Bulwer and Forbes on the water-treatment

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YALE MEDICAL LIBRARY

Preface

The compilation herewith presented to the public owes its origin to a strong desire on the part of the editor, that the various materials of which it is mainly composed, should be embraced in a suitable form for permanent preservation. Although some of the papers seem to have been originally designed for merely temporary purposes, yet he is so perfectly convinced of their lasting value, that he has deemed it well worth while to render them easily accessible to the public — and especially to all who may chance to be interested in the deeply-absorbing subject of which they treat. So great is their literary merit, so able and conclusive the arguments they embody, and so high and unimpeachable the social and professional reputation of their respective authors, that he cannot hjp feeling confident that there are a great many readers on this side of the Atlantic who will eagerly greet their present reappearance.

The leading paper, or Sir Edward Bulwek Lytton's " Confessions of a Water-Patient," which originally appeared in Colburn's New Monthly Magazine for September, 1845, is the only one of the number from a non-medical source. Its style is singularly quaint and pleasing, its manner warm and earnest, and its reasonings generally correct ; insomuch that it can hardly fail to become a favorite treatise on the modern Water-Cure among those who possess refinement of mind and a cultivated taste. Addressed as it is to literary men as a body, and written with a genuine friendliness and cordiality of tone, the editor ventures to add the hope that the brotherhood in America may profit by its admonitions and pay heed to its prophetic warnings.

Dr. Forbes's article on Hydropa'hy has already " made its mark," and provoked a deal of controversial criticism. It is included in this volume for the reason that it is perhaps the most thorough and satisfactory demonstration of the real merits and true province of the

6 PREFACE.

Water-Treatment yet offered to the public by any one member of the medical profession. Indeed, no compilation of the kind contemplated by the editor would be complete without this calm, able, and searching paper.

The succeeding article embraces a couple of chapters from a most excellent Treatise on Healthy Skin, by Erasmus Wilson, M. D., F. R. S., Consulting Surgeon to the St. Pancras Infirmary, Lecturer on Anatomy and Physiology in Middlesex Hospital, Author of a favorite Text-book on Anatomy, etc. Of these two chapters the one first given is the ninth in the order of the Treatise (the tenth, which is appended, being especially devoted to the consideration of the Water-Treatment), and follows a series of admirable expositions of the distribution of the skin ; its division into two layers, the external and internal ; the nature of the perspiratory apparatus, the oil-glands and the hairs; and the influence of diet, clothing, and exercise upon the health of the skin generally. [This explanation will render perfectly clear to the mind of the reader Dr. Wilson's allusion at the outset to several " preceding chapters."]

The fourth article is composed of a variety of testimonials to the efficacy of the Water-Treatment, voluntarily published to the world by some of the ablest members of the medical profession in England. As a fair sample of these, the editor would particularly refer to the frank, candid, and manly sentiments of Sir Charles Scudamore — a name so widely and deservedly honored both in England and America, that he needs no formal introduction or eulogy.

The editor has preferred to reprint these papers without notes or abridgment, rather than run the risk of doing injustice to their authors, and at the same time interrupting the attention of the careful reader. There may be some few points of a minor nature on which his opinions are at variance, to a greater or less extent, with those set forth in these papers with such brilliancy and force ; but the occasion does not call for any detailed notice of them here. His own " position " the editor has felt it to be most proper to " define " in a separate paper at the close of the volume. To this he respectfully refers the reader.

51 Tenth-street, New- York, July 14, 1849.

Table Of Contents

■ I. Confessions of a Water- Patient ; by Sir Edward Bulwer Lttton, author of " Harold," " The Last Days of Pompeii," " Rienzi," etc., etc., ■ . 9

II. A Paper on Hydropathy ; by John Forbes, M. D.,

III. Remarks on Bathing and the Water-Treatment ; by

II. The Water-cure, Or Hydropathy

FROM THE BRITISH AND FOREIGN MEDICAL REVIEW.

BY JOHN FORBES, M.D., F.R.S.,

One of the Editors of the " Cyclopaedia of Practical Medicine," Editor of the " British and Foreign Medical Review," etc., etc.

a. The Dangers of the Water-Cure, and its Efficacy examined. By James Wilson, M.D., and James M. Gully, M.D.— London, 1843.

3. The Cold Water-Care: its Use and Misuse examined. By Herbert" Mayo, M.D., F.R.S., formerly Surgeon of Middlesex Hospital. — London, 1845.

4. A Medical Visit to Graefenberg. By Sir Charles Scudamore, M.D., F.R.S. — London, 1843.

5. Hydropathy. By Edward Johnson, M.D. — London, 1843.

6. Graefenberg ; or, a Trne Report of the Water Cure, with an account of its Antiquity. By Robert Hay Graham, M.D. — London, 1845.

7. Life at the Water-Cure, or a Month at Malvern. By R. J. Lane. — London, 1846.

8. Cwnfessions of a Water Patient. By Sir E. B. Lytton, Bart. — London, 1845.

In consequence of the modern Water-Cure having been originated by a non-medical and uneducated man, and having been subsequently, for the most part, adopted and professed by lay practitioners, or by medical men of somewhat equivocal reputation — and yet more, from the system being held out as a panacea or cure for all diseases, with an exclusive scorn of medicinal aid — the medical profession, as a body, have naturally enough, and not inexcusably, treated it with much contempt, not to say aversion, and have shown a pretty general determination not to admit it into the catalogue of therapeutic means. Exercising a natural influence on the public, medical men have succeeded in communicating to a large portion of the intelligent classes the feelings entertained by themselves. Thus hydropathyhas become a tabooed subject, being either entirely excluded from medical journals and books, or only admitted into them for the purpose of being ridiculed or utterly denounced. Indeed, it is regarded almost as a violation of professional etiquette to mention this subject in the language of toleration, much more to speak of it with approbation. Accordingly, we think it not unlikely that some of our brethren, and those even of the most estimable, may regard our present article as a departure from what is medically proper, and will pronounce us almost worthy to have the severe sentence of " water-doctor" passed against us. We have, however, been too long accustomed to speak our opinions openly and boldly, when we believed them to be just, whether they were in accordance with the current notions or not, to be deterred, on the present occasion, by any apprehended risk of offending mere professional conventionalism. Whatever we conscientiously believe to be true in medical science, especially if, at the same time, calculated to promote the great end and aim of all professors of the healing art — the increase of the means of lessening the sufferings of mankind — that we shall freely and fearlessly promulgate, careless of personal consequences.

Our purpose, in this article, being carefully and calmly to investigate the real merits of the system now so widely established under the name of hydropathy, we hold ourselves absolved from mixing up this investigation with any considerations whatever respecting the merits or demerits, the objects or motives, of those who practise it. We regret to think that there is, and has been from the beginning, not a little quackery and mystification mixed up with really effective practice, in hydropathic establishments, and that not a few of the conductors of the water-establishments have been, and are, very ill-qualified to indicate, much less to direct and conduct, any therapeutic processes capable of modifying, in an important degree, the vital conditions and functions of the human body. If it shall appear, however, as we believe it will, on further examination, that the external application of cold water is capable of being beneficially applied, in the cure of diseases, in modes of greater efficacy, and to a much greater extent, than has been hitherto practised by medical men, there remains only one course for the members of the profession to pursue, viz. to adopt the improvements — if such they be, regardless of their origin, or their past or present relations. When the religious reformer proposed to adapt profane airs to church psalmody, saying that he saw no good reason why the devil should have all the good tunes to himself, he is generally supposed to have acted as wisely as he thought shrewdly and spoke quaintly. In like manner, we see no good reason why the doctors of the orthodox or legitimate school should refuse to accept good things, even at the hands of the hydropathists. They have done like things before now, as the pharmacopoeia, in more pages than one, can testify ; and we have not heard that there has been any great reason for regretting that they did so. For our own parts, we avow ourselves of such a catholic spirit, and so lowly minded withal, as to be ready to grasp any proffered good in the way of healing, whosoever may be the offerers, and wheresoever they may have found it. Not merely hydropathy, but even mesmerism, yea, stark-naked and rampant quackery itself, may, in this sense, be a welcome knocker at the gate of physic. It is not the demerits of the donor or the birthplace of the gift, that, in such a case, we are bound to look to — but simply whether it is qualified to aid us in our glorious and divine mission of soothing the pains of our fellow-men. If it is so qualified, the baseness of its source will be lost in the glory of its use ; and, if aught of its original impurity still attaches to its application in our hands, the fault will be in us, not in it. A saint may sing the devil's tunes without contamination ; a hero may wield the weapon he has wrested from a robber or a murderer ; the medicament or the formula of the most arrant quack may be hallowed in the prescription of the true physician.

It is in this spirit we enter upon an investigation of the claims of Hydropathy, as propounded and practised by Priessnitz and his disciples. And we invite our readers to follow us in a like temper, convinced that they will be benefited by an examination of the subject, whether they adopt our views or not. Some of our views we are sure they must adopt — particularly this : that cold water, applied in the manner of the hydropathists, is a powerful modifier of the condition of the human body, both in health and disease, and, when weighed in the therapeutic balance with other remedies, merits, at least, a fair trial in legitimate practice.

It will be an after-consideration in what manner, or under what circumstances, this trial can best be made ; and, supposing the result of the trial to be satisfactory, it will be a yet further consideration, and one of great importance, how the remedy shall best be applied in the ordinary practice of medicine. We ourselves believe that distinct bathing establishments will still be found best for giving full effect to the hydropathic system, although we believe, also, that many parts of it may be adopted in ordinary practice at the patients' own homes ; and the whole of it certainly be conducted at the water-establishments under the authority and general direction of the ordinary medical attendants. If hydropathy is, as we believe, a therapeutic agent of great power and value, it would be worse than absurd to exclude it from legitimate medicine ; but, if it is to be adopted by the profession, it can only be adopted in a strictly professional manner. If distinct establishments are found to be requisite for its complete and successful exhibition, the members of the medical profession can, of course, sanction and patronize those only which are conducted by legally qualified and competent practitioners. And they cannot be expected to show any countenance, even to those which, although under the superintendence of legally qualified persons, are conducted on empirical or absurdly exclusive principles. A hydropathic establishment should be simply a great bathing establishment, or water hospital, and should contain the means for using water in all its medicinal forms, hot as well as cold, in the form of vapor as well as liquid, medicated as well as pure. In such a hospital, although drugs would, doubtless, be but in slight requisition, it would be contrary to all rational proceedings to exclude their use entirely. The very fact of a case being sent to such a hospital presupposes the previous failure of drugs, or, at least, presumes their unsuitableness in that particular instance ; and they would, for the most part,. be dispensed with at the commencement of the treatment, at least : but no unprejudiced or competent observer can assert that drugs should be entirely banished from the treatment of any case at all times. The same scientific judgment and the same practical skill that prescribed the water-treatment as best calculated to fulfil the indications present at any one time, could alone determine whether, at any other time, medicaments might be proper, either as auxiliaries or substitutes. Nothing but the blindest dogmatism or the wildest empiricism could maintain that, because the water-treatment is found useful, all other means must be useless ; or, reversely, that, because drugs are often found beneficial, that therefore all other kind of treatment, hydropathy included, must be injurious. The absolute exclusionist, be he water-doctor or drug-doctor, is equally unreasonable and equally unjustifiable.

In the composition of the following article, we have derived our materials mainly from the published writings of hydropathists, but, also, partly from personal observation of the practice of hydropathy itself, and from the reports of patients who had been the subjects of it. We have been careful to select as our authorities the best informed and most impartial of the writers on the subject of the Water-Cure, and we have used our best endeavors to appropriate what alone seemed trustworthy. It is sa extremely difficult for a writer, on any one side of a question that has become the subject of active controversy, to avoid partiality in relating events and drawing inferences, that we make no apology to our authors for having on many occasions refused their evidence and rejected their conclusions. Many things, however, we have admitted on the authority of the writers alone, when they did not seem to be contradicted by other facts, and were in accordance with the general principles of physiology and therapeutics. We have so far admitted the validity of the maxim — cuilibet in sua arte credendum ; and, so qualified, we think the propriety of the ad mission will not be gainsaid. But we have gone further than this. We have accepted at the hands of our hydropathic authors more than one alleged fact and explanation, even although their validity seems to us questionable. And we have done this because tire statements are of a kind justly to challenge attention, and to demand thorough investigation.

On the whole, then, we wish the reader to be prepared to find in the following article, not simply an exposition of the doctrines of hydropathy, as they appear to us well established, but such also as they are laid down by the best authorities of the Water School ; one of our objects in writing it being, not merely to endeavor to ascertain what we consider as truth, for the benefit of our readers, but likewise to. incite them to make inquiry and examination for themselves, in order that agencies, of such obvious potency on the human frame, may no longer be permitted free scope if evil, or no longer be debarred from ordinary medical practice, if good.

The internal and external use of water, in the treatment of disease, has been frequently discussed by physicians in all ages, from Hippocrates downwards. Their opinions will be found cited in detail by the systematic writers on the subject of baths, and, among others, by Sir John Floyer and Lanzani. To them we refer such as are sufficiently curious to wish for an exact acquaintance with the subject, in its historical relations. For our present purpose, and to render the history of the medical use of water clear to the less minute student, we will group it under a few convenient heads.

1. According to Lanzani,* the true method of using cold water consists almost entirely in its internal administration, in very large doses, in certain stages of certain fevers. His work is most elaborate in every sense ; learned, methodical, and comprehensive. It is divided into two books : the first devoted to an explanation of the causes, symptoms, complications, and nature of fever ; the second, showing that copious imbibition of cold water is the best means of combating the symptoms, on scientific grounds, and consequently the best remedy for fever. This is obviously an argument somewhat theoretical, but it is supported by a chapter of cases, and backed by the opinions of a host of learned doctors, the author's predecessors. The actual value of the work is considerably diminished by its scientific character, because many of the doctrines held in its day have now become obsolete, and tend to

encumber and obscure, rather than strengthen and enlighten, the practical facts by which they are accompanied. But the same remark applies to the early advocates of other remedies. Lanzani appears to have had no knowledge of the external use of water, nor of its application to the treatment of chronic diseases. He used it in combination with drugs.

Lanzani may be regarded as the representative of a considerable number of writers and practitioners, both in Italy and elsewhere, among whom water has been employed (internally) as the most effectual febrifuge.

2. About the year 1700, Sir John Floyer and Dr. Baynard employed water very freely as an external application, in the ordinary manner of cold bathing, preceding it by a course of physic, and accompanying it generally by copious water-drinking.* Their practice appears to have been chiefly in chronic diseases, such as rheumatism, gout, paralysis, indigestion, general debility, and various nervous affections, in the whole of which a large amount of success is said to have been attained. The baths, at which their cases were treated, were frequently designated by some saint's name. Probably a remnant of superstitious reverence for the saint not only assisted to attract patients to the well, but infused into them a faith in the remedy, which materially promoted their recovery. The practice pursued was simply cold plunging, guarded by certain rules and cautions to prevent accidents.

* ^u^poXoiKri'u; or, the Hutory of Cold Bathing, both ancient and modern. By Sir John Floyer, of Lichfield, Knt., and Dr. Edward Baynard, Fellow of the College of Phyaicians, London. 2d edition. London, 1706,

Sir John Floyer supports his views by the citation of numberless learned authorities, from the Bible to Dr. Mead. He seems to have attached rather an excessive importance to grave precedents, causing his portion of the conjoint work to savor more of the library than the bedside. At any rate, he mingles together practical facts and opinions of writers, in such intricate relations, that it is not always easy to discover on which he relies most confidently for the maintenance of his tenets. Dr. Baynard, on the other hand, deals more in cases, of which he presents an abundant collection. His mode of reasoning is particularly pointed and sagacious. No one can leave the perusal of his works without a strong conviction of his being an honest, shrewd, enterprising, and diligent contributor to medical literature.

. These writers mention the occasional practice of persons bathing in their shirts, and wearing them throughout the remainder of the day, without drying ; they also give an instance or two of cases cured or relieved by the application of a wet towel. The former practice is alluded to as an instance of rashness on the part of patients, and the latter is so rarely mentioned, that in neither can they fairly be said to have anticipated Priessnitz in the systematic employment of the wet sheet or wet compress — although both were actually employed by them. They also speak in very favorable terms of a course of cold preceded by a month's warm bathing, but not in the modern hydropathic method of the cold following immediately upon the warm, or upon sweating, which is a practice they carefully deprecate. They seem to have had but a

DE. FORDES ON THE WATER-CURE. 55

slight acquaintance with the use of cold bathing in fever, or acute diseases, though instances of such practice are given.

The following passage from Dr. Baynard, though not strictly a part of our present subject, is a curiosity, and affords a good sample of his peculiar manner. When the period of its publication is considered, it must be regarded, in some of its parts, as a remarkable case of the forestalling of exact experiment by speculative reasoning. Baynard adduces the remarks it contains in support of his hydropathic views ; but we need not stay to examine them in that respect. We transcribe portions of the passage :

" / conceive life to be an actual flame ; as much flame as any culinary flame is, but fed with its peculiar and proper pabulum, made out of the blood and spirits for that purpose ; and my reasons are these, viz. : 1. Life is as extinguishable as any flame is, by excluding the air, &c. For hold your handkerchief close to the mouth and nose of any animal that has lungs, and life is put out ; the creature is dead in a moment ; there is no skin broke, nor bone broke ; no wound, nor bruise ; there is your whole man, but dead he is. 2d. No flame will burn without aerial nitre, or a quid aerium, whatever it be ; some will have it a mixed gas of nitre and sulphur, but whatever it be, 'tis a causa sine qua non, something without which no flame will , burn ; and that the lungs serve to this use, and are airstraftiers, is very clear to me, by that experiment of the candle and two puppy dogs, put into a great oven, and stopped close up with a glass door to see through ; and in a little time, when they had sucked in some, and the candle wasted the rest of the nitre, the dogs died, and the candle went out with them at the same instant.

" All ustion as the quid inflammabile wastes, leaves by incineration alkalious and caustical salts, either fixed or volatile, which from their figure or imbibed fire, become of a pungent corrosive nature, and fix upon the membranes, being nervous and most exquisite of sense and perception, which, by irritation, cause a slight inflammation, which inflammation is called thirst ; which salts are melted and washed off by drinking, the grosser by stool with the solid excrements, but those of most solid and subtle particles creep with the chyle into the blood, and have no way out but by the urine. Hence water is the best menstruum to dissolve salts ; and that which is most simple and elementary is the best water, as least impregnated ; such waters wash off and dissolve their points and angles, by which they prick, sheath, and envelope them in their own pores, and with themselves run off by urine ; but if so forced by heat and motion as to disturb them in their passage, the current of urine is checked, and the salts leave their hold of the water, shoot their vortex, and from the channels get into the habit of the body, which, if not dissolved, melted, and thrown off by sweat, they inflame and cause fevers, &c. ; nor will they cease their action and inquietude until totally dissolved, or forced back into their common passages, and the salts precipitated and run down by urine. For I look upon the pores and sweat-vents as so many back-doors and sally-port*, by which nature drives out the enemy crept into her garrison. The truth is demonstrated in all fevers, where the caustical salts are not washed off, but remain behind on the glands and membranes, forsaken of their dissolving menstruum, the water, &c., which that ingenious chemist, Mr. George Moult, by chemical analysis, made appear in six quarts of febrile urine, which I sent him, and he found but the thirtieth part of those salts usually found in a sound man's urine, so that of necessity they must remain behind and be left (like so many French dragoons) to quarter on the blood and spirits at discretion. The history of which is printed in the ' Philosophical Transactions' for some years since.

" Now, that which we call an insensible perspiration is nothing else than the smoke made from the vital flame, and the pores are the spiramenta through which it passes, and when these are stopped, this smoke is returned and the flame becomes reverberatory, which is sometimes necessary to force an obstruction, for the body has its registers and vent-holes, as well as other furnaces. But to proceed, these salts sometimes crystallize, so that the common menstrua will not touch them, no more than a file will steel or hardened iron, and then it is a true diabetes (and here the physician is at his wit's end, and that no far journey) : then hey ! for lime water, quince wine, and other restringents, which, if it were possible, would rather make a coalescence, and tie the knot harder. No : the cure lies in solution by melting down the salts, which must be done by open, raw, and unimpregnated menstrua, such as the Bristol waters are, as most simple, having least contents in them." (pp. 47 et seq.)

3. At about the beginning of the present century, Dr. Currie's practice in fever is well known to have 4 consisted principally of cold affusion, or immersion, in the early stages of the disease, and in certain acute affections of the nervous sytem. His work is so well known that it is unnecessary to enter into any detail as to contents.* He seems to have known but little of the application of cold water to the treatment of chronic diseases, as represented by Floyer and Baynard, or not to have employed the copious libations described by Lanzani. He cannot be said to have forestalled Priessnitz in any other respect, than in the prompt and energetic use of cold water in the suppression of acute febrile and nervous affections. He brings a large amount of scientific argument and practical experience to bear out his views. He has also placed in a clear light some points of practice on which important errors previously prevailed, such as the safety of cold applications when the body is heated beyond the natural degree, and the relative value and safety of cold or tepid water, of immersion, affusion, and ablution. On these points his work is of great practical value. We may have occasion to revert to some of them hereafter.

4. The prevalent opinions of medical men in this country, on the general subject of the external use of water, previously to the Priessnitzian era, may be considered to be represented in the article Bathing, in the " Cyclopaedia of Practical Medicine," published within the last twenty years. The article in question places

* Medical Reports of the Effects of Water, cold and warm, as a Remedy in Fever and other Diseases. By Tames Curkie, M. D., F. R. S., Fellow of the Royal College of Physicians, Edinburgh. 2 vols. 2d edition, London, 1805.

bathing in a very subordinate position among means available for the actual cure of disease. In its cold form, it is recommended as a valuable tonic, used with many restrictions, in nervous debility and other analogous states ; and, in its warm form, its use is almost limited to the allaying of irritation in certain disorders, the more formidable symptoms of which are to be encountered by other remedies. Other articles in the same work have done justice to Dr. Currie's views. Beyond this, the medical profession have hitherto done little or nothing with bathing as an instrument of cure. We shall hereafter find reason for believing that a vast superfluity of caution has existed in the employment of this remedy, and that some of the supposed cautions have really increased, instead of diminishing, the danger, as well as destroyed the efficiency of its application.

The author of the article in the Cyclopaedia describes cold bathing as partially or absolutely contraindicated in the following conditions : partially, in infancy and old age ; pregnancy ; indurations, obstructions, or chronic inflammations of internal parts; acute inflammations of the same ; chronic inflammations of mucous membrane : absolutely, during menstruation ; in great plethora, or tendency to active haemorrhage, or congestions in important viscera ; affections of the heart ; loaded state of the bowels ; great general debility — though then often advantageous after warm water or vapor bath.