A] 294 1630 THE // *J , J MANUAL, FOR INVALIDS. BY A PHYSICIAN. ■ :it. * &> a.,a" BOSTON: WELLS AND LILLY, COURT STREET. 1830. V/' \AlBA M W PREFACE. It has been too long the custom of writers on Popular Medicine, to direct their attention rather to sketching the outline of all the maladies " which flesh is heir to," than judiciously to unfold the true nature of health and of disease—lead the non-medical reader by the route which is open to reason—and, by thus placing the light on his path, enable him to see his own way. They have la- boured rather to make a grammar of health, than to give available advice,—classing with precision, causes, symptoms, and remedies for cure ; but leaving the patient to apply them without judg- ment—as one would direct a blind man on his way, by describing to him minutely the road-side scene- ry through which he was to pass. The object of the writer of this Manual, is to instruct his fellow creatures, first to know what health consists of,—then to lead their judgment to the care of it while it is in their possession, and to the regaining of it when disease may have de- prived them of it. So various are the shades in IV PREFACE. disease—so complicated the circumstances accom- panying it,—that, to place a list of treatises on ac- knowledged divisions in the hands of a non-medical reader, must be, if not dangerous, at least of little use. But to lay before him a series of instruc- tions and advices, drawn up with a view to open his mind to his true state regarding health—to en- able him to say, " Thus far should I go, and no farther : here I can assist my health, and here should consult my physician;"—this surely is desirable. To this one great object, then, is the " Manual for Invalids" directed ; and the writer trusts, that a long life devoted to the study of the laws of the animal economy, and to the circumstances which precede the change from health to disease, has qualified him for the task he thus undertakes. He also trusts, that his book will be read with interest alike to those in health and in disease ; that it will bear to be read " twice and again," by the inva- lid ; that it will instruct as well as interest ; and that the reader, above all, will derive practical benefit, as regards the greatest of all human bles- sings—Health. CONTENTS, CHAP. I. Page Introductory.—Philosophical Opinions concerning Princi- ples, in relation to Health and Disease.......8 CHAP. II. The Complaints of most Invalids referable to the State of the Brain, and Circulation of Blood therein . . . . . 1: CHAP. III. Digression, concerning the Nature and Extent of Human Knowledge.—Our Experience of the Nature of Disease, and the Power of Remedies, obtained by observation of the invariable succession of Symptoms......2(j CHAP. IV. The Occupation of the Mind.—The Attention should be directed to Objects of Usefulness, as tending to prevent Languor and Fastidiousness—The love of Literature and the Fine Arts.—The Cultivation of a correct Taste, &c. S'i CHAP. V. The Stomach considered—The Function of Digestion ex- plained—The grand Origin of Sympathy—Greatly affect- ed by Diseases of several of the Organs of the Tluman Body..................53 VI CONTENTS. CHAP. VI. Page The Liver considered—its Function explained.—The Secre- tion of Bile—its great importance to Health .... 58 CHAP. VII. The Healthy Function of the Digestive Organs.—The Chyle, or vital Principle of the Food.—Imperfect assimilation of Chyle into Blood, the Cause of what is commonly called Breaking-up of the Constitution.—Rules for Prevention recommended, and Remedies proposed......66 CHAP. VIII. The Process of Respiration considered.—Qualities of the Air breathed.—Wholesome and unwholesome Atmos- pheres.—The Effects of different Gases on the Health of Invalids,considered in their various chemical Combinations 78 CHAP. IX. The Animal Economy variously affected, both in Health and Disease, by aeriform Fluids introduced into the Blood through the Air-cells of the Lungs.—Their extensive Power over the whole Nervous System in the Valetudi- narian State, &c...............88 CHAP. X. Breakfast.—The different Qualities of Tea, Coffee, Choco- late, Cocoa, &c.—Effects upon the Stomach and Digestive Function.................HO CHAP. XI. Dinner.—The different kinds of Food considered, in relation to the Invalid State.—Farinaceous and Animal.__Beef Mutton, Veal, Lamb, Fish, Poultry, &c, examined . . 114 CONTENTS. vii CHAP. XII. Page Supper.—Late Suppers.—Animal Food.—Indigestible Mat- ter in the Stomach the cause of nervous Irritation, Rest- lessness, and want of Refreshment from Sleep . . . 118 CHAP. XIII. Chemistry recommended as a Study to the Invalid—its es- sential Service, &c..............1*3 CHAP. XIV. The beneficial Effects of Early Rising.—The State of the Pulse, as denoting greater Mental and Bodily Power in the Morning............... 130 CHAP. XV. Illustration of the Nature and resuscitative Power of Sleep; —Quantity necessary for Health ........132 CHAP. XVI. Gymnasia—The various Modes of Exercise—The Passive Mode by Carriage—The Active Mode by Walking—Run- ning—Horse-riding, &c............136 CHAP. XVII. The Influence and Power of Custom and Habit upon the Mind and Body...............142 CHAP. XVIII. The Sea Coast—its frequent Injury to Invalids, especially in the Summer Months.—The most desirable Retreat for an Invalid.................149 Vlll CONTENTS. CHAP. XIX. Pag« The Attachment of Sex, a Feature in the Character of Health.—Improper Attachments to be early checked, &c. 159 CHAP. XX. Various affections of the Skin, so common to Invalids.—The peculiarity of the Herpetic Tetter in the Face—Means of Prevention, and Remedies..........171 CHAP. XXI. The Hypochondriacal State.—Its Connexion with Insanity considered.—Prevention and Cure of various Morbid Af- fections of the Mind .............181 CHAP. XXII. The various Species of Tabes, or Consumption.—Organic Af- fections inducing Hectic Fever.—Tabes Dorsalis.—Tabes Mesenterica.—Rules of Prevention recommended . . 200 CHAP. XXIII. Philosophical Commentary, containing a Review of the Principles for the Attainment and Preservation of Health, and the Promotion of Longevity........210 CHAP. XXIV. The pernicious Effects of Empirical Nostrums on the Health of Invalids................220 CHAP. XXV. Select and Simple Prescriptions useful to the Invalid . . 230 THE MANUAL FOR INVALIDS. CHAPTER I. INTRODUCTORY. Philosophical Opinions concerning Principles, in relation to Health and Disease. It has been the wish of the writer of this Manual, in addition to the practical information it has been his en- deavour to convey, to illustrate many of the allowed principles in the treatment of disease, and to afford the reason a just and proper guide in the attainment and preservation of health. Some minute and curious in- formation shall be detailed respecting some of the more important functions of the animal economy, which, it is hoped, will enliven the subject, as well as increase its interest and utility. The ancient classic says, "Those will always carry their point, who unite the useful with the agreeable; and, making all due allowance for the discrepancy of taste, utility will frequently attach so much value to a subject, as to throw all minor considera- tions into shadow." These preliminary remarks are considered not irrelevant to our subject; nor are they caused from any vain parade, with a view to forestall the good opinion of the reader : as the author does not flat- 1 10 THE MANUAL FOR INVALIDS. ter himself he shall be able to conciliate approbation from his manner or style, he must endeavour to attract the attention, and secure the judgment, by precision of ideas, in detailing fixed principles with useful facts. The time will certainly arrive, when medical philoso- phy will form a very important part of general educa- tion ; for the valuable truths relating to health and dis- ease, are, in themselves, subjects of the most elevated interest and curiosity. In order to have a full know- ledge of their various combinations, the study of many years is often insufficient; but of their immense value, and of their great practical importance, it is impossible to remain long in ignorance. In this, as in many other affairs of life, " sorrow will bring us to knowledge." Health and disease are considered by many as abstract terms, and have been invested with a sort of personifi- cation. Instead of being viewed as varieties of exist- ence, they have been considered as things in their very nature contradictory, and opposite to each other. Sel- dom are these states of feeling regarded as having any common connexion; still more seldom, as being the re- sults of the same general laws, and consequences of the same principles of action. There are but few persons who have sufficient candour to acknowledge such mis- take ; but it is very easy to perceive, that a very great proportion of human beings, in other respects well in- formed, are, notwithstanding, governed through life by this error. There is a certain peculiarity in the human constitu- tion, called the predisposition to disease. All diseases have some exciting cause, acting upon a susceptibility variously modified ; but this susceptibility is exceedingly different in persons ; and this difference is not caused by the duration or quality of the exciting cause, but is THE MANUAL FOR INVALIDS 11 doubtless occasioned by certain tendencies in the consti- tution of the party, either original or hereditary, or which may be produced by habits unfavourable in their effects upon health. In reasoning upon the principles which bear a relation to disease, after having noticed what is termed the predisposition or susceptibility of becoming affected, the last movement of the healthy state, and the first of the morbid, claims some attention. This has been called the proximate cause. Much per- plexity has arisen from misunderstanding the nature of the term : a proximate cause of disease may, perhaps, be defined as that symptom, or appearance, in the body or part most immediately preceding the state which we call the disease; and without which previous symptom, the disease would not be known to exist. For, accord- ing to all the rules of philosophy and truth, the creation of disease must depend upon the ratio of excitement and of susceptibility. It would seem, therefore, that a very important benefit would be conferred upon individuals, and upon invalids more especially, by diminishing the susceptibility to the stimulus, which produces that change of action denominated disease. A few observations upon this subject will not be uninteresting to the reader. The proximate cause of disease has been just noticed ; but there are other causes, which are termed remote causes ; and if we were well acquainted with the train of causes which, in a regular series, succeed each other in the production of disease, we might probably establish prophylactic medicine—the most valuable boon the Al- mighty in his wisdom and goodness could bestow upon mankind. Man is rendered liable to many diseases in civilized society, from which, in a state of rude or un- cultivated life, he would be more or less exempt. One of the most productive causes of disease in society, is 12 THE MANUAL FOR INVALIDS. the morbid susceptibility which is engendered by almost all the habits of life: the constant effort of early exist- ence, is to obtain, by all possible means, the gratification of every want, and the instant removal of every thing that causes pain, either to the body or mind. We all know, that in civilized society, the wants of infancy and of childhood are satisfied as soon as they are expressed ; they are even anticipated and prevented. A great mass of calamities are produced by our affec- tions ; they are the offspring of our passions, and very seldom under the control of the understanding. It re- quires but little attention, in order to perceive that the charlatanrie of the usual modes of early education are productive of much moral evil. Under the present sys- tem of fashion and refinement, we are led to consider present indulgence as the most valuable purpose of our lives: we conclude, that the world w7as made for our pleasure ; we are, of course, averse to the trouble and effort of instruction ; and, as a natural consequence, we cordially hate those who either oppose or contradict us: we view them as causes of irritation. Every circumstance that creates a morbid suscepti- bility of body or mind, is a powerful productive cause of disease and misery ; for it is well known, that to this very criminal indulgence of the innate propensities of childhood, may be traced not only the liability to disease, but also a positive insensibility to the sufferings of others : all love of country, or of kindred, is absorbed in sensual enjoyments and habits; but this is in some measure avenged by the morbid irritability thus accumu- lated—the certain foundation for the valetudinarian state, perhaps, for the remainder of life. Doctor SamuelJohn- son has often said, that human life consists in a continued series of irritations ; and that scarcely any earthly good THE MANUAL FOR INVALIDS. 13 is to be obtained, without labour and suffering. He likewise asserted, that no true pleasure could be enjoy- ed by any one, who had not experienced pain. It is also very probable, that every good is enhanced by the dif- ficulty of attaining it. Many sufferings are alleviated by continuance of repetition ; for moderate evils are not much regarded by those who have been habituated to greater: the principal advantage of privation, is in dimi- nishing morbid susceptibility to excitement, which is the fulcrum upon which most of the complaints of invalids move. These general facts show, beyond all dispute, the truth of the proposition—that the predisposition to most of the causes of disease, grow out of habits which are chiefly peculiar to the condition of civilized society. It would be very easy to accumulate instances, and to demonstrate them by evidence ; but it would be no gra- tification to exhibit a detail of the prejudices, the weak- nesses, or the vices of mankind. In matters relating to health, nothing should be left to chance that can be governed by skill; though, in a strict and philosophical sense, there is no such thing as chance in the world. Our ignorance of the real cause of disease, or of the power of remedies, has the same influence on the understanding, and produces a like spe- cies of belief or opinion in watching the progress of fa- tal diseases, after all remedies have been laid by as use- less. I have often been amazed at the perfect progres- sion of the symptoms: no symptom usurps the place of another, either in the order of time or intensity. The process of disease is governed by organic laws; and to know them, is a research well worthy of our enquiry, The more we know of all causation, the more uniform and constant shall we discover effects: and if rhubarb should, in any particular case, cease to act as an aperient, 2 14 THE MANUAL FOR INVALIDS. we shall be convinced it is still an aperient ; but some cause, concealed from our view, has, in this instance, prevented its operation. The generality of mankind never find any great diffi- culty in accounting for the causes of disease, or for the more common and familiar operations of nature. The descent of heavy bodies is said to be caused by their weight, in ignorance of the laws of gravitation : so with the growth of plants, the generation of animals, or the nutriment of the body by food, the first principles of which are concealed from the research of the philosopher: yet, from their common and every-day occurrence, they are considered as well understood. And all this occurs, and, indeed, much more, because we are utterly unable, from any principle of philosophy, to demonstrate a posi- tive union of a cause with its effect. We cannot dis- cover a necessary connexion between the last healthy action and the first movement of disease : the conjunc- tion of the phenomena is what we are only permitted to witness. Why certain diseases should attack a per- son once only in life—small-pox, measles, scarlatina, &c, is a circumstance that can never be explained by any of the now acknowledged laws of the animal economy. Yet these ideas are, from experience, so associated in our minds, that we allow them the full practical opera- tion, without attempting to enquire farther ; as the most elaborate research would afford no proof of any necessary connexion between the cause and the result, in this case, nor, indeed, in any other. Since the phenomena of dis- ease is not the product of chance, but the necessary effect of certain prior causes, in full operation, the treat- ment of disease should also be rescued from the dominion of ignorance and chance ; and be invested in the hands of men whose minds have, through life, been disciplined THE MANUAL FOR INVALIDS. 15 to the study of those symptoms and character of maladies. What is called skill in medical science, is nothing but a just comparison of morbid symptoms, with the power of the remedies to be employed. In carrying into effect the objects, or indications in view, a skilful practitioner in medicine may be compared to a skilful mariner or pilot, who, from often repeated observation, has a precise s purport, and whose head and hand concur to carry that object into effect. Although it has been ascertained that there is no dis- coverable link between the cause and effect in the re- condite phenomena of nature, the invariable and regular conjunction of them, in the order of succession, are as readily discovered in medicine as in metaphysics or philosophy. The author has no vanity about him, and his only anxiety upon this question is, lest he should have the misfortune to be misunderstood, and that the reader should conclude, that what he is unable to under- stand himself, was equally hidden from the writer. When the causes of disease come into contact with a constitution whose susceptibility is favourable to its formation, a certain and invariable train of phenomena is called into action—there is a succession of symptoms in regular order and progression: an accurate observer, from experience, can easily foresee and foretell what symptoms are conjoined in this succession, and the me- thod of their appearance; but whatever knowledge he may bring into operation, he never will be able to dis- cover the necessary connexion, or uniting link, that one symptom has with another; but when long experience has convinced him, that certain symptoms have always been accompanied by other symptoms—by a law of * association, as soon as he perceives one, he expects the other ; nor does medicine, or pathological matters, ap- 16 THE MANUAL FOR INVALIDS. pear to me to be more unfortunate, in this particular, than either philosophy or metaphysics. When any species of event has always, without a single exception, been conjoined with another, we make no longer any scruple of foretelling the one upon the appearance of the other; nor do we hesitate to employ that reasoning, which can alone assure us of any matter of fact, or existence—we call the one object cause, the other effect : they are cer- tainly connected in our imagination, but the connecting link can never be found, either in the symptoms of dis- ease, or in the phenomena of metaphysics or philosophy.* The pathology of disease is a science of as determinate a character as any of the recondite truths of metaphysics, or the more familiar facts of geometry; but it is not a science capable of being taught. By the intervention of language, men can generally be made thoroughly to understand each other in mathematical propositions; lan- guage and figures are quite adequate to explain numbers in arithmetic, and quantity in algebra; but language is very unequal to explain a great variety of very important facts in the pathology of disease : it may be acquired by long observation, and experience, but can be but very imperfectly taught through the medium of sounds. The view of the diseased countenance is a better index to the complaint, than any detail of symptoms which his language can convey. Now, take for example one patho- logical fact, viz. diseased structure ; organic disease will in general occasion a less violent derangement of the system than the functional maladies of the same viscera. This is a fact known only by experience ; all language and reasoning, what is commonly called a priori, would be conclusive on the other side of the question. From * Montaigne, an old French writer, avowed his conviction of this fact some centuries since. THE MANUAL FOR INVALIDS. 17 the less violence done to healthy action in organic dis- ease, anterior to experience, we should naturally con- clude that it would be more manageable, and easier re- lieved. Now the very contrary is the truth ; for all affections of the structure itself are relieved with greater difficulty than affections of the function of the same or- gan. It may be observed, that the functions of a struc- ture are very rarely disturbed without some degree of organic affection ; and, on the other hand, that organic disease cannot perhaps long exist without the functions becoming in the end affected.* This is only true to a certain extent : it is found, by experience, that an affec- tion of the lungs, called catarrh, admits of a very early and important relief, however violent the symptoms may be, and the patient is as completely restored to health as if nothing had happened ; but a tubercular consump- tion, which is an organic affection of the same viscus, although the cough maybe moderate, and the symptoms mild, it will travel quietly on, and few maladies exist which are acknowledged to be equally fatal. We may be easily convinced, that in our researches into the nature of things, our notions of power are very imperfect. In common language we say—this disease has power to destroy—these remedies have been found to possess the power to restore the patient to health. It appears to me, that it is the unknown circumstance of an object, by which the degree, or quantity, of its effect is fixed and determined, (hat we call its power ; for in- stance, we are not equally able to move all the organs of the body, with equal power or facility; nor can any argument be adduced, except experience, for so great a variation between one and the other. We know, but * Most acute diseases commence with functional disorder. Most chro- nic with diseased structure. 2* 18 THE MANUAL FOR INVALIDS. only by experience, that the will has an influence over the tongue and the fingers—not over the heart or the the liver. We learn the influence of our will as we ob- tain a knowledge of disease—only by experience, which, in fact, alone teaches us how one event constantly fol- lows another, without instructing us in the analysis of power, which is the uniting principle, and which, in fact, renders them inseparable. From anatomy we learn that the immediate object of power, in voluntary motion, is not the member itself which is moved, but certain mus- cles, and nerves, and perhaps something still more mi- nute, and more unknown, through which the motion is successively propagated, before it reaches the member itself, and whose motion is the immediate object of the will. All these facts receive great illustration from the laws of chemistry with which we are at present acquaint- ed. We have, therefore, great reason to assume as a. truth, that the existence of power is nothing separate from the quality of the substance itself—that its effects are produced often to our cost; but the property called power is never seen. We assume its necessary connex- ion in producing the symptoms of disease, as we do the necessary connexion df cause and effect, which is also equally invisible ; yet, to the critical observer, the regu- lar* conjunction of antecedent and consequent may be as easily known in pathology and medicine, as in philo- sophy and metaphysics. *■ The various sympathies of different organs beautifully illustrate the truth of this position : indeed it would never be disputed,, were an explamu tion of the phenomena at all possible- THE MANUAL FOR INVALIDS. 19 CHAPTER II. The Complaints of most Invalids referable to the Stale of the Brain, and Circulation of Blood therein. The first symptom which is manifested in most inva- lids who are not labouring under any acute disease, is a certain listlessness, an apathy, a species of wearisomeness, a discontented temper, impatience of contradiction, sleep- less nights and toilsome days, false perceptions of things, inattention to the bowels, and frequently an obstinate costiveness, which is but very imperfectly relieved by purgative medicines, because it depends upon an inactive and disturbed function of the liver, the healthful action of which will keep the bowels in a comfortable state. It is certain that the symptoms and complaints of most invalids are, for the most part, very similar and uniform ; indeed, making allowances for the particular temper, age, sex, and condition of individuals, no cause and effect, either in physics or morals, can follow with more inva- riability. Now, I believe, in a very great proportion of cases, where there is no organic derangement of any viscus es- sential to life, that the primary cause of the first symp- toms of most invalids is a disturbed function of the brain. The influence of this organ upon the function of the stomach and liver, is immediate and great: indeed it exerts wonderful power over the whole of the laws of the animal economy, and manifests itself in an almost infinite variety of ways. The brain will suffer a consi- derable deviation from its healthy action, before the party is even conscious of any change ; especially as it is not unfrequently existing without local pain. In large ca- pitals, especially commercial capitals, such as London, 20 THE MANUAL FOR INVALIDS. Glasgow, Dublin, Amsterdam, St. Petersburg, Constan- tinople, and others, the great proportion of invalids are among those whose circumstances have been reduced by the casualties incident to mercantile life, and amongst in- dividuals accustomed to the society of persons well edu- cated, and whose habits and feelings are analogous to their condition. It is a very great mental infliction to be compelled to retire from such society, and to form a part with others whose feelings, habits, and sympathies are altogether alien to their own ; yet, in the various turns of the wheel of Fortune, this is very often the case. I have frequently seen individuals, such as I now describe, first seek solitude, grow silent and pensive, become captious, irritable, and ill-tempered : their mode of acting and thinking has undergone a change, and if hectic fever have supervened, the patient has become emaciated, and, at length, has died of what, in common language, may very properly be termed a broken heart;— yet there is no uncommon symptom observed to mark the counse of the malady. The power of the brain and nervous system upon the function of thought, as decisive of the character of individuals, must be admitted. In metaphorical lan- guage we often employ the head (meaning the brain) as the source of the operations of the intellect, and the heart as the source of the affections and sympathies. It is well known, that the internal organs, in proportion to their importance, as subservient to the purposes of health and life, are supplied with a greater or lesser quantity of blood. There is a much larger proportion of blood sent to the head in the human subject, than is necessary for the nourishment of that part. The brain, even for the healthy exertion of its function, requires a very large supply of blood. There is a much greater quantity of THE MANUAL FOR INVALIDS. 21 blood sent to the head of an individual whose mind is much exercised, than passes into the head of a person whose mind is in a state of inactivity or idiotism. The first thing that strikes the attention of anatomists, in the act of contemplating the head and the functions of the brain, is the very large quantity of blood destined to this part, when held in comparison with other parts of the body. A calculation has been made, that one-third of all the blood in the body is sent to the head : this may be overrated, but accuracy of proportion is by no means necessary to the establishment of the principle. We be- lieve we may fairly say, that the circulation of blood through the head, as compared with the other parts of the body, may be in a ratio, as one to four, or between four and five. Now we should naturally expect, from the nearness of the head to the heart, that the circulation through this part should also be proportionably rapid— so very delusive are first considerations. Now, on the contrary, we find it remarkably slow—a principle which nature adheres to in some other fery important functions of the animal economy, and especially where a secre- tion, upon which the future chance of offspring in the human species may depend. The causes of the slow circulation of blood in the vessels of the head are various. Firstly, the situation of the head itself, by which the blood has to ascend in direct opposition to its gravity; secondly, the acuteness of the angles at which the vessels supplying the head turn off; and we find both orders of vessels making various convolutions. Added to this, both the internal carotid, and the vertebral arteries or blood vessels, api pear, on entering the cranium, to lose, in a great mea-* sure, their arterial character, which is elasticity, and power of pressing the blood : they have now 90 little pf 22 THE MANUAL FOR INVALIDS. the muscular and elastic coats, so very essential to an artery, that it is with the greatest difficulty we can dis- tinguish the artery from the vein. The reason why I am thus minute in giving a descrip- tion of the distribution of blood to the head, is because I am convinced that from this source most of the symp- toms which invalids feel, arise. The particular economy of the brain seems to require that the circulation here should be slow ; for, to what purpose do we suppose this quantity of blood is sent to the head ? Certainly for the nourishment of the brain, and to enable it to perform its functions. As, therefore, the actions of the brain are of great importance, whether we consider the brain as the seat of reason, or merely as the origin of nervous energy to be distributed to the various organs of the body, it evidently follows that a very elaborate process, and a very considerable length of time, are necessary to separate the proper elements from the blood. From the most accurate observations it does not appear that much red blood is circulating through the substance of the brain: it therefore should seem that the more watery parts of the blood are those parts which place the brain in such a state as to enable it to receive impressions, and to perform the function of thought. The nerves, whose origin is from the brain, are the organs of sensation and sympathy. Now, as perverted sensations, or disturbed perceptions, are the cause of a variety of maladies under which the invalid suffers, we must enquire what is the nature of sensation. Sensation is an impression produced on the mind by some cause acting on the body, which the mind instantly refers to the part where the cause is applied ; but that it is not always correct in such reference, many examples might be given. Sensations are of various kinds ; indeed, THE MANUAL FOR INVALID^. . 23 so various, that it is doubtful whether or not language itself could define them. They are as various as the tints of colours : they may, however, be divided into two distinct classes, viz. agreeable and disagreeable ; though, in reality, this distinction appears almost super- fluous ; as there are very different effects produced by the same cause acting in a different manner—'for pain is noth- ing more nor less than our common sensations carried to excess. By different modes our sensations inform us of different circumstances, as different organs are by nature fitted for particular sensations—as the mouth for taste, the eye for light, the ear for sound, &c. Besides, there is a certain disposition of parts necessary for the recep- tion of particular impressions. All our sensations are much more acute in the early time of life than at other periods: indeed, it is often one of the characteristics of age to lose in part the senses of seeing and hearing ; which seems to arise from some partial paralysis of the nerves in the direction of those particular organs. There is a direct and an immediate influence upon the heart and circulation from the passions of the mind. Thus a variety of persons have felt palpitations when placed in particular situations; and this solely arises from the sym- pathy of the nervous system. Having thus shown in what manner the brain, and whole nervous system, is affected by external agents, we can the less wonder that all the functions dependent up- on that influence should become disturbed and disordered, when adversity, and all its attendant sorrows, attacks the sufferer with an overwhelming force, blackening every cheering prospect, to the extinction even of hope. We are not all endowed with the same resolution, or the same powers of bearing up against calamity ; for that which may be said to be but a trifle to one person, will prove 24 THE MANUAL FOR INVALIDS. an intolerable torment to another ; and what one, by his singular moderation, and well-composed carriage, can easily overcome, another is not able to sustain, but is compelled to yield to the circumstances of his condition: then his complexion changes, his digestion is impaired, his sleep is gone, his cheerfulness is banished, his spirits are low, and his heart is heavy—the whole character sustains a change, and every feeling becomes gloomy and melancholy. More or less of these feelings and symptoms are con- stantly observed to exist, for the most part, in all inva- lids where the disturbed function of the brain may be traced as the source of the varied phenomena—no doubt modified by the original temperament, and peculiar cha- racter and habits of each individual. Our temporal happiness consists in attaining that state and mode of life which our respective genius or inclination urges us to wish or to desire. Comforts, with respect to the feelings, may be compared to clothes with respect to the body; it not being possible to bring those which in ap- pearance are best made, to suit well with, or to fit, every shape. Some flexible tempers can accommodate themselves to every kind of fortune, and be content to live within the limits of its extension. Some waxen dispositions, at will, are enabled to accommodate them- selves in such a conciliating manner, that every thing seems to sit easy on them: nothing disturbs them, be- cause the softness of their nature gives way to every impression—they rise without fatigue, and they de- scend, in society without violence. They are of so particular a frame of mind, that, provided they do not feel the want of the common necessaries of life, they seem equally content in every station. Those whom I have now described seldom become invalids from a THE MANUAL FOR INVALIDS. 25 disturbed function, but they are perhaps even more lia- ble to organic affections, on account of the inactivity which is engendered by a state of things common with those who, having every wish accomplished, have, at least, but little to desire, if they have much to enjoy. But let us reverse this picture, and trace the causes which have probably brought our invalid to the neces- sity of reading this Manual. Our principal research must be to detail the symptoms and effects of unhappi- ness and misery. With those whose unfortunate desti- ny has drawn them into the events of life which are at constant war with their genius and inclination, the vio- lence done to that inclination is constant, and therefore their disgust is constant also; that which in its nature is sweet to others, is to them very bitter. It would seem to us a wise dispensation of Providence, that every hu- man being were placed in such a state of external cir- cumstances as would harmonize and dovetail with the internal feelings and temper. But the world is cer- tainly governed in a different manner. Some are ren- dered truly miserable by the events of fortune, but there are others (and those are not a few) who are so by nature—those, I mean, who, in their own proper genius, temper, and disposition, find their greatest ene- my—discontented persons, who are pleased with no- thing, but are always loathing what they are in posses- sion of—who never can be comfortable, and who in- crease their own misery by being envious of those who are so. When adversity, and the calamities of life, as- sail dispositions of this sort, it must have most decided power over the seat of the intellect, and will produce not only an aberration of mind, but those bodily disor- ders which are of the most deplorable nature, as a na- 3 2 b THE MANUAL FOR INVALIDS. tural consequence. To relieve such is one of the pur- poses of this Manual. CHAPTER III. Digression, concerning the Nature and Extent of Human Know- ledge—Our Experience of the Nature of Disease, and the Power of Remedies, obtained by observation of the invariable succession of Symptoms. This digression seems naturally to arise from the matters we have been previously discussing; for there cannot be a finer or more interesting subject for the ex- ertion of our knowledge, than the principles of life and of death. In all the efforts of our understanding, one very curious and important fact is developed—that eve- ry phenomenon, both of matter and of mind, is govern- ed by certain and invariable laws; and that those prin- ciples which govern phenomena are, to a certain extent, capable of being known and ascertained by human en- quiry. This is the only real foundation of human knowledge ; observing the order of succession by which one event succeeds another. It is this which forms a datum, upon which all reasoning, concerning matter of fact or identity, can be established. All prognostica- tions, arising out of symptoms, having heretofore been invariable in their succession, enables the skilful practi- tioner to foresee, and to foretell, nearly with certainty, the result of the phenomena of disease. Yet it has been observed, that men are often more anxious to find out the reason of a thing, than to find out the truth of it: they slide over suppositions, but very nicely examine consequences: they leave the visible and tangible things. THE MANUAL FOR INVALIDS. 27 and fly to anatomise causes. The various theories of physiology are most abundantly illustrative of this truth. In a general way, some will say that the knowledge of causes most concerns that being who has the conduct of them. We are compelled to yield an obedience to effects, without the capacity to understand the original principle or essence. Partial knowledge is worse than positive ignorance, because it is mixed up with the opi- nion of learning. Effects greatly concern us, often, when causes put our researches to scorn. It has been said, by a very learned and acute critic, that we are all as ignorant of first principles as we were in our cradles. It would certainly, appear just, to suppose, that the phi- losophy which regards the phenomena or appearances of things, as they take place in certain and invariable order, is the philosophy of every thing that exists in the universe; for upon what other principles can our knowledge or experience be grounded ? We see that every thing around us is the subject of unceasing change; yet appearances do not carry exactly the same aspect to all men : error assumes the appearance of the truth, and truth is sometimes so mixed with concurring events, as to make it appear in the garb of error. I have often been convinced of this position, in reading the beautiful thoughts of Cicero, whose vanity often subdued his attachment to truth : the great Cicero was not ashamed of a lie, and purely from motives of vanity. This frailty seemed quite congenial to his being: he wishes his friend to write the history of Rome, and to begin it with an account of his suppression of the con- spiracy of Catiline ; and then to give a retrospective narrative of events, to the time of Romulus: and in every thing in which he was concerned, regarding the transactions of his own times, he implored the historian, 28 THE MANUAL FOR INVALIDS. that the strict rules of truth should be exceeded, so as to give a brilliancy and lustre to his counsels and actions. Thus errors in philosophy and science are liable to the same casualties as the falsehoods of private life, and against which we cannot be too solicitous to guard our- selves ; for it would seem to me, that falsehood has an equal tendency with truth, to propagate itself, notwith- standing the famous proverb, which says:—Magna est Veritas, et prevalebit. Error rears a fabric; each party contributes a little, like patchwork ; so that the remot- est witness declares he knows more than the nearest, and the last informed is always more certain than the first. Thus it proceeds, in a very natural progress ; for whoever believes any thing, instead of enquiring if it be true, thinks it a much greater work of charity to re- duce others to the same opinion. We are conscious of perpetual change ; but often vain is the attempt to com- prehend either causes or consequences. We are not allowed to penetrate into the mysteries of the divine Mover; yet, with a presumption truly wonderful, we often ascribe good health and good fortune to our dis- cretion and prudence. But when the consequences of our folly and ignorance overtake us, we solace ourselves with the thought, that " whom the Lord loveth he chasteneth." Human knowledge could never yet ar- rive at the duties it could prescribe to itself; and, in- deed, were it possible to reach this mark, it would im- mediately prescribe to itself others beyond it—so great an enemy to consistency is our human condition. The ancient philosophers have prated for ages about the dead and motionless masses of matter—the vis inertia; which philosophy, in company with many other things, then believed as immutable truth, hath passed away. We now know that the world itself is one mighty system. THE MANUAL FOR INVALIDS. 29 of change : all things, unorganised matter, as much as the organised, are the subjects and exhibiters of un- ceasing variety. What seems to our eyes to be rest, is continued motion; and, what is truly astonishing, there is not a particle of the planet on which we dwell, that continues in the same point of space, even during the instant in which we strive the most rapidly to think of it. Life and death may be said to be a dissolution alike, or, more properly, in the same space of time. There is a more varied decomposition while we live, than when we die. Now, in the whole internal world, although the phenomena are of a different order, there is a variation of them as perpetual; and if the bodily functions of life continue only, the particles of the frame are quitting one place to exist in another. The func- tions of the intellect, which animates it, may be said to subsist only by the succession of feeling after feeling. The basis of all science, of all experience, is founded upon the great character of all these changes, and the regularity which they are known to exhibit: which re- gularity enables human beings to accommodate their plans with perfect foresight to circumstances which may not yet have begun to exist. The observation of the variable phenomena, as they are continually taking place around us, and within us, appears to be that of a moment, or point of time; but the knowledge which it affords, is far more extensive: it is truly, and virtually, information of the past and of the future, as well as of the present. For the future, when it arrives, we find it to be only the past, under another resemblance : thus the whole universe is but one perpetual motion, in which all things are incessantly rolling. The rocks of Caucasus, the pyramids of Egypt, both, by the general motion of the earth, as well as by a particular inherent 3* 30 THE MANUAL FOR INVALIDS. one of their own, are always in action. Even con- stancy itself may be said to be a mere steady or lan- guid motion. We must take our feelings at a point of time—just at the moment when we consider it,—the next moment revolutionizes us. Either we are not ex- actly the same beings, or we are subject to other influ- ences; or we lay hold on subjects with other circum- stances, considerations, and feelings. It is this perpetu- al vacillation that makes us appear so very inconsistent with ourselves, even upon the subject of knowledge and experience ; for the man of learning is not learned in every thing; but the presumptuous man is self-suffi- cient in every thing, even in his ignorance. At every moment of our consciousness some sensation, or thought, or emotion, is beginning in the mind, or ceasing, or growing more or less intense. Thus the changes which we know in the actual circumstances observed, we be- lieve to have taken place as often as the circumstances before were similar; and we believe also, that it will continue to take place, as often as future circumstances shall in this respect have a true resemblance to the pre- sent. Nor are we ever deceived; for what we thus believe, is always verified by subsequent observation. Thus do we truly obtain a prospective knowledge of the future, while we may seem to be only observing what is before us, or remembering what has been formerly observed; and in whatever way this prophetic gift may have been conferred upon us, it must be regarded as the most valuable of all gifts, since, without it, every other gift would have been of no use. It has been constantly observed, that the world is not a resting-place of a moment; it is the restless home of myriads of generations, for the many long years of their mortal life; and for the purposes of that life it is most won- THE MANUAL FOR INVALIDS. 31 derfully fitted with whatever is necessary either for sustenance or for shelter—for the prevention of painr and the enjoyment of pleasure : it is also well fitted for the exercise of those talents with which the Al- mighty has thought proper to endow us. Uneasiness determines the will to avoid the causes of uneasiness in future ; this leads to a critical examination of what are the causes, &c. The knowledge of the invariability of similar sequences or effects to the priority of certain antecedents, or causes, is essential not to science only, but to all the practical arts of life, and, of course, to the preservation of life itself; we rest upon it with a moral certainty nearly equal to the laws of physical matter. In whatever manner it may arise, and what- ever circumstances may or may not be necessary for giving birth to it, the belief itself is a fact in the hu- man mind which cannot be denied, and a fact as univer- sal as the life which depends upon it. What do we mean by saying such a person is very skilful, or a person of very great experience? Why our meaning is, that such a person has applied all his powers of attention to the succession of events, and constantly observed the regular order of sequences; we can have no other idea of power or causation, to what- ever objects either spiritual or material, the words may be applied. Now if- events had succeeded each other in perfect irregularity, such terms never could have been invented ; but when the successions are believed to be in regular order, the importance of this regularity to all our wishes, and plans, and actions, has of course led to the employment of terms significant of the most valuable distinctions which we are physically able to make. We always give the name of cause to the ob- ject which we believe to be the invariable antecedent 32 THE MANUAL FOR INVALIDS. of a particular change; and we give the name of effect reciprocally to that invariable consequent. This is all that constitutes either knowledge, science, power, or experience, or by whatever other name we think pro- per to give to those abstractions which we frequently personify. The late Mr. Fox said he entertained very great doubts respecting the accuracy of all abstract rea- soning whatever, from which matter of fact, as a guide of conduct in life, could be deduced. He was well aware of the great inconvenience of all abstract terms; for when they become very familiar, we are very apt to forget that they are abstractions, and to regard them as significant of some actual reality. The history of the errors, not of the unreflecting multitude only, but of philosophers themselves, is, in a great measure, the history of this very species of error, modified and di- versified in a variety of forms of prejudice and super- stition. We perceive the regularity of phenomena in the planetary system, in the processes of chemistry, and indeed in every part of the physical world; but we hesitate to apply the same simple principle to the feel- ings of the mind, or the phenomena of the moral world. Yet the Divine Author of nature has not multiplied causes without necessity, but has given us perfect free- dom to act in obedience to our will. The will he has decided should yield obedience to laws which he has created; for there is no created mind capable of begin- ning spontaneously a series of changes, more than any mass of created matter. All is only a continuance of changes, and often of mutual changes. The changes produced by mind in matter are indeed more obvious to the perception of others, and more directly measurable, than the changes produced by matter on mind ; but it is the simple production of a change, not the nature of the THE MANUAL FOR INVALIDS. 33 change produced, which is essential to the argument; and of the ever-varying phenomena of the material uni- verse, there is truly as little cessation, as of those which are most rapidly successive in mind: even the apparent rest of matter, it must be remembered, is a sort of ac- tion rather than repose. John Toland created to him- self many enemies for promulgating this simple truth, now so generally admitted : he asserted that all human knowledge, and what is called skill, or experience, in men, have their foundation in an accurate attention to the invariable succession of antecedent and consequent, and that in reality there were no strictly moral causes; but all events were practically and virtually physical. CHAPTER IV. The Occupation of the Mind—The Mention should be directed to Objects of Usefulness, as tending to prevent Languor and Fas- tidiousness—The Love of Literature and the Fine Arts—The Cultivation of a correct Taste, fyc. It is so very essential to the due performance of all the animal and mental functions, that the mind should have well-defined objects to pursue, that Gualter de- clares the mind can never rest, but is constantly meditat- ing on one thing or another ; and except it be occupied about some laudable pursuit, it is sure to produce a dis- turbed function of the brain, and is causing miseries of every description ; thus idleness, or apathy, or indo- lence, or want of intellectual action, is a paralysis of both health and energy. As fern grows in unfilled ground, and all manner of weeds are found to fructify, go do every unhappy feeling become an inmate of an 34 THE MANUAL FOR INVALIDS. idle mind. The horse that has never travelled—the hawk in the mew, that seldom flies,—are both subject to diseases, both of which, in a state of nature, would be free from such maladies. Inactivity or idleness of the mind has worse consequences than that of the body. Seneca settles the question, by declaring arugo animi —rubigo angenii ; thus evil and corrupt thoughts are constantly arising in an idle person. For what will not both fear and fancy work in an idle body ? what disturb- ed functions of the organs, most essential to cheerfulness and peace, will they not produce ? Those who know not how to spend their time, have much more business, more care, grief, and anguish of mind, than those whose powers of body and mind are in healthful exercise. An idle person knows not when he is well, nor what he would have. The want of healthful excitement has stimulated often to gambling—the beaten road to a violent death. The motto Otiosus animus nescit quid volet, is grounded in nature and truth. The idle party knows not what to will; he quietly waits for sensations, till every percep- tion is changed in its character, and a listless tedium vita succeeds every impression : he is tired out with every thing, displeased with all, and weary of his life—toappy neither at home nor abroad. Seneca says, Prastat aliud agere quam nihil. The Egyptians of old, and many of the more ancient com- monwealths, enjoined labour, both of body and mind, to all their subjects, and compelled them to give an ac- count of their time, to prevent the mischiefs that were found to arise from listlessness': the active power of doing, and the negative power of suffering, were found to be greatly increased by exercise. Every human being, in every station of life, either rich or poor, should have a definite, determinate pursuit, The very word THE MANUAL FOR INVALIDS. 35 pastime seems a reproach, as if we were born for no other purpose or end but to drive time away as fast as we can. To correct, or avoid all these evils, our learn- ed divines and physicians, nay, also our politicians, have, much to their credit, greatly urged us to cultivate our energies in entertaining and useful employment. The man of the world cannot easily obtain riches without labour and toil; nor can the elegant scholar obtain learn- ing without study and great mental exertion ; neither can our health be preserved without bodily exercise. The celebrated physician Areteus writes, De ambulatio per amoena loca, and advises those people who have the means to take pleasant journeys to so amuse themselves; but the most desirable, as well as the most delightful, of all exertions, are undoubtedly mental. Is it possible for any person, who is not wholly subdued with idleness, or involved in a vortex of worldly cares, that will not find his mind greatly relieved, as well as instructed, by the perusal of some useful and entertaining author ? Biog- raphy alone is a most delightful study, wherein we may observe, as it were in a glass, what our ancestors have done, in the most critical situations; the beginnings,pro- gressions, fall, and ruin of nations, as well as private men's actions displayed to the life ; the secret springs from which the most important actions have arisen are herein detailed. Julian, commonly called the Apostate, was so enraptured with an oration of Libanius the so- phist, that he declared it was impossible for him to rest until he had read it throughout. And we may say near- ly the same of any amusing or intellectual work thathas sufficient interest to arrest the attention, and carry it along with it. To most literary men it is an extraordi- nary pleasure to study: the labour is lost in the enthu- siasm. Progression in learning is not to be purchased 36 THE MANUAL FOR INVALIDS. with money. " There is no royal road to learning," any more than there is to happiness. What an almost infi- nite variety of good books offer themselves, upon almost every subject, art, or science—arithmetic, geometry, astronomy, perspective, optics, and, although last, not least, pathology and therapeutics ! This most delightful study has boundless resources for the occupation of the mind, and would repay, with most usurious interest, all the fund of attention expended upon it. What number- less volumes have been published, having for object to scatter knowledge in law, physic, and divinity—for pe- cuniary profit some, others for pleasure and speculation ! It is curious to observe what trifling analogy exists be- tween the law of nations and the law of nature; how local courts and jurisdictions are occasionally at war with the first principles of justice. We have thousands of authors upon these subjects; their very names would fill many volumes : many great and noble libraries, well furnished; and he must have a very imperfect and im- proper taste, who relishes none of them. Some take a very great delight in studying even the languages in which those books are written. The study of natural history is a beautiful occupation of the mind—to peruse the account of birds, beasts, insects, fishes, and reptiles. The class of serpents, their beauty, their variety, associat- ed with the fact of their bite being mortal, fills the mind with astonishment. Plutarch says, " What more plea- sant study than the mathematics ? Such are the excel- lencies of the sestudies, that all the ornaments and child- ish bubbles of wealth, are not worthy to be compared to them." Leonard Diggs, an English mathematician, wrote a work entitled " Prognostication Everlasting, or Rules to judge of the Weather ;" in which he says, Crede mihi extingui dulce erit mathematicarum artium THE MANUAL FOR INVALIDS. 37 Studio : he says he could live and die in such medita- tions, and take more delight in them than others do in a. the midst of their wealth. Similar pleasures may be created by any rational study or mental occupation ; itonly requires the predisposition to the pursuit; it would prove like Circe's cup, and would engross every feeling ; the whole man would be absorbed, as was Julius Scaliger, who was so affected by poetry, that he declared he would rather be the author of twelve verses in Lucan, or of the ninth Ode of the third Book of Horace, than to be the Etn>peror of Ger- many, Seneca carried his enthusiasm to such a pitch, that he declared his preference of Zen© and Chysippus (two men celebrated as stoics), before any prince or any general of an army. What must have been the sensa- tions of Orontius, the mathematician, who, in his admi- ration of Archimedes, calls him Divinum et homine ma- jorem ; and certainly such enthusiasm, in this instance, can scarcely be said to be ill-placed. Thus, we see that exercise of the body tends to preserve health ; and ex- ercise of the mind will give energy to the character, and develope everything that is sublime and noble in man. So entertaining and pleasant is the pursuit of study, that the more learning we obtain, the more we desire to have, and the last day is prioris discipulus—it is hard at the threshold, but pleasant as you advance ; the root is bit- ter, but the fruit is sweet; and we have many instances on record of men who have attained their century of years, retaining their intellectual faculties, and admiring mental acquirements with the avidity of youth : the longer they have lived, the more have they been in love with the Muses: yet it has become fashionable with those who are born to riches, to hold in contempt learn- ing adn libraries, while they venerate many other mat- 4 38 THE MANUAL FOR INVALIDS. ters of great expense and of small utility, and this en- tirely through error, ignorance, and want of a proper education. The acquirement of knowledge, by means of the expansion of the intellectual faculties, has many and very great advantages; it enables us to attach a just value to proper objects of pursuit, to place all objects in their relative position, as it regards the public in general^ and the individual in particular; a just estimate is by these means obtained between the bodily and the men- tal exercises. An excess of bodily exercise is frequently checked by the indolence inherent to our nature, or the repetition prevented by the lassitude and fatigue which it engenders; but the seductive nature of intellectual exertion requires the judgment to guide and regulate those amateur feelings; for, like everything else, when employed overmuch, its evils are severe—loss of the powers of digestion, depression, dejection, general weak-1 ness of the whole nervous system, atrophy, and, in some instances, from the mind being overcharged with a mul- titude of ideas, insanity has supervened, to usher in a premature death. There can be little doubt but great allowances must be made for the vast difference of structure and consti- tution of various persons. Some people have naturally a powerful and active organization, both corporeal and mental; of course, such will suffer less from exertion than others who are destitute of those advantages. It must follow, that those are most affected who, with an ordinary structure of mind, use endeavours to force it beyond its powers : and it is well known that excessive mental exertion, which we make involuntary, and which produces no pleasure, is certain to weaken us most. Every irregular action of our powers is hurtful; and we find that exertion of mind, without attention to bodily THE MANUAL FOR INVALIDS. 39 exercise, is greatly more prejudicial than when united with a proportionate action of the muscles. Thus we discover their mutual dependence upon each other. The learned Boerhaave informs us, that after having bestowed intense study for a few days and nights on one object, he fell suddenly into such a state of lassitude, that he lay for some time in an insensible and death-like condition. Therefore the same law appears to prevail here, as in regard to muscular motion, and ordains that we cannot think too closely or incessantly upon the same subject: a proper change of objects is essential to the due occupation of the mind, in order to study with- out injury to the health. There are many abstract thinkers, such as are metaphysicians, mathematicians, and philosophers, who, at a very advanced stage of life, are very happy and content, by observing this variety as a law or rule of conduct, taking care to divide their time between abstract studies and the reading of history, agreeable poetry, travels, and the works of natural his- tory. It is worthy of remark, that when a person em- ploys the intellect upon the abstract and very difficult points of philosophical subjects—such, for example, as the higher mathematics and metaphysics,—the object makes a great difference the more abstract it is, and the more it obliges the party to disengage himself from the sensual world, and, as it were, to insulate the mind from the body. Now this is a most unnatural state ; it is a condition of convulsion, inducing very great difficulty. A little time employed in sueh abstraction produces as great a lassitude of the mind as large bleedings produce in the body ; but here a great deal is relative. There are many people who seem born for intellectual labour, and are endowed with those powers and that frame of mind which its developement requires. It may seem" 40 THE MANUAL FOR INVALIDS. singular, that when it is requisite to raise up a weighty substance, we always first try our strength to learn whe- ther it be not too heavy for us ; but in regard to a men- tal burthen, we never suspect our powers, or imagine we are unable to accomplish the task. We must not penetrate the depths of philosophy, unless we have heads well organized for philosophical pursuits ; at all events, objects of simple utility should be chosen, instead of subjects of ornament or of curiosity. Gratification of amateur or virtuosi feelings, will be very dearly pur- chased at the expense of health of the body and peace of the mind. The creative labours of the mind are, by far, more exhausting than the recipient or passive state, enjoying foreign ideas ; as, for example, reading, or hear- ing of others read, requires but little effort compared with the productive quality of giving birth to original thoughts. The writings of many of the Roman philolo- gers seem to point out more to the perusal of good wri- ters than any other pursuit. They were so naturally prone to gymnastics and the ardour of military glory, that they certainly stood in no need to be stimulated to bodily exertion;—they always lean to the exertion of the intellectual faculties. Seneca, when an old man, said, " If you be very fond of books, you will have it in your power to escape much of the tedium vita, or ennui, of life; you will not sigh for the evening, nor feel disgusted with the occupations of the day ; nor will you live dissatisfied with yourself, or unprofitable to others."—(See his writings, De Tranquillitate.^) The whole writings of Cicero have given us continual recommendations to the study of the fine arts and the pursuit of polite literature. His Tusculan Disputations, his De Finibus, and the Academical Questions, more especially, abound with the finest thoughts, embodied ia THE MANUAL FOR INVALIDS. 41 the most elegantly classical language, to the same pur- pose, and particularly in his Oration pro Archid. He there lays it down as a law of nature, that study is the food of youth, and the amusement of old age. The younger Pliny, also, the friend and social companion as well as adviser of the Emperor Trajan, roundly asserts the following words :—" I am quite transported and comforted in the midst of my books : they give a zest to the happiest, and assuage the anguish of the bitterest, moments of existence. Therefore, whether distracted by the cares or the losses of my family or my friends, I fly to my library as the only refuge in distress ; and it is here that 1 learn to bear adversity with fortitude." —(The Eighth Epistle, chap, xix.) Thus, we per- ceive it is a matter of great importance in the occupa- tion of the mental power, to have resources within our- selves : for it is very certain that those who have no in.- ternal resources of happiness will find themselves un- easy in almost every stage of life ; they will derive no accession to their comfort from the activity or the hila- rity of youth, nor will they be able to draw peace from the gravity and experience of age ; but to those who are in the habit of deriving the greater part of their felicity from within themselves, no state will certainly appear a real evil, into which they are conducted, by the com- mon and regular course of nature. Yet such is the in- consistency of human folly, that a lengthened posses- sion of life, which it is every man's warmest wish, to at- tain, no sooner appears in consummation than it is im- mediately the object of lamentation and'grief; but if we be deceived by our false calculations, must not the blame rest wholly on ourselves? for the years that are elapsed, how numerous soever they may have been, can by no means console a weak and a frivolous mind, under tha 4* 42 THE MANUAL FOR INVALIDS. usual consequences of long life ; for unregulated pas- sions, and a froward disposition, with a petulance in tem- per and in manner, will embitter every season of our existence. A classical writer gives it as his opinion, that the human mind is more impaired by suffering its powers to lie dormant and unexerted, in a slothful and spiritless state, than by the natural effect of the pro- gression of time. The pursuit of literature, and culti- vating a taste for the fine arts, has a peculiar good effect in destroying a predilection for all fastidious proceedings. You seldom see a love for literature, in a drunkard or a debauchee. Wine, and the irregular pursuit of sexual enjoyment, has infatuated and ruined myriads of people. Persius, in his Fifth Satire, says, "Qui Vino indulget, quemque alea decoquit, ille In venerem putris;" and it certainly is no small privilege to be exempted from the tyranny of such violent passions. " To whom is sorrow (saith Solomon), to whom is woe, but to such a one a3 loves drink ?" The immoderate love of drink causes poverty and want, shame and disgrace. With respect to the other passion, the love of the sex, it is founded in nature ; and when cemented with virtue and honour, and a conformity of temper, tastes, and inter- ests, is the most delightful enjoyment we are capable of receiving: but its irregular and vicious gratification is not only a monstrous crime, but by its effects inflicts the most extensive misery upon both sexes. Menander says, Atque hornini cerebrum minuet, in its consequences; wounds are received, inflicted as by a two-edged sword: the drunkard and the meretrix God will judge. They lose both grace and glory ; amittunt gratianh, perdunt gloriam, are the words of Austin. THE MANUAL FOR INVALIDS. 43 They are likewise deprived of health and longevity, which frequently accompany each other. Cicero par- ticularly advises us to preserve with great care our in- tellectual powers, as being even of more consequence than those of the body; for the powers of the body, like the flame in the lamp, will become languid and ex- tinct by time, if not duly and regularly recruited; but there is this difference between them : bodily exertion will end in fatigue, whereas the mind is never wearied by its activity, if the study be analogous to the temper and the feelings of the party. There certainly is noth- ing more opposed to the energy or the perfection of the human character, than a slothful and spiritless life. The fact is clearly this : the irregular indulgences of the amorous passions, although a vice to which youth is very generally prone, is a vice with which only those young men are infected, who are unrestrained by principles of virtue, by a verisimilitude to that species of delirium or dotage to which some old men are incident; yet it is not observable in all, but only in those who have trifled away their time in frivolous pursuits of idleness and of folly. By directing our thoughts to objects of useful- ness, we not only prevent languor, but we receive great inward satisfaction from the retrospect of such conduct. Whatever represses inordinate and irregular desire, teaches us to retire within ourselves, and look for hap- piness in our own bosoms. This is no small moral bene- fit ; it is the sweet food of the mind, and which can only be gathered in the fields of science. In vain are the gay amusements of the theatre, the splendid display of a luxurious table, or the violence of irregular sexual enjoyments, compared to the calm de- lights of intellectual pleasure, which, in a mind proper- ly formed and sedulously cultivated, improve much by 44 THE MANUAL FOR INVALIDS. time, and gather strength with years. The great Solon declared that he learnt something useful to himself and others every day that he lived : it was a declaration much to his honour; for no person can dispute, that to be continually advancing in the path of knowledge is one of the most pleasing satisfactions of the human mind. I have said that we should cultivate a love of literature and the fine arts, and endeavour to possess and to improve a correct, chaste taste. For this purpose I am persuaded that rural and picturesque scenery is very favourable. The pleasures of rural nature are con- sistent with every period of our lives, and they certain- ly approach the nearest of all others to those of the purely philosophical kind. What possibly can be more delightful, than the very beautiful varieties to be ob- served in natural history—the properties of the earth, with its abundant fertility, which it readily yields to the cultivator's industry, and returns with interest whatever he deposites in her keeping ? How wonderful are the phenomena of nature ! A philosophic mind, devoted to the cultivation of the earth, must develope new sour- ces of gratification continually : agriculture, to a mind charged with a love of philosophy, is a noble study. I have very often been delighted with observing the pow- er, and tracing the process, of nature, in her vegetable productions. , Now, after our taste has been improved by the con- templation of the sublime and beautiful in nature, we feel a pleasure in works of art, and the embellishments of life. It is thus that the works of imagination bestow a source of pleasure and delight upon objects which, to a mind thus improved, appear as a new creation. It would also seem that our pleasures have, in a well-in- formed mind, an analogy with our respective periods of THE MANUAL FOR INVALIDS. 45 life : even the difference of sex forms a variety in the pleasure of particular habitudes and pursuits* Infancy and youth, manhood and old age, greatly differ; yet we do not find that youth regrets the toys of the child, or manhood lament that it has no longer the amusements of youth. An unceasing activity of body and of mind, bearing a just relation to its powers, seems to be an evident purpose of nature, in reference to human beings, and appears to be intended by Providence to preserve our health, and to continue our gratifications of a mental character, to the latest period of our lives. Therefore it is most desirable that we should encourage an enthu- siasm for the fine arts and the picturesque of nature,, that it may settle into a permanent habit; for what is effected by habit, is accomplished without any effort or constraint. An elegant writer observes—" And what, if men of genius, relinquishing their habits, could do this violence to their nature ; should not we lose the original for a factitious genius, and spoil one race without improving the other ?" If nature, and habit—that second nature which prevails even over the first, have created two beings distinctly different, what mode of existence shall ever assimilate them? Antipathies and sympathies, those still occult causes, however concealed, will break out on various occasions, either sooner or later. Another unfortunate effect of the power of habit is, that all per- sons surrounding and having frequent social intercourse with men of great talents, or original minds, are not able to appreciate the grasp of thought familiar to them; for the personal society of ordinary minds with men of great mental powers, often produces a most ludicrous prejudice. A Scotchman, to whom the name of Dr. Robertson had often been repeated, was very anxious. 46 THE MANUAL FOR INVALIDS. to know who he was: when informed that it was his neighbour, he could not easily persuade himself that the man he had so frequently conversed with was the cele- brated historian of his country. It is my anxious wish to render this Manual as ex- tensively useful, as the subject-matter of health is most deeply interesting. I may not always amuse, from the abstract nature of some of my observations, and the de- sultory manner which I have chosen to communicate information; but 1 hope always to profit the reader, from the useful facts which are herein recorded. Helvetius says, that the whole of man is sensation; that events, and the impression they produce upon the irritable organization of the nerves, constitute the tem- perament and character of the individual. In the tem- perament of talent, may we not discover certain indica- tions, or prognostics, announcing the permanent cha- racter ? It has become a question, whether or not great sensibility be not inseparable from a highly suscepti- ble organization. The modest, retired character wilt adhere to its obscurity, while the unalterable being of intrepidity and fortitude will be full of courage and resolution. We can readily perceive, in the human countenance, the developement of the mental character; whether such delineation be the result of the operation of causes which form the function of thought, produce those lineaments, and give determination and character to the expression of the museles of the face, or not, I will leave the reader to determine: but we are not very long in discovering whatever of character is either amia-, ble or interesting in the quality of the human mind. That such expressions exist, or that the human form is actually significant to us of mental qualities, and, as such, is productive of the emotions which such qualities* THE MANUAL FOR INVALIDS. 47 in themselves produce, is proved, beyond dispute, by the universal language of mankind. We speak of the form of the human face, as majestic, heroic, gentle, be- nevolent, determined, melancholy, or despondent; but what is much more, they are the only terms in which, in infant languages, or among the common people, the human form is described and distinguished. The pro- gression of art gives to the artist the advantage of tech- nical terms; but in every country, the great body of the people adhere to their first impressions, and distin- guish the individual qualities of mind of which they feel them to be significant. It cannot be for a moment doubted that the possession of health is necessary to the perfect developement of courage and mental powers ; yet I can conceive a very extensive combination of thought and great mental de- termination to co-exist in a body but delicately formed and easily disturbed in its functions. A well-informed mind upon the principles of health and disease, by a knowledge of the causes and the effects of maladies, will be certain to acquire considerable power over events: knowledge gives power and resolution also^ An ignorant or irresolute man is incapable of acting up to a firm purpose ; he often thinks what a determined course he could have pursued, if his talents, his health, and age, had been different to what they are ; every- thing must be moulded to his purpose, or he can do no- thing of himself; he must implicitly follow the current of events ; he uses no effort to stem or command them: perpetually querulous, and almost continually murmur- ing, he fritters away in useless complaint those energies which a very different conduct would have enabled him, with a vigilant eye, to have seen, and with a strong 48 THE MANUAL FOR INVALIDS. hand to have grasped, all the possibilities useful to his" purpose in his actual condition. There is nothing manifests the imperfection of our character more, than the perpetually vacillating incon- stancy of our actions. If every little diversity of feel- ing be to give a varied tone to our resolves, how can any person be enabled to form an opinion of us, upon which they might rely with tolerable certainty ? An irresolute man's opinions and actions are greatly de- pendent upon those of others; and what chance is there either for consistency or stability, while the per- sons with whom he may converse or transact, are so va- rious? A character so formed may be said to confess himself made for subjection, and will probably pass as a slave to each triumphant passion, in alternate succession, without effort of resistance or any struggle for relief. Yet it must be confessed that the regulation of all our plans must greatly depend on the course of events, which will sometimes come in an order, and in a sue cession, not easily to be either foreseen or prevented. But there is a very wide difference in men, in adapting themselves to the influence of the circumstances by which they are surrounded : there certainly does appear to be something of a sui generis character in such cases —somewhat of an idiosyncrasy, or peculiar structure of the organization, as well as a peculiar susceptibility of feelings. Were it otherwise, how could it happen that one man should seem to govern events and mould them to his purpose, while another becomes their willing slave,—either to be led or driven to whatever point they may tend ? And it would also seem strange, but it is very true, that, as in many other cases, extremes meet and produce nearly similar results. Thus, a man of an enlarged intellect and a very exalted understand- THE MANUAL FOR INVALIDS. 49 ing, by seeing the combination and relative bearings that one event has to another, will perceive what must occur, and will be prepared to meet it with a composure and equanimity that, to many, would appear like an utter ignorance and want of feeling. While the nega- tion of such a character by a heartlessness, obstinacy, and pertinacity,—by subjugating every feeling, and merging them all in a wilfulness of purpose, per fas et nefas,—will appear to have foreseen all difficulties, and by quietly waiting the event, should seem either to have provided for them, or have discovered that they are in- surmountable. By this confusion in the causes of our moving powers, or virtual motives to action, it has been affirmed that our will is adverse to our permanent health and peace,—it mars and saps the healthful func- tions of our various organs, gives delusive phantasms to our perception, and makes good appear to us as evil, and evil assume the appearance of good. In this Manual, our purpose is not simply to point out a curative mode of the various and specific diseases to which, by the dispensations of Providence, we are oc- casionally incident; but to give such an enlarged view of the remote and predisposing causes, which would, if not counteracted by other agents, bring into action the proximate causes upon which health and disease must depend. Now we have said, that to cultivate a love of literature and the fine arts, and to direct the taste to pursuits of usefulness, is very comformable both to health and happiness: but I may be asked, What are the cir- cumstances that give the impulsion ? What are the causes which create this inclination and this gusto for one pursuit in preference to another ? Beyond all question, as I have previously said, it greatly depends upon a peculiar temperament or constitution of the 5 50 THE MANUAL FOR INVALIDS; body ; nor have physiologists, as yetj been able to ex- plain, if it be explicable, in what manner the corporeal organization affects the mind. That it does produce im- mense changes is certain. We assume it as a fact war- ranted by experience, that there is, in the material con- struction of some persons, much more than in others, a something which much increases,—if it do not create,—• both stability of resolution and muscular power. Sen- sation can only be received according to the capacity of our organs; but we have every day's experience to de- monstrate that our organs may be greatly extended in power and capability of every kind by practice. But what are the circumstances that create this inclination ? The enthusiasm to a particular train of thought. This predilection, both of thought and action, to a certain ob- ject of research, would, at least, be a very interesting object of enquiry. There can be little doubt, that in the pursuit c-f li- terature, or the objects which are classed under the ge- neric term virtu, there are a great variety of very in- tense sensations, and frequently of a very pleasurable character, which are by far too mental to be incorporat- ed into existence by any sounds—they cannot be des- cribed by language. There are certain tastes and ob- jects of research, which are pursued with such avidity by many persons inspired by nature or acquired by art. Do they exist independent of education, and where it is not to be found ? Is it in the power of education to produce it ? See what fervour of enterprise exists among individuals. The author was personally ac- quainted with Mr. William Brown, the African traveller, and has had many and long conversations with him upon the subject before us. Mr. Brown thought that he first felt the wish for travel immediately after one morning's reading of Bruce's Travels, and his exertions in explor- THE MANUAL FOR INVALIDS. 51 ing the source of the Nile. He felt that he never should be able to remain in England, under an impres- sion that any European had penetrated the parts of Africa which never before had been trodden by an Eng- lishman. The same energies that actuated Columbus upon the Atlantic, possessed the mental power of Brown as he was exploring Africa. He had every comfort at home—an independent fortune, and intellectual trea- sures of no small extent; yet all could not induce him to be at rest. He had a presentiment of his fate. He had returned safe from his first perilous adven- ture ;—he went again to the scene of his former travels, and, in prosecuting them, fell a victim to his enthusiasm. The motto, Viator Caveto, ought to be inscribed upon a monument at the spot where the enterprizing traveller fell. Isocrates, whose lectures were much frequented, and very properly admired, imagined that he could discri- minate the character, the inclinations, and predisposi- tions of his pupils: some he advises to follow one thing, and some another : he clearly was of opinion that orga- nisation, and a temperament not created, but modified by circumstances and events, constituted the great va- riety of disposition and temper, and that it was the chief cause of all the energetic inclinations of the mind. The Jesuits established this principle, but upon a law of as- sociation of ideas; which I have no doubt David Hart- ley studied, and that he found it very useful to the for- mation of his theory. In tracing the history of men of great capacity and attainments, we occasionally find that both patronage and poverty operate as occasional causes, by the excitement they produce ; one receives the praise and support of power—the other is urged by the stern gripe of necessity. This Manual has given repeated ob- servations on the invariability of cause and consequence 5 52 THE MANUAL FOR INVALIDS. which will perhaps serve to explain, that although cer- tain causes do produce their inevitable effects, there do exist counteracting agents, which prevent from success some men who have an equal aptitude for intellectual perfectibility. Man is, to the full, influenced as much by moral causes as by physical; but their effects are less visible, and not so well understood. Men of great talent or acquirement are rare, because a combination of those coincidences which must concur to produce the effect are still more rare. It is the power of great and long at- tention which generally makes one man surpass another. The attentions which have been bestowed upon biogra- phy have discovered that the faculties of the mind are, not solitary gifts of nature, but are simply effects from human causes : nor does it follow that the highest facul- ties of the human mind shall meet with a commensurate reward, or even reputation. With respect to literary merit, in particular, the fact is notorious ; for most books are more read for curiosity than for pleasure. The reader has not marked, learned, and inwardly digested, the author. It has long been a just complaint among the authors of literary works, that readers are very ca- pricious ; and it too frequently happens that, from the same causes some are greatly delighted; others are, or affect to be, either disgusted or offended. Some of the most popular writings have not been of great intrin- sic value ; like a meteor, they blazed for a season, and were then neglected or forgotten. An old French writer, Montaigne, has complained that he frequently found his readers either too learned or too ignorant; and that he often could please only a certain class, who had just learned enough to comprehend him. THE MANUAL FOR INVALIDS. 53 CHAPTER Y. The Stomach considered—The Function of Digestion explained— The grand Origin of Sympathy— Greatly affected by Diseases of several of the Organs of the Human Body. The stomach is an organ of great importance in the animal economy, upon the perfect function of which the principles which regulate health or disease greatly de- pend. It is well known, that the function of the sto- mach is digestion, and that this is the beginning of a process, the object of which is to produce blood from food. There is no organ of the human body which is not variously affected by the operations of the stomach: it is also the recipient of most of the remedies which are employed as a relief in disease. Various fluids are rendered subservient to the process of digestion, viz. the saliva, which is secreted by glands situated in the mouth—the gastric fluid, secreted by glands situated in the stomach—the fluids secreted by glands in the small intestines—the bile secreted by the liver, and received into the gall-bladder, before it reaches the first bowel— the pancreatic fluid, which is formed by a gland called the pancreas : there are also other subservient fluids essential to this process. The peculiar qualities of these various secreted fluids have exercised the imaginations of many physiologists, and employed the thoughts and ingenuity of many philosophical chemists to analyze; but with no very satisfactory result. The Almighty Being has beautifully adapted them to the purpose of human digestion; and, in the healthy state, they are certain to answer the end. When we contemplate the mode of life pursued by 5* 54 THE MANUAL FOR INVALIDS. human beings, we immediately perceive that all their sustenance must be derived from either the animal or vegetable kingdoms; and all the animals which are fed and supported by men, to be destroyed for food, are themselves sustained by the vegetable kingdom: vege- tables are nourished by water and air. Thus, if we look through nature, there appears to be a regular con- catenation of causes in the production of the food for the use of man : thus vegetables assimilate water and air, and are themselves animalized by some animals, who, in their turn, become food for others. The mine- ral kingdom does not afford us any proof of a nutrient principle ; but we possess no facts to disprove the as- sumption. The human stomach receives nourishment from vegetable matter, in proportion to the gluten of its farina; but there are many vegetables without fari- na, which are very nourishing by the saccharine secre- tion they possess. The most nourishing part of animal food, by a wise law of nature, appears to be the most easily convertible into chyle. The process of digestion appears to be conducted by the stomach ; by virtue of its vital power, the laws of chemistry, or mechanics, will not explain it. The stom- ach certainly has mechanical power; but it is the vital principle that stimulates its glands to the secretion of the gastric juice, and also which endows it with such power- ful solvent properties. There is no doubt but gastric fluid exists in the stomach of all the class of warm-blood- ed animals ; yet it is of very unequal power in different animals, agreeably to their nature, and the food by which they subsist. It has been asserted, that the gastric fluid of the wolf has the power to render fluid, bones, and even ivory. It is less powerful in man ; his food must be broken down by trituration, or mastication, otherwise THE MANUAL FOR INVALIDS. 55 the function of digestion will be imperfect. It is a re- mark found to be consistent with the nature of things, and confirmed by experience, that animal food is best suited to those who are employed in laborious bodily exertion, and vegetable food most eligible to the exercise of the intellectual faculty. The process of digestion is not completed in the stomach ; for the food must pass through the stomach into the small bowels before perfect digestion take place. I will here observe, that it is not the whole surface of the internal coat of the stomach which secretes the gastric fluid; but those parts which do secrete it are immediately known, by their great vascularity. The stomach has more a solvent property than a digestive; the function of di- gestion is found proceeding in the first bowel, called the duodenum. For a long time it was supposed that di- gestion was obedient to the laws of fermentation; but those laws, however well understood, but little explain the process of digestion. Most of the animal functions are of a peculiar nature, and most certainly cannot, with propriety, be compared to the processes of art; analogy can alone be used with beings in possession of animation and life : attempting to explain the functions of the organs of living bodies upon the laws of mechanics, or reasoning from dead to living matter, is most absurd. The celebrated Doctor Mead has left us a memorable example of this climax of human folly. We find that air is very frequently extricated in digestion ; from this circumstance some have been led to suppose that air was contained in the food, while descending into the stomach; but we know, that, in dyspeptic patients, the symptoms are not caused by food, but by the vitiated state of the digestive organ. Mr. Hunter was induced to think that the body has the power of imbibing or of secreting air: 56 THE MANUAL FOR INVALIDS. we now know that all the membranous cavities do secrete air, which is fluid in an aeriform state; and that fluid is absorbed in cavities, from which it could not otherwise escape. This fact can be illustrated by analogy. Many animals have receptacles for air; this also exists in fish : it is doubtless secreted by the highly vascular surface of membranous cavities. I have said that the stomach is the grand organ of sympathy, and by which sympathetic affection it feels and suffers, when injuries are inflicted upon other organs or parts of the animal economy. This sympathy of the stomach, with various other organs, both in their healthy and diseased state, are many and diversified. After an acute disease,—fever for instance,—the appetite is very ravenous. While the fever is in progression, the patient is unable to eat : but when the disease has run its course, the sense of hunger is very severe. This does not de- pend upon an increased secretion of gastric juice, but is owing to the sympathy of the stomach ; as, during the disease, the stomach was much in arrear to the constitu- tion : the arrears are now to be paid off. So in cases of a disease of the stomach ; for instance, a schirrous of the pylorus, or lower aperture of the stomach, so as to prevent, in some measure, the admission of food into the intestines. The food is regurgitated ; and yet there is a constant desire to take more ; and, as little can pass to nourish the system, the sympathy of the stomach is con- stantly excited to send forward more. Nearly the same effect is produced by a certain stricture of the oesophagus, where there is almost an incapacity to take food. Sym^ pathy maybe defined a sensation, or action, produced in one part, in consequence of an impression being made upon another at some distance from it. The brain is an exten- THE MANUAL FOR INVALIDS. 57 sive organ of sympathy : whenever any impression is made on any part of the body, the mind always sympa- thises. The sympathies of the stomach are very exten- sive, as there are few affections of vital organs which do not draw it into suffering. We may readily perceive the mutual dependence between the stomach and brain, in observing the causes and effects of headach ; for, in severe headaches, sickness of the stomach is usually a concomitant symptom. The stomach frequently sympa- thises with various affections of the mind : thus we see that it is no uncommon circumstance for a person of deli- cate feelings to be affected with sickness on seeing a sur- gical operation for the first time. It sympathises with the general wants of the system, and causes that un- pleasant sensation which is usually termed hunger : some have ascribed this disagreeable sensation to another principle, viz. to the irritation caused by the gastric juice, which, when secreted, and having nothing to act upon, is said to irritate the stomach. However, it is a fact scarcely to be doubted, that hunger is a sensation, not alone existing in the stomach, but also connected with another sympathy. This may be illustrated by an ex- ample :—A lady, from being remarkably corpulent, be- came very much emaciated, even to the extent of being a disagreeable spectacle ; and at this time it was observed, she had a most enormous desire for food. The cause of this was unknown till after death ; when, on examina- tion, it was found that the mesenteric glands were in a state of disease ; so that the food could either not under- go the necessary change, or that the glands were imper- vious from disease, and the nutriment could not be received into the constitution. We have a most striking instance of sympathy between the vascular system and the stomach, by injecting a so* 58 THE MANUAL FOR INVALIDS. lution of emetic tartar into the veins, when the process of vomiting takes place the same as if it had been received into the stomach ; indeed, so universal is the sympathy of the stomach with most of the animal and vital functions, that there is scarce a disturbed function of any organ, but the digestive organ is more or less concerned in it. CHAPTER TI. The Liver considered; its Function explained.—The Secretion of Bile—its great importance to Health. Various and important are most of the secretions connected with the nutrient process; but that of the liver is by far too important to be overlooked in a Ma- nual intended to instruct Invalids in the management of their health. All the secreting glands secrete from the blood a specific fluid, different in all its properties from the blood itself; and they perform a most extensive and important office in the animal economy. Secretions are of more or less importance, in proportion as they have the power to influence healthy functions, or as they superinduce a state of disease: the secretion of bile is of such character; it assists vital organs in the performance of vital actions, the value of which, to the healthy state, can only be truly known, or understood, by considering the mischiefs that ensue from the sus- pension of this fluid, or the accurate knowledge of the diseases of the liver itself, by which the secretion is made. The liver is by far the largest of all the glands of THE MANUAL FOR INVALIDS. 50 the human body, and, in conformity with a principle of nature, it is most plentifully supplied with blood, which it "requires, not only for the purposes of nourishment, and which it possesses in common with all organized parts, but because to all secretory organs an additional quantity is necessary to enable them to perform their secretory functions, as it is from the blood that all the secretions of every description are derived. It has been a long time thought that the same vessel which conveys blood for the nourishment of a gland, is adapted also to the secretory function ; but they are doubtless two distinct functions, and in most cases, in all probabili- ty, conducted by different vessels. The function of the liver will probably elucidate this principle; for the office o( nutrition, and that of secre- tion, in this organ, is distinctly performed by different vessels. Now, it is a very remarkable fact, that there is a striking peculiarity in this organ, as compared with others in the human body. The liver performs its se- cretory function from venous blood ; while all other se- cretions of the animal, with which the physiologist has yet become acquainted, are formed from arterial blood. The vena portarum, which conveys the blood to the liver, from which the bile is produced, has travelled through the whole abdominal viscera; it is, therefore, on its return from having nourished the whole of these viscera, that it is adapted to the secretion of bile. It has been said, that all organs that secrete fluids, subser- vient to the animal economy, require an extraordinary supply of blood, because a double purpose is to be ob- tained, viz. the nourishment of the organ, and the office of secretion. Now, we know that the brain is an or- gan which, in relation to its bulk, receives a larger sup- ply of blood than i any other part of the body; yet its 60 THE MANUAL FOR INVALIDS- function as a secretory organ is not evident: it does, therefore, appear that organs, though not secretory, re- quire a supply of blood in proportion to the functions they perform. A writer of celebrity has asserted, that the exertion of a secreting organ necessarily implies a considerable supply of vital energy, as it consists in changing the blood into a fluid different in all its proper- ties from the blood itself, so that it may assume a new mode of existence. In other glands, arterial blood serves the double purpose of being the pabulum of the secretions, and of supplying the organ with vital energy sufficient to effect its purpose; but in the liver, where the secretion is performed from venous blood, which is unfit for furnishing it with vital energy, there the ne- cessity for a copious quantity of arterial blood seems very evident. There are many opinions among physi- ologists concerning the nature of the communication of the artery of the liver, which is its vessel of nutriment and presumed vital impulse, with that of the vena por- tarum, which is the carrying vein of carbonated blood, and by which the bile is secreted. That most important secretion, whose influence upon health is so great, deserves much attention, and a ques- tion most worthy of enquiry arises at the onset, viz. how far the secretion of the bile is connected with any peculiar arrangement or structure of these parts, or in what manner the secreting vessel communicates with the beginnings of the excretory duct, whether by a cylindrical continuation of canals, or by the interposi- tion of a cell, or follicle ? This circumstance may serve to humble the arrogance of pretension, for men of great professional attainments have materially differed from each other upon this subject. It is not, perhaps, of so much practical importance to our purpose, as the influ- THE MANUAL FOR INVALIDS. 61 ence which the secretion itself has upon the knowledge of disease, and its power of affecting health. In thus asserting our inability to determine the precise structure and mechanism of the parts which form the immediate seat of secretion, we have matter of regret, as it has caused such conflicting opinions among medical philoso- phers, as in some measure to have occasioned coldness, or loss of friendship. But to proceed. The circulation of the blood is much slower through the ultimate branches of the vena portarum than it is in any other gland. This slowness of the circulation probably gives an opportunity for the bile to be more perfectly secreted, and also prevents that purging which might arise from too quick a secre- tion of bile. Hence, in autumnal diseases, when the secretion of bile is much increased, and when it is con- stantly running down through the intestines, we find di- arrhoea is almost always a necessary consequence. Na- ture has furnished a reservoir for the reception of bile in some quantity, which is called the gall-bladder: we find, therefore, when the stomach is full, and when, in consequence, there is a necessity for bile to carry on the digestive process, the stomach presses upon the gall- bladder, and forces out the bile into the cystic duct, from whence it passes through the common duct into the intestine. But it may be said, why should we re- fer this contraction of the gall-bladder to external pres- sure ? We see the urinary bladder possesses a muscu- lar power of contraction in itself, and, from analogy, may we not also conclude that the gall-bladder also pos- sesses muscularity ? Anatomy will not enable us to solve this proposition, as no muscular fibres have been discovered in this sac, nor does it appear to be suscep- tible of contraction upon the application either of me- 6 62 THE M\NUAL FOR INVALIDS. chanical or chemical stimuli. But it may be asked, how, .then, is it that the gall-bladder can accommodate itself to its contents? That it does adapt itself to its con- tents, is very certain; but it does not greatly concern us to pursue this enquiry, as it is not much suited to our object. When bile is obstructed in its regular pas- sage to the first bowel, it becomes absorbed into the mass of blood, and so, by being circulated through every part of the body, it gives a yellowness to the skin, and produces jaundice. The cause of jaundice is usually referred to an ob- struction, in some part or other, of the biliary ducts. But there are cases which induce us to believe that jaundice may, and does exist, although the biliary ca- nals are pervious and free. The yellow fever of the West Indies furnishes matter of proof. The character of this awful malady is a diffusion of bile through the whole mass of blood, producing jaundice; while there is such an excessive quantity of it in the alimentary canal, that it is constantly being discharged by vomiting and purging. Now, in such cases, jaundice is most clearly referable to a redundant secretion. The opinions upon this subject of Boerhaave and of Morgagni, both great men in their day, are so opposed to truth and demon- stration, that it would be idle to detail them : they were founded upon the false principle, that all the secreted fluids pre-existed in the blood, and that the office of the glands went merely to the mechanical separation of those fluids. It is now universally known that the blood is the pabulum, or source, of all the secretions, and that the glands through which it circulates effect a change in its properties, each according to its peculiar mode of action; so that the secretions may be consid- ered as new fluids created by their respective glands. THE MANUAL FOR INVALIDS. 63 There is no such fluid as bile pre-existing in the blood vessels: it is the specific action of the liver that secretes bile. The liver is most powerfully influential in the constitution, in order to the preservation of health; and it performs functions whose necessities are by no means well understood. The paramount impor- tance of this viscus in the animal economy may be in- ferred from its early developement in the foetus, and from its universal existence in every animal possessed of a heart: and it is well known that insects, though de- void of other glands, secrete, from the internal surface of certain membranous bags, a yellow fluid apparently similar to bile. It often happens that bile is secreted in too small a quantity, as in hypochondriacal com- plaints, and in chlorosis ; in which diseases an unusual degree of torpor takes place, expressed, in the one case by dejection and despair, in the other by inactivity and languor. In these cases the stools are generally of a light clay colour, and the body is very costive. Bile, therefore, is a stimulus of a peculiar kind, by which tone and energy are communicated from the in- testines to the whole body. The defect of bile is more productive of disease on the first passage than the ex- cess. In the latter case, if it be healthy in its nature, it only proves purgative ; but if it be in a diseased state, it assumes peculiar powers. The ancients, and more particularly the Greeks, had peculiar terms for diseased bile, such as atrabilious, or melancholy ; and in this state, when absorbed into the system, they con- ceived it to produce most alarming symptoms, both in the assimilating and mental functions. The inhabitants of eastern and southern climates are much afflicted with diseases caused by the superabundant secretion of bile. Independent of its acrimonious or morbid properties, it 64 THE MANUAL FOR INVALIDS. produces a distressing languor of all the muscular and nervous powers, excessive nausea and vomiting, and, directing its course into the intestines, produces a se- vere and painful diarrhoea. These symptoms appear to arise simply from the effect of heat upon a sound con- stitution, not caused by any intemperance ; nor can they always be prevented by the most careful attention to diet, nor by avoiding such irregularities as usually predispose to that disease. It is presumed that in warm climates the bile is more pungent, better, and more con- centrated in its properties, than in colder regions : it is both more active as an emetic and purgative; and therefore, although the heat did not produce a larger secretion, it would, nevertheless, be more severe in its effects. I must here observe, that in what is commonly called sick headach, which generally arises from bile in the stomach, half a pint of warm water, taken at bed-time, has a good effect; for it must be remembered, that in all cases where bile is secreted in too large a quantity, the use of emetics is wrong : they increase the irrita- ble condition of the hepatic system, and direct the bile from its natural course—for in almost all cases where vomits are given, bile, during their action, is forced from the first bowel into the stomach, which would cer- tainly have been carried off by the bowels. The sense of nausea, and the action of vomiting, increase the se- cretion of bile ; and we always find that bile is a pur- gative sufficiently stimulating for its own evacuation, and pften requires nothing but warm water to facilitate its escape. It is a very curious circumstance, that mercu^ rial action, in affections of the liver, seem to act as a specific : for in disturbed function, when the secretion is often vicious and abundant, it is the best remedy, ju- THE MANUAL FOR INVALIDS. 65 diciously administered, to procure a healthy action, which moderates the secretion ; and in diseased struc- ture of the organ, where the secretion is often either suspended or destroyed, it is the only remedy upon which we can with confidence rely. We often find the unfortunate and unhappy troubled with an affection of this organ. Whether grief, and anxiety of mind, act immediately upon the liver, or produce its effects by first weakening the powers of the stomach, I am not able to determine ; but it is open to the observation of every one who feels an interest in the enquiry, that there exists a most wonderful sympathy between the brain and the liver, and that in maniacal cases we gene- rally find a great failure in the secretion of bile, even when we cannot detect any disease of the organ; unless, indeed, a partial paralysis of all the powers of secretion may, with propriety, be so named. To sum up, then, the process of digestion, let us say that the food having been received into the stomach there meets with the saliva of the mouth and the secre- tion of the stomach, which form it into a mass called chyme : this chyme passes into the next intestine, cal- led the duodenum, where it meets with the bile and pancreatic juice : it is by these juices changed into chyle, and in that form is absorbed into a long vessel called the thoracic duct, which empties itself into the left jugular vein, where its contents renovate the mass of the blood. The useless portions of the food pass off by the course of the intestinal canal. 6* 66 THE MANUAL FOR INVALIDS. CHAPTER VII. The Healthy Function of the Digestive Organs.—The Chyle, or vital Principle of the Food.—Imperfect Assimilation of Chyle into Blood, the Cause of what is commonly called Breaking-up of the Constitution.—Rules for Prevention recommended, and Remedies proposed. It has been before remarked in this Manual, that certain changes are produced upon food by the function of the stomach, and that when either animal or vegeta- ble matter has received the stamp of life, a train or series of peculiar actions must, of necessity, take place. Notwithstanding those actions are of the very essence of life, they have a tendency to exhaust or wear out the animal machine; and this waste must be made up to the constitution by nutritious animal or vegetable mat- ter. The change which the stomach causes upon sub- stance has been already observed; but this nutrient mat- ter is subject to other changes, and which take place in the intestines, in the process of what is usually called chylification, and also in the blood-vessels, in what is termed sanguification and still further by the extremities of these vessels, by which it is converted into a living solid. Digestion has been already shown to be a pro- cess simply of solution, by which the food is broken down by the stomach, and is thus prepared for the process of chylification. It may probably be asked, where does the function of chylification take place ? It is answered, certainly not in the stomach; for when the body of an animal is opened immediately after he has taken food, no chyle is to be found in that cavity; there will be nothing found there but a mass of digested matter ready to pass into the duodenum, or the first bowel; nor will THE MANUAL FOR INVALIDS. 67 chyle be found even in this bowel,—at least not in the upper portion of it; there is here to be found only a soft, pulpy substance—the digested food, called chyme. As chylification does not take place in the stomach, nor even in the upper portion of the first bowel, it cannot but be very interesting to enquire where this process does begin, and what are the agents which nature em- ploys to effect it. This discussion would be liable to seduce us into a wide field of speculation ; but it is the purpose of the writer of this Manual to shun the delu- sions of theory, and to attach value only to facts. Lord Bacon says, that the knowledge of truth is the sovereign good of human nature. In our present research, we have to deplore that facts will not bear us company through the whole of our journey. In the first place,.we may enquire what is the nature of chyme ? Various opinions are entertained concerning it; the description given is that it is very like paste, of a grayish or sweetish taste, slightly acid, and retaining some of the properties of food. It may be presumed that there are as many species of chyme as there are varieties of food. The solvent, antiseptic, or antiputrescent properties of the gastric se- cretion, we have said, cannot be explained by any of the known laws of chemistry. Various experiments have been made by Spallanzani, Magendi, and others, by intro- ducing tubes, with various descriptions of food, into the stomach, and observing the various effects produced upon each by the action of the secreted fluids to which it has been exposed. All these experiments, however, from many circumstances, must be very imperfect and incon- clusive. In the stomach, without the tube, the food is pressed and agitated ; both the saliva and the gastric fluid are constantly secreted and combined with it, and as soon as the chyme is formed it is carried away. We 68 THE MANUAL FOR INVALIDS. have no facts to demonstrate whether, in the formatioo of chyme, there is any extrication or disengagement of fluids in a gaseous state; and it is very likely that while the vital actions are regularly and healthfully performed, there is no such product; but in imperfect actions or disturbed functions of a morbid nature, the laws of chem- istry may obtain an existence, and gases may be formed similar to what would take place in a given temperature and motion. In the decomposition of analogous substances out of the body, it does not appear, from observation, that there is any chyle at the beginning of the intestines; but if we proceed in our search a few inches farther, we shall find a white substance of a bland, mild taste, ad- hering to their sides—this is the chyle ; the process which forms it, whatever it may be, is a vital action, and very rapid ; for chyle is found to exist in this part very soon after food has been taken. When considering the stomach, it was observed that there was a much greater degree of vascularity distributed over it, than was ne- cessary for its nourishment; and from this abundant vascularity the gastric fluid was formed. In proof of which it was asserted, that the vascularity was chiefly distributed over the inner surface of that organ. The same rule of analogy will here be observed ; for here is a much greater degree of vascularity than is necessary to sustain the intestine: and we find, upon opening this ibowel, there is a mucous secretion which is formed by the force of the circulation being directed to the villous coat, from and by which the raucous is poured forth. The intestines are also prepared with an apparatus of round, circumscribed glands, which secrete a fluid very much resembling the mucous: these glands have received their appellation from their particular disposition, or from the names of the anatomists who have paid particular THE MANUAL FOR INVALIDS. 69 attention to them. But are we to suppose there are no other agents than these to effect the important and vital process of chylification ? We have the pancreatic secre- tion to assist in the producing this effect. The sphincter muscle of the pyloris having relaxed sufficiently to allow the food in solution to pass into the superior portion of the first bowel, it is immediately exposed to a very co- pious secretion of bile, and what is commonly termed pancreatic juice, whose agency in the purpose of chyli- fication is very efficient, but the modus operandi is wholly unknown. The sensible effect visible to the physiologist, is an immediate precipitation of the nutritious portion of the food, or chyle, from the feculent residue. The chyle separates from, but cannot be remixed with, the rest of the mass. It now adheres to the coat of the intestine, and may be easily perceived entering the absorbent vessels, under the aspect of a fluid resembling milk; from which resemblance this class of absorbents have been termed lacteals. It has been observed, that the gastric fluid, in many animals, has intense powers of solution. It has also been observed, that all mucous surfaces, or membranes, are possessed of great vital energy and vascularity; they abound, both with absorb- ent and exhalent vessels, and are amply supplied with nerves, by which the small glandular bodies, termed follicles, are stimulated, and secrete the peculiar fluid agreeably to the structure; and such it was observed was especially the case with the mucous membrane of the stomach. It was also noticed, that the particular portion of the inner surface of this organ that secreted the gastric juice, was known, from the number of vessels there greatly exceeding the purpose of nutrition. But the chyme having reached the intestine, solvent power was here superfluous, and the secretion from the glands 70 THE MANUAL FOR INVALIDS. of the intestinal canal, either do not exert, or perhaps possess, the solvent and coagulate powers exhibited by the gastric fluid. The vital energy, also, of the intes- tines is certainly either less powerful, or less developed, than those of the stomach, having a function of a limited nature, although efficient and peculiar to its purpose, contributing but little, perhaps, to the concoction, as it is called, of the aliment, but greatly to the absorption of the chyle. The agency of the pancreatic juice in the process of chylification is proved from the fact, that in all animals that have been opened, either while living, or after death, no chyle has ever been found above the opening of the pancreatic duct into this intestine. Some physiologists have ascribed a power to the bile in the formation of chyle : the fact of the pancreatic fluid being admitted as an auxiliary, they insist that the bile has the same pretension, on account of the anatomical structure of the biliary duct, which unites with the pancreatic duct, ^nd they both become one duct on entering the duodenum. However plausible these circumstances may be, there are others which might be named, that would more than outweigh them; it is not, therefore, assumed, that bile is a component part of the chyle r the office of the bile is to produce a separation of the nutritious fluid from the excrementitious residue ;—in fact, to separate chyle from chyme. We here clearly perceive the very great importance to the animal econo- my of the bile, independent of its purgative properties, and facilitating the exit of the excrementitious matter; and this is the cause, when the liver is diseased or its functions impaired, of the very great emaciation which constantly ensues. The liver, which is by far the largest of all the glands, would seem to have a very subservient office, if bile were employed only to purge* THE MANUAL FOR INVALIDS. 71 off the faeces ; but when it is demonstrated that an essential property of bile is to separate the nutritious fluid termed chyle, from the solution of the digested mass, termed chyme, its vital importance is immediately established. The pancreatic liquor which enters the chyle, is separated or secreted from the blood by a con- siderable gland called the pancreas, and which receives its .blood-vessels from the splenic artery ; it is extreme- ly vascular, which is very necessary for its secretory purpose ; its vessels are very small, but they are very numerous. The internal structure of this gland very much resembles that of the gland which is situated be- hind the jaw, and which secretes the saliva. The ex- tremities of the blood-vessels terminate in small cells, from which arise several small ducts, and which verge to one common duct, from every part of the gland. This duct, as before observed, empties itself, in company with the biliary duct, into the intestine ; but these two ducts pierce the substance of this intestine by two sepa- rate openings, and unite before they perforate its coat, and open into its cavity by the same orifice. There are,' however, exceptions to this rule in the human spe- cies, and very frequently in animals. In birds, more particularly, there are several pancreatic ducts entering the intestine ; in rabbits the pancreatic and biliary ori- fices are constantly found separate from each other ; and in fishes the structure in this part is very peculiar indeed. It is, in fact, a matter of reasonable doubt whe- ther the substance called pancreas in them answers the same purposes as in the human subject. There is cer- tainly an analogy ; for that substance which Mr. John Hunter called the pancreas, consists of a number of bags or processes, but of its uses we have no data upon which to found any facts' useful to our purpose. 72 THE MANUAL FOR EVVALIDS. It is to be recollected, that the object of enquiry, viz* the process by which a nutrient fluid is absorbed into the blood, is of vital importance to an invalid, as a tolera- ble knowledge of the principles upon which the process depends may greatly facilitate the attainment and the preservation of health. A knowledge of chemical affi- nities will lead us but a little way, for vital functions very much vary the character of chemical agents and re- agents. The various naiwes given to qualities of fluids, as alkalis or acids, with their divisions and subdivisions, may be considered as a copia verborum, or mere sounds. That chylification is not a slow process, has already been said ; but it may not be equally quick in all ani- mals : for instance, in herbivorous animals this process will be much slower than in the carnivorous; for as the formation of chyle is a process of animalization, animal food will be much sooner assimilated than vegetable. The apparatus of chylification in these animals varies ac- cordingly ; for while the herbivorous animal has a great length of tube of intestine, its structure is membranous ; the carnivorous animal's tube of intestine is relatively short, but of a strong muscular structure. In the herbi- vorous creature, owing to the length and little contrac- tile force of the membranous canal, it suffers a slower and gentler action than in the carnivorous creature, where the muscular structure is powerful in contractility. It would be interesting to the curious to be able to subject chyle, after its separation from chyme, by the bile, to analysis; but a sufficient quantity can scarcely be pro- cured for the purpose. A portion was collected from the rupture of the thoracic duct: in that condition it was found to contain mucilage oil and coagulable matter, with a portion of gas. This experimental analysis was made by a very worthy and intelligent physician, Dr. THE MANUAL FOR INVALIDS. 73 David Macbride, than whom none was better qualified. His object went particularly to prove the similarity of chyle with milk; but milk, in addition to the other qua- lities of chyle, contains much saccharine matter, and there are many reasons to conclude them to be perfect- ly distinct fluids. In order to prove this, let us con- sider milk taken into the stomach as food. It is there subject to coagulation, and various other changes, before it becomes chyle. Again—if, by a process of injection, milk be thrown into the blood vessels, instead of nou- rishing the body, which it certainly ought to do, if simi- lar to chyle, it at least harasses and greatly distresses the animal. Some have declared that it has caused death. Chyle is generally white in its colour, but not always so: in birds it is pellucid. Before closing our observations upon the important function of chylification, it will be necessary to mention a structure commonly called the milt, or spleen, which is a viscus of a deep black or red colour in the human species. It is situated in the left side, immediately under the diaphragm, and above the kidney. The figure has little influence on the functions of the viscus. In man it may be said to be a depressed oval, nearly twice as long as it is broad, and almost twice as broad as it is thick; but in brutes it is of an oblong form, and in birds it is globular. The size is also subject to very great variety. I have seen a spleen in a healthy state not weighing more than one ounce, and I have seen another, without the least trace of disease, weighing more than one pound; but in a state of disease it frequently increases in size to the extent of several pounds. It is a curious fact, that the milt, or spleen, changes its colour as life advances. In infancy it is red, in old age it is livid, 7 74 THE MANUAL FOR INVALIDS. blue, or carbonated ; and in the ratio of the age does the colour vary from red to purple, or blue. The peculiar situation of the spleen renders it liable to pressure both from the action of the diaphragm and the distention of the stomach. The spleen is very plentifully supplied with blood vessels, far more numerous than appears to be essential to the nourishment of itself; and when this is the case with structures in other parts of the body, we discover that the superabundant supply of blood is ap- propriated to the function of secretion ; but with respect to this viscus, anatomists have hitherto been unable to find an excretory duct ; nor does it exhibit any irritabi- lity : its very existence is confined to the class of ani- mals called mammalia. Many of the ancients believed the spleen to be a gland, whose office it was to secrete the black bile ; while others believed this office to belong to the liver; but they agreed that the fluid was secreted by one or the other, or by both, and that it laid the foundation of the disposition, temper, and also of the character of the individual, and that its powers were so active, that when it was absorbed it produced madness. The absence of an excretory duct to the spleen, has made it questionable if it be really a gland. That it has been extirpated from animals without much prejudice, and has even been taken out of the human body, when in a state of disease, with safety and recovery to the patient, are facts which would induce us to believe that it is not of primary importance to the animal economy ; yet if we reason from analogy, we must be induced to believe that the spleen is, in some manner which may be inexplicable to us, subservient to the process of sup- plying the blood with chyle, because it is an established principle that very formidable, nay even fatal, diseases, may, and often do, attach to organs subservient to ex- THE MANUAL FOR INVALIDS. 75 crementitious purposes, without the creation of hectic fever, or the least emaciation; for instance, large stones have been repeatedly found in the bladder, and exten- sive ulcerations from stones in the kidneys, without the production of hectic fever, or without their having in the least diminished the bulk of the body, or having shown any symptom, during life, by which their exist- ence could even be known, or even suspected. Nor are we to imagine that pain simply acting on the nervous system, unless accompanied by vascular excite- ment, will have much power in reducing the bulk of the body ; but the spleen will not be subject to disease any length of time without subjecting the system to the most severe emaciation, attended with hectic and violent vas- cular action. This fact is conclusive that the whole constitution is roused by sympathy into consent with the affections of this viscus, and that its diseased state is inconsistent with the safety of the individual. A proneness in the system to reduce the bulk, as the dis- ease should happen to be situated in particular parts, is in itself both a very curious and remarkable circumstance, which, by introducing either high vascular excitement, or diminished powers of chylification, produces that melting away, that dissolution of all the animal and vi- tal powers, with extreme emaciation, that has been not inaptly called valetudo conquassata, or breaking up of the constitution. The symptoms of this malady are the following: great inability to exertion, a general prostration of all the animal powers; the vital actions are performed with diminished energy; a paleness or sallowness of the face ; a particular exhibition of features called the facies hippocraticae; occasionally a bloated face, with thirst and shortness of breath; palpitation of the heart; 76 * THE MANUAL FOR INVALIDS. troublesome flatulence; in some instances loathing of food ; sympathy of the stomach ; very great secretion from the kidneys, and most harassing diarrhoea ; swell- ing of the legs ; spasms in various parts of the body ; fever, trembling, and numbness of the extremities suc- ceed as the disease advances; great languor, drowsiness rather than sleep, with utter oblivion of common inci- dents ; disturbed perceptions of the mind ; watchfulness, and muttering delirium ;—these are the most remarkable of the symptoms. The causes which produce them ap- pear to arise from the following diseases, chiefly of gland- ular structure, and uniformly of those glands which are contributing a fluid essential to the nourishment or sup- port of the constitution. A comparison of the ravage of disease upon peculiar structures, will illustrate the facts of the proposition. First make a comparison of the diseased state of the mesenteric glands, and a dis- eased or a scrofulous affection of the breast in the dis- ease of the mesenteric glands : there is very great ema- ciation in the scrofulous breast, none at all in an ulcera- tion of the small intestines. Where the process of chy- lification is affected, great emaciation takes place ; in a schirrus, or even cancer of the rectum, none. In a dis- ease even of tbe gall bladder, which is subservient to chylification, the bulk of the body is rapidly sunk; but in a disease of the urinary bladder, which is subservient to the excretory office of the kidneys, little, if any, diminution'of bulk can be perceived. Also, in an ab- scess of the liver, the body becomes much emaciated, but in an abscess of the kidneys the bulk is not dimi- nished. These circumstances will much illustrate the nature of what is very properly called a break-up of the con- stitution ; for if we minutely examine into the functions THE MANUAL FOR INVALIDS. 77 of those organs, the diseases of which either do or do not occasion emaciation, we may most probably be able to ascertain the true causes of the differences of the symptoms; as also their effect on the bulk of the body. It will be necessary, in order to understand more clearly how the functions of those parts bear relation to each other, to bear in mind that all the glands of the body have specific functions ; some secrete a fluid from the blood, for the use of the system; while others secrete a fluid to be discharged from it. The first may be cal- led glands of chylification; the other glands of exuvia, or waste. It has already been more than once observed, that the small intestines abound with a multitude of absorbents, and, from their high vascularity, are known to be secreting surfaces, furnish a fluid for the support of the system, and are to be considered as performing the office of glands of supply. The structure of the large intestines corresponds with their function, inasmuch as they are furnished very nig- gardly with absorbents, but abundantly with a set of glands, which secrete a fluid, or perhaps, mpre properly, excrete, or withdraw from the system a mucous which lubricates the canal for the passage of the faeces, and which itself, together with those faeces, are destined to be discharged from the system as exuvia, or waste. It has long been known that those parts which secrete a fluid to be employed to the support of the system, as well as the glands of immediate supply, may be consi- dered the liver, the pancreas, the mesenteric glands, the glands of the stomach and small intestines, and, most probably, the spleen ; on the contrary, the parts of waste are the kidneys, breasts, exhalent arteries, perhaps the uterus, and certainly the large intestines. We may, therefore, with certainty, be convinced that what is cal- 78 THE MANUAL FOR INVALIDS. led the break-up of the constitution, is some affection of the organs of supply—some of the parts subservient to chylification. The best mode of prevention is scrupu- lously to avoid all excess, as the principal productive cause; to endeavour to restore the ebbing energies by light and nourishing food, carefully avoiding all stimulants, and by using exercise in the open air, in proportion to the strength. The curative process is more difficult, as it is most commonly a diseased structure in some of the or- gans. Perhaps a slow process of mercurial action intro- duced into the habit, by friction upon the skin, is the most likely remedy to give efficient relief. But this must not be done without the special superintendence of a physician. CHAPTER VIII. The Process of Respiration considered.— Qualities of the Air breathed.— Wholesome and Unwholesome Atmospheres.—The Ef- fects of different Gases considered upon the Health of Invalids, in their various chemical Combinations. The process of respiration in the human species, and indeed in all the classes of animals containing warm blood, is a process immediately essential and necessary to life : it cannot even be suspended many minutes Without producing a cessation of all the vital functions. Peath is the result. This function takes place in man, and other analogous creatures, almost instantly after the infant is taken from the uterus of the mother, and ex- posed to the action of the atmospheric air. The circu- lation of the blood, and the continuation of life, is ever after dependent upon this process. THE MANUAL FOR INVALIDS. 79 The lungs are a hollow, cellular, or spungy mass, ca- pable of containing air, and amazingly dilatable by it. In an infant who has breathed for some time, the whole blood of the vena-cava passes into the right ventricle of the heart, and thence into the vessels of the lungs, where it undergoes a process from the contact of air, at present not fully known, but which has given birth to numberless theories. Inspiration and expiration, which double operation is called respiration, is variously modi- fied by the will, and by certain emotions and passions. They are also often excited by imitations; and they are very much affected by the desire to remove pain and uneasiness, which operate more frequently on re- spiration than upon any other function of the animal economy. In the common condition of most invalids, the fact of respiring air perfectly congenial with health is of the greatest importance. There is a peculiarity in the nature of different people which will render abstract rules very uncertain ; but generally the air of large cities is very unfit for healthful purposes. There is another very common error—that air cannot be too pure. For the purposes of preserving or attaining health, a proper combination of aeriform fluids is what constitutes that state of the atmosphere which fits the air to be inhaled into such a delicate and important structure as the lungs; perfectly pure air would be very unfit for the purpose : for instance, air very highly oxygenated, which is an approach to what is called pu- rity, would be very improper to a patient labouring under a disease commonly called spitting of blood, and has been uniformly found to accelerate the death of the patient. It is certain that living in large cities is found greatly to shorten the average duration of human life ; not only is its duration diminished, but its healthful 80 THE MANUAL FOR INVALIDS. state is much deteriorated. In Constantinople, Grand Cairo, Vienna, Berlin, London, and Paris, it is invaria- bly found, that not only the healthful state, but the average duration of human life, from what it is in the surrounding parts of the country, is greatly reduced, and that the invariable effect is justly attributed to the cause specified. We find, by unerring experience, that the effect is produced nearly in the ratio of their density, and in the attention which they pay respecting the re- moval of the foetid exuvia arising from decomposed ani- mal matter, even the effluvia, which is, in other words, gaseous fluids, escaping in an aeriform state, are ex- tremely prejudicial to health. It has been asserted that, of all animals, man is least qualified to herd toge- ther in multitudes ; for the breath of man may be said to be very hurtful to his fellow creature. This is not simply a metaphor, but practical experience demon- strates its truth. The moisture and thickness, as it is commonly called, of the air, is one cause ; but the ani- malization which it acquires by so many people being crowded together, is a far greater. Experiment has demonstrated that the same air cannot enter the lungs more than four times without acquiring properties hostile to human existence. Reflect but for a moment on the nature of that atmosphere where it is next to im- possible for an inhabitant to inspire a mouthful of air that has not been for some time already in the lungs of another party. Let those who are able, and have plenty of means, avoid living in great cities, which may be called the sepulchres of the human species; and not only in a physical, but even in a moral, point of view, it is next to impossibility that an invalid can receive benefit, when he is respiring a product of air arising from the chemical combination of a variety of aeriform THE MANUAL FOR INVALIDS. 8T fluids, which produce a new compound to the circula- tion through the air-cells of the lung3. When those aeriform fluids become incorporated with the blood they not only become a part of the pabulum by which all the organs of the body are nourished, and the nervous power supported, but also furnish the material from which all the secretions are produced, and the secretory surfaces and organ sustained. The natural inference from these premises is, that they must give a decided character, not only to all the corporeal energies, but a tone and influence to all the sentient extremities of the nerves, affecting all the perceptions of the body, and modifying the process of thinking: the whole man must be changed by the source of all health, cheerfulness and hilarity being thus polluted at its source. The mddus operandi of respiration has been variously explained. Some have supposed respiration to depend upon the action of the moving powers in other parts of the body; for instance, from the pulsations of the pulmonary arte- ries ; but it is sufficient to observe, that the actions of the lungs, and the pulsations of the arteries, are by no means alike. Others have asserted that respiration de- pended upon the muscular power of the lungs, by which they contracted, after permitting distention to a certain degree; but no muscular fibres will be found in the lungs ; their structure are cellular. These viscera are, therefore, to be considered as mere reservoirs of air, which become distended from the chest enlarging, and leaving a vacuum between it and the pleura, in conse- quence of which the external air rushes through the trachea, distends the air cells of the lungs, and thus fills up the before.mentioned vacuum, between it and the pleura. It is very evident, that in each inspiration the abdomen is protruded a little forward. Jf we place our 82 THE MANUAL FOR INVALIDS. hands upon the abdomen, and so prevent the descent of the diaphragm, we shall find that other muscles will be called into action to elongate the chest. The same thing happens very commonly in persons afflicted with asthma and difficult breathing ; so that when a man is remarkably short of breath, it is very natural for him to press his hands upon some solid body, so as to fix the scapula, and give the muscles arising from them a fixed point to act from. I once knew a gentleman who was greatly afflicted with asthma, and I could easily dis- cover, even when walking behind him, whether his asthma was either'better or worse at that time; and this merely by the motion of his shoulders. Respira- tion is a function partly under the control of the will, and partly not : thus a man may breathe either quicker or slower, according to his wish ; but if he endeavour to suspend respiration, he will find that, after a certain time, an unpleasant sensation will arise in the chest, which will oblige him to use efforts to inhale air. As breathing is equally well carried on during sleep as when we are awake, it would seem that, although our will has a power over the organs of respiration, yet still that process goes on much better without its directions; for if any person should attempt to direct every motion of his lungs, he will very shortly find himself fatigued; but if he allow those motions to proceed without any effort of the will, no fatigue will ensue. The final end of this structure of the lungs we shall consider as we proceed. Jubertus, an ancient author, considers with great accuracy the highly important character of all the aeiitoim fluids that get united with the pabulum of life through the air-cells ; and Paulus says, that if air be im- pure and foggy, it dejects the spirits, destroys hope and courage, and causes sometimes mortal diseases, by a di- THE MANUAL FOR INVALIDS. 83 rect affection of the heart. Thus ancient authors observ- ed the fact, although they could not perhaps physiologi- cally discover the cause. More modern physicians, and among the rest the late Dr. George Fordyce, whose en- larged intellect very much reflected upon the subject in question, had many and long conversations with me. The doctor was greatly disposed to believe, that all the various attacks of what is commonly called fever—from the most malignant form, viz. plague, whose simple attack in many cases is fatal, without giving the heart an opportunity of reaction, to the simple continued fever, and where the powers of the constitution overcome the disease—may be attributed, in various degrees, to nox- ious principles being introduced into the blood through the lungs, and by those means destroying the functions of the brain and heart ; and if such minute particles of fluids, which escape the sight, are capable, by acting as a direct poison, of destroying us instantly, can we wonder that all the intermediate degrees of noxious par- ticles, of less direct power to kill, may have sufficient scope to disturb all the healthful functions, and give a delusive perception to the senses, and a melancholy tinge to all our thoughts and ideas, so that life itself may be comparatively of but little value ? Lemnius, an author by no means to be overlooked upon this most important subject, says, Qualis aer talis spiritus, el cujus modi spirilus humoris. Hippocrates, in one of his aphorisms, and, indeed, throughout the whole of his works, indispensably insists on the purity and healthful nature of that elastic fluid, which must soon become a component part of the living principle, if it enter the air-cells of the lungs, and must influence all our thoughts and actions. The air itself undergoes both a chemical and a physical change in its passage 84 THE MANUAL FOR INVALIDS. theough the lungs. Its temperature is nearly the same a3 that of the human body; but there escapes from the lungs a great quantity of animal fluid in the state of va- pour, at every expiration: this has been called by some, pulmonary transpiration. Whatever name you may give it, it possesses chemical properties very different from that of the inspired air. The proportion of azote is much the same; but that of oxygen and carbonic acid gas is very different. Whilst the air, in its passage through the lungs, becomes thus modified in its physical and chemical properties, the venous blood traverses the ramifications of the pulmonary artery, of which the tis- sue of the lobes of the lungs are partly formed. It then passes into the minute branches of the pulmonary veins, and very soon into the veins themselves; but in passing from the one to the other it changes its nature— from venous to arterial blood, by absorbing oxygen from the air breathed. The function of respiration has a final purpose, which appears to be twofold, viz. to communi- cate a vital principle, called oxygenation, to the blood, and also to develope animal heat. Slow were the pro- gression of facts upon this part of the animal economy. During the existence of what has been commonly called the mechanical philosophy, it was thought that air merely distended the lungs to give facility to the pas- sage of the blood through the vessels; but it began to be considered that something more was necessary, than merely for the blood to have a facility to move through the lungs, and that some effect was produced upon the air itself upon the blood. As it was now assumed that some change was produced upon the blood by the air, it was also thought that this would throw some new light upon the functions of the lungs themselves, and upon the nature and use of respiration. It therefore Tfl£ MANUAL FOR INVALIDS. $5 became a matter of serious investigation among philoso- phers and physiologists; and various experiments Were instituted to elucidate the subject. Among others, an animal was procured and placed under the glass receiver, and after a time it was found dead: the explanation of this fact was found to vary with the philosophy of the times. When this experiment was first made, the chemical qualities of the air were then in a great mea- sure unknown: therefore all the effects of air in respi- ration were attributed to its mechanical properties, which forced it into the lungs, and obliged them to ex- pand. It was, however, soon known, that air once re- spired became impure; and an endeavour was made to account for the impurity of air respired, that there was something absorbed from the air. This opinion, when first brought forward, was supported by many very re- spectable and intelligent people; but they conceived this something to exist in an aeriform state in the blood- vessels. This, however, was completely disproved by an experiment upon an animal, the particulars of Which we decline to name in this place. At or about this time, physiologists discovered that air, thus rendered impure by respiration, would extin- guish a candle ; and, on the contrary, where combustion had been long carried on in a certain quantity of air, that air became unfit also for the purposes of respiration : therefore they concluded that they were similar proces- ses, and capable of being mutually explained by each other. Various speculations were brought forward upon this subject. As the air was rendered worse, and as a candle was extinguished by it when respired, it was sup- posed that a quantity of fuliginous matter was evolved during expiration. This was called phlogiston ; and as 8 86 THE MANUAL FOR INVALIDS. it was found to exist in all combustible bodies, Stahl thought that the blood contained this in different propor- tions. And some experiments made by Doctor Joseph Priestley seems to corroborate this opinion ; for after hav- ing included a portion of atmospherical air in a receiver, he exposed it to a quantity of venous blood: after some time it was found that the blood had changed its colour, and on examining the air it was found to be phlogisti- cated. To air already phlogisticated venous blood was exposed, and in this no change of colour was found to ensue; but when placing a vessel containing arterial blood, where the air was phlogisticated, then the blood became darker, and the air was ameliorated. But be- fore we enter into a further investigation of this most important subject, it is proper that we should explain the nature and properties of the atmospherical air. This consists of three parts : the larger part is the dephlogis- cated air of Stahl; or, as it has been called from its fa- tal effects on animal life, azote ; or, from its being found the basis of nitros acid, nitrogen. This, though the most abundant, is not by any means to be considered the most useful; on the contrary, it acts altogether as a diluent upon the more useful part of the air. The air next in quantity is the dephlogisticated air of the elder philosophers; now called pure or vital air, from chiefly contributing to the support of animal life ; or by chemists it has been called oxygen, as being the basis of all acids. Besides these two airs, there is a small quantity of fixed air, or what has been commonly called mephitic gas, or aerial acid, but which is now generally known by the term of carbonic acid gas; and it obtains this name, as being obtained chiefly from charcoal. The proportion of these airs, or gases, are of course very various, and con- stitutes what is commonly thought to consist of whole- THE MANUAL FOR INVALIDS. 87 some or unwholesome air; but modern chemistry has af- forded the means of informing us, that there are a great variety of gases distinct in their character, and certain in their effects. The researches of a modern chemist all tend to give valuable information of this kind ; and there can be little doubt but almost all the anomalous and painful feelings of a sudden character, and which cannot be referred to any particular source, have their origin in this cause. The proportions of factitious airs must have a reference to different situations : as the air of the country will be more pure than that of a crowded city, the air of a charnel-house is of course less pure than the external air. Various methods are adopted for the pur- pose of analyzing of air ; and some are very accurate as well as curious. A certain quantity of oxygen is neces- sary in order for the process of combustion to go on ; as we may prove by exposing a candle in an inverted jar with a certain proportion of atmospheric air: in which situation the candle will in time be extinguished, and the gas will be found deleterious to animal life. This may probably be accounted for from the absorption of pure air. But how shall we account for the increase of fixed air ? It is probable that this carbonic acid gas is similar to the fuliginous matter, or to the phlogiston of Stahl; but these philosophers considered this as an ele- ment that was evolved in circulation. But modern chemists, who have carried their own views of this mat- ter to a much greater extent, are inclined to believe fixed air not to be an element, but a compound of a sub- stance which they call the carbonaceous and oxygenous principle. Hence, then, it seems, that the fuliginous matter, or phlogiston, may be this carbonaceous princi- ple. They also conceive that oxygen or pure air is it- self a compound of the oxygenous principle and of calo- 88, THE MANUAL FOR INVALIDS. ric, or the matter of heat. Fordyce has been consi- dered a chemist of the old school : he declared that he had no doubt of the fact, that an almost infinite variety of mephites does exist: no doubt various in their com- pounds, but equally destructive to life. Usage has adopt- ed the term mephitic for any thing that has a disagree- able smell. The carbonic acid has been called the me- phitic acid ; nitrogen has been called the mephitic air; but the true derivation of this term, from which it ought never to have been diverted, is mephuhith. It is either Syriac or Arabic, and literally means a blast; and the name is well applied to the thing. What existed in the mind of Fordyce has been demonstrated by modem chemists ; but sufficient credit has not been given to the master-mind that pointed out the truth ; nor is cre- dit given, even yet, for its wonderful effects, and which will be further elucidated in the following chapter. CHAPTER IX. The Animal Economy variously affected, both in Health and Disease^ by aeriform Fluids introduced into the Blvod through the Air*cellfr of the Lungs.—Their extensive Power over the whole Nervous Sys- tem in the Valetudinarian Slate.—The Atmospheric Air the Source of Animal Heat, and auxiliary to Muscular Poiver. When a party in perfect health, without any warning* or notice, uno ictu, like the electric fluid, is deprived of life, it is very commonly supposed that a spasm of the stomach, or an apoplexy in the head is the proximate cause of death. In Egypt, in Turkey, and in some of the islands in the Levant, they attribute these awful visitations to their natural causes. Ignorant of tha THE MANUAL FOR INVALIDS. 89 structure of the human frame, ignorant of chemistry, they assume no pretensions to abstract causes, but form their opinions simply from the effect. He or she hath died of the blast, is a very common exclamation. Whole caravans of pilgrims, in journeying over the Desert, have been suddenly overtaken, and have as suddenly perished. When an attack of plague is sufficiently power- ful to paralyze the nervous system and the heart's ac- tion, the mode of death is the same, or nearly so. There is such an utter extinction of all the powers of life, that the brain and heart, those vital organs, are unable to make any resistance. Nature forms those chemical gases in her elaboratory ; no doubt they exist in a very great variety of characters or bases; but as they are, in their concentrated form, productive of death, we are greatly concerned in their analysis, so that we may be enabled to avoid them, even in their diffusive state. The coal miners have more correct ideas frequently upon this subject, than those who are denominated the wise and the prudent. They frequently lose their fellow-work- men, and they not uncommonly fall victims, one after another, in the endeavour to recover the dead bodies of those who have perished. 7"he determination of trying to save a comrade, if possible, induces them to risk, notwithstanding all their experience, a similar fate. In their phraseology they call it the " choke damp," and a proper popular name it is to designate the thin°\ It is very probable that the base of this poison is a highly concentrated carbonic acid gas. We also find that air that has been frequently expired, is also very noxious; yet how the deleterious effects are produced, we are not very certain. Experiment is said to convince us. that the loss of pure air is about thirty parts to one. Now, if this be the case, more than a fifth part becomes 8* 90 THE MANUAL FOR INVALIDS. fixed air, which is deleterious >and mephitic. A> question would, arise—are the deadly effects of fixed air to be imputed to its preventing the accession of pure air, or entirely to some poisonous principle inherent in itself? The latter seems the most probable from experiment, for an animal will live longer in air deprived of its oxygen, than in air containing much of the carbonaceous princi- ple. We find the amphibia, as frogs,newts, turtles, snakes, &c, will continue to exist a very long time in air de- prived of its oxygen. An experiment has been tried— how long a frog would live exposed to fixed air. From a mixture of chalk and vitriolic acid, from which a stream of fixed air was extricated, and to which the frog was exposed, the animal died in about five or six minutes. Hence, it appears evident that fixed air has an inherent noxious property, and whose action is particularly confin- ed to the lungs, as fixed air can be thrown into the stomach without any bad effect, and as is often done under the form of mephitic alkaline water in disorders of the kidneys. Hence, it would appear that something noxious is separated from the blood, which, when it be- comes abundant, destroys life. It is also certain that this something is less slowly separated in some animals than in others, and in consequence of which their life is protracted. This is not matter of opinion, but is a law of nature, and may be demonstrated by an inspec- tion of the structure of the lungs of amphibious animals, as well as by the writings of Blumenbach and others. The air-cells of these animals' lungs are constructed much larger than in other animals; they can therefore exist much longer in certain portions of air, because there is less contact of surface between the air and the blood, than there is where the air-cells are smaller. And, here I cannot but observe, how ill-rewarded fre- THE MANUAL FOR INVALIDS 91 quently are those enthusiasts who have literally sacrificed' themselves to the pursuits of" science. The great and almost-forgotten John Mayow neglected- no means, either pecuniary or otherwise, to obtain a knowledge of pneumatic chemistry, by which he very materially illustrated animal physiology and human pathology. He possessed a knowledge, the value and bearings of which his contemporaries had not amplitude of mind sufficient to appreciate. He acquired a more accurate knowledge of respiration and of its effects,, than any man of his time. There is much vague and desultory matter in his writings, but this does not de- tract either from their importance or value. His trea- tise on Respiration, that on the Rickets, that also on the Respiration of the Foetus in Utero et Ovo, and on Muscular Motion and Animal Spirits, discover a research far above the level of his time. Yet what was the re~ suit? He was suffered to perish, unappreciated and unmourned, at the early age of thirty-four; nor was his equal produced in this country till full a century af- ter his decease. It would thus appear that the happi- ness and well being of individuals are sacrificed to the interest of the species, diminishing the value of life in the abstract^ to increase its value in the aggregate; but such things have ever been, which induced Bishop Hall to exclaim, " Were I a leech, the liberal man should live, but 1 would have the carl to die." The observa- tions made upon the nature and properties of the at> mospheric air, will convince any person that not only our invalid has, to a certain extent, a command over the physical agents that influence his health, but his longevi- ty also may be promoted by a serious attention to»the subject; for what is life but a peculiar chemico-animal operation—a phenomenon produced by a concurrence 98 THE MANUAL FOR INVALIDS. of the united powers of natural causes, with matter in continual action and perpetual change? It is not left to chance; there is no contingency but has certain in- variable and defined laws for its government. Thus ignorance abridges life, and knowledge extends its du- ration. By attending to just principles regarding its es- sence and its wants, and by attending to observations made from experience, the circumstances under which this process may be hastened and shortened, or retarded and prolonged, can be discovered. Upon this are found- ed those regulations which instruct the invalid in the best medical mode of treatment in the various and anomalous symptoms by which he is afflicted. The rules for the attainment and preservation of health in- clude also the science, or the knowledge of the means of extending life to the longest period allowed to mor- tals. The art of medicine, in promoting health, must have a relation to the peculiar state of the patient, and the disposition of that particular habit. But the sci- ence of extending life is regulated by general principles, and it has been found occasionally that the existence of certain complaints does not diminish the duration of the life of the individual. Who has not often heard of that wise remark, by the vulgar—"I do not hold with doc- tors, for we must all die when our time comes." It is very true our days are numbered, and so is the mea- sure meted out to us of the proportion of wisdom and of folly; and by which standard it will ever be found that the number of our days will be increased on the one part, and as surely diminished on the other. Health and long life will be the reward of those who will be at the pains to obtain the knowledge of the causes upon which both depend. The theologist, indeed, who no doubt wishes to enjoy the good things of this world THE MANUAL FOR INVALIDS. 93 without losing his reversion in the next, and to whom godliness is at present great gain, may sneer at this at- tempt to procure health or long life, and ask if the quantity of health, and the duration of life, are not al- ready determined by infinite wisdom to every humart being? He may also add, "Can you, by thinking, add one cubit to your stature? Why every hair of your head is numbered." All this is very true; but to every effect there must be an adequate cause. Nature, in her progress, disregards theological dogmas, but invariably follows her own laws. Those laws which regulate health and disease, the laws of life and death, are defi- nite, and may be known to those who, per fas et nefasy are determined upon enquiry and research. Hitherto it has been held, that premature or very early death among the human species, is a law of nature. Undoubt- edly myriads of human beings have been cut off under two years of age, thus opening their eyes in life to close them in death—they have been destroyed upon the very threshold of existence. There are diseases which are peculiar to the infantile state,, a great variety of which are of a very inflammatory character, and of course liable to be fatal, But are we to be told that our advances in the knowledge and treatment of disease does not afford us any power over the early mortality of our race ? The thing will not bear diseussion: we have every day proofs that knowledge is power. The Stoics, who used every effort to advance the importance of mind over matter, took an idea info their heads that man should bend his exertions to imitate and approach the immortal gods. They considered that the gods sus- tained not any infirmity; they therefore denied even pain to be an evil—they thought the gods wanted no* thing. Thus they reasoned;-—Let us, if we cannot 94 THE MANUAL FOR INVALIDS. annihilate our passions and wants, at least diminish them, that we may imitate the gods, who have neither passions nor wants. It did not occur to them, that by endeavouring to obtain a correct knowledge of the re- lation that one thing has to another thing, a knowledge of causation, of the invariable conjunction of antecedent and consequent, would give them a nearer approach to that divine wisdom who established causation, and in whom there is no variableness, neither shadow of turn- ing. The varied power of aeriform fluids generated in va- rious ways when introduced into the blood, have been described as greatly influencing our feelings, and giving a variety of sensations not easily to be classed under any generic term. Thus, among females of a high nervous irritability, sensations will be felt, and symp- toms exhibited, which assume the varied character of fever, hysteria, and, in some instances, of an aberration of intellect: all the animal and vital functions are dis- ordered, and it is as difficult to give a just character or definition of it, as it would be to depict the rays of light in the colours of the rainbow. A truly poisonous power is exerting its influence upon the brain, disturb- ing all its functions. Thus the patient or invalid, per- haps, at first, is simply uneasy, then restless: it is, how- ever, a general uneasiness, and a general feeling of be- ing ill. It does not appear that any particular spot or ■part of the body is the seat of local affection: it should seem that as the functions of the brain are primordially distuibed,the first symptoms are mental, and that through the mind the body suffers. A learned author has said, that it is a proposition hazarded with great doubt, that a disease should be in the mind; in a proper moral sense, those disorders which are found in the mind. THE MANUAL FOR INVALIDS. 95 Connected with bodily disease, having been considered as arising from some derangement of the bodily organs. This is a point we shall not discuss in this place. Along with this bodily uneasiness there is a mental restless- ness; the patient has an incessant desire to change his place or position very often; the mind cannot long fix its attention upon one object, and it very frequently wanders from one subject to another. There is an actual inability of exercising the great powers of the mind; the power of perception, arrangement of ideas, memory, and of judgment, are greatly altered from their healthful state. It would, perhaps, be useless to enter into a physiological discussion as to the immediate causes of these symptoms; and indeed it would be very difficult to do so: experience demonstrates the existence both of the feelings and the symptoms. A far more rational enquiry it would be to explain and relieve them. We may, however, be permitted to say, that the malady may be considered as irregularly progressive, sometimes exhibiting its power by paroxysm, at other times ap- parently quiet: there is great dejection of spirits, anxi- ety of mfnd, difficulty of breathing, and sometimes a palpitation of the heart: sometimes a sensation of a sudden despondency will occur, which can only feel re- lief from an effusion of tears. Yet these symptoms are considerably different from hysteria; that sensation of a ball arising in the throat, commonly denominated globus hystericus, is generally absent. Many of its symptoms would better accord, in some respects, with what occurs in hypochondriacs, yet with very considerable variation. The animal heat is very variable and uncertain, and it does appear to depend, in a great measure, upon the na- ture of the base of the poisonous fluids which is the ex- citing cause. A deathly coldness will exist, if a carbo- 96 THE MANUAL FOR INVALIDS. naceous principle prevail in the compound; the func- tions of the stomach, and of the whole alimentary ca- nal, are immediately changed into diseased action. The source of animal heat, and the principles upon which it is founded, will be detailed as we go along; but as the stomach and intestines are frequently so much disturbed in these cases, it is very often assumed as a cause, al- though it is but an effect or symptom; and as disorder- ed functions seldom exist for any great length of time without producing some organic disease, dissection has afforded proof that the liver, spleen, pancreas, and sometimes the stomach, has suffered in the ravage of its action. In some cases, invalids are punished with severe pain in the back and loins, which would seem, from its severity, described by patients, to partake of the character and feelings of that painful malady called tic doloreux. When it attaches to a membranous cavi- ty, such as the stomach and intestines, spasms of a se- vere character often take place, even to so great a de- gree, as to cause clammy sweats, a pale, cadaverous^ face, with coldness of the extremities; yet this state of symptoms are widely different from either syncopy or apoplexy. In syncopy the action of the heart nearly ceases; in the case in question it palpitates and is ir- regular. In apoplexy there is an abolition of sense, and of all voluntary motion, with snoring: the difficulty of breathing, perhaps, is nearly equal in both cases; but the state of the pulse is widely different, and there is, in the case before us, an utter absence of a congestion of blood in the head, which is one principal feature of apoplexy. A polluted circulation of blood, we find by experience, has the power of fixing upon particular or- gans : thus, in the heart it may produce a paralysis of that organ, and instant death; in the brain, aberration THE MANUAL FOR INVALIDS. 97 of intellect, with paralysis of the extremities; in the liver and pancreas, a disordered state of the alimentary canal, with an inexplicable alternation of purging and costiveness. It has been before said, that the action of all the aeriform poisons absorbed into the blood first produces its effects upon the heart, and after upon vari- ous parts of the animal economy. We have also said, that the heart is liable to be affected by the affections of the mind. Certain mental affections, operating through the brain, greatly influence its action, some- times very suddenly increasing the force to a very great degree, and others as suddenly diminishing it. This subject is enveloped in great obscurity, and it were much to be wished that we possessed a much better history than we have at present, recording the effects produced on the heart by the affections of the mind. Nor would such a history, although very desirable, be without its difficulties, because those very affections would, to a certain extent, tend to destroy the capacity for observation in the patient himself, and who could be the only accurate historian of his own feelings: the observations of others, however accurate, must be very imperfect, because the effects themselves would clearly vary according to the degree of the cause, and the pre- vious circumstances of the heart itself, and other con- comitant causes. We do not assimilate the effects of narcotic poisons, or medical agents, taken into, the stomach, to that of the poison of aeriform fluids, introduced into the blood itself —the effects are as different as are their causes : thus, digitales, opium, hydrocyanic acid, and many other com- pounds, either useful or deleterious to life, appear to act primarily on the brain, and do not, like the poisonous aeriform fluids, affect the heart through the medium of 9 98 THE MANUAL FOR INVALIDS. the organs of respiration. We surely need not attempt to prove, at this time of science, that the brain is the material organ of all the mental faculties: we are taught, by fatal experience, that mechanical causes, as well as chemical, disturb or annihilate its functions: thus, extravasation of blood into its medullary substance, or inflammation, will impair the mental powers; a blow on the head will take away the senses ; and a teaspoon- ful of blood effused into certain parts of the base of the cranium, will both instantly and permanently destroy all the functions of life. Hence it follows, as a matter of certainty, that in the human species the place of sensa- tion is the brain, and that the healthful function of the brain produces what we call the intellect, or mind, and understanding. It has frequently been said, that in health, but more especially in disease, the senses deceive us. I will not combat the opinion ; but it would appear that our senses require to be corrected by the empire of the understand- ing. Nor has any language hitherto been sufficiently either copious or expressive as to explain, with any tolerable accuracy, our feelings or sensations. Those sensations which are received from other parts of the body than what are very commonly called the organs of the senses, are expressed by the term which we apply to the sensation received by the skin. When we say, for example, that we feel either hunger or thirst, al- though we say that we feel pain, yet the idea held in common is not that the pain is particularly attached to the skin, or other organs of the senses, but that it is in various parts of the human frame. Universal experience attributes hunger to a sensation of the stomach; the best informed physiologists are, however, clearly of opinion, that it is not an affection of the stomach, in any THE MANUAL FOR INVALIDS. 99 other way than by sympathy. Hunger seems rather to be an affection of the blood-vessels, or a desire to fill themselves, than any particular affection of the stomach itself. If hunger were originally an affection of the sto- mach, the appetite would surely not exceed the power of digestion; it would not defeat its own purposes, or go beyond its own resources. On the contrary, when the vessels are very full, there is very often no sort of appetite, although the stomach is not in the least inca- pable of digesting a large quantity of food thrown into it, without the least inconvenience whatsoever. It is, therefore, properly contested, whether the sensation of hunger can, with propriety, be said to be an affection of the stomach ; and if this sensation, about which nine- tenths of mankind entertain no doubt to be a most pain- ful affection of the stomach—if this be founded in error, which is truly the case, it will go a great way to show how little reliance can be placed upon our sensations, as forming correct ideas upon other matters. I am prepared also to show, that our other imperative sensation, so well known by the name of thirst, were we to be governed entirely by the impulse of feelings, we should say, and do say, that it is referable to the mouth fauces, and organs of deglutition ; yet the truth will be found, that those sensations only exist here, through the inexplicable power of sympathy. Thirst has often been known to be very intense when the glands of the mouth have secreted their ordinary quan- tity of fluids, and when the membranes lining the inside of the mouth, with its numerous follicles, have been abundantly supplied with fluids. Sometimes the mem- branes of the mouth will be perfectly moist, yet' if a large quantity of the watery parts of the blood be eva- porated in the form of an insensible perspiration, escape 100 THE MANUAL FOR INVALIDS. from the skin in sweat, or by any other means thrown out, by any of the excretory organs, which commonly throw off watery fluids (as, for instance, in diabetes), great thirst is certain to ensue, although there does not appear to be any particular affection of the mouth. We cannot surely say that an affection of the mouth is the cause of the thirst ; because the sensation may be quite as well produced by a simple want of water in a suffi- cient proportion in the blood-vessels; and thirst from this cause commonly produces a desire to drink, whether the mouth be disordered or not. It has also been ob- served, that the feeling of thirst may be considered, in some respects, as a matter of habit; for there certainly are some people who have never felt the sensation of thirst, and who, when they drink, do so from a sort of sympathy, but who certainly could live a long time with- out thinking of it, or suffering from the want of it. There are also other persons in whom thirst is often re- newed, and become so strong as to make them drink from thirty to forty pints of liquid in twenty-four hours. In this respect great individual differences are observ- able, which afford proof that habit has considerable share in the practice. A celebrated writer has defined thirst to be an internal sensation—an instinctive feeling ; he says it belongs essentially to the organization, and admits of no explanation. There is a fact, worthy of notice as connected with this subject, and seems intimately involved with the process of respiration—the absorption of aeriform fluids and the varied feelings arising out of it, which is, that in all the cavities of the human body, gases are liable to be produced, and, by a process so very instantaneous, as to perplex the mind in its endeavour to give an ad- equate explanation of its formation. The term flatulen- THE MANUAL FOR INVALIDS. 101 cy is familiar to all ; and when it is confined to the large cavities of the stomach and intestines, it has been conjectured to arise from a fermentation of the food, indigestion, &c. We know that gas is evolved by fer- mentation, which is a chemical change in the state of fluids. Indigestion is also a concomitant effect of flat- ulency, but certainly not the cause. This creation of gas, which, in some cases of hysteria in females, and hypochondriasis in males, is formed in such quantities as to be very distressing, is purely a process of the mental faculty ; it is, in fact, a secretion. We all know, that although secretion is furnished by peculiar organs, such as glands, mucous follicles, or membranous secreting sur- faces, &c, that the whole process is greatly, influenced by the function of the brain, and that it is a phenome- non, in the present state of our knowledge, inexplicable. We know that grief enables the lachrymal glands to se- parate, instantly and abundantly, a watery fluid from the blood, which we call tears, and which frequently is the safety valve by which it escapes, and the mind obtains re- lief. We know that the liver, under a certain mental stimulus, will form bile so abundantly, that it frequently goes on till it produces the death of the patient in a few hours. The kidneys also, under certain states of ner- vous excitement, will throw fluids in quantities so pro- digious, that it very far exceeds all the fluid matter re- ceived into the stomach ; it must, therefore, be drawn from the circulation. And such is found to be the fact, as it often runs on till the death of the patient. These circumstances premised, we have no hesitation in saying, that under peculiar morbid excitement of the nervous system, the process of secreting animal gas is inherent in the secreting organs themselves. Its formation is fre- quently very rapid and formidable ; it therefore often 102 THE MANUAL FOR INVALIDS. causes very great agony for the time. By means of distention it escapes by every possible outlet; and for- tunately it is that it does so, or the invalid must un- doubtedly perish. From analogy, I am also led to be- lieve, that, as animal gases, of various basis and com- pounds, are secreted according to the nature of the ner- vous excitement, or of the secreting organs or surfaces, so also has the constitution a power of absorbing these gases into the blood, which, as they are produced by a morbid excitement, partake of the nature of a morbid poison, and do, in fact, when entering the blood-vessels, produce very calamitous results. Sensations are often felt which cannot be described; and as our sensations give birth to our ideas, which, as it were, grow out of them, they are the material products by which we think, judge, and act, and constitute the sanity or insanity of our intellect. Our healthful body and sound mind are, therefore, dependent upon a great variety of circum- stances which are regarded as innoxious by the multi- tude ; for it has pleased the Almighty Being to cause an organized material substance to be the medium of all the mental faculties, subject, therefore, to physiological and pathological laws ; for the brain, and, through it, the mind, is stimulated to the exercise of all its varied affec- tions and functions, not only by direct sensations, but also by ideas, and by that particular arrangement of them which constitutes the memory and the judgment. These several affections, mutatis mutandis, act in their own peculiar manner on the brain and nervous system; and, through one or the other of them, on some part, or the whole of the sanguiferous system. And as these emotions of the mind, acting through the brain, produce these and many other effects on different parts of the sanguiferous system, so that system itself THE MANUAL FOR INVALIDS. 103 reacts in a very powerful manner again on the brain. We know that perception is a primitive law of the organi- zation itself, inscrutable in its nature, and, like digestion and the variation of the secretions, only to be known by its effects. We all know how very difficult it is for the imagination to explain the phenomena of thought, with the movements of matter, but we also know that such connexion exists. We are equally ignorant why certain aeriform fluids, when absorbed into the blood, become poisons. A great variety of facts,—the truth of which we never doubt, but of the proximate cause of which we are very ignorant,—fill us with wonder. Numerous facts and experiments have shown us that carbonated venous blood, if, by any means it find a passage into the arterial side of the circulation, is a deadly poison to the party, striking, with a deathly palsy, every organ to which it gains admission. When- ever an organ has a peculiar function to perform, the vessels subservient to that function are distinct from those vessels destined to its nourishment and support. Thus, the lungs are not nourished by the blood that passes through them for the purpose of respiration, but have appropriate nutritive organs like other organs. Now the importance of a most perfect oxygenation of the blood, through the respiration, is evident to be essential to all warm-blooded animals;—it is connected with their nutritive fluids, and with the quantity and activity of their general functions, and more especially with that of muscular motion. Thus, the muscular and nervous tissues are, of all parts, the most abundantly supplied with blood ;—thus birds, who consume an amazing quantity of air, are capable of much greater and of longer continued exertions than any of the other classes of warm-blooded creatures. The relation be- 104 the Manual for invalids. tween respiration and muscular motion is very observa- ble, even amongst individuals of the same species, the strongest animals having generally the largest chest; and we are all aware that more air is always consumed When great muscular exertion is used, than when at rest. The vitality of most reptiles is not so very closely de- pendent on the quantity of air—their respiration is very imperfect; and although many of them, particularly of the class of serpents, are capable of very violent exer- tion, per saltum, yet if those exertions be continued, their efforts become less active, and they are soon ex- hausted. In all animals whose respiratory powers are ample, the divisions of the windpipe are very minute, and the air-cells, consequently, are very numerous; their aggregate surface is, perhaps, greater than their whole body. What can exhibit a more beautiful cellular, or spongy structure, than the human lungs ? On the con- trary, in the cold-blooded animals the lungs are vascu- lar, consisting of much larger divisions, and affording a surface proportionably much smaller for the contact of the atmosphere. The respiratory organs of insects are diffused through every part of their body ; they com- municate with the external atmosphere through the trachea, which opens on each side of the animal at the several joints of the abdomen. If any of those orifices be stopped With oil, the parts which they supply with air become paralytic, and the insect dies. The importance of respiration, as a vital function, was justly rated by the ancients. The language of antiquity is strongly tinctured with a philosophy, in which air and combus- tion forms a prominent part. They had observed the analogy between the respiration and the flame of burn- ing materials; and they also early observed, that the presence of air was necessary to COrtibustion. The an- THE manual for invalids, 105 cients >simply observed a variety of facts, but did not attempt, like the moderns, to give definite causes for the phenomena that they saw. Later experimentalists have been rather too presumptuous in attempting to ac- count for everything by the laws of chemical action, without sufficiently taking into the account that the vital principle exerts its living power over all the animal fluids, and governs that inscrutable process of secretion which cannot be brought to acknowledge any laws of chemical action. We must not end our remarks upon respiration, and1 its effects, without taking notice of the series of pheno- mena relating to the temperature of the human body. This also has been, like many other appearances, sought to be accounted for and explained, upon the principles of the modern chemical schools, without much reference to those vital laws upon which all animal functions de- pend. All living beings have a prescribed range of tem- perature, within which alone they can perform their func- tions. The temperature of warm-blooded animals seems. very much to depend upon the quantity of air absorbed into the blood by the process of respiration : heat and carbon seem to have but little affinity: heat unites with the carbonaceous principle with great reluctance. Thus, wherever there be a great proportion of the carbon, there is but little heat, and vice versa. Now the blood which is carried through the lungs by the pulmonary arteries, is highly carbonated by its circulation through the body, and consequently it follows that it has a less disposition to combine with heat; while the blood in the pulmonary veins, having lost this carbonaceous prin- ciple, by that means, possesses a stronger attraction for heat. Thus the source of the heat is the air, as we are able to evince every day, in a common fire, when the 106 THE MANUAL FOR INVALIDS. more air that is admitted the more rapidly it burns; and, on the contrary, where the air is excluded, combustion ceases. This air, then, is taken into the lungs at the time of respiration. Pure air, as was before said, is a compound of oxygen and caloric : here, then, we see that the heat, being in a combined state, is not sensi- ble. The blood, in passing through the pulmonary ar- teries, parts with its carbonaceous principle, which unites with the oxygen of the pure air, and forms fixed air; while the blood in the veins, having its attraction for heat increased, readily absorbs the heat thus set at liberty. Now it may be asked, by what means do the veins absorb the caloric ? To this we answer, by open bibulous mouths ; as we know that the same process is the economy of the veins in other parts of the body, it is certainly fair to suppose a similar structure here. Though such structure may elude our research, we cer- tainly ought not, merely on that account, to conclude that it does not exist; yet it does not appear by what means the heat becomes sensible in the body. If the human frame be heated by arterial blood, it seems that something is wanting to decompose that blood, and to make it give out its heat in a sensible form : this process appears to take place in the small vessels where the blood becomes carbonated, and consequently has its attraction for heat diminished. Thus we see the heat is set at liberty, and diffused among the surrounding parts, as the small vessels are ramifying in every part of the body: the heat has, therefore, an endless surface to which it is exposed. Thus, as air is the source of heat, we should be apt to conclude that the tempera- ture would *be in proportion to the quantity of blood, as the larger the quantity of blood exposed, the more heat is absorbed in the lungs; but this does not appear to THE MANUAL FOR INVALIDS. 107 be conformable to facts, at least, not without many cases of exception. As all animal heat is produced by respiration, it follows that animals, whose air-cells are small, and of course more frequently replenished, will be of a higher temperature than those whose air-cells are larger; and in this we find the predictions of theo- ry confirmed by experience: thus, vipers and adders, and most reptiles of that class, whose air-cells are very large, partaking rather of the vesicular than the cellular character, their temperature is but little, comparatively to the atmosphere in which they live; while in dogs, whose air-cells are small and very numerous, their tem- perature is always high, as compared with the atmos- phere in which they live. This principle, which is as curious as important to understand, may be illustrated throughout all nature. Frogs are found at an animal heat of 61, when the temperature is 57. Also in newts, whose lungs can be hardly considered in any other cha- racter than as a single bag or bladder, the animal heat was 54^, when the temperature was 52 : in snails the principle is still farther illustrated. In fish also, as in eels, whose element is naturally cold, the animal heat was found at 59 in water of 57. In a leech, in an at- mosphere of 53, the animal heat was found to be scarcely 54. The circulation in these animals is also found to differ very materially from the human subject, as has been before observed. It is a very curious circum- stance, that the standard temperature of the human body is the same both in summer and in winter, in cold as in warm climates; though there is no doubt that the tem- perature of the air differs materially in different seasons and in different situations. We have before explained the cause of the curious fact of nature, viz. that as the heat in the blood is in a state of combination, it conse- 108 THE MANUAL FOR INVALIDS. quently bears no relation to the temperature. Thus, reasoning is confirmed by experiment, that the quantity of caloric is variable, and exactly corresponds with the necessity of the case ; and that cold air contains a larger quantity of the matter of caloric than hot air.—For in- stance : cold air is less rarified and more condensed ; and next, it contains more of the carbonaceous principle. Now, although carbon has no affinity to heat in itself, by its combination it causes its developement. Ought we not to look with great admiration to the great First Cause, who combines principles to produce certain re- sults, and adapts means to ends with such wonderful accuracy ? It must be most pleasing to that Almighty Power, to observe creatures, whom he hath formed, employing that reason with which his goodness has en- dowed them, in the pursuit of truth and the practice of virtue. We have said, that the source of heat is pure air; but to procure it, it is necessary to decompose this pure air; and this is effected in the lungs by the carbonaceous principle, which, by combining with the oxygen of the vital air, forms a carbonic acid gas; while the heat, escaping, combines with the blood. Were we, by the way of corollary, to condense what we have said, it would amount to this:—that heat was imparted to the body by the decomposition of pure air, by means of the carbonaceous principle; and that the heat set at liberty by such decomposition, is absorbed by the open bibulous mouths of veins ; while the oxygen, uniting with the carbonaceous principle, forms fixed air. The quantity of pure air consumed by animal life is immea- surably large ; even a small animal will decompose a gallon in a very short space of time. When we reflect on the number of animals, as well as fires, that are constantly consuming the pure air, it should seem won- THE MANUAL FOR INVALIDS. 109 derful that the atmosphere is able to support the con- sumption ; yet the atmosphere does not appear less sa- lubrious than heretofore. Now, as the atmosphere is known to extend only a few miles around the surface of the earth, there must be some specific cause that this purity is preserved. There can be no doubt, but that this was a question which must frequently have occurred to philosophers, both ancient and modern ; but it was reserved by Providence for the persecuted Joseph Priestley to explain to an admiring world the principles upon which its purity is preserved. He exposed in a receiver, containing impure air, a sprig of mint: he ob- served that, so far from this impure air being unfavour- able to vegetation, it certainly improved the growth of the plant; and, on examining the air after this process, he found it completely purified. Hence, vegetation seems designed by nature as a counterpoise to respira- tion ; and, in the following manner, it appears that pure air, by respiration, is converted into fixed air, or carbo- nic acid gas ; while, in vegetation, it is probable that the fixed air is decomposed, and the carbonaceous prin- ciple absorbed; or, possibly, the vegetable may absorb the whole of the fixed air, and give a part of it out pure air. We know that vegetables, as well as animals, are organized bodies: they have their sap-vessels, and their air-vessels ; therefore they may possibly take up as pa- bulum, what to us is useless, or even noxious. Thus we discover how beautifully nature has made two parts of the creation subservient to the other. Perhaps, an- other source of pure air arises from the decomposition of water, by vegetables a but it has been ascertained by experiment, that it is only when light is admitted to ve- getables that there is any amelioration in the state of the air; for in the absence of light the air is rendered more 10 110 THE MANUAL FOR INVALIDS. impure. Thus it appears that light must be considered as a means of purifying the atmosphere, as well as being necessary to vegetation : thus light, heat, clearness of thought, calmness and correctness of mind, as well as muscular motion, are all, in some degree, dependent upon the healthful state of the lungs, and the process of respiration. CHAPTER X. Breakfast.—The different Qualities of Coffee, Tea, Chocolate, Co- coa, fyc.—Effects upon the Stomach and Digestive Function. The stomach having been in a quiescent state during the process of sleep, begins again to feel the necessity of being supplied with its necessary sustenance, upon which to exert its power. The character of the feelings of an invalid require that the stomach should not be pro- voked to an action beyond its strength ; and various articles of food have been suggested, by different writers, as of more or less salubrity, to be adopted, to the exclu- sion of others. Less regard is necessary to persons in health respecting the articles of diet, as well for break- fast as for other meals; and the taste of such persons may be indulged with little probability of doing harm, because healthy digestion has the power of producing nutritive chyle from varied and heterogeneous sub- stances : but to the invalid, whose restorative powers may be presumed to partake of the nature of the illness under which he labours, it is of considerable advantage so to conciliate the stomach to the nutriment received, that no additional inconvenience may be sustained by the sufferer from that cause. THE MANUAL FOR INVALIDS. Ill With respect to coffee, our first article, the opinions concerning its properties are almost as various as the colours of the rainbow. Its general effect upon the nervous coat of the stomach is, unquestionably, a gentle stimulant; and, as most substances of that class, has, to a certain extent, a tonic power, I do not hesitate to recommend it to those invalids whose powers of diges- tion have been debilitated by stimulants of a more power- ful character, such as fermented liquors, wine, spirits, &c. The custom, however, of taking coffee after a late dinner, for instance, and just before retirement to rest, is bad; because its stimulant property upon the nerves of the stomach exerts a power destructive to sleep—it pro- motes an activity to the mind, and gives a range to the imagination which prevents self-forgetfulness, that sure harbinger of repose. With respect to the article of tea, our ancestors cer- tainly did very well without it; they enjoyed good health, and, in all probability, lived both as happy and as long, before this plant was brought from the remotest part of the earth for our accommodation. It is, indeed, a most powerful instance of the influence both of fashion and habit, that this plant should have taken such firm hold of the opinions and feelings of the people of the western part of Europe, and most especially of England. The Government of the country, much to its credit, has taken advantage of the mania, and made it contribute very largely to the national revenue. There are two kinds of tea imported into this country —denominated black and green; and a very common opinion has prevailed, that it is the same plant, varied in colour by being dried, the one upon iron sheets, the other upon copper. This is, however, a vulgar error, as the plants are certainly very different. No 112 THE MANUAL FOR INVALIDS. quack medicine has had more numerous advocates than the tea-plant; it has been extolled to the skies, as it is probable most articles will be, that carry so high a duty in proportion to the intrinsic value of the article itself. The Americans, whose China trade is not under the monopoly of an East India Company, do not discover such amazing salubrious properties in tea: nor is the American Government enabled to inspire the people with such enthusiasm, of which they might take advantage. With regard to the qualities of the plant itself, its gene- ral operation is doubtless both astringent and narcotic. I believe, also, it has both a stimulant and a sudorific power. But the constitutions of different persons have a great latitude in this particular: in some cases a cup of tea, particularly green tea, will throw the whole ner- vous system into very great disorder,—exerting a stimu- lant power bordering upon phrenzy. On the other hand, there have been cases where its narcotic power upon the system has been most alarming. In its gene- ral operation, its universal reception must prove that it is a beverage very agreeable, and, to persons in health, perhaps harmless. But I should certainly advise our invalid to be sparing of its use, at least until he has experienced its effects. If the introduction of tea into Europe has had the effect of producing a less desire for intoxicating liquors, which is the opinion of many, this is a recommendation of which I should be very sorry to deprive it of the full credit. The quantity of sugar that is used by the tea-drinkers is certainly injurious to the stomach, and ought to be cautiously avoided by every person in a valetudinarian state. Chocolate and cocoa may be classed together: they are very nutritious, and it requires strong powers of digestion to receive them with impunity; and as a very THE MANUAL FOR INVALIDS. 113 importunate symptom with most invalids is a disordered function of the stomach, I would most decidedly advise them to be very cautious of the use of either. As the oil is very abundant, the difficulty of effecting perfect assimilation must be very great. I well remember the case of a patient, who was gradually recovering from a regular continued fever: a perfect crisis had occurred, and the appetite was beginning to develope itself, when some wiseacre of a friend, as she was called, sent a present of chocolate, with a strong recommendation of its many very excellent properties; and, among the rest, of its being so very strengthening. The patient yielded to the suggestion, a relapse of the fever took place, and the sufferer narrowly escaped with life. I have a very excellent opinion of whey as a common beverage for invalids, and I am very much disposed to think that its use would be attended with less inconvenience than many of the other diluents that are taken; for breakfast it seems well suited, on other accounts. Butter is so very changeable an article in its qualities, and it passes so readily into a putrescent, or a rancid state, that dry toast, or biscuit, would suit much better the stomach of invalids. An egg, not much boiled, is not objectionable; but eggs boiled hard must not be tasted. Bread and boiled milk is a very famous breakfast for those who are constantly out in the open air, and are using much exer- cise; but to an invalid it will not do, as it frequently forms a hard coagulation in the stomach, and is then very difficult to digest. 10* 114 THE MANUAL FOR INVALIDS. CHAPTER XI. Dinner.—The different kinds of Food considered, in relation to the Invalid State.—Farinaceous and Animal—Beef, Mutton, Veal, Lamb, Fish, Poultry, fyc. examined. The dinner-meal ought to be the most substantial supply the system should receive in the course of the day : and it is in modern times, and in large cities, made a source of luxurious festivity to a person in health. Roast beef and roast mutton is the most eligible of all food for this meal. But to persons in an invalid state this must be liable to certain exceptions : there are few persons who are ill, who have not the stomach and di- gestive functions much affected ; and it would not pro- mote either health or comfort, to throw a burthen upon the digestive process, which cannot be sustained. The proper time of the day for the dinner of invalids should be early—at all events, not later than two o'clock in the afternoon; later hours would be attended with much exhaustion, and a greater depression of the digestive power. Unless our invalid have suffered debility from evacuations, I am of opinion, that the functions of the stomach would be more easily accommodated to farina- ceous than to animal food. That vegetable and fari- naceous substances are perfectly conducive to muscular power, we have sufficient evidence ; the lower orders of the Irish, for instance, consume, comparatively, a very small proportion of animal food, and there are no men capable of greater or longer continued muscular ex- ertion. Many animals, constituted by nature to subsist upon vegetables only (the elephant, for example), are capable of amazing exertion and power. We must, perhaps, regard animal food, in relation to the invalid THE MANUAL FOR INVALIDS. 115 state, more in the character of a simple stimulant upon the vascular system, than as a tonic acting upon the ner- vous tissue. Veal and lamb are both of them improper for the valetudinarian state, upon this principle—they are more indigestible, and not easily assimilated to nour- ishment, it is most true, that young animals, not yet arrived to perfection, are unwholesome ; and although some people in health have stomachs so strong that they can digest any food, yet to an invalid it is very hurtful. Food in which the nourishing properties are highly con- centrated, is not proper for the stomach of an invalid. Fish, in order to be preserved fresh for the market, are allowed to linger and die, instead of being put to death in health, as every living thing intended for food ought to be ; and this circumstance very much alters its na- ture and properties as food ; and probably is one cause why, with some people, fish is said to disagree, by ex- citing disturbance in the alimentary canal. It is less nutritive than the flesh of warm-blooded animals, and of course is less stimulant to the circulation. Where the complaint is attended 'with febrile excitement, fish is more proper than flesh ; and in all cases where the di- gestive powers are sunk, it is proper, as being easily con- verted into chyle. Fish, in proportion to its bulk, may be said to be almost all muscle ; and you may readily know if it be in high perfection, by the layer of curdy matter interposed between its flakes. It often happens that those parts of fish, viz. the pulpy, gelatinous, or glutinous, which are considered the most delicious, are the most indigestible, and unfit for the stomach of an invalid. Lobster sauce is a very bad addendum ; the best accompaniment is vinegar. Most shell fish are very indigestible, and, from the indisposition caused occasion- ally by eating them, the idea of their being poisonous 116 THE MANUAL FOR INVALIDS. has been created. Oysters, when eaten in large quan- tities, often cause great disturbance: shrimps and mus- cles have produced death ; but whether from their in- digestibility or poisonous quality, 1 cannot determine. Thus much with respect to fish, as food for invalids, in which it would appear that it would be safer to avoid shell fish altogether. But it is less stimulating, even when perfectly digested, than animal food, or the farina of vegetables. It is, perhaps, but of little practical im- portance to know whether fish produce its mischief by a specific poison, or whether its effects are caused by its indigestibility ; for, whatever is incapable of being pro- perly decomposed by the living action of the stomach, may, in effect, be considered as poisonous, as it will ex- cite a derangement in the functions of the intestinal canal, and, if excessive, would be likely to prove fatal. It may be here proper to notice, that in regard to many articles of food, the old adage may, in some degree, be said to be verified, viz. " That what is food for one shall be poison to another." The stomach has its pe- culiar disposition, like other organs; and when persons are in health, it may, perhaps, be allowed to be a good instinctive guide ; for very seldom what is desired with great earnestness, is found to be a source of alimentary disturbance. I once lost all hope of recovering a patient in cholera morbus, when he declared he would eat as many broiled rashers of bacon as he could swallow be- fore he died. The sickness and evacuation at this moment were dreadful: he insisted upon the bacon, and he ate no less than half a pound of bacon, cut in thin slices, and broiled on a gridiron. He ate them voraciously: the, sickness ceased, and the purging too ; and from that moment he dates his recovery. Now he thinks every body may be cured, of a similar, complaint, if they will THE MANUAL FOR INVALIDS. 117 take, like him, rashers of bacon: this, of course, is ab- surd. With poultry I shall not have much to say: it is light, and easy of digestion, but there is very little nourish- ment in it in proportion to quantity. Most of the white meats, are detained a considerable time in the stomach, and furnish but a moderately stimulant chyle ; yet it is so far objectionable, that it is likely to go into a state of acetous fermentation. It may be useful in all cases where there is a high state of vascular excitement, and where more stimulant food would be very hurtful. I shall now notice as food the farina of wheat. The grain of wheat is provided with a case, or cortical part, which, if swallowed in an unbroken state, would pass through the alimentary canal unchanged, and without affording any nourishment to the system. Wheat has more gluten in its composition than either barley, rye, or oats; and which is the chief reason of the preference given to it in the formation of that most valuable neces- sary of life, named bread. This staff of life, when pure, is very salubrious, but it is liable to great abuse from the avarice of mankind. Purewheaten bread is very nutri- tive, tonic, astringent, and of easy digestion. The alum and potatoes, with which it is plentifully mixed, is a great evil to an invalid, because it leaves him not only in a state of uncertainty as to what is the food he is taking, but likewise as to the cause of the particular effects that are produced. Newly baked bread is universally known to be improper to be eaten, because it swells like a sponge in the stomach. It is very indigestible. A too great proportion of bread food produces heartburn and acidity. A physician of celebrity asserts, that it gives children a pale countenance, and breeds worms. He also says that all pastry is an abomination ; and he 118 THE MANUAL FOR INVALIDS. thinks that one half, at least, of the cases of indigestion which occur after dinner parties, may be traced to this cause. There is no doubt of the fact ; but perhaps it may be principally occasioned by the admixture of but- ter, which, although good to the eye, may yet be ad- vanced to a state bordering upon rancidity or putres- cence. CHAPTER XII. The subject of Supper considered.—Late Suppers to be avoided: mostly injurious to Invalids.—Animal Food to be superseded by any light Diet, of easy Digestion.—Indigestible Matter in the Stomach the cause of nervous Irritation, Restlessness, and want of Refreshment from sleep. We have general'y suggested in this Manual, the su- perior advantages of abstinence, in regard to health, when held in comparison with repletion ; but it is more es- pecially applicable to the meal commonly termed supper, as it is attended with consequences the more important, because thereas an absence of the exertion of muscular motion, which often acts as a safety-valve in preventing the evil effects of intemperance. These observations were premised, from a conviction on the part of the author, that the evils of late (and what are commonly called hearty) suppers, are but very imperfectly known. Effects are constantly attributed to wrong causes: we are continually bribing our judg- ment to justify our inclinations. In a great proportion of the sudden deaths which are continually happening, two-thirds, at least, are found dead in their bed in the morning. In these cases, the victim is prevented from THE MANUAL FOR INVALIDS. 119 relating a detail'of the sufferings, or his opinion of their cause: but a large portion of cases of gout, asthma, haemorrhoids, apoplexy, and many other diseases, may be fairly attributed to late and hearty suppers ; for they happen very often among that class of persons who give themselves this indulgence. It has been more than once mentioned in these pages,' how very much the process of digestion and chylification depended upon the vigo- rous and healthful function of the brain. Can a gorged stomach, at bedtime, be wholesome, when there is an absence of all intellectual energy to carry on the func- tion of digestion ? In the reign of the Tudors, the no- bility and the gentry of England were accustomed to take dinner at twelve, and to sup at six in the evening, and to retire to rest about nine. That our ancestors were great supper eaters, and, perhaps, with impunity, is very probable, as we perceive it was under circum- stances that prevented any bad consequences resulting from it. In our former discussions concerning digestion and chylification, every argument employed will illus- trate the folly of indulging'in hearty suppers; because it was clearly shown, that the three most important pro- cesses—0f digestion, chylification, and sanguification, required the activity of the muscles as a kind of outlet for the abundant stimulus that was by those means pro- duced ; besides, sleep is confessedly unfavourable to al- most every stage of digestion : going to bed with a full stomach must be peculiarly hurtful to a person in health—much more prejudicial to the invalid. It also gives occasion to that most painful affection called spasm; and if it should attack with severity an organ whose functions are essential to life, it will instantly destroy. The system of making repletion the basis of consolidat- ing or perpetuating of friendship is most absurd; yet 120 THE MANUAL FOR INVALIDS. nothing is more common, in order to obtain the charac- ter of being a friendly and social fellow. You are re- quired to sacrifice your understanding, and to make your very existence the pledge of your sincerity. The in- fluence of a supply of food upon the animal economy, is most extensive. Forming our opinions simply from our feelings, it is allowed to be exhilarating and comfort- able ; but an unseasonable, irregular, stimulus of this kind, is a very frequent source of functional disturbance. The stimulus of nourishment acts upon the system not merely by the quantity, or even the quality, of the fluids which enter the thoracic duct, but also by an inexplicable impulse which the stomach receives ; and as the great organ or centre of sympathy, it propagates its effects over the whole animal economy. We have a remark- able instance of its sudden and quick operation in cases of great fatigue or exhaustion ; when the faint, uneasy sensations, are almost instantly relieved, before the de- glutition of the first morsels can have given any supply to the circulating fluids. It is no argument in favour of late or hearty suppers, to,adduce instances of individuals having allowed them- selves this indulgence for many years^ without any ap- parent injury to their health ; for, independently of the received principle, that to every general ru|e there must he some exceptions, we know tfie farce of habit will cjhange the natural and relative hearings of thingS;;-^-- fp,r instance, almost every person who has reached an ad- vanced period of,life, has made many dietetic discoveries relative to himself, which woujd not be allowed in re- ference to others. Some people, .tyho pay considerable- a^nUon t© this subject^ have associated in their ininds; a. sort of (catalogue of dietetic substances, which* though generally, whoj^soraft to.themselves, arepfte».,sources,of THE MANUAL FOR INVALIDS. 121 inconvenience and sickness to others; take, for example, fat meat, which, in a powerful stomach, fully equal to its digestion, is a wholesome and nutritious food. But the same food, in persons whose digestive organs are feeble and irritable, is a frequent cause of heartburn, sickness, and vomiting, with a great variety of other inconvenien- ces. Also, in cases of fever, nothing is more usual than for the friends of patients to throw out insinuations that the patient will die of exhaustion on account of the in- ability to take food ; and the practitioner is frequently under considerable embarrassment to explain the folly of the measure to their satisfaction. And when the prin- ciple has been violated, and food has been taken, under circumstances of fever, it has always been followed by an exacerbation of the paroxysm, a protracted crisis, with much derangement in the circulating system, flush- ed countenance, and often intense head-ach ; and not unfrequeatly does it happen, that a physician, acting upon the most judicious principles for the safety of his patient, has to contend with ignorance and calumny as a reward for his pains. His reputation will probably be estimated by the result; and there is, perhaps, no pro- fession where the advantages are so very inadequate to the risk of detriment, in fortune or in fame : for acci- dent will often accomplish what merit strives for in vain ; and those coincidences of circumstances which frequently elevate one man and depress another, in the healing art, is more the production of what is common- ly called chance, than from any extension of mind, or any peculiar tact or skill in the art of intellectual com- binations. It has been recommended to take no animal food for supper: and most certainly, for an invalid, such food is very improper; for, in almost all cases, the valetudina- 11 122 THE MANUAL FOR INVALIDS. rian has a pulse much above par, and the quantity of animal gluten which it contains, must, of necessity, throw an injurious stimulus into the system, which is a cause of an accumulation of high irritability. Light fa- rinaceous food, well fermented, and well baked, is the only supper, in a state of ill health, which can be taken without mischief; because such food does not give a weak stomach much trouble to digest; nor does it oc- casion an excess of stimulus beyond the irritability. If we introduce any substances of an indigestible charac- ter into the stomach, all the animal functions immedi- ately sympathize with the suffering organ ; and a train of symptoms are formed, which it will be found no very easy matter to manage,—a peculiar species of what is called nervous irritation takes place, the mind is dis- turbed equally with the body, altered perceptions give occasion to gloomy and melancholy thoughts, a general restlessness is produced, and, as a natural consequence, all the restorative powers of sleep are chased away ; nor can you possibly discover any substitute for nature's sweet restorer. In respect to the quality of refresh- ment from sleep, all the medicines given as sedatives, will prove but a very indifferent succedaneum. Opium, to which invalids often fly for relief, is a medicine that, if possible, should be very seldom used for the mere purpose of producing sleep, in cases unattended with other symptoms than those which arise from derange- ment of the digestive organs : and in nine cases out of ten, the invalids who are able to walk about, visit, dine, &c, will find the seat of their complaints in the deranged functions of their digestion. Opium is an able operative in the hands of a skilful physician, but a very dangerous one with those who are rather pleased with its power than acquainted with its virtues. Its great evil is its THE MANUAL FOR INVALIDS. 123 tendency to produce costiveness. A light supper, of easy digestion, no meat, and an early retirement to rest, give the best promise of repose upon the pillow, and the best security that you will awake with renovated powers, and rise like a giant refreshed, in the morning. CHAPTER XIII. The Science of Chemistry recommended as a Study to the Invalid, a Pursuit both entertaining and instructive;—enters every Com- position employed as Dietetics, and of Medicine;—of most essen- tial Service in obtaining a Knowledge of factitious Airs ;—useful in leading the Judgment to a right knowledge of Symptoms in Disease. The leading feature of the purpose of this Manual, has been to elucidate in what manner the mind, or, in other words, the irregular functions of the brain, disturb the healthy actions of the animal economy. It has been asserted that every person who is comparatively happy, is also in a state of health corresponding with this ratio. A person whose mind is in a state of high susceptibility requires a corresponding excitement to produce sensa- tion, or the mind will shake the edifice of its own struc- ture, by the creation of false perceptions. An indefi- nite, but highly interesting mental stimulus, is a most essential agent, or remedy, in the curative process of the health of an invalid, and even in chronic, or organic disease, it is also not without its use; I therefore rank the science of the laws of chemical agents as an im- portant instrument in the production of health. The almost infinite variety of its products will astonish and delight; its close alliance with natural history will ren- 124 THE MANUAL FOR INVALIDS. der it very interesting; while its practical operation en- ters into most of the combinations which give elegance to almost all the embellishments of life; its utility is no less evident to the perfectibility of the arts and of pro- fessions; it gives value and dignity to the character of man, as a member of civilized society. Without a knowledge of chemistry the principles of vegetation and of agriculture could never be called into operation in a manner so as fully to develope the fertili- ty of the earth; even the nature of loam, and of ma- nure, would have remained unknown. This science assures us, that the earth has an analogy to an animal body; it requires rest, it must occasionally lie fallow; it also requires nutriment to call forth its productive energies, and this it obtains from the manure that is spread by provident agriculturists, with a bountiful hand, over its surface. It affords us the means of ascertaining many of the phenomena which are intimately connected with vegetable life; it enables us to understand many of the diseases to which vegetation is subject, and the nature of the death to which, in common with all or- ganised bodies, it must submit. The sap of the vege- table, which is its vital fluid, has been subject to analy- sis, and its varieties and specific properties ascertained; the laws of attraction, gravitation, electricity, magnet- ism, hydraulics, and hydrostatics, all unite with chemical science in explaining the wonderful laws of the vegeta- ble world. Can it be said that, under various interesting em- ployments of the mind, the invalid is not consulting his restoration to health, in turning his attention to the beau- tiful philosophical phenomena of chemical science ? With- out it he cannot even understand the process by which his food sustains his strength, nor the manner of reme- THE MANUAL FOR INVALIDS. 125 dies employed as curative agents, in affording him relief when afflicted with disease. It is a science which in- vestigates the composition of material substances, and the permanent changes of constitution which their mu- tual actions produce. It is a branch of natural philoso- phy which unfolds the nature of all material bodies, de- termines the number and properties of their component parts, and teaches us how those parts are united, and by what means they may be separated and re-combined. It would, perhaps, not be too much to say, that the ob- jects to which the scientific chemist is directed, compre- hend the whole of the substances which compose the habitable globe. It explains the nature of salutary pro- cesses ; it detects, and subjects to analysis, deleterious agents, and shows in what way its powers may be either eluded or destroyed. The health of all persons is so deeply implicated, in relation to the application of any poisonous fluids to the body, through the medium of touch, which constitutes what is familiarly termed contagion, or through another medium equally important, viz. the air-cells of the lungs, received in their gaseous form, and absorbed in- to the blood, which is termed infection, that a science which has reduced to certain properties these hurtful agents, must rank as of primordial importance. By chemistry may be analysed all those subtile particles arising from putrid substances, and also those evanescent fluids which escape from persons labouring under cer- ' tain diseases, and by means of which the disease infects others. Thus the miasma of bogs and fens, the vapour and effluvia of dead animal and vegetable substances, the fumes of these, and many other destructive poisons, are now many of them well known, and to some of 11* 126 THE MANUAL FOR INVALIDS. them re-agents have been discovered, destroying their pestilential character. By a knowledge of chemistry we have under control one of the most horrible and destructive of all morbid poisons. The properties of a metal acted upon by the agency of fire neutralizes this virus, and extinguishes the disease. It is not to be understood that we have a perfect chemical knowledge of all the various poisonous effluvia, but we know that they are formed by certain proportions of hydrogen in union and combination with sulphur, phosphorus, carbon, and azote, and that the only proper antidotes, or destroyers of these gasiform poi- sons, are nitric acid vapour, muriatic acid gas, and chlo- rine : the two last named are very efficacious, and it is to the study of this most delightful science that we have obtained a knowledge of these re-agents, which, in their practical effects, may be said to restore patients from the verge of the grave. A knowledge of the specification of most of the vegetable narcotic poisons leads us, by the same ratio, to adopt remedial measures, and often to restore animation, to all human appearances gone for ever. The nature of combustion, to a philosophic enquirer, affords an almost infinite variety of phenomena, as yet not sufficiently understood. It is, however, well ascer- tained that flame is caused by the consumption or ab- sorption of oxygen gas, and this is illustrated by an ex- periment; for the oxygen gas that has been absorbed by the flame of the burning body, may be reproduced, or recovered from the created compound; and it is cu- rious to observe, that the weight of the air regained will be equal to that which was lost during the combus- tion. Chemical experiment has demonstrated, that air, in which a body has been burnt, is by that process ren- THE MANUAL FOR INVALIDS. 127 dered 'unfit for the continuance of combustion, or for ' the important function of sustaining animal life. The process of detonation is occasioned by the union of oxy- gen and hydrogen; a great impulse is given to the sur- rounding air; the detonating substances occupy much less space before the inflammable process, and the sound is caused by the rush of air to occupy the va- cuum. The wonders of magnetism, electricity, &c. is well adapted to evolve all the mental energies, and to create or excite a principle of curiosity sufficient to induce us to become acquainted with many of its very varied phe- nomena. The ancients first found out some of its more obvious properties in amber, and which, in their idiom, was called electrum; and hence arose the term electri- city, which is continued in our times. The simple facts of electricity are highly entertaining in their own nature, without any reference to the many objects of practical utility to which it may be rendered subservient. Thus, if we rub a piece of sealing wax and a dry warm flannel together, we shall discover that they become, by the pro- cess of friction, capable both of attracting and repelling light bodies. A dry and warm sheet of common writing paper, rubbed upon Indian rubber, or a glass tube rubbed upon silk, exhibit the same curious phenomena. Various experiments, illustrating the principles of electric attrac- tion and repulsion, might be here detailed ; but it is not to our purpose, further than to observe, that a mind absorbed with the beauties and wonders of chemistry, has little occasion, and probably will feel but small incli- nation, to create to itself fictitious alarms, or give cause to the formation of fastidious sensations, alike destruc- tive both of health of body and peace of mind. This science informs us of the peculiar qualities of 128 THE MANUAL FOR INVALIDS. factitious airs, and of their specific and particular effect upon the various structures of the animal economy. The various poisons of a vegetable or narcotic character, which produce in many cases instant death, do not in every instance leave an alteration of structure, but act by a chemico-electric power upon the nerve, whose mi- nute threads are expanded over mucous membranes, and produce an immediate sympathy with their common ori- gin, the brain. The knowledge of the laws of chemistry greatly elucidate in this manner medical jurisprudence ; it elucidates also the peculiar quality of poisonous gases, and the particular structures that are fatally affected by them ; for instance, carbonic acid gas, is constantly taken into the stomach, in fermented fluids, such as champaigne, cider, Burton ale, soda water, and a great variety of others, which could easily be named, with perfect im- punity, and, in some instances, with considerable tonic effect. But let it be remembered, that it is this very gas, when taken in quantity into the air-cellfcof the lungs, which produces death, and leaves no traces of its rav- age upon the living tissue. The deadly poison of the viper, or rattlesnake, can be swallowed with crumb- bread without injury ; the power of the gastric secre- tion immediately acts as a chemical agent, and neutral- izes its poison. Even the common purgative bitter extract, called aloes, although useful and medicinal to the human species, is a deadly poison to dogs and wolves; and the author has been informed, by a very intelligent naturalist, that it is equally so to the tiger and to the lion. It is also certainly known to the medi- cal philosopher, that the plant called water-fennel, or fine-leaved water hemlock, will instantly destroy the horse ; but oxen often devour it greedily, and with perfect impunity. Its mode of operation upon the horse THE MANUAL FOR INVALIDS. 129 is that of a direct sedative ; it not only impairs, but destroys the function of the brain, and he dies very quickly. But by chemistry we discover that its proper- ties of destruction are alkaline ; and we find, by ex^ perience, that a strong solution of citric acid decomposes this deadly quality, and renders it harmless. And the different poisonous gases, such as hydrogen and azote, would doubtless be rendered inefficient by chemical agents, if their action were not so instantaneous as to preclude the use of any remedy. The hydrocyanic, or prussic acid, the essential oil of tobacco, and a great variety of other poisons of a vegetable kind, produce their fatal effects, without leaving any traces upon the organic structure : they act upon the functions of vital organs, and, according to their specific nature and proper- ties, produce their certain effects, either of suffering, or, in the infliction of death, the extinction of all suffering; and when such very important results may be, in a great measure, fully elucidated and known, by attention to the nature of chemical combination, and the salutary power of its agents, who, that has leisure, would hesitate to employ it in endeavouring to obtain a kowledge that can be rendered so very useful, as well as entertaining? We avoid going into a detail of the universality of its powers ; it is known to destroy material products, and to create new substances from its ruins. The allwise Author of Nature has thought proper to produce most of the changes which his wisdom effects, on the earth we inhabit, and the atmosphere which surrounds us, by laws truly chemical : in proportion as we obtain a know- ledge of the certain principles by which the Divine goodness regulates the relation that all organized beings have to each other ; in that same proportion is humanity dignified, our usefulness and our happiness increased j 130 THE MANUAL FOR INVALIDS. and if, as it sometimes happens, that an increase of knowledge produceth sorrow, it is a sorrow that con- forms the principle ; because he who possesses much knowledge, is best convinced of his ignorance, and assured that ignorance and misery are terms nearly allied. CHAPTER XIY. The beneficial Effects of Early Rising—The State of the Pulse, as denoting greater Mental and Bodily Power in the Morning. The old adage of rising with the sun, like many others of the same description, although used as a metaphor, is not without a reference to a rule of life, the obser- vance of which has an influence upon health that is very remarkable. There can be no doubt but that the at- mosphere most conformable to the expansion of the lungs, and the more perfect oxygenation of the blood, is that of the morning. After a state of repose, when all the voluntary muscles have for many hours been in a state of inaction, the heart is found to be more pow- erful, more regular, and more slow in its contractions, than at night, after the fatigue, the anxiety, and the ir- ritable fidgety sensations accompanying the actions of laborious exertion during the day. How the heart should possess a power of restoring its own energies, while its action continues, is one of those first principles which we know, but of its cause we remain as ignorant as we were when in the cradle. The functions of the brain also are decidedly more perfect in the morning than at any subsequent part of THE MANUAL FOR INVALIDS. 131 the day ; for the mind, while a man is asleep, is at rest, at least so far as regards the power of perception. Here, then, we perceive there are several concurring causes why an invalid, who wishes to obtain health, or others, who wish to preserve it, are directed to the morning as a most powerful auxiliary. Upon the perfect function of the brain, which con- stitutes what we have denominated mental power, not only health, but even happiness itself, do greatly de- pend. All nervous irritation, all mental irritability, must be dispersed by that regular vascular excitement which takes place after a perfect night of repose. In a good sleep the action of the body, which makes impres- sion on the mind, if not altogether at rest, is much more so than when the body is awake. When a person goes to sleep, he puts himself in a recumbent posture, which is not a posture he commonly assumes when awake. In this position he is supported by a great number more points than when standing, sitting, or walking ; there- fore, more points being pressed upon, it requires less exertion to avoid the effects ofvsuch pressure. So far, therefore, the body may be said to be more at rest when asleep than when he is awake. A twelve or sixteen hours uninterrupted continuation of active exertion, causes such an impetuous strain of consumption, as pro- duces a more violent pulse, a kind of general fever, com- monly called an evening fever : sleep then comes to the relief of both the body and mind ; and after seven or eight hours pause of this kind, the stream of vital con- sumption is so much checked, and what has been lost is so fully renewed, that pulsation, and all its other movements, are again performed, slowly and regularly, and the course of life proceeds in a healthful manner, as before. Nothing, therefore, is able to waste and destroy us so 132 THE MANUAL FOR INVALIDS. soon as long-continued want of sleep. It has been broadly asserted, that even trees, whose duration is so far extended beyond animal life, would be utterly un- able to continue their being, if it were not for the long inactivity and sleep during winter. Bellini gave us some very curious observations concerning the state of the pulse, as resulting from that tranquil feel, when every animal and mental function has been repaired by sleep ; and which, I contend, is only to be felt in its perfection in the morning. I have given a variety of reasons why the invalid should, if possible, take the ad- vantage of the morning air, which is a time when every > function, both animal and mental, is most perfect, and best calculated to convert the tonic power of the air into gentle excitement and pleasant feelings; for the exertions, both of body and mind, are daily much great- er than could be supported for a continuance, were it not for those intervals of repose which they receive during sleep, and of which we have just spoken. CHAPTER XV. Illustration of the Nature and resuscitative Power of Sleep;— Quantity necessary for Health. The nature of sleep itself has been variously con- sidered. By some it has been held as a definite func- tion, but as the term function is equal to action, it is most certainly an abuse of words to apply it to a state which consists in the negation of action. Sleep has, by others, been considered to be a venous plethora, or an accumulation of blood in the venous vessels of the THE MANUAL FOR INVALIDS. 133 head. They draw this analogy from apoplexy, which is very imperfect; inasmuch as they compare a fatal dis- ease with " tired nature's sweet restorer—balmy sleep." The beneficial effects of sleep, as a restorative process, are universally felt, and it would be only ingenuous to confess what is really the truth, that we are utterly ig- norant of the physiology of this healthful function. The state of the circulation through the brain in sleep is not continued with the same velocity as when awake. The heart continues its action when the man is asleep, but not with the same force; for the pulse, the measure of the heart's action, is neither so frequent, so full, nor so strong, as when he is awake; nor does the breathing go on so quickly ; nor any of the other actions necessa- ry for life. It would also appear, that sleep does not necessarily fall upon all the animal organs at the same moment of time. In sleep the judgment is often at rest —perhaps the memory and imagination also; the state of the body, which gives the mind a means of percep- tion, is also, in most instances, totally at rest. Sleep, therefore, may be considered as a state of nervous qui- etude, during which all the animal and mental powers are recruited: it is, in truth, in the healthy subject,the most powerful tonic nature can command. It is well known that a privation of sleep for any great length of time, will prevent the necessary accu- mulation of the powers of the body, and induce such a state of weakness that the system will become quite exhausted, and the party will perish, or a state of ma- nia will be superinduced; in which it has been often observed, that little sleep is necessary to the existence of the unfortunate victim. It is a most curious fact of pathology, that animals can be deprived of sleep to an amazing extent, without any effect upon their health or 12 134 THE MANUAL FOR INVALIDS. brain—even febrile action does not appear to be pro- duced in some cases. If they have previously been fat, they lose a portion of their bulk, but they appear more muscular, and sustain no loss of their animal pow- ers. Mania, or madness, as an affection of the mind, although so common a calamity to the human species, does not affect animals; at least we have no evidence to prove that it does. The circumstance of hydropho- bia being a specific malady, and capable of communica- tion by a specific infection, is no exception to the ob- servation just made. People should remember that our place of repose should be quiet, easy of access, and obscure. The less our senses are acted upon by external impressions, the more perfect will be our rest. Through sleep we may be said to be daily reborn, we pass every morn through a state of temporary annihilation into a new and a refreshed life. The alternations of labour and rest are, therefore, blessings bestowed upon us by the all-wise Benefactor of all living beings; for without this continual change, this incessant renovation, how wretch- ed would our condition be, and how depressed every mental and physical feeling! Take from us hope and sleep, and nothing of value would remain. The quan- tity of sleep necessary to preserve health, is certainly very different in various persons; perhaps, as a gene- ral rule, it may be laid down that not less than six hours, nor more than eight, will answer the purposes of nature. Those are, therefore, very unwise, who imagine that, by taking as little sleep as possible, they either prolong, or render happy, their existence. They may, indeed, spend more hours with their eyes open, but they will never enjoy life in the proper sense of the term, nor that freshness and energy of the mind which THE MANUAL FOR INVALIDS. 136 are the certain consequences of sound and sufficient sleep, and which gives a character of decision on all our undertakings and actions; for nothing can be said to waste us so much before the time, and give us the early appearance of age, as the want of this restoration: it retards all the vital movements, collects the vital pow- er, and completely restores what has been lost by ex- ertion and fatigue in the course of the day; there is also an expurgation of what is hurtful. It is, as it were, a daily crisis, in which all the secretions are performed in their utmost perfection. From such a state we arise like a giant refreshed, to our work. From the oldest times, the superior advantages of an early retirement to rest, and an early rising in the morn- ing, has been inculcated, not only by writers, but by a more unerring test, the general experience of mankind; yet the inconsistency of theory and practice is very re- markable:—we acknowledge what is right, and practise what is wrong. " Early to bed and early to rise, Will make us healthy, wealthy, and wise," is an old saw full of pith and truth. While patients are found so inconsistent, the practitioners of medicine must have much vexation. We are all subject to a great va- riety of diseases, and medical men, in order to cure or relieve them, study the art and science of medicine at great expense. All the preparatory studies of anatomy, physiology, and pathology, are pursued, the principles of relief are .clearly explained and recommended; but so perverse are the views of many patients, that they adopt their own inclination, temper, and passions, in the choice of remedies, leaving to their medical adviser only responsibility in case of failure; while, if they do 136 THE MANUAL FOR INVALIDS. well in defiance of advice, they laugh at their doctor, and take the credit of the cure to themselves. CHAPTER XVI. Gymnasia—The various Modes of Exercise—The Passive Mode by Carriage—The Active Mode by Walking—Running—Horse- riding, Sfc. In early times, the Greeks, who lived under a pure atmosphere, were convinced that a rational enjoyment of nature, and a continual exercise of their powers of body and mind, were the most certain means of con- solidating their health, and of prolonging their life. Those readers who have had an opportunity of perus- ing the writings of Hippocrates, will soon be convinced that the physicians and the philosophers of that age knew no better method of attaining their end, than by moderation in diet, the free use of pure air, bathing, and, above all, by friction of the body, and by almost constant exercise. A particular art, called the gymnas- tic, arose, approved by the greatest philosophers and men of learning, who never forgot that both body and mind ought to be exercised in the same relative propor- tions. This art has been much neglected with us, part- ly from the natural indolence of the human character, and partly from its prophylactic properties. It has but seldom been much encouraged by medical men, whose money interest has been rather to encourage disease than to prevent it. The ancients, however, suited exercise to the different constitutions, situations, and wants of man : they employed it, above all, as the means of THE MANUAL FOR INVALIDS. 137 keeping his internal nature in proper action—thus ren- dering the causes of diseases ineffectual, and proving a remedy to those already in existence. Every thing in nature may be said to be preserved in a proper state by action—even metals and minerals may be said to be in active state: indeed, it would appear that motion is es- sential to matter as well as to mind. The whole solar system is an illustration of this truth: the earth and all the planets keep their constant motions—the air is toss- ed by the winds—the waters are ebbing or flowing, no doubt to the preservation of their healthy state, afford- ing us a useful lesson of the advantages of activity. The propensity to bodily movement is in man as great as that of eating and drinking. Let us only look at a child:—Sitting still is to it the greatest of all possible punishments, and inactivity and listlessness is a proof of an unnatural, if not of a diseased state. Nothing tends to produce tranquil feelings, or to allay nervous irritation, so much as moderate exercise in the open air. The influx of riches, and the general accommodations which it brings in its train, has made it very fashionable to adopt the passive mode of exercise, viz. the various vehicles of carriages. This may be very flattering to vanity; but, unless an invalid be very far sunk in debi- lity, it is certainly not very conducive to health. The muscles of the human body have very little employment in carriage exercise, and (unless so far as air is con- cerned) carriage exercise is but little calculated to in- crease strength, which is principally wanted; for, in a great proportion of invalid cases, weakness is a very leading symptom. Exercise must always be suited to the powers of the patient : if a burthen be imposed be- yond the capacity, weakness, not strength, will be the 138 THE MANUAL FOR INVALIDS. result. Moderate exercise after eating is found very much to assist and accelerate digestion, and to promote the absorption of chyle, upon which the restorative pro- cess greatly depends. Exercise, of all things, is most improper during a hard or an accelerated pulse. Neither inflammatory nor febrile actions will bear the stimulus of exertion without being attended with lassitude and fatigue : even the stimulus of a light room, without any muscular exertion, has been known to be hurtful when the system is under a morbid excitement. This fact will admit of illustration by the operation of the mind itself upon the muscular power of the body. In a state of perfect health, when the animal functions are carried on with regularity, and all impressions upon the nervous sys- tem are of a pleasant character, producing an exhilarat- ing effect, the muscular power is wonderfully increased simply by such feelings ; the party is capable of under- going exertion much longer, and much more severe, without lassitude and fatigue, than under an opposite state of things. Whenever the mind is under a state of de- pression from any cause, either real or imaginary, the muscular powers of the body immediately by sympathy partake of the impression, and a corresponding detrac- tion from all the bodily energies is the consequence. From the observations now detailed, this practical fact may be very naturally deduced, that all invalids, whose complaints arise, in a great measure, from mental, or what is commonly termed moral causes, are thereby prevented from employing much bodily exertion, from the wearisomeness that often succeeds. Carriage move- ment, or passive exertion, will be best suited to their condition, until their powers be sufficiently recruited to afford more muscular efforts. The active mode of exercise, as walking, running, THE MANUAL FOR INVALIDS. 139 horse-riding &c, and every species of gymnastics, where the muscles of the body are frequently called into con- siderable action, are best suited to persons free from any local affection, either imflammatory or otherwise. Febrile excitement seems rather to be an affection of the whole system, than attached to any particular part; but it equally disqualifies a person from any desire for exertion, or the chance of deriving any benefit from it. Violent efforts are clearly improper, under any circum- stances, as they produce a very great acceleration of blood through the brain and lungs, and may be produc- tive of immediate death. Besides, where no such cala- mity happens, there is, in violent action, a large con- sumption of the vital power, with corresponding lan- guor and dejection, alike injurious to health as aggravat- ing to disease. Walking, or riding in the open air, both excellent in themselves, must always have a reference to the existing capacity of the party. Exercise should be carried to such an extent as to require the restora- tive power of sleep : when this is the case, the invalid will awake with greater capability ; but when carried to the extent of great fatigue, instead of rest come lassitude, ennui, and great nervous irritation;, banishing sleep> and inducing languor and debility. Moderate exercise is principally to be recommended ; and, if the liberty of choice as to the time of the day, remain with the party, the morning is on every account to be chosen as the best. With respect to dancing—a delightful employment among the young and the active—it is so very seduc- tive an amusement, that, although capable of the greatest benefits, 1 am much disposed to think it is practically very liable to do harm. The exertions are often too violent, and much too long continued : the rapid circu- 140 THE'MANUAL FOR INVALIDS. lation of the blood caused by it; the transudation of fluids through the surface of the skin ; and, more espe- cially, as it is most common in the long winter nights, exposing to the certain loss of sleep, and the very high probability of taking cold ;—make dancing, with all its pleasures, chargeable with many evils. Indeed, I have frequently known that the foundation of that most fatal malady, pulmonary consumption, has been very clearly traced to the returning home from the ball-room. I have repeatedly expressed, in the course of this Manual, that cheerful and delightful sensations have a wonderful power in giving nervous energy to the mus- cles of the body : now, this is most decidedly evinced in the hilarity and enthusiastic joys of the ball-room. If it were possible to inflict upon dancers one quarter of the extraordinary efforts they use, in the nature of punish- ment, or as opposed to inclination, what victims to ex- haustion would they instantly become! but their inter- nal feelings beating in unison with the " light fantastic toe," they neither fear, nor do they feel, that extreme debility which such great efforts must, under other cir- cumstances, occasion. With respect to this particular exercise, 1 feel I am treading upon a very delicate foundation : it has very great antiquity, and great exam- ple, to exhibit in its behalf. The great Socrates, who, if we are to credit the Pythian Oracle, was the wisest of men, not only praised dancing, but condescended him- self to learn it,—attributing extraordinary effects to mu- sic, numbers, and modulated motions, in regulated time ; nor was he ashamed, ay we are informed, even when an old man, to consider it as a most serious thing. Other names, of great character and splendid reputation, have given their suffrage to the exercise of dancing, as both conducive to happiness and health. In the Augustan THE MANUAL FOR INVALIDS. 141 age, after the carnage arising out of the civil wars and the proscriptions of that time, dancing was regarded as an elegant embellishment of civil life. Plato himself only complains, that some of its movements are calcu- lated to awaken feelings which require no stimulus ; and he even regulates and divides them : some he calls use- ful and agreeable, and rejects some as very rude, and even indecent; some movements he praises as graceful, others he admires. The Abbe Du Bos has detailed a variety of informa- tion concerning dancing, as connected with the passions and manners ; but has thrown but little light upon the subject that can be of service to an invalid, who is most interested in its bearings on his health. I remember, also, many years since, reading a work, entitled " Weaver on Dancing ;" and believe he simply gives an account, that the mimics and pantomimes were introduced in the de- cline of the Roman empire, when a total depravity of taste prevailed. Though dancers, they had all their names from acting or imitation ; thus the terms mimio and pantomime; copying all the force of the passions merely by the motions of the body, and without the help of words. Hence has arisen the Italian method of dumb show. Before I conclude upon this subject, I have to observe, that a physician, of great eminence in his day, but now numbered with the dead, has frequent-, ly declared his conviction, that many chronic affections of some of the abdominal viscera have been removed, after the patients have been saturated in vain with me, dicines of various descriptions, and that he could attri- bute their removal to no other cause so probable as th$ exercise of dancing. 142 THE MANUAL FOR INVALIDS. CHAPTER XVII. The Influence and Power of Custom and Habit upon the Mind and Body. The remarkable influence of custom and habit over the action of the muscles of the body, may be exempli- fied in numberless cases of gymnastics. The almost superhuman actions exhibited by the gladiators, of the ancient Romans are almost incredible. What should we think, now-a-days, of men contending with wild beasts, lions, tigers, &c, similar to what is authenticated of the Romans ? But it is not because mankind are become weakened; it is because the same motives do not exist, to induce men to develope all the energies of which they are capable. The gradual increase of the use or exertion of any of the animal functions will certainly in- crease the power of the function to a certain point. I do not mean to contend, that this principle can be carried on ad infinitum; but we can scarcely determine the extreme limits of our capabilities, until circumstances call them out. The present bull-fights of Lisbon, if they be valuable on no other account, are still interesting, as they give modern instances of the truth of the position for which we are contending. It is not only true in those cases where mere physical power is requisite, but where very nice and critical skill is necessary to effect certain objects. The various riding schools, and the extraordinary shows of skill at Astley's, are beyond the belief of human testimony, did not our eyes behold it. The Merry-Andrew system, the tumblers, and more especially the rope-dancers, exhibit what custom and habit pan effect. We all know that the parties, who astonish us with such display, do not obtain the dominion THE MANUAL FOR INVALIDS- 143 over their muscles per saltern; it is a very gradual acquirement, and their mechanical perfectability makes a sure but a very slow progress. Even the singers do not obtain the power of producing melody, by the almost. infinite modulations of the voice, but by a slow pro- ceeding, and often with great difficulty. The sense of sight, and also of hearing, are capable of great perfecta- bility—not by inaction, but by perpetual use. The North American Indians trace their enemies over tracts where, to an European eye, there appears no vestige of any human foot: this is the power of custom and habit: their sense of hearing is brought to equal perfection by the same means. The times of archery are gone by, excepting here and there an amateur of the science; but in this art the power of habit in the production of skill is wonderful. 1 have seen an archer, with his bow and arrow, take off the point of a crow's bill, at fifty yards distance, as it was sitting upon the bough of a tree ; he could, he assured me, with equal precision, have taken off its head, or perforated its heart. So much for the power of tact in custom, and habit in our automatic motions. The influence of custom and habit upon the structure and functions of the mind are wonderful indeed. Habit or custom produces very curious effects; it enables us to perform any work of art with greater ease than for- merly ; it also alters our feelings with regard to objects or exertions, by rendering that pleasing which was origi- nally painful; and lastly, which is the most important, and is, in some respects, a most dreadful thing, it influ- ences our opinions on some of the most dear connexions of life ; it often makes that appear right, which is fre- quently wrong, and things appear rational and just, which, in their own nature, are both irrational and wick- 144 THE MANUAL FOR INVALIDS. ed* Habit, so far as it enables us to accomplish any well understood purpose with greater facility than for- merly, is an affection of the memory or train of ideas. The repetition of an exertion, or the frequent presence of a disagreeable object, is gradually productive of ease or indifference, because the pleasure or uneasiness which attends our perceptions or efforts, is always diminished by being repeatedly felt. Things, at one time very disagreeable, as fcetid smells, or the taste of tobacco, or the mental effort in the study of language, often become even positively pleasing by habit; because the pain they once occasioned gradually leaves, while the plea- sure arising from activity remains and renders them, in some degree, acceptable, and sometimes, in the end, objects of passionate desire. What is it but custom and habit, under the name of fashion, which so far influences our opinion of what is morally right, however flagitious in itself, by so dimi- nishing the uneasiness with which we regard improper conduct, when it is continually in our view, till at last we begin to reckon it as a thing of course, and part and parcel of the order of nature ? In this way it is most grievous to tell, that the most absurd laws, creeds, &c, as well political as theological, come to be regarded, first with indifference, and eventually with pleasure. This debasing power of habit is also produced by our associ- ating bad actions in the memory with the persons who have committed them, and with the splendid situations which they occupy in the order or rank of society. It is the character of ordinary intellects to admire and regard, with more than common pleasure, the power- ful and the rich. Now this pleasure, occupying an undue share of attention) balances and overcomes that sentiment of disgust and hatred with which we should otherwise regard their improper actions. Hence, a mo- THE MANUAL FOR INVALIDS. 145 ral wrong is inflicted solely by the. influence of habit, and the vices and enormities of the rich and great are looked upon with far less hatred than the vices of men who occupy the lower stations of life ; and if the force of habit had not obliterated correct moral feeling, and crushed the sense of modesty and shame, would it be possible that adultery, which frequently leads to murder, and is, perhaps, without exception, the most pernicious crime that can take place in society,—that this crime of adultery should be less punished or less hated than most offences against property ?—in fact, adultery in En- gland, is not known to our boasted laws as a crime at all. It is not an indictable matter ; it is only profitable work cut out for the gentlemen of the long robe, in the way of action for damages. Thus the rich may make the happiness of the poor a matter of money calculation. To steal a chicken, or to filch a pocket handkerchief, is felony ; 'and frequently long speeches are made before grand juries upon the enormous increase of such crime. .But would you know the source of the difference? Gallantry, as it is called, is the vice of the rich and powerful, whereas thefts are generally outrages commit- ted by the poor. So perverted are our moral notions also, that war between nations is contemplated without horror; and the mutual destruction of the species is re- garded as a wise dispensation of Providence, to prevent the too rapid increase of mankind. This digression concerning the influence of custom and habit has an intimate relation to the state of inva- lids : it proves that all our muscular or mechanical move- ments are decidedly increased or diminished by habit; that not only our health, but, to a certain extent, our happiness also, is governed by it; because we are com- pelled, by the constitution of our nature, to yield obedi- 146 THE MANUAL FOR INVALIDS. ence to its laws. Whoever has read the Life of Elves, the Miser, by Topham, or the Life of Cook, of Penton- ville, by Chamberlayne, will readily admit its truth. Elves was a miser from the habit of seeing those around him, to whom he looked up as examples, pursuing parsi- mony as a principle. It was, therefore, natural to him, that it should become a law of his nature. It would be absurd to blame an individual, because all the moral in- fluences to which he is exposed, without any redeeming properties, should produce an ascendancy over his mind. Now, Cook illustrates the truth of this principle in a very different manner: he was born poor, and continu- ed so for some time in the onset of his life, and had witnessed deeply the sufferings that arise from poverty : he was determined to steer as clear as possible from what he considered as the greatest, if not the only, cala- mity on earth that he dreaded; he concentrated all the powers of his uneducated mind to one focus ; all his energies were directed to this object; and as to the means, as far as a sense of shame could be presumed to act, the end sanctified them. Most men, who have seen or felt the sufferings arising from distress, naturally try to remedy the inconveniences of their situation. In thus doing, they acquire the habits of economy and in- dustry, which do not forsake them even when they cease to be necessary. Their children are either taught, or follow from habit, the same course ; unless, as some- times is the case, extremes in nature produce equal ends; then the children feel disgusted at the contempt for the conduct of their parents shown by society ; they pursue the opposite extreme of prodigality, and thus, what is acquired by avarice is often dissipated by folly. Frugality is useful as a general rule, because the mass of mankind feel its benefits: it is far more necessary to THE MANUAL FOR INVALIDS. 147 the poor than to the rich : habits of great frugality in a very rich man, we immediately perceive, are not analo- gous to his station in society, and we withdraw a pro- portionate respect from such a character. Thus the power of custom and habit frequently gets an undue ascendancy over the understanding, and the associations of memory rule the mind, Thus the discernment of good and evil is obscured; and when the understanding loses its command, the distinctions of right and wrong, just and unjust, are very faint, and often disregarded al- together. Custom is a violent yet an insinuating teach- er: she establishes her authority over us very grad- ually, and by a smoothness that is at first barely felt: by little and little the power increases; yet having, by such a gentle and humble beginning, firmly planted and fixed it, she immediately unmasks, and exhibits a fu- rious and tyrannic face, against which we dare not look. We frequently see custom breaking through the laws of nature—Consuetudinis magna vis est. It has been said that our greatest vices are derived from the impres- sion made on us in our most tender years. We fre- quently think that we discover genius in a lad, when we see him outwit a play-fellow by some stratagem ; yet this is the ground-work of future tyranny, cruelty, and fraud. Children should be very carefully taught to abhor the vices of their own contriving ; and the natur- al deformity of them ought to be so represented, that they may not only avoid them in their actions, but hate them in their hearts. The power of custom over the mind appears to me to be established with less resistance than over the body. Indeed, what can it not effect ? It is constantly imposing upon our judgment and credu- lity. See its influence over all the Mahometan States: they are as firmly persuaded of the truth of the law of 148 THE MANUAL FOR INVALIDS. the Prophet, as we are convinced of the truth of the revelation of Jesus. Thus they substitute prejudice and custom instead of divine truth. It has been said, that there is no fancy, how absurd soever, that can enter into the imagination of man, that has not the example of some public practice, and that will not prove a sanction to our reason. Even miracles ap- pear such to us, because we are ignorant of the laws of nature, and not from the nature of the thing. Custom blinds the eye of judgment ; for if a reason be requir- ed of us why we do a thing, we have a ready answer —we say, " Does not every one do the same ?" In this manner, habit and example hide the true aspect of things from our eyes : thus a scrutiny into the abstract reason of things becomes very difficult. A great vari- ety of things bid defiance to research, as to a foundation in nature and truth ; justice, for instance, is simple, and ought not to be hedged in with local distribution or ju- risdiction ; yet what a complexity is exhibited in this divine article, not only in the various nations of the earth, but in the different courts of the same kingdom. Can any thing be more abominable,—and it is known as a matter of history, in a neighbouring nation,—that the venerable office of a judge has been1 sold, and sen- tences have been purchased with money ? In a philo- sophical view, the laws of ail countries ought to be the perfection of reason. We need not ask what they are in their practical operation ; and if the force of habit had not destroyed in us the very blush of shame, could we possibly endure such a reproach. But things grow familiar to our minds by their being very often either seen or felt: the monstrous become passable by custom: even our curiosity becomes less. Habit makes absurdities familiar; we neither admire beauties THE MANUAL FOR INVALIDS. 149 nor censure defects, nor do we enquire into the causes of them. It is clearly the novelty, rather than the grandeur, of things, that induces us to investigate their causes. Custom and habit exert their power over our opinions; for even poverty and riches are much altered in their nature by the opinion which we entertain of them ; for riches, no more than either glory or health, have any more value than we please to attach to them. Every one is well or ill at ease, just as he feels himself; not he whom the world believes, but he who believes himself; and in this particular, belief gives itself being and reality. All external accessions or deprivations, therefore, receive their relish, colour, and character, from our internal constitutions ; for, in the absence of bodily pain, it should seem that custom has a tendency to dead- en every sense, both of the good and of the ill, and levels all things. CHAPTER XVIII. The Sea Coast; its frequent injury to Invalids, especially in the Summer Months.—The most desirable Retreat for an Invalid. The advantage to individuals in dyspeptic complaints, of breathing in good air, has been particularly considered, under the chapter which treats of the function of respi- ration ; but there are other benefits, which have not yet been detailed, viz. the operation of good air and water upon the skin. We represented, when speak- ing of exercise, the great advantage the surface of the body received from friction, and recommended the use of the flesh-brush, particularly to the extremities. The 13* 150 THE MANUAL FOR INVALIDS. ancients, in most of their writings, very much applaud friction, as an agent of much power, both in the preven- tion and cure of disease. The moderns have disregard- ed it, without wisdom or excuse: of late a party have started up, who again are restoring the practice, and, in some cases which I have seen, with very signal advan- tage. The veterinary surgeons are devoted to the use of the curry-comb ; and they assert, that, from the sti- mulus thus applied to the skin of the horse, his animal spirits, and capability for exertion, are greatly increas- ed ; they say it makes him look sleek—he becomes gay, lively, and very active ; and they suppose that the function of digestion is much improved by the practice. The force of analogy will apply this mode of reasoning to the advantage of invalids, in all cases where torpor of the minute vessels of the skin is one of the symptoms of the complaint. Upon a visit to the sea-coast, our invalid very natural- ly wishes to be informed upon the subject of bathing, and under what circumstances, and what degree of tempera- ture, it would be most advisable for him to engage in this operation. In the first place, he should be informed that it is by no means an inefficient process. The skin, —an extended surface, highly vascular, and reticulated with a nervous expansion,—has very important func- tions assigned to it, and those functions have an inti- mate relation to the stomach, and the whole of the assi- milating organs. It may fairly be inferred, that there is no neutral ground upon the subject of bathing; and that, in almost all cases, in which there is no benefit re- ceived, there is positive mischief suffered. Great dan- ger will often arise at the very onset of the process, on account of patients indulging their taste upon the matter without advice,—and indulging in it rather as a matter THE MANUAL FOR INVALIDS, 151 of luxury, than as a process for the recovery of health. They are liable, also, to mistake their sensations, and imagine themselves labouring under debility, when it has sometimes happened that internal inflammation in some of the thoracic or abdominal viscera has been sub- sisting; and the use of the cold bath under such cir- cumstances has been fatal to the patient. That peculiar debility caused by great anxiety or mental exertion, in the absence of bodily disease, often vanishes after cold bathing, and the strength of the patient is restored. It is perhaps a matter of importance, as to what particular time of the day cold bathing should be employed. The dyspeptic invalid should never venture into a cold medi- um without the stomach receiving the stimulus of food. The robust and the healthy may bathe early in the morn- ing—if, indeed, they should feel any necessity for bath- ing at all; but, as a general rule, the period best chosen for the cold bath, should be about two hours after having taken breakfast. Dr. Currie notices that patients ought not to wait on the edge of a bath, or of the sea, until they be perfectly cool, for if they plunge into the water in that state, a sudden and an alarming chilliness may be expected, which would not have been the case, had they been moderately warm when they went into the water. In the opinion of the writer, an invalid should never remain longer than about one minute in a cold medium, and he should be covered all over with the water; the air should not come into con- tact with some part of the body, while the other part is immersed ; a bath at a temperature of about eighty-five degrees Fahrenheit is perhaps the best to begin with ; it can easily be lowered to a number which will suit the patient. The cold bath should never be employed, if the patient complain of any fixed pain in the head, side, 152 THE MANUAL FOR INVALIDS. or any part of the chest, where congestion of blood in any of the vessels may be presumed to exist ; or in any case of internal inflammation; under such circumstances it is capable of producing very serious mischief. The use of the warm bath need not be encumbered with so many memoranda; it is very often useful in local affections of the joints ; it must also be useful in many cases which require the circulation to be carried to the extremities of the vessels of the skin. Count Rumford has published such a very interesting Essay upon this subject, and many of his positions are so very true and proper, that the reader may safely be referred to him as a guide upon this matter. Perhaps a patient ought not to remain longer in the warm bath than about twenty minutes; and as to the time of the day, the best for employing it is about an hour or two before din- ner. The author before mentioned says, that a person may gain fresh health, activity, and spirits, by bathing every day, at two o'clock in the afternoon, at a tempe- rature of 96 or 97, and remaining in the bath half an hour. Warm bathing has been presumed to have a very debilitating effect, as being the converse of cold bathing, which is known to be restorative ; but this does not of necessity follow, nor does the cold bath inevitably give power: the effects of both are governed by existing cir- cumstances, which will form the rule for the patient. If warm bathing should induce profuse perspiration, it should be abandoned, as this circumstance will generally be hurtful to an invalid. As warm bathing is known to lessen the resistance in the arterial system to the ac- tion of the heart, it would, perhaps, be best to avoid it in the evening ; the accelerated action of the vessels, near the surface, might provoke a nervous irritability, inducing restlessness and absence of sleep. With tera- THE MANUAL FOR INVALIDS. 153 perate baths, and the shower bath, the invalid ought to be but little acquainted, as the principle upon which they can be useful he cannot be presumed to know; and if he be under the guidance of a scientific practi- tioner, all observation upon their use would be unne- cessary. Before any observations are made upon the advan- tage of the air of the sea coast to invalids, I shall no- tice that, in the case of dyspeptic patients, it would ap- pear highly probable, from the symptoms, that it is chiefly from the sympathy which is felt from mental in- quietude that the disease is caused. A very full illus- tration has been given of the functions of the stomach in this Manual, and in which it was demonstrated to be the grand organ of constitutional sympathy. It is very difficult to explain a variety of very distressing local af- fections of patients in particular parts and organs, where no symptom of diseased function, or of organic lesion, may be presumed to exist. These affections are said to arise from sympathy ; yet no connexion, perhaps, can be traced between the source of the stimulus and the seat of local pain. Vascular fulness is generally an ac- companiment of that series of anomalous symptoms which usually belong to dyspepsia ; and the author has very long been convinced, that not only flatulency, in- digestion, palpitation of the heart, hysterics, and like- wise that peculiar feeling called heartburn, are entirely affections of the beautifully nervous web-work expanded on mucous surfaces ; often in the cavity of that particu- lar organ, to which the sensation happens more intimate- ly to refer, as are many other sensations at present very unaccountable; but it may be asked, how does it occur, that the nervous expansion on mucous surfaces is so peculiarly affected by mental emotions ? I answer, be- 154 THE MANUAL FOR INVALIDS. cause the surfaces are secreting surfaces. It has before been explained, and it is hoped to the satisfaction of the readers of this Manual, that the functions of the brain have a direct and immediate power over all the secre- tions, whether of glandular or of membranous structure ; and in which it was asserted, that it was a proof of great ignorance of the animal economy, to deny the vast power the mind possessed over the whole capillary system. Upon this datura arguments may very safely be ground- ed, to explain not only many of, the symptoms of dy- spepsia, but the manner of obtaining relief from many of the remedies which are often employed. The author has sometimes seen violent dyspepsia produced by a very evident cause—deep sorrow; and which was accompanied with a morbid vascular fulness of the villous coat of the stomach;—lower orifice be- came painful, and a schirrous tumour formed, which ended in cancerous ulceration and death. It is a very usual thing, when what they commonly call a disordered stomach takes place, to attribute such uneasiness either to the quantity or the quality of the food that has been taken; but it is, perhaps, well known, that if the internal feelings be perfectly in unison with the external circumstances, neither the quantity nor the quality of the food will produce the smallest effect;—nor, perhaps, will it pro- duce any inconvenience in healthy stomachs. It is usu- al with some people to attribute the effect to the forma- tion of acetous acid; with others, to the extrication of an unusual quantity of carbonic acid gas; but the curi- osity of the fact is, that neither one nor the other of these substances will produce a similar uneasiness in the stomach of any healthy person: to any thing, or to almost every thing, may it be attributed, save and ex- cept the true cause, viz. the omnipotent influence which THE MANUAL FOR INVALIDS. 155 the mind has over the reticulated nervous expansion upon mucous membranes, which line the internal cavi- ties of most organic structures. These preliminary remarks, which would appear, to a cursory observer, not to be intimately related to the subject of this chapter, were introduced with a view to illustrate some observations, respecting the benefit to be derived from leaving the metropolis, and going to the sea-coast, which is become a very fashionable practice of late years; and, in regard to the benefit derived, many are of course highly gratified, while others are equally disappointed. The effect of the different gases, or aeriform fluids, upon the constitution, when introduced into the blood by means of absorption from the air-cells of the lungs, has been sufficiently explained in a former chapter. The effect of cold and warm bathing, and also of fric- tion of the surface of the skin, has also received recom- mendation; and its beneficial operation upon health has been shown; but the operation of the atmosphere upon the healthy functions of the animal economy has not been sufficiently illustrated or explained. The skin and the lungs present most extended surfaces for the ab- sorption of this vivifying fluid: nor has sufficient credit been given for the very great advantages which have been received from this source. It may be said,—What benefit can arise from the change of air? is not the air nearly the same in all situations? does not air, analyzed by chemistry, present nearly the same combinations and results ?—That change of air has a powerful influence upon invalids is an indisputable truth;—how it produces that object, is a circumstance worthy of enquiry. The experiments of Gay Lussac, in his aerial ascent, in the month of September 1805, would lead us to sup- 156 THE MANUAL FOR INVALIDS, pose there is no distinguishable difference from the greatest elevation: he went nearly 8000 yards above the level of the sea, and found very little difference in the composition. It cannot be denied, but there are various foreign bodies in the air, either in chemical so- lution or mechanical union : where there is a dense population, there must be a great quantity of carbonic acid gas, animal exhalations of various kinds, and smoke in abundance. The question immediately recurs—What are the co-existing circumstances that render the air of some places so much more healthy than others? and from what source arise the advantages which are expe- rienced by invalids from change of place? This ques- tion may be answered by another:—Is it a fact, that they do receive this advantage ? and can such benefit be fairly laid to the account of change of air and of place? In another chapter of this work, it was assert- , ed that the large capitals of Europe were, more or less, i the sepulchre of the dead and the hospital of the living: j the mortality of the people in the metropolises of seve- ral kingdoms were stated, and a comparison made with the surrounding country villages; and the result of the comparison proved the truth of the proposition. We have every day proof that children become very unhealthy when constantly confined to the air of large cities; robust and healthy persons are not so much af- fected. We have a proverbial saying—" The weakest must go to the wall." In all unhealthy situations, the highly irritable susceptible being is nearly certain of be- coming a sacrifice; on this account the delicate dyspep- tic invalid should avoid, if he have the power, the in- salubrious atmosphere of large cities. To the philoso- pher, an examination how these effects are produced, may be interesting; but to the invalid, nothing is so THE MANUAL FOR INVALIDS. 157 valuable as to know how to avoid being the victim to whatever cause the unwholesome properties of the at- mosphere of large cities may be attributed—whether to dampness and stagnation of air, or to the animal efflu- via and the carbonaceous matter which is constantly floating about them and in them. That they are so is certain; and to the truth of this the bills of mortality will bear sufficient testimony. It is, perhaps, not suffi- ciently known, that the skin is an absorbing surface of great extent, as well as the air-cells of the lungs; and the action of the absorbents are continually, with their bibulous mouths, taking up particles which produce im- portant effects upon the animal functions : we know that iron will rust with more rapidity in London than in the country; we know, also, that plants will wither and die, after they are brought from their nursery grounds and placed in the London court-yards, although they may have been attended to with much care. I am persuaded that cheerfulness and the animal spirits are produced and increased, as much by the process of absorption from the skin, as from any other cause ; and when the mind is happy, it tends, more than any thing, to regulate the feelings which have such great influ- ence over all the secretions and excretions of the body. The sea-coast has been found often hurtful to inva- lids. In most affections of the lungs, and in cases of spitting of blood, it has accelerated the fatal event. In the summer months, the intense heat of the sun fre- quently produces lassitude and debility; and it often happens that you have no protection from the power of its rays, either by shelter or by shade. The comforts and benefits arising from the breezes of the sea, are to be experienced by an invalid as useful only in cases of simple debility, in which its effects are restorative. It 158 THE MANUAL FOR INVALIDS, will be of no use to go to the sea-coast with an organic disease, as it confers no sort of advantage. I have said that Penzance is a desirable situation for many people in ill health—and it certainly is so ; and many parts of Devonshire, not very far from the coast, would be, per- haps, a very healthful and desirable residence for an invalid : but change of place is as beneficial as change of air; monotony of scenery is irksome to people in health, and must be more so to those under various cau- ses of irritation. But, although 1 think the sea-coast not to be chosen for the abode of the patient, a rural residence offers every probability of advantage. The enjoyment of pure, sound air; simple and frugal food; away from the corroding sensations of avarice; daily exercise without doors, in proportion to the muscular powers of the person; established regularity in all the vital functions, and a frame of internal peace and sereni- ty ;—what sources of vital restoration are here exhibit- ed! Were it possible to be surrounded with intellectual society in the country, equal to what can readily be found in London, who, possessing the liberty of choice, could hesitate what to do ? Who would not remove from the dissipation and worthlessness of large towns, where fashion,—the bane of wisdom and the law of folly,-—rules triumphant, and where many deadly vices lose their natural deformity by the frequency of their practice ? A country life affords the best chance of equanimity and peace of mind, which are the great supports of life; our enjoyments are increased without violence or passion, and moderated by the eloquence of nature,—quiet and serene, inspired with cheerfulness and hope. Can we wonder that, uniformly, the greatest instances of long life are to be found in the country ? In rural retirement, with good health, moderate fortune, THE MANUAL FOR INVALIDS. 159 and a happy partner in marriage, he must be insensible indeed, who would not lay his hand upon his heart, re- turn thanks to his God for the happiness, and exclaim— " How bless'd do I live! how calm will I die I" CHAPTER XIX. The Attachment of Sex, a very important Feature in the Character of Health.—Improper Attachments to be early checked, before the imagination becomes absorbed with its Object to the Injury of all the Animal and Vital Functions. The subject of this Manual is the attainment and pre- servation of health, and the very interesting matter of this chapter will receive no other uisGUssiuu man as it relates to that object, either physically or morally. In the examination of causes connected with various matters of enquiry, it has often occurred to me, that we often overlook those which lie nearest to us, and assume others, frequently the most absurd, in order that our minds may be at rest, and that we may indulge the indo- lence of our dispositions as much as possible. The first fact which I shall notice upon this subject, is to assume that it becomes the duty of every person who has the guidance and guardianship of youth, to take care that sexual attachment should receive no artificial excite- ment to call it too early into existence. The preserva- tion of the species will not be endangered by the exer- tion of individual prudence, but the happiness and health of the party may be immolated by the absence of dis- cretion ; nor can I reprobate, in language sufficiently strong, the depraved taste and demoralized principle 160 THE MANUAL FOR INVALIDS. which induces young men to seek gratification and enjoy- ment from a variety of females : it is an outrage upon the most important of nature's laws, the violation of which is sure to produce mischief and repentance. Those who have read Tacitus De Moribus Germa- norum, must admire the description which he gives of the manners of that people in regard to chastity and marriage. In relation to their health, sexual intercourse was regarded by public opinion as a crime, previous to the connubial state. None of the imaginary evils aris- ing from continence, which a licentious mind creates to itself as an excuse for indulgence, were either felt or feared by the Germans. The muscular powers of the body, and the energies of the mind, received their full developement before marriage was thought of or expect- ed : both mind and bodv united to give energy to oWacter. and produced a result which caused the astonishment and the terror of the Romans. Among such a people, nervous invalids must have been an extra- ordinary phenomenon. It is to be supposed there was but little mental irritability, few cases of insanity, little of hypochondriasis among the men, or of hysteria among the women. I should apprehend there must have been but a very moderate demand for any hypercritical re- searches in pathology or medicine ; and probably as they were but little required, they were but little studi- ed It does appear to me, that the present age has very much fallen into a taste for the times of chivalry, and that all romances must, either more or less, assume that form, in order to please. 1 have always admired, and still think worthy of admiration, the great, noble, and resolute principle of thinking and of acting of those old Germans, who, from the forests of their nation, gave brilliant examples of moral feeling, and of institutions, THE MANUAL FOR 1NVALTDS. 161 which have been adopted and imitated by modern nations, in the exact ratio of their love of freedom. The more we are excited by their example, the nearer do we approach the proper dignity of the human charac- ter ; and in nothing were they more remarkable, than in their strict continence, and in sparing their physical manhood until the proper period arrived for marriage. Voluptuousness and debauchery, the prevalent vices of modern times, formed no part of their character ; the physical propensity to amorous intercourse with the female did not, among them sink into brutal enjoyment, but was exalted into sentiments of honour and fidelity. The historian says that each person bore in his heart the image of his beloved object ; and this romantic love was the shield of his continence and virtue, and this abstinence gave physical energy to his body, and courage and resolution to his mind. These notions may be considered as romantic, or even impracticable, by the irritable and fastidious being of modern times ; but if health, strength, and longevity, be objects of acquirement, they must still, to a certain extent, be adopted. The passion of k>ve, which, in those "times, Was, among that people, regarded as a security against luxury and voluptuousness, is at present degenerated into mere brutal gratification. The virtue of chastity till the period of marriage, which is the principal foundation of moral firmness and manliness of charac- ter, has become a subject of irony and ridicule ; and, as a learned writer has properly said, that, which ought to be the last and sweetest reward of toil, labour, and danger, has become a flower which every stripling crops by the Way. If any purpose of nature be clear with respect to the union of the sexes, it is that of an indis- soluble' union of hearts in affection and love; and this 14* 162 THE MANUAL FOR INVALIDS. alone can lay the foundation for a dutiful generation of children, and a healthful or happy old age. There is nothing that requires more discretion than sexual indulgence, as it respects both the health of the body, peace of mind, and salvation hereafter. It has been found by experience, that those persons who have employed their minds upon serious and abstract subjects, have had this feeling more under restraint than others not so employed; as, by these means, they are induced to avoid all artificial allurements, and the simple impulse of nature is allowed to run its course without excite- ment. It is impossible for a well-regulated mind to view early, irregular, and illicit indulgence, without feel- ings of horror. Is a man the seducer of early innocence, or of conjugal affection, his moral degradation is com- plete ; for he who has exposed to physical and moral misery an innocent being, whose future errors and li- centious conduct must be ascribed to him as the first exciting cause, is " ripe for treasons." There was lit- tle of infidelity to the marriage bed among the Anglo- Saxons, our German ancestors; the thirst for gold did not cause among that people improper or incongruous matches, incompatible with human peace. Universal execration would have followed the monster who should disturb and poison the matrimonial and domestic felicity of a whole family, for his brutal and sensual gratification. What are the physical results to the unhappy female, who becomes the victim ? Sorrow and perpetual grief, acting upon a too susceptible temperament, disturb the function of the brain, and change the healthy actions, of all the glandular and nervous structures; every percep- tion, every feeling, is associated with horror, until its progression often terminates in insanity and suicide I THE MANUAL FOR INVALIDS. 163 These effects upon the health and existence of the poor sacrificed victim are manifested by every day's ex- perience ; but the crime of corrupting the wife of, per- haps, your friend, has consequences more extended, if not more dreadful. This is a crime which, according to every moral tendency, is more detestable than rob- bery, or even murder, which it often causes ; for what is the value of any other property, when held in com- parison with the property of the heart? and what is the robbery of goods and chattels, when compared with the destruction of all natural sympathies ? A rapid succes- sion of crime generally follows these enormities; nor can it be expected that the sensual character will abstain from the lesser, when he has so frequently practised the greater, evil. There is a disease of a terrible character, which should seem to be designed by Providence as a punish- ment justly appropriated to the criminal who indulges in licentious gratification ; but spectacles of misery, in the sufferings of others, are seldom of sufficient efficacy to reclaim the party, whose passions hurry him to his fate ; not to mention, that pathological science has so much advanced within these few years, that the power medical knowledge has obtained over the dreadful symp- toms caused by this disease, greatly diminishes its hor- rors, and of course, with it, the force of example. But it may, perhaps, be properly asked, why do I compare the simplicity of the iron age of the ancients with the golden age of the moderns ? The difference of circumstances will always produce corresponding results. Luxury and refinement engender a taste for fastidious and expensive enjoyments, which cannot be compassed by persons of moderate income : example, custom, and fashion, with inexorable tyranny, are continually goad- 164 THE MANUAL FOR INVALIDS. ing On persons to a mode of expenditure which their in- come will seldom bear; and as the state of marriage, in modern society, is such as to give occasion to very great increase of expense, many are obliged to avoid it, because they will not sacrifice the appearance of wealth to the reality of the pure enjoyments of nature. The battered beau, the debilitated debauchee, after having rioted in the round of sensuality, verging near his half century, begins to look about him for a wife; but where seeks he the wife of his fancy ? A respectable female, but little below his own age, will never suit a man of such habits; he must look about him for youth, beauty, and fortune : and if he have little or no property of his own, the more necessary is it that he should eunningly fasten upon his object; swear, and forswear, that she alone can make him happy ; and, if she have the mis- fortune to believe him, he boasts that he has made Cupid the broker to supply his own necessities; and, when too late, his young wife detects the unworthiness of his motive, respect is banished for ever: thus, for the most part, they live on, to love less and less. And now permit me to ask, if those who are so closely, unit- ed, and in whom so many sympathies ought to play in unison are the torments of each other, where shall we find tenderness, comfort, or consolation ? But will you ask me what bearing or relation this has,. upon the subject matter of health, which is the object of this Manual? I answer, that nothing influences happi- ness, or misery, so much as sexual intercourse, either with or without marriage. Persons who are happy are generally in good health ; and those who are miserable are either diseased, or soon will become so. Well-re- gulated affections are certain evidences of passions held in control, and of a judgnieat unclouded. Perhaps no- THE MANUAL FOR INVALIDS. 165 thing can be said to be well done, that is done out of season. It is said " that May and December can never agree." Marriages may be contracted too early, or too late : both are evils; but they are evils of very different kinds : very early marriages, before the powers of na- ture are fully developed, are injurious to health, both of parents and offspring; besides, they are apt to cause a rivalry between parents and children ; the son or the daughter is anxious to come into the enjoyment of the world, before either the father or the mother shall be willing to quit it. A celebrated writer has said, that the daughter begins to bloom before the mother can be content to fade : thus jealousies are created ; irrita- tions are formed ; and causes of vexation and disquie- tude arise, rather out of the nature of circumstances, than from want of affection, or personal dislike ; and in a society of artificial wants and fastidious desires, a very numerous progeny requires a large expenditure, whkb. cannot always be conveniently met. Thus mutual re- criminations too often exist, when the res angusta domi appears as an occasional visiter, or a perpetual inmate, asserting the truth of the often-repeated observation, « that when poverty comes in at the door, love flies out at the window." Can we promise better results from marriage con- tracted too late ? Can it, with propriety, be said, that the longer the time which is employed in deliberation, the more fortunate or happy will be the choice ?. Will length of time employed in balancing of chances inevi- tably give advantages in this matter ? Where marriage is a circumstance of cold calculation, and the passion of love and affection is out of the question, time will in- crease experience, and give better opportunities of re- search and selection : the number of children will,, also, 166 THE MANUAL FOR INVALIDS. probably, be fewer, and they will not so immediately tread upon the heels of their parents. But it must be recollected, that as life advances, opinions become fixed, friendships are contracted, and habits are established. Nor will it often happen, that either will be readily in- duced to forsake that which custom has rendered pleasing. Time itself, as it insensibly modifies the external cha- racter and manners, also determines both the power and the direction of the passions; and whoever attempts materially to change the bent and course of his own life, will very often find such labour to be in vain. And can we expect to do that with others, which experience demonstrates we are unable to do with ourselves ? The author remembers the observation of a much esteemed, but now deceased friend, who often declared, that there was nothing that so properly excited the sympathies of others, as a father reduced to poverty by a numerous family. If the accurate calculator determine to marry late, because his children shall be few, he will find, by experience, that if, from this source, he have less to fear, he will have also less to hope; and although I cannot counsel or advise marriage too early, the greater evil is certainly marriage out of season, or too late. The sweet endearments of early love they lose, without any equal value ; and what can compensate for the great probability of leaving helpless clildren, deprived of a parent's care or affection, ignorant, and perhaps diseased, without either a heart to pity, or a hand to relieve ? And what grief must assail a parent, who knows he must leave the world, before those whose existence he has caused can have acquired either knowledge or discre- tion to conduct themselves in it ? Nor will leaving of property always secure the object for which it is intend- ed. When the shepherd becomes a robber, the lambs THE MANUAL FOR INVALIDS. 167. will be fleeced. Nor is this a mere theoretical sug- gestion ; the records of the Court of Equity exhibit but too many practical evidences of its truth. But, according to every principle of philosophy, we must acknowledge, that to every effect there must be an adequate cause: all the phenomena, both physical and moral-, that exist in the world,—what concerns us here, as living beings, or hereafter, as subjects of a retri- butive providence,—have their spring either in the physical nature of man, or in the institutions of society to which he is compelled to yield obedience. There- fore, what must be the cause why the licentious should avoid both the comforts and advantages of marriage, and pursue a career of folly and of guilt ? It is the mammon of unrighteousness—that sacred thirst of gold—that root of all evil, which seems to have taken an undisputed possession of the human heart. All the laws of civilized life view the protection of property as the end of their institution, and which they effect by the execution of numberless living beings, who are continually sacrificed to this Moloch! Even the ministers of our holy reli- gion are but too much tainted with this disease of the mind; they, whose kingdom should be hereafter, and who declare that covetousness is idolatry, and that " it is easier for a camel to go through the eye of a needle, than for a rich man to enter the kingdom of heaven,"— these sacred characters, instead of stemming the current, are content to float with it. Virtue is praised, but starved ; avarice is condemned, but practised ; the pro- fession of godliness is made great gain; and whoever does not amply provide for the wants of his own house- hold, per fas et nefas, is considered as having denied the faith, and is worse than an infidel. Therefore, in the only legitimate intercourse of the sex,—the insti- 168 THE MANUAL FOR INVALIDS. tation of marriage,—avarice forms an important feature, both as to the time and the object. Marriages, which ought to be so largely an affair of the heart, are entered upon from principles of convenience or expediency: under some circumstances, it is little better than legal prostitution; for if the goods and chattels of the betroth- ed parties can be brought to unite, their loving and sympathetic souls will ever be found ready to guaranty the treaty! The learned Burton says, that the dearest affections ^of the heart are made a matter of bargain and sale; that marriage, whose superstructure should be built _• upon the foundation of health, love, and care of offspring, is reared upon that of private convenience; and often, from more degrading motives, we marry disease, and, as a valuable consideration, we receive money. This, he says, is the great goddess we adore and worship ; this is the sole object of our desire. If we gain money, we are esteemed, notwithstanding our habits ; if we are unfortunate, we are despised, nor shall we be thought to possess either talent or virtue. The respect of the world lasts no longer than our wealth; when that is gone, farewell friendship. The dearest ties of nature are broken by poverty: and when money is gone and spent, the lamp of love is out; for money was the fuel that (ed the flame. We love those that are fortunate and rich ; we admire those who thrive ; we hate and abhor those, on the other side, who are poor, ill, and miserable, or by whom we even suspect it likely v e shall suffer loss or inconvenience ;—there is nothing so agreeable as profit. Health is considered a precious thing; to recover and to preserve which, many will un- dergo almost any misery ; but some are very reluctant to give money for it. But give them wealth and honour—j- THE MANUAL FOR INVALIDS. 169 give them gold—you immediately possess their affec tions. Thus it was when Lucian wrote; and Burton says, that the moderns are worse, because they endea- vour to conceal their guilt under the mantle of religious hypocrisy. The observations heretofore made upon this subject, have related to its physical and moral influence upon (he health; but the attachment of sex has other verT im- portant pathological relations. To the critical observer it is well known, that the union of sex is caused by feelings more early and more powerfully excit»d in some temperaments than in others. It should be a matter of very early enquiry, whether there exist any sufficient cause, or obstacle, which ought to be heU as a sufficient reason to prevent the object in view- affection ought not to be called into action, where t*ere are insuperable barriers to ultimate union. Fenr'es> particularly, are liable to severe mental affection?'1'0"1 disappointments of this nature; because, from the" high nervous susceptibi- lity, their feelings are much ^ore acute ; and because of the vital importance to them of being happily matched,— their peace of mind, and health of body, depending upon that event,—it is truly t*e crisis of their fate. The pre- disposition to disease *as been discussed in the other part of this Manual; hut the hereditary character of dis- ease presents new futures and dreadful consequences to those who consul-' only their own convenience of wealth and expediency without taking other valuable adjuncts into the accost. Who, that has any love for their chil- dren, would be the voluntary cause of propagating here- ditary disuses ? Would any man be happy under the thought, *iat suffering disease and premature death, had been in^cted by him, in the want of discretion in pro- perly /electing the object of his choice ? Neither male, 170 THE MANUAL FOR INVALIDS. nor female, should be induced to form a matrimonial union, where mania, gout, and more especially scrofula, are known to exist; and although the fashion of the times has been pleased to discredit much of the humoral pathology of the ancients, sufficient remains to demon- strate that those diseases, and others that might easily be n\med, are undoubtedly transmitted by parents to their childrm. It is much to be regretted that, if the adored object l^ve captivated the affections, less attention i» paid to tKs subject than its importance demands. These' diseases imUCe painful sensations ; these sensations dis- turb the ac^i-acy 0f the perceptions ; the temper is soured, and m tives are misrepresented ; and as it has pleased Provide^e to make an organized material sub- stance the mediun.^y which all the mental energies are carried on, every daj>s experience affords abundant proof that the mental affecting are produced by the bodily feelings and movements vhich accompany them, and by the trains of thought, or «.action, to which they give birth : but this subject has *,ver been carried on to its remote effects. There is a disease which produces a gluey softness of the bones ; in this the animal ^ten abounds, and the earthy particles of the bone are ^sorbed. Now, this disease has been remarked to occif m children—the produce of very early, and in those o\very late, marri- ages : deformity of figure is the result 0f this disease. When invalid unites with invalid; when morbid irrita- bility seeks a union with nervous suscepfbility, what product can be expected ? The breeders of animals have a method of improving the race, by what they^all cross- ing the breed : nature seems to exert the powvr of al- most infinite variety ; uniformity and sameness appear to cause degeneracy and weakness. Our object shodd be THE MANUAL FOR INVALIDS. 171 to acquire power both of body and mind, and to trans- mit these blessings to our children. The most certain method of obtaining such desirable objects, is to adopt the means that have been recommended to diminish our susceptibility to all morbid excitements; we shall then both attain and preserve our health. CHAPTER XX. Various Affections of the Skin, so common to Invalids.—The Pecu- liarity of the Herpetic Tetter in the Face.—Its Dependence upon the healthy or disordered State of the Secretory Organs demon- strated.—Means of Prevention explained, and Remedies proposed. We can, perhaps, scarcely receive a better proof of the sympathy of parts, as suffering in conformity with the particular state of the mind, than is exhibited in affections of the skin. The various authors who have written upon cutaneous disorders, have ascribed it to various causes; and many of them very different in their nature to each other. It has often been asserted with great confidence, by many who were said to be " wise in their generation," that all affections of the skin are caused by the stomach being in a suffering state; and a par- ticular state of the skin is now commonly called a sur- feit. The intestines, and the whole of the abdominal viscera, have in their turn received the character of producing a correspondent derangement of this organ- ization. Perhaps it would tend to illustrate this matter somewhat, by describing the particular texture which is called the skin. If we view its surface, even with the naked eye, we shall find it to be very porous,—more so In some places than in others; and the pores are also 172 THE MANUAL FOR INVALIDS. much larger in some parts than in others. By placing a portion of this tissue under a lens, we discover that many of these pores are ducts of sebaceous glands ; others serve to transmit hairs; another class are, per- haps, of a secretory character,—for the perspirable matter is seen to exude through them. A class of ves- sels, with bibulous mouths, are also found by the sides of these pores, which, from their function, are called absorbents ; and these vessels take up morbid fluids, under certain states—as in the bite of the mad dog, the case of inoculation for cow-pock or small-pock, and several other affections or states of the body : in dropsy, for instance, the skin absorbs fluids from the atmosphere. Without, however, attempting to elucidate what are often called final causes, but simply to record facts as they are exhibited to our senses, it will be sufficient to observe, that the complexity both of the structure and function of this texture is very evident. It has a variety of pro- perties; it is endowed with great powers of dilatation, and a corresponding property of elasticity: we are un- able, however, to detect muscular fibres ; but it has pro- perties very similar to muscle, for it contracts and re- laxes. Another peculiar property is its extreme vascu- larity. The property of intense sensibility is equally evident: the net-work of nerves, which are spread over its whole surface, is the cause of intense suffering under circumstances of inflammation or disease. Those who have undergone surgical operations, uniformly agree that the anguish was greatest in the division of the skin. It is thickest in those parts of the body intended by na- ture to bear weight or pressure ; as on the back, the soles of the feet, and palms of the hands. We find it thin on the fore-part of the body, on the inside of the arms and legs, and where opposite surfaces touch each THE MANUAL FOR INVALIDS. 173 other. It is extremely thin on the lips, and in very delicate complexions it is transparent, and the colour of the blood may be seen shining through it. All parts of the body are not equally endowed with sensibility : the marks of superior feeling or touch in the skin, are the projec- tions above the common surface of those little congeries of nerves, arteries, veins, and absorbents, called villi. The nerves upon the skin may be said to be an expansion of net-work, rather than distinct chords : they are here very small, but very long and numerous. Perhaps there is no part of the living texture subject to such a variety of distinct and specific eruptions as this structure. This must arise from its whole surface being an assemblage of secretory organs. The nervous energy acts upon the skin at every instant, and a critical eye can easily discover even the minutest effect. By the impulse of hope, the face glows with animation : it is a stimulus which in- creases the momentum of the blood, and gives spirit and power to every mental feeling. On the other hand, the sedative operation of fear renders less powerful, but more tremulous, the action of the heart and arteries. It, to a certain extent, may be said to paralyse the whole mental machinery : its decisive effect upon all the se- cretory surfaces i3 instantly evident; the face is as pal- lid as death ; the extremities are cold; the heart rather palpitates than contracts ; the whole surface of the skin is in a state of spasm; and the human body, und^r its action, positively occupies less space than it dtf when free from it. The little congeries of vessels/lately de- scribed as small protuberances, by which certain func- tions were performed, increase greatly in size, appear like little mountains upon the surfrce, and obtain the name of goose's flesh. The larger ^'andular structures do not escape its power: the kid*«ys instantly secrete most 15# 174 THE MANUAL FOR INVALIDS. abundantly ; the bladder can no longer retain its con- tents, and an involuntary flow takes place ; the whole cylindrical surface of the intestines participate in the ef- fects, and an abundant excretion succeeds. This simple principle will not only elucidate the na- ture of a variety of the eruptions and diseases to which the skin, in cases of ill health, is more particularly liable, but has a direct reference to that universal sympathy of parts to which all nervous tissues are subject. The author has before fully discussed the physiology of the stomach, and demonstrated that it is a great organ of sympathy ; but he should think himself much mistaken, were he to attribute almost every evil to which the hu- man frame is liable, to the stomach. An eccentric phy- siologist of modern times has carried his opinions to such an extent, as to cause apprehensions concerning the san- ity of his understanding. He is right, to a certain de- gree, as to what is often called the proximate cause ; but there, is also a predisposition to disease, which is often invisible to the eye, and sometimes inscrutable to the understanding. The agency of the stomach is only an effect of a previously existing cause. It may, indeed, originally be subject to organic disease, like any other viscus; but as the productive cause of affections of the skin, or other structures, it acts only by sympathy. It is very true that none of us,—even the best philoso- phers,—are infallible: we but too often mistake effects for causes : the author could as easily believe that the disease ol the maniac, whom a misapplication of words often terms «. lunatic, was caused by the influence of that planet, as Ve could be induced to believe that the stomach is the cause ^f the variety, of affections for which, it has the credit, if an eruption upon the skin happens to take place aftei certain food is taken, it is THE MANUAL FOR INVALIDS. 175 immediately described as indigestible, and that nature has relieved herself by the throw-out upon the surface. Dr. Robert Willan had been for years in social inter- course with the author ; and his opinion of cutaneous affections, as to their cause having uniformly been re- ferred to the stomach, suffered some change before his voyage to Madeira, which ended in his lamented death. The brain is the source of all the nervous power. We know, from experience, that the skin immediately feels the effect of all the mental emotions—joy, hope, shame, terror. It participates in every feeling ; is respondent to every sensation : it is, to all intents and purposes, a secretory surface, and, of course, liable to all the changes, either in function or structure, to which the varied and rapid alterations in the state and temperature of the at- mosphere renders it subject. On all susceptible tex- tures, the peculiarity of the stimulus gives the charac- ter to the morbid results ; and this position is explained by the nature of the stimuli of various affections which most concern the skin,—as scarlatina, small pox, mea- sles, erysipelas. The various description of herpes, pemphiges, several of the blooms or efflorescences, and what are often called mental roses, which give a glow upon the surface, are all so many proofs of the local ir- ritability of the capillary vessels. One of the diseases just mentioned, viz. pemphigus, is clearly a constitutional affection, and the functions of the brain are disturbed before the eruption appears. It is very reasonable to imagine that this disease must long have existed, but only in modern times has it been described with any tolerable accuracy. So very rare was the disease when Dr. Cullen wrote, that he never saw it until it was shown to him by Dr. Home. The symptoms are, in- tense pain in the. head, sickness at the stomach, great 176 THE MANUAL FOR INVALIDS. oppression about the heart, excessive lassitude and weariness on the least exertion, with great stiffness and rigidity of every joint: there is also some affection of the mucous membranes; for the throat is very sore,skin intensely hot, the eyes very dull and languid, but sel- dom with delirium ; the whole surface of the skin is interspersed with bladders of various sizes—some of them of the size of an ordinary walnut, and, in some instances, larger, especially on the arms and breast. After existing for a certain time, they form a whitish scab, or crust; and the constitutional symptoms declin- ing in the same ratio, the patient recovers his health. We have observed, that the herpetic tetter is very common to invalids ; and, from some cause hitherto in- explicable, it fixes its seat very often in the face. This fact alone, unconnected with other considerations, is sufficient to render it an object of interesting enquiry. We have already explained the pathology of some of the diseases of the skin, as arising from certain states and conditions o{ the mind, and have considered the sto- mach simply as an agent in producing eruptions on the surface. The term herpes has been given to this parti- cular tetter, from its disposition to spread, or creep, on the skin. It covers a large space in a small portion of time. They may be classed into divisions, each some- what differing from the others: they are known by an assemblage of numerous little creeping ulcers, forming clusters, and itching very much ; often difficult to heal, and terminating in a sort of branny scales. This parti- cular eruption has obtained the name of the dry tetter: it is the most simple of all the varieties, and there is less of inflammation and heat before it terminates in its scurf. There is much of itching during the period of vascular inflammation. Theii course is ended by forming a white THE MANUAL FOR INVALIDS. 177 powder similar to bran, while underneath the skin is perfectly sound and healthy ; when, from any renewal of the exciting cause, it returns again in the form of a red surface or efflorescence, which ends as before. The most common of the varieties of herpetic tetter are the following :—The pustular tetters, which begin in a distinct form, but frequently run into a cluster, and become confluent; at the beginning the tetter contains a thin, watery serum, changing to yellow, forms a thick crust, or scab. After it has existed some time, the mat- ter of the tetter becomes acrid, the scab is lifted up before the granulation has taken place, and the parts underneath are ulcerated. This description of tetter is very troublesome, as it often attacks the face, and forms amongst the hairs of the head, where it is excessively disagreeable. The miliary tetters frequently break out indiscriminately over the whole body : they appear in clusters, and sometimes in distinct rings or circles ; they are very minute, and have obtained their name from their resemblance to millet seeds ; they are a separate and distinct kind of tetter, and contain a particular clear lymph, which, in the course of the complaint, excretes on the surface, producing distinct scales, which at length fall off, and leave much inflammation below. The itch- ing also, in this particular tetter, is very troublesome, and the discharge from the pimples is very tough and viscid___causing most of the substances applied, to ad- here to the parts, which are afterwards, with much dif- ficulty, removed. We have said, there are a great variety of distinct genera of tetter, but as those above- named are what most commonly affect invalids (and the other descriptions are frequently so formidable that pro- fessional aid cannot be dispensed with), 1 shall, without 178 THE MANUAL FOR INVALIDS. considering the other species of this disease, speak of the means of prevention and cure. We are now come to a more agreeable part of our pur- pose, which is to point out a probable means of preven- tion of this annoying complaint. If any person in good health should, on reading this chapter, be disposed to imagine that I have given this subject more importance than it should seem to deserve, I can only say that such opinion, not being founded upon a sad experience of the complaint, would deserve but little attention. Those who labour, or have laboured, under its ravage, will at- tend with eagerness to everything that can be said, that tends to explain the pathology of their sufferings, the method of prevention, or remedies for the cure. There is scarcely anything, to the female part of the species, more truly destructive of good temper and human hap- piness than this peculiar complaint. We have said, that the whole surface of the skin is a living texture of secretory organs. When this tissue receives its healthy, nervous stimulus, its function is in unison with all the secretory mechanism of the animal economy ; but acted upon by morbid stimuli, its secre- tion loses its salubrious character, it becomes acrid and poisonous: and that tjiis is demonstrative as matter of fact, we have only to give in evidence a description of a particular tetter, which, from its poisonous ulcerative quality, has obtained the name of herpes exedens, or corroding tetter. When the tetters first come, they ex- hibit small painful pimples, which soon ulcerate, collect into spots of various sizes and figures, always accom- panied, more or less, with an erysipelatous inflamma- tion ; they very soon secrete a quantity of very thin, sharp, and truly poisonous fluid, which, increasing in acrimony and power, spreads along the neighbouring THE MANUAL FOR INVALIDS. 170 parts, and produces deep ulcerations. It will sometimes not only destroy the skin and cellular membrane, but even the muscles,—forming a structure of secreting sur face, which, when taken up by the absorbent vessels, produces hectic fever, and occasionally death. We sup- pose this will afford sufficient evidence that a disturbed function of a secretory surface, when assuming its mor- bid character, is capable of producing effects truly alarm- ing, and much to the detriment of all comfortable exist- ence. * The first measure of prevention which the author Wo^d suggest, is dietetic. Avoid all animal food that has beetM^^ saturate(j jn flujd having muriate of soda for its base, °^-^is commonly called brine ; as, by these means, all the a,.. ^.^ es ^ ^^ ed, and immediately enter ^.^ combinati(m with that fluid. The quantity . ^ ^ should be very moderate, and must be ^ ^ ^^ tious description. Neither lamb, veal, nor ^^ ^^ be eaten ; but beef or mutton, either roasted or bron**. The indication in view, is to enable the secretory or- ganization of an extended surface to resist ordinary sti- mulus. Farinaceous food, as being very nourishing and of easy digestion, should be chosen ; all fermented li- quors, having in any way alcohol for its base, must be avoided. The food in general should be of a light and wholesome description, with a tolerable proportion of fresh vegetables ; it being found, by experience, that those vegetables which contain a native acid, as oranges and lemons, give strength, and, at the same time, dimi- nish the morbid irritability. It has been remarked, that fermented liquors, which contain a considerable portion of farinaceous gluten, have been useful, such as ale, spruce beer, &c. It has been observed, also, that a 180 THE MANUAL FOR INVALIDS. moderate proportion of fluids which contain carbonic acid gas, taken when in the act of effervescence, such as cider, soda water, &c, by its invigorating quality, has given power to the secretory surface. Another method of prevention, of much efficacy, is friction upon the sur- face of the skin, and ablution with a large sponge and water: the friction should have sufficient power to ex- cite a moderate glow, or a sense of heat, upon the skin. And wherever there is a predisposition to pimples or tetters upon the surface, shell fish should be avoided. Water-cresses, and the stem of the lettuce, as posses- sing both sedative and tonic powers, have the'" ' .... r > ' 1 • a -•»' view. when the indication of prevention is chie** m, , . . r . , . ,.