The profession of physic is that, of all others, in which the generality of mankind have the fewest lights, by which they can discern the abilities of its professors; because the studies which lead to it are[219] more out of the road of usual education, and the practice more enveloped8 in technical terms and hieroglyphical9 signs. But I imagine the safest criterion by which men, who have not been bred to that profession, can form a judgment10 of those who have, is, the degree of sagacity and penetration11 they discover on subjects equally open to mankind in general, and which ought to be understood by all who live in society. You do not mention particularly what has been prescribed by either; only that the former physician seemed to rely almost entirely on exercise and regimen, whereas the present flatters our friend with a speedy cure, by the help of the Pectoral and Balsamic medicines which he orders in such abundance, and which he declares are so efficacious in pulmonary consumptions.
Having lamented12 with you the mournful events which render the name of that disease peculiarly alarming to you, and[220] knowing your friendly solicitude13 about Mr. ——, I do not wonder at your earnest desire to know something of the nature of a distemper with which he is threatened, and which has proved fatal to so many of our friends. But I am surprised that you have not chosen a more enlightened instructor14, when you have so many around you. Though conscious that I have no just claim to all the obliging expressions which your partiality to my opinions has prompted you to make use of, yet I am too much flattered by some of them, to refuse complying with your request. My sentiments, such as they are, will at least have the merit of being clearly understood. I shall observe your prohibition15, not to refer you to any medical book; and shall carefully avoid all technical terms, which you so much abominate17. With regard to your shewing my Letter to any of the faculty18; if you find yourself so inclined, I have not the smallest objection; for those[221] who have the greatest knowledge in their profession, are best acquainted with its uncertainty19, and most indulgent to the mistakes or errors of others.
Alas21, my friend! how is it possible that physicians should avoid mistakes? If the ablest mechanic were to attempt to remedy the irregular movements of a watch, while he remained ignorant of the structure and manner of acting22 of some of the principal springs, would he not be in danger of doing harm instead of good? Physicians are in the situation of such a mechanic; for, although it is evident that the nerves are the organs of motion and sensation, yet their structure is not known. Some anatomists assert they are impervious23 cords; others, that they are slender tubes, containing a fluid. But what the nature of this fluid is; whether it serves only to nourish the nerves themselves, or is the medium by which they convey feeling and the power of motion to other parts, is not[222] ascertained24 even by those who argue for its existence; far less is it explained in what manner ideas, formed within the brain, can, by the means of solid cords, or by a fluid contained in tubes, communicate motion at pleasure to the legs and arms. We are ignorant why the will, which has no influence over the motion of an animal’s heart, should find the feet obedient to her dictates25; and we can no more explain how a man can move one leg over the other by volition26, or the mere27 act of willing, than how he could, by the same means, move Ossa on the top of Olympus. The one happens every moment, the other would be considered as a miracle; but they are equally unaccountable. While parts so infinitely28 essential to life are not understood, instead of being surprised that so many diseases baffle the skill of the physician, we have more reason to be astonished that any can be alleviated29 or cured by his art.
[223]
The pen of the satirist30, no doubt, may be fairly aimed against the presumption31 and ignorance of many individuals of this, as of every other profession; but cannot with justice be directed against the art itself: since, in spite of the obscurity which still involves some parts of the animal economy, many disorders33 are relieved, and some of the severest and most disagreeable to which the human body is liable, are cured with certainty by the art of medicine.
Unfortunately for mankind, and in a particular manner for the inhabitants of Great Britain, the pulmonary consumption is not of the number.
This disease may originate from various causes:
2d. The disease called pleurisy, including in that term an inflammation of the lungs themselves, as well as the membrane35 which covers them.
[224]
3d. The bursting of some of the blood-vessels36 of the lungs, independent of external injury, and owing to a faulty conformation of the chest, and the slenderness of the vessels.
The first cause I have mentioned is an external bruise or wound.
An accident of that kind happening to the lungs, is more dangerous and difficult to cure, than when the same takes place in most other parts of the body; because the lungs are vital organs, essentially necessary to life, and when their motion is impaired38, other animal functions are thereby39 injured; because they are of an uncommonly40 delicate texture42, in which a rupture43 having once taken place, will be apt to increase; because they are in constant motion and exposed to the access of external air, both of which circumstances are unfavourable to the healing of wounds,[225] and because the mass of blood distributed to the whole body passes previously45 through the lungs, and consequently the blood-vessels of this organ are more numerous than those of any other part of the body.
When we consider these peculiarities46, it is natural to conclude, that every wound of the lungs must necessarily prove mortal; but experience has taught the contrary. Many wounds of the lungs heal of themselves, by what is called, the first intention. The physician may prevent a fever, by ordering the patient to lose blood in proper quantities, and he may regulate the diet; but the cure must be left to nature, which she will perform with greater certainty, if she is not disturbed by any of those balsams which the wounded are sometimes directed to swallow on such occasions. But when the wound, either from injudicious treatment, or from its size, or from the bad habit of the patient, degenerates47 into an ulcer48 attended[226] with hectic49 symptoms, the disease must be treated as if it had arisen from any of the other causes.
The pleurisy, or inflammation of the lungs, is a disease more frequent in cold countries than in mild; in the spring than in the other seasons; and more apt to seize people of a sanguine50 constitution than others.
Plentiful51 and repeated bleedings, fomentations, blisters52 near the affected53 part, and a cooling, diluting54 regimen, generally remove it, without its leaving any bad consequence. Sometimes, by the omission55 of bleeding in due quantity at the beginning, and sometimes in spite of all possible care, it terminates in an abscess, which, on bursting, may suffocate56 the patient; or, if the matter is coughed up, becomes an open ulcer, and produces the disease in question.
The third cause of the pulmonary consumption above mentioned, is, a spitting[227] of blood, from the bursting of vessels of the lungs, independent of external wound or bruise. People of a fair complexion57, delicate skin, slender make, long neck, and narrow chest, are more subject to this than others. Those who have a predisposition to this complaint, by their form, are most apt to be attacked after their full growth: women from fifteen to three-and-thirty; men two or three years later. In Great Britain, a spitting of blood generally occurs to those predisposed to it, in the spring, or beginning of summer, when the weather suddenly changes from cold to excessive hot; and when the heat is supposed to rarify the blood, before the solids are proportionably relaxed from the contracted state they acquire during the cold of winter. When a spitting of blood happens to a person who has actually lost brothers or sisters, or other near relations, by the pulmonary consumption, as that circumstance gives reason to suspect a family[228] taint20 or predisposition, the case will, on that account, be more dangerous.
Violent exercise may occasion the rupture of blood-vessels in the lungs, even in those who have no hereditary59 disposition58 to such an accident; it ought therefore to be carefully avoided by all who have. Violent exercise, in the spring, is more dangerous than in other seasons; and, when taken at the top of high mountains, by those who do not usually reside there, it has been considered as more dangerous than in vallies. The sudden diminution60 of the weight of the atmosphere, co-operating with the exercise, renders the vessels more apt to break. Of all things the most pernicious to people predisposed to a spitting of blood, is, playing upon wind-instruments. Previous to the spitting of blood, some perceive an uneasiness in the chest, an oppression on the breath, and a saltish taste in the spittle; but these symptoms are not constant.
[229]
Nothing can be more insidious61 than the approaches of this disease sometimes are. The substance of the lungs, which is so full of blood-vessels, is not supplied so liberally with nerves; the lungs, therefore, may be materially affected, before danger is indicated by acute pain. And it sometimes happens, that people of the make above described are, in the bloom of life, and generally in the spring of the year, seized with a slight cough, which gradually increases, without pain, soreness in the breast, difficulty of respiration62, or spitting of blood. A slow fever supervenes every night, which remits63 every morning, with sweats. These symptoms augment64 daily; and, in spite of early attention, and what is thought the best advice, the unsuspecting victims gradually sink into their graves.
Those who by their make, or by the disease having in former instances appeared in their family, are predisposed to this complaint, ought to be peculiarly attentive65 in the[230] article of diet. A spare and cooling regimen is the best. They should avoid violent exercise, and every other exciting cause; and use the precaution of losing blood in the spring. If their circumstances permit, they ought to pass the cold months in a mild climate; but, if they are obliged to remain during the winter in Great Britain, let them wear flannel66 next the skin, and use every other precaution against catching67 colds.
The fourth cause above enumerated68 is, tubercles in the lungs.
The moist, soggy, and changeable weather, which prevails in Great Britain, renders its inhabitants more liable, than those of milder and more uniform climates, to catarrhs, rheumatisms, pleurisies, and other diseases proceeding69 from obstructed70 perspiration71. The same cause subjects the inhabitants of Great Britain to obstructions72 of the glands73, scrophulous complaints, and[231] tubercles in the substance of the lungs. The scrophulous disease is more frequent than is generally imagined. For one person in whom it appears by swellings in the glands below the chin, and other external marks, many have the internal glands affected by it. This is well known to those who are accustomed to open dead bodies. On examining the bodies of such as have died of the pulmonary consumption, besides the open ulcers75 in the lungs, many little hard tumours or tubercles are generally found; some, with matter; others, on being cut open, discover a little blueish spot, of the size of a small lead shot. Here the suppuration, or formation of matter, is just going to begin; and in some the tubercle is perfectly76 hard, and the colour whitish, throughout its whole substance. Tubercles may remain for a considerable time in the lungs, in this indolent state, without much inconveniency; but, when excited to inflammation by frequent catarrhs, or other irritating causes,[232] matter is formed, they break, and produce an ulcer. Care and attention may prevent tubercles from inflammation, or may prevent that from terminating in the formation of matter; but when matter is actually formed, and the tubercle has become an abscess, no remedy can stop its progress. It must go on till it bursts. If this happens near any of the large air-vessels, immediate77 suffocation78 may ensue; but, for the most part, the matter is coughed up.
From the circumstances above enumerated of the delicate texture, constant motion, and numerous blood-vessels of the lungs, it is natural to imagine, that a breach79 of this nature in their substance will be still more difficult to heal than a wound from an external cause. So unquestionably it is; yet there are many instances of even this kind of breach being repaired; the matter expectorated diminishing in quantity every day, and the ulcer gradually healing; not, surely, by the power of[233] medicine, but by the constant disposition and tendency which exists in nature, by inscrutable means of her own, to restore health to the human body.
It may be proper to observe, that those persons whose formation of body renders them most liable to a spitting of blood, have also a greater predisposition than others to tubercles in the lungs. The disease, called the spasmodic asthma80, has been reckoned among the causes of the pulmonary consumption. It would require a much greater degree of confidence in a man’s own judgment, than I have in mine, to assert, that this complaint has no tendency to produce tubercles in the lungs; but I may say, with truth, that I have often known the spasmodic asthma, in the most violent degree, attended with the most alarming symptoms, continue to harass81 the patients for a long period of time, and at length suddenly disappear, without ever returning; the persons who[234] have been thus afflicted82, enjoying perfect health for many years after. It is not probable that tubercles were formed in any of these cases; and it is certain they were not in some, whose bodies were opened after their deaths, which happened from other distempers, the asthma having disappeared several years before.
Certain eruptions83 of the skin, attended with fever, particularly the small-pox, and still oftener the measles84, leave after them a foundation for the pulmonary consumption. From whichever of the causes above enumerated this disease takes its origin, when once an ulcer, attended with a hectic fever, is formed in the lungs, the case is, in the highest degree, dangerous. When it ends fatally, the symptoms are, a quick pulse, and a sensation of cold, while the patient’s skin, to the feeling of every other person, is hot; irregular shiverings, a severe cough, expectoration of matter streaked85 with blood, morning sweats,[235] a circumscribed86 spot of a crimson87 colour on the cheeks, heat of the palms of the hands, excessive emaciation88, crooking89 of the nails, swelling74 of the legs, giddiness, delirium90, soon followed by death.
These symptoms do not appear in every case. Although the emaciation is greater in this disease than in any other, yet the appetite frequently remains91 strong and unimpaired to the last; and although delirium sometimes comes before death, yet in many cases the senses seem perfect and intire; except in one particular, that in spite of all the foregoing symptoms, the patient often entertains the fullest hopes of recovery to the last moment.
Would to heaven it were as easy to point out the cure, as to describe the symptoms of a disease of such a formidable nature, and against which the powers of medicine have been directed with such bad success, that there is reason to fear, its fatal termination has been oftener accelerated[236] than retarded92 by the means employed to remove it! To particularise the drugs which have been long in use, and have been honoured with the highest encomiums for their great efficacy in healing inward bruises94, ulcers of the lungs, and confirmed consumptions, would in many instances be pointing out, what ought to be shunned95 as pernicious, and in others what ought to be neglected as futile96.
Salt water, and some of the mineral springs, which are unquestionably beneficial in scrophulous and other distempers, have been found hurtful, or at least inefficacious, in the consumption; there is no sufficient reason to depend on a course of these, or any medicine at present known, for preventing or dissolving tubercles in the lungs. Mercury, which has been found so powerful in disposing other ulcers to heal, has no good effect on ulcers of that organ;—though some physicians imagine it may be of service in the beginning to[237] dissolve tubercles, before they begin to suppurate; but as there is no absolute evidence, during life, of indolent tubercles being formed, there can be none that mercury cures them.
Various kinds of gums, with the natural and artificial balsams, were long supposed to promote the healing of external wounds and ulcers, and on that account were made the basis of a vast variety of ointments97 and plaisters. It was afterwards imagined, that the same remedies, administered internally, would have the same effect on internal ulcers; and of course many of those gums and balsams were prescribed in various forms for the pulmonary consumption. The reasoning on which this practice was established, however, seems a little shallow, and is far from being conclusive98; for although it were granted, that these balsams contributed to the cure of wounds, when applied99 directly to the part, it does[238] not follow that they could carry their healing powers, unimpaired, from the stomach to the lungs, through the whole process of digestion100. But more accurate surgery having made it manifest, that the granulations which spring up to supply the loss of substance in external wounds, and the healing or skinning over of all kinds of sores, proceeds from no active virtue101 in the plaisters or ointments with which they are dressed, but is entirely the work of nature, and best performed when the mildest substances, or even dry lint102 only is applied; and that heating gums, resins103, and balsams, rather retard93 than promote their cure; the internal use of such remedies ought to be rejected now, on the same principles they were adapted formerly104.
No kind of reasoning ought to have weight, when opposed by fair experience. But physicians have formed contrary and opposite conclusions, with respect to the[239] effect of the natural and artificial balsams, even when they have laid all theory and reasoning aside, and decided105 on their powers from practice and experiment only. This is sufficient to prove, at least, that their efficacy is very problematical. For my own part, after the fairest trials, and the most accurate observations I have been able to make, I cannot say that I ever knew them of service in any hectic complaint proceeding from an ulcer in the lungs; and I have generally found those physicians, on whose judgment I have more reliance than on my own, of the same opinion.
It is far from being uncommon41 to see a cure retarded, not to say any thing stronger, by the means employed to hasten it; and physicians who found their practice on theoretical reasonings, are not the only persons to whom this misfortune may happen. Those who profess2 to take experience for their sole guide, if[240] it is not directed by candour, and enlightened by natural sagacity, are liable to the same. A man may, for twenty years, order a medicine, which has in every instance done a little harm, though not always so much as to prevent nature from removing the complaint at last; and if the reputation of this medicine should ever be attacked, he may bring his twenty years experience in support of it. It ought to be remembered, that as often as the animal constitution is put out of order, by accident or distemper, nature endeavours to restore health. Happily she has many resources, and various methods of accomplishing her purpose; and very often she succeeds best without medical assistance. But medical assistance being given, she frequently succeeds notwithstanding; and it sometimes happens, that both physician and patient are convinced, that the means which did not prevent have actually performed the cure.
[241]
A peasant is seized with a shivering, followed by feverishness106, and accompanied with a slight cough—he goes to bed, and excessive heat and thirst prompt him to drink plentifully107 of plain water; on the second or third day a copious108 sweat bursts from all his pores, and terminates the disorder32. A person of fortune is seized with the same symptoms, arising from the same cause, and which would have been cured by the same means, in the same space of time; but the apothecary109 is called, who immediately sends pectoral linctuses to remove the cough, and afterwards gives a vomit110, to remove the nausea111 which the linctuses have occasioned: the heat and fever augment; the physician is called; he orders the patient to be blooded, to abate112 the violence of the fever, and gives a little physic on some other account. All this prevents the natural crisis by sweat; and the patient being farther teased by draughts113 or powders every two or three hours, nature cannot shake off the fever so[242] soon by six or seven days, as she would have done had she been left to herself. She generally does her business at last, however; and then the physician and apothecary glory in the happy effects of their skill, and receive the grateful thanks of their patient for having cured him of a dangerous fever.
Every body of common penetration, at all conversant114 in medical matters, must have seen enough to convince them that the above description is not exaggerated; but it is not to be inferred from this, that the art of medicine is of no use to mankind. There are many diseases in which nature sinks, without medical assistance. It is the part of the penetrating115 and experienced physician to distinguish these from others, and leave it to the knavish116 and weak to assume the merit of cures in cases where they know, or ought to know, that medicine can do nothing.
[243]
Some physicians, who have abandoned the other resins and gums, as useless or hurtful in hectic complaints, still adhere to myrrh as a beneficial medicine; but from what I can learn, the cases in which this gum has been thought serviceable, are hectic complaints, from debility, in consequence of excessive evacuations of various kinds, and not proceeding from ulcerated lungs. After it is fully16 established that myrrh is of use in such instances, it will still be worthy117 of investigation118, whether it is of more or less than Jesuits bark. I have repeatedly mentioned blood-letting, and a spare, diluting regimen, as the most powerful means of preventing and curing all affections of the lungs that depend on inflammation. In the case of external wounds, or bruises of the lungs, this method facilitates the immediate cure by the first intention. It is the chief thing to be depended on for the cure of pleurisies; and it is often owing to a neglect, or too sparing an use of this evacuation, that the complaint[244] terminates in an abscess. In people predisposed by the form of their bodies, or the nature of their constitutions, to a spitting of blood, it may prevent the turgid vessels from bursting; and in those who have tubercles in the lungs, it is of the greatest utility, by preventing those tumours from inflaming119, and becoming ulcers; but after the ulcers are actually formed, I have great doubts with regard to the propriety120 of attempting a cure by repeated bleedings, even in small quantities. This method has been often tried; but I fear the success with which it has been attended, gives no encouragement to continue the practice. That symptoms may be such, in every period of this disease, as to require this evacuation, is not to be denied; but there is a great difference in the application of what is considered as an occasional palliative, and that from which we expect a radical121 cure. In the one case, it will only be used when some particular symptom strongly urges; in the other, it will be used at stated intervals,[245] whether the symptoms press or not; and may tend to weaken the already debilitated122 patient, without our having the consolation123 of knowing, with certainty, that it has had any other effect.
Blisters do not weaken so much; they are of undoubted use in pleurisies; perhaps, by exciting external inflammation, they may contribute to draw off the inflammatory disposition within the breast: perhaps—But in whatever way they act, I imagine I have frequently seen blisters and setons, particularly the latter, of considerable service, even after the symptoms indicated the existence of an ulcer in the lungs.
As for the numerous forms of electuaries, lohochs, and linctuses, composed of oils, gums, and syrups124, and by the courtesy of dispensatory writers called pectoral; I am convinced they are of no manner of service in this complaint, and seldom have any other effect than that of loading the stomach,[246] and impairing125 the digestion of salutary food. So far from being of any permanent service to the disease, they cannot be depended on for giving even a temporary relief to the cough; when that symptom becomes troublesome, gentle opiates will be found the best palliatives. Some practitioners126 object to these medicines, on a supposition that they check expectoration; but they only seem to have this effect, by lulling127 the irritation128 to cough; the same quantity will be expectorated in the morning, after the influence of the opiate is over. It is surely better that the matter should accumulate, and the patient spit it up at once, than allow him to be kept from rest, and teased with coughing and spitting through the whole night. These palliatives, however, are to be managed with great caution; never exhibited while the patient enjoys a tolerable share of natural rest. Small doses should be given at first, and not increased without absolute necessity. Exhibited in this manner, they cannot do harm; and those who reject the[247] assistance of a class of medicines, which afford ease and tranquillity129 in the most deplorable state of this disease, ought to give better proofs than have hitherto appeared, that they are able to procure130 their patients more valuable and lasting131 comforts than those they deprive them of.
The known efficacy of the Peruvian bark, in many distempers, especially in intermittent132 fevers; the remission of the symptoms, which happens regularly every day at a particular stage of the pulmonary consumption, and in some degree gives it the appearance of an intermittent, joined to the failure of all other remedies, prompted physicians to make trial of that noble medicine in this disease. In consequence of these trials, the bark is now pretty generally acknowledged to be serviceable in hectical complaints, proceeding from debility, and other causes, exclusive of ulcerated lungs; but when the disease proceeds from this cause, the bark is supposed, by[248] some very respectable physicians, always to do harm. I am most clearly of the first opinion, and perhaps it would not become me to dispute the second. It may be permitted, however, to observe, that the most discerning practitioners may be led into a notion, that a very safe medicine does harm, when it is exhibited at the worst stage of a disease, in which hardly any medicine whatever has been found to do good. In every stage of this disease, elixir133 of vitriol may be used. It is a pleasant and safe medicine, but particularly efficacious when the patient is troubled with wasting sweats.
Having, in obedience134 to your request, delivered my sentiments freely, you will perceive, that, besides the objections already mentioned to the person under whose care our friend is at present, I cannot approve of his being directed to take so many drugs, or of his being detained in town, at a season when he may enjoy, in the country, what is preferable to all medicine; I[249] mean air, exercise, and, let me even add, diet.
Had I known of our friend’s complaints earlier, I should have advised him to have met the advancing spring in the South of France; but at the season in which you will receive this letter, the moderate warmth, and refreshing135 verdure of England, are preferable to the sultry heats and scorched136 fields of the South. From the view I have of his complaints, I can have no hesitation137 in advising you to endeavour to prevail on him to quit his drugs, and to leave London without delay. Since he bears riding on horseback so well, let him enjoy that exercise in an atmosphere freed from the smoke of the town, and impregnated with the flavour of rising plants and green herbage; a flavour which may with more truth be called pectoral, than any of the heating resins, or loathsome138 oils, on which that term has been prostituted. Let him pass the summer in drinking the waters,[250] and riding around the environs of Bristol. It will be easy for him to find a house in the free air of the country, at some distance from that town; and it will be of use to have an additional reason for rising early, and riding every morning. It is of the greatest importance that he continue that exercise every day that the weather will permit: a little cloudiness of the sky should not fright him from it; there is no danger of catching cold during the continuation of that movement which assists digestion, promotes the determination of blood from the lungs to the surface of the body, and is more salutary in the morning than after dinner.
With respect to diet, he should carefully observe the important rule of taking food frequently, in small quantities, and never making a full meal; that the digestive organs may not be overpowered, or the vessels charged with too large a quantity of chyle at a time; which never fails to bring[251] on oppressive breathing, and augments139 the fever and flushing, which in some degree succeeds every repast.
Since all kinds of milk are found to disagree with his constitution, that nourishment140, which is in general so well adapted to similar complaints, must be omitted, and light broths141, with vegetable food, particularly of the farinaceous kind, substituted in its place.
Acids, especially the native acid of vegetables, are remarkably142 agreeable and refreshing to all who labour under the heat, oppression, and languor143, which accompany hectic complaints. It is surprising what a quantity of the juice of lemons the constitution will bear, without any inconveniency, when it is accustomed to it by degrees; and in those cases where it does not occasion pains in the stomach and bowels144, or other immediate inconveniencies, it has been thought to have a good effect in abating145 the force of the hectic fever.
[252]
I have met with two cases, since I have been last abroad, in both of which there seemed to be a quicker recovery than I ever saw, from the same symptoms. The first was that of a young lady, of about seventeen years of age, and apparently146 of a very healthy constitution. In bad weather, during the spring, she caught cold: this being neglected in the beginning, gradually grew worse. When physicians were at length consulted, their prescriptions147 seemed to have as bad an effect as her own neglect. By the middle of summer her cough was incessant148, accompanied with hectic fever and flushings, irregular shiverings, morning sweats, emaciation, expectoration of purulent phlegm streaked with blood, and every indication of an open ulcer in the lungs. In this desperate state she was carried from the town to a finely situated149 village in Switzerland, where, for several months, she lived in the middle of a vineyard, on ripe grapes and bread. She had been directed to a milk and vegetable diet[253] in general. Her own taste inclined her to the grapes, which she continued, on finding, that, with this diet only, she was less languid, and of a more natural coolness, and that the cough, fever, and all the other symptoms gradually abated150. She seemed to be brought from the jaws151 of death by the change of air, and this regimen only; and she returned to her own home in high spirits, and with the look and vigour152 of health. The ensuing winter, after being heated with dancing at the house of a friend, she walked home in a cold night; the cough, spitting of blood, and other symptoms immediately returned, and she died three months after.
In the other case, there was not such a degree of fever, but there was an expectoration of matter, frequently streaked with blood, and evident signs of an ulcer in the lungs. The person who laboured under these symptoms, had tried the usual remedies of pectorals, pills, linctuses, &c. with the usual success. He grew daily worse.[254] He had formerly found much relief from bleeding, but had left it off for many months, on a supposition that it had lost all effect; and he had allowed an issue to be healed, on the same supposition; though he still persevered153 in a milk regimen. I mentioned to him the case of the young lady, as it is above recited. He immediately took the resolution to confine himself to bread and grapes for almost his only food. I advised him at the same time to have the issue opened, and to continue that drain for some time; but this he did not comply with. He forsook154, however, the town for the country, and passed as much of the morning on horseback, as he could bear without fatigue155. He soon was able to bear more; and after about three weeks or a month, his cough had greatly abated. When he had persisted in this regimen between two and three months, he had very little cough; and what he spit up was pure phlegm, unmixed with blood or matter. He has now been well above a year; and[255] although I understand that he occasionally takes animal food, he has hitherto felt no inconveniency from it. He passed the second autumn, as he had done the first, at a house in the country, surrounded with vineyards. The greater part of his food consisted of ripe grapes and bread. With such a diet, he had not occasion for much drink of any kind; what he used was simple water, and he made an ample provision of grapes for the succeeding winter.
Though I have no idea that there is any specific virtue in grapes, for the cure of the pulmonary consumption, or that they are greatly preferable to some other cooling, sub-acid, mild fruit, equally agreeable to the taste, provided any such can be found; yet I thought it right to particularize what was used on those two occasions; leaving it to others to determine, what share of the happy consequences I have enumerated were owing to the change of air, how much may have flowed from the exercise, how[256] much from the regimen, and whether there is reason to think, that the favourable44 turn in both cases depended on other circumstances, unobserved by me.
I have now, my dear Sir, complied with your request; and although I have endeavoured to avoid technical verbosity156, and all unnecessary detail, yet I find my letter has swelled157 to a greater size than I expected. I shall be exceedingly happy to hear that any hint I have given has been serviceable to our friend. If the cough should still continue, after he has passed two or three months at Bristol, I imagine the most effectual thing he can do will be, to take a voyage to this place; he will by that means escape the severity of a British winter. The voyage itself will be of service, and at the end of it he will have the benefit of the mild air of the Campagna Felice, be refreshed and nourished by the finest grapes, and, when tired of riding, he will have continual opportunities of sailing in this charming bay.
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entirely
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| ad.全部地，完整地；完全地，彻底地 | |
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profess
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miraculous
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apothecaries
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essentially
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| adv.本质上，实质上，基本上 | |
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drawn
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| v.拖，拉，拔出；adj.憔悴的，紧张的 | |
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coxcomb
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| n.花花公子 | |
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enveloped
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| v.包围，笼罩，包住( envelop的过去式和过去分词 ) | |
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hieroglyphical
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| n.象形文字，象形文字的文章 | |
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judgment
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| n.审判；判断力，识别力，看法，意见 | |
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penetration
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| n.穿透，穿人，渗透 | |
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lamented
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| adj.被哀悼的，令人遗憾的v.（为…）哀悼，痛哭，悲伤( lament的过去式和过去分词 ) | |
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13
solicitude
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| n.焦虑 | |
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14
instructor
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| n.指导者，教员，教练 | |
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prohibition
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| n.禁止；禁令，禁律 | |
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fully
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| adv.完全地，全部地，彻底地；充分地 | |
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abominate
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| v.憎恨，厌恶 | |
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18
faculty
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| n.才能；学院，系；(学院或系的)全体教学人员 | |
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19
uncertainty
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| n.易变，靠不住，不确知，不确定的事物 | |
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20
taint
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| n.污点；感染；腐坏；v.使感染；污染 | |
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21
alas
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| int.唉(表示悲伤、忧愁、恐惧等) | |
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22
acting
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| n.演戏，行为，假装；adj.代理的，临时的，演出用的 | |
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impervious
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| adj.不能渗透的，不能穿过的，不易伤害的 | |
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ascertained
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| v.弄清，确定，查明( ascertain的过去式和过去分词 ) | |
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25
dictates
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| n.命令，规定，要求( dictate的名词复数 )v.大声讲或读( dictate的第三人称单数 )；口授；支配；摆布 | |
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26
volition
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| n.意志；决意 | |
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27
mere
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| adj.纯粹的；仅仅，只不过 | |
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28
infinitely
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| adv.无限地，无穷地 | |
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29
alleviated
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| 减轻，缓解，缓和( alleviate的过去式和过去分词 ) | |
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satirist
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| n.讽刺诗作者，讽刺家，爱挖苦别人的人 | |
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presumption
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| n.推测，可能性，冒昧，放肆，[法律]推定 | |
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disorder
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| n.紊乱，混乱；骚动，骚乱；疾病，失调 | |
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disorders
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| n.混乱( disorder的名词复数 )；凌乱；骚乱；（身心、机能）失调 | |
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34
bruise
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| n.青肿，挫伤；伤痕；vt.打青；挫伤 | |
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membrane
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| n.薄膜，膜皮，羊皮纸 | |
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36
vessels
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| n.血管( vessel的名词复数 )；船；容器；（具有特殊品质或接受特殊品质的）人 | |
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37
tumours
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| 肿瘤( tumour的名词复数 ) | |
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38
impaired
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| adj.受损的；出毛病的；有（身体或智力）缺陷的v.损害，削弱( impair的过去式和过去分词 ) | |
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39
thereby
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| adv.因此，从而 | |
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40
uncommonly
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| adv. 稀罕(极，非常) | |
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41
uncommon
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| adj.罕见的，非凡的，不平常的 | |
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42
texture
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| n.(织物)质地；(材料)构造；结构；肌理 | |
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43
rupture
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| n.破裂；(关系的)决裂；v.(使)破裂 | |
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favourable
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| adj.赞成的，称赞的，有利的，良好的，顺利的 | |
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previously
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| adv.以前，先前（地） | |
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46
peculiarities
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| n. 特质, 特性, 怪癖, 古怪 | |
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47
degenerates
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| 衰退，堕落，退化( degenerate的第三人称单数 ) | |
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48
ulcer
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| n.溃疡，腐坏物 | |
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49
hectic
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| adj.肺病的；消耗热的；发热的；闹哄哄的 | |
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sanguine
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| adj.充满希望的，乐观的，血红色的 | |
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51
plentiful
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| adj.富裕的，丰富的 | |
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52
blisters
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| n.水疱( blister的名词复数 )；水肿；气泡 | |
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53
affected
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| adj.不自然的，假装的 | |
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54
diluting
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| 稀释，冲淡( dilute的现在分词 )； 削弱，使降低效果 | |
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55
omission
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| n.省略，删节；遗漏或省略的事物，冗长 | |
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56
suffocate
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| vt.使窒息，使缺氧，阻碍；vi.窒息，窒息而亡，阻碍发展 | |
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57
complexion
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| n.肤色；情况，局面；气质，性格 | |
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58
disposition
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| n.性情，性格；意向，倾向；排列，部署 | |
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59
hereditary
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| adj.遗传的，遗传性的，可继承的，世袭的 | |
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60
diminution
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| n.减少；变小 | |
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61
insidious
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| adj.阴险的，隐匿的，暗中为害的，（疾病）不知不觉之间加剧 | |
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62
respiration
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| n.呼吸作用；一次呼吸；植物光合作用 | |
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63
remits
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| n.职权范围，控制范围，影响范围( remit的名词复数 )v.免除（债务），宽恕( remit的第三人称单数 )；使某事缓和；寄回，传送 | |
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64
augment
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| vt.(使)增大，增加，增长，扩张 | |
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65
attentive
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| adj.注意的，专心的；关心(别人)的，殷勤的 | |
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66
flannel
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| n.法兰绒；法兰绒衣服 | |
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67
catching
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| adj.易传染的，有魅力的，迷人的，接住 | |
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68
enumerated
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| v.列举，枚举，数( enumerate的过去式和过去分词 ) | |
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69
proceeding
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| n.行动，进行，(pl.)会议录，学报 | |
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70
obstructed
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| 阻塞( obstruct的过去式和过去分词 )； 堵塞； 阻碍； 阻止 | |
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71
perspiration
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| n.汗水；出汗 | |
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72
obstructions
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| n.障碍物( obstruction的名词复数 )；阻碍物；阻碍；阻挠 | |
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73
glands
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| n.腺( gland的名词复数 ) | |
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74
swelling
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| n.肿胀 | |
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75
ulcers
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| n.溃疡( ulcer的名词复数 )；腐烂物；道德败坏；腐败 | |
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76
perfectly
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| adv.完美地，无可非议地，彻底地 | |
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77
immediate
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| adj.立即的；直接的，最接近的；紧靠的 | |
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78
suffocation
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| n.窒息 | |
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79
breach
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| n.违反，不履行；破裂；vt.冲破，攻破 | |
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80
asthma
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| n.气喘病，哮喘病 | |
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81
harass
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| vt.使烦恼，折磨，骚扰 | |
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82
afflicted
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| 使受痛苦，折磨( afflict的过去式和过去分词 ) | |
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83
eruptions
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| n.喷发，爆发( eruption的名词复数 ) | |
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84
measles
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| n.麻疹，风疹，包虫病，痧子 | |
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85
streaked
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| adj.有条斑纹的，不安的v.快速移动( streak的过去式和过去分词 )；使布满条纹 | |
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86
circumscribed
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|
| adj.[医]局限的：受限制或限于有限空间的v.在…周围划线( circumscribe的过去式和过去分词 )；划定…范围；限制；限定 | |
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87
crimson
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| n./adj.深(绯)红色(的)；vi.脸变绯红色 | |
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88
emaciation
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| n.消瘦，憔悴，衰弱 | |
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89
crooking
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| n.弯曲（木材等的缺陷）v.弯成钩形( crook的现在分词 ) | |
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90
delirium
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| n. 神智昏迷,说胡话;极度兴奋 | |
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91
remains
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| n.剩余物，残留物；遗体，遗迹 | |
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92
retarded
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| a.智力迟钝的，智力发育迟缓的 | |
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93
retard
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| n.阻止，延迟；vt.妨碍，延迟，使减速 | |
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94
bruises
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| n.瘀伤，伤痕，擦伤( bruise的名词复数 ) | |
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95
shunned
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| v.避开，回避，避免( shun的过去式和过去分词 ) | |
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96
futile
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| adj.无效的，无用的，无希望的 | |
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97
ointments
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| n.软膏( ointment的名词复数 )；扫兴的人；煞风景的事物；药膏 | |
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98
conclusive
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| adj.最后的，结论的；确凿的，消除怀疑的 | |
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99
applied
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| adj.应用的；v.应用，适用 | |
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100
digestion
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| n.消化，吸收 | |
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101
virtue
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| n.德行，美德；贞操；优点；功效，效力 | |
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102
lint
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| n.线头；绷带用麻布，皮棉 | |
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103
resins
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| n.树脂，松香( resin的名词复数 )；合成树脂v.树脂，松香( resin的第三人称单数 )；合成树脂 | |
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104
formerly
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| adv.从前，以前 | |
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105
decided
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| adj.决定了的，坚决的；明显的，明确的 | |
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106
feverishness
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107
plentifully
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| adv. 许多地，丰饶地 | |
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108
copious
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| adj.丰富的，大量的 | |
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109
apothecary
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| n.药剂师 | |
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110
vomit
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| v.呕吐，作呕；n.呕吐物，吐出物 | |
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111
nausea
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| n.作呕，恶心；极端的憎恶(或厌恶) | |
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112
abate
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| vi.(风势，疼痛等)减弱，减轻，减退 | |
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113
draughts
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| n. <英>国际跳棋 | |
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114
conversant
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| adj.亲近的，有交情的，熟悉的 | |
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115
penetrating
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| adj.（声音）响亮的，尖锐的adj.（气味）刺激的adj.（思想）敏锐的，有洞察力的 | |
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116
knavish
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| adj.无赖（似）的，不正的；刁诈 | |
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117
worthy
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| adj.(of)值得的，配得上的；有价值的 | |
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118
investigation
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| n.调查，调查研究 | |
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119
inflaming
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| v.（使）变红，发怒，过热( inflame的现在分词 ) | |
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120
propriety
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| n.正当行为；正当；适当 | |
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121
radical
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| n.激进份子，原子团，根号；adj.根本的，激进的，彻底的 | |
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122
debilitated
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|
| adj.疲惫不堪的，操劳过度的v.使（人或人的身体）非常虚弱( debilitate的过去式和过去分词 ) | |
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123
consolation
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| n.安慰，慰问 | |
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124
syrups
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| n.糖浆，糖汁( syrup的名词复数 )；糖浆类药品 | |
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125
impairing
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| v.损害，削弱( impair的现在分词 ) | |
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126
practitioners
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| n.习艺者，实习者( practitioner的名词复数 )；从业者（尤指医师） | |
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127
lulling
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| vt.使镇静，使安静（lull的现在分词形式） | |
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128
irritation
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| n.激怒，恼怒，生气 | |
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129
tranquillity
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| n. 平静, 安静 | |
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130
procure
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| vt.获得，取得，促成；vi.拉皮条 | |
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131
lasting
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| adj.永久的，永恒的；vbl.持续，维持 | |
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132
intermittent
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| adj.间歇的，断断续续的 | |
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133
elixir
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| n.长生不老药，万能药 | |
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134
obedience
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| n.服从，顺从 | |
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refreshing
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| adj.使精神振作的，使人清爽的，使人喜欢的 | |
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136
scorched
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| 烧焦，烤焦( scorch的过去式和过去分词 )； 使（植物）枯萎，把…晒枯； 高速行驶； 枯焦 | |
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137
hesitation
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| n.犹豫，踌躇 | |
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138
loathsome
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| adj.讨厌的，令人厌恶的 | |
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139
augments
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| 增加，提高，扩大( augment的名词复数 ) | |
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140
nourishment
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| n.食物，营养品；营养情况 | |
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141
broths
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| n.肉汤( broth的名词复数 )；厨师多了烧坏汤；人多手杂反坏事；人多添乱 | |
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142
remarkably
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| ad.不同寻常地，相当地 | |
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143
languor
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| n.无精力，倦怠 | |
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144
bowels
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| n.肠，内脏，内部；肠( bowel的名词复数 )；内部，最深处 | |
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abating
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| 减少( abate的现在分词 )； 减去； 降价； 撤消（诉讼） | |
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146
apparently
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| adv.显然地；表面上，似乎 | |
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147
prescriptions
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| 药( prescription的名词复数 )； 处方； 开处方； 计划 | |
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incessant
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| adj.不停的，连续的 | |
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situated
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| adj.坐落在...的，处于某种境地的 | |
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150
abated
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| 减少( abate的过去式和过去分词 )； 减去； 降价； 撤消（诉讼） | |
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151
jaws
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| n.口部；嘴 | |
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152
vigour
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| （=vigor）n.智力，体力，精力 | |
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153
persevered
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| v.坚忍，坚持( persevere的过去式和过去分词 ) | |
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154
forsook
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| forsake的过去式 | |
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155
fatigue
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| n.疲劳，劳累 | |
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156
verbosity
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| n.冗长，赘言 | |
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swelled
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| 增强( swell的过去式和过去分词 )； 肿胀； （使）凸出； 充满（激情） | |
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