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A Plea for a Simpler Life
Chapter I

The simpler life for which I plead in the following pages is very different from that usually recommended by the profession, and followed when possible by the public. I am thus called upon to give some reasons which have led me to adopt it for myself, and for those who have come under my care, and were willing to follow my guidance for themselves and their families. I must also show how, from circumstances, I have had special advantages which have given me an open mind in considering various important questions, while most of the medical men of the day, especially the younger men, have more or less implicitly followed the teaching of the schools without doubt or hesitation.

It is easier for most men to be guided by authority than to think for themselves. There is much more free-thinking outside the profession than within it. In the profession I have had but few followers, although these are by no means wanting. With outsiders I have been much more fortunate. For thirty-five years I had more clients than I could do justice to without assistance, and many of them were of first-class ability and position. It is with the hope that this little volume may reach some, both :’n the profession and out of it, who would adopt a better system if they but knew it, that I offer it to the public. I have frequently been asked by professional and other friends to publish my views, but from various reasons which I need not mention I have hitherto refrained from doing so. The delay has at least given me abundant time to reconsider them. and. after being for fifteen years in a great measure outside the profession, I feel less inclined to modify them than ever.

I have long been convinced that the present system of medical teaching and practice is wrong. As to the former, it is so complex and multiform that the most industrious and capable student has to load his memory with a mass of ‘ notions ’ which he soon finds are for all practical purposes useless, and which he soon forgets, most of them never to be recalled, or, if wanted, to be found at any time in a few books of reference. Each professor, of course, on the ‘ nothing-like-leather ’ principle, thinks his own branch the most important. In this respect the teaching of medicine has got much worse in recent years, and seems to be still on the down grade. But for the plan of consecutive examinations, which allows the student to confine his attention to a limited number of subjects at one time, the present system would certainly break down.

As to the main principles which guide the Practice of the day, they differ toto coelo from those taught sixty years ago when I began my medical studies. Most of the common diseases were then ascribed to overaction of some sort, and the remedies were bleeding, vomiting, purging, sweating, etc.; in short, depletion was the order of the day. I still retain my silver lancet case given me by a ‘grateful patient’ in 1845. About this time the tide turned, and I wonder how many physicians carry a lancet case now! The change came quickly, very much from the teaching of an eminent and popular physician in London, who taught that disease as a general rule depended on a weakened action of the functions, and required ‘setting up’; the means being stimulating and tonic medicines, and plenty of good food and drink. [It is instructive to note that the physician alluded to died comparatively young from disease of the liver.] A history of the transition from the one method to the other would be very instructive, bat on this I cannot enter. Some excuse was necessary to explain the change. This was found in a supposed alteration in the human body, which rendered it less able to bear lowering measures than formerly. My friend, Dr. J. Hughes Bennett, was a strong exponent of this idea, but I and others never could see it. [Dr. Bennett did much good work in Edinburgh; I will only mention the introduction of the use of cod-liver oil in phthisis.]

The new system of treatment reached its full maturity in a very short period, passing from one extreme to the other, with little or no resting at any intermediate point. The question naturally occurs—Are we to have a backward movement to the old depletory practice, or are we to have a forward rush sooner or later, it may be to a better, it may be to a worse fashion of the day? Or may we hope for a reaction from the extreme doctrines of to-day which may happily come to a stop before it reaches the opposite extreme? And here also the old adage may be to and good, Inedio tutissimus ibis. It is to the realisation of this last idea that I would fain lend a helping hand; and there are some advantages that have accrued to me in the course of my long observation of medical science and practice which may help me in the task.

I began my medicai studies in 1836 and took my degree of M.D. in 1841. I have been a Fellow of the Edinburgh College of Physicians since 1845, and now there are but two members senior to me.

I was one of the last of the Edinburgh apprentices, one of several. Our master took much pains with us, gave us much practical aid, and long before I was an M.D. I had seen and attended large numbers of sick as a dispensary pupil. This enabled me to derive real benefit from a full course of attendance at the Edinburgh Infirmary. Owing to the illness of my father there, I spent most of the winter of 1839-40 in Perth. There I attended closely the clinique of Professor Schoepf Merei, director of one of the three hospitals for children then in existence, and editor of the only Hungarian medical journal. I spent the winter of 1841-42 in the hospitals of Paris, and the classes of the Iicole de Medecine. After this I was assistant to Professor, afterwards Sir James, Simpson, who was then at the commencement of his brilliant career. This occupied me very fully for a year. I then went to Rome for a season, intending to practice there for a time, but owing to the prevalence of homeopathic ideas which I could not adopt, I had no encouragement to return. In the wards of the Santo Spiritu Hospital I witnessed the 'Hippocratic succussion,’ the only physical diagnosis I saw practised there, though now it is very different. The rest of the year I spent travelling in the East, mostly in Palestine and Syria, where our dragoman, who had never been with a real ‘ hakim ’ before, kept me rather too fully occupied with a varied clientele, from Turkish pashas and Arab sheiks down to the poorest inhabitants of the country in their tents or more wretched villages. In 1845 Professor Simpson asked me to join him as colleague. After five years I left him and continued to practise in Edinburgh till 1880.

From the above short history it will be seen that early in my professional life I had a varied experience of the different modes of treating disease at different schools and in different parts of the world. There was but little scientific treatment in those days; it was mostly empirical, and the remedies were comparatively few. Bleeding was in full swing in Edinburgh in the Thirties, and in 1842 Bouillaud was still carrying out his plan of venesection coup sur coup, which was perhaps the greatest extreme to which depletion was ever carried.

But there were signs of change. Majendie in Paris, and Sir John Forbes in London, had come to the conclusion that strong measures were of no use in such severe diseases as pneumonia, and found that the patients did quite as well when simply kept in bed and let alone. On the other hand, Hahnemann and his followers were trying to prove that infinitesimal doses of medicine had stronger effects on the system than the large doses hitherto employed. The Rev. Dr. Stewart of Erskine greatly changed the treatment of consumption by stopping the plan of depletion and starving, and putting his patients on a more generous diet. Amongst others he cured a daughter of Lord Blantyre, who afterwards became his wife and the mother of my worthy old friend, the late well-known Dr. P. Stewart of London.

A good specimen of the mode of treating chest cases in those days, and one which naturally impressed me most, was the case of my father, a very powerful man of forty-four years of age, who in the year 1834 was treated for a smart attack of pneumonia or pleuro-pneumonia. He was well bled, blistered. and generally depleted. On recovering he went to Deeside for change of air. and was almost restored to health when, from his bedroom window being accidentally left open, he caught cold. He consulted the two then most famous physicians in Aberdeen, father and son, who told him he was threatened with consumption; ulcers of the lungs were mentioned, I remember. He was ordered to go home, keep in two rooms at a temperature of 6o° during the winter which was then approaching, put on a most restricted diet, and for a time to have blood taken from his chest by cupping twice a week. After six months of this treatment, as may be imagined, he was reduced to so low a condition that his friends who saw him off in the early summer for a change of air never expected to see him again. But with the change of air and the stoppage of all treatment he very soon rallied; and though more or less an invalid tor the rest of his days, and never able to resume regular work, he lived till the good age of eighty-nine, and he never to my knowledge showed any sign of lung disease whatever. He was, in fact, till treated in the above fashion a very healthy and powerful man of 6 feet 2 inches. His ordinary walk was at the rate of 5 miles an hour, and this he had on occasion kept up for 70 miles; and his lungs were remarkably large and healthy.

From my varied medical education and experience it need not be wondered at that I gradually lost faith in the ordinary medical dogmas of the day, and especially in the depleting and drugging system as then practised and considered orthodox. I had a strong conviction that homeopathy—however wrong in its own dogmas—would at least show the absurdity of the orthodox system of drugging. The doses were then really infinitesimal, and they were coming to be used by non-professionals, especially by ladies, many of whom had their book and their box of globules arid tinctures, and treated not only their own families but all others who would consult them; some who had done this for years have told me it was no use to say there was nothing in homeopathy, for the change in the health of their families had been most manifestly better since adopting it: and among them were women far above the average in power of observation and common sense. I had no doubt whatever of the good faith of those ladies, many of whom were personal friends and relatives; and to me the only possible way of accounting for the phenomena was that the benefit derived was not from the infinitesimals, but from the absolute withdrawal of ail drugs whatever, and from greater attention to simple methods.

One of my most intelligent lady friends, wife of a Highland chieftain, treated her own family and those of most or all her tenants with great success for a period of four years. She told me that she then came to the conclusion that the benefit was entirely negative, so far as drugs were concerned; and she found that the same common complaints did just as well without any medicine at all. By and by, from whatever reason, the professional homeopaths began to use powerful remedies, but in very small bulk, and now it is by no means safe for everybody to use these remedies; and, so far as I understand, the book and box have fallen more or less into disuse. Certainly, the effect I had hoped for has not arrived, and drugs are now much more numerous and much more used than ever.

I was further induced to look with distrust on the plan of perpetual and varied drugging by noticing the practice of some of the most eminent of the older practitioners of the time, who used very few and very simple remedies. I need only mention Dr. Abercrombie and Mr. Syme, both of Edinburgh. The former, who was a great friend of my father, was very kind to me as a student, but I only met him once in consultation. The patient was an old lady in George Square, Edinburgh : she was suffering from a smart feverish attack, and the doctor was much pleased to find that she was gettr'ng no medicine, and for food only a small quantity of milk and lime-water, a very favourite prescription with him. Mr. Syme used to say that doctors were of no use, and that if anything was really wrong they must come to the surgeons. Certainly, I never heard of him giving beyond a small dose of rhubarb and soda, unless ii was minute doses of bichloride of mercury, and this with the view of eliminating from the system other forms of mercury, for which he always had a great dislike. He was himself a very abstemious liver. He gave excellent dinners to small parties of eight or ten, at which I often ‘ assisted,’ and they were the pleasantest I ever knew. But he was heard to say that after soup and fish he considered he had dined, and anything further he only played with. He enjoyed, however, a glass of good sherry, and to this, probably, were owing the attacks of gout to which late in life he was liable.

There were other old physicians and surgeons who were by no means so sparing in their use ot drugs, and from whom I got practical lessons in an opposite direction. Two cases which I saw with Professor Alison made a lasting impression on me. One was that of a poor old woman whom I was asked to see, as Dr. Alison, who was one of the kindest of men and had been visiting her regularly, was laid up with illness. She was suffering very much from a collection of biliary calculi in the gall-bladder, and was reduced to the utmost degree of emaciation. She had been treated very actively, especially with strong mercurial remedies, but with no good result; and to keep up her strength she was getting all the little luxuries in meat and drink that could be thought of by the wife of the Rev. Dr. Hunter of the I ron Church, who asked me to see her. The case seemed hopeless, the day of removing such calculi by the knife not having yet arrived; but, in the hope of an easier death for the poor woman, I stopped ail treatment and put her on small quantities of milk and lime-water. The effect was wonderful, and she was making great progress to at least a temporary recovery, when the worthy professor again took her in charge. The old remedies were resumed, and the old suffering was soon ended by death.

The other case I saw along with Professor Simpson. It was that of a child from the country with serious head symptoms. There was a doubt whether they were from an organic or from a merely functional cause. Professor Alison decided that it was safest to take the serious view of the case, and he recommended very active measures. After he left, and after some further consideration. Simpson decided for the simple view; the child got the benefit of the doubt, and soon was quite well without any active treatment whatever.

My own personal experience gave me also a dislike to drugs from a child. I was considered the weakly one of the family, and therefore was the most dosed. Calomel was in fashion, and the day after getting some grains of this I suffered so horribly that I resolved, if I ever should be a doctor, I never would give a child a dose of it; and I never have.

But the medicines then used were all nauseous, and no doubt this in a great measure prevented their use to the same extent as now, when they are made up (as a general rule) so as to cause no immediate disgust. Pills were only coming into use. The most common was I)r. Gregory's or colocynth pill, easily swallowed, but often causing much suffering afterwards. What proved a very favourite ‘dinner pill,’ the first I remember of a now numerous progeny, was ‘Thomson’s antibilious pill’; Thomson being the Rev. Dr. Andrew Thomson of St. George’s Church, Edinburgh, one of the most brilliant preachers and debaters of his day. He was a great diner-out, and no doubt his pill helped him to dispose of many a good dinner ; but he died of apoplexy wher. a comparatively young man. His was a simple aloetic pill; Gregory’s was aloes and colocynth. The •Irritating effect of the latter was soon lessened by adding henbane, and the aloes-and-hen-bane pill became a great favourite. Somewhat later, Sir Charles Bell got much credit for advising that all such pills should be taken after a meal or with a light one, as at tea-time, dinner being then taken at a comparatively early hour, and tea a few hours afterwards. His reason was, that the action is thus so much milder that, as a surgeon, he could recommend aloetic pills without the risk of bringing on haemorrhoids, a common result if aloes be taken on an empty stomach. The amount of ingenuity expended since these days in rendering medicines palatable is something wonderful. Perhaps the amount of money spent in advertising new medicines, many of them worthless, some of them fortunately innocuous, is more wonderful still.

To complete my own personal experience with drugs. Having involuntarily begun the habit of using aperients (and with no fixed ideas as to food, for I never was taught any),

I continued their use as I thought I required them up to the age of thirty-five. I had abundance of hard work, and very little recreation. I no doubt made grave errors in diet, both as to quantity and quality, as I perpetually suffered from so-called bilious attacks, lasting for two or three days. With them I had intense headache, aggravated no doubt by the remains of malarial fever, which I contracted in Syria, where I spent five months of the spring and summer of 1844, living in tent, exposed to all weathers, and sleeping often on the ground with only a rug to lie on. Already I was treating my patients with very little medicine ; and I began to find that instead of doing me good, an aperient gave me no relief, even temporary: and I quite gave it up. For full forty years I do not remember having once taken an aperient. I still suffered however much as before, and soon resolved to give up work, and to move to some warmer climate, as my attacks usually commenced with a chill, and I found the climate of Edinburgh very trying. Fortunately I wrote of my intention to my old friend, Dr. Merei of Perth, then a Hungarian exile and settled as a physician in Manchester. He strongly advised me before taking so serious a step to give up butcher's meat, reduce my tea and coffee by a half, and of wine to take only a little light claret to dinner, if I found it to suit me. He had written on the diet proper to different temperaments. He knew that mine was very strongly nervous, and he considered that red-meat diet rendered the blood too irritating for my excitable nerves. I had the sense to act on his advice, and soon found that I was in the right direction ; and though I still suffered more or less for many years, I was able to continue work for twenty-five years longer, and then it was not my stomach that failed me. That is now fifteen years ago. I had still something to learn as to diet, but, with rest and comparative freedom from anxiety, I now enjoy such health as few can boast of after an active and anxious life of more than three-quarters of a century.

I have spoken hitherto of aperient medicines, these being far most commonly used by the profession, and still more by the laity. In England, so far as I can judge, they have been and still are more used than in Scotland. It may not be so much the case now, but when my patients had occasion to consult a first-class London physician, the prescription was almost always an aperient and a tonic, either singly or together. A single mutton chop, lightly cooked, with bread and a glass of sherry for lunch was a very favourite prescription, but this did not necessarily interfere with a moderate but more varied dinner afterwards. Frequently food was not mentioned, and a worthy old friend of mine, a well-known physician nearer home, used to tell his patients that if at forty they had not learned what was best for their stomachs, he could not help them.

Of the innumerable new remedies that have come into notice in recent years I need say little. Some of them, as the various anaesthetics and antiseptics, are most valuable. They have revolutionised surgery, but have not done very much for medicine. Of the new chemical remedies the number is so great that it is impossible for the ordinary medical mar. to give them a fair trial, and they add enormously to his already too numerous tools. If they do all that is said of them, nature will have less chance still of snowing what she can do without them, and we will have specialists of drugs as well as of diseases. Of the older remedies the ultimate effects on the system are very imperfectly known; some, as sarsaparilla, have been proved to be inert and of others, as digitalis and alcohol, the effect has been shown to be the very opposite of what they were supposed to be until a recent period.

It must not be supposed that, while condemning the abuse of medicines, I do not know and acknowledge the real value of some of them, when used in the proper cases, and in the proper manner. Iodide of potassium is an admirable remedy for eliminating some deleterious matters from the body. In syphilitic cases no one doubts its efficiency. I have used it infinitely more frequently in cases where—from overfeeding mostly—the system had got loaded up, and a peculiar sallow look and ill-health indicated some general derangement. In most of those cases aperients and tonics had been used, often for a long period, with the object of helping digestion. There was usually some lowness of spirits, or irritability, or both, and always a want of strength. If the iodide is used in this condition the relief to the patient is often very remarkable, and, ii accompanied and followed by a fitting change of diet, it is usually permanent. But it also may be abused if taken with the view of letting the full diet be continued with more comfort. From sixty to one hundred grains in small doses usually sufficed to give the patient a good start, but in one perhaps unique case a middle-aged lady took close on ten thousand grains in the course of five years. For all the warnings I gave her she would not give up her Bass and her beef; her excuse being, that without these she could not do her duty to an old lady she looked after, and who certainly was rather exacting: and she could not take them comfortably without her medicine. For two years her health was better than before, then it began to fail, and three years later she died. Her general symptoms were those of phthisis, but without the distinctive physical signs.

Another most valuable medicine is quinine, especially for malarial fever; but it too may be used in a wrong way. Mrs. A. returned from India with fever. I had long been the doctor of her family, but the husband’s friends would not hear of the ‘ starving doctor ’ being called in. After six months she was no better, but worse, and I was asked to take charge of her. I found her in a wretched condition, extremely weak and emaciated, and having severe attacks of fever every second day. She was encouraged to get out of bed on her free day, but was getting unable to do so. It was a case, if ever any was, for stopping the fever and getting up the strength; but how was this to be done? Quinine, arsenic, and iron had failed, as had wine and all sorts of rich tempting food, but for want of better these were still being pushed. The internal congestion was such that quinine could not keep off the shiver, the first stage of the fever, and it took a long and severe hot stage to restore the balance of the circulation, and this, followed by a drenching perspiration, left the poor lady so exhausted that any attack might have carried her off. I had now a perfectly free hand. All medicine was stopped, and all stimulants.’ for food she had the well-tried milk, lime-water, and white of egg, in very small quantity; and she was kept constantly in bed, and mustard poultices freely used. The fever came every second day as before, but after ten or twelve days her condition otherwise was so much improved that I ventured to give the quinine again in full dose. It at once checked the fever, and it did not return. She could soon take a reasonable amount of light food, her strength slowly returned, and in a wonderfully short time she was enjoying very fair health, and returned to India.

How is it that the commoner medicines still hold their place so universally if, as I believe, they are mostly useless, and often injurious? One reason no doubt is that patients have not much patience, and wish for some immediate relief. In some cases, where it is clearly impossible or may be unsafe to give this relief, a placebo may be of use. I have always had too much respect for my patients and for myself to have recourse to this as an ordinary practice; but I once got more credit for prescribing a box of bread pills than perhaps I ever got from giving a stronger medicine. Another reason why medicine is still so much used arises from carrying into practice the well-known aphorism of Hippocrates: ‘Melius remedium dubium quam nullum ’—Better a doubtful remedy than none. There is an old saying of the Rev. Dr. Chalmers: ‘No one can tell what evils may result from the enunciation of a wrong principle.’ I know no wrong principle from which so much evil has resulted as that enunciated in the above axiom. The fallacy lies in the word remedium. It implies that the doubtful means employed is a remedy, though it may not act as such in the case in hand. The. idea that it may hurt is left out. It is a strong measure to correct Hippocrates, but for his axiom I would substitute the following: ‘Melius medicamentum nullum quain dubium ’—Better no medicine than a doubtful one. The new word implies a doubt, an uncertainty of good or evil, and from this the inversion of the rest of the sentence naturally follows. When a doctor is called in he is expected to do something, and, the course of the disease being so very uncertain, it is not easy for the patient, nor for the doctor either, to know, should improvement follow, what share in this the medicine may have had : and, vice versa, if the symptoms become aggravated, this may be in spite of the means used, and altogether from the disease. The Hippocratic maxim is no doubt a great source of comfort to the doctor; and so long as he knows that he has followed the teaching of the experts of the profession, and gives the remedies indicated by the symptoms of the case—is thoroughly orthodox, in fact,—he may keep an easy mind. If his patient dies, he gets credit for having done all that was possible. But a very serious ‘ evil' arises from always acting on the principle which the maxim so clearly ‘enunciates.’ He can never know what is the natural course of the disease for which he has used the doubtful medicine, and he may go on during a whole lifetime obstructing nature instead of helping her.

I will give here only one disease where the usual treatment is, I am sure, in many cases, most injurious; and simply because it interferes with nature’s processes. In a case of scarlet fever it is the almost universal practice to give at once a dose of aperient medicine. Now, when the doctor is called in in this case the disease has already reached its second stage. The first step is the absorption of the poison and its effecting a lodgment in the system, and this is seldom attended with any marked symptoms. These are produced by the reaction of the system to throw off the poison, and unfortunately it is these which we are apt to look upon as the disease itself, and therefore to combat. In an ordinary case of scarlet fever the poison is thrown out by the skin and the mucous surfaces of the throat and pharynx. In some cases, perhaps from some previous errors in diet, there is diarrhoea, or irritation of the stomach and vomiting : and these cases often do badly. It seems natural to suppose that a dose of aperient medicine will, by causing more or less bowel irritation, interfere with the natural action of the skin and throat, and may turn a simple case into a severe one ; and this I have found to occur in practice. I have often read of cases where this evidently happened, and I have met with it in cases I have seen with others. From almost the beginning of my practice I have never given a dose even of the simplest kind. In a very small proportion of cases the poison is so strong that it kills it. twenty-four hours, or little more. In these there is no room for treatment. In old times Dr. Armstrong recommended bleeding to relieve the great internal congestion, and it is possible that this treatment might be attended with success; nowadays I fear that if the patient died it would be said that he was murdered. I have met with one such case. In a few others which proved very rapidly fatal, the insanitary condition of the house was a sufficient cause ; and in one—of a strong boy, who had eaten butcher’s meat three times on Christmas Day when he took ill—a moderate degree of scarlet fever, which must have been approaching the stage of eruption, was accompanied with persistent bilious vomiting, which went on till he died. Two other members of the family had at the same time the disease in a moderate form. In ordinary cases of scarlet fever the bowels usually move of themselves in two or three days; but I have known this not to happen for a week, and on one occasion only after nine days, and the motion then has, whenever I have ascertained the fact, been perfectly natural. I believe that this was one main reason why I rarely lost a case of scarlet fever, even though severe; and some few friends who have followed my example have had the same experience. I may mention one in Edinburgh who has a large family practice, and with whom thirty years ago I saw some very bad cases. He then always began the treatment with a dose of aperient medicine; and he was astonished when I told him my suspicion of this being mainly the cause of his bad results. Six months after giving this up he told me that the change was very beneficial ; he had some severe cases, two of which he said should have died, but they did not. Lately I saw him, when he told me that now he seldom loses a case. I have told many of my experience, but few, I fear, have taken my advice. Some years ago, in the British Medical Journal, an English doctor published a letter strongly recommending giving no aperient in scarlet fever; but his letter was immediately followed by two from other doctors giving directly the opposite advice, and the question dropped.

My colleague and successor in Edinburgh. who has always for twenty years avoided aperients in scarlet fever, is equally convinced of the great advantage of following this course. He also, as I did, seldom meets with a case of albuminuria after scarlet fever; but our young patients have been in some measure properly fed when well, and get nothing stronger than milk for at least three weeks after the fever shows itself.

But equally important with drugs as remedies are stimulating drinks and foods : the same remarks apply to both of these as to the lirst-named. They are both in fashion just now, when the great object of medical treatment, in a large majority of cases, is to 'keep up the strength.’ But is this really their invariable, proven their ordinary, action in states of disease? I am convinced that it is not.

First, as to Drinks. I believe, from observations on myself and on others, that Sir B. W. Richardson is quite right in his conclusions, come to from strictly scientific investigation, that alcohol, in every form, lowers the strength both of man and beast. For long I have looked on alcoholic stimulants as I do on a whip or a spur to a horse. They may bring out more force at the moment, but the effect is very transient, and is attended with a decided loss of power. They may possibly be of use in the rare occasions where a temporary stimulus is all that is wanted, but even for this there must be already some stock of force, capable of being called out at the moment, and also sufficient to carry on the necessary actions of the system afterwards. If this demand on the potential strength of the victim is called for by repeated doses of the stimulant, the ultimate effect must be exhaustion. The conclusion then is the absurd one: that when stimulants are given to ‘support the system.' or to ‘keep up the strength,’ the force must be there already, or the stimulant can have no action whatever.

The last of the remedies to be mentioned is Food, and this must be placed in the same category as the other two doubtfuls when we come to consider its value in disease. All food, in the widest sense of the word, is taken for the purpose of nourishing the body, and rendering it fit for its daily work. In the healthy conditions of the digestive organs this is done automatically, and all that is wanted is a regular and moderate supply of what is proper food under the circumstances. But in disease the organs of digestion are not in a healthy condition. In a very large proportion of cases they lose more or less their power of digesting food at all, or they do it in a very imperfect manner. Even when there is no structural change to be noted, the nervous force necessary to perfect digestion is wanting, and to take any food into the stomach can only do harm. Nature in most cases provides against this by stopping all appetite for food, while usually the desire for water remains, or is even increased; but water undergoes no change in the body, and requires no digestion. Besides this, nature provides in the human body a store of food which has been already digested, and requires absorption only to fit it for carrying on all the more necessary functions, supplying as it does the heat of the body, and also the force which keeps the heart and the muscles of respiration going, and any other muscular movements that are called for. We now know better than formerly that this reserve of food suffices to support life for days and weeks, with no addition except that of water, which is much more essential than food. Dr. Tanner and his followers have proved this, and perhaps more fully than was necessary. The doctor has done a good work. I have often thought that he had been worried—as I myself have been times without number —by the friends of his patients insisting on his giving them food, when he knew it could do nothing but evil; and he wished to show how utterly baseless were their fears. It would seem that not only the friends but often the doctors also forget, or at least ignore, this store provided by nature. A healthy man when he takes no food loses in weight at first about a pound a day, which is gradually lessened to half a pound if the abstinence is prolonged. If no food is taken by a person suffering from disease, the amount lost seems to depend in a considerable degree on the amount of fever present, which causes a more rapid consumption of material, or burning. I am not aware that this has been accurately worked out, but I have often suspected that the daily loss is greater when the patient is induced to take food; and it is needless to point out how this should be so. This I am convinced of, that in almost every case disease is aggravated by food taken when it cannot be properly digested, and that the suffering to the patient is enormously increased. I know this above all from personal experience; for when ill I have often taken food as a duty when I had r.o desire for it, and I know now that I only prolonged my illness, and my misery as well. I have been careful to say that, in the conditions indicated, food is not to be taken as a general rule. In acute cases much prolonged, and in chronic cases, much must be left to the prudent practitioner as to the propriety of giving and withholding rood, so much depending on the condition of the digestive organs; but he should always have a salutary dread of giving too much, as well as of giving too little: and he should act on the amended aphorism and not on the original. By doing so he may have fewer diseases to treat, and they may be more easily cured; but he will, I am convinced, have more clients, as their lives will be longer. I could give many cases to show the long period food may be abstained from in acute attacks of illness. I will only mention that of a lady suffering from a large fibroid of the uterus, from which she died. In the course of her illness, and when already greatly pulled down, she had a severe attack of pleurisy. She suffered much from breathlessness, and very nearly died. For full three weeks she literally took nothing beyond occasionally sucking an orange ; and she thanked me afterwards for not troubling her with food or stimulants; had I done so she felt sure she would have died. So far as the pleurisy was concerned she made a good recovery.

We have seen that in sickness neither medicine nor alcoholic stimulants nor food are necessary as a general rule, but, on the contrary, are often absolutely injurious; and the only conclusion we can come to is that the sick are in most cases to be left to nature’s methods, and to these only. Now, what are these ? When one falls ill, in the first place he usually loses all appetite for food. He thus tends to give Rest to the stomach: tends, I say, for often the stomach has a long period of work before it gets rid of its contents in the first place, and then of the secretions which come into it, chiefly from the liver by regurgitation, and from the blood. If the illness has been brought on by taking any poisonous or deleterious matter into the stomach, or even by taking too much of the proper food, the cure may be speedy, and there may be no occasion to fall back on the stored-up food of the body; and here no one would dream of fresh food being taken. But if the poison is of a slow-working character, and a long period for its elimination is required, or if some (it may be reparatory) process of inflammation is going on. which upsets all the nervous functions of the body, so that the nervous energy of the stomach so necessary for the digestion of food is wanting—if time runs on, and still no food is demanded by the patient—the friends begin to get anxious, and the dread of ‘ letting the patient get too low’ comes strongly to the front. It is well for the doctor if he is of the same mind, and as I know to my cost it is bad for him if he is not. If the case is a simple one, as fortunately is the rule, recovery comes about, although there may have been considerable errors in giving food too soon, or in too large quantities; but there can be no doubt that a simple and short case is often converted into a severe and long one by giving food when it is not wanted, and when it can be of no use.

The other means which nature employs is giving Rest to the whole body by sending the invalid to bed. In a cold climate this is of special value. Warmth is of great use in many cases, both in preventing chills, and in saving the bodily heat and thus rendering heat-making food less necessary. It is thus a means of keeping up the strength so much desired by the friends, but one which, I fear, they rarely think of. In certain cases of high temperature, the use of cold is now much more appreciated ; but in these, rest in bed is still essential, and the application of cold, when indicated, is usually very acceptable to the patient.

An abundant supply of fresh air and of good water is essential in most states of disease, but the value of these is generally fully appreciated; at any rate the doctor has usually little difficulty in getting his wishes carried out in regard to them, if, as is by no means always the case, they are to be had in their natural abundance and purity.

A most valuable method of employing heat and water in sickness is by combining them. I have long looked on hot water as the most real stimulant that we have. It supplies ready made the heat which is, in health, the product of the chemistry of the body acting on all carbonaceous food. In most states of disease we do not look for any building up of the body, which is the main duty of nitrogenous aliments; but when the system is really in a low condition, and then only a stimulant is wanted, we need a supply of heat, which, being convertible into all other forms of force, keeps up the temperature of the body, and the absolutely necessary movements of the heart and lungs, and the functions of the nervous system.

Another element in the cure of disease is Time, and chiefly for this reason, that if the patient, though apparently well, tries to get too soon up and back to his ordinary work and food, before he has got a sufficient stock of nervous energy, the chemistry of digestion at once goes wrong, and he falls back to his old condition; and he must again rest both body and stomach, perhaps for even a longer time than before. The best tonic is a little wholesome abstinence.

To sum up: the doubtful remedies which, according to the new axiom, are as a rule to be avoided in states of disease are medicines of all kinds, alcoholic stimulants, and food ; and nature’s methods which we advise to be substituted for them, or rather to be allowed full play without them, are rest, not forgetting rest to the stomach; warmth, or in rare cases, cold; a free supply, usually of water, and always of fresh air; and sufficient time for the organs to recover their ordinary working powers, and especially for the nervous system to make up its wasted energy . In short, we must fall back on the old and much forgotten vis medicatrix natnrce.

I have heard of old men who never had taken medicine, nor consulted a doctor, and who. if they felt unwell, at once stopped all food: if this was not enough they went to bed, and remained there till they were better. The first rule I have followed for forty years, the last for fifteen, since I have been able to do so. and it has very rarely been necessary; and I do not intend to do anything more in the future. My friends can see the difference in my health, and I feel it. Many of my younger medical friends, who worked on very opposite lines, used to laugh at me as a very poor specimen of the mode of living I allowed myself and recommended to others. One told me if I would daily take a good beefsteak and a pint of Burgundy, as he did, I would be equally strong and well. Another recommended his three B’s—beef, beer, and bread ; another honestly said he would not live as I did—he would rather die; that he went in for a short life and a merry one. When at last I got the long-needed rest, 1 resolved to give myself all possible fair play, with the object of proving to these men and others that there was some good in my methods after all. But the element of Time was a great one in my case, and now, when I am not ashamed to offer myself as a good specimen of an old man who lives a most simple life, I have no one left of the old scoffing friends whom I was most anxious to appeal to. They have all had the short life, but not, I fear, the merry one. In most instances one severe illness carried them off when at the height of their work and prosperity. It is a sad recollection.

It may be asked—If the present system of treating the sick be so hurtful, how do so many recover under it? I answer by asking another question. How is: that so few reach the age of fourscore, which, from the time of Jacob, has been considered an extreme old age? May not this bad treatment of the sick be one large cause of the shortened life, as is the bad treatment of themselves by the healthy, on the ‘short life and a merry’ principle? The human body is, or at least we consider it, the highest work of the Creator, and it can stand a great deal of bad treatment at one’s hands. My wonder is that it stands it so well. Or I might give a shorter answer by asking. How did any of the sick treated on the old plan recover at all? I would be glad to have an answer to this question from the advocates of the new.

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