propel and accelerate the circulation of the whole mafs of blood, in order to force and clear thefe pipes, and to triturate., cribrate, and purify the fluid palTing through, forming every particle of it m .1 *5 ] into a perfect globule, which is the form all the a- toms of matter muft take from much agitation. Without this extraordinary occafional aid, the little veffels would, by their natural elafticity, clofe up in- to fibres, or be obftructed by rough angular particles ftick'ing in them, and flopping all paflage. Num- berlefs evils of the chronic kind, efpecially all nerv- ous difeafe?, owe their origin to this caufe alone. Accordingly we fee moft of thofe who have lived for any time in aftate of indolence, grow emaciated and pale by the drying up of thefe fine veffels ; or, if they happen to be of a lax habit, having a good ap- jpetite, and nothing to vex them, they may be loaded with fat; but they grow pale withal, many of thofe fine pipes being neverthelefs clofed up ; fo that they appear bloated, and their fat unwholfome, having much lefs blood in their veins than thinner people. Hence we may learn why thefe languid pale perfons upon the leaft motion become faint and breathlefs, the blood hurrying through the larger veffels yet free, and, like a crowd obftructing its own paffage, caufing a dangerous fuffocation. Or, if they have not been long in this ftate, nor the cap- illaries quite clofed, they glow, efpecially young wo-, men, with a momentary red, the fine veffels being for that time expanded. Thus inactivity firft forms obstructions in thefe exquifitely fine parts, upon which the health and vigor both of body and mind depend entirely, and lays the foundation of many difeafes to come ; which other concomitant circum- ftances, fuch as a violent cold, excefs of any kind, P [ 26 J . § infection from without, or a particular difpofition of i he body within, make often fatal to many in this habit of life ; and which the induftrious and active never feel. Now I would ate any reafonable perfon, capable j of confidering this operation of nature with the leaft glimmering of philofophy, or even the attention of common fenfe, and moft afluredly it concerns every man to confident well, whether he can conceive it poffible to fubftitute any medicine to be fwallowed, that fhall act upon the blood and veffels like the joint force of all the mufcles of the body, acting and 1 reacting occafionally in a regular courfe of moderate daily labor or exercife. Unlefs this can be done, I will venture to pronounce that there is no fuch thing as a lafting cure, either for the gout or any other chronic difeafe. Yes, Sir, fays a common practi- tioner, cordials, volatiles, bracers, ftrengtheners, will do this, will keep up an increafed circulation. Pofiibiy they may for a few hours, by doing mifchief for many days : but their action foon fubfides, and she fUmulus ceafcs; they muft therefore be repeat- ed and repeated for life. Woe be to him that takes them,oc to him that leaves them off,unlefsit be done ' with great judgment. While they act, they coagu- late the juices and corrupt the whole mafs of blood ; and when omitted, the patient mult feel all the lan- guors and horrors of a crapulary fever after repeated debauch •, and muft have recourfe to them again and again, h.ke a dram-drinker, who cannot bear his [ *7 ] exiftence but m a ftate of intoxication. No,* art can never come up to nature in this, tnoft falutaiy ot all her operations. But thefe obftructions from crude particles of the blood, and this inanition of the capillaries, are not all the evils produced by indolence. That fprightly vigor and alacrity of health which we feel and enjoy in an active courfe of life, that zeft in apetiie, and refrefhment after eating, which fated luxury feeks in vain from art, is owing wholly to new blood nude every day from frefh food prepared and diftributed by the joint action of all the parts of the body. No man can have thefe delightful fenfations who lives two days with the fame blood, but muft be languid and fpiritlefs. To introduce new juices the old muft be firft thrown off, or there will be no room, there will be too great a plethora or fulnefs •, the firft caufe of difeafe in many cafes. In a fhvc of inactivity the old humors pals off fo flowly, the in- jenfible p^rfpiration is fo inconfiderab'e, that there is no void to be filled •, confequentiy by degrees the ap- * petite, Which is the lift thing that d-*-.ayi, that is, the defire of fupply, muft daily diminifh, sndatlaft be totally loft. Here art can do wonders ; it can pro- cure evacuations ; we can bleed, purge, and vomit ; but then, to do any good by thefe, the cafe muft be recent, before the humors are vitiated by too long a ftay in the body, which will be thecaie very foon, for they are all in a perifhable ftate, which makes their daily renewal fo cflentially neceflary to health : but tiict thefe artificial cvacur.tions d^Jurge ;:: a];::ci -.h* [ 28 ] new,the middle,andthe old juices; that is, the chyle,the ^ blood,theferum,ancflymph ; and by thisindifcriminate \ action make ftrange confufiort in thofe that remain; whereas in nature's courfe there is a conftant regular 1 tfanfmutation and fuccefiion from one ftate to ano- ther ; that is, from chyle into blood, and blood into ferum, ferum into lymph, and fo on, till they are all in their turn, having done their office in vari- ous fhapes, elaborated and ground to fuch a minute fubtility and finenefs, that, like wave impell- ing wave, they fuccefiively pafs off in the vapor of infenfible perfpiration. In a ftate of indolence they do not pafs off either fo foon or fo regularly as they ought, becaufe there is not motion, nor confequentiy ■< heat enough to throw off the vapor : they lodge in the body too long, grow putrid, acrimonious, and hurtful many ways, like the matter formed in an ulcer, which, while it is yet fweet, is more healing rhan any balfam the furgeon can apply ; but, when confined, it foon becomes corrofive,and like a cauftic <^ats it's way all round in fiftulas to find vent. This fhews the virulent acrimony of thefe confined and ftagnating humors : hence the breath and per- fpiration, what there is of itoccafionly, of indolent i people is never fweet ; and hence in jails, where thefe noxious vapors are collected and condenfed from crouded wretches languifhing in indolence, very malignant and peftilential fevers arife, Perpetual blifters have been often thought, and fometimes found, to be ferviceable in draining off I fome of the fuperfiuous juices before they are much corrupted, and making, by a faint refemblance of L 29 J nature*s action, a little more room for new : and t| is for this reafon they do any good at all, by increa- fing the general circulation, and forcing off a few or of thofe humors that had circulated too long in the body, and were becoming acrid : for the quantity they difcharge is fo trifling, that there could be r.o phyfiology, nor even common fenfe, in •fuppofing the evacution to be the benefit procured^ By a vomit or a purge the difcharge is a hundred fold more, but the good obtained not always fo great>be* caufe by thefe the humors areindifcriminately thrown off,& much more of the new than the old. Many have ufcd frequent bleeding to renew their blood, and I have known it anfwer very well to fome, efpecially old people who had been long accuftomed to it,, whom it preferved to great age : but then it muft be begun in time, before the whole mafs of humors be vitiated, and continued for life. Is it not ftrange that men mould feek and preftr thefe violent arrm* cial methods to the fimple, eafy, pleafant, and con- ftant action of nature, and chule rather, to take a vomit or a purge than a walk* and wear a perpetual »blifter than make the leaft ufe of their limbs-i Thus indolence muft inevitably lay the founda- tion of general difeafe, and according to the con- ftitution and a few concomitant circumftan- ces will be the kind of the . difeafe : in the very beft it may be gout or rheumatifm ; in the weaker habits colic, jaundice, palfy, ftone, &c. with all of the hyfterical & hypochondriacal clafs. In vain have ingenious men of reading and ftudy, mental \\boi [ 3<> J and fedentary life, who are more fubject to difeafe in general than the gay and thoughtlefs, endeavored to obviate the evil by abftinence, an excellent means of remedy in many cafes, and which few practife but true philofophers, who are not the moft likely to want it. But yet even they do not find it anfwer,and for the reafons which I have juft given ; that we can- not live two days in health and fpirits with the fame blood ; there muft be a new daily fupply of that ethe- real part of our food called up to the brain to fup- port its own, as well as the labor of the whole body. By this I mean the moft elaborated, refined parts of all our juices, which conftantly repairs and nourifhes the fmalleft veffels and fibres ; whether I may be allowed to call it animal fpirits or not,is not material. Whenever this asther fails, we muft neceffarily feel langour and laflitude both of body and mind : with this difference, that in wearinefs of the limbs from much action the lees and coarfer parts are thrown off alfo, and the firft meal and firft fleep foon fupplies the defect. In mental labor the feculence remains to obftruft all appetite; there is no room, and there- ■ fore no call for fupply ; the whole man fuffers and finks. Of Intemperance. » IC O M E now to fpeak of Intemperance ; for Indolence, blunting all our fenfations, natu- rally leads us to intemperance : we want the whip »nd fpur of luxury to excue our jaded appetites. I 3' ] There is no enduring the perpetual moping languor of indolence: we fly to the ftimulating fenfualities of the table and the bottle, friend provokes friend to ex- ceeded accumulate one evil upon another; a joyous momentary relief is obtained, to be paid for feverely foon after ; the next morning our horrors increafe, and in this courfe there is no remedy but repetition. Thus whoever is indolent is intemperate alfo, and partly from neceflity ; and the evils neceffarily follow- ing both thefe caufes often make the rich &greatmore wretched than the poor, and the ballance of happi- nefs is held more equally between them ; for how- ever other things maybe diftributed, happinefs, like water, always finds its level among men. I wifh this obfervation might cure thefe of their envy, and teach the others how to enjoy their wealth. Before I return to my fubject, I fear I muft make an apology for what I am going tofay,and hope no one will be offended when I venture to fay that nine in ten of all the chronic difeafes in the worid,particu- larly the gout, owe their firft rife, to intemperance. Many a good man,who piques himfelf upon being the moft fober regular creature alive, and never eats but of one or two plain difhes, as he calls them, nor ex- ceeds his pint of wine at any meal; keeps good hours, and never fleeps above eight or nine, may be fur- prized, if not affronted, to have his difeafe imputed to intemperance ; which he confiders as a great crime. And yet he is often ill, fick in his ftomach, troubled with indigeftion, and crippled by the gout, Thecafe is,wejudgeoftemperance and intemperance [ S* I from our own habits, without any juft idea of either. What we are ufed to do, and fee others do, we think right, and never go up to nature for our knowledge. The beft way to explain what I mean by intempe- rance, may be to enquire what is nature's law of tem- perance, and todeviatefrom that muft be confidered as intemperance. And here I muft beg leave to ob- ferve, that temperance is a thing of which no Eng- lifhman has or can have the leaft idea, if he judges from his own or his neighbors habits. To form fome notion of it he muft have feen other countries, particularly Spain, Portugal, or Italy, and obferved how men live there. What they call temperance, or even tolerable living, with us would be thought downright ftarving. In this view temperance,is lo- cal and comparative ; but what I mean is natural temperance not depending upon place or cuftom (for I do not mean fafting or abftinence, which can never be falutary but after repletion) ; and we muft not judge of it from countries where a piece of bad bread and an onion with a draught of water is thought a tolerable meal; nor from our own, where beggars live better than the nobles of fome coun- tries, and where we riot in the choice of plenty na- tive and exotic every day. To come then to my idea of it: I think there is an abfolute, determined temperance, to be meafured by every man's natural unprovoked appetite, digef- tion and confumption, while he continues in a good ftate of health, and right habit of life. As long as a man eats and drinks no more than his ftomach L 33 ] calls for, and will bear without the leaft pain, dif- tention, eructation or uneafinefs of any kind ; nor than his body confumes and throws off to the laft grain ; he may be faid to live in a very prudent well- regulated ftate of temperance, that will probably pre- ferve him in health and fpirits to great old age. This is nature's law : and the reverfe of it, or in- deed any great deviation from it, muft be intempe- rance. When we eat without appetite, or urged beyond moderace fatiety, provoked by incentives of any kind : when we drink without thirft for the fake of the liquor. Indeed I cannot allow him to be, ftrictly temperate who drinks any wine or ftrong liquor at all, unlefs it be medicinally, or now and then for the fake of fociety and good humor, but by no means every day. Now let us compare this fimple idea o&tempcr- rance with the common courfe of moft men's lives, and obferve their progrefs from health to ficknels ; for I fear we fhall find but very few who have any pretenfions to real temperance. In early youth we are infenfibly led into intemperance by the indul- gence and miftaken fondnefs of parents and iriends wifhing to make us happy by anticipa- tion. Having thus exhaufted the firft degrees of luxury before we come to the dominion of ourfelves, we Ihould find no pleafure in our liberty- did 4\*e not advance" in new fenfarions, nor feel our- E [ 34 1 felves free but as we abufe it. Thus we go on till fome friendly pain or difeafe bids, or rather forces, us to ftop. But in youth all the parts of our bodies are ftrong and flexible, and bear the firft loads ot excefs with lefs hurt, and throw them off foon by their own natural vigor and action, or with very lit- tle affiftance from artificial evacuations. As we grow older, either by nature in due time, or repeat- ed exceffes before our time, the body is lefs able to free itfelf, and wants more aid from art. The man however goes on, taking daily more than he wants, or can poflibly get rid of; he feels himfelf replete and oppreffed, and, his appetite failing, his fpirits fink for want of frefh fupply. He has recourfe to dainties, fauces, pickles, provocatives of all forts. Thefe foon lofe their power ; and though he wafhes down each mouthful with a glafs of wine, he can relifh nothing. What is to be done ? Send for a phyfieian. Doctor, I have loft my ftomach ; pray give me,fays he, with great innocence and ignorance, fomething to give me an appetite ; as if want of ap- petite was a difeafe to be cured by art. In vain would the phyfieian, moved by particular friendfhip ro the man, or that integrity he owes to all men, give him the befl advice in two -words^u^ere fudando, leek it by labor. He would be thought a man void of all knowledge and fkill in his profeffion, if he did not immediately, or after a few evacuation", prelcribe ftomachics, bitter fpicy infufipns in wine or brandy, vitriolic elixirs, bark, fteel, &c. By the ufe of thefe things the ftomach, roufed to a little [ 35 ] extraordinary action, frees itfelf, by difcharging it's crude, auftere, coagulated contents into the bowels, to be thence forwarded into blood. The man is freed for a time, finds Tie can eat again, and thinks all well. But this is a fhort-liv'd delufion. If he ;is robuft, the acrimony floating in the blood will be thrown out, and a fit of gout fuceeeds ; if lefs fo, rheumatifm or colic, ore. as I have already faid. But let us fuppofe it to be the gout, which if he bears patiently, and lives moderariy, drinking no madeira or brandy to keep it out of his ftomach, nature will relieve him in a certain time and the gouty acrimony concocted and exhaufted by the fymptomatic fever that always attends, he will recover into health ; if afiifted by judicious, mild, and foft medicines, his pains might be greatly affuaged and mitigated, and he wonld recover fooner. But however he recovers, it is but for a fhort time ; for he returns to his for- mer habits, and quickly brings on the fame round of complaints again and again, all aggravated by each return, and he leis able to bear them ; till he becomes a confirmed invalid and cripple for life, which, with a great deal of ufelefs medication, and a few journies to Bath, he drags on, till, in fpite of aK the doctors he has confulted, and the infallible quack medicines he has taken, lamenting that none have been lucky enough to hit his cafe, he finks be- low opium and brandy, and dies long before hi* time. This is the courfe I have lived to lee manv take, and believe it to be the cafe of more whom I h?.ve never heard of, and which any or.e may obferve ,' the ekele of his acquaintance, ah this chain pi [ 3« ] evils is brought on and accumulated by indolence and intemperance, or miftaken choice of diet. How eafily might they have been remedied, had the real caufe been known and attended to in time. I believe I muft here explain a little more fully what I mean by • provoking the appetite, which I < take to be the general mode of intemperance among j men ; for cuftom has made all kinds of incentives to excefs fo common, that thofe of daily ufe, far from being confidered in the clafs of intemperance, are by moft people thought to be not only falutary i but necefifary ; and they never fufpect the leaft j evil from the common decoraments of the tabie, fait, pepper, muftard,vinegar •, and yet, however ex- j traordinary it may feem, 1 will venture to pronounce n that excefs in any of thefe muft be doubly prejudicial to health : hurtful in themfelves by their acrimony, ' they provoke the appetite beyond natural fatiety to receive an oppreffive load, which the ftomach it felt* {, would foon feel, were it not artificially ftimulated J to difcharge it into the blood by wine and ftrong li- j » quors immediately after. Thus one error brings 1 on another, and when men have eaten too much, fl they drink too much alfo by a kind of ncceflity. ■ He will certainly be a h althicr man, who is very ^) moderate in the ufe of thefe things, than he who ex- W ceeds; they may be fometimes ufeful as medicines; ,vj: can never add to the wholfomnefs of our daily ' food. To give fome v/eightto what I fay, there are 3,-hole nations in the world that haye never know& .'■ [ 37 J any of them, and are healthy, ftrong, and vigorous I do not mean by this to profcribe them intirely, efpecially fait and vinegar -, but only to recommend great moderation. If this be true of the common provocatives at e- very poor man's board, who is there that exceeds not nature's law ? who is truly temperate ? What fhall we fay of that ftudied, labored, refined extrava- gance at the tables of the rich, where the culinary arts are pufhed to that excefs, that luxury is become falfe to itfelf, and things are valued, not as they are good and agreeable to the natural and undebauched appetite ; but high, inflammatory, rare, out of feafon, and coftly ; where, though variety is aimed at, every thing has the fame tafle, and nothing it's own. I am forry and afharr.- ed, that men profeffing luxury fhould underftand it lo little, as to think it lies in the difli or the fauce or multitude of either ; or that urging beyond natural fatiety can afford any real enjoyment. But this they do by all the refearches of culinary and medical an, introducing all the foreign aids to luxury, everv itimulating provocative that can be found in acids, falts, fiery fpices, and effence^ of all kinds, to roufe theirnerves toalittle feeling; not knowing the more' they are chafed and irritated the more callous they ftill grow ; and the fame things muft now be more frequently repeated, increafed in quantity, end ex- alted in quality, till they know not where to ftop, and every meal they make ferves enly to overload and opprefs the ftomach, to foul and inflame rh> [ 3« 1 | blood, obftructandxhoak all the capillary channels,. J bring on a hectic fever of irritation,that though it raife j| the fpirits for the evening, leaves behind it all the. horrid lenfations of inanition and crapula the next morning; and but that nature is fo kind as to ftop them in their career with a painful fit of gout or fome other illnefs, in which fhe gets a little refpite, they would foon be at the end of their courfe. Men bring all thefe evils upon themfelves, either ' hot knowing or not attending to two things: the one, that plcafure is a coy coquet, and to be enjoyed jj muft not always be purfued ; we muft fometimes fit ftill, that fhe may come and court us in her turn : **j the other, that pleafure and happinefs are as diftinct things as riot and enjoyment : befides, pleafure is not infinite, and our lenfations are limited : we can bear but a certain meafure, and all urging beyond it, infallibly brings pain in it's Head. Let the men of high experience bear me teftimony, that this is true of all the luxuries of the table, wine, mufic, women, and every fenfuality. Thefe men may tell me, perhaps that, I have * a^ade a mighty fine declamation againft luxury and ty intemperance : but what is this to the.purpofe ? they defire not to be told of their faults, nor to hear dii- -agreeable truths which they know already. Have 5 no art or fkill to reconcile health and luxury, no | remedy, no rare fecre: to repair and reftore fen fa- / tion and vigour worn to rags ? No Medea's kettle „ [ 39 3 to boil anew ? If not, do not defcribe to us a life of moderation, temperance, and exerciie : it is not worth having upon thefe terms. I am aware of the unreafonable expectations ofmany,that their demands would rife high, fome of them to ths impoflible. At prefent lam only fetting forth the caufes ; when I come to talk of remedy, I will endeavour to con- vince them that the artificial helps they expect are not in nature, but that there are in nature ways and means by which many gouty, broken conftitutions, that have been defpaired of, might be repaired and reftored to a very defirable degree of health and en- joyment. But I muft firft fay a word or two to the intemperate or miftaken in the middle clafs of life. In England all degrees of men are furnifhed wi,ththe means of intemperance, and therefore it is no wonder that moft men are intemperate. If they are lefs fo in other countries it is not that they have more virtue, but they want the means : their oppreffive govern- ments, the precarious ftate of property, and their fuperftitious religion, keep themfo poor that luxury is not in their power. They have however this ad- vantage from their poverty, that they are much lefs afflicted with chronic difeafes than we are. I verily believe there are more gouts in England,than in all the reft of Ei1 rope : a proof that good living is more univerfal. But not to the advocates for this good living do I wifh to addrefs myfelf ; I fear they will be as incorrigible as their fuperiors in higher and more refined luxury. But there are fome not in« temperate from choice, but exr.mple. habit, cuvtcm, [ 4° ] miftake, not knowing their daily diet to be unwhol- fome, and productive of their difeafes. To thefe it may be of fome ufe to have the unwholfome pointed out, and their choice directed to better things. Men of laborious occupations, who work in the open air, can and do bear great exceffes and much unwhol- fome diet without much hurt: I never knew a fick • or gouty gardener that was not a remarkable fot. But men of fedentary trades and bufinefs, fhop- keepers of all kinds, feel much fooner and more heavily the ill effects of intemperence or miftaken choice in their meat and drink. Their firft care therefore ought to be, not to add the difeafes of in- temperance to thofe of inactivity, but proportiofll what they take, as well in quantity, as in quality, to their confumption. But let us fee how well they do this. They all fay they live upon plain things, and never indulge in made difhes; but they will eat hear- tily of a goofeor duck,with a large quantity of fage, . onion, pepper and- fait, a pig with fimilar prepara- . tion, and a hare with higher and more compounded feafoning. Do they ever eat veal without fluffing, or even a leg of mutton without caper-fauce ? If ever they eat a fteak or a chop, if it is fometimes without pepper, I believe it is never without pickles, the worft of all poifons. They are fur- prized that fuch meals fhould rife on their fto* machs with flatulence, four and bitter hiccups and eructations, which, if they did not keep them down', with a fufficient quantity of wine or fometimes a dram, they would be troubled with all the time of digeftion. If this method fucceeds fo far as to quiet) their ftomachs for the prefent, they go on with it,' [ 41 ] regardlefs or ignorant of future and diftant confe* quences. Thus are thefe fharp, harfh,' hot and inr flammatory things forced out of the ftomach into the blood, before it has had time to dilute and fub- due, or reject them, and the fuperfluous load they bring along with them. And thus is laid the foun- dation of every difeafe, that appears when thefe acrid and fiery particles are accumulated in the blood to a certain degree. There are others whofe pretenfions to plain diet may feem better founded, but who neverthelefs eat, and are fond of, things unwholfome, and very un- fit for men of fedentary lives ; fuch as faked and fmoaked flefh and fifh of all kinds, hams, tongues, heavy flour puddings, toafted cheefe, &c. all which are of fuch hard and indiffoluble texture, that they never diffolve well in the ftomaeh of a plowman : the fame fait, feafoning, and fmoke which harden and preferve them from putrefaction before they are eaten, keep them from diffolution afterwards, fo that they never are digefted at all •, nor is it poffible any good nourifhment Ihould ever come from them : the falts they contain are indeed melted in the inr teftinal juices, and get into the blood, producing, in the belt conftitutions, thofe tettery, itchy, or fcaly eruptions, commonly but very erroneoufly called the fcurvy, which is quite another kind of difeafe. To this kind of food is owing the bad health of country people, and their children's rick- ety hearls and limbs, and big and hard bellies. F [ 42 ] Another capital miftake many people fall into, who in other refpe&s are very moderate in their diet, |.< is, that the flefh- meat they eat is always over-done; if boiled too much, the juices are loll -, if over-roafted I fried, or broiled, the action of the me continued too • long, changes the mild animal flefh into fomething of another° quality ; the fat is'made bitter and rancid, which fire will always do by the fweeteft oil ; and the fcorched outfide of the lean, dry and acrimonious : the lefs therefore all flefh - meat undergoes the power of fire, the milder and wholfomer it is. I do not mean by this to recom- mend the cuftoms of Cannibals and Tartars who eat raw flefh ; or beafts of prey, that devour animals a- live : but it may be obferved, that the firft are free p from our difeafes, and the others amazingly ftrong & vigorous. We may learn this from them at leaft, that our meat cannot be the whoiefomer for being, as fome call it, thoroughly done ; and that we mould learn to like it with fome of its red juices unfpoiled by the fire. Upon this principle the Englifh cook- ery is to be perfcrredto-the French, who flew and 3 roaft to rags ; and of Engiiik cookery broiling muft be the beft. This leads me to another obfervation, which per- haps none but phyficans, or thofe who have ftudiei well the nature of man and his aliments, are able to make. It is this : that man being born to devour moft of the fruits and animals of the earth and water, there ought to be a certain proportion of animal and vegetable ftubftances in his food ; the animal tending fpontancouOy to putrefaction.: the vegf ruble [ 43 1 correcting that tendency from going too far: thus from the due mixture of both qualities refults that neutral proprety, equally diftant from acid as alkali, that is cffentially neceflary to produce good blood. This is fo manifeft, that who ever will obferve atten- tively may fee, whenever either of thefe prevails in body, there is fo ftrong a defire and longing for things of the other fort, as well as pleafing fenfation in the palate and ftomach when they are taken, as plainly indicate the natural want. Let a man have lived long upon flefh-meat wholly, he will have a moft eager appetite for fruit and vegetables ; and if kept too long without them,as is the cafe with thofe who have lived fome time at fea,will grow fick of the real fcurvy ; but if before they are too far gone they reach the land, they will eat the firft common grafs they can come at, with more avidity than a horfe or ox, and be perfectly cured by it. In like manner they who have lived long upon vegetables (which re- gimen is often prescribed to invalids, efpecially in the gout)will have great craving for flefh-meat. We ought to learn from all this to attend diligently to the calls of nature,and ballance the mixture with due proportion, not only that our vitals may have the lefs labor in preparing and making our juicier fit for nourifhment, but to prevent the difeafes that are peculiar to the predominancy of cither. And here I may obferve, that the error of moft men's diet in every clafs of life is, that the acid, crude and auftere, aimoft always abound : not that they do not eat flefh-meat enough, but they fpoil it in the pre- paration and cookery, changing its animal nature [ 44 ] into fomething worfe than vegetable, taking off in* tirely all its tendency to diflblution and putrefaction by faking, fmoking, pickling, potting, and preferr- ing things that in their own fimple nature would foon corrupt anddiflblve ; but by there preparations are hardened and embalmed to keep for years like mummies. The fame may be faid of. every kind of made difhes ; the falts, fpices, hot herbs and acids, with which they are feafoned and compounded, preferve and harden them to keep for ever : the fauces and gravies they fwim in have the fame effect as fo much pickle. The things we feed upon ought all to be irt a perifhable ftate, or they will never furnifh the materials of good blood ; and what ever is hardned or feafoned i^o as to keep long before it be eaten ought not be eaten at all, for it will never diffolve in the ftomach. The nature of moft chronic difeafes, and their firft fymptom heartburn,as it is commonly called,plainly fhew the original caufe to beacid crudity prevailing in the juices ; producing coagulations, c oncretions and obftructions of various kinds ; all which are very manifeft in the gout, rheumatifm, ftone, and moft nervous cafes : the remedies alfo, that fometimes re- lieve and palliate,confirmthis; fuch as the volatile al- kalies, hartfhorn,falt ammoniac, teitaceous powders, ibpc, &c. Many may be furprized at this, and fay, it cannot be ; for, though they have thefe difeafes, they takelittle or no acids: but there are many things \ they take that are acefcent, that is liable to become [ 45 ] acid, efpecially by the heat of the ftomach. Thk they are not aware of; but they are in their nature much more prejudicial than things already four: for, befides that people take not thefe in any quan- tity, the acefcent never become four but by the act of fermentation, which, being raifcd in the ftomach where it ought never to happen, produces ftrange tumults, wind, vapor, gas, that is, that fume arifing from fermenting liquors of any kind,which has been known fometimes to kill at a ftroke. It may here be neceflary to enumerate fome of thofe things call- ed acefcent. Thefe are fweets of every kind, pud- dings, cakes, paftry, creams, confections, &c. and every thing made of flour, efpecially fermented •, bread in particular, fo far from being the wholfome thing many imagine, is not only unholfome by it.j acefcency, but, by the ftrong ferment it contain:;, whenever it predominates, it forces into fermentari- On every thing capable of it, that it meets with i,i the ftomach * : the bread of London I fear io parti- cularly fo ; parti/ by being robbed of its bran, which in fome degree would foften and correct it, hut chiefly by having in it, befides its ufuai ferment, a great quantity of four alum, moft abfurdly added to make itunnaturally white, j Many eat bread from principle, and like it by habit ; Lake a flice between meals,and * Whoever requires proof of this, may have it by the following experiment : Put a common toafl into halt a pint of water, and let it (land fix or eiyht hours near the fire, fo as to be kept in the heat of the human ftomach, and it will be four as vinegar. f To be convinced of this, boil a pound of ccrr.rncn London bread in a fufEcient quantity of watt* to make i* C 46 ] with their fruit as a corrector ; and think a bit of bread and glafs of wine a moft abftemious excellent fuppf r. I think they are miftaken in all this, and thar bread ought to be eaten but fparingly, and tor want of other and better vegetables. In this light we muft- alfo conlider moft iorts of feafonings, fluf- fing, force-meats, and compounded fauces. But the • greareft acefcent, or rather bane of all, high and low, rich or otherwife, whoever they are that take it con- ftantly, is wine : wine alone produces more difeafes | than all the other caufes put together. All men allow that wine taken to excefs is hurtful: they fee the immediate evils that follow ; but diftant effects, that require more attentive and deducive obfervatiom very few fee or believe ; and judging from prefent and agreeable feelings, they fay that a little wine is vvholfome, and good for every one, and accordingly take it every day, give it their children, and teach* ihem to like it by debiuching their natural tafte in . the earlieft infancy : thus they come to relifh it by habit, and to be uncafy without it, like muff takers without their tobacco : the want is equally habitual.' and unnatural in both cafes ; for the ftomach wants wine no more than the r.ofe does fnuff: the immedi- ate fenfation of both,aftera little ufe,is pleafant; but fhe remote effect of wine taken conftantly infinitely.* more pernicious than of the fnuff. This hurts the- hofe onb*; the other accumulating a little indiseftion thick as gruel. Let it ftand to fub.fi Je ; pour off the clear, J and boil away u'l the water ; the alum will be found ?t bottom, mixed with a .li't!e common hit, i 47 ] every day, corrupts all the juices of the body moft eflentially. And though it be often taken with a View to promote digeftion and aflift the operations of the ftomach, it manifeftly does harm to both. Inftead of digefting and dilibl zing, it hardens, and prevent:; diffolution, and curdles and corrupts the milky chyle and firft juices produced from our food, h warm;; indeed and ftimulates the ftomach to greater exerti- on than is natural or neceflary, and thereby enables it to difcharge it's contents the fooner ; whence that agreeable feel of warmth and comfort from it's im- mediate action. But by this extraordinary action it forces our food out of the ftomach too foon, before it is foftened, diiTolved, and properly prepared, and fends it into the bowels crude, hard, and auftere, in that ftate to be carried into the blood, there to pro- duce every kind of difeafe. Whatever therefore the advocates for a little wine every day may think, or argue in favor of it ; they are moft undoubtedly in a very great error, and it were certainly much bet=- ter and fafer to drink a bottle and get a little merry once a week, drinking water only or fmall beer at ™-all other times : in which interval nature might to- 'Jtally fubd-ie it, and recover intirely. Water \:, the • iflnly liquor nature knows of or ha3 provided for all animals-, and whatever ' nature, gives us, we may "" depend upon it, is fafeft and beft for us. Accord- in-' [/ we f*e that when we have committed any ex- ce-les o: miftakes of any kind, and fufler from 'them, i: is water that relieves. Hence the chiei px-d of Bath, Spa, and many other med.unal. wa- Zn,:-.r. etpeciajly to hard drinkers. It i: the c.krne&t C 48 ] . that dilutes and carries off crudities and indigeftions, &c. the mineral virtues they contain may make them tolerable to the ftomach in their paflage, but do, as I believe, little more in the body : it' is the water that cures. Wine, if it be not of our own in- ventions, was given us as a cordial in ficknefs,weari- nefs, forrow, and old age, and a moft falutary charm • it would be for moft of thefe evils, did we not ex- hauft it's power by daily ufe,and inftead of taking it as fuch, drink it up as common draught in youth and . health to make us mad. I know this is a very tender topicto touch upon,and too favoritea pleafure to argue j againft, with any reaionable hope of convincing ; moft men having fo indulged themfelves in this be- I witching habit, that they think they cannot live ' without a little wine every day,& their very exiftence depends upon it ; their ftomachs require it, nature" calls for it, St. Paul advifeb it, it muft be good. ; Thus men catch at every fhadow of an argument .. that favors their inclinations. St. Paul advifes it as . a medicine fometimes, but certainly not every day. Jj There is no medicine I know of, that, taken every' day, will not either ceafe to act entirely, or by act-^ ing too much do harm. It will be laid, that many drink wine every day without gout, ftone, orfl any difeafe at all in confequence of it. I believel not many, or I fhould know fome of them. If any are fo ftrong as to bear it to old age unhurt,, they muft be very active as well as ftrong to fubdue it. ' But I have nothing to fay to thefe ; my bufinefs is with invalids who complain, and certainly ought not :o meafure conftirations ^'ith thofe a'^ove the:; r 49 ] match. The fame arguments will hold equally in favor of every other bad habit. Your nofe will want it's fnufF, your palate it's fpices ; and when the fafhion was for women to be fmall waifted, their galled fides grown callous by the long com- preflion of the flays wanted their fupport. Nature, like a true female, cries out ac the firft violence, but fubmits in time, is reconciled, and grows fond of the ravifher. But it is the bufinefs of philofophers to diftingufh carefully between the real wants of na- ture and the artificial call; of habit; and when we find thefe begin to hurt us, we ought to make the utmoft perfevering efforts to break the enchantmenc of bad cuftoms ; and though it coft us fome uneafy fenfations at firft, we muft bear them patiently ; they will not kill ; and a very little time will reconcile us to better modes of life. There is another capital miftake many labor un- der in the choice of their wine, preferring the ftrong, hot, and coarfe forts, Medeira, Port, Mountain, &c. to the milder, more elegant, and certainly lef^ un- wholfome French and Italian wines, accounting them better for the ftomach, and good againft wind, &c. My obfervation has been,that they(who ufe thefe ftrong ftomach wines to cure wind are never free from it, and all the gouty diforders of indigeftion. Indeed, it cannot well beotherwife ; for there is no- thing fo repugnant to natural digelcion as the ufe of th?feftraa°" liquors, which inftead ofdiflblving hard- G t 5° i en every thing ; and thus for ever, when the fiffl warmth is gone off, leave a crapulary, crude, four load of yefterday, to ferment, fret, and irritate the ftomach and bowels every dav. Thus have I endeavored to point out two of the true primary, capital caufes of the gout, and moft (J other chronic difeafes ; and moft fincerely wifh that # what 1 have faid may engage thofe whom it moftly concerns, the gouty, the infirm and valetudinary of every clafs, to obferve, reflect, and think for them- |j felves upon the hints 1 have thrown out; in which ■ light what I have faid, muft be confidered, rather 1 than as logical or demonstrative proof. I know the ;■ reafoning and arguments may be much improved and carried farther,and if I had more leifure I might "I have attempted it: but I am well aware of the un- furmountable difficulty of convincing men againft their will by any arguments at all, I chufe there- lore at prefent to invite them to felf-conviction from I there own obfervations and experience. I flatter S inyielf they will find it well worth their pains, to jfl reafon a little more than they do with and for them- I felves ; and it will be a great point gained for them, if it turn their mifled opinions from all that imagin- M ary power of reftoring health in any of that multi- w tude of ridiculous and moft truly contemptible me- f- dicines, that are daily obtruded upon the public, |tj with endlefs lie: to recommend them, by a fet of the , pooreft, meft ignorant and paltry rogues in the na- i§ Lion;, and engage their attention to their true reme--- 4 ■ C 5i ] dy, a right inftitution of life. In judging of which, if they find themfelves unequal to the tafk, they may be aflifted by men of humanity, fkill, and ho- nefty. Of Vexation. IC O M E now to the laft general caufe of chro- nic difeafes, Vexation. A very fruitful parent of many bodily evils, producing generally difeafes of inanition, much more difficult, not only to be cured, but relieved, than thofe we fufler either from Indolence or Intemperance. But as it is not fo y common a caufe of the gout as the other two, it may \$f not be necefTary to confider it very minutely at pre- fent. 1 fhall not therefore enter deeply into the re- $ gions of metaphyfical conjecture, nor run wild after v my own conceits, or theirs who have gone aftray be- ,' fore me, in gueffing at the incomprehenfible union £* A foul and body, and their mutual powers of act- Iing upon each other. I fhall content myfelf with obferving only, what may be of fome ufe, that eve- ry great degree of vexation, whether in the fhape of anger, envy, refentment, difcontent or forrow, has moft deftructive and deleterious effects upon the ' vitals of the body, whether fudden and violent, or . flow and lading. '^ The firft immediate effect of violent grief cr vex- r\:.\\ is to take off the action of the ftomach intire'y. C 52 ] Let us fuppofe a man, in the beft health, the higheft good humor and fpirits, as well as good ftomach, fitting down to dinner with his friends, receives ftiti- denly lome very afflicting news. Inftantly his ap- petite is gone, and he can neither eat nor fwallow a moriel. Let the fame thing happen after he has made a hearty, chearful meal, as fuddenly the action of his ftomach, the whole power of digeftion is cut 3 off totally, as if it were become paralytic ; and what he has eaten lies a moft oppreflive load. Prehaps, as the excefs of weaknefs is often convulfion, it may be rejected by a violent vomit, or do greater ^mif- chief. For which reafon fuch ftrokes oi diftrefs are \ lefs hurtful received upon an empty than a full - ftomach. But why is this? what connexion is the-e between a piece of bad news and a mans ftoma;h full or empty ? Whatever the caufe be, the efrecj is certain and invariable. Is it becaufe the animal fpirits^ or the action of the nerves, whatever be the fecret cau'e of their power, is called of to fupply. | and fupport the tumultuous agitation of the brain, '■, and the ftomach, with all it's appendages and their fecretions, is left powcrlefs and paralytic, and mdft M therefore either act convullively or not at ail ? 1 Befides this pernicious effect of perverting the J natural action of the ftomach and inteftines, the whole circulation of the blood is difturbed. The contraction and dilatation of the heart,that is,the al- •, | te'rnate action by which it opens to receive the blood from the veins, and clofes again to forge it out [53.] through the arteries ; which operation ought to be as true and certain as the vibrations of a pendulum ; are broken and uneven : the heart flutters, palpi- tates ; now is overloaded with blood and in danger of fuffocation, now receives none at all: confequent- iy all the fecretions muft be as irregular, fome of the glands receiving too abundant a fupply, that either hurries through, or oppreffes and overpowers them, others none at all. Hence that ha fly gufli- ing of pale limpid urine in amazing quantities, thofe fudden burfts of unmeaning tears : fometimes great drynefs and choaking thirft, fometimes the overflow- ing of the mouth with water inftead of faliva, and many other nervous and hyfterical affections, fits, fyncope, epilepfy, &c. all which indicate the greateft tumults and perturbations in the in moft receffer. of the nervous and vital frame. Many kinds of dif- eafe have fprung from this fountain, of fuch unac- countably horrid and terrifying appearances, that formerly they could no otherwife account for them, > but by the malefice of forcery, and the immediate . poflcflion of devils. In flower, more filer*., but longer continued grief, If the effects are fimilar, but not io violent. Many lit ' tie ftrokes repeated wil' do the fame thing in time that a great blow does at once. The function or the ftomach will be more gently difturbed and per- ' verted, it'sjuices vitiated, and all its contents will forever turn four, bitter, or rancid ; fo that r,o mild milky chyle, or wholfome material of nouriihmrnt, : can ever come into the blood. The patient muft L £4 J Janguifh mith cachectic inanition, univerfal bad habit of body, or pine and wafte with atrophy, the wanr ofnourifhing fupply ; whence arife complications of various difeafes fucceeding each other, always from bad to worfe : and unlefs he can fubdue his anxiety, and reftore peace of mind, he muft in time fink un- der it, and die, as it is faid, of a broken heart. Whoever vexes long, muft certainly want nourifh- ment-; (or, befides the difturbed ftate of the fto- mach, it's broken appetite and bad digeftion, from whence what fupply there is muft Come not only ill prepared, but vitiated, into the blood ; there can be no fkep in this ftate of mind ; the perturbed fpirit cannot reft ; and it is in fleep that all nourifhment is preformed, and the finer parts of the body, chaf- ed and worn with the fatigue of the day, are repair- ed and reftored to their natural vigor. While we arc awake this cannot fo well be done ; becaufe the incefiant action of the body or mind, being al- ways, partial and irregular, prevents that equal dis- tribution of the blood to all parts alike, from which each fibre and filament receives that fhare or portion that fuits it beft. In fleep, when it is quiet and na- tural, all the mufcles of the body, that is, all its active powers that are fubjeft to our will, are lulled to reft, compofed and relaxed into a genia1, tempo- rary kind of palfy, that leaves not the leaft obftruc- tion or hindrance of the paffage of the blood to every atom. Accordingly the pulfe is always flower and more equal, the refpiration deeper and more regu- lar, and the fame decree of vital warmth difrufed a- [ 55 ] like through every part ; fo that the extremities are equally warm "with the heart. Vexation operating in this manner upon the or- gans of digeftion and concoction, and difturbing * and obftructing the natural progrefs of nutrition, muft often produce difeafes fimiliar to thofe of iong- f continued intemperance ; it's firft effect being indi- • geftion with all it's fymptoms, wind, eructation, [ heart-burn, hiccup, &c. It is no wonder therefore it fhould fometimes bring on a fit of gout,which as I have faid,is manifeftly a difeafe of crudity and in- digeftion ; and often the gout in the ftomach and ; bowels. Indeed moft cold crude colics are of this I kind. Schirrous concretions will alfo be formed in the fpleen, liver, glands of the mefentery, and ; throughout the whole fyftem of the belly. Many of thefe indurated tumors will appear outwardly, fo as to be felt by the hand ; thefe in time will degene- rate into cancers and cancerous ulceration;;, and many fatal evils, not the leaft of which, in my opi- nion, is, that the patient will fuffer a long time be- rbre he dies. All the pafBons, when they are inordinate, may * have injurious effects upon the vital frame : excef- ffive joy has fometimes given a fatal blow, and fud- " den burfts of laughter done great raifchiefs, efpecial- ly to delicate or weakly people who have often been ■thrown into fpafms, cramps, convulfion>,hyfteric fits and hemorrhages by them. But as I think the [ 5<5 ] word Vexation comprehends the chief of thofe p^f- fions that hurt us moft,and mean not to make a me. taphyfical enquiry about them, it is needlefs to be particular upon each. It may fuffice to have fhewn fhe immediate and remote influence ofvexation up- on the human body. Whatever men may think of their difeafes, their ftrange fymptoms & appearances, and their unaccoun- table caufes, thefe are the three original great fources of moft of the chronic difeafes of mankind ; which I have endeavored to fet forth and explain in fo fa- £ miliar a manner, that I hope I have been perfectly intelligible to every one who will venture to think and judge for himfelf. To fuch rational people .on- ly I addrefs myfelf; and to enable them to do this the better, I have furnifhed thefe hints and obferva- ^ tions, which may be extended, improved and ap- plied to particular cafes. I want not, nor wifh to obtrude my ideas upon any man, however warrantee^ I may think myfelf from the obfervation and expe- rience of my whole life : my principal aim has been only to make men ftop a little in their career, and confider with themfelves whether it may not be pof- fible for them to be miftaken, even in that courfe of diet and thofe habits of life which they never fuf- pected. If they are ill, and for any time, there muft be a more fubftantial caufe for it, than they] are in general willing to allow. It is not always catching cold, for we do not catch cold fo often as we think we do ; and when a healthy robuft perfon takes cold, which can happen but rarely, if this be f 57 ] the whole of the difeafe, it cannot laft long. But the truth is, when the crudity, fuperfluity and a. cnmony of an indolent, intemperate life have accu- mulated to fuch a degree as to make us fick, then we fay we have taken cold, or complain of a bad conftitution,when we have fpoiled perhaps a very good one ; or with Sydenham, that the epidemic confti- tution of the air has infected us, or that this or that trifle has difagreed. I am fully and firmly perfuaded, that whoever will reflect with fome degree of intel- i ligence and fanity, be juft to himfelf, and candid ,,: with his phyfieian,will in general be able to trace his >; complaints and difeafes up to one or other of thele \ three caufes. And whoever does this, muft infallibly j fee how vain and idle all his hopes and expectations * of lafting remedy and eftablifhed health muft be* from any kind of quack medicines, or indeed the common and too general practice of phyfic, when the whole is refted upon fomething given to fwallow ; how inadequate the means are to the end propofed and hoped for ; how ill vomiting and purging can fupply the place of temperance ; bleeding, blifk-r- ing,and all artificial evacuation,of activity ; cordials L& opium, of peace of mind. Is not this to fill the bo- Bdy with harfh& unholfome juices,and then tear it to ;_ pieces to get them out again ? To make artificial ' holes and fores in the fkin to renew, the blood and | difcharge fuperfluities, inftead of employing mufcu- * lar motion to rub off and grind down all the acrimo- ny of angular aculeated particles, and make them j. fmooth and round, &eafilydivifible ; and to employ 11 [ 5? ] intoxication and ftupefaction to take off the ferife of pain, and leave the caufe where it was, or fix it.faft- tcr ? Can any reafonable perfon hope for health or^ long life by any of thefe unnatural methods, when thefe only are employed ? Let him look round a- mong his neighbours and acquaintance, and tell me whether, nt* -only all the gouty, but rheumatic, colicky, jaundiced, paralytic, dropfical, hyfterical people he has ever feen, a're not either always fo, or by fits fo ; and whether thofe returning paroxyims or fits of thefe diforders do not always grow worfe and worfe, in fpite of all their medication and quack- ery, till a complication or apoplexy comes on, that at laft, though long before their time, puts an end to their miferable lives. Thefe evils are confidered as the inheritance of human nature,unavoidable & incu- rable, and fubmitted to in abfolute defpair; though there has not one rational attempt, that I know of, ever yet been made to remedy them in earneft. All the methods hitherto employed have only been to relieve, and thofe often fo pernicioufly, that the fu- ture health has been facrificed to obtain prefent relief or eafe. This muft for ever be the cafe when in chronic cafes it is obtained by art, and nature has no fhare : or where the phyfieian does all, and the pa- tient nothing for himfelf. [ 59 3 Of the Cure of the Gout and all other Chronic Difeafes, and the Repair of a brokenConftitution, HAVING fet forth the real-caufes of the gout, & all it's congenial difeafes, I come now It,- to the moft eflTential part, to adminfter all poflible comfort to thofe whom great pain and long fuffering may have made attentive and docile, and willing to . ( take health upon the terms it is poflible to have it. ;. To the young and voluptuous,whoareyetin their ca- ' reer, and declare for a fhort life and a merry one, I , . have nothing to fay but this, that a fhort life is very ,■ feldom a merry one; on the contrary, is generally made up of a few years of riotous pleafure without : t happinefs, to be feverely paid for by as many more i of pain, ficknefs, regret and defpair. Having fhewn that the gout is not hereditary, not inherent in our conftitutions, but produced by the daily accumulations of indigefted, unfubdued acri- mony and fuperfluity, which, when they abound to a certain degree, muft end either in a fit of the gout f or fome other difeafe, according to the conftitution, as long as any vigor is left in the body ; for nature will for ever free or endeavour to free itfelf, [-and purge the blood of its impurities by gout, by fever, by pain of one kind or other, that takes off. the appetite, and for a time gives refpite, and pre- ( 60 ] vents the pouring in of more and more enemies to difturb it's operation, and make it ineffectual. Thus young people, after a fit of gout is happily and well gone oft,are as free from it as if they had never had it; and if they would take warning and be careful notto breed it again, moft certainly would for ever remain free. How abfurd therefore, how ridiculoufly igno- rant muft be every attempt to cure the gout in futuro by medicine, before it be yet formed, before it has any exiftence ! Can fuch a medicine give fuperna- tural ftrength, and enable an old man living [in in* dolenee to digeft and copfume, or difcharge the fu- perfluities of his daily intemperance ? that is,to give him more vigorous powers than nature gave him at one-and-twenty, or when the gout came firft upon him. The Duke of Portland's powder promifed to, do fomething like this, and moft certainly kept off the gout for two or three years* But what was it I and what did it really do'? It was a ftrong fpicy hitter taken in fubftance, in a large quantity, for a long time ; its. effect was to keep up a conftant fe- ver as long as it was taken ; this kept the gouty matter always afloat, and prevented its fixing any where. But there was no living long with a con- ftant fever; accordingly many of thole who took it died very foon. I myfelf obferved between fifty and fixty of it's advocates, fome my patients, fome my acquaintance or neighbors, who were' apparently cured by it for a little while ; but in lefs than fix years time, omnes ad internecionem c^Ji^ they all died to a man. Many fimilar attempts have been made with other medicines to cure not only the gout, but moft other chronic difeafes, and with the fame fatal effects. An- tirriony and Mercury elaborated into poifons by chemiftry have been adminiftered, particularly the folution of fublimate has torn many a ftomach to ; rags, fo that it could never bear common food after- wards. The deadly night-fhade, and hemlock, and many fuch dreadful poifons, have been given as al- ii teratives to reftore health. The intention here feems I to be, kill or cure, to raife a violent agitation or fe- ver in the body, in hopes it may prove ftrong enough to throw off the difeafe and medicine together. The effect has ever been, notwithftanding a little appa- rent and deceitful relief may have been perceived from the firft efforts, that it has funk under both r loads, and, exhaufted by repeated ftraining, much r fooner than by the difeafe alone. ' Can any one in his fenfes fuppofe that difeafes a man has been his whole life contracting, and to Jwhich he is adding every day by perfeverance in un- ^wholelome diet,^and bad habits, are to be thus re- moved by a coup de main ou de baguette f ox that they will not return, be they cured or conjured away ever |fo often, whilft he continues the fame mode of %fc that brought them on at firft ? % What then is to be done ? how and in what man- ner are chronic difeafes and cachexies to be cared, \*nd health reftored and eftablilhed ? I have already [ 62 J fhewn that the caufes of thefe evils are Indolence, Intemperance, and Vexation ; and if there be any truth or weight in what I have faid, the remedies are obvious : Activity, Temperance, and Peace of Mind. It will be faid the remedies are obvious, but impracticable. Would you bid the feeble cripple, who cannot ftand, take up his bed and walk ? the man who has loft all appetite, abftain ? and the fleeplefs wretch racked with pain enjoy peace of , mind ? No certainly ; I am not fo abfurd. Thefe muft be afiiited by medicine ; and if they have not exhaufted all it's power already, a little refpite, a favourable interval may Be obtained, that, with o- ther artificial aids co-operating, may be greatly im- proved to their advantage, and if rightly employed ( they may get on from ftrength 10 ftrength, till they recover into perfect health. But it is not my de- fign at prefent to expatiate upon that particular kind of medical relief which every chronic cafe may re- quire ; it would lead me into too wide a field, and too far from my prefent purpofe, which is to fhew that the gout, in moft of its ftages and degrees, may , be cured, a prefent paroxyfm or fit relieved, it's re- turn for ever fafely prevented, and the patient efta- blifhed in perfect health. Let us fuppofe the cafe of a man from forty to fifty years of age,who has had at leaft twenty fits of gout;. by which moft of his joints have been fo clogged, & obftru