PLEA FOR A SIMPLER LIFE OBOROB S. KB1TH FADS OF AN OLD PHYSICIAN PLEA FOR A SIMPLER LIFE FADS OF AN OLD PHYSICIAN GEORGE S. KEITH. Plea for a Simpler Life and Fads of an Old Physician BY GEORGE S. KEITH M.D., LL.D., F.R.C.P.E. " I yield it just," said Adam, "and submit. But is there yet no other way, besides These painful passages, how we may come To death, and mix with our connatural dust ': " "There is," said Michael, " if thou well observe The rule of Not too much, by temperance taught In what thou eat'st and drink'st, seeking from thence Due nourishment, not gluttonous delight, Till many years over thy head return. So may'st thou live, till, like ripe fruit, thou drop Into thy mother's lap, or be with ease Gathered, not harshly plucked, for death mature." Paradise Lost, Book XI. LONDON ADAM AND CHARLES BLACK 1900 All rights reserved PREFACE IT is now upwards of four years since the ' Plea for a Simpler Life ' was published. As the views given in it are mostly directly opposed to those held at the present time by the medical profession, I expected that they would meet with much criticism and opposi- tion. Of the latter they have had plenty for all I know, but although ten thousand copies of the book have been sold, in all English- speaking countries, I have not seen or heard of a single hostile criticism, while it has met with a hearty reception from most of our leading journals, three of them medical. I have been still more gratified by letters from older and well known members of the pro- 2019042 vi PREFACE fession both in this country and in America. But there is an opposite side to this pleasant picture. From the young men I have no recognition whatever. In the medical journals of the clay I have seen recently strong recommendations of such old - fashioned remedies as bleeding, leeching, emetics, etc. Although these were no doubt much abused in my early days, I have never entirely given them up ; but the present fashion of physicing and overfeeding, so far as my own observation and reading go, still carries the day, as it has done for more than fifty years. Previous to the publication of 'Fads of an Old Physician ' I was inundated with letters asking for more minute directions as to food, etc. I usually advised that the ' Plea ' should be given to the family doctor, who might be willing to try my methods if he knew them to be agreeable to the patient. The plan, PREFACE vii however, almost invariably failed, and I was induced in a number of cases to try treatment by letter. This I found, as I expected, to be most unsatisfactory. Since the publication of ' Fads ' I have had far fewer letters asking for help, and I now tell inquirers that they must learn to treat themselves, with the guidance of my volumes, if they cannot get their own or any other medical man to treat them on any but the most opposite principles. The letters from ladies especially, are often very sad. A recent one from a lady, aged sixty, told that she had been an invalid since she was twelve years old, during which time she had upwards of thirty doctors. She must have had a splendid constitution, as some of her complaints had been very severe, and most of them (excepting the surgical), had they been let alone, should have given her very little trouble. The worst was an Influenza, treated in the usual fashion, the viii PREFACE dregs of which, ending in a pelvic abscess, kept her in bed for five years. The plan of self-treatment has answered admirably. Judging by the number of my correspondents who have had no doctor, some of them for years, the loss to the profession must have been very considerable, and it is rapidly increasing. In this way I hope that my simple methods will come to be appreciated. The younger practitioners will not try them, and in this they are often encouraged by the women, whom I have found to be quite as opposed to me as the doctors. I only know of one, a young colonial doctor, who has been converted, and in this way. I had sent him the 'Plea! In writing to thank me he said it would never suit them in the Colony, as beef and mutton raising was the chief industry, and it was from this that the doctors got their fees. Some years later he asked a member of his family PREFACE ix to tell me that I had one follower in New Zealand. It came about in this way. There was a very fatal epidemic of Influenza with Pneumonia in the district. The priest had somehow got my book, his servant was taken ill, and he resolved to try upon him my method of giving neither food nor stimulants. The case did well ; my friend, not wishing to lose his clients in this way, tried the same method in other cases and with equal success. I would not, however, undertake to cure every case in such a meat-eating country as New Zealand, but there is certainly even less need for food and stimulants there than here. It is quite as difficult, if not more so, to convince a woman not to ' keep up ' a sick husband or child. I have known many cases where the consequence was fatal. One of them I may mention, the parties being all dead. A much valued friend, an honoured x PREFACE Edinburgh citizen, not a patient of mine but I had attended some of his nearest relatives, had often occasion to meet me. He well knew my peculiar views. I saw that he was showing marked signs of serious illness. I urged him to change his mode of living. He was willing to do so, but said he would have difficulties at home. I soon saw a change on him for the better, and hoped that he was all right. I was now absent from home for several months, and on my return I found he was back to his old condition. I urged him to return to the diet which had been so efficacious, and he did so with the same manifest advantage as before. I was then absent for a longer period, and when I returned found him worse than ever. I asked why he had taken to his old way of living for a third time, and his answer was very emphatically, ' the womenfolks will not have it.' The beaten man gave up PREFACE xi the contest, and the end was not long in coming. There is a very serious difficulty to one who wishes to be his own doctor. The pro- fession is recognised by the law ; a registered practitioner has privileges which are possessed by no one else ; and a man who knows that his own health and that of his family is better without physic or a physician, has good cause to complain that he cannot use his freedom without being liable to much worry and vexa- tion in time of trouble. I know no monopoly as this to which our country has given up its liberty, and I doubt if any such exist. A monopoly may become a tyranny, and in this respect that allowed to our medical authorities certainly beats the record. But the law is not unchangeable. In America, whence we are getting many lessons, a new medical school started some years ago on principles said to be more simple and xii PREFACE rational than ours ; however that may be, it is now recognised by eight of the Western States. This gives a hint to the profession which I would earnestly advise it to ponder. It is long since I recommended a friend not to make his son a doctor, as the present system could not last ; but time moves on slowly, and conventionalism is still the greatest enemy to progress. While condemning the prevailing methods, I do not recall a word of what I have written (' Fads,' p. 33) of the value of the doctor's services to his clients. In the country especially, he also gives the only surgical aid available, and this is no small part of his duties. In sanitary matters his assistance is often invaluable. But I have already come to know that, on simpler lines, and mainly by following nature's sugges- tions, a man may more easily than I thought come to be his own doctor, with PREFACE xiii much benefit both to his health and to his pocket. There is one disease which, from time to time, carries off many victims, most of whom would be saved by the adoption of a different treatment. This is Influenza. The cases are mostly slight, and a common cold is often spoken of as Influenza and gets well even if treated badly ; and, like Diphtheria in its early days, some can say they cure all cases of Influenza who may never have seen a genuine case. The prevailing treatment of severe cases I have condemned strongly in both these volumes, and have given cases proving the benefit of leaving them to nature. Since their publication I have come across nothing to change my opinions, and I have met with other cases, which from the import- ance of the subject I give here, instead of relegating them to the small type of an appendix. xiv PREFACE Robert Glass has been with me as gardener for fifteen years. He had improved much in health after taking to a simpler diet than before, and he had learned how to manage his own health. I heard he was suffering from a smart attack of Influenza, then prevalent. After a week he was able to be about again and was doing some light work. He said that he had no appetite, and look- ing at his tongue I found it still raw and irritable, and I told him that the less food he took the better. Three days afterwards I heard he was back in bed, and on asking what he had been doing he told me he had gone to the doctor of a Friendly Society from which he had an allowance when laid up, but for this a doctor's certificate was necessary. Before leaving, the doctor asked if he had got his appetite, and after looking at his tongue the same as I had seen it on the same day he said, ' this will never do,' and PREFACE xv gave him a tonic. He took the tonic, which soon made him feel hungry, and he had taken some food, with the result just mentioned. In three days he was up and found no difficulty in doing some light work before he had taken any food whatever. His health has been decidedly better since. The wife of the gardener had, shortly after this, her third attack of Influenza. She was left to the care of her husband, and was doing very well, though, like him, feeling intensely weak. On the morning of the fourth or fifth day I heard she was very ill. I found her in an alarming condition, very feverish, suffer- ing from severe pains in the head, back, and thighs, and all the previous night she had been in high delirium. I asked her if she had taken any food, and she said nothing but a bit of dry bread yesterday. I was anxious about her for three days, during which she took nothing but hot water. On xvi PREFACE the morning of the fourth day I was pleased to find her, as she said, quite well. The delirium and all other symptoms were gone, and she had slept quietly all night. Several days afterwards, when still in bed but enjoy- ing a little simple food, she laid her hand over her stomach and said, ' I feel so different here this time.' Had I been unable to see her, and another doctor been called in, he would certainly have said she was sinking. He would have given both food and stimulants, and very possibly she would have died. She also has enjoyed much better health since. A case like the following sometimes makes me wish that, for my own comfort, I had been born twenty or thirty years later, and that in happy ignorance I had followed the multitude in doing evil. A very old friend, a well-known scientist in his own department of medicine, had an PREFACE xvii attack of Influenza. Nine or ten months after this I heard he was dying from some organic disease in the abdomen. I called to ask for him and was told that he was very ill, but was able sometimes to see a friend. I sent up my card, and was at once admitted. He was much pleased to see me, and said he was just on the point of asking me to visit him ; that his doctor and friends insisted on his taking a glass of whiskey with his meals thrice a day, and he was sure it was doing him harm. I quite agreed in this, and he resolved he would take no more. I also advised him to reduce his meals, as I found he was suffering from dyspepsia, which had come on during a sea voyage he had taken some months before. The weather was cold ; he could rarely get on deck, while he was tempted to indulge freely in the pleasures of the table. I could discover no organic disease. He had been a strong healthy man b xv iii PREFACE as I knew him, and he had still enough of superfluous tissue to enable him safely to take a long fast if necessary. But he was now so weak that he could not get out of bed without risking a faint, which he had on more than one occasion. This gave me no alarm when I heard how he had been living and saw the state of his tongue, but in the meantime I advised him not to attempt to rise, or even to sit up in bed. I saw him again after ten days. The servant told me he was much better, and this was confirmed by his friends. I found him in a much safer condition. His tongue was more natural. He had taken no whiskey. I spoke strongly to his friends, who seemed pleased with his improvement. He was perfectly fit to be his own doctor, and had he been let alone I cannot doubt that he would have recovered. Ten days later I was grieved to find him by no means so well, and was not astonished at PREFACE xix this when I found that instead of the whiskey he was taking three large glasses of Burgundy a day. He could not resist his friends and the doctor. I had the melancholy satisfac- tion of seeing him again two or three times at intervals, but he was gradually losing ground, and he died from Pneumonia about a couple of months after my first visit. Some months before I saw the last case, I met in the West Country a younger man, manager of a large business, which kept him a very busy man indeed. He looked a strong man quite broken down. I found from a mutual friend that he had a bad attack of Influenza several months before. I suspected how he was being treated, and sent him my 'Plea' He wrote at once that he already had the volume and had read it frequently. He had, however, till some ten days before I saw him, followed his doctor's advice ; he then took advantage xx PREFACE of his absence to change the treatment, and at once he felt better. He was about to take a long sea voyage in a warm climate, and had he still been trying to keep himself up, he could scarcely expect to do otherwise than follow the course of my older friend. I heard soon that he was working so hard where he was abroad that he must be better. Lately I heard from himself that though now doing his work, he felt it very severe upon him, also that there were 'continual skirmishes going on with the home authorities, who believe feeding -up to be the proper remedy.' It is sometimes very long, after a badly-treated Influenza, before one is quite restored. Rest of body, mind, and stomach are here most needful. The last time I visited my literary friend, whose case is the penultimate one in ' Fads, 1 I found that he, his secretary, and two others in the house had been down with Influenza PREFACE xxi several months previously. He and the secretary had followed my rules of treatment, and were in excellent health. The other two had been treated by the doctor, and were still completely broken down. Here we have four cases of the same epidemic treated by the different methods, and with the usual results. If my contention is true that the effect of alcoholic stimulants is depressing ('Plea,' p. 33), and that hot water is the best stimulant we possess (p. 42 andfiassim, and ' Fads,' p. 67) and neither of these con- tentions has been controverted then my treatment is the scientific one. On the positive side it gives the stimulant for which the demand seems so imperative, and negatively it withholds the food which the stomach is in no condition to digest, and, if it were, the brain could give none of the nerve energy required for its digestion. It follows that the older and feebler the patient xxii PREFACE is, the greater is the necessity for following this conservative and scientific treatment. I am indebted to the publishers for the suggestion of a joint volume, each of the two being retained in its original form. The one is, in fact, the complement of the other, and I will thus be saved answering occasional letters which I still receive from those who have only seen the first volume. CURRIE, MIDLOTHIAN, January 1900. PLEA FOR A SIMPLER LIFE PREFACE IN the following pages I have made state- ments reflecting on the teaching and practice of medicine at the present day, and to these I must adhere. I do not, however, call in question the good faith either of the teachers or of the practitioners. The former teach what they have been taught and believe to be true ; the latter naturally follow their teachers. Nor do I call in question the value of much that is taught, and of much that is done by the bedside, and in the labora- tory, or by those who ransack all nature's products in air, land, and water to discover means by which human suffering may be alleviated. The value of even a discovered iv PLEA FOR A SIMPLER LIFE truth may lie for a long time unknown, till some further discovery brings it into notice and use. True seekers after truth always have their reward, though it may be delayed ; but somehow in this world things get occasionally into a rut from which extrica- tion is difficult. There is an inertia in the mind as well as in physics, and it may re- quire a strong force to overcome it. What I have proposed to myself in the following pages is to point out some of the evils that have arisen from opposite lines of thought which have much affected the practice of medicine during this century. The change from a severe system of treating disease by depletion in all its modes came in with a great social change, especially as regards the upbringing of the young. In my young days this was rather trying. Home discipline, as well as that in the schools, was harsh, even with the upper classes. The PREFACE v boy must do as he was bid without delay and without protest, or it was the worse for him. What are now necessaries were then luxuries. Pleasure for its own sake was at a discount. In Scotland, at least, the extreme doctrines of Calvin held sway, and a severe sway it was. Reaction came at last, and along with other changes came that of the treatment of disease, first by modifying the old methods, and very soon by adopting others at the opposite pole. The change fell in with the spirit of the times, and, I fear, goes with it still. The difficulty of modifying it may therefore be great ; and my efforts in that direction may avail little. But I have said what I have long wished to say. If any good follows I shall be rewarded ; and if not, I shall at least enjoy an easier mind. I have been subjected to so much opposi- tion in my daily life and work that more vi PLEA FOR A SIMPLER LIFE public criticism can touch me but little. My feeling on this is pretty well expressed in a somewhat defiant family motto which may be seen on the entrance hall of Marischal College, Aberdeen : ' Thay haif said : Quhat say thay : Lat thame say.' G. S. K. CURRIE, MIDLOTHIAN, July 1895. CHAPTER I THE simpler life for which I plead in the following pages is very different from that usually recommended by the profession, and followed when possible by the public. I am thus called upon to give some reasons which have led me to adopt it for myself, and for those who have come under my care, and were willing to follow my guidance for them- selves and their families. I must also show how, from circumstances, I have had special advantages which have given me an open mind in considering various important questions, while most of the medical men of the day, especially the younger men, have more or less implicitly followed the teach- 2 PLEA FOR ing of the schools without doubt or hesi- tation. It is easier for most men to be guided by authority than to think for themselves. There is much more free-thinking outside the profession than within it. In the pro- fession I have had but few followers, although these are by no means wanting. With out- siders I have been much more fortunate. For thirty-five years I had more clients than I could do justice to without assistance, and many of them were of first-class ability and position. It is with the hope that this little volume may reach some, both in the profession and out of it, who would adopt a better system if they but knew it, that I offer it to the public. I have frequently been asked by professional and other friends to publish my views, but from various reasons which I need not mention I have hitherto refrained from doing so. The delay has at least given me abundant time to recon- sider them, and, after being for fifteen years A SIMPLER LIFE 3 in a great measure outside the profession, I leel less inclined to modify them than ever. I have long been convinced that the present system of medical teaching and practice is wrong. As to the former, it is so complex and multiform that the most industrious and capable student has to load his memory with a mass of ' notions ' which he soon finds are for all practical purposes useless, and which he soon forgets, most of them never to be recalled, or, if wanted, to be found at any time in a few books of reference. Each professor, of course, on the ' nothing-like-leather ' principle, thinks his own branch the most important. In this respect the teaching of medicine has got much worse in recent years, and seems to be still on the down grade. But for the plan of consecutive examinations, which allows the student to confine his attention to a limited number of subjects at one time, the present system would certainly break down. As to the main principles which guide the 4 PLEA FOR Practice of the day, they differ toto ccelo from those taught sixty years ago when I began my medical studies. Most of the common diseases were then ascribed to overaction of some sort, and the remedies were bleeding, vomiting, purging, sweating, etc. ; in short, depletion was the order of the day. I still retain my silver lancet case given me by a 'grateful patient' in 1845. About this time the tide turned, and I wonder how many physicians carry a lancet case now ! The change came 'quickly, very much from the teaching of an eminent and popular physician in London, who taught that disease as a general rule depended on a weakened action of the functions, and re- quired ' setting up ' ; the means being stim- ulating and tonic medicines, and plenty of good food and drink. 1 A history of the transition from the one method to the other would be very instructive, but on this I 1 It is instructive to note that the physician alluded to died comparatively young from disease of the liver. A SIMPLER LIFE 5 cannot enter. Some excuse was necessary to explain the change. This was found in a supposed alteration in the human body, which rendered it less able to bear lowering measures than formerly. My friend, Dr. J. Hughes Bennett, was a strong exponent of this idea, but I and others never could see it. 1 The new system of treatment reached its full maturity in a very short period, passing from one extreme to the other, with little or no resting at any intermediate point. The question naturally occurs Are we to have a backward movement to the old depletory practice, or are we to have a forward rush sooner or later, it may be to a better, it may be to a worse fashion of the day ? Or may we hope for a reaction from the extreme doctrines of to-day which may happily come to a stop before it reaches the opposite extreme ? And here also the old adage may 1 Dr. Bennett did much good work in Edinburgh ; I will only mention the introduction of the use of cod-liver oil in phthisis. 6 PLEA FOR be found good, medio tutissimus ibis. It is to the realisation of this last idea that I would fain lend a helping hand ; and there are some advantages that have accrued to me in the course of my long observation of medical science and practice which may help me in the task. I began my medical studies in 1836 and took my degree of M.D. in 1841. I have been a Fellow of the Edinburgh College of Physicians since 1845, an d now there are but two members senior to me. I was one of the last of the Edinburgh apprentices, one of several. Our master took much pains with us, gave us much practical aid, and long before I was an M.D. I had seen and attended large numbers of sick as a dispensary pupil. This enabled me to derive real benefit from a full course of attendance at the Edinburgh Infirmary. Owing to the illness of my father there, I spent most of the winter of 1839-40 in Pesth. There I attended closely the A SIMPLER LIFE 7 clinique of Professor Schoepf Merei, director of one of the three hospitals for children then in existence, and editor of the only Hungarian medical journal. I spent the winter of 1841-42 in the hospitals of Paris, and the classes of the Iicole de Mddecine. After this I was assistant to Professor, after- wards Sir James, Simpson, who was then at the commencement of his brilliant career. This occupied me very fully for a year. I then went to Rome for a season, intending to practice there for a time, but owing to the prevalence of homeopathic ideas which I could not adopt, I had no encouragement to return. In the wards of the Santo Spiritu Hospital I witnessed the ' Hippocratic succussion,' the only physical diagnosis I saw practised there, though now it is very different. The rest of the year I spent travelling in the East, mostly in Palestine and Syria, where our dragoman, who had never been with a real ' hakim ' before, kept me rather too fully occupied with a 8 PLEA FOR varied clientele, from Turkish pashas and Arab sheiks down to the poorest inhabit- ants of the country in their tents or more wretched villages. In 1845 Professor Simpson asked me to join him as colleague. After five years I left him and continued to practise in Edinburgh till 1880. From the above short history it will be seen that early in my professional life I had a varied experience of the different modes of treating disease at different schools and in different parts of the world. There was but little scientific treatment in those days ; it was mostly empirical, and the remedies were comparatively few. Bleeding was in full swing in Edinburgh in the Thirties, and in 1842 Bouillaud was still carrying out his plan of venesection coup sur coup, which was perhaps the greatest extreme to which depletion was ever carried. But there were signs of change. Ma- jendie in Paris, and Sir John Forbes in London, had come to the conclusion that A SIMPLER LIFE 9 strong measures were of no use in such severe diseases as pneumonia, and found that the patients did quite as well when simply kept in bed and let alone. On the other hand, Hahnemann and his followers were trying to prove that infinitesimal doses of medicine had stronger effects on' the sys- tem than the large doses hitherto employed. The Rev. Dr. Stewart of Erskine greatly changed the treatment of consumption by stopping the plan of depletion and starving, and putting his patients on a more generous diet. Amongst others he cured a daughter of Lord Blantyre, who afterwards became his wife and the mother of my worthy old friend, the late well - known Dr. P. Stewart of London. A good specimen of the mode of treating chest cases in those days, and one which naturally impressed me most, was the case of my father, a very powerful man of forty- four years of age, who in the year 1834 was io PLEA FOR treated for a smart attack of pneumonia or pleuro-pneumonia. He was well bled, blis- tered, and generally depleted. On recover- ing he went to Deeside for change of air, and was almost restored to health when, from his bedroom window being accidentally left open, he caught cold. He consulted the two then most famous physicians in Aber- deen, father and son, who told him he was threatened with consumption ; ulcers of the lungs were mentioned, I remember. He was ordered to go home, keep in two rooms at a temperature of 60 during the winter which was then approaching, put on a most restricted diet, and for a time to have blood taken from his chest by cupping twice a week. After six months of this treatment, as may be imagined, he was reduced to so low a con- dition that his friends who saw him off in the early summer for a change of air never expected to see him again. But with the change of air and the stoppage of all treat- ment he very soon rallied ; and though more A SIMPLER LIFE 11 or less an invalid for the rest of his days, and never able to resume regular work, he lived till the good age of eighty-nine, and he never to my knowledge showed any sign of lung disease whatever. He was, in fact, till treated in the above fashion a very healthy and powerful man of 6 feet 2 inches. His ordinary walk was at the rate of 5 miles an hour, and this he had on occasion kept up for 70 miles ; and his lungs were remarkably large and healthy. From my varied medical education and experience it need not be wondered at that I gradually lost faith in the ordinary medical dogmas of the day, and especially in the depleting and drugging system as then prac- tised and considered orthodox. I had a strong conviction that homeopathy how- ever wrong in its own dogmas would at least show the absurdity of the orthodox system of drugging. The doses were then really infinitesimal, and they were coming to be used by non-professionals, especially by 12 PLEA FOR ladies, many of whom had their book and their box of globules and tinctures, and treated not only their own families but all others who would consult them ; some who had done this for years have told me it was no use to say there was nothing in homeopathy, for the change in the health of their families had been most manifestly better since adopt- ing it ; and among them were women far above the average in power of observation and common sense. I had no doubt what- ever of the good faith of those ladies, many of whom were personal friends and relatives ; and to me the only possible way of account- ing for the phenomena was that the benefit derived was not from the infinitesimals, but from the absolute withdrawal of all drugs whatever, and from greater attention to simple methods. One of my most intelligent lady friends, wife of a Highland chieftain, treated her own family and those of most or all her tenants with great success for a period of four years. A SIMPLER LIFE 13 She told me that she then came to the con- clusion that the benefit was entirely negative, so far as drugs were concerned ; and she found that the same common complaints did just as well without any medicine at all. By and by, from whatever reason, the profes- sional homeopaths began to use powerful remedies, but in very small bulk, and now it is by no means safe for everybody to use these remedies ; and, so far as I understand, the book and box have fallen more or less into disuse. Certainly, the effect I had hoped for has not arrived, and drugs are now much more numerous and much more used than ever. I was further induced to look with distrust on the plan of perpetual and varied drugging by noticing the practice of some of the most eminent of the older practitioners of the time, who used very few and very simple remedies. I need only mention Dr. Abercrombie and Mr. Syme, both of Edinburgh. The former, who was a great friend of my father, was I 4 PLEA FOR very kind to me as a student, but I only met him once in consultation. The patient was an old lady in George Square, Edinburgh; she was suffering from a smart feverish attack, and the doctor was much pleased to find that she was getting no medicine, and for food only a small quantity of milk and lime-water, a very favourite prescription with him. Mr. Syme used to say that doctors were of no use, and that if anything was really wrong they must come to the sur- geons. Certainly, I never heard of him giving beyond a small dose of rhubarb and soda, unless it was minute doses of bichloride of mercury, and this with the view of elim- inating from the system other forms of mer- cury, for which he always had a great dislike. He was himself a very abstemious liver. He gave excellent dinners to small parties of eight or ten, at which I often ' assisted,' and they were the pleasantest I ever knew. But he was heard to say that after soup and fish he considered he had dined, and anything A SIMPLER LIFE 15 further he only played with. He enjoyed, however, a glass of good sherry, and to this, probably, were owing the attacks of gout to which late in life he was liable. There were other old physicians and surgeons who were by no means so sparing in their use ot drugs, and from whom I got practical lessons in an opposite direction, Two cases which I saw with Professor Alison made a lasting impression on me. One was that of a poor old woman whom I was asked to see, as Dr. Alison, who was one of the kindest of men and had been visiting her regularly, was laid up with illness. She was suffering very much from a collection of biliary calculi in the gall-bladder, and was reduced to the utmost degree of emaciation. She had been treated very actively, especially with strong mercurial remedies, but with no good result ; and to keep up her strength she was getting all the little luxuries in meat and drink that could be thought of by the wife of the Rev. Dr. Hunter of the Tron Church, 1 6 PLEA FOR who asked me to see her. The case seemed hopeless, the day of removing such calculi by the knife not having yet arrived ; but, in the hope of an easier death for the poor woman, I stopped all treatment and put her on small quantities of milk and lime-water. The effect was wonderful, and she was mak- ing great progress to at least a temporary recovery, when the worthy professor again took her in charge. The old remedies were resumed, and the old suffering was soon ended by death. The other case I saw along with Professor Simpson. It was that of a child from the country with serious head symptoms. There was a doubt whether they were from an organic or from a merely functional cause. Professor Alison decided that it was safest to take the serious view of the case, and he recommended very active measures. After he left, and after some further consideration, Simpson decided for the simple view ; the child got the benefit of the doubt, and soon A SIMPLER LIFE 17 was quite well without any active treatment whatever. My own personal experience gave me also a dislike to drugs from a child. I was con- sidered the weakly one of the family, and therefore was the most dosed. Calomel was in fashion, and the day after getting some grains of this I suffered so horribly that I resolved, if I ever should be a doctor, I never would give a child a dose of it ; and I never have. But the medicines then used were all nauseous, and no doubt this in a great measure prevented their use to the same extent as now, when they are made up (as a general rule) so as to cause no immediate disgust. Pills were only coming into use. The most common was Dr. Gregory's or colocynth pill, easily swallowed, but often causing much suffering afterwards. What proved a very favourite ' dinner pill,' the first I remember of a now numerous progeny, was ' Thomson's antibilious pill'; Thomson being the Rev. Dr. Andrew Thomson of St. George's Church, ,8 PLEA FOR Edinburgh, one of the most brilliant preachers and debaters of his day. He was a great diner-out, and no doubt his pill helped him to dispose of many a good dinner ; but he died of apoplexy when a comparatively young man. His was a simple aloetic pill; Gregory's was aloes and colocynth. The irritating effect of the latter was soon lessened by adding henbane, and the aloes-and-hen- bane pill became a great favourite. Some- what later, Sir Charles Bell got much credit for advising that all such pills should be taken after a meal or with a light one, as at tea-time, dinner being then taken at a comparatively early hour, and tea a few hours afterwards. His reason was, that the action is thus so much milder that, as a surgeon, he could recommend aloetic pills without the risk of bringing on haemorrhoids, a common result if aloes be taken on an empty stomach. The amount of ingenuity expended since these days in rendering medicines palatable is some- thing wonderful. Perhaps the amount of A SIMPLER LIFE 19 money spent in advertising new medicines, many of them worthless, some of them for- tunately innocuous, is more wonderful still. To complete my own personal experience with drugs. Having involuntarily begun the habit of using aperients (and with no fixed ideas as to food, for I never was taught any), I continued their use as I thought I required them up to the age of thirty-five. I had abundance of hard work, and very little re- creation. I no doubt made grave errors in diet, both as to quantity and quality, as I perpetually suffered from so-called bilious attacks, lasting for two or three days. With them I had intense headache, aggravated no doubt by the remains of malarial fever, which I contracted in Syria, where I spent five months of the spring and summer of 1844, living in tent, exposed to all weathers, and sleeping often on the ground with only a rug to lie on. Already I was treating my patients with very little medicine ; and I began to find that instead of doing me good, an aperientgave 20 PLEA FOR me no relief, even temporary; and I quite gave it up. For full forty years I do not remember having once taken an aperient. I still suffered however much as before, and soon resolved to give up work, and to move to some warmer climate, as my attacks usually commenced with a chill, and I found the climate of Edin- burgh very trying. Fortunately I wrote of my intention to my old friend, Dr. Merei of Pesth, then a Hungarian exile and settled as a physician in Manchester. He strongly advised me before taking so serious a step to give up butcher's meat, reduce my tea and coffee by a half, and of wine to take only a little light claret to dinner, if I found it to suit me. He had written on the diet proper to different temperaments. He knew that mine was very strongly nervous, and he considered that red-meat diet rendered the blood too irritating for my excitable nerves. I had the sense to act on his advice, and soon found that I was in the right direction ; and though I still suffered more or less for many A SIMPLER LIFE 21 years, I was able to continue work for twenty-five years longer, and then it was not my stomach that failed me. That is now fifteen years ago. I had still something to learn as to diet, but, with rest and com- parative freedom from anxiety, I now enjoy such health as few can boast of after an active and anxious life of more than three-quarters of a century. I have spoken hitherto of aperient medi- cines, these being far most commonly used by the profession, and still more by the laity. In England, so far as I can judge, they have been and still are more used than in Scotland. It may not be so much the case now, but when my patients had occasion to consult a first-class London physician, the prescription was almost always an aperient and a tonic, either singly or together. A single mutton chop, lightly cooked, with bread and a glass of sherry for lunch was a very favourite pre- scription, but this did not necessarily interfere with a moderate but more varied dinner after- 22 PLEA FOR wards. Frequently food was not mentioned, and a worthy old friend of mine, a well-known physician nearer home, used to tell his patients that if at forty they had not learned what was best for their stomachs, he could not help them. Of the innumerable new remedies that have come into notice in recent years I need say little. Some of them, as the various anaesthetics and antiseptics, are most valuable. They have revolutionised surgery, but have not done very much for medicine. Of the new chemical remedies the number is so great that it is impossible for the ordinary medical man to give them a fair trial, and they add enormously to his already too numerous tools. If they do all that is said of them, nature will have less chance still of showing what she can do without them, and we will have specialists of drugs as well as of diseases. Of the older remedies the ultimate effects on the system are very imperfectly known; some, as sarsaparilla, have been proved to be inert ; and of others, as digitalis and alcohol, A SIMPLER LIFE 23 the effect has been shown to be the very opposite of what they were supposed to be until a recent period. It must not be supposed that, while con- demning the abuse of medicines, I do not know and acknowledge the real value of some of them, when used in the proper cases, and in the proper manner. Iodide of potassium is an admirable remedy for eliminating some deleterious matters from the body. In syphilitic cases no one doubts its efficiency. I have used it infinitely more frequently in cases where from overfeeding mostly the system had got loaded up, and a peculiar sallow look and ill-health indicated some general derangement. In most of those cases aperients and tonics had been used, often for a long period, with the object of helping digestion. There was usually some lowness of spirits, or irritability, or both, and always a want of strength. If the iodide is used in this condition the relief to the patient is often very remarkable, and, if 24 PLEA FOR ' accompanied and followed by a fitting change of diet, it is usually permanent. But it also may be abused if taken with the view of letting the full diet be continued with more comfort. From sixty to one hundred grains in small doses usually sufficed to give the patient a good start, but in one perhaps unique case a middle-aged lady took close on ten thousand grains in the course of five years. For all the warnings I gave her she would not give up her Bass and her beef; her excuse being, that without these she could not do her duty to an old lady she looked after, and who certainly was rather exacting; and she could not take them comfortably without her medicine. For two years her health was better than before, then it began to fail, and three years later she died. Her general symptoms were those of phthisis, .but without the distinctive physical signs. Another most valuable medicine is quinine, especially for malarial fever ; but it too may be used in a wrong way. A SIMPLER LIFE 25 Mrs. A. returned from India with fever. I had long been the doctor of her family, but the husband's friends would not hear of the ' starving doctor ' being called in. After six months she was no better, but worse, and I was asked to take charge of her. I found her in a wretched condition, extremely weak and emaciated, and having severe attacks of fever every second day. She was encouraged to get out of bed on her free day, but was getting unable to do so. It was a case, if ever any was, for stopping the fever and getting up the strength ; but how was this to be done ? Quinine, arsenic, and iron had failed, as had wine and all sorts of rich tempt- ing food, but for want of better these were still being pushed. The internal congestion was such that quinine could not keep off the shiver, the first stage of the fever, and it took a long and severe hot stage to restore the balance 'of the circulation, and this, followed by a drenching perspiration, left the poor lady so exhausted that any attack might have 26 PLEA FOR carried her off. I had now a perfectly free hand. All medicine was stopped, and all stimulants ; for food she had the well-tried milk, lime-water, and white of egg, in very small quantity ; and she was kept con- stantly in bed, and mustard poultices freely used. The fever came every second day as before, but after ten or twelve days her con- dition otherwise was so much improved that I ventured to give the quinine again in full dose. It at once checked the fever, and it did not return. She could soon take a reasonable amount of light food, her strength slowly returned, and in a wonderfully short time she was enjoying very fair health, and returned to India. Howis it that thecommonermedicines still hold their place so universally if, as I believe, they are mostly useless, and often injurious ? One reason no doubt is that patients have not much patience, and wish for some im- mediate relief. In some cases, where it is clearly impossible or may be unsafe to give A SIMPLER LIFE 27 this relief, a placebo may be of use. I have always had too much respect for my patients and for myself to have recourse to this as an ordinary practice ; but I once got more credit for prescribing a box of bread pills than per- haps I ever got from giving a stronger medicine. Another reason why medicine is still so much used arises from carrying into practice the well-known aphorism of Hippo- crates : ' Melius remedium dubium quam nullum ' Better a doubtful remedy than none. There is an old saying of the Rev. Dr. Chalmers : ' No one can tell what evils may result from the enunciation of a wrong principle.' I know no wrong principle from which so much evil has resulted as that enunciated in the above axiom. The fallacy lies in the word remedium. It implies that the doubtful means employed is a remedy, though it may not act as such in the case in hand. The idea that it may hurt is left out. It is a strong measure to correct Hippocrates, but for his axiom I would substitute the 28 . PLEA FOR following : ' Melius medicamentum nullum quam dubium ' Better no medicine than a doubtful one. The new word implies a doubt, an uncertainty of good or evil, and from this the inversion of the rest of the sentence natur- ally follows. When a doctor is called in he is expected to do something, and, the course of the disease being so very uncertain, it is not easy for the patient, nor for the doctor either, to know, should improvement follow, what share in this the medicine may have had ; and, vice versa, if the symptoms become aggravated, this may be in spite of the means used, and altogether from the disease. The Hippocratic maxim is no doubt a great source of comfort to the doctor; and so long as he knows that he has followed the teaching of the experts of the profession, and gives the remedies indicated by the symptoms of the case is thoroughly orthodox, in fact, he may keep an easy mind. If his patient dies, he gets credit for having done all that was possible. But a very serious ' evil ' arises A SIMPLER LIFE 29 from always acting on the principle which the maxim so clearly ' enunciates.' He can never know what is the natural course of the disease for which he has used the doubtful medicine, and he may go on during a whole life- time obstructing nature instead of helping her. I will give here only one disease where the usual treatment is, I am sure, in many cases, most injurious ; and simply because it interferes with nature's processes. In a case of scarlet fever it is the almost universal practice to give at once a dose of aperient medicine. Now, when the doctor is called in in this case the disease has already reached its second stage. The first step is the absorp- tion of the poison and its effecting a lodgment in the system, and this is seldom attended with any marked symptoms. These are produced by the reaction of the system to throw off the poison, and unfortunately it is these which we are apt to look upon as the disease itself, and therefore to combat. In an ordinary case of scarlet fever the poison 30 PLEA FOR is thrown out by the skin and the mucous surfaces of the throat and pharynx. In some cases, perhaps from some previous errors in diet, there is diarrhoea, or irritation of the stomach and vomiting ; and these cases often do badly. It seems natural to suppose that a dose of aperient medicine will, by causing more or less bowel irritation, interfere with the natural action of the skin and throat, and may turn a simple case into a severe one ; and this I have found to occur in practice. I have often read of cases where this evi- dently happened, and I have met with it in cases I have seen with others. From almost the beginning of my practice I have never given a dose even of the simplest kind. In a very small proportion of cases the poison is so strong that it kills in twenty-four hours, or little more. In these there is no room for treatment. In old times Dr. Armstrong recommended bleeding to relieve the great internal congestion, and it is possible that this treatment might be attended with A SIMPLER LIFE 31 success ; nowadays I fear that if the patient died it would be said that he was murdered. I have met with one such case. In a few others which proved very rapidly fatal, the insanitary condition of the house was a sufficient cause ; and in one of a strong boy, who had eaten butcher's meat three times on Christmas Day when he took ill a moderate degree of scarlet fever, which must have been approaching the stage of erup- tion, was accompanied with persistent bilious vomiting, which went on till he died. Two other members of the family had at the same time the disease in a moderate form. In ordinary cases of scarlet fever the bowels usually move of themselves in two or three days ; but I have known this not to happen for a week, and on one occasion only after nine days, and the motion then has, whenever I have ascertained the fact, been perfectly natural. I believe that this was one main reason why I rarely lost a case of scarlet fever, even though severe ; and some 32 PLEA FOR few friends who have followed my example have had the same experience. I may men- tion one in Edinburgh who has a large family practice, and with whom thirty years ago I saw some very bad cases. He then always began the treatment with a dose of aperient medicine, and he was astonished when I told him my suspicion of this being mainly the cause of his bad results. Six months after giving this up he told' me that the change was very beneficial ; he had some severe cases, two of which he said should have died, but they did not. Lately I saw him, when he told me that now he seldom loses a case. I have told many of my experience, but few, I fear, have taken my advice. Some years ago, in the British Medical Journal, an English doctor published a letter strongly recommending giving no aperient in scarlet fever ; but his letter was immediately followed by two from other doctors giving directly the opposite advice, and the question dropped. A SIMPLER LIFE 33 My colleague and successor in Edin- burgh, who has always for twenty years avoided aperients in scarlet fever, is equally convinced of the great advantage of following this course. He also, as I did, seldom meets with a case of albuminuria after scarlet fever ; but our young patients have been in some measure properly fed when well, and get nothing stronger than milk for at least three weeks after the fever shows itself. But equally important with drugs as remedies are stimulating drinks and foods ; the same remarks apply to both of these as to the first-named. They are both in fashion just now, when the great object of medical treatment, in a large majority of cases, is to ' keep up the strength.' But is this really their invariable, oreven their ordinary, action in states of disease ? I am convinced that it is not. First, as to Drinks. I believe, from ob- servations on myself and on others, that Sir B. W. Richardson is quite right in his 3 34 PLEA FOR conclusions, come to from strictly scientific investigation, that alcohol, in every form, lowers the strength both of man and beast. For long I have looked on alcoholic stimulants as I do on a whip or a spur to a horse. They may bring out more force at the moment, but the effect is very transient, and is attended with a decided loss of power. They may possibly be of use in the rare occasions where a temporary stimulus is all that is wanted, but even for this there must be already some stock of force, capable of being called out at the moment, and also sufficient to carry on the necessary actions of the system after- wards. If this demand on the potential strength of the victim is called for by repeated doses of the stimulant, the ultimate effect must be exhaustion. The conclusion then is the absurd one: that when stimulants are given to ' support the system,' or to ' keep up the strength,' the force must be there already, or the stimulant can have no action whatever. A SIMPLER LIFE 35 The last of the remedies to be mentioned is Food, and this must be placed in the same category as the other two doubtfuls when we come to consider its value in disease. All food, in the widest sense of the word, is taken for the purpose of nourishing the body, and rendering it fit for its daily work. In the healthy conditions of the digestive organs this is done automatically, and all that is wanted is a regular and moderate supply of what is proper food under the circumstances. But in disease the organs of digestion are not in a healthy condition. In a very large proportion of cases they lose more or less their power of digesting food at all, or they do it in a very imperfect manner. Even when there is no structural change to be noted, the nervous force necessary to perfect digestion is wanting, and to take any food into the stomach can only do harm. Nature in most cases provides against this by stop- ping all appetite for food, while usually the desire for water remains, or is even increased; 36 PLEA FOR but water undergoes no change in the body, and requires no digestion. Besides this, nature provides in the human body a store of food which has been already digested, and requires absorption only to fit it for carrying on all the more necessary functions, supply- ing as it does the heat of the body, and also the force which keeps the heart and the muscles of respiration going, and any other muscular movements that are called for. We now know better than formerly that this reserve of food suffices to support life for days and weeks, with no addition except that of water, which is much more essential than food. Dr. Tanner and his followers have proved this, and perhaps more fully than was necessary. The doctor has done a good work. I have often thought that he had been worried as I myself have been times without number by the friends of his patients insisting on his giving them food, when he knew it could do nothing but evil ; and he wished to show how utterly baseless A SIMPLER LIFE 37 were their fears. It would seem that not only the friends but often the doctors also forget, or at least ignore, this store provided by nature. A healthy man when he takes no food loses in weight at first about a pound a day, which is gradually lessened to half a pound if the abstinence is prolonged. If no food is taken by a person suffering from disease, the amount lost seems to depend in a considerable degree on the amount of fever present, which causes a more rapid con- sumption of material, or burning. I am not aware that this has been accurately worked out, but I have often suspected that the daily loss is greater when the patient is induced to take food ; and it is needless to point out how this should be so. This I am convinced of, that in almost every case disease is aggra- vated by food taken when it cannot be properly digested, and that the suffering to the patient is enormously increased. I know this above all from personal experience ; for when ill I have often taken food as a duty 38 PLEA FOR when I had no desire for it, and I know now that I only prolonged my illness, and my misery as well. I have been careful to say that, in the conditions indicated, food is not to be taken as a general rule. In acute cases much prolonged, and in chronic cases, much must be left to the prudent practitioner as to the propriety of giving and withholding food, so much depending on the condition of the digestive organs ; but he should always have a salutary dread of giving too much, as well as of giving too little ; and he should act on the amended aphorism and not on the original. By doing so he may have fewer diseases to treat, and they may be more easily cured ; but he will, I am convinced, have more clients, as their lives will be longer. I could give many cases to show the long period food may be abstained from in acute attacks of illness. I will only mention that of a lady suffering from a large fibroid of the uterus, from which she died. In the course of her illness, and when A SIMPLER LIFE 39 already greatly pulled down, she had a severe attack of pleurisy. She suffered much from breathlessness, and very nearly died. For full three weeks she literally took nothing beyond occasionally sucking an orange ; and she thanked me afterwards for not troubling her with food or stimulants ; had I done so she felt sure she would have died. So far as the pleurisy was concerned she made a good recovery. We have seen that in sickness neither medicine nor alcoholic stimulants nor food are necessary as a general rule, but, on the con- trary, are often absolutely injurious ; and the only conclusion we can come to is that the sick are in most cases to be left -to nature's methods, and to these only. Now, what are these ? When one falls ill, in the first place he usually loses all appetite for food. He thus tends to give Rest to the stomach : tends, I say, for often the stomach has a long period of work before it 40 PLEA FOR gets rid of its contents in the first place, and then of the secretions which come into it, chiefly from the liver by regurgitation, and from the blood. If the illness has been brought on by taking any poisonous or deleterious matter into the stomach, or even by taking too much of the proper food, the cure may be speedy, and there may be no occasion to fall back on the stored-up food of the body ; and here no one would dream of fresh food being taken. But if the poison is of a slow - working character, and a long period for its elimination is required, or if some (it may be reparatory) process of inflam- mation is going on, which upsets all the nervous functions of the body, so that the nervous energy of the stomach so necessary for the digestion of food is wanting if time runs on, and still no food is demanded by the patient the friends begin to get anxious, and the dread of ' letting the patient get too low' comes strongly to the front. It is well for the doctor if he is of the same mind, and A SIMPLER LIFE 41 as' I know to my cost it is bad for him if he is not. If the case is a simple one, as fortunately is the rule, recovery comes about, although there may have been considerable errors in giving food too soon, or in too large quantities ; but there can be no doubt that a simple and short case is often converted into a severe and long one by giving food when it is not wanted, and when it can be of no use. The other means which nature employs is giving Rest to the whole body by sending the invalid to bed. In a cold climate this is of special value. Warmth is of great use in many cases, both in preventing chills, and in saving the bodily heat and thus rendering heat-making food less necessary. It is thus a means of ' keeping up the strength ' so much desired by the friends, but one which, I fear, they rarely think of. In certain cases of high temperature, the use of cold is now much more appreciated ; but in these, rest in bed is still essential, and the application of 4 2 PLEA FOR cold, when indicated, is usually very accept- able to the patient. An abundant supply of fresh air and of good water is essential in most states of dis- ease, but the value of these is generally fully appreciated ; at any rate the doctor has usually little difficulty in getting his wishes carried out in regard to them, if, as is by no means always the case, they are to be had in their natural abundance and purity. A most valuable method of employing heat and water in sickness is by combining them. I have long looked on hot water as the most real stimulant that we have. It supplies ready made the heat which is, in health, the product of the chemistry of the body acting on all carbonaceous food. In most states of disease we do not look for any building up of the body, which is the main duty of nitro- genous aliments ; but when the system is really in a low condition, and then only a stimulant is wanted, we need a supply of heat, which, being convertible into all other forms A SIMPLER LIFE 43 of force, keeps up the temperature of the body, and the absolutely necessary move- ments ot the heart and lungs, and the func- tions of the nervous system. Another element in the cure of disease is Time, and chiefly for this reason, that if the patient, though apparently well, tries to get too soon up and back to his ordinary work and food, before he has got a sufficient stock of nervous energy, the chemistry of digestion at once goes wrong, and he falls back to his old condition ; and he must again rest both body and stomach, perhaps for even a longer time than before. The best tonic is a little wholesome abstinence. To sum up : the doubtful remedies which, according to the new axiom, are as a rule to be avoided in states of disease are medicines of all kinds, alcoholic stimulants, and food ; and nature's methods which we advise to be substituted for them, or rather to be allowed full play without them, are rest, not forgetting rest to the stomach ; warmth, or in rare cases, 44 PLEA FOR cold ; a free supply, usually of water, and always of fresh air ; and sufficient time for the organs to recover their ordinary working powers, and especially for the nervous sys- tem to make up its wasted energy. In short, we must fall back on the old and much for- gotten vis medicatrix natures. I have heard of old men who never had taken medicine, nor consulted a doctor, and who, if they felt unwell, at once stopped all food ; if this was not enough they went to bed, and remained there till they were better. The first rule I have followed for forty years, the last for fifteen, since I have been able to do so, and it has very rarely been necessary ; and I do not intend to do anything more in the future. My friends can see the difference in my health, and I feel it. Many of my younger medical friends, who worked on very opposite lines, used to laugh at me as a very poor specimen of the mode of living I allowed myself and recommended to others. One told me if I would daily take a good beef- A SIMPLER LIFE 45 steak and a pint of Burgundy, as he did, I would be equally strong and well. Another recommended his three B's beef, beer, and bread ; another honestly said he would not live as I did he would rather die ; that he went in for a short life and a merry one. When at last I got the long-needed rest, I resolved to give myself all possible fairplay, with the object of proving to these men and others that there was some good in my methods after all. But the element of Time was a great one in my case, and now, when I am not ashamed to offer myself as a good specimen of an old man who lives a most simple life, I have no one left of the old scoffing friends whom I was most anxious to appeal to. They have all had the short life, but not, I fear, the merry one. In most in- stances one severe illness carried them off when at the height of their work and pros- perity. It is a sad recollection. It may be asked If the present system of treating the sick be so hurtful, how do so 46 PLEA FOR A SIMPLER LIFE many recover under it ? I answer by asking another question. How is it that so few reach the age of fourscore, which, from the time of Jacob, has been considered an extreme old age ? May not this bad treat- ment of the sick be one large cause of the shortened life, as is the bad treatment of themselves by the healthy, on the ' short life and a merry ' principle ? The human body is, or at least we consider it, the highest work of the Creator, and it can stand a great deal of bad treatment at one's hands. My wonder is that it stands it so well. Or I might give a shorter answer by asking, How did any of the sick .treated on the old plan re- cover at all? I would be glad to have an answer to this question from the advocates of the new. CHAPTER II I HAVE endeavoured in the former chapter to show how little can be done by drugs and stimulants and food to combat disease, and I have mentioned some cases where their use is positively injurious. Is there any general rule that can guide us as to when we are justified in not interfering at all, and in leav- ing the case to the simple methods followed by nature ? Perhaps no absolute rule can be given, but our action should be guided mainly by this consideration, that diseases, as we are called to treat them, or, in other words, the abnormal phenomena presented to us by the sick, are not the essential elements of the case, but are signs of processes set up in the 48 PLEA FOR body in order to relieve itself of some dis- turbing influence threatening to interfere with its functions, or (it may be) to destroy them altogether. In a large number of cases there is no difficulty. The cause of the illness may be obvious, or may be readily discovered, and any needful treatment may be at once had recourse to in order to remove the disturbing cause. But the disturbing cause may be doubtful, and, any ' remedies ' that may be thought of being (as we have seen) also doubtful, we have a double reason for exer- cising a wise forbearance, and for leaving the case alone so far as any other means are concerned than those demanded by nature. I think I will best serve my purpose by restricting this chapter mainly to cases which illustrate the evils that arise from interference with nature in carrying out her own methods, and the benefits which accrue to the sick from leaving them alone, or from using only the A SIMPLER LIFE 49 simplest means to aid nature in her work of reparation. The science of surgery is a very different one from that of medicine, and its advance during the last fifty years has been enormous. The practice of surgery has kept pace with the science. The surgeon in a great majority of cases knows what he is about, and the patient knows what he is suffering from. An injury is manifest to the eye or to the trained touch in far the larger number of cases, and any doubt as to the cause or the nature of the ailment is excluded. In a certain number of cases, even in surgery, this does not hold, and in these the prudent surgeon may have to act on the principle of letting alone, as in doubtful medical cases. But the advance in the means of diagnosis renders even these cases much less common than formerly. Also in the methods used the surgeon has great advantage over the physician. He can much more easily discover if he is doing good to his patient or the reverse and can at once 5 o PLEA FOR alter his treatment ; and he can also know much more certainly if the case be hopeless and any treatment unnecessary. It is well to notice that in most cases, even in surgery, the best measures are those which ensure rest to the injured part, and this kept up till time is given for the restorative process of nature to effect a cure. Many cases of internal injuries must be included in the common domain of the surgeon and the physician, as in injuries to the head, where there may be fracture of the base of the skull, with rupture of blood-vessels and internal haemorrhage. As a physician, I have had more to do with cases of apoplexy from rupture of an artery in the substance of the brain. Here all we can do is to prevent if possible the further escape of blood, and to encourage if we can its absorption. The old method was of course to bleed the patient with the view of lessening the pressure on the cerebral vessels, and perhaps there was some sense in this, though much might *be said on A SIMPLER LIFE 51 the subject perhaps to little purpose. Now, various medicines are often given, adminis- tered by the mouth if swallowing is possible, or by the bowel, and very soon the attempt is made by food and stimulants ' to support the system.' I am very sure my success has been greater since I have trusted entirely to rest and time, and have given neither food nor medicine. If the lower bowel is loaded, it may be right to remove what is there mechanically or by a mild enema, and emptying the bladder may have to be seen to if necessary. But beyond this rest should be absolute. The straining caused by the simplest aperient may make to the patient the difference of life or death ; abstinence from food and mostly from drink of any kind will soon diminish the volume of the blood, and if continued will help to absorb the clot of blood, which may be looked upon as an addition to the store of nutriment we have spoken of as laid up in the system to meet such a contingency as now presents 5 2 PLEA FOR itself. Thirst, if it by and by comes on, may be relieved by frequent minute sips of cold water better than by a large draught of any liquid ; and later, if there be signs of exhaustion or of failure of the heart's action, my experience is that hot water will be of far more use than any alcoholic stimulant, or, if this cannot be taken in any quantity, some small doses of carbonate of ammonia. There are, of course, cases where the escape of blood is so large that there is no chance of recovery from the first ; but I have seen many cases apparently hopeless, and where for many days there has been no sign of conscious- ness, that have been pulled through, not by the physician, but by nature left entirely to her own resources. In a large proportion of very severe cases which I have been allowed to treat in my own way, the patients, even though well up in years, and in one remark- able case very old, have afterwards enjoyed excellent health for many years without one sign of paralysis of any sort ; and some have A SIMPLER LIFE 53 done a large amount of head-work, and have died from diseases of quite a different char- acter, or from simple old age. One case, treated in a very different way, caused me perhaps more worry and anxiety than any other I ever attended. A gentleman of middle life, whose family I had long looked after, had an attack of apoplexy in the north of England, where the family had gone for the summer. He was a strong, healthy man, and I do not remember that he ever required from me any medical advice ; but he was certainly too well fed. After some months he was brought back to Edinburgh by the medical man who had attended him through his illness, and whom I was asked to meet along with one of our consulting physicians. The patient was still a great invalid and much paralysed. He was quite helpless, and the English doctor, who was well pleased with the improvement so far, seemed most anxious to impress upon us the necessity of keeping up his strength. 54 PLEA FOR He was taking as much ' good ' food as he could, and also stimulants. On leaving, the consultant told me he had been much amused at the way the English doctor, a young man, had laid down the law to me, a much older man. ' But,' he said, ' you can now take your own way,' which he knew very well. But I could not get my own way, and had not the patient been an old and intimate friend I would have given up the case, the more readily that I got no help from my consulting friend. At last most marked gouty symptoms appeared, and then I suc- ceeded better in getting my own way. It was too late and the patient died. I suc- ceeded in getting an examination of the brain made by the then pathologist of the In- firmary. We found, besides a quantity of clear fluid on the surface and in the ventricles of the brain, what looked like a small tumour embedded in the substance of the cerebrum, where it might have given but little trouble. But it proved to be the remains of a clot of A SIMPLER LIFE 55 blood, partially organised, and with vessels through its substance. The full feeding had given no chance to its being absorbed, and the continued irritation kept up by it had led to effusion ; and the pressure of the fluid on different parts of the brain accounted to us for the curious changing symptoms which the case had shown all through its course. It has often been to me a sad reflection that wealth, which here was in abundance, and the kindliest of feelings for my friend was blessed with one of the best of wives should, from want of a little knowledge of the laws of nature, be turned into true causes of suffering being aggravated and death brought on prematurely ; and that the acquisition of that knowledge is hindered by the varying fashions of the day, as they affect the teach- ing and practice of medicine. I have myself suffered in many ways from my heterodoxy. A few of my good patients have left me a very tew, and as I have good reason to know, not always to their own advantage. Servants 56 PLEA FOR in families in which I attended frequently would have none of me and demanded another; and I have even been threatened with the terrors of the law. My worthy friend, then Police Surgeon of Edinburgh, will, I think, forgive my giving a short story which afforded us both a good laugh the last time I had the pleasure of see- ing him. Some twenty-five years ago, meeting him in the street, he told me most seriously that I must take care what I was about, or I would certainly come within the clutches of the law. This coming from him rather startled me, and I asked what he meant. ' Oh,' said he, ' there is old General C., next door to me, ill in bed, getting no food, and nothing being done for him.' I felt relieved and answered that I would take the risk. The old gentleman soon got well ; no doubt he has occasionally gone through the same experience since, but he is still alive, and the last time I saw him very much so; and now, at the good age of ninety-five, he is, A SIMPLER LIFE 57 I am told, the oldest officer of Her Majesty's Service. If ' something had been done for him,' as my friend suggested, then and on other occasions, he might have lived as long, but I doubt it. There is another set of cases where great mischief is done by a free use of food and stimulants, viz. in haemorrhages from some other internal organ, as the stomach, lungs, or kidneys. The old idea was to remove the cause of the haemorrhage by lessening the pressure of the blood ; and this by reducing its quantity by bleeding, or by putting leeches on a distant part of the body, with the view of drawing the blood into another direction. The idea now almost always acted on is to keep up the strength by stimulants, and to make up the loss' as quickly as possible by giving good food ; while also a variety of so-called styptic medicines are used, with, in some cases, the local application of cold. The sceptical physician who does not pursue these methods runs a considerable risk of getting 58 PLEA FOR into trouble ; but I have often run the risk during the last forty years, and I have never, so far as I know, had cause to regret it. I will give a few cases which I choose out of many as perhaps the most illustrative of my heterodoxy both in theory and in practice. A gentleman about middle age and of a healthy constitution was long addicted to turns of deep drinking. He was absolute master in his own house, and he never allowed me to be sent for till he was just on the verge of delirium tremens. In a previous attack he had some haemorrhage from the stomach, owing evidently to a cirrhotic liver. This alarmed him, and for a much longer period than usual he had kept off all stimul- ants. At length, however, he had to allow me to be sent for, and from his fears of haemor- rhage somewhat earlier than usual. I found that for ten days he had taken no food what- ever ; but was drinking largely strong wines and spirits. He was not yet in the state that I could stop this and give him some mild A SIMPLER LIFE 59 food, but every day he promised me that he would take no more, and next day he ex- pressed great regret that he had found it impossible to do so. This went on for three or four days, when one morning I got an urgent message to see him. I found that all of a sudden he had vomited an enormous quantity of blood. I guessed it at ten or twelve pounds at least. I certainly never saw such a quantity of vomited blood before, nor anything like it. No pulse could be felt in any of his extremities, which were cold, and his heart could scarcely be heard to beat. He had some consciousness ; he seemed to wish to speak to me, and putting my ear close to his mouth, I heard, in the faintest whisper, ' a big drink.' My first thought was to gratify him, as he seemed in a quite hopeless condition ; but I knew that to con- tinue the stimulants was to give him no chance at all, and that if there was any doubt he should get the benefit of it. His great want now was evidently fluid, and some safe 60 PLEA FOR stimulant, if there was such, to keep up the heart's action. I got a tumbler of quite hot water, with a teaspoonful of Liebig's Extract dissolved in it, and I poured gently on the surface of this a single teaspoonful of whisky, the fumes and taste ofwhich might deceive him into the belief that I had yielded to his wish ; and he swallowed this with some effort. The same dose was repeated in some twenty or thirty minutes, and these two teaspoonfuls of whisky were all the stimulant he got ; but the hot water and Liebig were continued at frequent intervals and were well taken. By evening some reaction came on, and to the astonishment of every one he made a steady recovery. He lived carefully for some years, had no return of haemorrhage, and he died from the effects of a severe chill from long exposure to rain and cold. A young married lady, an old patient, came to Edinburgh to consult me for a severe chest affection of some standing. I had gone to the south of France, so she consulted one A SIMPLER LIFE 61 of the ablest physicians of London, now de- ceased. He gave her mother, who accom- panied her, such a hopeless opinion, and, at the same time, ordered so very different a diet from what she knew I would approve of that she followed me south, hoping that I would take a less desperate view of the case. I found that it was a very serious one indeed. The upper part of both lungs was inflamed and congested, one much more than the other, about one -half of the lung being affected, and in it there was at least one con- siderable cavity already formed. There had been repeated attacks of haemoptysis to rather an alarming extent. The London physician, who had been extremely kind and sympa- thetic, told them not to be alarmed at this, as it must occur from time to time. He re- commended some drugs, I forget what, but his great anxiety was that she should be well nourished, and he wrote out a diet for her which she was to follow as far as possible. Her mother had tried to keep her up to the 62 PLEA FOR mark, but she herself complained to me strongly that the attempt to do so only made her more miserable. Her coated tongue at once proved to me that she could not digest such a diet, and she was delighted when I told her I would not ask her to take more food than she wished or could enjoy. I re- commended a very moderate quantity of milk and an egg or two as her only animal diet, and I ordered no drugs. I also told the mother that I took a much more serious view of the haemorrhage ; that had she been able to take and to digest the quantity of nourishment ordered in London, an occa- sional bleeding might relieve the congested and now evidently inflamed lungs ; and that had the blood come from some external part of the body little mischief might result, but that a portion of it would most probably remain in the lungs, and would certainly set up further irritation. The old lady saw the common sense of this, and no longer urged food on her daughter. Next day I found A SIMPLER LIFE 63 good milk was not to be procured. The cows of the hotel were fed more or less on oranges, and the milk had a peculiar flavour which rendered it undrinkable. Nor were fresh eggs to be got. The friends I was living with close by had, fortunately, a cow properly fed, and had also a number of fowls, and they kindly supplied my patient with one pint of milk and a couple of eggs every morning. On these and on nothing else the invalid lived for several weeks ; and though the weather was such that she could get but little out of doors, the change on her was really marvellous. She lost her pinched, pallid, suffering look, slept better, was able to move about, her cough improved, and she had no more haemoptysis. But the great change was in the lungs. The congestion in the best lung almost disappeared ; and in the bad one the local signs were so much modified that, but for the undoubted presence of a cavity, I might have hoped that there was no phthisis at all. Had the London 64 PLEA FOR physician seen her four weeks later he could not possibly have given so hopeless a pro- gnosis. I never saw her again, and she died of phthisis two years afterwards. Some years ago I spent a few weeks near Rio. I was there asked to meet the late Dr. F. of Rio to consult about an English gentleman living in the hotel. The case was one of severe hsematuria. He had suffered for years from dyspepsia. A sea voyage was recommended ; but after a short remission the stomach ailment returned, ac- companied with hsematuria, and he arrived in Rio much exhausted. After some weeks' rest in a delightful climate he was no better, and Dr. F. advised him to get home as long as it was possible for him to travel. His general health was wretched, and the main object of the doctor and of his nephew, who was with him, was to get him to take any tempting food he could, to make up for the loss of blood, which was considerable and constant, and to keep up his strength. Every A SIMPLER LIFE 65 possible remedy had been tried, the doctor told me, except turpentine, which he pro- posed we should give him ; but he con- sidered the case hopeless, and wished to get him home if possible ; as he was unfit to travel the ten miles to Rio and get on board the steamer in one day, he kindly offered to take him to his own house for the night. It looked very much as if some organic change of the bladder was present. I suggested that possibly the cause might be a simpler one, and that, as the bleeding had come on when he was living, as he told me, on fuller diet than usual, on board ship, and during very hot weather, it might at first have been an effort of nature to relieve a congested organ, and that the weak part had not had a chance to heal from the constant use of as full a diet as was possible. This was quite a new view of the case both to the patient and to the doctor, and the former was most willing to change his mode of living. It was agreed not to try the turpentine nor 5 66 PLEA FOR any medicine whatever, and to adopt at once and for the future a very simple and restricted diet. He left next day, and on my return home I found a letter from the nephew, dated six weeks after I had seen the invalid. He writes : ' My uncle's hsematuria ceased with- out any assistance from medicine as soon as we got fairly through the tropics, and he began to mend slowly, and by the time he arrived at Liverpool he had regained some of his strength. The change of air on get- ting home did him good, and, on the whole, I think he has very nearly recovered what he lost on the voyage. I attribute his recovery greatly to your advice.' How often I have known a simple case converted into a com- plicated and hopeless one by exactly the same treatment ! I will give one other case, perhaps the worst case of haemorrhage from a fibroid tumour I ever met with. A lady, from Glasgow, where she kept house for a brother, came to see me several times and lived A SIMPLER LIFE 67 with a sister in Edinburgh. I advised rest and light food.* She was rather of the full plethoric type. She got worse and worse, and at last finding she could not take rest at home I insisted that she should stop with her sister, remain absolutely in bed, and, though she was now very weak and bloodless, that she should live on a very restricted, al- most starvation diet. I had given her freely the favourite styptic remedies, especially Ruspini's Styptic, which then enjoyed a very high reputation. The surgical methods now used in such cases, and electricity as now practised with often the best results, were not then thought of. At once she began to improve, and at the end of three or four months, during which she rested, and I may say more or less starved, the attacks left her and did not return. She soon gained strength and went home. The end was rather a sad one. Some three years after I was called to see her in Glasgow. She had kept quite well, and got strong and full as before. 68 PLEA FOR Whether I haa not enjoined her strongly enough to avoid getting too full and plethoric now that she had not her previous relief, or that she had not considered it necessary to be any longer so careful, I do not know ; but I found her suffering from a very severe attack of pleuro-pneumonia, to which she succumbed a day or two after. Twenty years earlier she would have been bled and bled again, and the result might have been different. In such a case as the last, I have all along occasionally ventured to bleed, and my successor has done the same. Fortunately the result was always favourable. We know from such cases as I have given the details of, that one can lose a vast amount of blood and be ultimately not one whit the worse for it. Above all, in a case of congestion of the lungs the remedy seems the natural one. The whole mass of the blood must circulate through the lungs, as well as through the rest of the body. If the lungs are swollen and congested this becomes impossible, and A SIMPLER LIFE 69 surely it is a more rational method to relieve them of a portion of their load, rather than to try to force the whole of it through by stimulating the heart's action, as is the method universally adopted nowadays. I heard and knew little or nothing of the com- plaint in my younger days, perhaps because by early bleeding it was rarely allowed to get ahead, but was checked at the commence- ment. I find that the same mode of treating con- gestion of the lungs now prevails in France as in this country. The change from the old to the new treatment, and the usual results, was told me very graphically some years ago by a fine old French gentleman whom I had seen from time to time near Antibes, where he was the neighbour of friends I frequently visited. I heard he had been ill, and went to see him. He told me he had been very ill, and that the wonder was he was alive. He had had congestion of the lungs. ' In my young days,' he said, ' when any one got 7 o PLEA FOR congestion of the lungs, he was bled, and he was cured. But now, if you take congestion of the lungs, the doctor will not bleed you, and there is nothing to do but to send for the padre.' As I wish to notice the evils that result from full feeding in asylums, I may here give some account of my experience in treating cases of insanity, and give one or two illustrative cases. I may be told that I can have but little knowledge of this exten- sive subject, as I have never been attached to any establishment dealing with it. This is true, but I have had much experience outside, where I was not bound very much by rules, and could treat each case as it arose. As proof that I was considered by experts as knowing something about the insane, my ad- vice has more than once been asked by them when their own relatives were threatened. There is no harm in stating that an old friend, who was long held, and justly so, as the head of his specialty in Scotland, when A SIMPLER LIFE 71 he feared that a very near relation was becom- ing insane, put her under my care, and let me have a free hand in her treatment. On stopping her stimulants and good food, we found that the insomnia and other more sus- picious symptoms soon went off, and our anxiety about her was speedily relieved. More recently another medical man, who occupied a high position in connection with lunacy, asked me to look after a friend, an old lady who had still more advanced symptoms than the last-mentioned. In his letter to me he said he knew nobody but myself who could be of any use to her. I could give numerous cases of good results from, as I think, a rational mode of treatment. An old lady, long a patient of mine, lived undoubtedly too well. She was a robust, healthy woman with a good stomach, and she took advantage of it. About once a year she had a severe attack of erysipelas of the head, which cleared her out for a time. One 72 PLEA FOR year the erysipelas did not come on, and instead of it she had an attack of acute mania. She was making a slow recovery after the acute symptoms were over, and for a change she went to the country. There her friends put her on a better diet. She did not improve, and they called in the physician of the county asylum. He wrote me that the case was a hopeless one of senile insanity, and told me what would be the course it would certainly run. He also said that it was not safe to leave her at large, as in such cases there was a tendency to suicide. Of course he approved of good living. If his views had been carried out, I have no doubt his prognosis would have proved correct. But I managed to get her home, put her again on a restricted diet, and though not quite sound she lived for years with her daughters in town, and never showed signs of senile insanity nor of any other form of it. A much younger lady I kept out of an A SIMPLER LIFE 73 asylum for twenty years. She had occa- sional attacks of insane excitement during all that time, but she had an excellent maid, and little was needed except an occasional quiet change to a lodging in the country. She was getting past her change of life, and I quite expected she would have a comfort- able and calm old age. At one time she asked me if she should not adopt vegetarianism pure and simple. I had put her at least half- way towards it ; and I afterwards regretted that I had not let her follow her wish. But I pointed out to her that she was doing very well as she was, and thought it would be better that she did not change. She was now living by herself in her own house, in a fine healthy locality. By and by she was so well that she went to pay a visit to friends at some distance. There one of her excited turns came upon her, I know not from what cause. Her friends got alarmed and sent for their doctor, a valued friend of mine, long since dead. He at once said she was too 74 PLEA FOR low, and changed entirely her mode of living Ere long I was asked to send a professional nurse to bring her back to Edinburgh. She was soon much in her usual again. At the desire of the friends I got an excellent lady attendant for her, and hoped all would go well. But now the friends, who had left me quite alone hitherto, interfered with the lady attendant, and she had to give up her place. Seeing I could do no more good, I had also to give up my patient, very much to her sorrow, and my own. All along she had dreaded being sent to an asylum, and made me promise that I would never allow it. It was soon resolved however to send her there, the chief reason given being as before, that there was risk of her committing suicide. She was sent to what are justly considered most comfortable quarters ; but very soon the physician of the establishment came to tell me that on one of the first opportunities she had committed the act the fear of which had led to her seclusion. I was not astonished, A SIMPLER LIFE 75 though I had never seen the slightest ten- dency in her to injure herself during the twenty years I had the care of her. In cases where it is possible, and these are not a few, my desire has been, especially in recent years, to keep my patients out of any asylum ; and I have not had cause to regret it. Simple feeding does more than make up for all the advantages and these are very great of the best regulated establishment. Happily there are already some signs of a coming change. I shall now give a few purely medical cases, illustrating the two opposite modes of treatment, and extending over a period of more than quarter of a century. In November 1869 I was called to Helens- burgh to see Mrs. S., an old lady who was supposed to be dying from cancer of the stomach. The patient was well on to eighty years of age. She had enjoyed good health, had been well fed, took a moderate amount of wine, but for some years had attacks of 76 PLEA FOR disordered stomach, accompanied with vomit- ing, which was the chief symptom. These attacks had been getting more frequent and severe, but the present one was much the worst she had ever had. For twelve days nothing had remained on her stomach ; she had got very thin ; her colour was very bad ; but the vomiting now was more from irritation of the stomach than from bile. After the vomiting fits, which were very distressing and exhaust- ing, she had a desire for something to drink, and this was freely supplied -in the varied forms of champagne, soda and brandy, beef- tea, and turtle-soup. For a few minutes she was relieved, but the distress and vomiting soon returned. Her strength was rapidly failing, and it looked as if one or at the most two days more would bring the end. From being full and plump, she had got so thin that the edge of the liver could be felt a little below the ribs, and this had led to the idea that she might be suffering from cancer of the stomach. After finding out all I could A SIMPLER LIFE 77 about the case I withdrew to consult with the doctor and a semi -medical friend of the family. I was able to assure them that the case was not one of cancer ; that the old lady had still some life in her ; and that if only we could give the stomach a rest it might recover its functions and she might yet get well. I pointed out that the desire for drink or such fluid food as she was taking so freely was not a true call of nature for nourishment, but a crave for something to dilute the acrid mass which soon formed again after each fresh supply, aggravating the irritation of the nerves of the stomach, and bringing back the misery which, for a short time, had been relieved. She had of course been taking a variety of medicines. I recommended that all these should be stopped, as also the stimulants and food, and that the old lady should have nothing whatever but hot water, and of this just as much as she cared to take ; that this should be continued at least for twelve or twenty-four hours, when, if it seemed to suit, 7 8 PLEA FOR a very small quantity of milk could be added to it, and gradually, as it could be done with- out the least discomfort, a very little mild food, as gruel, or weak chicken soup, might be given occasionally. This was all agreed to most readily, as it was clear to every one that on the present lines of treatment the case was utterly hopeless. As we were talking, a message came that Mrs. S. had been sick again, and would she take soda and brandy, or what ? She had had a bad fit of sickness. I said that now was the time to begin the hot water, the stomach being well emptied ; and I sent her up a full tumbler, about as hot as one could drink it, to be taken at once in whole or in part, just as she felt inclined. In about half an hour, before leaving, I went to her room and found her in a much more satisfactory condition. She had taken the whole tumbler greedily, and it was, she said, the only thing that had done her good. She felt soothed and comfortable. I did not see her again, but from this turning-point she A SIMPLER LIFE 79 made a steady though necessarily a slow re- covery, only somewhat retarded on one or two occasions by the desire of the doctor to get up her strength a little faster. She quite re- covered her health and her former plumpness, and she lived for I do not know how many years. The two following cases I met with in London, where I spent two winters some ten or twelve years ago : I had heard of the illness of a young married lady, a friend of my family, and one day her mother came to ask if I would see her as a friend. She told me her daughter had been gradually getting into bad health, and that now they were very anxious about her. Her stomach had got so weak that it could retain next to nothing ; on the previous day all her food was five oysters, and they were pleased that these had not been vomited. One of the first physicians had seen her in consultation, and ordered wine and a tonic. On a second visit he had ordered stronger o wine and a stronger tonic. These were so 8o PLEA FOR manifestly injurious that the mother, who well knew my methods though she did not follow them, in despair about her daughter, begged that I would see her. I told her I could not do so in the way she wished ; that no good could come of it, as I certainly would advise a very different treatment ; that I would stop all medicines and stimulants, and would give little or no food until the stomach had rest and could digest it. I asked her to tell the doctor what I said, and if then he was willing to see me I would be glad to meet him. I heard nothing for five days, and was then informed that the doctor had at once adopted my suggestions, and that the patient had showed so much improvement that they did not think a consultation necessary. After another week, however, I got a request to meet the doctor, as the patient, on being tried with stronger food, had at once gone back to her old condition. I found her terribly emaciated, lying on a water-bed to prevent bed-sores which had threatened. There were A SIMPLER LIFE 81 some symptoms of pelvic irritation, but she was not pregnant. Her family, consisting of two fine healthy boys, quite young, took up much of her time ; she was much in society ; and she had continued her duties to both long after she was quite unfit for the exer- tion. Her exhaustion was now extreme, and both doctor and friends were afraid to con- tinue the only treatment which had in the least degree done her good. Though by no means sure of the result, I strongly urged as the only chance of preserving life that the stomach must have rest ; that in its present condition any stimulating food or medicine could only do mischief; and that if time could not be given it to recover its tone the patient must die. As the only food I re- commended a few sips from time to time of well-diluted milk, lime-water, and white of egg, and, as the only stimulant, hot water as she could take it. This was agreed to. I think I also recommended a large sinapism over the stomach at bed-time, kept on only 82 PLEA FOR so long as it was pleasant. This I have long found to allay irritation and miseries when the stomach is irritable, and very often it produces a quiet sleep. At once she rallied, the sickness stopped, and she even gained in strength. The process of recovery was very slow, but pretty steady, even when she began to take a little more simple food, such as well-boiled gruel, soup of young chicken or of young lamb. I had several meetings with the doctor, who was astonished and de- lighted with the result of a mode of treat- ment which was absolutely new to him. He told me that he could only account for the condition of his patient when I first saw her on the idea that she was falling into acute phthisis, although the chest signs were as yet very trifling. By and by the signs of pelvic irritation became more marked and had to be attended to ; but it was years before she was fit for much exertion. She is now in excellent health. My next case is a sad contrast to the A SIMPLER LIFE 83 former. A nervous Scotchman of a decidedly gouty type, a resident of Edinburgh, suffered so frequently in our irritating climate from bronchitis and stomach attacks that I had advised him many years previously to go to London. The change was advantageous for him as to his business, and he found the climate much more suitable. He came down from time to time to Edinburgh, when I usually saw him, as the return to the North often, as I have seen in others, brought back something' of his old ailments. But altogether he enjoyed very fair health, and, as he lived very carefully, I expected for him a long life. I did not see him for some years, when, happening to be in London, I called for him as usual. I was astonished at the change in his appearance. He had got stout and full, a great contrast to his ordinary condition. He told me that a year ago he consulted a doctor who told him that his was poor man's gout, and he put him on a full diet both of food and stimulants. He soon 84 PLEA FOR got into robust health, 'but,' he said, ' I had a terrible winter.' He was attacked with eczema over his whole body, and had to be in bed, I think he said for six months, with a wire cover over him to prevent the clothes from touching his body. He was of course dosed and dieted, and as the weather got warmer he got free of the eczema. That was three months before I saw him. He had resumed his full living, and he was again strong and stout. Though he did not exactly say it, I saw that he thought I had been too strict with him. I had not the heart to frighten him, and only remarked that it was lucky for him that the gout had taken an outward direction. Three months later I went up to London for the winter, and one of my first visits was to my old friend. I was told he was very ill and could see no one. I was admitted, however, and his wife told me his history since I had seen him. He had kept in excellent health all the summer ; but when on a visit to the A SIMPLER LIFE 85 country three weeks before he got a chill, and one of his old bronchitic turns came on. He got home, and had gradually got worse. On going to his room I found him in a very suffering condition. He seemed still a large strong man compared to what he used to be ; but, in addition to the bronchitis, his stomach had now gone wrong, and he was so wretched he could scarcely speak to me. He told me that his wife, by the doctor's orders, was always urging him to take food and stimulants, and he was sure they did him no good. He did not vomit much, if at all, but his uneasiness and misery were un- ceasing. I saw that his stomach was full of acridity, and happening to have some liquorice in my pocket I gave him a good piece of it. It at once relieved him, and he was able to talk more comfortably. After a little he suddenly took up a tumbler of rich London milk, and before I could stop him swallowed some mouthfuls. In a few minutes his intense uneasiness returned ; the milk 86 PLEA FOR had at once soured and formed a hard curd in his stomach. This accident confirmed me in the belief that his suffering was mainly from a grievous error in diet. I gave the wife a strong message to the doctor : that I had known his patient much longer than he, and that a very different diet would be much to his advantage. Three days later I called to see him, and found him much the same, still taking too much food, etc., but his wife was not now so urgent for him to take it. I also got a message from the doctor that the patient was a strong man, that there was no fear of him, but that I must have forgotten how old he was he was perhaps a trifle older than myself, and that it was absolutely necessary to keep up his strength ; I was sorry, but could say no ' more. Twice again I called to ask for him at intervals of three days, and the last time' was told the doctor was getting rather anxious about him, and would be glad to meet me. I agreed of course to meet him at any time he fixed. A SIMPLER LIFE 87 I heard nothing for two days, and then a black-bordered letter intimated his death. I know that it is the prevailing opinion that old people require more ' keeping up ' than younger persons. My experience tells me that this is a great mistake, both in health and in disease. I am perfectly sure that the old bear stimulants much worse than the younger. I have often seen a new lease of life follow the giving up of even a very moderate use of wine which had been in- dulged in for the greater part of a lifetime, and had thus become a habit. That the same holds in the case of disease will perhaps be better illustrated by the following case, one of the latest of the very few I now have occasion to treat. An old lady of eighty- seven had a year ago a severe attack of influenza then epidemic in Edinburgh. She usually enjoyed fair health for her age, and the rarely if ever took any stimulants, but I could not get her off what I consider the bad 88 PLEA FOR habit of taking aperient medicine. For some years she had suffered much from chronic rheumatism, which had at last rendered her quite helpless, and she could not turn in bed without great pain. Massage more than once relieved her considerably, but finding that the relief was only temporary she got discouraged and gave it up. Having a fair stomach and no exercise she got full and un- wieldy, and it looked as if soon she would be unable to leave her bed. When I saw her she was evidently in for a severe attack ; I advised that she should take no medicine, as much hot water as she pleased, and little or no food. The state of the tongue was proof enough to me that she could digest nothing, and she had an abundant store of nutriment in her body to last for weeks if necessary. I tried to comfort her two anxious daughters by say- ing that I hoped she would weather the influ- enza ; and that if she got fairplay, she would almost certainly be cured of her rheumatism, and possibly of her habit of taking medicine. A SIMPLER LIFE 89 Almost from the first the head was affected, and the old lady at the end had lost all that had occurred during at least two weeks. On the fourth night of her illness she remembered that her bowels had not been opened for four days, and she insisted that the nurse should give her a dose of castor oil ; the effect was rather severe, and that, with the necessary movement, so exhausted her, that in the morning I found her in a state of collapse, and feared she was to die. By evening, how- ever, she rallied without any stimulant but some doses of carbonate of ammonia in camphor mixture, a stimulant much prefer- able to wine or brandy when the stomach is disordered. She now forgot all about her bowels and they moved of themselves twelve days later, when everything was so perfectly natural that the nurse, to whom this treat- ment was altogether new, and the daughters also acknowledged that I had been right. The case went on with no improvement, but fortunately no chest symptoms supervened 90 PLEA FOR except a troublesome cough. One night, about a fortnight after the commencement, the daughters feared she was lower, and sent for the neighbouring doctor. He at once ordered brandy, but it was not given till I should see her next morning. I found her much in the same condition, and the brandy was not given. She did not show any sign of improvement till the end of three weeks, when a copious erythematous rash came out on the lower part of the body, and we had much trouble to prevent bed-sores. She was now however round the corner, her tongue cleared, and she could take a little simple food. She made a steady if slow recovery. She has had no rheumatism since, and though, from the bad summer and worse winter, she has got but little out of doors, and has not yet much power of walking, she now enjoys better health than she has had for years. She lost at least a stone and a half in weight, which is a great advantage to her, and which I advised her not to try to make up. She A SIMPLER LIFE 01 lives well on considerably less food than she took before her illness, and she is quite resolved to do so for the future ; and she requires no aperients. I tell her that I hope she will now live out her hundred years. I could give other cases of influenza quite as illustrative as the above. I have known the disease since 1837, when there was an epidemic which few escaped in Aberdeen, where I was a medical student. I have had my share of cases in most epidemics since. I have never treated them on the keeping-up plan, and I have had no occasion to regret it. The orthodox treatment has run the whole extent of the gamut since 1837. There are no doubt great differences both in the epidemics and in individual cases; but I have failed as yet to meet with any case for which I would consider an alcoholic stimulant necessary, unless it be where such an accident occurred as happened to the old lady whose case I have given somewhat in detail, and where I gave some doses of carbonate of 92 Pl&A FOR ammonia. In such a condition it is possible that a temporary fillip may help to bring the patient round a corner, but even for this I consider the ammonia preferable to alcohol. In this case too the collapse was undoubtedly brought on by an error in treatment. There is in most cases of influenza of the recent type a great and sudden depression and a feeling of intense weakness. But this is caused by the unknown poison. It is not of short duration, but may remain for many days, and a mere fillip is not what is required. Surely this depression cannot be relieved either by alcoholic stimulants, which notoriously lower all the chemical actions of the body, and are much more likely to prevent the elimination of the poison than to aid it, nor by food of any kind, which must use up some nervous energy in its digestion, and which, under the circum- stances, it is not likely to get. Anyhow I have used neither, but have trusted to hot water alone during the earlier days, and I have given little or no food till, from the state A SIMPLER LIFE 93 of the tongue, I could judge that its digestion was possible, and then in very small quantity. With this treatment I have not met with any case of an influenza patient suffering from ill- health for months or years from what is called the dregs of the disease. These are common enough, but I believe they are mostly or entirely due to giving any food in the early, and too much in the later stages and after- wards. CHAPTER III I HAVE as yet only attempted to lay a foundation for my 'plea for a simpler life,' the main object of this book. I have tried to show that when disease comes upon us, the means ordinarily used to restore us to health other than those which nature herself employs are mostly at best doubtful and uncertain, often injurious, and varying at different times, and I may add in different countries. I have pointed out that in a large pro- portion of cases what we call disease is the means adopted by nature for the cure, or, I may add, for the checking of some evil lurk- ing in the system, which, if allowed to go on, might lead to permanent impairment of PLEA FOR A SIMPLER LIFE 95 some of the important organs of the body or of their functions, or even to loss of life. If this is true, the inference is clear that some- thing has occurred, either suddenly, or since a longer or shorter period, which has led to the necessary interference on the part of nature. To point out what this something is, in the whole domain of medicine, is a very large order indeed ; and here there is room for the highest knowledge and skill that professional men are ever likely to attain to, and where these will always have their work^ and their reward. My object is a much humbler one, and is mainly to point out that the means com- monly adopted at the present day for the cure of a large part of the diseases which are commonly met with in our ordinary practice are precisely those which are them- selves, when used improperly, the main causes of these same diseases. I allude, of course, to food and stimulants, and these 96 PLEA FOR assisted by drugs to do their evil work un- observed. Food is essentially, as has often been pointed out, of two kinds. The one is that which, by slow combustion in the body, and mainly in the lungs, goes to the* production of heat. This is used up mostly in sustain- ing the heat of the body, but it is also, by some subtle chemical or other change which we do not know, converted into force, in the forms of muscular, nervous, and mental energy, and perhaps of electricity. This, which may be called the working food, is mostly carbonaceous, and includes all matters which burn in the fire, as sugar, starch, oily matters, and alcohol, which all burn readily and leave no residue. The other kind of food is what goes mainly to form and to keep up the body, and to supply its waste ; the essential element in its composition is nitro- gen. It will not burn in the fire, but is slowly consumed, leaving only a small quan- tity of mineral matter in the form of ash. A SIMPLER LIFE 97 This also assists in a minor degree in keep- ing up the heat of the body and in the pro- duction of energy, by a slow oxygenation in its passage through the body, which it leaves mostly through the kidneys. It is represented chiefly by animal flesh of all sorts. Other substances used as food are combinations of these two, and of these bread and milk are the most important ; but it includes all cereals, and the pea or lentil tribe, which are astonishingly rich in nitrogen. Vegetables belong mostly to the carbonaceous group, but vary much in composition, as also do fruits, which often contain little but water, with more or less sugar or some acid peculiar to the fruit itself. All foods contain some saline matters, varying much both in quan- tity and kind, but some of them absolutely necessary to the health or full development of the human body. The above is a very elementary and im- perfect history of the two forms of ordinary food, but it is enough for my present purpose. 9 8 PLEA FOR Of stimulants I need only'mention alcohol, wine, and beer, and these very shortly. That they are not necessary for life there can be no doubt whatever. Nature does not provide them ; they are artificial pro- ducts ; and how long man existed and pro- gressed without them we do not know. In large regions they are not used or are not to be had, and these regions lie in all parts of the world hot, cold, and temperate. The evils arising from them we all see and deplore, and any benefits they confer either in health or disease we have seen to be very doubtful. Fashion changes in regard to them much as with drugs. Formerly it was wine, then brandy, and now Scotch or Irish whisky. In India some thirty years ago the run was upon strong Burton beer. Now com- paratively little of this is exported, and its place is taken by lighter beers from this country and a much lighter country beer, or by light claret, and brandy and water or whisky and water. A SIMPLER LIFE 99 I will now consider in a general way how errors in food affect the healthy and induce disease ; or, in other words, render inter- ference necessary in order to prevent some greater evils. If a healthy person takes too much car- bonaceous food, the error sooner or later shows itself. For a time the excess is set aside in the form of fat ; and the discomforts from this, or still more frequently the change in the figure, attract attention, and, if the case be wisely treated, relief is got from less food and more exercise. Or the secretion in the liver of bile which contains so large an amount of carbon that it burns in the fire is unduly increased, the blood gets carbonised, langour and discomfort come on, appetite fails, and a chill, followed by irritation of the stomach, ends in a bilious attack. This, with the enforced starvation, it may be for several days, clears off the superabundant carbon, and leaves the sufferer in a healthy condition. The case is very different when the excess TOO PLEA FOR has been in animal food. This may go on for many years, even for what may be con- sidered a fair lifetime ; and, if the individual is of a sound constitution, and under favour- able circumstances, he may dispose of twice or thrice the quantity of flesh food that is re- quired by his system, and still retain his health to all appearance unimpaired. The kidneys, which eliminate with some little help from the skin all effete animal matters, will do double or three times their necessary work for an indefinite period ; and if life be cut short by accident, the case may be quoted as one of a remarkably healthy life, and the credit of this may be given to the full mode of living. But if not cut short by accident, and if there be no weak organ which may break down earlier, sooner or later, but long before what should be the natural span of a healthy life, ugly signs of disease un- expectedly manifest themselves, and the till now strong and healthy man is told that his case is hopeless and beyond the means of A SIMPLER LIFE 101 possible cure. Naturally the overworked kidneys are the first to give out, and failure on their part may prove fatal ; or the blood gets loaded with animal matters of which they fail to relieve it, and these are deposited in various organs in some in the form of fibrin, which by and by hardens, and destroys more or less their substance and their func- tions. A very common form of evil arising in this way is what is called general paralysis ; I never heard of this in my student days, and not till long after. No doubt cases occurred before and were known by a different name, but they were few, and their number has increased enormously during the last thirty years. The symptoms and pathological changes vary infinitely, according to the part of the nerve centres affected, and the stage of the disease. I cannot recall a case which was not that of a previously healthy indi- vidual, and who lived fully. What I wish mainly to draw attention to as to those two errors of excess is, that in the 102 PLEA FOR first nature interferes soon and sharply, and no permanent mischief is left ; and in the other, excellent health may be enjoyed for very many years, while all the time changes are going on which give no sign till the case is hopeless. In the great majority of cases of errors of food in quantity, the excess is of both kinds, carbonaceous and nitrogenous ; and no doubt there are very few healthy people who can afford it who do not usually exceed. Appe- tite seems to call us to enjoy it, and a ' healthy appetite ' is applauded by all, while a ' poor appetite ' meets with general re- probation, and any one who ' picks ' is looked on as a poor creature. If appetite threatens to fail there are plenty of ' pick-me-ups ' to have recourse to ; and if any discomfort is felt after a meal there are plenty of pills ready at hand to relieve it. Then as ' pre- vention is better than cure ' a wise saying if properly used the pill is taken before or with the meal, and all goes merrily, for a time. The A SIMPLER LIFE 103 blood-vessels of the stomach and the stomach itself get enlarged, and demand a larger supply of food to give satiety, a tonic is now needed and a stronger pill, then a stronger tonic, which by the bye seldom does any good ; but sooner or later dyspepsia comes on if no more serious ailment, with its innumer- able miseries ; for the nerves of the stomach when irritated seem to take a pleasure in worrying all the other nerves of the body. Innumerable 'remedies' are now available- pepsins, peptones, alkalies, acids, etc., all with the view of assisting digestion. Dys- pepsia is a mine of wealth to the doctor and the chemist, not forgetting the proprietors of patent medicines whose ' infallible cures ' are legion. The invalid may suffer for the rest of his life, and, as his spirits and temper are often none of the best, his misery is often shared by all who are about him. The ablest men in science, art, and literature seem to suffer most. It may be that their condition is only better known, from their 104 PLEA FOR lives being made public ; but in reading biographies I have often been saddened by occasional hints of sufferings brought on un- doubtedly by resisting natural laws, a resist- ance kept up till the very last days of life. The worst case of this I ever came across was that of a well-known public man, not so many years ago, whose case was watched by many as given in regular medical bulletins published in the daily papers. I pointed out, just a month after they began to appear, how the reports alternated in this way. For a few days they were despondent, as the patient was lower and could take no food. Then (after the abstinence) he improved, and satis- faction was expressed that the appetite had returned and that he could eat ; very soon appetite failed, and he was weaker. This went on for some four months, the strength however gradually failing. At length the case got hopeless and was acknowledged to be so, but still the attempt at feeding went on, and on the very last day of life A SIMPLER LIFE 105 food was pressed on the unwilling sufferer, even though it was immediately rejected. Here unfortunately the case is ended, and no other method can be tried. There is but one chance. If nature had been allowed to have her way, had the abundant material stored up in the body been left to do its own work, and little or nothing been added but a supply of plain water, the best diluent and eliminator, and with it, if considered neces- sary and if agreeable to the patient, more or less force-giving heat the only real stimul- ant I cannot but think that the result would have been very different. I am not orthodox enough (blasphemous enough ?) to believe that these sufferings are all sent by Provi- dence. An old man who has lived a natural life, and has reached his full time, has an in- finitely better chance of passing away with- out suffering, and without regret. I have seen both. In such badly treated cases in my opinion as the above, I cannot blame either the 106 PLEA FOR medical men or the friends of the sick. It is the bad system which guides the former, and anxiety to leave nothing undone that could benefit the loved one which influences the latter. It is only a little want of knowledge which unwittingly leads to so much suffering and death. To what degree this want of knowledge extends amongst the profession the following will tell. I was asked by a young friend to meet the headmaster and other teachers of a large educational establishment which shall be nameless. There were many boarders, who were treated generally and fed in the way followed in the leading English schools of the day. My friend, who was one of the teachers, had himself suffered when a boy from intense headache, and had got benefit from my advice ; and he knew well the evils which resulted to youths from too high feed- ing. I dined with the party; we had a friendly enough discussion, but I could not alter their opinion in the slightest degree. A year A SIMPLER LIFE 107 later I had occasion to see the headmaster again. After our business was finished he said to me, ' You will remember our talk, just a year ago, about the general mode of treating our boys, and especially about their food.' ' Perfectly,' I answered, 'and precious little I made of you.' ' That I allow,' he said ; ' but I know now that you are right, and I very much wish you could help us, but in the meantime we are helpless. It is the system known to the parents and expected of us. If, for instance, the boys do not get the best butcher meat, and as much as they wish every day, they can write to their parents ; they would- write to the directors ; and, in short, we must go on as we have done.' I said that I was much pleased to hear that he now agreed with me, and I hoped something better might come of it ; but that I should like very much to know what had made him change his views so completely, and in so short a time. He told me it was a very simple matter indeed. He had an older io8 PLEA FOR brother, an English clergyman, who for many years had suffered from rheumatic gout, and who went annually to one of the favourite baths in France or in Germany. He returned always somewhat improved in health, but he lost it all and more by the next season, and latterly he had been going fast downhill, and it looked as if he would soon not be able to go at all. Last year, since we had our conversation, he went to Germany, and he met at last an honest doctor, who, when he was leaving, said to him : ' What is the use of your coming here, or elsewhere, once a year to get washed out, and then going home and living in a way which absolutely destroys all the benefit and brings back all your ailments ? ' ' But what struck me most,' the headmaster added, ' was that he put my brother upon precisely the food you recom- mended for our boys, and that he has kept well since, and has had no occasion to return to Germany.' It was this that converted him. A SIMPLER LIFE 109 What I wish to notice specially here is, that the advice as to diet which the German doctor gave the clergyman was perfectly new to him. He had consulted medical men both in this country and abroad, but had got no warning from any of them. He at once saw the common sense of the advice, and was only too glad to follow it. Many, I know, would not have done so even had they been warned. For many years after giving up ordering drugs I sent patients to Germany for a course of baths, and saw great benefit in some cases where a more rational diet was adopted for the future. But too many others used the benefit they got only to .enable them to exceed again with some comfort for a time ; and in some the end certainly came sooner in consequence. I have a hope that a few who read this may be induced to follow the example of the old clergyman, and get the same benefit that he did. I am quite aware that in most work i io PLEA FOR which treat of such diseases as mentioned above, one cause of them always given is too rich living ; but I am not aware that I ever saw it given as the essential cause, and in practice it seems to be overlooked both by patient and doctor. The fear of ' letting the system run down ' seems to neutralise every other consideration. The evil principles as to diet which pre- vail in this country are, I fear, at least as dominant in the colonies and across the Atlantic. I have had some experience as to both, but can only afford room for the following. Four years ago I was crossing from New York to Glasgow. One day, on entering the smoking-room, I found a hot discussion going on as to the advantages or otherwise of tobacco. One elderly gentleman who had injured himself by its abuse was insisting that its effects were always bad, and that its use should not be allowed. I was appealed to as a medical man to decide between the A SIMPLER LIFE in parties. This I managed to do to the apparent satisfaction of both. I pointed out that tobacco is a natural product ; that it has come to be used in all parts of the globe where it can be got ; and that this fact alone surely indicated that it must have some quality which fitted it for man's use. Though no regular smoker myself, I had often found, when anxious or worried and worn out, that a very mild cigar had soothed me, and en- abled me to take a more hopeful view of what was troubling me. Of course I noticed the evils of excess, but added that every good thing is liable to abuse, and, as I always do when I have the opportunity, I spoke of the abuse of flesh food as doing perhaps more harm than all other evil habits together. This was a new doctrine to all, and we went into it pretty fully. By and by a youngish gentleman who had said nothing started up and, in a somewhat excited manner, said that I had exactly described his case ; that this was the turning-point of his life ; and that he H2 PLEA FOR would at once change his mode of living. 1 had noticed his pallid, 'seedy' look, and as he sat at a table near me I could not help seeing that he regularly, after a few days' sea-sick- ness, took for a little man, as he was, an enormous quantity of beef and mutton. He afterwards told me his history. He had been in his father's business, an important one, in one of the largest Canadian cities. So long as he could take it easily, and had plenty of out-of-door exercise, especially in hunting, he enjoyed the best of health. By and by he became a partner of the firm ; he was kept much more closely to the office and could get very little exercise. Soon his health failed, and he became utterly unfit for busi- ness. Four doctors, he said, had treated him with no good result, and he was sent off for a three months' holiday. I asked him why he took so much animal food. He said he felt so weak that he thought the more he could take the better, and he had never been warned against it. One of the medical men, A SIMPLER LIFE 113 he remembered, had said he was taking more food than was good for him under his circum- stances ; but he understood that the circum- stances ought to be changed and not the food. My observations in the smoking-room were, in fact, a revelation to him. He at once altered his diet both in quantity and quality, and after a week, when the voyage ended, he already felt much better, and there was some slight appearance of colour in his face. I heard from him a month later, when he wrote that he was very much better ; that his strength was returning, and that he could now walk five miles with ease ; and he thanked me warmly for having ' taught him how to live.' He visited me before returning home, and he certainly looked a very different man. Later I had a letter from him, in which he states : ' I am pleased to say that I am feel- ing splendid, and am holding fast to your method of living. In fact, I have not tasted butcher's meat half a dozen times since my return home, which is six months ago.' ii 4 PLEA FOR Another of the party who heard the con- versation in the smoking-room a Scotch clergyman also adopted a different mode of living, and, as he told me, with great ad- vantage to himself and family. To him also the doctrine was a new one. How many there must be who ' perish for lack of knowledge ! ' So much for the evils arising from abuse of food, especially of animal food ; I have no doubt I will be told that all that I have here brought forward has been preached and published times without number, not only by vegetarians, homeopaths, etc., but also by members of the profession. This is no doubt true, and it is well that it is so. I am pleased to know that I am not the only black sheep in the fold ; and I trust their number will increase, and that they will put themselves in evidence more and more. I have no wish to monopolise the fighting, and will be glad to pass it on to younger hands. Much is to be hoped from the work of medi- SIMPLER LIFE 115 cal scientists, among whom there are many eminent workers and searchers after truth. I am not sure that practical medicine has as yet been much assisted by their labours. A genuine medical fact is about the most diffi- cult fact to establish, so that it may be use- fully and safely acted on. It has to deal with such complexities of chemical and physio- logical and vital changes within the body acting and reacting on each other, and these affected by temperament, heredity, idiosyn- crasies, and external surroundings, that a final and reliable determination is always difficult and often impossible. Medicine as a fixed science does not as yet exist. But the work of medical scientists in many different lines, if it has not as yet done much to help forward the practical treatment of disease, has at least shown the uselessness (or worse) of some medicines or methods hitherto in repute. One of the most interest- ing of these is seen in the recent investiga- tions of Dr. A. Haig, which go to prove the u6 PLEA FOR effects of uric acid in the blood in destroying its coloured globules, and thus inducing anaemia, for which good ' red meat ' has hitherto been considered the fittest cure. In experimenting on himself to try to ascertain the action on the blood of uric acid taken into the stomach, he took a certain quantity of beef-tea as an equivalent for a certain number of grains of the acid. He shows also that iron is useless so long as it is given with red meat, and he thus accounts for its failure in many cases. I long ago came to the same conclusions, but could not give the same scientific reason. Perhaps the most white-faced family I ever saw was one of six, in South America, who had at least two full meals daily of beef and mutton. The only exception was the baby, which was still at the breast and which was a fine rosy child. The parents were Scotch. They lived in the country, in a fine airy house, and about the last thing one would expect to see there was anaemia in any form. A SIMPLER LIFE 117 In the British Medical Journal, 3ist March 1894, is a review of the last work on Skin Diseases by Dr. H. Tenneson of the Hopital St. Louis, Paris. Dr. Tenneson's views on eczema are specially noticed, and they are virtually those which I have held for forty years. As to medicines in this disease, he says that several are injurious, none are useful. As to food he says : ' Many people, because they have a good appetite, think they have a good stomach ; and manu- facture daily in their overloaded digestive tracts toxic substances, which, after they are absorbed, excite abnormal effects both on the skin and all the other organs of the body.' His rule therefore as to food is simply restrict- ing the quantity, particularly at the mid-day meal. His local treatment is allowing or provoking the oozing as long as possible, and he finds that the soothing ointments used owe their value solely to the lard with which they are made. I have constantly pointed out to my patients that eczema is a natural u8 PLEA FOR relief to the system, as it throws out safely on the skin some of the excess of plastic matter in the blood, which it cannot dispose of in the natural way through the kidneys. The next safest exit for this material is by the mucous surface of the throat and larynx and bronchia ; and the amount excreted from them in cases of chronic bronchitis, which are so common in gouty and rheumatic subjects, is sometimes very great. The phlegm coughed up is not mere watery fluid, but is more or less pure animal matter, as may be seen by putting it into spirit, when, like white of egg, it gets solid. Unfortunately both these skin and mucous exudations are treated as diseases per se, and are checked if possible. Surely it is better to allow the excess of material to escape from the blood in this way (if we do not cut down the excess of food which produces it) than to force the blood to relieve itself by depositing it in deeper and more important organs, as the A SIMPLER LIFE 119 liver, the nerve centres, or the heart. As the product of these exudations is purely nitro- genous, I would blame excess of flesh food as their cause ; and as Dr. Tenneson says that it is the mid-day meal which specially requires reduction, and as this is in France the chief flesh meal of the day, we may be practically at one. But nature clearly throws off the exces- sive plastic matter from the blood clean and unchanged, and I do not see the necessity for the previous formation of toxic matters from the intestines, at least not in the cases we have been considering. There is much, therefore, to be hoped from the progress of science. But its influence on practical medicine has been long in coming, and unfortunately hitherto one scientist has but too often only overthrown the conclusions of another. Is not this after all the ordinary way by which truth is reached ? The evils of food excess are much aggra- vated if at the same time alcohol is taken, even in very moderate quantity. This follows 120 PLEA FOR from what we now know from the researches of Sir B. W. Richardson. He was, I believe, the first to prove that the presence of alcohol in the body hinders all the chemical actions going on there, exactly as it stops or modifies fermentation in a barrel of wine or beer. In both it retards oxygenation, and lowers the heat. Hence its use in cases of fever, or where it is given in extreme cases when the temperature threatens to rise to a dangerous height. In cases where very little food is habitually taken, it may do little harm, as it lessens the waste of the body, and to a small extent acts as a true food. A Highlander frequently takes as much whisky as would render most persons useless, but living as he often does on a very small amount of oatmeal or potatoes and a little milk, he may do a good day's work if not too severe, and he may live to a long life. I was told by one of the first financiers in Scotland, that such a life about the age of sixty is a much better one on which to buy an annuity, than that of A SIMPLER LIFE 121 a well-fed Yorkshire teetotaler of the same age. Had the drinking Highlander been also well fed, or had the well-fed Yorkshire- man indulged in alcohol in any form, neither of the two was likely ever to have reached the age of sixty ; but after sixty the average life of the Highlander was appreciably longer than that of the Yorkshireman, and therefore more valuable for the financier's purpose. What is heterodox in me was much grati- fied, now many years ago, by the somewhat unprofessional appearance in the Times of a letter from the first of our surgeons in his own line, Sir Henry Thompson. I have not a copy of the letter, but it took a strong hold on my memory and was to the following effect. He wrote, that after a large practice for twenty years among rich and poor, he felt constrained to publish as his strong conviction, that the main cause of the terrible sufferings he had to treat was the glass or two of wine which so many of his patients had been in the habit of taking daily. This was no new idea 122 PLEA FOR to me, only it told me that these very moderate drinkers were also well fed, a matter which, for the time, Sir Henry seems to have over- looked. Some years later he published an excellent book on diet. In the second volume he gave menus for dinners, which were admirably adapted to assist a weakened stomach to digest with comfort what is generally considered as a fair amount of food, and which it could not do if the food was presented to it, in a more gross, or to speak politely, in a less scientific form. But still later by some years Sir Henry published a paper in one of the monthly magazines, with almost every line of which I could cordially agree. He pointed out in a very graphic manner the evils that arise from too much food, and that it is our teeth, and later in life our artificial teeth, that cause us so much misery, and bring so many to an untimely grave. I have been very much indebted to this paper, and have often fallen back on it when put on the defensive. I wish we had A SIMPLER LIFE 123 such another from one of the first-class London physicians. At one time I had hopes of it, but the eminent doctor I allude to got into Punch as the ' starving physician,' a name I have long been rather proud of. Perhaps this had nothing to do with it, but to the end of his life I have known nothing to throw any doubt on his thorough ortho- doxy. A ' starving doctor ' would not, I fear, have as yet a very long career as a fashionable and popular physician in London. If the evils of high living are bad for the adult, they are still worse for the young, and not only from a physical but from a moral standpoint. For the growing youth until he reaches his full development a larger pro- portion of nitrogenous food is required, and this nature provides in milk, the most perfect food that exists, and which supplies all that is wanted for the sustenance and growth of a healthy body, flesh and bone. I have only 124 PLEA FOR met with one case where the child, on leaving its mother, could not take cow's milk or any other ; but I have known some and heard of others who lived on milk for years, in one case for thirty years, and enjoyed the best of health. After weaning, cereals in various forms, eggs, and soups from chickens and young animals should be, along with milk, the ordinary food for some years, when a moderate allowance of flesh from the same young animals or from fish may be added. The only error I should like to notice, in the early steps of a child's life, arises from the dislike of most to give water. A child when feverish from any cause, as a chill, teething, etc., has often a desire for fluid, which it manages easily to express in its own way. But in a vast majority of cases, according to my experience, unless this is much changed during the last fifteen years, the only drink allowed is the ordinary food, possibly in some cases somewhat more diluted. This the stomach by and by rejects, and the case from A SIMPLER LIFE 125 this cause alone may get serious. An ex- treme case will illustrate my meaning. I was called to see a child about eighteen months to two years of age. It had been left in the charge of two elderly aunts, the parents being missionaries in India. I found the child in a very precarious condition. Nothing would remain on its stomach ; its extremities were cold and shrivelled, the stomach hot and distended. The eye had a peculiar, glistening, eager look, which at once told me it wanted something. I asked if they had given any water. Mistaking my meaning, and perhaps fearing a reprimand they said no, but immediately added that they had given a very little, but they had boiled it first. I asked for a jug of cold water and a tumbler. I shall never forget the eagerness with which the child eyed the water, and grasped the tumbler. To the bewilderment of the aunts it drank the whole to the last drop. It all returned in a few minutes, con- siderably heated. Another tumbler was 126 PLEA FOR given, and another and another. These were returned after somewhat lengthening periods, but the fifth remained. Already the heat of the stomach was gone, the extremities were warmer and beginning to fill up. The eager glistening look was changed into a calm placid one, the fever disappeared as if by magic, and the child was soon in a quiet and natural sleep. The cure, in fact, was complete. The aunts said it was a miracle, but I told them it was only a case of common sense. I have rarely felt such well-justified anger, and I fear I did not try to conceal it. As this is the only occasion I will have to allude to the earliest period of life, I will shortly notice the mischief which may arise from beginning to give aperient medicine. The first milk of all animals has an aperient tendency, and this is sufficient. Sir James Simpson used to say that if nature had required anything more it would have been provided. But in my day nurses considered it as part of their duty to give castor oil very A SIMPLER LIFE 127 soon after the infant was born, and in Hints to Mothers by first-class accoucheurs it was laid down as a rule that the bowels must be moved once a day ; in one well-known little volume it was twice a day. The worst case I ever saw of a large mass collected in the bowel was in a child who got medicine daily, the result being always a liquid motion. I very rarely gave any medicine at all, and on one occasion I was very unexpectedly pulled up when I did so. An excellent nurse had come to a family I looked after from a doctor's family, where the children were dosed in the orthodox fashion. She took very badly with the new system, and the mother told me several times of the trouble she had in preventing her from doing what she honestly believed to be part of her duty. Time passed, and one day I was asked to see one of the children. To gratify the nurse, I fear, and to show her that I was not absolutely incorrigible, I said she might give a small dose of castor oil. But I had miscal- 128 PLEA FOR culated the power of observation of the nurse and her common sense. She told me next morning that the child was all right, but that she had not given the oil. The terrible evils that are seen in later life from the unnecessary use of medicine in infancy must be my excuse for giving the two cases which follow. I could give many others. Owing to the death of the family adviser I was asked to see a girl of some ten or twelve years of age, the niece of a very old medical friend in Edinburgh. She had been treated in true orthodox fashion, but it had been found necessary to give her stronger and stronger physic, till now she was daily getting pills of the strongest kind, and such as are only used by strong men. Her health was suffering, and her education was inter- fered with. With very much trouble, by using milder means and fitting diet, after two years she got rid of all medicine, and a year or two later she went to school in A SIMPLER LIFE 129 London. She kept quite well for three months, when influenza broke out in the school, which unfortunately she did not escape. The doctor, one of the first in London, of course began her cure" with a dose of medicine. This started again the evil habit which with such difficulty she had got rid of; and after three months more she returned with her box of strong pills in much the same state as when I first saw her. I now failed to cure her. This happened fully twenty-five years ago. She has had wretched health ever since, and has tried many doctors and cures in this country and abroad. The only time that she has been in a natural con- dition, her uncle told me, was after an attack of typhoid fever, which she caught on the Continent. I do not blame the London phy- sician. Every one would have done the same. Much about the same time I saw a child of about three years of age under precisely similar circumstances, but already suffering to a much greater degree. She had to get 1 30 PLEA FOR strong medicine every day, and she suffered tortures from its effects. I tried milder measures with no result ; she was going down rapidly, and she was evidently dying. I gave up all physic, and told the nurse to use mechanical means only for her relief. She found that this was impossible ; the poor thing was locally so tender that even touch- ing her risked bringing on a fit. The only thing to be done was to leave her entirely to nature. At once she began to improve. The bowels moved naturally every twelve or four- teen days. The suffering then was great, but not more so than was the daily suffering previously, and she had time to recover in the intervals. She soon recovered her health. After some years the intervals gradually shortened, and the last time I heard of her she was natural in every way and enjoyed the best of health. Let us return to errors in food, and first, as to their effect on the healthy and from a physical point of view. A SIMPLER LIFE 131 Space will not allow me to consider the evils of too little food. In a country like ours this is frequently bad food, and got and eaten with more or less irregularity as to time. This naturally can be best studied in infirmaries and hospitals for the sick, where rest and warmth may be often helped by a moderate supply of good food, and possibly sometimes even of stimulants. But these cases of real debility from want differ pro- digiously from cases we meet with elsewhere, where debility, perhaps much greater and requiring very different treatment, arises from an entirely opposite cause, viz. failure of the digestive organs, from long overwork in dis- posing of more food than it was possible to make a right use of. In these cases a long period of clearing out is needed before the organs can be usefully employed for again building up the system in a wholesome manner. This may be done quickly by a fever or other acute illness, which, if it does not kill the patient, very soon burns off the 132 PLEA FOR offending matters, although, as we see in cases of influenza, the benefit may be lost by a foolish system of feeding and stimulating, both during and still more after the illness. If this rapid method of cure is not available, it may be reached much more slowly by failure of appetite coming on, or perhaps some of the more acute forms of dyspepsia. If these are allowed to effect their work of elimination by a more or less protracted process of starvation, all may come right. But if the lowering of the system letting it get ' under par ' is the favourite phrase is looked upon as the evil, and if the object aimed at is to get the stomach to do more and better work by the help of some of the innumerable ' remedies ' of the present day, some temporary relief may be got, but a real permanent cure, I believe, never. This, in my experience, is one, per- haps the chief, cause of those chronic illnesses which are, and very properly, considered as the opprobria of the profession. Is it possible that the love of modern A SIMPLER LIFE 133 physicians for good feeding and stimulants may have some connection with the source whence they get most or all their teaching and their experience ? Teachers, the favourite ones, are often clever young men, well up in science, but who have never had any outside experience ; and in England at least such youths start at once as full-blown consultants, by virtue of their degree alone. I am old- fashioned enough to think that apprenticeship under a good master is not a bad introduction to general practice, and that eminence gained as a general practitioner is a good preparation for a consulting physician. I could give some strange illustrations of this, but I for- bear. In my young days, in the Twenties and Thirties, the food of the working-man, and also of most of the upper classes, was simple and good. It consisted mostly of milk, eggs, fish, oatmeal, potatoes, and a few other vege- tables. There was no baker nor butcher in the parish, and there was no doctor within 134 PLEA FOR five miles, and as his fee was \ he was rarely wanted ; the clergyman was the ordinary medical adviser. On one occasion typhus fever broke out in a fishing village. There were twenty cases ; only one of these could afford to get a regular doctor, and his was the only case which proved fatal. The others were, I suppose, left very much to nature. Yeast was the only ' remedy ' that was given, and it got the credit of pulling them through. The sanitary state of the houses was worse than now, and croup and a peculiar local form of ague were no doubt due to a want of drainage of the fields. But with the good food which I have just mentioned there was not much general sickness. It supplied all the wants of the body in a per- fect manner, and gave no great temptation to excess. By and by times changed, and white bread and flesh came into general use. Along with these luxuries came the doctor, although owing to railway facilities he is no longer located in the district. From A SIMPLER LIFE 135 what I find on occasional visits I am not at all sure that the general health is improved ; indeed, I doubt it very much. One fact at least is certain that the doctor is much more required than formerly. The improved sani- tary conditions alone should have led to a healthier state of the community. Is it wicked in me to suggest that perhaps the changes from the simpler to a fuller mode of living may have helped to neutralise those undoubted advantages ? A very large element of the diet both of young and old nowadays is white bread and butcher's meat. I have often pointed out that both are very insufficient foods, especially for the growing child and youth. In the oat, which is now too costly for the poor, and which requires cooking at home, the phosphates essential for the growth of the bony skeleton pervade the whole grain. In wheat it is mostly confined to the outer skin, and as this is entirely removed for the sake of appearance, there is little or nothing in the white loaf of I 3 6 PLEA FOR bony matter. It is the same with flesh. The animal makes a perfect body from despised vegetable matter pure and simple, but the phosphates go to form the skeleton, and in the muscle, which we eat, they are conspicuous by their absence. The want is most im- perfectly made up by chemical phosphates, which have come much into use in recent years, and which, no doubt, have helped the purses of the chemists who manufacture them, and of the doctor who very properly, under the circumstances, prescribes them. Had nature been allowed her way, neither chemist nor doctor would have been needed. In youth, as I have already said, a due supply of nitrogenous food is required to build up the body, in addition to what is wanted to supply what is lost by its ordinary waste. The waste varies considerably with the amount of exercise or work. A certain amount of exercise is needed in order to keep the system in a perfect condition of health, and if less work is done than usual less food A SIMPLER LIFE 137 should be taken. This, however, is a rule which is very often overlooked, although it appears so simple. I have occasionally been consulted by gentlemen in apparent good health, but who complained of being quite ' out of sorts,' and who said they -never felt really well except when hunting or shooting or taking strong exercise of some sort. On asking them, they told me they went on taking the same amount of food whether they were active or idle ; and on more close inquiry I found their diet was a very full one at all times. They, of course, most of them, took medicine, but they did not find that sufficient. It had not occurred to them to reduce their diet, and they wanted some prescription to help them. I always pointed out the risks they were running, and simply recommended a more rational diet. To assist them I advised them to take their food more slowly, and assured them that they would find that less would satisfy them ; 138 PLEA FOR and this if carried out will often enable a man to reduce his food by one-half, and will add very much to his comfort and health. I have frequently had Mr. Brassey's experience cast up to me. He got excellent work from his English navvies ; but on ex- tending his contracts to the Continent, he found that the poorly-fed natives could not do the same work till he got them to use the same food. This was triumphantly put to me as a sure proof that a man is a better man when he is well-fed. ' Undoubtedly,' I replied ; ' the man is a better man for Mr. Brassey, but what about the man himself? A navvy is worn out by the time he is forty, and a navvy at forty-five is scarcely known." This fact I had full forty years ago from a Dunfermline doctor, a large part of whose practice was among navvies. This was an argument new to my opponents, but it was always sufficient. In more advanced life, and in old age, a simple and restricted diet is even more A SIMPLER LIFE 139 necessary than before. The natural loss of teeth gives a good hint that the more solid articles of food should be withdrawn. Arti- ficial teeth are of obvious use in other ways, but it is here that Sir H. Thompson's saying about the grave being dug by the teeth mainly comes in. The digestive organs get weak with the rest of the body, and the com- parative rest which age entails lessens the demand for food, both for the production of motive and other force, and for replacing the waste of the body ; and the heat of the body can be partly kept up by external warmth. Stimulants do even more mischief than for- merly. It is a common remark that cold weather kills old people, and it is a true one. But I was far more afraid of this when the friends insisted on giving the old a regular allowance of wine, in the belief that this would help to keep them alive. The fallacy of this is apparent. The glass of wine may give a fillip for the moment, but it only lasts at the most for half an hour. No fact has 140 PLEA FOR been better proved than this. To be of any use it should therefore be repeated twice every hour. This is of course absurd. After the little excitement is over there is naturally a slight reaction, and this is the time, when the system is really ' below par,' that the cold produces its fatal action. But, apart from cold, there is a very common idea and this is shared in by the profession that old people who may have taken no stimulant hitherto require it, or, at least, are better for it as they get old and frail. There can be no greater mistake. I always recommended my elderly friends, even those who had been accustomed to take alcohol in some form all their days, to stop it, whether at once or gradually it did not much matter, and I have never seen any harm result. On the contrary, the effect has been always good and has been acknowledged to be so both by the patient and by friends. The desire, if any, soon passes off, as does that, sooner or later, A SIMPLER LIFE 141 which has been brought on by any other bad habit. I have seen such undoubted prolongation of life, both in middle and in what is usually held as old age, by changing to a simpler mode of living from one very much the reverse, that I came to the conclusion that with fairplay from the commencement the ordinary life of man should reach one hundred years. This would only apply to those born with a sound constitution. From the errors of our parents, and perhaps of theirs, many are born into the world under very unfavour- able circumstances, and it might require proper living for some generations to restore a family to a natural condition of health. To expect that this may ever happen is, I fear, quite Utopian ; and nature usually cuts the knot in a more speedy fashion by extinguish- ing the family altogether. I was pleased to notice recently that Sir B. W. Richardson, working on other lines, viz. by comparing the period of full development of animals 1 42 PLEA FOR with their average length of life, and this with the same data in man, has come to the conclusion that the natural life of man is one hundred and five years. If this be true there must be a terrible fault somewhere, as the estimate exceeds the reality by more than one-half. Instinct seems to do for animals what reason, assisted (or hindered ?) by the resources of civilisation, does not do for man. There is no proof that in the early ages of mankind life was longer than now, or that it is so now among tribes living in a state of nature. If life is to be prolonged, therefore, man must work out his own salvation, and perhaps it is true here also that perfection cometh through suffering. In my more orthodox days I used to point out that our antediluvian ancestors who lived such long lives were vegetarians. I also pointed out as a proof that animal diet gives a desire for strong drink, that the first thing we read of Noah, after permission was given to eat flesh, was that he was drunk. The A SIMPLER LIFE 143 critics have deprived me of these argu- ments. CONCLUSION On the subject of the moral effects of high living, especially on the young, I do not enter ; it does not come within the scope of this work. But it is notorious that the morals of the country have not improved during the last half-century ; and this may be taken along with the Scriptural statement that ' Strong meat belongeth to them that are of full age.' To keep to the physical side of the question, we have also Paul's apt and terse statement : ' They that strive for the mastery are temperate in all things.' A very old friend, well known as the best shot of his day, gave me the credit of his son being the first champion of England. This was from my having got him, at any rate when shooting, to carry out this ' temperance in all things.' Two other volunteer friends, who were fortunate in competitions, also 144 PLEA POR ascribed their success to their having followed my recommendations. This was long ago ; but I am told that it is now well known that high living is fatal to good shooting. In the pleas I have advanced for a simple life so far as food is concerned I have pur- posely abstained from giving any fixed rules. Much must be left to oneself, or to those in authority. A long experience bears me out in this. A mistake made and felt tells more than any argument. In some cases strict rules must be given by a medical adviser when he knows that a general rule will not be attended to. But, on the whole, they are better omitted, especially in cases of disease, when the state of the patient may vary from hour to hour. What I would mainly urge is that, when any amount of food can be had, the risk of taking too much is much greater than the risk of taking too little. If this were only known and acted on the change would be very great and very A SIMPLER LIFE 145 salutary. Another simple rule is to eat slowly. This acts beneficially in two ways. It mixes the food better with the saliva, thus promoting digestion ; and it satiates the appetite sooner, so that less food is taken. Less food should be taken or none at all when one is worried or anxious, or when en- gaged in any severe mental work. There is in these conditions little or no nervous energy to spare for the stomach. I came long ago in the course of reading on three celebrated men who, when engaged in work- ing out some great problem in science or war, took actually no food till the strain was over. They were Sir Isaac Newton, Napoleon, and the Duke of Wellington. The latter was always a careful eater. The late General Crockett, who was with him in the Peninsula, told me that, often when a long menu was presented to him, he would run his finger down it till he came to the pudding, which he would order and dine 146 PLEA FOR upon. In a recent American work on Edison, I find that he follows the same rule as the other great men, and sometimes en- forces it on his assistants by locking them with himself into a room or workshop till the job (some difficult one) is completed. I had the pleasure once in Edinburgh of dining with the late Sir Erskine May. Our host was an English clergyman pretty far gone in phthisis, whom I had difficulty in getting to reduce the full diet which he had been ordered in the South. Sir Erskine had just finished a long session in the House of Commons, where he was perhaps the busiest man. He seemed to be in the best of health, and he looked more like a healthy English farmer than an over-worked clerk of Parlia- ment. I could not help asking him how he kept his health so well with such an amount of anxious work, and with such long hours. He told me that his rule was, while the House was sitting, to take a chop in the middle of the day, and only a cup of tea at night. He A SIMPLER LIFE 14? added that Lord Palmerston followed the same plan, though on an occasion he could enjoy a very full dinner. Our host stared, and I had less difficulty with him as to food afterwards ; the plain narration had more influence than a thousand arguments. If, when in good health, we took only the food necessary for our comfort and for our work and no more, instead of working the stomach to the utmost, and helping it when it flags by dainties, as well as by drugs and stimulants, we would have much more pleasure from our meals, and a much longer continuance of strength and health. We would also escape many of the ills that life is said to be heir to ; or, should some disease perchance come upon us, if we could eliminate from the old system of cure a large amount of the depletion, and from the new a still larger amount of the feeding and physicking, we would come nearer to nature's mode of preventing and curing diseases ; we would find that prevention would be far the larger 148 PLEA FOR element of the two, and that the need for the other would be wellnigh extinguished. But the physician need not as yet have much fear for his craft. The Archbishop of Cambrai put into the mouth of his wise Nestor that the time will surely come when we will be ashamed to be sick, the causes being our own indiscretions and ignorance. That was two hundred years ago, and as yet there is no sign of the prophecy being nearer its fulfilment. Changes for good come very slowly, and with much back falling and opposition. The way to life is narrow, the other way is broad ; and few walk in the one, and many in the other. Whatever our beliefs regarding a future life, we might be more careful of the present which we most certainly possess, and more readily adopt the simpler ways which lead to its being both longer and happier ; we might seek truth and follow after righteousness for their own sake, and with no thought of reward, and no fear of punishment ; and lastly, we A SIMPLER LIFE _ 149 might use the increased means which the simpler life would afford us to show a more helpful sympathy with the fallen, who, often from no fault of their own, but from their birth and surroundings, are doomed to a life of degradation, misery, vice, and crime. I offer no apology for the free use I have made of the personal pronoun in these pages. Had I not done this, I could not have said what I wished to say ; and so I will take for my ' finis ' the hopeful motto of my family, of which I have for fifteen years been the oldest member 'VERITAS VINCIT' FADS OF AN OLD PHYSICIAN PREFACE I HAVE frequently been asked by readers of my ' Plea for a Simpler Life ' for more details regarding matters treated in the volume. Some of these details were given in an appendix written at the time and intended to be issued with the text, but it was omitted for what were thought to be sufficient rea- sons. This appendix forms the basis of the present volume ; and I have taken the opportunity to give to the public and the profession my views on some other matters of general interest to both, bearing more or less directly on the prevention and treatment of disease in a simpler way than is generally followed in this country. vi FADS OF AN OLD PHYSICIAN In the preface to the 'Plea' I ventured to speak somewhat defiantly of the criticisms which I expected would follow its publica- tion. This I have found to have been an unnecessary precaution, as the volume though in many respects opposed to the ruling ideas of the day both as to principles and practice has met with no hostile criti- cism whatever, although its reception by the public has been such as is seldom given to an unknown writer. On the contrary, it has been favourably reviewed by most of the leading papers and by several of the medical journals ; and some of the older heads of the profession, both physicians and teachers, in this country and in America, have written to signify their approval of my attempt to simplify the teaching and the practice of medicine. As yet, however, I can see no signs of improvement. During the last twelve months I have come across instances PREFACE vii of such gross maltreatment as I never before met with or even heard of. At the same time I am constantly told that there has been a vast improvement, and that there is no such physicking, feeding, and stimulating as there was some twenty or thirty years ago. I sincerely hope that it is so, but I can see no proof of it whatever, and I wish much that some of the younger members of the profession would point out to the public what are the principles by which they are guided in treating their patients. Not many months ago a mother came to tell me how her son, who was said to be suffering from an enlarged stomach, was being treated by the family doctor under the direction of a leading consulting physician. Into this enlarged stomach there daily passed a pound and a half of pounded beef, a pound of fish, two large meals of revelenta quantity not known exactly, but a packet which cost us. viii FADS OF AN OLD PHYSICIAN lasted about a fortnight one large meal of Danger's Food made with strong meat stock, six to eight tumblers of milk, with part of which the revelenta was prepared, coffee, and during the night biscuits. To get this into a stomach an enlarged one was pos- sible ; to digest it from day to day was a different matter ; but science now came in, in the form of the stomach-pump, which was used every night to get rid of the fermenting mass and to wash out the unhappy organ. This had gone on for the last five months ; the youth was still able to go about, and even to do a little business. Was this a new form of homeopathy, only going from the extreme of infinitesimals to an extreme of quantities, a big stomach to be relieved by extreme repletion? My theory is that the quantity of food was so enormous that it had not time to get very acrid and intoler- able before it was removed ; and this would PREFACE ix also explain how that during the night, when pain came on in the emptied stomach (no doubt from acid poured into it from the blood), biscuits were given to dilute the acid secretion and render it less intolerable. The youth did not seem much the worse for this strange cure. I should like much to hear what was expected from the treatment ; and if it was only an experiment I doubt if it will be often repeated with the same immunity. Once I was threatened with the law for leav- ing an old gentleman to get well in his warm bed without food or physic, and he did not disappoint me. I would not have taken the hint so calmly had I been acting contrary to nature and to common sense, as in the case I have mentioned. I could not have credited the story had I not got it at first hand. The knowledge that such cases for this is not the only one are possible in the present day, will explain if it does not excuse x FADS OF AN OLD PHYSICIAN some plain speaking in the following pages. Most of my peculiar ideas have been looked on and spoken of as ' Fads ' by my medical friends. I do not object to the word, as I have noticed that the faddist not infrequently gains the day in the long run. It is therefore in a hopeful spirit that I have adopted the word in the title of this volume. G. S. K. CURRIE, MIDLOTHIAN, January 1897. CONTENTS PAGE PREFACE . . . . . . v 1. ON SO-CALLED 'STARVING' . . I. 2. THREE DIFFERENT METHODS FOR PRESERVING AND REGAINING HEALTH . .- . . . 10 3. ON STIMULANTS . . . . . 35 4. ON SELF-MASSAGE . . . ... 47 5. ON HOT WATER ..... 65 6. ON LIQUORICE . . . . . -77 7. ON CANCER . . r . . .82 8. RELIEF OF PAIN AND SLEEPLESSNESS . . "97 9. ON RHEUMATIC FEVER .... 109 10. HOW ONE SHOULD LIVE IN A HOT CLIMATE . Il6 11. ON MATTERS WHICH RETARD DIGESTION AND PRE- VENT WASTE . . . . . .124 xii FADS OF AN OLD PHYSICIAN PAGE 12. ON NATURAL CRAVINGS AND DISLIKES . . 130 13. THE RESPONSIBILITIES OF HEALTH . . . 141 14. THE EFFECTS OF HIGH LIVING _ ON THE MORALS OF THE YOUNG . . . . . .154 15. MY TEACHERS ... 160 SO-CALLED 'STARVING' I HAVE frequently in my ' Plea for a Simpler Life ' spoken of starving, and of being rather pleased with the name often applied to me of a 'starving doctor.' I never, of course, allowed that my treatment was a starving one in the ordinary sense of the word, and frequently was able to prove that it was exactly the contrary. I had to work with the stomach as I found it, and that was often in a weaker condition and less fit for work than any other organ of the body ; very often because it had been specially overtaxed in a vain attempt to 'keep up the system.' I have sometimes said to ignorant intruders who were urging me to give food to their " i 2 FADS OF AN OLD PHYSICIAN weak friends, that I would gladly do so if, in the first place, they would kindly provide them with fresh stomachs. Here the infalli- bility of inexperience and of ignorance comes in very strongly, and with much evil to the patient, as well as worry to the prudent doctor. A case or two will bring out the force of these remarks better than any argument. A lady came to Edinburgh from Ceylon, suffering from that very serious disorder, tropical diarrhoea. She saw several medical men, but with no benefit, and she went to die quietly in the country, in the house of a friend formerly a colonel in one of the Ceylon regiments. This gentleman and his wife had got benefit from my treatment some years previously, and, on finding that I had not seen his friend, he insisted that she should return to Edinburgh and try if I could do something for her. I found her reduced to an extreme degree. She was taking a large quantity of food and stimulant, SO-CALLED ' STARVING' 3 which all passed through her in the usual form it assumes in such cases, but clearly with no benefit to the patient, as she was gradually losing what little strength and flesh she re- tained. I was shown a great bundle of pre- scriptions I only once saw a larger which had been given for her relief. Everything that drugs or food could do had been tried already by some of the best of our doctors, and had failed. This I pointed out to the friends, and it helped me very much in aban- doning all attempts of relief on these lines. I felt very hopeless of being able to do better than the others. Shortly before I had read of a Russian cure for extreme cases, called the 'skim-milk cure,' and as it exactly carried out my views I was glad to try it. I advised that all drugs and stimulants should be at once stopped, and that the only food given should be an ordinary wine-glassful of skim milk three times in the twenty-four hours. This was the Russian cure. To this, as she was so excessively low, I added a minute 4 FADS OF AN OLD PHYSICIAN quantity of extract of malt, also thrice a day in the intervals of the milk. This, with hot water, was literally all she got. In a week the diarrhoea quite left her, and she had even got a little stronger. I then left her in charge of my brother, long my colleague, and when I returned after a six weeks' holiday I found her, I may say, quite well. Some years later I was called to look after a lady for a medical friend who had to leave town for a time. She was dying from old heart-disease, with general dropsy of the body. She suffered terribly in breathing, and could only sit in her chair, lying down bringing on suffocation. Sir Robert Christi- son had seen her, and the case was looked on as hopeless. I was told that milk treatment had already been tried, and had failed. On inquiry I found that it had been given in considerable quantity. She was now taking what concentrated food she could, and a fair amount of wine. With great diffi- culty I got the lady to try the milk again, SO-CALLED ' STAR VING ' ; 5 but in the same quantities as in the former case ; she was very unwilling to give up the wine, as she felt some momentary relief from it. At last, as her only hope, she agreed to give it up and try my plan. Except three small glasses of skim milk a day, and hot water, she had literally no other sustenance. But she soon rallied, was able to lie down comfortably, and by and by to take some food. She made a rapid recovery, and she died several years afterwards from blocking of the arteries of the lower extremities, probably from a clot which had formed in the heart. Knowing as I did, from long experience, that I could starve my patients to a good purpose even in such extreme cases as the above, the name so freely bestowed on me gave me very little trouble and did me no harm. Sir J. Simpson used to say that abuse did one as much good as praise, sometimes more. Milk is perhaps the best of all foods, but it too may be abused. Returning once from 6 FADS OF AN OLD PHYSICIAN a professional visit to the West, I met in the railway carriage an oldish baronet on his way to Edinburgh to see his doctor. I was told he was sure to tell me of his case, as he knew I would be in the train. He soon told me all about himself. He was suffering from his stomach, and had tried many cures ; he was now living solely on milk, of which, he said, to my horror, he was taking fourteen tumblers a day by his doctor's orders. He was almost skin and bone. At Stirling he went out, and on returning was very angry, as he could only get one tumbler of milk instead of three, his ordinary dose. Very soon he began groaning loudly from pain, and as there were ladies in the carriage it was very unpleasant to all of us. In about half an hour the groaning stopped, much to his astonishment, as he said the pain usually went on till towards his next meal. I mildly suggested that perhaps one tumbler did less mischief than three. I had already given him my mind about the treatment, as he had SO-CALLED 'STARVING' 7 asked it. I do not know if the milk was continued ; probably it was given up as a proved failure. But this I know, that, had I then begun to take fourteen tumblers of it daily, I would not have lived as he did for three months longer. My own stomach was then in a very irritable condition. I rarely took plain milk, as it at once brought on pain as it did with this gentleman, and no doubt from the same cause, the immediate formation of hard curd, which irritated and brought on spasm. The case just related is one of the many I have met with of real starving from taking in too large quantity what, under other circumstances, might be the very best food. The gentleman mentioned was, I was told, supposed to be suffering from cancer of the stomach. If such was the case, there was still less need to torment the diseased organ in the manner which I witnessed in a minor degree. It has been an absolute rule with me from a very early period, when milk 8 FADS OF AN OLD PHYSICIAN disagrees with a child, to stop every drop of it till the last trace had left the stomach, along with the well-known ferments which cause its conversion into hard curd, or what in Scotland we call green cheese in its first stage. This will often at once put an end to diarrhoea in children who may hitherto have lived on milk only. Water will suffice for a few days, if the stomach is out of order as well as the bowels. If something more is wanted, very thin soup from young meat or chicken may be given, or thin oat- meal gruel well boiled. After three days the milk may usually be resumed with safety. Many adults cannot take pure milk, who take it freely in bread or puddings. When so taken, it cannot form a curd even if it meets with acid in the stomach. This acidity is a very common cause of trouble. If the youth or grown-up person who suffers from it, instead of taking drugs for immediate relief, would exercise in a greater or less degree, as may be necessary, a wholesome SO-CALLED 'STARVING' 9 abstinence or call it starvation he would soon find that he had no cause to accuse a weak stomach for his share of the misery which so many of the well-fed suffer in this country, and all the world over. This is the key-note of what I have to teach in this as in my former volume, and it indicates a strange bias in human nature that it should be necessary to harp on it so often and so loudly. I am by no means the only one in the profession and out of it who, but often in vain and with little thanks, endeavours to benefit his fellows in a way that runs contrary to custom and fashion, and which has only experience of its value and common sense to recommend it. II THREE DIFFERENT METHODS FOR PRESERVING AND REGAINING HEALTH WITHIN the last two years two volumes besides my own have been published which recommend the treatment of disease by a different method from that usually taught. The one is by Dr. Haig of London, 1 the other by Dr. Dewey of Meadville, Penn- sylvania. 2 Both differ on many points from the method laid down in ' Plea for a Simpler Life,' but all three have much in common in their endeavour to arrive at the same end. Dr. Haig, whose method is 1 Uric Acid in Causation of Disease. J. and A. Churchill. 2 The True Science of Living. Henry Bill Publishing Company. METHODS FOR PRESERVING HEALTH 11 based on strictly scientific investigations carried on for several years, and suggested to him very much by his own personal experience, finds in uric acid, present in the blood or deposited in different structures of the body, the cause of most of our common and troublesome ailments. For the prevention and cure of these ailments, he recommends mainly abstinence from all foods which contain uric acid, or its elements. Under the first category are to be found all animal foods except milk, and under the second, tea, coffee, cocoa, etc., which contain xanthin, a chemical substance which he says is always changed in the system into uric acid, and which thus possesses the same disturbing properties. His own food, which he gives in full detail, consists of milk, cheese, and butter, with a liberal variety of bread stuffs and other cereals, and of vegetables and fruits. By adhering to this diet he has raised himself from a very low and suffering condition ; he is now in the enjoyment of 12 FADS OF AN OLD PHYSICIAN good health, and he has seen equally good results in those who have followed his example. To start his patients on their new mode of life, Dr. Haig gives some drugs to wash out the excess of uric acid in the blood, or deposited in the various textures and organs of the body. These are salicylate of soda, and others, but with a proper diet none of these should be afterwards required. Dr. Dewey's method is a very different one. He had found very early in his practice that he cured his patients at least as well with small doses of medicines as others bid with big ones. Twenty years ago he met with a case of typhoid fever in a young, full, married woman, whose general health had not been good, and whose stomach now rejected all drugs, food, and drink. This went on for three weeks ; on the twenty-fifth day the aversion to beef-tea ceased, and for ten days longer, when his services were dis- pensed with, he left the feeding to the patient. A perfect cure was effected without METHODS FOR PRESERVING HEALTH 13 food and without remedies, with no unusual wasting of the body ; while the mental and physical strength increased with the decline of symptoms, and before any food could be taken. Dr. Dewey had already seen, as has every physician, numerous cases where for a time little food had been taken with no loss of vital power ; but this one led him to look more into nature's methods, and to the dis- covery of the value of the store of nutriment which is found in every human body until reduced to what he calls its skeleton form. Thus far Dr. Dewey's progress was owing to observation of others, and it affected only his treatment of the sick ; but eight years later he was led by his personal experience to apply his method also to the more or less healthy. ' I was,' he said, ' the victim of slow digestion never attended with pain, but always with discomfort, which disappeared under the excitement of business. I never was without appetite in fact, it was always too strong to be manageable. I was 14 FADS OF AN OLD PHYSICIAN never disabled by it an hour in my life, but there was always an abiding sense of dis- comfort when not under excitement.' ' I habitually ate a hearty breakfast every morning, with or without previous exercise ; no meal ever fully satisfied hunger. I could take a lunch between meals with relish, only that I dared not ; and all through the days, the months, and the years I was more or less starved because of habitually overtaxed machinery.' At last one morning he got up without an appetite, having partaken of a heavy meal the preceding evening. He now recalled what a friend had told him some years before. He had been on a tour in England, and had noticed that a common breakfast there was a cup of coffee and a roll. Dr. Dewey bethought him to try this instead of his usual heavy meal, but as he had no appetite he omitted the roll. The result was that instead of feeling faint, as he had feared, he had, he says, a ' forenoon of such lofty mental cheer, and such energy of soul and METHODS FOR PRESERVING HEALTH 15 body, such a sense of physical ease, as I had not known since I was a young man in my later teens.' He continued the coffee breakfast, and in the course of a few weeks, he says, ' there was such a quickening of my life in every line that friends began to notice it. It was very cheering to be met in the streets with the remark that I was looking better ; and all the more as I had reached a time when mental and physical wreckage seemed not so very far off.' Dr. Dewey's grand means of cure now is abstinence for the time from all food, and this he carries out to a degree which must astonish most physicians of the present day, as well as their patients. During times of sickness, when there is no desire for food, he gives none till the desire comes, and then only if the state of the tongue and general condition show that the power of digestion has returned. This may be in a few days, or in severe cases, as of rheumatic fever, it may not be for forty days or even longer. 16 FADS OF AN OLD PHYSICIAN He points out very forcibly that we have all a store of material laid up in the body which supplies what is required for keeping the necessary functions of the system going, while no food can be usefully taken into the stomach. I had mentioned this provision in my 'Plea, 1 and had stated that so long as it lasts it is sufficient to preserve life. I also suggested that it might be found that the waste of the body was less when this internal supply was alone trusted to, than when it was supplemented by food from without which the organs of nutrition were not in a condition to utilise. This, to my mind, Dr. Dewey has proved to be the fact, and no one can read his cases without being convinced that it is so. He gives a most interesting table from Dr. Yeo, showing what textures of the body waste most rapidly in disease. Fat is at one end of the scale, and at the other the brain, which does not waste till all the other textures and organs are depleted to the utmost. METHODS FOR PRESERVING HEALTH 17 In cases of slighter disease, where the patient is able to be about, or to carry on his business, but with discomfort, the same abstinence from all food is recommended. It is usually found that work can be done more easily, and that strength actually in- creases, although the starving may have to be kept up for several days. But the great coup in Dr. Dewey's practice is, that to im- prove or to preserve health he advises all to give up breakfast, and to fast till the mid- day meal. In this he has had a very large number of followers, very much to their advantage. It may be that the omission of breakfast is more needed and has greater effect in America than it would have on this side of the Atlantic. In America the meal is usually a very full one, made up in a large measure of a variety of hot cakes, also flesh food and tea or coffee. The other two meals of the day are full, ' square ' meals likewise. I have seen much overfeeding in this country, but never to such a degree, and 1 8 FADS OF AN OLD PHYSICIAN so generally, as I have seen in America and in American steamers. In one of the latter the cooking was the worst I ever met with, but the hard meat was swallowed all the same, and the consequences must have been grievous. Dr. Dewey gives much prominence to the relief got in following his plan of no breakfast by the women of the household, who are thus saved a large portion of their work. This is of much wider importance in America than in this country, as even in better -class households, from want of ser- vants, much work necessarily falls on the women of the family. In Dr. Dewey's first volume (p. 172) he states with approval that by adopting his system more food will be taken and properly digested than when too much is taken from day to day, with occasional breaks-down and inability to take food. He seems to use abstinence from time to time as others do aperient medicines, and visits to spas, in METHODS FOR PRESERVING HEALTH 19 order to clear out the digestive organs, and thus enable them to do more and, for a time at least, better work. I ventured to express my fear that in this way though an in- finitely more rational way than is usually followed life may be no longer than it has hitherto been. The return to a fuller diet than is necessary, though stopped from time to time by the rule that no food is to be taken when it is clearly not properly utilised, is fitted to render the blood more abundant and richer than the secreting organs can properly manage, and may lead to acute attacks of illness from chill or other accidental cause, or to deposit, in some perhaps weaker or overworked organ, a part of its overload of plastic material, and thus bring on per- manent changes most difficult, or impossible, to get rid of. In a later work, however, by Dr. Dewey, A New Era for Women, published in 1896, he states (p. 75), that by following his method of no breakfast a much more moder- 20 FADS OF AN OLD PHYSICIAN ate mid-day meal is required, and the even- ing meal becomes very light indeed, the one square meal of the day having been much more thoroughly digested. Another slight criticism which I will ven- ture to make on Dr. Dewey's method is, that he notices with approval the feeling of keen hunger as necessary for the enjoyment of a plentiful, or of any meal. I have long maintained that keen hunger, in most cases, if not in all, implies a more or less morbid condition of the stomach. This indicates that it is not empty, as it ought to be after a meal is fully digested, but contains some acid or acrid matters, which may be part of the food previously taken turned sour, or, if the food has entirely left it, an acid secretion from the blood. In either case there may be a feeling of keen hunger, but this is only a crave by the nerves of the stomach for relief, which the sufferer knows from experience is to be got by diluting the acrid mass with a fresh supply of inert food. That this is METHODS FOR PRESERVING HEALTH 21 the true reading of such cases I have often proved. Relief for the time may be got by using plain water for dilution, or by eating a bit of liquorice, or by taking an alkali. Some of the most satisfactory cases I have* had to deal with were of ladies whose health had gradually deteriorated, and their strength got to so low an ebb that they required, or were supposed to require, food or wine every two hours. Such a case is difficult to manage, as the immediate relief from tak- ing food is so great. I have sometimes succeeded by pointing out that the ease and renewed strength which at once ensue cannot possibly arise from the food, as there is no time for its digestion. If the case is not too chronic, the result of rational treatment is very satisfactory. One of the best instances of this I have met with was that of a young lady of good Scottish family, who had married two years previously in Yorkshire. I had known her a perfectly healthy and handsome girl, plainly and healthily brought 22 FADS OF AN OLD PHYSICIAN up. In her new home the mode of living was a full one. She had two children, the first of whom she tried to nurse. This was supposed to demand still fuller living and a larger amount of stimulant. She had to give up nursing, and was gradually getting into bad health. She did not attempt to nurse her second child, and now she fairly broke down ; her mother, who brought her to Edinburgh, told me she could not under- stand her at all. I found her pretty much a wreck, mentally and bodily. By the doctor's orders and her own desire, she was taking food or wine every two hours, and a good deal even during the night. All her stimu- lants and medicines were stopped at once, and more than half her food, which was given at proper intervals. In one fortnight she was able to walk along Princes Street as well as ever she was. But in this case I had the mother's help, and could at once do what I knew to be best. Dr. Dewey, in his two volumes, gives METHODS FOR PRESERVING HEALTH 23 many instances of cures effected quite as rapidly, by his mode of complete abstinence from food for an indefinite period. He makes no use of stimulants, and his one drug is opium given by injection, which in painful cases he uses to give relief, while nature unassisted is curing the disease. The method I have been led to follow in the treatment and prevention of disease, as given in the ' Plea for a Simpler Life' agrees in its essential features with the two methods we have been considering. With Dr. Haig I give up, under all states of ill-health, the use of strong animal foods, especially beef; and I also give up these in all who, though in their usual health, are of a decidedly nervous temperament, or of the rheumatic or gouty diathesis. To all, even the healthiest, I advise their use to a very moderate extent, from their tendency to bring on acute rheumatism and gout, and, if taken even by the healthiest too freely and too long, causing, through deposits in 24 FADS OF AN OLD PHYSICIAN the internal organs, diseases which only in- dicate their presence after cure has become impossible. For the young I recommend little or no strong animal food till they reach the term of puberty in this following the rule laid down by the writer of the Epistle to the Hebrews, that ' strong meat be- longeth to them of full age.' There are few rules that have no exceptions, and although beef may seem my Mte noire, I have used it even with children, and with great benefit. In some protracted cases of diarrhoea in children a year or two old, given raw, or slightly warmed, and pounded very fine, it often acts splendidly. The child usually takes it at once and greedily, and will live on it for some weeks, when the desire ceases ; but the child is now cured, and can take other food. Raw beef has much in common with the albumen of white of egg, and in the circumstances mentioned I would just as soon think of giving hard- boiled egg as cooked beef. Beef slightly METHODS FOR PRESERVING HEALTH 25 cooked, and in moderate quantity, is some- times very grateful to a convalescent from acute disease, and for a time may be indulged in with safety and even benefit. There is an abundant outlet for butcher's meat in its moderate use by the healthy, and especially by the working man. I do not altogether follow Dr. Haig in proscribing tea and coffee and all substances containing xanthin (see Chap. XI.). One consequence is that I consume daily much less food than does Dr. Haig. He gives a detailed account of his food, and it amounts to more than three times what keeps me in the best of health. As I have been asked by readers of the ' Plea ' to give my own diet, I take this oppor- tunity of doing so. This will save me much writing. I have always to explain that what I do myself I do not urge on others. Here they have three different ways of living, which may help them to fix on what is best under their own perhaps widely-differing circumstances. 26 FADS OF AN OLD PHYSICIAN For breakfast I have a large cup of tea, with milk or cream ; brown bread from two to three ounces, and usually one and a half ounce of fish, or half that quantity, and that very rarely, of bacon. Sometimes for a few days I take a cup of coffee with half milk, but no fish nor bacon. Lunch is a cup of cocoa or chocolate, if the weather be cold ; if it is warm, a small tumbler of milk, about six ounces, with, the same quantity of bread as at breakfast. At both meals I use butter, not a quarter of an ounce, and quite as much jelly or marmalade. This is my usual lunch, but occasionally instead of cocoa I have a baked apple or some prunes with milk, or strawberries and cream so long as I can get them, or, very rarely, vegetable soup. When I have no milk I take usually a morsel (not half an ounce) of cheese. At 4 P.M. a small cup of tea, and some- times biscuit or cake. For dinner at 7, which is my chief meal, I have soup, from peas, lentils, potatoes, celery, carrot, etc., METHODS FOR PRESERVING HEALTH 27 the first two made with no meat stock, and the others with that from lamb or a bone, or only with a little milk and butter; or fish soup, the only pure animal soup I indulge in. Of fish I take about three ounces, with a potato and always another vegetable fresh from the garden. If there is no fish, I may take once or twice a week an ounce or two, certainly not more, of lamb, game, rabbit, or tripe ; but often I have neither fish nor flesh. The dinner ends with stewed fruit with cream, or pudding or fruit tart of these I take a fair helping. During the winter season, instead of fruit or pudding, I often have celery with cheese, oatcake and butter. On this diet I enjoy the best of health, and for my age (78) am up to a fair amount of exercise, walking three to six miles daily in good and sometimes in bad weather, and usually part of this is up a steep road with a rise of 250 feet. The only confession I have to make is, that 28 FADS OF AN OLD PHYSICIAN when at home I do not rise till I have had breakfast and read the newspaper. This is a habit I have recommended to many ap- proaching my own age, and those who have tried it admit that they are stronger for the rest of the day. I enjoy breakfast just as much as my other meals, though I never feel what can be called hunger, and have not done so for many years. I could omit a meal at any time without discomfort. This I have long looked on as the best proof of perfect digestion. During very warm weather I take rather less bread and butter, and I do not try to make this up by taking more of anything else. In Dr. Haig's book he gives full details of his daily food, and it amounts to above 74 ounces, 42 being milk, with jam, sugar, potatoes, and fruit in addition. Mine cer- tainly does not rise to one-quarter of this ; it comes much nearer to that given by Cornaro, 1 the well-known Venetian who lived 1 How to Regain Health and Live a Hundred Years, by One who did it. Simpkin, Marshall, and Company, London. METHODS FOR PRESERVING HEALTH 29 his hundred years, and whose food amounted to 12 ounces a day, with 14 ounces of light wine. With me tea takes the place of his wine, and were I living in a hot climate I should be much inclined to follow his example, and thus escape taking any xanthin, which Dr. Haig so strongly condemns. I tried lately for about six weeks to take milk at breakfast and lunch instead of tea and cocoa. The only difference I noticed was that, al- though there is much more nourishment in a cup of milk than in the same quantity of tea, I felt that I began sooner to think of lunch and almost to feel a desire for it, and I missed the feeling of satisfaction which a good cup of tea certainly gives. In the afternoon I took sometimes a cup of Paraguayan yerba, which I had got to like in South America, and which sets one up even more distinctly than tea; so I fear that this too contains xanthin. Without tea or cocoa I would, no doubt, find myself taking more food, but I am not sure that this would be more bene- 30 FADS OF AN OLD PHYSICIAN ficial, and I am sure that to me at least it would not be so enjoyable. I doubt if any one enjoys his food more than I do. I endeavour always to eat slowly, but I am sometimes told that in this respect precept and practice do not quite accord. I have only given an outline of the two other methods, and my readers will do well to study both volumes for themselves. On the diet indicated, I find that if I have to live differently in travelling or visiting, I can make considerable errors for a time with but little harm. The last great error of this sort was several years ago, when I spent six weeks with hospitable friends in South America. There I partook of at least three times the amount of flesh food that I do at home. I kept in excellent health, but to- wards the end of my visit I felt that I had gone far enough astray. Fortunately, prob- ably from the heat of the weather causing a determination to the surface, I suffered from a great increase of eczema, which had stuck METHODS FOR PRESERVING HEALTH 31 to me for many years and has not yet quite left me. This with lighter living for a month near Rio, and some wholesome sea-sickness, restored me to my ordinary condition, and the effect of the trip was on the whole salu- tary. Last spring I made a three weeks' visit to the Riviera, going and returning by sea. My previous experience made me more careful ; I could manage my food better as to quantity, but the quality was too rich, and the consequence was that in six weeks, with no sea-sickness, I lost four or five pounds in weight. This I began to make up at once on my simpler home fare, but it was only after several months that I recovered my normal weight. Dr. Haig's personal experience seems to indicate that, if substances containing uric acid, or xanthin, are practically eliminated from food, a much larger amount can be taken than if even a very moderate quantity of flesh, etc., is substituted. I am not astonished, however (p. 540), that if he at- 32 FADS OF AN OLD PHYSICIAN tempts to increase his fish and egg, he 'at once begins to suffer for it in the way of headache, dyspepsia, catarrh, asthma, or some other trouble connected with uricacidsemia.' I have had my full share of these troubles; now they are but a memory of the past, and it will, I believe, be my own fault if they do not remain so in the future. A friend of my own age, who for thirty years has followed very much my mode of life, lately came across a disciple of Cornaro, a man several years older than himself, but enjoying even better health and spirits. He determined to adopt the very restricted diet which seemed to suit an older man so admir- ably. I quite encouraged him to do so. After two or three months his wife got alarmed that he was even thinner than formerly, he being always on the spare side, and he returned to his old diet. The ex- periment, however, did him no harm at the time, and he has certainly enjoyed better health than he did before. Should he ever METHODS FOR PRESERVING HEALTH 33 care to repeat the experiment, it will be with full acquiescence on my part. I have gone more into detail in matters of food than I wished ; but I am so often asked to do so, and to give something more than a few general rules, that I see there is need for something more precise. Strict rules, how- ever, can only be given with safety by one who can examine and judge each case by itself, and this is the duty of the medical adviser. Hence my earnest wish to do something to change the teaching and prac- tice of medicine in this country. It is to the medical man we must look for any real and general advance in medical science. But he must learn to think for himself, and not go on the easy idea that all he has been taught in the schools is true, and that if the patient does not improve as he ought, the fault is with the patient, not with the treatment. A trusted doctor is the most prized of all one's friends, and the exigencies of society are such that it is not easy to guide oneself by 34 FADS OF AN OLD PHYSICIAN the most perfect rules, even if these were to be had. Under present circumstances it takes as long a time, and as many failures, to enable one safely to be his own doctor, as to be his own lawyer. What a simpler system may effect in both instances can only be dimly seen as yet, but it is worth working for. If a few of us, on very different lines, have found each from his own experience that we can get health ourselves, and give it to our patients, by methods very much the reverse of those which we have been taught, and have for a time followed, it may be hoped that others will follow our example, or, what is better still, may discover other methods more suc- cessful and more generally applicable. Ill ON STIMULANTS SOME of my teetotal friends and I have many have urged me to adopt their cause, and to promote it. I have always assured them that I firmly believe I can do, and have done, more for the cause of temperance, if I leave myself free to act as I think best in each case as it arises. As to the evils which attend the use of alcoholic stimulants being enormously in excess of any benefits that may arise from them, both in health and disease, I can have no doubt whatever ; and could I see any possible means of stopping their use entirely, I would most gladly assist in their adoption. There are a few cases, however, in which I have found a temporary 36 FADS OF AN OLD PHYSICIAN use of some form of alcoholic stimulant of very decided advantage. From these I give two or three. When at - on a professional visit, I was asked to see, a few miles off, the elder sister of the lady I was visiting. I was told she had been on her back for twenty years, and was only able to have her bed made every second night. She had suffered so much pain that for many years she had taken a large dose of opium every night. This quieted her till next night, when, from a re- newal of pain, she always wearied for her dose. She took almost no food, but seemed to live mainly on the opium. No attempt at any change had been made for years. Her illness had commenced very much as that of her younger sister, who, it was feared, was falling into the same helpless condition. I had seen several such cases before, and had declined others my medical friends had wished me to take over, botfi they and I knowing the difficulty of treating them with any success ; ON STIMULANTS 37 but I had noticed that sooner or later they came right of themselves, if at all simply managed, or rather if mostly let alone. 1 It occurred to me that in this case, as the patient was getting up in years, the cause of her ill health might have passed off; and that the pain or supposed pain, want of ap- petite, etc., might now be owing to the con- tinued regular use of the opium. I advised that the opiate should be stopped at once, and for a time in its stead half a tumbler of London stout should be given at bedtime, and that a little more food be given as she could take it. The result was better than I or her friends ex- pected ; and just six weeks later she was able to come up to Edinburgh in very fair health. I doubt if this could have been done certainly not so easily without the stout. 1 These I believe are the best, if not the only, cases in which the ' Weir-Mitchell ' treatment gives such splendid results. I have known about half-a-dozen cases, and could wish I had also known this method of treating them. But I doubt if I would have continued the feeding so fully or so long after the desire for food and its healthy digestion were restored. 38 FADS OF AN OLD PHYSICIAN I have met with a few cases of great depression and irritative fever after a very bad confinement in which a temporary use of stout, or of a still pleasanter and more potent liquor, Prestonpans old twelve- guinea ale, has been of great and undoubted service. My brother, the late Dr. Thomas Keith, was recovering slowly from a severe attack of scarlet fever. He was a most temperate man, and rarely took any liquor whatever. But quite unexpectedly to himself he took a great desire for sherry, a wine that he had never cared for. He got it, and was astonished to find it so good. Every drop of it he spoke of as nectar ; he looked forward to enjoying sherry all the rest of his life, and could not understand how he had not discovered its value sooner. He certainly did well upon it, and made a more rapid recovery than he otherwise might have done. But, after taking two bottles in the course of a fort- night, he was equally astonished to find that ON STIMULANTS 39 the pleasure from it was gone, and he never cared for sherry since. This case and others have led me to what I believe is the proper use of wine and other stimulants. If one who is not, and has never been, in the habit of taking wine or alcohol feels a natural desire or crave for it, I usually let him have it, but I always tell him to stop at once when he finds he no longer cares for it. It is rarely wanted for above a few days, or at the utmost for a week or two, when it may be stopped without the slightest difficulty. Un- fortunately this rule is not followed by most medical men. Their patients, on the con- trary, have pointed out to them the benefit they have clearly got from the stimulant, and they are told to continue it. If they do so for anbther week or ten days after the desire has gone off, the original enjoyment does not return, but in its stead the stimulant has already created a want asking to be supplied, a bad habit is formed, and the result may be most unfortunate. 40 FADS OF AN OLD PHYSICIAN I have met with unfortunates, especially ladies, who have strongly blamed the doctor or the nurse for launching them on a course of intemperance from which they could find no escape. In the too rare case where an acquired habit of intemperance has been given up, I know of no circumstances in which I would order any alcoholic stimulant ; and some of the cases given in my 'Plea' will show that even in extreme states of debility we can get on very well without it. For those who have once fallen victims to intemperate habits there is no safety but in absolute abstention. From purely medical treatment I have known very little benefit in cases of con- firmed intemperance. Some of the numerous vaunted cures may be of use, but I have no experience of them. But in one case the effect of a powerful and now old-fashioned remedy was very gratifying. A young married lady after her first confinement gave way to intemperate habits. She blamed the ON STIMULANTS 41 nurse, but of this I was by no means certain. She got worse and worse, though her husband used all possible measures short of absolute seclusion for her reformation. At length she got so violent that, fearing it might be necessary to lay her up, I asked the husband if her friends, who lived in Eng- land, knew anything of her condition. He told me they did not. I advised him to take her to them, and leave her with them for a time. She remained for several months, and when she came back she was perfectly cured. The doctor of her family tried a remedy, with which I was told he had succeeded before. He put her to bed, gave her mercury to the extent of causing severe salivation, and this he kept up for six weeks. At the end of this treatment her system seemed to have undergone a great change, and for several years, when the family left Edinburgh, she remained perfectly well. I have long been convinced that there is a causal connection between a free use of 42 FADS OF AN OLD PHYSICIAN flesh foods and an inclination for stimulants, especially in the young. Roast beef is perhaps the most sapid food that exists. Desire gratified leads to a demand for some- thing higher in the same line. This cannot be had from food, but it may from drink. This seems a very vague mode of argument, but I have known cases for which I could give no other or more rational explanation. Many years ago my old friend Dr. Farquhar, physician to the Governor-General of India, asked me to take him to Morningside Asylum, and introduce him to the physician, Dr. Skae. There was, he told me, a proposal to set aside part of the fort buildings of Agra as an asylum for intemperate British soldiers, with a view to their reformation, by keeping them for a time from the use of all strong drink. Dr. Farquhar wished first of all to ascertain what might be expected from such a course. Dr. Skae at once threw cold water on the scheme. He said that in his ex- perience forced abstinence was of no use, and ON STIMULANTS 43 a patient, after being with him for twelve months, was very likely to go wrong on the first day of his freedom. My friend was much disappointed, and I do not know if the experiment has ever been tried. But Dr. Skae's patients were kept on full flesh diet. Some time after this, a young friend of mine who went so far wrong from drink that he could not be kept at home, was sent to an establishment in America which had a name for reforming youths in his condition. The manager, an enthusiast, had given evidence in London when an inquiry was made by the Government as to whether more power might be given to medical men to lay up for a time those who, through indulgence in drink, had become a nuisance to the community. This gentleman stated that in his establishment cures were made of 30 per cent of those who remained long enough and submitted to his rules. This, Dr. Skae said, was simply untrue ; it was so different from his own experience. No explanation was given as to 44 FADS OF AN OLD PHYSICIAN the methods of treatment. Shortly after this my young friend entered this same establish- ment. He was accompanied by a faithful servant of his family, an old cook. The cook remained for a time, and he by and by wrote the mother of the youth, giving an account of the establishment in his own way, rather a graphic one. Part of the letter the lady copied for me, and it was to the follow- ing effect. He was pleased with everything except the cooking, and he asked the negro cook why he always spoiled the good meat. The answer was, ' Meat not good for the thirst ; if meat not good, must eat what is better for them. 'Cos why ? must eat some- thing, you know.' Besides the beef and mutton which were always spoiled, there was abundance of lighter food well cooked, and at all meals there was a large supply of apples in all forms. This explained to me the success of the doctor, though but for the accident of the cook being there I would not have heard how it was brought about. My ON STIMULANTS 45 young friend, who had got to live very much on roast beef, would not have gone near the place had he known he should get none of his favourite victuals ; and he would no doubt take the badly-cooked meat till he discovered that there was something better. As a large board was charged, and meat is cheap in America, it was no doubt found more profit- able to spoil the meat every .day than to frighten away new-comers by a premature disclosure. I read the letter to Dr. Skae, and he was obliged to own that there might be something in it. Some years later I happened to come across the report of another establishment in America for the same purpose. In this report the doctor states that during twenty- five years he has cured 98 per cent of those who submitted to the rules. The main treat- ment was abstention from all flesh food whatever. He says that there is something in this that, if it is indulged in, renders the cure of intemperance impossible. If ab- 46 FADS OF AN OLD PHYSICIAN stained from, the crave for drink by and by passes away and does not return. Another rule he mentions which recommends itself specially to me ; it is, that if any one falls sick while under his care, he must get well the best way he can without any medicine whatever. In the numerous cases of intem- perance I have had to treat, I have acted as far as possible on the principles stated, and have had at least a fair share of success, but under present circumstances it is very difficult to carry out thoroughly any such plan ; and this has shown me very strongly the necessity for preventive treatment as the real method of getting rid of a horrid evil. Here also ' strong meat ' is only for those ' of full age,' and under some circumstances not even for them. IV ON SELF-MASSAGE WHAT is now called massage has come much into use in recent years for numerous ail- ments. Under the old name of rubbing I have long been familiar with its great and varied usefulness. One of my oldest recol- lections is of a boy who was going about on crutches. The doctors could do nothing for him, but an ' old wife ' undertook to cure him, and did so merely by rubbing. He soon discarded the crutches, and is now one of the oldest of the Scottish clergy. There have been rubbers in Edinburgh almost as long as I have been there, and I have known good work done by them. Massage has now been taken up by the profession ; like other 48 FADS OF AN OLD PHYSICIAN good things it may be abused, and it has been. I have long known its use in rheu- matism, both for relief of pain and still more for preventing or relieving stiffness of joints and muscles. I have frequently known its good effects to be lost, from its being done at first too strongly and for too long a time. It exhausts, and is discontinued. This arises very much from the usual mode of remunera- tion of the masseur being at so much an hour ; and canny Scotch people like to get the good of their money. Many also find that though it gives relief for a time it requires repetition, and this and the cost disheartens them. Quite one-half of my friends who have tried it have given it up for these reasons. Some rub on no plan, even of those who have been trained, and when they cause pain at any point they avoid it, whereas in proper cases the pained or tender parts are exactly those which should be acted on though gently at first, and at short intervals till the pain is removed. ON SELF-MASSAGE 49 Having been rheumatic from my youth, and of a strong inherited gouty diathesis, I have had abundant experience of both rheu- matism and gout in the chronic form ; and after all, one's own body is the best corpus vile to experiment on. I have thus become aware of the advantages of rubbing oneself, which I have had occasion to do for a large portion of my life, but more in recent years ; and I have no doubt whatever that but for this useful habit, I would long ere now have been as distorted, stiff, and helpless as were some of my forbears. I have had to do it many times a. day if I have remained long in one position ; or have over-exerted some muscle, which frequently brings on pain ; but this is easily removed if the rubbing is had recourse to at once. Chiefly, however, the rubbing is done at night, and before getting up, when ten minutes' work lets me rise supple and fresh, instead of stiff and languid. There is a knack in it, and many cannot do it with any satisfaction to others ; but with a 4 50 FADS OF AN OLD PHYSICIAN little perseverance I believe that most can do it for themselves, and with this advantage that each one knows best for himself what are the aching parts, and he can take his own time. It is amazing how many pains may be relieved in this way other than in the muscles and tendons, as in the head, the intercostal spaces, and the surfaces of the joints, especi- ally the knee-joint. The pains over bones seem to arise from congestion of the peri- osteum. On touching the part tenderness is felt at once, which comes to pain after a slight rubbing, but by continuing this, then stopping for a few minutes, and again re- peating the process, the pain and tenderness pass off, and in some cases do not return. I have known a pain in the knee on attempting to move it, of months' standing and so bad as to stop walking almost entirely, removed permanently by one rubbing, followed by an occasional rub by the patient himself. I have also known very long-standing pain, ON SELF-MASSAGE 51 seemingly of a rheumatic character, removed at once by passing through the part a large volume of galvanism, such as is used by Drs. Apostoli and Keith in cases of fibroid uterine tumours. Here probably there is a molecu- lar massage of the muscle or part affected, and I have had personal experience that it is very effective. But my chief reason for mentioning mas- sage here is, that I may take this oppor- tunity of giving somewhat in detail a use of it which so far as I know is new ; at least, in four years I have come across no one who had heard of it. During the whole period of my profes- sional life, being of a very nervous tempera- ment, and having peculiar views as to the mode of treating my patients, mostly antago- nistic to those held by others, I often had times of great anxiety. Sometimes, besides pure mental trouble, I was conscious of a dull physical sensation in the region of the heart, rarely amounting to pain, but in a few 52 FADS OF AN OLD PHYSICIAN instances, when very much exhausted as well as anxious, with acute pain. On one occa- sion this got so severe as to feel intolerable, and had I not gone home and at once taken a full dose of chloroform I felt that I should have died. After giving up practice I had little or none of this feeling for many years ; but some four years ago I got as a trustee into a very troublesome lawsuit which worried me very much. The old well- known feeling returned, though never to the extent of causing pain. Naturally, somehow, I often found myself rubbing the upper part of the chest, especially over the heart, and there must have been some relief in this, as I often had recourse to it. One night, for it was then I was most frequently affected in this way, I found a distinct tenderness in the space between the first and second ribs of the left side, apparently in the intercostal muscle ; and, as I had done in different parts of the body before whenever I felt such tenderness, I began to rub it. After ON SELF-MA SSA GE 53 getting rather sore for a short time, the tenderness went off, and to my astonishment and delight the peculiar feeling of oppression went with it. At the same time I felt in- clined to take several full breaths. I have often had the same experience since, and have invariably got relief in the same way. The relief is very great ; it somehow enables one to take a more satisfactory view of what is causing the trouble, and, what is even of more consequence, it makes it possible to forget it, and to go quietly to sleep, which before was impossible. After a sleep there may be a return of the feeling, but a very little rubbing now at once removes it. Before making this discovery I had been very sure that the worst attacks I had long ago were of the nature of angina, the essence of which seems to be intense anxiety accom- panied or not with pain. Of the few old friends who when sick would still see no one but myself, there were two who had occasional attacks of that most serious 54 FADS OF AN OLD PHYSICIAN trouble, and I took the first opportunity of trying if they could be relieved in the same way, and the result in both cases gratified me very much. One was a retired medical friend who had already, on two or three occasions, alarmed his friends by falling down by the roadside when on a walking tour. He also had some attacks very like angina, coming on in bed, and always the precursor of a bilious attack which, after a few days' sickness and vomiting, left him all right again. One morning I was sent for, and I found him at 6 A.M. suffering from severe angina which had lasted for some hours. There was little or no pain, but intense anxiety and oppression in breathing. On being pressed pretty firmly with the point of the finger between the first and second ribs on the left side, he at once complained of pain. I commenced rubbing, at first very gently, and then somewhat more strongly. At once he felt relieved, and took full deep breaths which were before impossible, and in ON SELF-MASSAGE 55 a very few minutes the fit was over and did not return. He had his bilious attack, how- ever. Several months after I was sent for again. I arrived at his house at midnight, and found that he had got so much worse that my friend Dr. Wyllie had been called in. He had given a dose of nitro-glycerine, which had relieved him considerably, so I went to bed after a talk with Dr. Wyllie on my new method. In half an hour I was sent for ; the symptoms had returned. I found the old tenderness, and relieved it and the other symptoms just as formerly, and I had no further call during the night. The bilious turn, however, came on, and was a bad one. After this he was most careful in his mode of life and in avoiding climbing any height, and he got to enjoy really good health for several months, with no heart trouble whatever ; but one day he was walking up a steepish street to attend a meeting, and had perhaps hurried a little. He fell down on the street, was at once 56 FADS OF AN OLD PHYSICIAN carried into a shop, and then into a cab, but before it reached the infirmary, which was close by, he was dead. On the former occasions of his falling down he was allowed to remain till he was better. So far as I know his heart was a sound one for his age, which was much about my own. My other patient is a lady, about the same age, who has suffered from heart disease for at least forty years. I was about that time cautioned by her uncle, a medical man, not to give her chloroform at her first confinement, she had so bad a heart. It looked as if there must be some aneurismal swelling in the immediate vicinity of the heart, the throbbing was so great to the sight as well as to the touch. She never would permit a proper examination to me or to any one, so I do not know what may be the real condition of the organ. But all along she has been one of the most careful livers I ever knew, mostly a vegetarian, and a very small eater of any- thing. For many years she could not go up- ON SELF-MASSAGE 57 hill, and for the last three or four years she has had attacks of real angina. One day, nearly three years ago, I found her ill. She at once complained of the tenderness between the first and second ribs as in the former case, and was as speedily relieved. I had pre- viously given her nitro-glycerine and amyl, but they had little effect. A year later she told me she had no relief from them, but always from the rubbing, which she did for herself. Two summers ago I found her at the seaside some distance from her house and looking better than I had seen her for years. About four years ago I had a meeting in London with a friend who was equally con- cerned in a troublesome lawsuit with myself. Our business was a particularly anxious one. Something in his look made me think that my friend was suffering in the way I have described. I asked him to let me give his O chest a rub, to which he agreed. There was no tenderness, or it was very slight, and he 58 FADS OF AN OLD PHYSICIAN thought only from the friction. At the moment he did not speak of any change, but within two minutes he got up, stretched him- self quite erect, took a full breath or two, and said that somehow he felt ever so much better. About a year afterwards he was found dead in bed, and the cause was ascertained to be a fatty heart. We have here three instances of relief from a most simple procedure, and in each the condition of the heart was very different from that of the others. It would seem that the structural condition of the heart has little to do with this peculiar form of physical oppres- sion. The most common cause, so far as I can judge, is a purely nervous one, brought on by a strong mental impression, and giving rise to some local congestion. It must act through some of the nerves which supply the heart, and probably through the pneumo- gastric, which also goes to the stomach. This is rendered more probable by the fact that in some cases of worry the oppression is ON SELF-MASSAGE 59 felt over the stomach just below the end of the sternum. When this is so, tenderness is felt in that locality, affecting apparently the superficial muscles, and the relief by rubbing is very much the same as is got by rubbing between the first and second ribs. This I have often observed in myself and others. In a very few instances I have found that the tenderness was greatest between the second and third ribs, and sometimes it extended slightly to the opposite side. In other cases of nervous shock or of great anxiety and distress we have undoubted local congestions, which are relieved by secre- tion of different fluids. Thus a sudden terror is often followed by a cold sweat ; great doubt as to anything much feared, or even hoped for, may bring on a copious flow from the kidneys, or more rarely from the bowels. Students going up for examination are well acquainted with this. Deep sorrow relieves itself by a flood of tears and it is always well when this relief comes. In all these 60 FADS OF AN OLD PHYSICIAN cases there must be some congestion, that is, an additional flow of blood to the part from which the secretion comes. As there is no secreting organ in the region of the heart except serous surfaces which do not seem to be affected in this sudden way the mechan- ism of relief from oppression in that quarter must be different. In some states of sorrow relief is got by a succession of sobs that is, of strong spasmodic breathing after periods of very imperfect respiration ; these tend to quicken the circulation through the heart and lungs, and relieve congestion in this way. If the imperfect respiration is long continued, and if this leads to congestion and tenderness of the intercostal muscle, the g&ne to the respiration will be still more increased till it may bring on a fit of real angina. In this condition, or in the slighter forms of the same, smart friction to the affected intercostal muscle may at once remove its congested state and tenderness, and thus allow, or per- haps excite, a freer respiration, and this in ON SELF-MASSAGE 61 its turn may quicken the circulation through the heart and lungs and remove the feeling of oppression and anxiety. Whatever be the modus operandi the salutary effect is un- doubted, and the relief is immediate and great. The connection of the heart with the stomach, most probably through the pneumo- gastric nerve, has been long familiar to me, and here the value of simple living comes in very strongly. Every one knows that a full stomach, whether from food or from flatulence, often brings on derangement of the heart's action, it may be to a very serious or even fatal degree. But the quality of the food is of equal importance with the quantity. Savoury food, such as roasted beef above all, attracts blood to the stomach at once, as well as to the tongue and gullet. This I have frequently known to affect the heart in a very remarkable degree. A good many years ago I was asked to look after a well- known Edinburgh literary man. He was 62 FADS OF AN OLD PHYSICIAN a very powerful man alike in mind and body, and had enjoyed excellent health. He was past middle life. He was blessed with an excellent stomach, and had taken full ad- vantage of it ; but for some years he had felt something wrong in the region of the heart. By the time I saw him this had come to very frequent attacks of angina, from which his only relief was by inhaling amyl ; but he was now getting quite unfit for his literary work, he had to give up all his outdoor pur- suits, and latterly he could scarcely walk across the floor without a threatening of an attack. He had not been dieted in any way, but naturally his appetite was not what it had been. I stopped all stimulants at once, and still more emphatically all beef and mutton, and recommended great moderation in simpler food. He very soon began to improve, was able to resume his literary work, and even in a moderate degree shooting and fishing, of which he had been very fond. His attacks of angina became very few, and I daresay ON SELF-MASSAGE 63 they never came on without a cause. On three occasions only during a period of four years he partook of beef at dinner, and on all three he had one of his worst attacks. I was beginning to hope that the angina was of an entirely functional character, and that with great care his life might be a prolonged one. He was preparing to go to his place in the country, and had on the previous day done more than his usual amount of literary work, which he accomplished with ease ; but in the morning he was seized with a severe attack of his ailment. This continued, and was followed by pneumonia and inflamma- tion of the heart, and after a hard struggle he died. On examination the heart was in one part found to be riddled with small deposits of pus, and one of the coronary arteries was found so contracted that a minute bristle could not be passed into it. The other organs, except the liver, which was somewhat enlarged, were splendidly healthy ; the brain was about the largest we 64 FADS OF AN OLD PHYSICIAN had ever seen ; and had our much-honoured friend lived a simpler life all his days he might well have attained to his hundred years. As it was, considering the condition of the coronary artery, which is the most fatal cause of angina, the comparatively good health he enjoyed for four years was remark- able, and it was no doubt due entirely to his changed mode of life. NOTE. Massage is coming rapidly into use, and is, after long resistance, acknowledged as an admirable remedy by many of the profession. For myself, I have for the last twenty-five or thirty years given more relief by its means than by all the drugs of the pharmacopoeia. Locally it removes most pains. Ubi dolor ibi fluxus where there is pain there is congestion. Massage relieves the pain by sending the blood on its course. On the general system it acts as a fever does, by clearing off rapidly the debris of the muscles, etc., and thus removing from the body any excess of matters which may be disturbing its functions. If this is followed by simpler dieting in the future, a large portion of the ills of life may be avoided. So far as my own experience goes, the excess of food given to those treated on the Weir-Mitchell system does much more harm than good ; but this shows what massage can do even when so strongly handicapped. 3rd Edition. HOT WATER THE drinking of hot water as a remedy has come much into vogue in recent years. I take this opportunity of telling how it has come into general use. It was recommended to me for headache by Dr. Merei of Pesth, afterwards of Manchester. I was then living too fully, and I could not take it ; it brought on fulness about the head. When later, after having given up the use of butcher's meat, I took to it again and found its great value, Dr. Merei was dead, and I never knew what were his ideas about it ; he died in 1857. It often enabled me to go on working longer, and it sometimes kept off a chill or a threatened headache. This it 5 66 FADS OF AN OLD PHYSICIAN did, no doubt, partly by diluting acrid matters in the stomach, and partly by its stimulating effects enabling the organs to get rid of these, and to send the blood to the surface. This was the introduction of hot water as a remedy into Scotland. Gradually it came to be used by my patients, and by a few medical men ; and by and by it spread into England also. A few years ago the Edin- burgh Medical Journal spoke of me as the 'Apostle of Hot Water.' The writer thought he had got me into a difficulty about the ' Salisbury Treatment,' of which we have heard so much lately, where hot water, combined with beef in huge quantity, is said to work wonders. He well knew my antipathy to the latter, and he did not see how I could explain the good results. Some ten years ago there was a great run on hot water in London. I have not heard so much of it there lately, and I suspect that like most good things it also was abused, and may have fallen somewhat into discredit. During HOT WATER 67 all the time I have used it I have only come on two individuals who had discovered its value for themselves. Hot water may be used properly as a diluent, as a stimulant, or as a food ; and all these actions may be usefully combined in the same case. As a diluent its action is so manifest that little need be said. Cold or tepid water has much the same effect. Its only perfectly safe competitor that I know is liquorice, of which I speak elsewhere. Hot water acts as a stimulant by supply- ing ready - made heat or force, when the organs are not able to form the same by the ordinary digestion of carbonaceous food. Hot water thus aids, or rather supplements, the chemical actions of the system. Alcohol, on the contrary, checks these actions, and its effect therefore is to lower the activity of the system that is, to reduce the strength for the time ; or at the best it may give, through some obscure nervous action, a short-lived 68 FADS OF AN OLD PHYSICIAN fillip; but this is speedily followed by re- action and by an increase of weakness. I have given in the ' Plea ' cases to show that this stimulating action of hot water is suffi- cient to bring the body out of the very lowest condition as to strength, and that in cases where alcohol had entirely failed to do so. I could give numerous instances of the same kind. A medical friend who was liable to very severe headaches, which prostrated him for days, was spending some time in London. On the evening before he left he entertained some friends to dinner, and, being very hospitable, he showed them a good example, and took a hearty meal. Next morning he awoke early, and was much annoyed to find one of his headaches coming on, as it was most inconvenient for him to delay his return. He bethought him of the hot water, which he had often heard of from me but had been in- clined to laugh at. He rang his bell and asked ' Boots ' to bring him a large jug of very HOT WATER 69 hot water. This he drank right off and lay down. He fell asleep, and in a few hours awoke quite free from headache and ready for his journey. I read a similar story told in an amusing manner in an American periodical, where the effect of a huge drink of hot water was equally successful. Before America was opened up from west to east, as it is now by railways, two English gentlemen took the journey across a great portion of the continent on foot ; their only provision was hard biscuits and a spirit-lamp to boil water. The hot water they used at first to soak the biscuits in, but they soon began to drink it, and were astonished and pleased to find that it acted as a powerful stimulant and producer of strength. Till they thus accidentally made the discovery they had no knowledge of the strengthening virtues of hot water, and they acknowledged the benefits they derived from it in their long and perilous wandering. Hot water acts as a food under precisely the same circumstances. 70 FADS OF AN OLD PHYSICIAN Carbonaceous food, if only enough and no more be taken for daily need, goes to burn in the system, and to form bile. 1 If more is taken, and if the digestive organs are healthy, the surplus is stored up as fat, to be used subsequently as circumstances may require. If no carbonaceous food can be usefully taken, the heat in the water takes its place, and may alone supply the wants of the system, or may supplement the fat laid past, which also now comes into use ; and it is in this way that hot water acts as a true food. It would take a considerable amount of carbon fuel, say in bread and butter, to produce the quantity of heat in a tumbler of hot water. Hot water is abused if advantage is taken of its stimulating action to force more food through the organs than is wanted. It gives great relief for the time in this way, and it 1 I am not speaking here quite scientifically, but suffi- ciently so for the purpose. A larger or smaller quantity of carbon in the food passes undigested. Hence in many climates the dung of animals, such as the camel, is often the principal article of fuel HOT WATER 71 may be gone on with for a long period. But the ultimate effect on the overtaxed organs can be nothing but hurtful. It is in this way, I fear, that most use it. Under some cir- cumstances this may be allowable and even salutary for a time, when an error has been already made, and if care be taken that the error is not repeated. Drinking hot water may also, in a small degree, take the place of exercise, by increasing the action of the heart and lungs, and thus of the nervous system. The first time I knew of hot water being taken as a remedy was in dining in 1834 in London with the widow of Admiral Lord Keith. She took no wine, but half an hour after dinner she sipped a large wine-glass of quite hot water, and she ascribed much of her good health to this practice. She said she had used it regularly for thirty years by the advice of her doctor, whose name I forget. She was Dr. Johnson's favourite pupil, his 'Queenie,' daughter of Mrs. Thrale. 72 FADS OF AN OLD PHYSICIAN Since this volume went to press, I noticed in the British Medical Journal, 6th March 1897, a short article on 'John Hunter as a Physician,' from which I extract the follow- ing (the article refers to Dr. Newton Pitt's oration before the Hunterian Society in 1895): 'Dr. Hunter was the subject of vertigo, and suffered from noises in his ears and insomnia. Nothing gave him relief till he took a tumblerful of hot water every night just before going to bed. This gave him a good night's rest. So impressed was he with the value of this simple therapeutic measure that he frequently prescribed it for patients with irritable stomachs, and with the greatest success. I have often found a glass of hot water useful for insomnia, but in two cases it had to be given up as it brought on irritability of the bladder an- other cause of insomnia, particularly in elderly people. A glass of milk, which also sometimes relieves insomnia, may cause the same irrita- tion, and with children frequently does so. HOT WATER 73 The ' Salisbury ' treatment of most chronic complaints by hot water and beef has had a considerable run in recent years, and the immediate effect of this strange combination has in many cases been highly satisfactory. Here the relief to the stomach, liver, and other organs of digestion is enor- mous, inasmuch as ready-made caloric takes the place of the more crude fuel from which heat is usually manufactured. If carbon- aceous food had been used in too great quantity and it is in a great measure in many cases the cause of illness the relief of symptoms may be very great. But what about the ultimate effect on the great eliminating organs of nitrogenous foods, the kidneys, when such a large addition to their work is thrown upon them by the enormous quantity of flesh taken, which must be dis- posed of somehow? For a time, no doubt, the stimulus of the hot water will enable the kidneys to do more work with ease and comfort to the patient, and with no signs 74 FADS OF AN OLD PHYSICIAN of mischief, such as soon show themselves when the excess is in carbonaceous food. I believe that an equally satisfactory cure could be got in the same cases, by stopping for a time most or all carbonaceous food, which may be replaced by hot water ; giving a moderate amount of nitrogenous food, but not necessarily beef; and resuming a more natural and rational mode of living as soon as the overloaded organs have recovered their functions. I think I have seen quite as brilliant and almost as rapid results from this mode of treatment, and common sense might tell us that they will be much more permanent. I am by no means sure that the plan of Dr. Dewey, of abstinence from all food for the necessary time, may not be a still better method. It has the virtue of simplicity, and he has shown it to be safe. I had a couple of years ago the pleasure of lunching with Mrs. , the apostle of the Salisbury treatment in this country. She HOT WATER 75 lunched on a large quantity of beef pure and simple, more, certainly, than I ever before saw taken at one meal by man or woman. My lunch was a modest supply of straw- berries and cream, a very common mid-day meal when I can get it. After lunch we had a long talk, when I pointed out to her that I had taken practically no beef for forty years, and now enjoy better health than when I gave it up ; while after some five or six years of a very full beef diet, she did not seem to me to be in better health than before. She had during these years some very serious illnesses which, I believe, had enabled her to continue her system. In her last book she has modified her treatment, and she only recommends one pound of beef to be taken daily, instead of as much as could be taken, or could be got by her poorer patients. She also recommends some carbonaceous food, as biscuit. I cannot help thinking that had she taken my advice when a mutual friend asked me to see her pro- 76 FADS OF AN OLD PHYSICIAN fessionally years ago in London, when she was a great sufferer from rheumatic and other ailments, and had she then reduced her diet generally till she could digest it properly, the good effect might not have been so brilliant as it was when she adopted the hot water and beef treatment, but it might have been more permanent. But my mind is always open to conviction, and I have been watching with much interest this curious episode in the history of medicine. VI LIQUORICE LIQUORICE as a remedy has hitherto been very little known, if at all. But it has some most useful properties. For relieving the symptoms caused by acrid matters in the stomach, I know nothing to equal it, and I have used it for this purpose for at least forty years. It does not, like alkalies, con- vert acids into more or less inert salts, but it seems to remove their irritating effects in some other way, and the result in relieving the irritation of the nerves of the stomach is much the same. Many object to the use of alkalies, especially of soda if used fre- quently and in large quantities, as it often is, as injuring the coats of the stomach, and 78 FADS OF AN OLD PHYSICIAN thus doing permanent mischief. No doubt this action may be from the use of the soda prolonging the period during which relief from the acid can be readily got, and the mucous surface may be injured by the con- stant recurrence of the acidity rather than from the soda. But this evil does not attend the use of liquorice. It in some way of its own for it is neither from mere dilution nor from neutralising the acid removes the irritable quality of the acid or acrid mass, and adds nothing deleterious to the contents of the stomach. It certainly relieves, often in a very remarkable way, the innumerable pains and discomforts, mental and bodily, which arise from irritation of the gastric nerves, as local pain of stomach or bowels, headache, sleeplessness, lowness of spirits, or irritability and general misery. I have known relief from liquorice in a very large number of cases both of dyspepsia and sleeplessness. I may mention two of these. LIQUORICE 79 A lady from Forfarshire consulted me for severe dyspepsia. She got rid of all her dis- comforts except pains in the small intestine, which came on about three hours after taking food. This proved very difficult to remove, till it occurred to me to recommend liquorice in large quantity before food. This at once relieved the pain, and permanently. Either it soothed an irritable bit of the bowel, or it prevented some change in its contents, which may have come on in the course of digestion at a distance from the stomach. I met one day in the street a friend who afterwards developed general paralysis. He was a strong healthy man who lived well, and did a large amount of head-work. He slept badly, and had found that for a time a good tumbler of whisky and water enabled him to sleep better. This, however, had lost its effect. He was induced to take a less full diet for a time, and he got to sleep at least as well without the whisky. But on the day I met him he told me he was again 8o FADS OF AN OLD PHYSICIAN sleeping badly, and I advised him to take a piece of liquorice on going to bed. The next time I saw him he said the liquorice had been a great success, and he was using it, and was sleeping much better. Liquorice may, of course, be abused if taken to enable one to consume with less immediate discomfort too much or improper food, but of itself it seems to have no evil qualities whatever. It has antiseptic proper- ties, and is used to preserve such articles as fluid extracts of coffee, but the taste it gives to these is not agreeable. To most it is pleasant to take, and I have sometimes given it in considerable quantity. In quality it varies greatly. Solazzi brand is perhaps the best, but good Pontefract cakes are a very handy form, and there are some excel- lent concentrated forms in small pellets, which are to be had from a good druggist. Many years ago when visiting a lady in East Lothian, I mentioned to the doctor that his patient might be benefited by LIQUORICE 81 liquorice. He told me he had found it very useful in a way I had not known. Many farm servants, who smoked strong tobacco, could not look at breakfast till they had a smoke ; this was always relieved by taking a bit of liquorice on getting up. He had got great credit from their wives for this pre- scription, so I concluded that the men's temper had also suffered. This is the only doctor I have met who knew the value of liquorice, but I have heard of its being used, and much prized, by old people a generation or two back. NOTE. I have heard recently of many who have got much benefit from liquorice. Messrs. Hillaby, large makers of Pontefract cakes, etc., wrote me that their work- women, when pregnant, took it in large quantity, as it kept off sickness. I have long used it in the same cases. I recommended Messrs. Hillaby to try a combination of liquorice with peppermint, which is so useful for flatulence, and as an antiseptic ; it is usually taken in lozenges with sugar, which is apt to turn sour in a bad stomach. They found them to combine perfectly, and many prefer the new lozenge to the old one. To some liquorice and peppermint are disagreeable, but the taste of both is in a great measure covered in the combination, and the risk of acidity is done away with. 3rd Edition. VII ON CANCER SEVERAL years ago I read in the British Medical Journal a debate on Cancer in one of the London Medical Societies. Two or three of the surgeons who took part in the debate spoke of starvation as the only remedy for the disease. This interested me much, as I had not noticed similar views in any medical literature with which I was acquainted. I had long known, however, that high living, that is, the use of wine and other stimulants, and of strong animal food, aggravated in an extraordinary manner all the symptoms arising from this terrible disease ; while abstinence from these, and the use of a light and sparing diet, if it ON CANCER 83 could not cure, certainly relieved in a high degree the pain and irritability of the patient ; rendered the course of the local disease slower and prolonged life, while it made it much more tolerable till the very end. I know of no class of cases where the benefit that follows a change of living is so marked, and I am not sure that I know of any in which the change is so difficult to make, whether the sufferer be rich or poor. In the one case the relatives, from the kindest of motives, take every care that the doomed one shall want nothing that money can supply, and in the other, kind friends and neighbours have a similar care for the poorer sufferer ; while most surgeons, thinking of the exhaust- ing nature of the malady, recommend all sorts of what are usually considered the richest and most setting - up meats and drinks ; and trust to opiates and other drugs to relieve the pain and suffering. My own experience has led me to adopt a very different treatment to that which is certainly 84 FADS OF AN OLD PHYSICIAN still followed as a rule, both as to feeding and giving soothing medicines, and I have found that if a proper diet is given, there is little call for relief by opiates, and sometimes none at all. Some twenty years ago I read, I think in the same medical journal, a short notice of a woman who had for some years suffered from cancer in the breast. At last her con- dition got so low and her digestion so bad that she could only take for sustenance a very small quantity of milk. On this alone she lived for two years, and at the end of that period the cancerous growth had quite disappeared. Unfortunately in neither case have I kept a note of the date of the journal. I give a few cases, which I have met with in my own practice, where I have found the good effects of light living, both in easing the patient and in prolonging life. I first saw Mrs. M at Leith in 1852, owing to the death of her doctor, a kind old friend whom she deeply lamented. I had ON CANCER 85 known him well, and we were good friends, though differing very much in the mode of treating our patients. Mrs. M was then about 40, of a very nervous, irritable tem- perament ; she was constantly suffering from some mucous irritation to a degree I have rarely met with, and she had also a moder- ately-sized uterine fibroid. She had been kept up with the best of everything though from the state of her stomach she could take but little but with no good result, and she remained wretchedly thin and rarely able to be out of doors. A change of diet and an almost complete cessation from drugs rendered her life on the whole a much more tolerable one, and of this she was so well convinced, that afterwards when on more than one occasion I begged her to get a local doctor, as she lived out of my usual beat and I had difficulty in giving her proper care when ill, I could only get free for a few months, when again I had to renew my attendance at her urgent request. On 86 FADS OF AN OLD PHYSICIAN the whole her health gradually improved ; she was able to go to the country and to visit her friends, and she could take more food and had got a little stouter although living very sparingly. Thirty years after I first saw her, she told me that one of her breasts was beginning to trouble her as it had done long ago. I was startled to find a well-marked knot of scirrhus, and told her my opinion of it. She then said that she had been told the same forty years ago, and she was sure of the date as it was before 1 843 which was an epoch in her life, as the year of the Disruption of the Church of Scotland, she being a keen Free Church woman. Dr. Kellie of Leith, a well-known physician there for a long period, was then her doctor ; and her breast had been seen at that time by two other surgeons, and all agreed as to the nature of the case, and said that the tumour should be removed. I rarely saw her after this, having now given up practice. The breast, I was told, gave her considerable ON CANCER 87 trouble, but she died from a general break-up when upwards of eighty years of age. I was asked by an Edinburgh client to see his sister who was then an inmate of an asylum for the insane in York. She was suffering from malignant disease which had been operated on some months previously, and my opinion was wanted as to whether a further operation would be possible. Another point on which the brother wished to consult me was as to whether it would be prudent for him to receive his sister into his house in Edinburgh. Before coming to the asylum she lived with another brother, and the care and anxiety which her suffering, and still more her irritability, occasioned, had quite upset two of his daughters, and had rendered her removal to where she could be more easily controlled a matter of necessity. She had improved somewhat, and the doctors found that the case was not one fitted for an asylum. My friend had only one daughter at home, a very delicate girl, and though 88 FADS OF AN OLD PHYSICIAN most anxious to do the best for his sister, he feared much for the health of his daughter if she was subjected to the same anxiety and worry which had upset her cousins. If was an easy matter for me to find that no further operative treatment of the disease was pos- sible. The other point was more difficult to decide. I ascertained, however, that though of a nervous temperament, the lady had not, till disease came upon her, been irritable and troublesome ; also that to help her to support the weakening discharge from her ailments, which was very abundant, she had been kept on a very stimulating diet, both as to food and wine. In the asylum this had not been carried out in the same degree, and she was already calmer and more easily managed than before. Taking these circumstances into consideration, I recommended that she should be taken to Edinburgh ; and that with the help of a still less stimulating diet, I hoped that no harm would result to her delicate niece. She was accordingly re- ON CANCER 89 moved to her brother's house, where she spent the last two years of her life. She took no exciting food, and no stimulant whatever, and she required no medicine of any sort. There was a large vinery on the place, and, while they lasted, her chief sus- tenance was from grapes, which she enjoyed more than anything. The irritability left her at once and completely, and I seldom had a more contented patient, or one whom it was so much a pleasure to visit. On one occasion her brother on his birthday brought her a glass of champagne. She unwillingly tasted it, but at once rejected it, and said it put her mouth on fire, although formerly she could and did partake of it very freely and with relish. In this case no one could doubt that the extremely light and sparing diet prolonged life, and, what is more important, made it much more tolerable both for the patient and her friends. Lady at an advanced age suffered from a large, open cancerous tumour of the 90 FADS OF AN OLD PHYSICIAN breast. It had existed for years, but I did not know of it till it was far advanced, and no operation could be thought of. The suffering was considerable, but was relieved from time to time by rather alarming bleeding. She was able to be out of doors, and to look after her household. She lived carefully, but till lately not very sparingly. In the autumn she went to live with a brother near Lin- lithgow, and my friend the late Dr. attended her. After she had been there for some months, I was asked to see her. She had lost very much and certainly seemed to be near her end. She had, I found, been treated in a very different way as to food and medicine, but fortunately her stomach had got so weak that she could take little of any- thing. The great desire was to get home to Edinburgh, but this her friends and doctor considered quite impossible, and as a com- promise I was asked to visit her. After full consideration, and seeing that there was still some life in the old lady, I told the ON CANCER 91 friends that I did not think she would die on the road, and that it might be best to let her have her own way. This was very un- willingly agreed to, and she was driven to Edinburgh a few days later. She now gladly returned to her old mode of living, and to the astonishment of all but myself, she soon got back to much the same condition as she was in before she went to the country. For two years she was able to be from time to time at church and market, and she died at last from exhaustion and with comparatively little suffering. I have to acknowledge that it was but rarely that I could carry out in its fulness what I considered to be the right treatment in such cases, the difficulties, as always, being due to the friends much more than to the patient. Few of my colleagues have even attempted to follow my example. I was pleased, how- ever, lately to hear from a patient of a friend now deceased, and who had twice been operated upon, both of her breasts having 92 FADS OF AN OLD PHYSICIAN been removed by him, that on the last occasion she had by his orders lived for three months on three meals daily of oatmeal gruel, and on nothing else. On the first occasion she had told no one of her ailment, and had lived as usual so that there might be no suspicion of anything being wrong with her. It was necessary to operate at once, if at all, and she suffered terribly almost, she said, going wrong in her mind. On the second occasion she had no suffering what- ever, and made a rapid recovery. The first tumour removed was most markedly malig- nant ; the second was not so, and was judged to be of a simple character, although its history and diagnosis were such as to call for its removal. On discussing this matter several years ago with my friend the late Mr. I , F.R.C.S.E., and telling him that I believed that high living was certainly one cause of the scirrhus form of malignant disease, and that I had never met with it except in well-fed women, with ON CANCER 93 one doubtful exception, he said that he was the distributor of a fund for poor women suffering from advanced cancer, and he did not think that what I said could apply to them. I asked him to inquire into each case as it presented itself. After six months he told me I was quite right, and that as a general rule he found that his poor clients had been well fed, and so far as they were able to indulge, were well fed still. He took some trouble to get them to alter their ways and live more simply and sparingly, and to some of the stronger ones he gave by my advice small doses of iodide of potassium. A year later he told me that I had brought him into a difficulty. Formerly he had been able to take on most of the fit cases which had applied, and could usually admit the same number from year to year, their average life being one year after admission to the fund. Now he said they were living longer, and several applicants were waiting whom he could not admit. An experiment such as this 94 FADS OF AN OLD PHYSICIAN requires much time and pains to carry out, more than a busy man can afford, and probably it was gradually dropped, as, so far as I recollect, my friend never again mentioned the subject. Some twenty years ago I was called to the west of Scotland to see a young married gentleman with malignant disease in the groin. He had much pain and suffering, and had already been operated upon ; but the disease had returned. For his relief he was taking opium freely, and he was being as well fed as was possible ; but he was losing ground fast, was quite confined to his bed, and from being of a particularly happy and gentle dis- position he had become irritable and morose, much to the distress of his friends. I could recommend nothing for the local symptoms, but I advised that he should be put on a much more simple and restricted diet, and I hoped that by this means they would be able to reduce or stop the opiates, which were blamed as the main cause of the sad change ON CANCER 95 in his mental condition. This was done, and the result was even better than I had hoped. He improved so much in every respect that his medical adviser was soon able to get away for his holiday, which he had put off owing to the constant attendance on his patient, who was an important one. While he was away I was requested to make a second visit, as after some weeks of comparative quiescence the local disease was getting more trouble- some. I found the gentleman in a very different condition mentally and bodily, although his case was quite hopeless ; and all his friends were loud in their appreciation of the change of treatment. The end came soon, but there was no occasion to resume the opium. The few cases I have mentioned will, I hope, induce some surgeons to try the method I have indicated on their patients suffering from ordinary cancer. They may have difficulty in so doing, as I have already stated, but if it is tried and carried out, especially 96 FADS OF AN OLD PHYSICIAN with those of a nervous temperament, they will at once notice a change for the better. Such at least has been my invariable ex- perience. I am pleased to see that Dr. Haig states that cancer has been noticed to be rare among vegetarians, and that he has long thought that it is at least possible that it may often have the way paved for it by the chronic and recurrent local irritation produced by urates in the tissues. 1 I was told many years ago by a medical friend who was long in India that some forms of malignant disease were common among tribes who lived mostly or entirely on vege- table food ; and I was told by another that they were also common where the only animal food used was fish. These statements have made me all the more careful to inquire as to the mode of life of my own patients before they came into my hands. 1 On Uric Acid, p. 320. VIII RELIEF OF PAIN AND SLEEPLESSNESS SOME medical men seem to think it a duty to relieve pain whatever may be its cause ; and if one form of sedative is evidently in- efficient or attended with bad results, they try another and another. As the number of these is now legion, there is abundant room for experimenting on this line, and the result is no doubt often satisfactory. It is, however, often the reverse, and experience of this taught me early to do without sedatives when there were other methods of relief. Of these a little patience was often the best ; I have frequently been told by invalids that they would much rather submit to pain than to the unpleasant effects of opiates 7 98 FADS OF AN OLD PHYSICIAN given to relieve it. There are in a number of cases other means of relief, as hot fomenta- tions, mustard poultices, opiate or belladonna plasters, and above all massage, and of this the best and most powerful form I know is dry-cupping. I got a lesson in this at an early period from a country gentleman who suffered from spasms of the stomach. He had got made for himself a small cupping- glass to which was attached an air-pump. The glass was placed on the back, and the air exhausted to a moderate degree, so that the glass could be drawn along the back and all over it. A red wheal is left behind, and soon the whole surface is as if a strong mustard poultice had been applied. The relief to the spasm was immediate. The instrument could be used by any one with a strong hand, and the butler was well up to its use. I have often had recourse to this mode of dry-cupping with great effect. It can be done with an ordinary cupping-glass, if the air is only partly burnt out so as to RELIEF OF PAIN AND SLEEPLESSNESS 99 permit of the necessary traction. I never knew the pain of lumbago to resist this method or even the ordinary dry-cupping by fixed glasses left on for a few minutes. I have had relief from the pain of lumbago in this way scores of times, and my servant could use the glasses in both ways with great facility. I mention under 'Self- Massage' the numerous pains which can be relieved by rubbing. I remember when the now common mode of using opiates by injection was introduced by my friend the late Dr. Alexander Wood. No practitioner now is without his injecting- syringe and needle. The relief from pain is delightful and is almost immediate. But severe and prolonged sickness often follows, and some suffer the pain rather than have recourse to the injection a second time. With others the agreeable sensations are enjoyed quite as much as the relief from pain, and if the process is often repeated a bad habit is easily formed, which may be loo FADS OF AN OLD PHYSICIAN as difficult to cure as is that from taking opium in the ordinary way. I have seen terrible evil from this, and to surgeons as well as their patients. I soon became so afraid of the evils arising from opium given or taken in this way, that I am not sure if I have used it in a dozen cases since its introduction. While by no means con- demning its use in every case, I cannot use too strong terms in giving a caution to the younger members of the profession. Anaesthetics, which are perhaps the greatest blessings of the age when properly used, may also be abused when given as antidotes to pain not caused by a surgical operation. Here also a bad habit may be formed, from the ease with which anaes- thetics, particularly chloroform, can be ob- tained and used. I must plead guilty to having employed this new remedy on myself in an extreme and foolish manner. But at the time there was some excuse for me. Being the colleague of Professor Simpson RELIEF OF PAIN AND SLEEPLESSNESS 101 when chloroform was introduced, I was often asked to try the drug as manufactured by different chemists, and also to try instru- ments which were at first considered neces- sary in using it. Besides taking it to relieve headache and sleeplessness, I took it for a considerable time twice or thrice a day, to see if any evil results would follow. This I was soon not allowed to do at Professor Simpson's house, as on coming out of the chloroform I had such a craving for more, that I sometimes broke through all rules of propriety in attempts to get possession of it. This strong desire I have seen in others, and it helps me to sympathise with persons given to drink. The desire which follows chloroform is much more transitory than that which follows alcohol, but for the time it is very commanding. I did not keep an exact count of the number of times I was under chloroform, but I calculated that within six months after it was introduced I had taken it some three hundred times. roi PADS OF AN OLD PHYSICIAN It was certainly injuring me, upsetting my stomach and liver especially, though I am not aware that it caused any permanent harm. Perhaps I could not have continued to take it much longer, as I was coming to have an intense dislike to it, so that the sight of the bottle or even the thought of it brought on a feeling of disgust, and almost of sickness. This went off as soon as a few breaths of it were taken. I have known the same effect produced in others who had become addicted to the practice of inhaling chloroform. For inducing sleep opium in its numerous forms has always been much in use. Of the new remedies I have no experience, and no knowledge except from reading. I am constantly receiving papers and pamphlets from the manufacturers or sellers of these, with wonderful reports from medical men and others of the value of some new chemi- cal of which I had not previously heard. They often insist on the superiority of the RELIEF OF PAIN AND SLEEPLESSNESS 103 new drug over any previously used, of which they proclaim the faults in no measured words. It is to be hoped that some grains of real value may result although much chaff may have to be blown away ; but it would be well if more time and care were taken in honest inquiry into the effects, immediate and final, of each novelty, and if the consideration of its commercial possibilities were deferred till its true value has been fully established. In my own practice the use of drugs for procuring sleep gradually got less and less, as has their use for relieving pain. In this matter my own case has given me most help. I have slept badly for at least three- fourths of my life, partly from a nervous temperament, partly from a bad stomach, and these aggravated for many years by frequent calls during the night to visit the sick. On one occasion, from a bad chill, I was seized with severe pain over the left shoulder-blade, ending in an abscess, which destroyed part 104 FADS OF AN OLD PHYSICIAN of the periosteum and of the bone under it. I was then in poor health, and vainly trying by too much food and physic to keep up my strength. I suffered so much before the abscess was opened that for three full weeks I had no sleep whatever, and very little for as much longer, when 1 went to the west coast for a yachting cruise. My sleep gradually came back, but at this time it was at best restless and unrefreshing sleep, and I was sometimes tempted to try chloroform or an opiate, but that I did very rarely ; opium alone made me more restless. I had been recommended some years before by a country gentleman to use for toothache a full dose of laudanum with a tablespoonful of castor oil. This I was told was an excellent cure, and I found it so in my own case and many others. Years before this I had once taken half a drop of croton oil for toothache and found immediate relief. I was then a student and I had seen croton oil recommended for toothache and neuralgia. The two oils have RELIEF OF PAIN AND SLEEPLESSNESS 105 much in common. The addition of castor oil to opium certainly increases its soothing effects, and prevents unpleasant consequences. This was one of the few remedies that I adhered to long after giving up almost all others. When suffering from gastric attacks with severe headache, although the dose had no effect the first day or two, thirty drops of nepenthe with a tablespoonful of castor oil often removed the headache and restlessness, and sometimes induced a long sleep, from which I woke up comparatively well. Since getting into better health, although I usually sleep badly I can rest quietly, and I have found that this makes up, in all essential points, for a shorter period of sound sleep. For this comfortable if not perfect mode of spending the night the great necessity is perfect digestion, so that when one goes to bed there is no sour indigested mass in the stomach, and when the stomach is empty there is no flow of acid secretion into it from the blood. To reach this happy condition of io6 FADS OF AN OLD PHYSICIAN digestion once it has gone wrong is a slow process at best, but the simplest and most rapid method of bringing it about is by more or less complete abstinence from food, and this may be safely done to a very much greater degree than is supposed safe by those who have never tried the experiment. Tem- porary relief may sometimes be got by nature's own method, complete rejection of the acid mass by vomiting, or it may be neutralised by alkalies, or by a free use of liquorice. All of these frequently allay the general irritation and induce sleep, but unless the hint is taken and a more rational use of food be followed, these and other worse attempts at cure only allow the wrong system to be carried on longer, and the disorder to get more fixed and chronic. One useful lesson I have learned from my own case and from others is, that a large amount of sound sleep is not essential for any one, that what is taken is very much a matter of habit, and that if sleep be wanting for a RELIEF OF PAIN AND SLEEPLESSNESS 107 time, it is as a rule safer to await its natural return than to have recourse to drugs which, though they may give some immediate relief, may in the end be the cause of still greater evils. I know that this view can be contro- verted, but I only seek to uphold it when it is combined with a rational plan of giving food and stimulants. When the stomach is very irritable, quiet sleep may frequently be obtained by the use of a large mustard poul- tice. It should be kept on only so long as it is quite easily borne. Sometimes the effect is so prompt, and the sleep induced so sound, that the pain may not be felt until the skin has become so inflamed as to be troublesome for many days. Thinking, especially if the subject is an unpleasant one, is the bane of sleep. I have often been able to counteract this, and some- times to induce sleep by fixing the eyes and noticing the curious changing forms of light and sometimes of colour which usually appear when the attention is turned on them ; or the io8 FADS OF AN OLD PHYSICIAN eyes may simply be kept fixed, in an upward direction in the darkness, or, if there be light, on some object in the room. The slight effort required for this is enough to stop the current of thought. If continued for some minutes it becomes somewhat irksome and tiring, and unconsciously one sometimes falls asleep These little experiments at least help to pass the time, and to break the continuity of a long night. A not infrequent cause of sleeplessness is liability to cramp in the legs, especially in persons of advanced years. This is sometimes relieved by raising slightly the lower part of the bed, so that the lower extremities are higher than the rest of the body. This simple change will prevent congestion of the muscles, which may be the exciting cause of the spasm. IX RHEUMATIC FEVER RHEUMATIC fever or acute rheumatism has always had an attraction for me. It was the first disease which I had specially considered, as it was the subject of my thesis required for passing as M.D. I got up all its litera- ture on which I could lay my hands, as I then knew nothing of it practically. It was the treatment that chiefly interested me. There was not much room for coming to any definite idea about this. The only conclu- sion I arrived at was that cases treated with quinine were shorter than those treated in any other way, but that this treatment led to more deaths. This disease is, I believe, a much more no FADS OF AN OLD PHYSICIAN common one now than it was fifty years ago, especially among the young, and it leads to a large proportion of the cases of organic heart disease, which also tends to be much more common than formerly. It is to be met with occasionally amongst children of only a few years old, but more frequently among boys at school and youths at college. It is not even yet a very common disease, and a school may have had no case of it for years. I have never in all my experience met with it in young or old except when the diet had been full, and had consisted largely of beef and mutton, and the changed feeding of the young in this respect is to my mind the main, if not the only, cause of the compara- tive frequency of acute rheumatism at the present day. I have been on the outlook for at least forty years for a case of the disease in a child or youth who had not been fed on red meat, and I have not once either met with or heard of a clear case of the kind. Once, indeed, some twenty years ago, I R HE UMA TIC FE VER \ 1 1 thought I had come on a slight though well- marked case, and was looking on it as the exception which proves the rule. The child was four or five years old. The mother, before her marriage when she came under my care, had got into bad health from the prevalent too good feeding, and I doubted if she could have had a child at all but for a complete change in her mode of living, which after some time restored her to a fair state of health. I had told her what I thought the right way to feed her boy, and never dreamt that she would try any other. He was quite healthy, but being light- haired and rather pallid, and of the pure nervous temperament, he had not the robust florid look of children of the sanguine or muscular temperament. I found him one day very feverish, with dry furred tongue, and complaining of pain in front of one ankle, which was somewhat red. I told the mother that the symptoms pointed to acute rheumatism, but that I did not think it possible it could be so in a child that had 112 FADS OF AN OLD PHYSICIAN been brought up as hers was. Next day the other ankle was affected in the same way, and by and by both knees. There could now be no doubt whatever that the case was one of acute rheumatism. It was a mild case, however, and in ten days the symptoms were passing off. The mother now told me she had a confession to make that a friend had been telling her that it was foolish to try to bring up her pallid boy in the way I recom- mended, and had induced her to give him a bit of meat every day. This was begun six months ago ; after two months he looked no better, so for the last four months she had given him more meat, and still with no change in his appearance. She was glad now to return to the old diet. The only evil that resulted was that the heart was decidedly affected and gave trouble for years, but when last I heard of the young man he was in good health. It was well for him that the disease came on so soon, as, had it been delayed and the flesh feeding RHEUM A TIC FE VER 1 13 continued, the result might have been very different. When in the Argentine Republic some ten years ago I was told by the principal English doctors in Buenos Ayres and Rosario, the two chief towns, that rheumatic fever is there an exceedingly common disease among the young, and that it leads to most of the heart disease, which also is very common. The amount of meat, especially of beef, consumed there by old and young is enormous, when compared with what is eaten here. The main evils I myself saw from this were anaemia in children, and neuralgia both in old and young. I believe that high living may do less harm in so fine a climate, and there seemed to be fewer sufferers from dyspepsia and other functional ailments. I have attended several third attacks of acute rheumatism, but I never had a recur- rence of it in my own practice, as I always proscribed beef and mutton for those whom I saw once with the disease. During the ill- 114 FADS OF AN OLD PHYSICIAN ness I gave little or no food, and a favourite remedy was small doses of iodide of potassium. Two severe cases which occurred about the same time I treated with hot water only. One was a third attack. Sir Robert Christison saw them both, and was pleased with the treatment, and he recommended nothing else. In neither case was the heart affected. Dr. Dewey has had much more experi- ence of rheumatic fever than I have had. He believes that it is due to disordered digestion, arising from eating for an unknown period beyond the power to digest and assi- milate. As his clients, old and young, con- sume much more butcher's meat than did mine, his experience quite coincides with my own. But his treatment is much more thorough, though quite in the same lines. He gives nothing but water whatever be the length of the illness, and in one case there was no call for food for forty-six days. He then gives whatever the patient asks for, but RHE UMA TIC FE VER 1 1 5 not till the tongue is clear and the appetite evidently a natural one. The late Dr. James Begbie, who was considered our first authority on gout and rheumatism, told a lady patient of mine, whom I had seen through her third attack of rheumatic fever, that for the rest of her life she ought not to touch beef, mutton, beer, wine, or brandy. I had asked him to see the lady when her friends were insisting that, now she was getting well, she should return to her ordinary mode of life. I had found it useless for me to point out to them that this was precisely what had already subjected her to three attacks of a most dangerous malady. X HOW ONE SHOULD LIVE IN A HOT CLIMATE IN a warm climate less food is required than in a cold one, as in the latter a large portion of our food goes to keep up the temperature of the body. This is a self-evident pro- position, but it is often forgotten, and especially by sufferers from dyspepsia who go to a warm climate for their health. The immediate relief is often very marked. Dys- pepsia is usually attended with, and often caused by, an irritable state of the stomach. This implies some degree of congestion that is, of too much blood going to the organ, and the necessary complement is that too little goes to the skin. In a warm state of the atmosphere there is much more tendency of LIVING IN A HOT CLIMATE u ? blood to the surface, and this alone is enough in many cases to cure dyspepsia. If a rational system is now followed, and no more food taken than before, or only enough to restore an impoverished condition of the system, the cure may be permanent. But if, as often happens, more food be still taken than is required, the health may be good for a time, but by and by the same symptoms may recur as before, and now the same means of cure are not available, and the last state is worse than the first. Many also who go to a warm climate and whose health is good, if they continue to take the same food as in a colder country, by and by suffer in one of the many ways that repletion leads to, unless they are wise enough to reduce their diet, especially the carbonaceous or fuel part of it. But many do not think of this, and as they become languid and oppressed, as they suppose from the heat, they often have recourse to some stimulant to relieve them. There would be no great harm from this, provided ri8 FADS OF AN OLD PHYSICIAN they at the same time reduced the quantity of food. It follows that, if food be properly managed, life should be longer in a hot than in a cold climate, as there is less tear and wear of the organs, less work being required of them. A very large number of both sexes who have returned from India have come under my observation, and as a general rule so far as I can recall, a universal rule those who have kept their health at least as well as they had it in this country, and have returned sound and strong, had been moderate eaters, and still more moderate drinkers. On the other hand, a large portion of those who broke down had soon found it necessary to take to stimulants to help them, and their career was often very short. One curious observation forced itself on me long ago, that abstainers from all alcoholic stimu- lants sooner or later were liable to break down and to have to return home, when a temporary use of some form of stimulant might have tided them over. It would have LIVING IN A HOT CLIMATE 119 acted by diminishing the waste of the body, and thus acting as a food, when the weakened stomach would not do its duty. Cases of this nature are, however, rare compared to those where the combination of too much food with an undue amount of stimulant have sent the young and strong homewards pre- maturely, and often with the foundations of permanent disease. Upwards of forty years ago I had the opportunity of sending a young medical friend to Madras as assistant to a civil doctor there. He suffered much from dyspepsia, and was somewhat afraid of the climate. I assured him that the warmth would suit him, and that if he did not take undue advantage of his improved health the relief would be per- manent. For five and twenty years he was perhaps the busiest doctor in Madras, as besides his practice he lectured in the medical school and was coroner. When he returned, he told me that I had been right in advising him as I did. His dyspepsia very soon left 120 FADS OF AN OLD PHYSICIAN him, but he did not take the care that I had recommended, and for a time his stomach again failed him. He now took to living as he should have done from the beginning, and got into excellent health, which he brought home with him. I saw him for the last time five years ago, when he was well and doing a fair amount of work in his native city. He died three years later. I have met with many cases of maltreat- ment of friends which have roused me to try to improve the methods of the leaders in the profession, but none of them vexed me more than the following. During the mutiny in India in 1857, the wife of one of the most active officials in putting down the rebellion was a patient of mine in Edinburgh. Her husband, one of the hardest workers in India, was a most moderate liver, his only stimulant being one glass of beer a day. He retired soon after the mutiny was ended, and he returned home in the enjoyment of excellent health, and looking, for his age, none the LIVING IN A HOT CLIMATE 121 worse for his long and laborious residence in a hot climate. Several years later I saw him in Edinburgh on his way to recruit in the Highlands. He had had some alarming attacks of haemoptysis, and his London physician feared his lungs were in danger from phthisis. He had got weak for a time, and he was of course being well fed. When I saw him he had had no bleeding from the lungs for some weeks, and the signs of mis- chief in the lungs were by no means decisive; there was nothing, in fact, but what might have been caused by the local haemorrhage, although of course this of itself was a sus- picious symptom. I put him on a much- restricted diet, and with little or no wine. On his return in a few months, he was in very much better health and stronger. There had been no return of the haemorrhage, and after a careful examination of the chest I came to the conclusion that he was all right, and only required care, especially in diet, to enable him to continue so. By and by I 122 FADS OF AN OLD PHYSICIAN was grieved to hear that he was ill again. The London physician to whom he reported himself on his return at once put him on his old full diet and stimulants, and very soon the haemorrhage returned, and in a few months he died. Shortly after, I had a letter from my old friend Dr. F , formerly doctor to Lord Lawrence, and through whom I had first known the lady and her husband, in which he wrote that he was pleased to know that I was not the medical man who had put his old friend on a wrong diet. I will finish these few notes with an extract from a letter from a medical man living in a hotel in the south of France to a friend close by. It gives very neatly the view that most English residents in a warm climate take of the situation so far as heat and free living are concerned : ' This seems the coldest day we have had this winter, and I see the low hills white with snow, but the change seems to suit most people in this house. Continuous sunshine LIVING IN A HOT CLIMATE 123 and warmth do not fit in with the English habit of over-eating. We prefer the weather to change a little rather than be bothered to alter our ways. In short, we get out of the difficulty by saying that too much sun- shine and brightness are unwholesome.' XI ON MATTERS WHICH RETARD DIGESTION AND PREVENT WASTE THERE are several substances in common use as medicines or foods which check the chem- ical actions concerned in nutrition, and thus lessen the waste of the tissues, and also the secretions which carry off effete products from the system. These are alcohol and opium in all their forms, tea and cognate substances, and osmazome of flesh which gives their stimulating quality to beef-tea, Liebig's Extract, and other preparations of beef. Any of these may be given for a long period, and may favour long life, provided that the quantity of food taken is in an in- verse ratio. It is a well-known fact that an RETARDED DIGESTION 125 old woman can live with comfort on a free supply of tea, with very little else. The same is the case, as I have pointed out else- where, with an old Highlander who lives mostly on whisky ; and also with the Indian or Chinaman, who, if he takes a moderate amount of opium, can do much work on very meagre fare. It needs no argument to show that if one or more of these inhibiting sub- stances be taken with an ordinary quantity of food and they are often taken under the false idea that they assist an enfeebled di- gestion the result must be hurtful. It is only the younger and the very healthy who can for any lengthy period indulge in such an unscientific mode of life, and it is those, if they have no one organ weaker than the rest to give them a timely warning, who die earliest. Many years ago I had it from the manager of our foremost life insurance office, that his company lost more on the healthiest lives to which no objection whatever could be made, than on those which, though ac- 126 FADS OF AN OLD PHYSICIAN cepted at the ordinary rate as sufficiently good, were not altogether of a first -class character. I had asked him the question, and got the answer I expected. The num- ber of the healthy who throw away their lives in this way is, I am convinced, much greater than is generally believed ; and in- stead of living longest as they certainly ought, they must help very materially to lower the average of human life. The cause of error with most of them is simply want of knowledge, which, to those who do not look beyond their own case, comes too late. I have given a warning to many when I had the opportunity to do so, and not a few have gladly taken it, and have got the sure re- ward. On the many, however, the advice is thrown away, and they have chosen what they consider the pleasanter path. Here, too, they are wrong, as, if they but knew it, the pleasure is all on the other side. With a good stomach, one which would do its duty for a long lifetime, if its very goodness did RETARDED DIGESTION 127 not lead so easily to its abuse, the habit of taking too much food is easily acquired. This soon leads to a more abundant supply of blood being sent to all the abdominal organs, as they are all engaged in the pro- cess of digestion. The vessels of the stom- ach become enlarged, and also its capacity to receive food, and satisfaction with a meal is not arrived at till the expectant organ is fully supplied. If alcohol, or osmazome, or tea, or all of them together be also taken, as is usually the case, a crisis is sooner arrived at. There may be a period of enjoyment in the consumption of a long and varied meal, but even with the healthiest this cannot last, unless assisted by aperients and other means which are resorted to by almost all who live fully. Were it not for these aids, nature would soon assert itself, and apply the fit punishment for its broken laws by an un- pleasant but salutary cessation of all desire for food, which, if allowed, would soon re- store in some measure the health of the 128 FADS OF AN OLD PHYSICIAN damaged organs. This should suggest to a rational sufferer that the manifest cause of his discomfort should not be repeated, and if this simple rule were attended to, what an amount of suffering and of lives shortened would be saved to humanity ! But we live in an age of science, false as well as true. Nature, if its first hints are not taken, resorts to severer and sharper ones ; the doctor is called in, and, according to the rules of treat- ment of the day, drugs are given to relieve troublesome symptoms ; and if food is de- clined for a few days, it must be taken whether the patient desires it or not, and, along with food, one or more of the inhibit- ing substances we have been speaking of. What might have been only a salutary sick- ness of a few days, resulting in a return to health, may be converted into a long illness, leaving the system seriously impaired. If now a more rational mode of living were adopted, a fair amount of health might be recovered and maintained ; but the anxiety RETARDED DIGESTION 129 of the patient, and of his friends and doctor, is to get up the strength as fast as possible, and satisfaction is felt if the weight lost is rapidly regained. The real benefit from the illness is thus lost ; the evil round recurs, and the strong man becomes a confirmed invalid, or, what is perhaps better, comes to an early and premature grave. XII ON NATURAL CRAVINGS AND DISLIKES A NATURAL and sometimes an extreme crav- ing by the sick for some special food or means of relief is not uncommon, and it is usually looked on as absurd, and is disre- garded. A remarkable instance of this is given at p. 37. A somewhat similar ex- perience happened to myself when a youth, and suffering from a severe attack of scarlet fever. The fever was strong, and my tem- perature was no doubt very high, but we had not begun to test it by the thermometer. The weather was intensely cold, and I would not allow the window of my very small bed- room to be closed night or day. For several days I kept thinking of the delights of sea- ON NA TURAL CRA VINGS AND DISLIKES 131 bathing and swimming, which I used to enjoy like other lads. I was looking for- ward with much satisfaction to next season's sea-bathing. This was in February. The fever was relieved at last by a copious bleeding from the nose, which for a time was rather alarming. I now lost all desire for a swim, as my brother did for sherry. A cold bath as a remedy for my hot condition was not then thought of, although about the beginning of the century Dr. Currie of Liverpool had begun to recommend it for scarlet fever. He had few followers till a more recent date, when the local use of cold water or ice was gradually adopted by many as the best means of reducing the tempera- ture of the body when excessive. A well-known doctor of divinity in Aber- deenshire was visiting an old woman sup- posed to be at the point of death. He was left alone with her, but he could not get her to attend to his services, as she had taken such a craving for green cheese that she 132 FADS OF AN OLD PHYSICIAN could think and speak of nothing else. He returned to the friends and told them the circumstances. ' We know,' they said, ' the craze of the poor body ; she has done nothing but cry for green cheese all day.' ' Why do you not give it her ? ' said the clergyman. ' Because it is the worst thing for her,' was the reply. ' But she is dying, is she not?' 'Oh yes, she is dying.' ' Then the green cheese can do her no harm, and it will let me speak to her quietly.' This was unanswerable; the green cheese was given and eaten greedily, and the old woman recovered. The reverend doctor was in the habit of saying that after this he would never refuse a sick person anything. This story I had from my father, the son of a neighbouring clergyman. If I am not much mistaken, a wider and more important subject is the converse of this craving for some specific means of relief; I mean the dislikes of the sick, especially to food, but also to noise, motion, ON NA TURAL CRA VINGS AND DISLIKES 133 light, or close air. In all these matters the invalid is, when it is possible, allowed to have his own way, except in the case of the most important of them all, his dislike for food. Here he is very much at the mercy of his doctor and his friends, and unless he has a very strong will he must obey. He may indeed be a willing victim so far as he can resist his natural antipathy ; and sup- posed duty may induce him to take what he would much rather avoid. I have the strongest conviction, and that after more than fifty years' experience, that the forced giving of food when it is not wanted is the cause of more misery, more aggravations of disease, and greater shortening of life, than all other causes put together. This doctrine I have held absolutely for very many years, almost indeed from the beginning of my medical career. I long ago said that I knew of no circumstances in which it was proper to force food on an unwilling patient except in the case of a lunatic who refused 134 FADS OF AN OLD PHYSICIAN to take anything. Even this solitary excep- tion I gave up, on coming upon the follow- ing case in a medical journal. Unfortunately I took no note of it, but it was some twenty years ago, or more. A man had been in an asylum for the greater part of his life. From time to time he refused food, and it was put into his stomach by a tube. At last his health quite failed, so much so that it was considered useless to force food any longer upon him, and he was left to die in peace. He did not die, and, more than that, he recovered his sanity, and was able soon to leave the asylum. This case recalls to me one given by Dr. Dewey (p. 314). A boy of five had lost his appetite a year pre- viously. All means were used for his relief by regular and homceopathic doctors, but he got worse, and his food was regularly ejected shortly after it was taken. All hope of re- covery was lost, and as a last resort his father was carrying him to a consultation of several doctors. On the way a friend met ON NA TURAL CRA VINGS AND DISLIKES 135 him who had been cured, after a much longer illness, by Dr. Dewey, and he urged the father, weak as the boy was, to give him nothing till a desire for solid food returned. The father had faith in his friend, took his boy home, and gave him no food for four days. A beef-steak was now asked for and digested, and soon the boy was in the best of health, in which Dr. Dewey saw him five months later. ' This boy,' he remarked, 'had suffered a living death, week after week, month after month, and yet always within four days of a beef-steak appetite' a very natural remark, but what a reflection on our science of medicine ! Had the poor boy been let alone at first till the dislike for food was changed into a natural desire for it, what an amount of suffering to him and anxiety to his parents would have been prevented. I have noticed very often that after an acute illness when little or no food has been taken for a considerable period, a time comes 136 FADS OF AN OLD PHYSICIAN when the natural desire for food is strong, and, if indulged in according to the patient's feelings, leads to too much being taken for the still weak stomach to digest, and to con- valescence and return to health being more or less retarded. I have also noticed that if this too keen appetite is not given way to, but a wholesome restraint is exercised, in a very few days the appetite becomes more natural, and in the end a more complete cure is effected. If one has, previous to the ill- ness, been a too free liver which has very probably been the cause of the illness this is now the time when he can with least trouble adopt a less full and simpler way of living for the future. The short abstin- ence enforced by the illness has done what it would have taken a long period of volun- tary moderation to effect. Since these pages were written I have read in the British Medical Journal^ i3th February 1897, a short paper on 'Artificial Feeding of the Insane.' As it is by a ON NATURAL CRA VINGS AND DISLIKES 137 medical officer in a private asylum in England, I may take it as giving the ordinary treatment in such an establishment. There are several statements in the paper which I should like to notice. Refusal of food is said to be more com- mon in an asylum for private patients than among paupers. May not the reason of this be that the wealthier had more need for temporary abstinence than the poorer, and that nature points this out to them ? Of the last 200 patients admitted to the private asylum, 27 required forcible feeding, and these were ' performed upon ' by the doctor nearly three thousand times. This is quite a hundred times on the average for each patient, and as ' in some cases a few feedings effected a cure of the habit of refusal,' these must have been very few, or the average performances must have been still more numerous. 'The 27 did not include many patients whom the attendants were able to feed with 138 FADS OF AN OLD PHYSICIAN a spoon, but only those who successfully resisted this method.' ' Complete refusal of food for twenty-four hours in a strong well-nourished patient, or the missing of two meals by a feeble one, may be taken as a general rule to indicate the operation ; freshly-admitted cases with a history of starvation, who are feeble with weak pulse, should be fed at once.' I say nothing of how the forcible feeding was carried out. It is not pleasant reading, and had better be left buried in the pages of the Medical Journal. The food is given thrice a day, and is made up of three pints of milk, six eggs, a pint and a half of beef- tea, two ounces of whisky, two ounces of port wine, and an ounce of maltine. This, to a strong well- nourished patient who has refused food for twenty-four hours, is a pretty full allowance, but his stomach may dispose of it better than would that of a ' feeble one with weak pulse,' who apparently gets the same quantities. ON NA TURAL CRA VINGS AND DISLIKES 139 The effect of this forced feeding is said to have been very good, and ' no doubt the lives of many were saved by its adoption.' What the result would have been had the patients been left to themselves, we have no means of knowing, but none of them, I imagine, had approached Dr. Dewey's skeleton form, and 'the strong well - nourished ' amongst them must have had at least a month's supply of food laid up ready for absorption, and requir- ing no nervous energy to digest it. Believing as I do that rest is nature's great cure for a damaged organ, I cannot help thinking that this rest to the brain might be a large element in the cure of the insane, and certainly the experiment of giving it would be a very safe one. An accidental experiment of this nature is actually given in the paper, with an excel- lent result. ' In one lady, a case of stupor, gastritis was set up "by irritation from the tube," and, curiously enough, the pyrexia was coincident with the commencement of her recovery.' Although this is not mentioned, 140 FADS OF AN OLD PHYSICIAN the gastritis necessarily rendered the feeding impossible, and we may well suppose that stopping the feeding would have been equally salutary, without the gastritis. The lasting moral effect of this barbarous treatment is said to be good ; so is the moral effect of a Maxim gun on a crowd of savages, and it may be lasting on the survivors. If water is refused as well as food, the experiment can be carried on safely for a much shorter period. Fluid could, if abso- lutely necessary, be given by the bowel, with but little trouble ; but if water is left in the way of the patient, and no inducement what- ever is given to take it, there can be little risk of death from thirst, the craving is too strong ; but force naturally excites resistance. XIII THE RESPONSIBILITIES OF HEALTH HEALTH is to man his supreme blessing. With- out it life is a more or less constant misery. The force of the instinctive dread of death may be measured or judged of by the rarity with which the miserable bring it on them- selves, when suffering becomes intolerable; and when the desire for ease and rest, which is so easily within their reach, so fills their thoughts as to exclude every other feeling. The health of the individual, like his religion, depends originally, not on himself, but on the circumstances of his birth and his surround- ings, on the health of his progenitors, on the care taken of him before he can do anything to guide himself; and then on making the best 142 FADS OF AN OLD PHYSICIAN of the bodily condition in which he finds himself. Up to the age of puberty a man has little responsibility for his own wellbeing. His actions are so dependent on the will of his parents and teachers that little room is left for self-guidance, and his habits are often formed before his own observation and experience have taught him what is essenti- ally right and true. He may be already on a path which will lead him downwards, and his life may be a lost one before he has begun to realise its value. There are others, however, and it is to be hoped the great majority, who, when come to years of discretion, have a more or less healthy body entrusted to them, which they may use aright or which they may abuse. The authority to which they have been subjected must still in a great measure influence their actions from the habits formed during its rule ; but they can now use their reason in judging of the value to be attached to the teachings ot this authority, and they can strike out a new path THE RESPONSIBILITIES OF HEALTH 143 for themselves. It is right that it should be so, otherwise there would be no progress in humanity, as here what applies to each indi- vidual applies to all. One generation thus becomes responsible in a great degree for the wellbeing of the next, and the result may be progress or deterioration according as the general influences of the day are conducive to the furtherance of what is good and true, or of what is evil and false. If we are right in the foregoing general remarks, it needs no argument to show how great is the responsibility of every one of us for our free actings, as it is by these only that we can affect one way or other the tendency, good or bad, of human progress. We not only, each one of us, receive for ourselves the reward or punishment of an honoured or a broken law, but we pass on to another generation, as our parents passed on to us, the blessings or the curses which are the certain consequences of our good or evil actions. How needful, therefore, it is for us 144 FADS OF AN OLD PHYSICIAN to search out, so far as our powers and our opportunities allow us, what are the laws by acting in harmony with which we may live and prosper, and by resisting or opposing which we doom ourselves and others to degradation and premature extinction. Here we will deal only with the physical side of the question, and this may prove to be the most important, as without a sound and well- regulated body there is little or no hope of a healthy and well-ordered mind. As has been noted elsewhere, 1 the laws by which we are governed are often made clear to us by the results which follow their being broken. We may learn in this way by the experience of others, but the lesson is much more effectual when we ourselves are the sufferers. But even so, the lessons may be many and sharp before we come to their true reading, especially if they are contrary to what we consider our very natural desires and feelings. Our appetites seem to be given 1 Plea for a Simpler Faith, p. 124 THE RESPONSIBILITIES OF HEALTH 145 us that they may be gratified, and we have to learn that their full enjoyment can be ours only when they are used temperately, and with occasional intermissions when their pru- dent use may have gone on to abuse. To many it will be a novel idea, and some- what of a paradox, that health may be too good, and a cause of evil to its possessor. Like all other good things, it may be abused, and its very goodness may lead to its being so. A strong machine is the only one which will stand a large amount of overwork and ill-treatment, and for a time show no signs of failure ; but its period of usefulness is unduly shortened, and sooner or later it comes to a premature end. It may be that this is right and proper, as it may suit the owner better to have from it a larger quantity of work done speedily, than to have the same work spread over a longer period ; and when the over- worked machine is worn out another can be put in its place. It is not so with the human body, a healthy condition of which is neces- 146 FADS OF AN OLD PHYSICIAN sary for the performance of its proper func- tions. If from an excess of work demanded of them the organs become weakened and worn out, there is no possible means of re- placing them. Nature may demand a cessa- tion from work before exhaustion is complete, and life may still be prolonged for a time, but it will be a life not worth living, all useful- ness and happiness having gone out of it, and nothing being left but suffering aggra- vated by deep and unavailing regrets. There are, no doubt, circumstances under which a man may knowingly shorten his life by over- working his body, with honour to himself and benefit to others, but such a sacrifice can seldom be demanded, and at best it implies the breaking of nature's laws. The very much more common case is that from ignor- ance, or from wilful indulgence, the system is so overloaded by more food being taken than is required for the proper acting of its func- tions, that undue means must be taken to get rid of the excess. This may be done by THE RESPONSIBILITIES OF HEALTH 147 over-stimulation of the organs of digestion by drugs ; or by excessive and useless muscular work, as an engine can be got to use up more steam than is required for its proper work, by increasing its speed ; thus wearing out the machine, and it may be lead- ing to the work being done in a less satis- factory manner. To some it may seem absurd to dwell on these so manifest truths. But it is still more absurd for any one to for- get them, and this forgetfulness or inattention undoubtedly has led to the existence of more misery and more throwing away of health and of life among the strongest and healthiest of the well-fed, than has war, pestilence, and famine among the same races of mankind. It is the strong and healthy individual only who can make grievous errors, and continue them for an indefinite time, with no sign of failure, and with no hint or warning of com- ing evil ; and he may go on in comfort till all his organs have become irretrievably dam- aged. The weaker in constitution, especially 148 FADS OF AN OLD PHYSICIAN if one organ or set of organs is even more feeble than the others, cannot go so far wrong. He is pulled up in time ; and though he may not be able to enjoy life and its good things so freely as his apparently more for- tunate brothers, yet with care he may be quite capable of doing all the work required of him with ease and comfort, and for a much longer period. I have known very many strong, healthy men and women who natu- rally would be expected to live to a long age, but most of them, from presuming on their strong constitution, and living too freely, have died while still in their prime ; or of the few who have reached a moderate old age, it has been with health much broken down ; and the very few who have attained to their threescore-and-ten and upwards have had their years renewed by one or more severe illnesses from which recovery for a time seemed to be hopeless. It is reasonable to think, that if the strong and healthy who lived too fully had done as their weaker brethren THE RESPONSIBILITIES OF HEALTH 149 were obliged to do, their lives would, compara- tively, have been much longer and happier, and they would have transmitted to another generation in a still higher degree their own inherent good qualities ; and if their descend- ants should happily learn to follow in the right path, there might well be reached in a few generations the term of a hundred years and upwards, which some physiologists have fixed as the natural period of human life. The pity of it is that most medical men overlook the evils which come upon the healthy from free living, and that in this they are encouraged by the prevailing doctrines of the day as taught in the medical schools, and that they misread the clear warn- ings which nature gives. Some there are, no doubt, who do recommend moderation when excess is carried so far as to be manifestly dangerous, but even they, when nature rebels against a wasteful abuse, instead of prescrib- ing abstinence till she indicates the restora- tion of the exhausted organs, resort to I5o FADS OF AN OLD PHYSICIAN drugs to do what in most instances is being better done without them, and, if the desire for food does not return in a very few days, they force it in some form on the reluctant sufferer. This they do on the false idea that it will support his strength, and enable him to throw off the disease, whatever this may mean ; or that it will at least retard the waste of the body. I have known for many years that there is no truth whatever in these ideas, and that on the contrary nothing causes more discomfort and weak- ness than taking food which cannot be di- gested, and which only adds to the matters which the system is busied in getting rid of. In my anxiety to get well quickly, I tried this method on myself times without number, and I now know that I only aggravated and prolonged my sufferings. Dr. Dewey of America, whom I have already quoted, has proved, in a very large number of cases, the benefit which follows complete abstinence from food, both in acute and in chronic THE RESPONSIBILITIES OF HEALTH 151 ailments of all sorts, and this he does much more thoroughly than has been my custom. For upwards of fifty years I acted on the idea that white of egg much diluted, or lime-water and milk, or both combined, helped to carry down the bile and other secretions ; and they certainly were often grateful to the patient, when taken from time to time in small quantity, and they seemed to relieve better than anything else the irritable stomach. 1 If plain water was preferred, it was given instead, and had I the occasion now to use either, I would 1 I first saw white of egg in water used for diarrhoea by Chomel, in the Hotel Dieu, Paris, in 1841. It was given ad libitum, and with no other food or medicine. The effect was excellent on a large number of cases, an epidemic of diarrhoea having prevailed at the time. The patients were kept strictly in bed. For diarrhoea I have rarely used any other means, unless it was accompanied with pain, and then opium, or opium with castor oil, is very efficacious. I have known white of egg most useful in catarrhal jaundice, probably from relieving irritation of the duodenum, and temporary obstruction of the gall-duct. I read long ago in a medical annual that before mercury came so much into general use white of egg was used for the same pur- poses. 152 FADS OF AN OLD PHYSICIAN follow Dr. Dewey's example and give water alone. In my own case I have done this frequently, but I cannot recall an instance in which it was necessary for more than three days. When very busy at home I had to go to London to give evidence in a law court. I lived for three days and nights in a hotel in Jermyn Street. The hurry to get away and the journey brought on a slight attack of my old headache and sickness, and as the case was de- layed till the third day, I was glad to re- main in bed. One day I asked for a cup of tea, but could not drink it, and I took liter- ally nothing but water. As soon as the trial was over, I told the landlady that I was to return to Edinburgh by the night train. She expostulated with me for dreaming of taking the journey without food, when I told her I would take nothing till morning, if then, but that I was nearly well, and would be able to do my next day's work. She then told me that she was treated very differently by her THE RESPONSIBILITIES OF HEALTH 153 doctor. She was a stout, dark woman, and one would not have taken her for an invalid, but she suffered from terrible headaches. She was ordered to live very freely, and to take a full supply of wine. Her last pre- scription, a very recent one, was to take on going to bed a large glass of whisky, with water. Next day she told the doctor that she could not take this as it made her tipsy. The doctor's answer was, ' Take the whisky after you go to your room, and no one will see you tipsy ' ! I gave her very different advice, but I do not know if it was acted on or not ; most probably it was not, but, should this meet her eye by any chance, I would be glad to know. Our meeting was twenty -seven years ago, and unless she changed her mode of living, the chances that she still survives are very small. XIV EFFECTS OF HIGH LIVING ON THE MORALS OF THE YOUNG IN the ' Plea for a Simpler Life' \ scarcely touched on the subject of the moral evils that arise from bringing up the young on a too full and exciting meat diet. This is a matter which it is difficult to treat in a popular manner^ and some may blame me for touching on it at all. I have done much for many years privately, whenever I had the oppor- tunity, to impress on fathers and mothers the danger to their sons and daughters from exciting prematurely their natural desires and passions ; but custom and fashion have so powerful a hold, especially in the higher circles of society, that I have frequently had HIGH LIVING AND MORALS OF THE YOUNG 155 to feel that my efforts were in vain. The foundation of mischief is often laid at home, but the evil system reaches its highest de- velopment in many, if not all, of our first- class public schools and colleges, where the youth is away from home influences, and comes into contact with others older than himself, whose evil communications soon put him on a level with themselves. The exist- ence of bad habits in such schools is well known to the masters, and they take what measures they can for their preven- tion. Even when they know the truth, the strength of custom and habit so impera- tively demands a full diet for the growing youth that they are obliged to fall in with the fashion of the day. But few of them are aware of the main cause of the evil, and the last thing most dream of as a remedy is a simpler diet. They think to give vent to the spirit of their boys, and to make them strong, hardy, and self-reliant, by encouraging them to the utmost to active exertion in the 156 FADS OF AN OLD PHYSICIAN gymnasium, and in outdoor games, and by free use of cold-water bathing. They think they prove the value of these exercises when they point out that some of the best athletes are also the best scholars. But this only proves that vigour of mind and body often go together, which was well known before so much credit was given to what many consider a premature use or abuse of physical energy. It may be well to err rather on the side of exerting one's muscles somewhat too much than too little, but there is a medium in all things ; and, if an abnormal amount of exercise is required in order to redress a too full diet, the final result may be an unneces- sary waste of energy and of bodily strength ; just as too much premature mental study and strain weakens the mental power, often for a time, and sometimes permanently. It is well known that a large amount of mental as well as bodily work may be done on a moderate diet made up wholly of vegetable food and milk, and that this may be kept up HIGH LIVING AND MORALS OF THE YOUNG 157 for an indefinite period, with no risk to the system ; while it is also known that a pro- fessional, or any one else, if he lives too long on a training diet, made up very much of flesh, often comes to an untimely end, unless he be pulled up in time by an acute disease. In New Testament times and countries morals were at a very low ebb, even in the Christian communities, and good rules are given for attaining a higher moral standard than was professed by the surrounding heathen world. Some of these rules have a physical as well as a moral side. The former may be found, in a very precise and emphatic form, in the last verse of the fifth chapter of the Epistle to the Hebrews. ' Strong meat belongeth to them that are of full age, even those who by reason .of use have their senses ['organs of sense/ as literally translated by Dean Alford] exercised to discern both good and evil.' In the first lines of the passage we have given in a complete form the rule which in a very modified form I have en- 158 FADS OF AN OLD PHYSICIAN deavoured to inculcate for wellnigh half a century. In the remainder of the verse we have the reason given why the rule is neces- sary. It is, that only those who arrive at full age can make a right use of the organs indicated, which are absolutely needful for the preservation of the species. If they are excited prematurely they can only be made a bad use of, and this precocity comes as a consequence of giving strong meat before the arrival of full age. Punishment necessarily follows every broken law, even though it is broken in ignorance. It is a sad thought that so many of our best youths, especially in the higher classes, are subjected to a bring- ing-up which makes it very difficult for them to live a natural and pure life. Youths of a coarser fibre, especially those of the muscular or sanguine temperament, may stand a great deal of wear and tear with but little per- manent injury. Such may 'sow their wild oats ' freely enough, and become after it all respectable members of society. But those HIGH LIVING AND MORALS OF THE YOUNG 159 of a more sensitive and delicate type, and of the nervous temperament, suffer most, and, unless they have an unusually strong con- stitution, often permanently. A headmaster, as I have told in the ' Plea ' (p. 106), was con- vinced that high feeding was the cause of much evil, but under the circumstances in which he was placed he could do nothing to prevent it. Some twenty years later, the same master said to a friend of mine, who had asked him what became of all the fine lads under his charge, ' One-half of them go to the devil.' And the same system goes on still. The subject is an unpleasant but a very important one. I would not have touched it had I no remedy to offer. A youth on simple diet may go wrong; on a full diet and with a good stomach he can scarcely fail to do so. XV MY TEACHERS THE history of three ladies, who fell to my care very early in my professional life, gave me timely hints of the benefit which may result from a very restricted diet both temporary and permanent. They owed nothing to me for the adoption of a method that proved so salutary, and the only credit I can take is that I watched the process with an open mind, and had the good sense to make use of it for others when I had seen its value. I must confess, however, to an error I made in the case of another lady, whom I could not induce to take the food I considered necessary for the work she had to do in the way of teaching. At last I told her I would MY TEACHERS 161 not continue my attendance, as it could be of no use so long as she would not take suffi- cient nourishment. I left her, and I heard long after that she was still taking her own way, and was getting on very well without me. This also was a lesson. A lady, Mrs. S , about middle life, was in 1845 put under my care by Professor Simpson. He told me that she could not live long, as she was in an advanced stage of albuminuria or Bright's Disease not so well known then as now. She was very thin and very irritable, but had still some strength, especially of will. For some time Simpson and her husband had been making every effort to induce her to take more food and any stimulant she could fancy ; of the latter she would take none, and of food in any form extremely little. A reason pressed on her was that she must take something to make up for the constant loss of albumen. At first I did my best to induce her to eat, but to no purpose, and I dare not mention the amount 162 FADS OF AN OLD PHYSICIAN and kind of food she took ; it would not be believed. Time went on, she continued to do the duties of her household ; she spent the summer always in the country, and though incapable of any but the most moderate exercise she in a measure enjoyed life. After some years I found that the albuminuria had completely ceased. She was now taking a little more food, but still her diet would be considered a starvation one. After twenty years and she had her troubles in the mean- time, from the death of her husband and other circumstances she began to enjoy better health, and latterly she liked a glass of wine. But by and by, when arguing with a fishwife at her own door one cold day, she got a .bad chill. Acute albuminuria now came on. She got over the first attack, but another in a few weeks killed her. The kidneys were both found to be reduced to a mere shell, and this, I believe, must have been very much their state from the time I first saw her Had she fed then as we all MY TEACHERS 163 wished, no doubt her life would have been a very short one. Mrs. F , a pretty, young, healthy woman, one of a large family of daughters, all robust and good-looking, suffered very much on a long and rough voyage across the North Sea. She was very sick and did not get her clothes off during the voyage. She had a bad fever, which ended in an unsightly eruption on her face which would not leave her. Everything was tried by others, and then by myself in 1847. The chief means I used was careful dieting, but with little benefit. I had not seen her for about six months, when, to my astonishment, I found her with a face free of eruption and fair as before. She told me that Captain had advised her to give up all flesh meat. He had been troubled with a similar rash, and had found this a perfect cure. Very soon, on the same plan, Mrs. F had the same experience. She was now married, and by and by had a well-developed, healthy child. I was by no means sure that 1 64 FADS OF AN OLD PHYSICIAN she would make a good nurse on her present fare, and advised that she should take a moderate amount of boiled fowl. She tried it a few times, but she thought the eruption was threatening to return. She dropped it, and has gone on her old way for fifty years. She has had a large and very handsome family of sons and daughters. When I first knew her she had bad heart disease, which came on also after her voyage. It has given her much trouble in recent years ; but, as I have found in others, her simple living seems to have checked its development. Her diet has been extremely simple, and in quantity very restricted almost as much so, in recent years, as that of Mrs. S . Mrs. L , a young married lady, came under my care in 1849. She was healthy and had already a young family. She was in a good position, and enjoyed life and its usual com- forts, but occasionally she made a bad break- down. It was in one of them I first saw her along with Professor Simpson. She went to MY TEACHERS 165 bed and took almost no food ; for weeks it was only a little oatmeal which she kept by her, and occasionally she wet her finger and put to her mouth what adhered to it. I think this first attack was the longest she had, and it prepared me for others, of which she had altogether a good number, sometimes at inter- vals of years. She had other illnesses, but there was nothing remarkable about them. The difference from the two other cases I have mentioned was that she lived well during the intervals, while the others lived always most sparingly. Later in life she had a smart attack of the prevailing influenza. She followed my plan of treatment, or rather I should say I encouraged her to follow her own. As she was getting better, she told me one day with some amusement that her sister- in-law, a younger and much stronger woman, was also laid up with influenza, and was taking a rather gloomy view of her case. She was, of course, being treated on the 'keeping-up' plan. One day, in presence 1 66 FADS OF AN OLD PHYSICIAN of her doctor, one of her friends tried to cheer her up by alluding to herself (Mrs. L ), and pointing out that she was much older and frailer, and had a worse attack. 'Yes,' she replied, ' but she has a sensible doctor.' The younger and stronger lady died in a few days, much to the distress of my patient, who lived for years after this and died at a good old age. But for the fact of my having met with these three cases so early in my professional life, I doubt if I would ever have come to carry out so thoroughly the natural mode of treatment I have so long followed, or that I would have ventured to recommend it to the public and to the profession. And had I not been so convinced of the great mischief, especially of late years, to sufferers from influenza from the opposite treatment, I would still less have dared to mention the rather grim anecdote I have just related. Had the treatment in the two cases mentioned been reversed, I cannot but think that the MY TEACHERS 167 result in both would have been reversed likewise. But as I have said elsewhere, the physician has but one chance. The three histories given above were, more than any others, of great value in showing to me nature's methods of dealing with disease. But ever since they put me on the right road, my education has been carried on by the occurrence of innumerable instances in which I have been enabled to give help in well-nigh hopeless condi- tions, where the opposite plan of ' keeping up the system ' had been long followed, with no result but more or less rapid deterioration. The two following cases I am tempted to give as fair specimens of the safety with which the necessary change of treatment can be made when strength is at the lowest, and as indicating what an amount of suffering might have been spared had the change been made at an earlier period. In August 1874 a youth of eighteen was brought to Edinburgh. His health had broken down 1 68 FADS OF AN OLD PHYSICIAN eight months before when studying for college. He had spent some months at a hydropathic institution in England, and had subsequently been under the treatment of two of the most eminent physicians in London. His health had gradually got worse, and he was now reduced to an extreme state of emaciation and feebleness. Any food he tried to take brought on pain and chilliness to a degree I had never met with before, and I never undertook a more hopeless case. On the lines of treatment followed hitherto there was manifestly no hope whatever ; but my methods were known to some near relatives, and I was able to treat him as I wished. Very small quantities of farinaceous food with a little milk gave less discomfort than anything he had tried, and to this he was restricted for many weeks ; but the cure, which commenced at once, was a very tedious one. The great peculiarity in the case, was chilliness coming on when he took anything like a meal. He could swallow MY TEACHERS 169 nothing without hot bottles to his stomach and back, or when somewhat stronger he sat with his back to a hot fire ; and when he was able to take a drive, he needed hot bottles and the warmest clothing even in fine weather. Another difficulty was to keep the bowels open. In infancy, from a fall owing to the carelessness of a nurse, he got hemiplegia of the right side. This no doubt rendered the bowel difficulty greater, and, after some attempts were made at intervals to relieve it by medicine and other means which did more harm than good, it was absolutely 'left to nature; and for twenty years no artificial means whatever have been required. His strength slowly improved and ability to take more food, which had still to be of the simplest kind. After nearly five years I advised that he should go to a warm climate, and he went accompanied by an excel- lent nurse to Pau, Portugal, and Madeira. He returned after a year and a half very much improved, and he was soon able to 176 FADS OF AN OLD PHYSICIAN occupy himself with literary work, in which, both in prose and poetry, he has proved him- self a successful worker. He is of too high- strung a temperament even yet to indulge in wine or strong meat, but this notwith- standing, he can enjoy London society in a moderate degree with safety and pleasure. Twenty years ago I was asked to visit a lady at Tunbridge Wells. I had seen her occasionally before when she was a patient of Professor Simpson. She was then very delicate, and suffered from neuralgia. Her health got gradually worse, and she had to spend the winter in the south. She had just come from Cannes. I found her in about the lowest condition I ever saw any one. The best of everything had been tried to keep up her strength, but to no purpose. She told me that at Cannes she remembered I had said, twenty years before, that if she would give up wine which she was taking freely by order, she would get rid of her neuralgia ; and in despair, and against the MY TEACHERS 171 advice of her doctor and all her friends, she gave up all stimulants. The result was as she hoped rather than expected, and she resolved to see me as soon as possible. As I have stated, she was in a wretched con- dition, and she did not seem to have a sound organ in her body. The food which she still tried to take was doing her no good, and she was about as thin as possible. I confess I had not much hope of being of use, but as the only chance of getting her stomach into a better condition, I stopped all rich food and put her on the lightest of diet, and very little of that. Very gradually she began to improve, but for years she lived on the most meagre diet. She came up to London, and for many winters she kept her room, and mostly her bed. But she gradu- ally got stronger ; her heart and lungs, from which she suffered most after her stomach improved, got into a healthier condition. For some years she has gone to the south during the winter, but her headquarters 172 FADS OF AN OLD PHYSICIAN are in Scotland. Though still requiring to live very carefully, she is now in better health than I have known her at any time. Of late years she has escaped the dreadful rounds of neuralgia she was used to. These in a milder form were long troublesome, and during them I re- commended a moderate use of wine, and she found it helpful. These and other cases which I have given in this volume and 'in the 'Plea,'' give full information as to my ordinary, and I may say invariable methods of treating disease when I was allowed to have a free hand. They differ absolutely from the depleting measures which ruled the profession during my student days, and early professional life ; and they differ just as widely from the medical doctrines and methods now generally taught and practised. I can claim no special skill in treating disease apart from the methods used, nor any immunity from errors in diag- nosis to which all are liable. If I have been MY TEACHERS 173 right in adopting a middle course for half a century, during which my clients have given me credit as a successful physician, there must be some huge errors on the part of those who follow methods which in many cases are the very opposite. THE END Printedby R. & R. CLARK, LIMITED, Edinburgh. INDEX I. refers to Plea for a Simpler Life. II. refers to Fads of an Old Physician. ABERCROMBIE, Dr., I. 13 Abstention from food, I. 38, 41, 44, 57, 132 Abuse of flesh food, I. 111-114, 119 Age, old, I. 46, 56, 86, 105, 138-142 Air, fresh, I. 42, 44 Alcohol, I. 22, 34, 119, 140; useful in rare cases, II. 36 Alison, Professor, I. 15, 16 Ammonia, carbonate of, I. 52, 89 Anremia, I. 1 16 Aperients, I. 19, 23, 126-130; in apoplexy, 51 ; in scarlet fever, 29 Aphorism of Hippocrates, I. 27, 38 Apoplexy, I. 50-55 BATHS, German, I. 108, 109 Beef, raw, in children's diarrhoea, 11.24 Bleeding, I. 4, 8, 30, 68 Bouillaud, I. 8 Brassey, Mr., I. 138 British Medical Journal, I. 32, 117 : II. 82 CALOMEL, I. 17 Cambrai, Archbishop of, I. 148 Cancer, aggravated by high liv- ing, II. 82 Cornaro, II. 28, 32 DELIRIUM TREMENS, I. 58 Depletion, order of day, I. 4 ; in treatment of consumption, 9 Dewey, Dr., II. 12, 22, 114, 134, ISO Diarrhoea, tropical, II. 2 ; abuse of milk in children's, 8 ; raw beef in children's, 24 ; white of egg in, 151 Diet, of different temperaments, I. 20; the young, 123; the aged, 138; the hard-worked, 145 ; the healthy, 147 ; Dr. Keith's, II. 26; Dr. Haig's, 28 ; in a hot climate, 1 16 Drugs, number of new, II. 102 Dyspepsia, I. 103, 132 EAT slowly, I. 137, 145 Eczema, I. 117 Edison, T. A., I. 146 1 7 6 INDEX English versus foreign navvies, I. 138 Exercise, I. 112, 136, 137 FASHION in medicine, I. 3-8, 57, 68, 91, 98 ; in stimulants, 98 Fever, action of, as an eliminant, aperients in scarlet, I. 29 ; Indian, 25; typhus, 134; rheumatic, II. 109 Flesh food, abuse of, I. 111- 114, 119 Food, abstention from, I. 38-41, 44, 51, 132; in disease, 35, 54, 57 ; carbonaceous, 96- 99, 10 1 ; nitrogenous, 96, 99, 101 ; excess in, aggravated by alcohol, 119: enjoyment of, II. 29 GERMAN baths, I. 108, 109 Gout, rheumatic, I. 108 Hsematuria, I. 64 Haemorrhage, I. 57 Haig, Dr. A., I. 115; II. 10, 25, 96 Heart disease and dropsy, II. 4 ; troubles aggravated by irritation from stomach, 61 High living and morals, I. 143 ; II. 154 Hippocrates, aphorism of, I. 27 Homeopathy, I. 9, 11-13 Hot water, I. 42, 60, 77, 78, 8 1, 88, 92; II. 65; story of its introduction, 65 ; as a stimulant, 67 ; as a food, 70 ; abuse of, 70 ; use of, 152 INFLUENZA, I. 87-93 ; H. 165 Insane, artificial feeding of, II. 136 Insanity, treatment of, I. 70, 72 Intemperance, cure of, by sali- vation, II. 40 ; aggravated by butcher meat, 42 ; cured by abstinence from butcher meat, 43 Iodide of potassium, I. 23 "KEEPING up system," I. 33, 53, 54, 86 LIEBIG'S Extract, I. 60 Life, prolongation of, I. 141 ; II. 149 Lime-water and milk, I. 14, 16, 26, 81 ; II. 151 Liquorice, I. 85 ; II. 77 ; and peppermint, 81 Lungs, congestion of, I. 61 MAJENDJE, I. 8 Massage in heart troubles, II. 5 1 ; relief of pain by, $o, 98 Matters which retard digestion and prevent waste, II. 124 May, Sir Erskine, I. 146 Medical teaching and practice, L ? Merei, Professor Shoepf, I. 7, 20 ; II. 65 Methods of cure, Nature's, I. 39, 44, 48, 94, 105, 147 Milk, I. 63, 78, 123 ; abuse of, II. 5 ; in diarrhoea of children, 8 ; and lime-water, I. 14, 16, 26, 81 ; II. 151 Morals and high living, I. 143 ; II. I 54 NATURE'S methods of cure, I. 39, 44, 48, 94, 105, 147 Navvies, English and foreign, I. 138 Nitrogenous food, I. 96, 100- 104, 123 INDEX 177 OPIUM, abuse of injections of, II. 99 PALMERSTON, Lord, I. 147 Paralysis, general, I. 101 Phosphates in food, I. 135 Pills, I. 17, 102 Pneumonia, treatment of, in 1834, I. 9- 1 1 Potassium, iodide of, I. 23 Prolongation of life, I. 141 ; II. 149 QUININE, I. 24 RELIEF of pain and sleepless- ness, II. 97 Remedies, new, I. 22 ; drink, 34, 39 ; food, 35, 39 ; medi- cine, 43 Reserve of food in body, I. 36, 40, 51, 88, 105 Responsibilities of health, II. IS' Rest to the stomach, I. 39, 67, 79 ; to the body, 41, 44, 131 Rheumatic fever, II. 109 ; more common than formerly, 1 10 ; very common in Argentine Republic, 113; gout, I. 108 Russian skim milk cure, II. 3 SALISBURY treatment, II. 73 Scarlet fever, I. 29 Self-massage, II. 46 Simpson, SirJ., I. 7, 16, 126; II. 100 ; Starving, two ways of, I. 131 ; so called, II. i j Stimulants, I. 34, 39, 42, 51, 59, 98, 131 ; II. 35 ; alco- holic, useful in rare cases, 36 Stomach, rest to, I. 39, 67, 80 ! Syme, Mr., I. 14 j TANNER, Dr., I. 36 i Teachers, my, II. 160 Teaching and practice, medical, I- 3 Thompson, Sir H., I. 121, 139 Time an element in cure, I. 43 Tobacco, I. no Tropical diarrhoea, II. 2 ! Typhus fever, I. 134 i URIC acid, I. 116 VlS MEDICATRIX NATURM, I. 44 WARMTH, I. 41, 131 Water, I. 35, 44. 124-126; hot, II. 65 ; as a stimulant, I. 105 ; II. 67 ; abuse of, 70 ; as a food, 70 Weir-Mitchell treatment, II. 37, 64 Whisky, I. 60, 120 White, of egg, I. 81 ; bread, 134, 135 Wine, I. 87, 98, 121, 139 YEO, Dr., II. 1 6 THE END R. & R. CLARK, LIMITED, Edinburgh. Eighth Reprint^ Crown 8vo, Cloth, price 2s. 6d. PLEA FOR A SIMPLER LIFE BY GEORGE S. KEITH, M.D., LL.D., F.R.C.P.E. PRESS OPINIONS "Whatever discussion may arise over this book between the author and his fellow medical men, the fact will not be altered that there is much in it that ought to be carefully considered by most of us." The Scotsman. " There is much sound advice given in this little volume which will be of great service to both the healthy and the unhealthy." Dundee Advertiser. " His opinions may be read with advantage." The Times. " Pithy and pungent little treatise." The Globe. ' ' There is no doubt whatever that the book is full of wise counsel. " Edinburgh Medical Journal. " There is much truth, and earnestly expressed, in the pages of this small volume, and we sincerely hope that it may receive the attention which it assuredly deserves, from the medical practitioners of the present generation and that the publication may bear fruit towards the reformation of some few, at least, of the many flagrant abuses of medical teaching and practice." Dublin Journal of Medical Science. "Dr. George Keith's closely-reasoned and temperately-worded 'Plea" for a Simpler Life' cannot be dismissed as superfluous. Much of his advice is as shrewd as it is sound." The Speaker. " There are few works containing more sound common sense and good practical wisdom put into small compass as in the little book bearing the above title. It is worth its weight in gold to the man who would rather go in for prevention than cure." The Liberal. " It is the old exhortation, plain living and high thinking. But it is more, it shows the way to reach it. It is indeed a most earnest yet scientific exposition of the evil we do to our bodies and souls and spirits by mixed dishes and medi- cines. If we would follow Dr. Keith's advice and take his prescriptions, we should have less dyspepsia and less atheism amongst us, less need for doctors of medicines and less need for doctors of divinity." Expository Times. " This very interesting little book." TJie Guardian. "As interesting as it is disinterested, and as valuable as it is cheap." Great Thought*. " The treatise is a powerful argument against the abuse of food and stimulants, both in health and sickness." St. fatness Budget. " The book is well worth reading." The Lancet. " This essay is a most profitable and even weighty contribution to medicine, full of observation and original thought." The Academy. " This is a charming little book. There is much sound common sense and a great deal of solid truth in what he says, and his little book deserves to be widely read." Manchester Guardian. " Most of us, I suppose, want to live as long as we can, and to make our lives as comfortable as possible. Various counsellors in all ages have given advice with a view to the attainment of these desirable ideals ; but I am not sure that any one of them hits the nail on the head with a finer precision than is achieved by Dr. George S. Keith, whose ' Plea for a Simpler Life ' is of sturdy common sense all compact." The New Age. LONDON : A. & C. BLACK, SOHO SQUARE.