Part 18

LIV. As I observed before, I am neither a partizan of the Helmonists, nor a favourer of the Galenists; but I look upon it as a thing certain, that an intemperate use of purging and bleeding, has destroyed many men, and especially, if administered when nature is much weakened; notwithstanding which, I am persuaded that they are serviceable in many cases. Whether they are absolutely necessary, and whether patients could not do well, if other remedies were substituted in their places, is a point I will not take upon me to determine; and especially, when I have fresh in my memory, the declaration of a physician, whose authority has great weight with me. This is Lucas Tozzi, a famous Italian physician, who in his exposition of the third aphorism of the first book of Hippocrates, _Habitus Athletarum, &c._ after combating and controverting the usefulness of bleeding, with seemingly very efficacious and persuasive reasoning, he asserts, and offers to prove, that it is not necessary in any one of the diseases, in which the Galenists insist it cannot be dispensed with; and in answer to the experience they alledge of its utility, he quotes his own; and says, _if they appeal to experience, and insist that it is evident from thence, that many people have been cured of various disorders by blood-letting; I reply, that in the hospital of the Anunciada at Naples, where I have officiated as physician many years, I have cured in a short space of time, and without taking from them one drop of blood, hundreds and thousands of patients, who have been attacked with some one or other of the following disorders, frensies, pleurisies, quinsies, inflammations of the liver, spitting of blood, erysipelases, and all kinds of fevers_.

LV. What shall we say to this? Lucas Tozzi was not only a great theorist, but also a most expert, successful, and much esteemed practitioner, and as such, his advice was solicited with anxiety by people of the first rank. If he without bleeding cured all those disorders, which in the common opinion stand most in need of that evacuation, and not only cured them, but did it in a short time, what diseases must they be which cannot be cured without blood-letting?

LVI. And it is very remarkable, that in the same manner the Galenists endeavour to deduce from experience the necessity of blood-letting in many diseases, they endeavour also to establish the preference, that should be given to drawing blood in particular disorders, from particular veins, such as the hepatic, and cephalic. Anatomy however, makes it as clear as the sun at noon-day, that this preference is not grounded on any solid foundation, and that the cephalic vein bears no more relation to, nor is any more connected with the head, than the hepatic, nor the hepatic with the liver, than the cephalic; and that all the veins of the same arm, communicate indifferently with all parts of the body, as the laws of circulation demonstrate; and as that observation which was pretended to be derived from experience, was founded in mistake, it is not improbable, that that which is generally alledged in favour of bleeding, may be so likewise.

LVII. What appears to me is, that the rule so much cried up by the Galenists, and which establishes the necessity of bleeding, in pleurisies, is liable to so many exceptions, that we ought not to regard it as a general one; and we have observed in another part of our works, that in some epidemical pleurisies, it has been found to be evidently injurious. It is but a little while ago, that a learned French physician, whose works are mentioned in the Memoirs of Trevoux, wrote strongly against bleeding in winter pleurisies and peripneumonies; and his reasoning had great weight with some eminent physicians of Paris. I can certify, that in the last winter 1731, when many people were attacked with pleurisies in this country, it was generally remarked, and we received informations to the same effect from all quarters, that those who were blooded died, and that those who were not did well.

LVIII. I would have it understood, that I wish all I have said, with respect to the utility or inutility of purging and bleeding in general, should be considered as the sentiments of a man, who takes no side in the dispute, but who proposes what he advances problematically, and with a view of convincing the world, that in order to avoid being misled, they should examine with great attention and exactness, any observation that is alledged to be founded on experience, for this is the principal object I had in view, in writing this discourse.

LIX. It would argue weakness and want of judgment, for any one to esteem a thing as a remedy for a particular disease, without reflecting and making a remark, the propriety of which must stare every man in the face, and that is, comparing the success of the practice of those who use that medicine, with that of those who do not make use of it. There have been physicians, who have declared themselves enemies to the administration of the bark; but notwithstanding this, there is no body at this day, who disputes its febrifuge efficacy in intermittent cases; for experience shews, that it will stop the fit, although it may return again afterwards, and although in the opinion of some people, the medicine may leave some bad impression on the body. If purging and bleeding would have the same effect, in some sort of fevers, we should all agree in attributing to them a febrifuge virtue; notwithstanding that some practitioners, might give the preference to other remedies, as more safe, and better adapted. But this is so far from being the case with respect to these evacuations, that their efficacy of removing fevers, is at this day strongly contested, for experience has not yet manifested, that they are remedies for these disorders, in any degree or manner, that is not exceedingly doubtful or disputable.

SECT. XIV.

LX. As far as the nature of the case will permit us (for all things are not capable of being mathematically or decisively demonstrated), we should endeavour to discover the truth, by imitating the diligence and attention which many English physicians exercised, in examining into the eligibility of the precautionary remedy called inoculation, practised by the Turks, to elude the fatal effects of the small-pox. This is a subject, that has been much talked on in other kingdoms for some years; although in Spain we have hardly heard it mentioned. The event of communicating the infection in this way, most generally is, that the person inoculated has the distemper very lightly, and is hardly ever obliged through the whole course of the disease, to keep his bed.

LXI. The account of this precautionary method, was brought to England by one Maitland, who was surgeon to Mr. Wortley Mountague, his Britannic majesty’s ambassador at the Porte, and was from thence communicated to the other nations of Europe. Maitland had observed, that this practice was almost universal in all the cities of the Levant, and that it was attended with wonderful success. He communicated these remarks to Mr. and Mrs. Mountague, and they had fortitude enough, upon the faith of what he had told them, to make the experiment upon a son they had with them of six years old, which being attended with success, they repeated it upon another of their children when they returned to England. Many were animated with these examples and these accounts; and the practice of inoculation, began to be much approved, and much adopted in England, notwithstanding it was greatly opposed, and objected to by some people there, and by many in other countries; and especially by the physicians of Paris, who exclaimed strongly against it.

LXII. But as this contest was such a one, as ought not to be determined by speculative reasoning, an appeal was made to experience, which appeal, was prosecuted in such a manner by those who were advocates for the practice, as seemed to exclude all doubt and perplexity. Physicians who resided in different parts of the kingdom, were requested to give accounts of the success of their practice by this method, and to transmit them to London, which when received, were printed and published. By these accounts, two facts were established; the first was, that inoculation freed the patient from the danger of a second infection; and the second was, that those to whom the small-pox was communicated in this way, very rarely died; and although it is true that some few of them miscarried, they were mostly such, as were afflicted with some other disorder at the time of their inoculation, of which they would have died, if they had not had the small-pox; but these altogether, did not amount to but very little more than a tenth part of those, who perished by catching it in the natural way; for by the best calculation they could make, one out of eight died of the last, and not above one in eighty of the first.

LXIII. This is the account I have read of this matter in the Memoirs of Trevoux; to which some may object, that it is possible the relations of the cases, were not published so faithfully as they were received. To this I answer, that it is probable great pains were taken in making the enquiries, and great fidelity observed in publishing the accounts, as the Memoirs of Trevoux tell us, that upon the strength of their authority, some of the royal family of England were inoculated.

LXIV. And let it not be insisted in opposition to this, that if the fact had been so well established, it could have admitted of no contradiction. They know little of the human passions, who think this remark a solid one. Those who contradict, either through blind prepossession, or from motives of emulation, interest, or envy, seldom submit, or will own themselves convinced by proofs that are self-evident; nor is there any species of evidence, that can bar every door, at which a false subterfuge may steal in, nor against the intrusion of a thousand sophistical objections, introduced by those, who are under the dominion of the beforenamed passions. I speak feelingly of this matter, having had woeful experience of the truth of what I assert, since I first began to write for the public.

LXV. In reality, some of the objections that were made to inoculation, were the most ridiculous in the world. Some rigid Presbyterians, made the cause of religion interested in the question, and asserted, that that practice, was an affront to the sovereignty, and an opposition to the decrees of God; and one of them declared in his preaching, that it was a diabolical invention, for the devil by inoculation had communicated the small-pox to Job, which was the distemper that so sorely afflicted that holy Patriarch. Into what absurdities, does a violent ardour hurry a man in a controversy! Of all sensible human beings, there are none so nearly allied to mad men, as passionate disputants.

LXVI. Towards the conclusion of this virulent contest, a very curious circumstance came to light, which was, that this precautionary method which had made so much noise, and which had generally been supposed to have been brought from Turkey, had for ages before, been in use in the island of Great Britain itself; for that it had been practised from time immemorial, in the southern parts of the principality of Wales, where they communicated the infection in two ways either by rubbing some of the variolous matter hard on the skin of the person to whom the distemper was to be given, or else by dipping a needle into that matter, and pricking his skin with it; and as they gave the person from whom the matter was taken a small sum of money, this was called buying the small pox; and they produce very authentic testimonies, that scarce any one of those who came by the distemper in this manner died, and that there was no instance of a person who had acquired the disease in this way, ever having had it a second time.

SECT. XV.

LXVII. We shall conclude this discourse, by pointing out three capital errors, which are derived from want of proper attention in making experiments. The first is, that of taking for the effect, what in reality is the cause, and taking for the cause, what is nothing more than the effect. The second consists in taking for the cause, something that comes in by accident, and which has no influence whatever. The third consists, in between two effects proceeding from one and the same cause, taking one of them for the cause of the other. I shall give examples of these three errors, in observations appertaining to medicine, which are said to be derived from experience, because mistakes in this branch, are generally attended with worse consequences, than those in other ordinary physical matters.

LXVIII. It happens, that a man feels an ardent and extraordinary thirst upon himself, without being able to assign any apparent cause of it; he drinks water to great excess, and in a few hours is seized with a fever, or an acrid fluxion. It is common in such cases, to attribute the indisposition to the excessive drinking of water, and to apprehend, that was the cause of the disease; but this was so far from being the case, that the indisposition was rather the cause of his drinking to that excess. But I would have it observed, that I speak of an instance, in which the thirst was not brought on by any manifest or apparent cause, such as the having used any violent exercise, or having been exposed to some great heat, either of the sun or fire, or having been a long time without drinking, or having eaten something very salt. I say that agreeable to this state of the case, it is very clear, that the thirst must have arisen from some internal cause; but the question is, from what cause? Why it could be from no other, than a morbific disposition, that had begun to prevail within his body; or let us express it in another manner, and say, that it proceeded from an acrid or salt humour, which had just begun to get in motion, and by vellicating the fibres that produce the sensation of thirst, had by that means excited it. Every preternatural and extraordinary effect, demands a preternatural and extraordinary cause to occasion it; and if we suppose that the thirst was such an effect, and we cannot assign any external cause to which we can attribute it; we must conclude that it proceeded from some preternatural internal cause; which in all probability, must be the morbific disposition.

LXIX. The want of this reflection, occasions great errors to be committed in physic, for by running counter to the course of nature, you must unavoidably mistake the road that leads to the cure. The consequence of mistaking the effect for the cause, is administering as a medicine, what in reality is poison; for it is clear, that if the physician apprehends the humidity and coldness of the water to be the cause of the distemper, when in truth it was produced by the acrid, salt, peccant, or inflammatory humour, I say if this should happen to be the case, and he calculates his prescriptions to correct the humidity and coldness, he by so doing, will inflame and increase the original disorder.

LXX. This species of error, is not confined to the case we have instanced, but is capable of being extended to a vast expanse. I am much inclined to think, that all the extraordinary and vehement emotions, both of the irascible, and libidinous kind, which precede distempers a small distance of time before they make their appearance, and for which you can assign no special external cause, are the effects of those distempers, in their original stages; I mean, that in the first agitations of such cases as we are speaking of, a person is apt to fall into violent passions upon very slight provocations, such as he knows by his own experience, were never used to agitate or have that effect on him, and either immediately, or within a few hours afterwards, he is seized with a fever. People are apt to suppose, that the passion was the cause of the disease; but I say, that the disease occasioned the anger; for if this man, agreeable to his natural disposition, was never subject to such violent starts of passion, upon such, or even greater provocations, it necessarily follows, that that which he experienced upon this occasion, must have been the effect of some preternatural internal cause, which lay concealed within him, most probably the first fermentative movements of the peccant humour, which soon afterwards produced a fever. In reality, it is easy for any one to perceive, and I have remarked it many times both with respect to myself and others, that the irascible passion, is much more apt to be inflamed upon slight occasions, in those first stages, or almost insensible beginnings of such indispositions as tend to be somewhat serious, than at other times.

LXXI. I do not however deny, that the ardour of passion may excite a fever; for this without doubt, may have a great share in producing such an effect, and we may reasonably suppose that it has, and especially in such people as are of a choleric disposition; but when this is not the case, we should rather suppose, that the passion tended to augment the indisposition which followed the sudden fit of anger, and which would have made its appearance without the intervention of that anger, although it might have been attended with milder symptoms. And the same we say of anger, is applicable to sadness and fear also, for they conformable to the language of the philosophers, are passions appertaining to the irascible.

LXXII. We may reason in the same general way, upon the effects of the amorous passion. All vehement desires for ordinary objects, which frequently present themselves to a man’s view, and which are totally unusual to him, and for which we cannot assign any special external circumstance that should excite those desires, we should conclude, that they proceed from some preternatural internal disposition. The indulgences or gratifications of these extraordinary desires, are always attended with actions of excess, to which are generally attributed the indisposition that follows them; but in truth, the indisposition which laid concealed, irritated the appetite, and was the cause of the excess, and not the excess of the indisposition.

LXXIII. The following mistake also, is very frequently fallen into. A person who has always been indifferent about this or that particular food, we will say lettuces for example, all of a sudden takes a great fancy for them, and will eat two or three large ones. If he is afterwards attacked with a pain of the head, and defluxion upon the breast, or a diarrhœa, the fault is sure to be laid upon the lettuces, which are accused as the cause of all the mischief; but in reality, the mischief had before crept into the constitution, and had induced the extraordinary desire to eat the lettuces.

LXXIV. I would not however, be understood to insinuate, that eating of any thing to excess, does not frequently occasion or bring on various diseases; for I only mean that my position should be understood to allude to a desire that is vehement, and unusual to the person, and for which, you can assign no visible external cause that should excite it; for under such circumstances, there is a necessity for concluding it was owing to some internal cause, that was sufficiently powerful to merit the name of a morbific disposition; which is an appellation it could not have deserved, if the appetite although extraordinary, had not been excessive.

LXXV. I am confirmed in the truth of the remark I have just made, by the reflexion, that a diversity of appetites, must undoubtedly proceed from a diversity or alteration of temperaments; and it follows of course, that every alteration in the temperament, must be attended with an alteration of the appetite. It is easy to discern, that no sick person, preserves his appetite in the same even state, in which it continues when he is in health; and this not only with respect to the quantity he eats and drinks; but with respect to the quality of his nourishment also; nor is this confined to the objects of his palate only, but extends to those of all his other feelings and inclinations, both internal and external.

SECT. XVI.

LXXVI. The second capital error committed in making experimental observations, and which is more common than the first, is that of mistaking for the cause, something that intervenes by accident, and is neither cause nor effect. There is scarce any sick person, who does not fancy he knows what has been the cause of his disorder, which he generally imputes to something particular that he has done, or some alteration he has made in his way of living a little before he was seized with his distemper; although the thing to which he imputes it, bears no allusion to, nor any proportion with the disorder that afflicts him. The having eaten an olive more than it was usual for him to eat, or having fasted a quarter of an hour longer than his usual time, or having drunk two spoonfulls more than common, or abated twenty yards of his ordinary walking, together with some other particulars, that are equally trifling and insignificant with those we have mentioned; but notwithstanding the futility of these observations, he is apt to impute to such causes the disorder he labours under, without reflecting, that this machine of ours, from the weakness of its own texture, is sufficiently exposed to its breaks, ebbings and flowings. The humours of the body, even when the influence of all external causes, and every thing that depends on our own free will, are regulated with perfect uniformity, are nevertheless exposed to various alterations. The heterogeneous nature of them as they respect one another, and also considered with respect to every particle of each of them separately, must necessarily conduce to their being in different states. If those superstitious spirits, who are such idolaters of their health, that with respect to their own regimen they would weigh even atoms, would well consider this, they would free themselves from the continual anxiety in which they live, and which is more pernicious to them, than those very indispositions they are so terrified at, and which they are at so much pains to escape.