Besides the weak State of the Blood, the Ventricle is always more or less impair’d in this Distemper, and consequently unable to be put to bear the violent Stimuli of the stronger Purgers, without Danger of having its Tone irrecoverably ruin’d.
It may likewise be Prudent to forbear Purging in this Case, left happily there should be some greater Obstruction in the Liver, than we are aware on, for then it might be follow’d with ill Consequences; ’tis true, if that Bowel is really Schirrous, it may be discern’d, or a great Tendency toward it, will shew it self sometimes in the Greeness and Virulency of the Bile mixt in the Excrements, together with other Indications; but a slight disorder there, is not always regarded, and Brick-colour’d turbid Urines are so common in all kind of Dropsies, that we may not discern that the Blood does abound too much with Bile, and so a Purge given at such a time may do a great deal of Mischief, for the Bile is of a light Nature in Comparison of the Phlegm, and moves easily, and no Man knows what he does when he rouzes it; I knew an ill accident happen once upon a Purge, given by a very Eminent Physician, to a Gentleman in a Jaundice, which put him into the most extravagant and fatal Hypercatharsis: thus bold Administrations to such weak Subjects, may be attended with Tragical Accidents, but the milder and gradual measures may succeed, without such dangerous Risks, if we consider what have been the Difficulties which have lay in the way, and hindred the Operation of our Diureticks.
The ill Success of our Diuretick Method in this Distemper, is very much owing to our giving those Medicines in so small a Quantity, and to our not changing ’em for some of a quite different Nature, when one sort us’d pertinaciously does not take; that the quantity must be encreas’d, there needs no better Argument, than what is brought for the use of Purgers; for if the Blood can dispense with the Particles of a Purgative, it will certainly bear a great quantity of those which are Diuretick only. What Wonders has that Golden Remedy of Pythagoras done, the Acetum Scylliticum, when given to a proper quantity? And what may not be expected from the Sal Succini, which may be given to a Dose large enough to irritate the Fibres of the Stomach, and in some measure supply the place of a gentle Purger; but when it is come into the Blood it may prove Cordial as well as inciding? And now I am speaking of augmenting the Quantity of our Diureticks, I can here affirm a very strange Effect that follow’d upon an excessive Dose of Millepedes in an odd kind of a Rheumatick Case, for the Cure of which, several things had been try’d in Vain, by very good Advice; the Millepedes were given to a quantity scarce credible, to several Ounces, and gave a Relief in a little time that exceeded all expectation. This with other instances something of the like nature, every where to be met with, may convince, us that we ought to advance the quantity of these Medicines, to which if we apply the Use of Exercise, the highest Advantages may be expected: For to grant as much as the favourers of the Purging Method can demand, that by reason of the foremention’d Ropiness of the Serum, the Diureticks and Chalybeates will but distend the parts, and make the Juices grow Turgid. Is there no way to remove the Dam, but by shaking all Nature at the same time? Must we blow up the House to get the Enemy out? To what purpose do we talk so much of the Animal Oeconomy, if we reduce its Rules to Practice no more than we do? We are taught the Benefit arising from the Constriction of the Muscles upon the Vessels; and can there be any Case which does more apparently call for it than this? When it is hazardous to attempt by inward Violence to dislodge the Viscous Concretions, certainly it is high time to do it by Muscular Force. This Hippocrates seems to be experimentally convinc’d of, by his frequent inculcating the Use of Exercises in this Distemper, Δεῖ ταλαιπωρέειν you must labour, is his constant Expression, whenever he speaks of the Dropsie; which, whoever considers the Conciseness that is in all the Writings of that Great Man, will be apt to imagine that it carries its Weight with it, and implies the absolute necessity of acting upon the Lentor of the Phlegm, by the playing of the Muscles. Besides Exercise will help to restore the Tone of the Parts, which is sometimes spoil’d by too great a Distension, even so much as to be in a manner benum’d, which Helmont seems to lay much stress on, when he, according to his odd fantastick way, calls it the Anger of the Archæus, that won’t let the Waters pass; and if there is this kind of Spasmodick Affect in the Parts leading to the Kidneys, then certainly there is as much Reason for one in a Dropsie to get into a Coach upon his taking his Medicines, that the frequent jolting may assist their Operation, as there is for one in a Fit of the Gravel so to do. The Heat that is acquir’d by the Motion of the Body, must needs comfort the Parts, and rarifie a great deal of the Moisture, so that it may the more easily pass the Membranes, as they are dilated by Exercise; and if we can by squeezing, make Water pass through Leather, the whole Skin dry’d and prepar’d, may it not much more easily pass the Membranes of a living Animal, when work’d and stretch’d by Motion, and assisted by the Warmth which that Motion produces? These may be thought little things by some, but they will be found to be of great Consequence; by such minute Measures, Nature can produce great Effects; and by a Neglect of these things, many a great Life has been lost, in Dependence upon something of a greater Name, that has had no Relation to the Genuine proceedings of Nature.
These are some of the Reasons which have convinc’d me of the Preference of the Diuretick Course, and which I think can’t be overthrown, by all the Examples of the Success of Purgers, because if we compute the Ill Effects of ’em likewise, and set ’em to balance the good, the very Cures done by ’em, will seem but as so many Splendida Peccata. We ought not hastily to quit safe Means for those which are dangerous, only because they are a little more expeditious; when a Case is within our Reach, we ought to Establish our Prognosticks upon sure ground, tho’ they may not be so quick as could be wish’d; we have other Dropsies that are dubious enough, but in this Case we ought to study to bring things to a certainty as much as possible; which how can we do unless our Methods are Uniform? It behoves the Patrons of Purgatives to assign some certain Rule, to render the Use of ’em alwayes safe, which seems impossible to be done; and it behoves those who are for insisting on Diureticks, to find out some such Measures, as may make these milder Medicines always Efficacious; which is what I have been attempting to do; and which, if I don’t flatter my self, I think I have made to appear plain and obvious; for if we can’t arrive at some comfortable certainty in this Case, I don’t know in what we can do so; for we are so happy as to have those things as will certainly act upon such a Crasis of the Blood, as will revive and enrich it, when decay’d, tho’ not always in the like space of time; and when they act too slowly, we can enforce their Virtue, by these ways I have been speaking of.
These things are no Figment of mine, they have been the Practice of Ancient Times, and are so natural a Result from a due Consideration of the Animal Oeconomy, that I cannot enough wonder that in so many Discourses upon those Fundamental Rules, there has been so little Notice taken of the Effects of the Motion of the whole individual, as superinduc’d to the internal Motions, that make up the Oeconomy; for if this had been duly regarded, it could not but have been reduc’d to Practice, and apply’d particularly to the Cure of this Distemper.
Lastly, I know these are hard Sayings to some People, who send for a Physician, as for one that deals in Charms, and can remove all their Afflictions, while they are wholly Passive; and they would take it very ill that they should be compell’d to a sort of Labour, while they carry about ’em a Load in their Limbs; but yet for all this, Nature will be Nature still; and if this be her Voice it must be obey’d. He that is in a Dropsie ought to be Alarm’d, and look upon himself as in something the like Case with those Criminals whom the Dutch, upon their refusing to Work, confine to a Cellar, and let the Water in upon ’em, that they may be in a Necessity either of Pumping or Drowning. And I believe there are but few, but who, upon their being convinc’d of the real and surprising Benefit of these Means, would readily undergo the Fatigue of ’em; and things may be so manag’d, that Exercise may not be so troublesome as the Sick imagine; an easie Pad will quickly grow familiar; and where the Legs happen to be so very much distended, that there may be some danger, lest the Skin should be rub’d off, a Chaise may serve the turn.
OF THE
Hypochondriacal
DISTEMPER.
The third and last Case, which I shall expresly consider, is the Hysterick or Hypochondriacal Case; in the Cure of which the several Exercises, which I shall hereafter Recommend, may all be us’d. This Distemper falls the most under a Gymnastick Method, because the least proper to be treated with much Internal Physick; this is a Distemper which will not drive, as we say, but if kindly treated will lead, that is, will not be expell’d by Purging, Bleeding, Sweating or the like, but must be treated by more gentle and leisurely Methods; ’tis a Distemper of the Spirits, and the Vessels which immediately convey ’em; and therefore those means by which they are more immediately affected, are the most likely to prove beneficial. Here it is, if ever, strictly true, that a little Matter gives the turn, but then that little matter must be equally apply’d; we must give an equal lift to all the Parts of the Oeconomy at the same time, we must not apply to the Fluids, and neglect the Solids. ’Tis the want of this Distinction, which I take to be the Ground of all our mistakes in the Cure of this Distemper; we cure but half the Man, When I meet with a Languid Hysterick Pulse, I can easily raise it, and give a full Beat to the Artery, by Anti-Hysterick Medicines; but then what becomes of the Nerves, they are not much help’d by this, But sometimes impair’d by it? but then let the same Person have Recourse to some moderate Exercise, his Pulse shall rife as high as upon the use of Internals, but with this Difference, that the Nerves as well as the Blood partake of the Benefit. For we may distinguish between this natural advance of the Bodily heat, which is procur’d by Exercises, and that which is acquir’d by Medicines, just as we may between the Effects of the Kindly Heat of the Sun, and those of an Artificial Fire: Now in the matter of the Vegetation of Plants, and the Management of some sorts of nicer Workmanship, tho’ the greatest Care and Industry be us’d to raise a gentle heat, which to our Senses and even to the Measure of the Thermometer, may seem equal to that of the Sun, yet it shall never be able to produce the same exquisite effects, as the heat of the Sun does. And so we see in this Case the mildest and seemingly most agreeable Gumms prove Purgers to some of these People, others again can’t bear Castor, without some troublesome inconveniences; and how much soever some People may be Rapt up with their Sal Volatile, and such like Preparations, I can perhaps give an instance of more wonderful Relief given in this Case, by a more Common Cordial, than ever those splendid Medicines could produce; it may not be amiss to relate it in this place, because it serves to illustrate my Design in shewing that nothing that has the least seeming Violence in it, or rather that nothing, which is not very mild and agreeable to Nature, can be of very great moment in the Cure of this Distemper. The Instance then I mean, was communicated to me by an Eminent Physician, and very Learned Writer, and is this; He was call’d to see a Maid which had been severely Tormented with Hysterick Fits for several days, and had taken plenty of the Remedies usual in that Case, without any effect; upon which he was resolv’d to try, what a good large Dose of a true generous Wine would do, considering she was a Servant, and consequently could not be suppos’d to be accustom’d to that Liquor, which would have render’d his attempt fruitless; he therefore prescrib’d some Pouders of no Efficacy, to obviate the Phancy of the By-standers, and order’d the Apothecary to ply her with some Wine of his own procuring, that he could depend upon, till she had taken a quantity, which to her might be reckon’d very large; this succeeded like a Charm, after a good Sleep, she was freed of all her terrible Symptoms the next Morning, tho’ before she could scarce stir her head from the Pillow, but she fell into a Fit. And I have twice had the Occasion, to see something of the like nature my self; the first was, where a large Dose of Wine took off some very ill Symptoms, occasion’d by strong Purgers, erroneously repeated in a certain Nervous Case. But the Person had not been us’d to drink Wine, otherwise it could not have produc’d such a happy effect. I instance in these things only to shew, that the Remedies which are most proper and adequate to this Case, must be such as have something of an inimitable Mediocrity in ’em; and that Exercises do produce Alterations in the Body, which resemble the effects of such a singular and Noble Mean, is not improbable, in regard they act so equally (as I observ’d before) both upon the Solids and Fluids. And one would think the Ill Success of any thing, but like Violence, should lead us to some such Measures as these. One would be apt to think that when a Distemper, which carries as little, or may be, the least danger of Life in it, of any whatsoever, tho’ so very troublesome, when this nevertheless becomes one of the most difficult to be perfectly rooted out, one would think, I say, that this odd Circumstance, so like to Contradiction, should prompt us to look out for the real Reason of it.