American family physician ... With an appendix

Front matter

I

I i

1 3

Dedication

To Hobert Oliver, Esquire, of Baltimore.

Dear Sir :

While reading the celebrated Essays of

Preface

"Whether popular treatises on medicine have proved more serviceable or injurious to the public, is a subject which has been variously viewed by some observing men. No one can doubt that conceited medlers have often, from their ill-timed prescriptions^ increased the diseases and accelerated the death of many. But it is evident that the injuries have arisen from the injudicious manner in which such instructions have been generally made public. They are not accompanied with those explanations of the principles of medicine, which should properly govern the spirit of inquiry, and the course of practice to be pursued by the reader. — The doses are dictated, for the names of diseases, seldom with any regard to the varying state of each varying system. However mortifying to the pride of professional research, it is but too true that no certain remedy has ever been found out for any one complaint ; and not only from past experience, but from the nature of the human body, it may with safety be declared none will ever be discovered. This accounts for the innumerable contradictions in the mouths of every body, about the efficacy of particular doses and treatment in stated cases. It should deeply impress on the minds of all men, the folly of prescribing and acting without reference to, or knowledge of, the condition of the patient. — It should constantly be remembered that the adage, " what is one man's meat, may be another man's poison," is not more true than what will cure the same man at one time, may kill him at another.

But, whatever any one may think on this subject, the voice of the people, long since, in England, and very generally in this country, is decidedly in favour of popular treatises respecting the prevention and cure of diseases. And this voice ought long since to have been attended to by the more respectable part of the profession. They appear to have laboured under the erroneous impression that it was beneath their dignity to write for the unlearnxst

ed ; losing sight of the fact, that no man could be lowered by acting in any serviceable station for the public : that, of whatever nature might be the duties, they should have felt like Plutarch, the pride, not of receiving, but, of giving importance to the occupation.

Defective as have been popular treatises respecting the preservation of health and cure of diseases, it is scarcely credible what numbers are annually disposed of in the United States. Such has been the demand, that the most contemptible productions meet with a ready sale. The dispersed population of the country, rendering it often actually impossible to procure, in proper time, the aid of physicians, makes such works almost indispensably necessary. These, to be most serviceable, should be plain, intelligible, and systematic ; shewing medicine, as it ought always to have been shewn, divested of all mystery — needing for its successful application to practice, no extraordinary powers— no leger-demain — nothing but common sense, with common study and observation.

No physician, with a mind superior to the petty spirit of acquiring importance from the concealment of pretended secrets in the profession, would say otherwise than that he would greatly prefer practising in families, rational — correct — in what medical information they possessed, rather than in those which are ignorant. He feels satisfied that the knowledge of the one will secure a ready observance of his directions ; while the ignorance of the other, with its usual attendant, presumption, will be perpetually intruding doubts and countervailing doses. The strongest tendency of correct information on the subject, among families, must be to create diffidence, and consequently an early appeal to physicians of skill. If it were followed by no other advantage than putting an end to applications to impostors, and to using medicines contrary to the indications for cure, its attainment would be justified under circumstances of far greater difficulty.-— But when forced to prescribe in the absence of physicians, the prescriptions of the better informed will be made with anxious caution — not with the audacious boldness of the pretender, which has destroyed ten lives for one, which have sunk from the timidity of prescribers. Even unassisted nature is greatly to be preferred to the rudeness and guessing of the ignorant.

Xlll

Doctor Buchan was the first English author who wrote for the public of his country on medicine. Probably he rendered the British nation more service, by his treatise on domestic medicine, than all the physicians of his age put together. His directions for preserving health are exceedingly judicious ; those for the practice of physic are very tolerable, at least, for his own country : but his work is replete with false, absurd, exploded doctrines — with unnecessarily compounded prescriptions, and with many medicines disused, at least, in the United States.

Our latest and greatest improvements in the medic art, arise from the simplification of its theories or doctrines, which has led to a correspondent simplicity in practice. My preceptor in medicine, the late Dr. Rush — a man most dear to the recollections of all who heard his lectures — was the author of the prevailing and increasing simplicity of theory and practice in this country.-— That a work on medicine is now wanted for the public, in unison with the doctrines of that great ornament of medical science, cannot be questioned. The last book of the kind published in the United States, is, in its directions for practice, rather better than any preceding ; but is excessively incumbered with complicated prescriptions. It is true, that, by the aid of recommendations so easily obtained, and by bestowing praises on so many men, " spirits blue, black, and grey," it has gone through several editions ; notwithstanding some glaring defects in its details — * great ignorance of authors — much absurdity of doctrine — and an enormity of price, excluding it from those whose circumstances most require cheap instruction. It will be enough to state of the Work, that the fifth edition before me, having on its title page "greatly imfiroved" contains 649 pages, of which 178 are on the art of preserving health ; all of which are so full of poetry — stories to amuse school-boys — moral subjects — and such other irrelevant matter, not excepting examples of getting the brains blown out as proof of the health of patriotism, — all chiefly taken from the " Medical Extracts" published by a wild visionary, Dr. Thornton, (this one is of London) ; that persons would be apt to mistake the object of the part, were they not perpetually reminded of it on the top of the page. It only contains 216 pages relating to diseases : and full 168 about a Materia Medica and Dispensatory, of which probably as many lines would have been sufficient. It

XIV is said to be, and contains internal evidence of its being, the work of two sorts of empiricks : the one in medicine — the other in literature. The first, in opposition to the great Dr. Darwin, who taught that "to think was to theorize, and that the patient who had the best theorist, had the best physician;" perseveres in refusing to learn the doctrines of the medical schools, being well satisfied with his own very successful practice. The other is noted throughout the country as a kind of composer of queer pieces, with some original dashes of non-descript character. — Whether his writings be most of a moral or immoral nature, has not yet been determined : but his name need only be mentioned to excite mourning or merriment at his rapid mutations, in the course of one revolving moon, from preaching to peddling — from praying to piping at parties — from the pulpit of his church to the carry-all for his pamphlets.

Indeed, it is a misfortune of no trivial kind for the literary character of our country, that many works beneath the tlignity of criticism receive the unqualified approbation of men of distinction. Scarcely a new book appears, without having tacked to it letters and certificates of its excellence, which would indelibly disgrace those who gave them, were they not screened by their supposed good nature and patriotic desire to give encouragement to American genius. Vanity has certainly its influence with many of them; — the application makes distinction ; compliments are seasonably applied ; and, occasionally, a douceur softens the sting of self-condemnation for false encomiums. The case of a book published in New York, called the American Herbal, affords remarkable illustration of this. Contemptible and disgraceful as is the book, it is well backed by commendators, whose names I do not mention from respect for their characters and sorrow for their folly. But it is indeed scarcely pardonable that the public should be gulled in matters relating to health and life : and the less so, when effected through the commendable spirit to encourage all useful productions of the country. The true interests of science, and the real utility of all native works of merit, are materially injured by these impositions on the credulity of the public. That patronage which the people could afford to give, is bestowed upon the pushing unworthy, instead of the modest worthy ; and prejudices are thereby created against sub-

XV

se-quent productions of Americans — prejudices, most readily transmitted to, and propagated by, our trans-Atlantic enemies. — However attached to — however connected with, the applicants for recommendations, it should never outweigh a regard for the interests of those generously confiding in the integrity of the recommendator. Surely judgment, not feeling — justice, not friendship, should be exercised on such occasions. They should pretend — if they have not the reality — to have something like the spirit of the Consul Brutus, on ordering his rebel sons to execution :

" 'Tis love of honour and his country's good,

" The consul, not the father, sheds the blood."

For the volume now offered to the public, no recommendations were asked — no approbation wished, but such as each reader, without reference to authority, should find it deserved, after he had followed its directions. And the evidence of this I would only have him shew, by giving the advice to those who know not its utility. It would afford me far greater pleasure to have all the errors erased, and all the better parts strictly attended to by the uninformed, than to have my vanity gratified by the praises of every commendator, commentator, and critic, in the country.

A considerable part of the work is taken from one I published some years since, entitled " Letters to Ladies concerning themselves and children." About three thousand copies were disposed of; yet as some parts are deemed exceptionable, they are omitted. — Enough, however, it is hoped, is retained to enable women to perform the necess? t ry offices to each other in childbed, without the interference of men mid-wives in common cases. The part relating to children is retained in its original state, excepting some additions. As no sort of objection has been made to its prescriptions, I trust they will be more generally attended to. Some parts were also taken from my Discourses on Chemistry, published in 1806; and much more is taken from the learned, "Practice of Physic," by Dr. Thomas, which I have freed from its technical phraseology. No one could suppose that a work of this kind could be much more than a compilation, — yet it does contain something original in matter and manner ; but its chief object is to simplify, to render more intelligible to the common reader, the researches of others ; to press more

XVI

particularly the most simple modes of preserving health antf. treating diseases; and to enjoin the use of what is in every body's power, rather than foreign articles — obtained with difficulty, often adulterated, and often most injudiciously applied. If the work succeed in these objects, I shall be satisfied to have all its original parts ascribed to those who have published before me. The style is, like that in which I have always written, irregular, containing internal evidence of no study in composition; and the epistolary form was preferred because most familiar.

The reader will find but very few medicines recommended, because in reality very few are ever wanted. Not many physicians of my age have seen, or have had more extensive practice than myself, in public hospitals, and particularly among poor people. And I have no recollection of ever having used more than about fifty articles properly called physic ; ten or twenty forming about the ordinary number. The weeds or trash with which the old physicians encumbered their prescriptions, and by which their patients often perished, are now disused by the more respectable part of the profession. To endeavour to afford relief by the judicious administration of a few medicines, is infinitely to be preferred to a resort to the compounded stuff of the apothecary. Indeed, it is only owing to the remains of ancient practice, to the prejudices of the old in its favour, that the shops are still so crowded with a great variety of drugs. As to the cant about American Medicines, Indian Specifics, and such like baits for the vulgar, it may be observed, that there are about ten or fifteen worth preserving; the rest fill space, but give no service, and, like the obsolete words of dictionaries, should be erased from the list of medicines. The noise which is every now and then made by those who take the subject in hand, always reminds me of men placed at some unimportant part of an edifice to give a little support ; finding scarcely any thing to do, they amuse themselves with bawling about their arduous duties, and fain would make every one believe that on their shoulders rested the great work.

Perhaps some may think it improper to blend an account of the management of women in labour, with the diseases of men. This is done in all works of the kind, and I believe it is indispensably necessary to render them generally useful. For domestic purposes, all medical knowledge should be equally given to men

XV11

and women. Females are almost always the first to prescribe in their families; they generally act as attendants on the sick; and they have collected and will continue to collect much useful infor* mation for the faculty. On the other hand, their husbands should be their nurses, and equally exercise their abilities in attending to them, even in child-bed. Instead of their remaining in some distant room, grinning at good and groaning at bad reports of the state of their wives, they should follow the example of the Emperor Napoleon, on the accouchment of his Empress Maria stay at the bedside of their wives, and render all the assistance in their power. They might, at all events, prevent the injudicious interference and destructive violence of medlers, while their sympathy would alleviate the sorrows of the suiferers.

If there be a country where medical information ought to be diffused, it is in the United States, where professional services are so often dilatory and out of time. If there be a part of the community to whom this knowledge should be confined, it is, assuredly, the female part, — at least concerning themselves and children. Their delicacy of frame, and sensibility of system, leading to speedy termination of disorders, renders this knowledge, by them, not of questionable value, but of most important benefit. Instead of giving articles to the sick in their families, contrary to proper treatment, or withholding some little remedy, equal to the cure in the commencement, they might, without much intellectual exertion, acquire such knowledge as would insure essential service — at least until the arrival of physicians. The more they attend to such knowledge, they will be endeared the more ; and be, as they should, alike contributory to the interests and to the pleasures of man.

To ladies of good candid minds, no apology will be necessary for the plain manner in which I have stated some subjects, deemed offensive to converse about, yet important to health. Only those of affectation of feeling, can fancy there is indelicacy in understanding what may save from exposure, disease, and death.-— I was pleased with a French lady, who, shortly after her arrival in my neighbourhood, sent in the night for a physician to her child, suddenly taken alarmingly ill : on his entrance, observing her nearly half naked, he was about withdrawing, when the earnest mother exclaimed, in broken English, — " Sacrez ! fool C

Doctor — you let my child die cause I no dressed.'* It is certain, that the mind in private, with perfect purity, turns to every point; and instead of seizing at extraordinary means on emergencies, we should deliberately, previously acquire qualifications for acting. I am conscious of pressing into this work several practices, which many of the respectable part of the community are in the habit of observing, without the advice of a physician. Such directions are offered only to those who do not observe them, and the more earnestly to induce those who do, to assist in inculcating them among the negligent and uninformed. To produce the stronger impressions in other cases, I have purposely repeated the same advice.

An essential part of the education of every male and female, in my opinion, should be a general knowledge of the outlines of the nature of their bodies, and the principles of the cure of their disorders. Not for the purpose of practising physic, but to enlarge the mind ; to habituate it to think rationally on the subject, and to guard against the innumerable impositions of quacks, as well those who advertise as such, as those of vast boasting experience — deceptious only to the ignorant. Had but the slightest knowledge been cultivated on these points, the world would never have been festered with the innumerable and preposterous accounts of doses " for thinning the blood, for correcting the bile> for purifying the urine," and for the like ridiculous objects. It is well known how greatly the science of chemistry has improved since the introduction of proper names ; and the same would take place in medicine, if the same accuracy were observed.— Most of the improvements in medicine were discovered by the common people ; and how much greater these must have been, had they understood the principles of the science. The persons feeling the disorders must more accurately describe their varying stages, and the effect of medicines, than their attendants can possibly do.

It must be a very contracted or narrow-minded physician, who thinks that the interests of the profession can be injured by diffusing medical knowledge among the common people. The forms of law and of religion are open for the inspection of all; yet there are as many lawyers and priests now, as when those professions were enveloped in mysterious garb. We have every reason

XIX

* TT I /

to believe that the result would be similar if a knowledge of medicine were equally diffused. When we see our first physicians, in sickness among themselves and in their families, calling on each other for medical advice, can we doubt that such would be the call of every man who had only the superficial view of the subject which could be derived from reading one or two popular and general views of the subject ? In short, the real interests of the profession must be promoted by a diffusion of medical knowledge : for, it will excite a correspondent desire to employ, in sickness, the more intelligent part of the faculty. The sooner it is freed from its lumber of impostors-— to whom the door of admission is now so widely opened — the sooner will it ged rid of the opprobrium with which it has so long been oppressed: the sooner will merit rise to respectability, independece, and usefulness.

C

U i^ilQ)

ADDRESS L PRESERVATION OF HEALTH.

PART I. RESPECTING INFANTS. To Mothers

As the foundation of many of the diseases of the human body is made in infancy, it appears proper to commence my observations for the preservation of health by the treatment of children. It is a subject about which a great variety of notions have been entertained, in consequence of the general failure to attend to the course pointed out by nature, and pursued by all animals below the human. It ought to be well understood by all mothers, to enable them to direct, if not perform, the necessary duties, without a dependance upon ignorant nurses or attendants. The variety of plans recommended, and modes adopted, would fill a volume. Even the stupid would be astonished to observe some kinds of treatment, different from that which they follow, probably of not worse tendency than their own usages. Every midwife and every family appear to have some peculiarity in the treatment of children. Surely the whole of them will have to account for the injuries they have done to babes, if we have ever to account for follies which might have been avoided by the exercise of our natural sense. As an example of such follies, in one of the most intelligent families I have ever seen, the midwife was allowed, at every birth, on first dressing the child, to hold it up by the heels, and give it a shake ! then a moderate dose of brandy and water : this stimulus, aided with sugar and nutmeg, was poured down the throat I Indeed, almost in every house, I have been struck with the infatuation that prevails on such occasions ; something must be given! every thing appearing, but good common sense. Because the business of generation seems so mysterious, something extraordinary is supposed to exist in every department! To break the spell, to put down the preposterous boast of experience among old nurses, and some mothers ; to teach the bystanders, that the bodies of the little babes are subject to the same'laws as their own, becomes important, from the singular infatuation prevailing on the subject. If the little innocents could speak, they would tell you, they knew no difference between being disordered and destroyed by intended kindness, or by intended neglect.

In the hope that you will yield to reason ; with the earnest entreaty, that, for the sake of humanity, you will conform to the course pointed out and confirmed by the most successful practice of the greatest physicians, I proceed to state the directions for the treatment of children which should govern every woman.

When the child is separated from the mother, the utmost care is to be taken to prevent its receiving colds. These colds affect it most seriously, producing inflammations of a destructive kind, in the lungs and bowels. In order to guard against them, the child should be received in a warm flannel, having an opening to breathe, and kept in a warm place, where no cool air can have access, until warm water is procured for washing it. Never use cold water for the purpose, and nothing but warm water. By gently washing it in warm water, the matter adhering to the skin will come off, if not the first, the succeeding day. It is to be kept in the water a few minutes, undergoing this gentle washing, and to have a linen rag put on its navel — a burnt rag, or any charcoal, might be first applied to lessen the offensive smell of the part that comes off. — Generally there is a sore, made by the nutmeg and other trash foolishly applied ; there will be none, if the parts are dressed with simple sweet oil, or hog's lard, after the separation of the cord, which takes place about the sixth day ; no irritating matter, nothing but something mild, is wanted to exclude the air from the surface. After a linen rag is applied to the navel, a band is to be put around the belly, not tight by any means, as compression of the belly will be injurious. The next object is, to dress the child : no clout is necessary to be put on ; the child can't turn, and simply putting- a cloth under is sufficient for a month ; its clothes should be of linen — no pins to secure them, but strings ; never allow its limbs to be confined ; the more it can use every part, the sooner will it strengthen. Under no circumstances, should any thing be applied that presses on any part. A tight bandage will cause the absorption of the hardest parts of adults ; and how much more destructive to children ? The best article, for some time, is simply as was put on our Saviour, a swaddling cloth ; and afterwards, instead of keeping the child screaming, as is universally done, with the ridiculous pieces of clothing — shirts, petticoats, and the like evidences of folly; let it have nothing but one pelisse, as thick or as thin as the season requires, which can be put on in an instant, and made as fine as the parent can afford for the gratification of vanity.

The child being dressed, it requires nothing more than to be laid down, level, to repose quietly. From the fifth to the tenth hour after birth, it should always be applied to the breast of the mother. It wants nothing else ; the milk is its physic, and its best nourishment. You will observe the redness of the skin, sometimes blisters, and extreme irritability in every part. These are symptoms of its inflammatory state ; and these, exclusive of experience, proclaim the folly of giving it other stimulants, drinks, or mixtures, to add to the too much excited action of its body. It wants nothing but its mother's milk, for which it should be applied to the breast in the time above directed. The first discharge from the breast will, in all probability, open its bowels in sufficient time. If the bowels be not opened the second day, pushing gently, half an inch up the fundament, a small quill covered with an oiled rag, will produce the evacuation ; in case of failure, a tea-spoonful of sweet oil poured down its throat, to repeated in three hours, if the first be not successful ; lastly, continued failure, a tea-spoonful of castor-oil, or a little man: might be given on the third day. I never knew the introducti of the pipe, as above advised, to fail in producing an evacuati< It is always to be preferred to giving medicine.

It will not be necessary to refer to the medical part, the tre ment of the small blisters, swellings, and inflammations, wh: are so apt to appear on the skin, and parts compressed at bij m

The cure is to be effected, by not touching them ; some prefer puncturing- the blister with a sharp needle, so as to let out the water, without letting in air ; — a cold, wet rag, applied for a few minutes, will expedite the dispersion of the swellings. For other complaints, I refer to the medical treatment.

The rules for nourishing children are, never for sixty or seventy days, give any thing but the mother's milk ; in the beginning, give the breast every three or four hours. Some have urged to begin with establishing hours for this supply ; but they mistake. The habit is best acquired weeks after. In the womb its body was slowly and constantly nourished ; and we should imitate, by having in its stomach always a little, never much at a time. I suppose the means I shall hereafter recommend for exciting the breasts, will be used to insure the supply of milk. But if accidental causes should render it impossible for the mother to give milk, then, as the lesser evil, some woman should be procured who can yield the supply. Giving infants other food, has done incredible mischief. No other animal requires aught but the mother's milk ; yet there is scarcely a midwife or nurse in the country, who is not for pouring down the child's throat, soonafter its birth, some of their mixtures. There is not one of these compounds that does good. They pretend they give very little ; then the very little can be of no service* — never yielding a fiftieth part of the nourishment taken away by its acting as irritating substances in the bowels. Instead of giving up the early treatment of children to such attendants, there is stronger reason then than in subsequent advanced stages, for the mothers and friends to exert all their senses on the subject. Follow nature ; I cannot impress on you too much. Nature never intended, that, for your child's accommodation at birth, a ship should have to sail to the East Indies for nutmegs, and another to the West Indies for spirit and sugar, to make the almost universal doses given to children. Nature could hardly have provided against such abominable outrage on its laws : to add to this sugar and water, and nutmeg, the intoxicating liquors, is shameful in the extreme. If there be not enough milk in the mother's breast, and another nurse cannot be had, then give the like — cow's milk newly drawn, mixed one-third with warm water, with very little, if any, sugar. After sixty or seventy days at least, the child may then properly

■have its diet changed : first, it is best for some other woman occasionally to suckle it, then the mixture above mentioned, and then milk alone, until all the common articles of our diet may be administered in gradual succession.