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moved. I have a right, therefore, to say, as I have already done, that this high florid color, so far from being a sign of health, is a sign of disease. The tongue is become quite clean, and the teeth are without any incrustation. Indeed, the use of the pure water alone took off the remarkable foulness of the front teeth. The swelling of the thyroid gland has disappeared.
If I were to say that the affection of the head is wholly removed, I should say what is certainly not true. But it is so much removed, that she has every external appearance of good health ; nor could it be discovered that she has at present any complaints about the head, without a minute and critical examination. The common observer would pronounce her in perfect health.
The similitude between the circumstances of this disease and the pains of the head related in the first case (see p. 151), are sufficiently obvious. This case again warrants the conclusion that, in deep-seated constitutional disease, the effect of vegetable diet is slowly, but progressively and regularly, to diminish the intensity of the paroxysms which form its external sign and character.
And when I consider the early period at which these signs of disease in the most important organ of the system appeared, and the great pertinacity with which they have continued for a series of years, I think myself fully warranted in the supposition that, under common circumstances, these symptoms must have been continually aggravated ; that they would have led to a fatal disease of the brain, probably under the form of the hydrocephalus internus ; and that it is very unlikely that she would have reached puberty, or even that period of life at which she is now arrived.
Though this child has now for several years been in a very good general state of health, she has commonly, at least once a year, a mild febrile attack which confines her for two or three days. The head is always the part most affected.
Three other young people, members of the same family as those whose cases have been related, have used the same regimen for about the same period of time. They are and have been, since its adoption, without any thing like serious diseases. The oldest (now in her nineteenth year has a better general state of health than in the early period of life; but there are no circumstances worthy of relation, except it be, that, notwithstanding the attention paid to her diet, she has some thickness about the throat. The thyroid gland is large, and the whole throat is larger than in common, or than is perfectly natural. The gland has not the size which can be called bronchocele, and is in texture, as far as can be determined by the feel, sound and healthy; but it is obviously the embryo or germ of a bronchocele. The second, aged thirteen, had some indisposition of a few days, when she had left off animal food nine months. She also lost her color, which was fine, so as to be a considerable ornament to her person. This occasioned much regret. But, with the above trifling exception, she has enjoyed a complete and uninterrupted state of health. Her color improves a little, but she is still a pallid girl. The third, aged twelve, likewise lost his color; but has scarcely had any indisposition, even of half an hour, now for eight years. His color is of late years much improved; but it is not nearly so high as when he used animal food.
I cannot help noticing a fact which occurred to the second of these children, the girl of thirteen. It is so trifling and common an occurrence, that nothing but the inference to which it obviously leads can justify the mention of it. But we are really apt to overlook, by attempting to think too deeply, the just consequences of what we are seeing every hour.
In this child then, in the spring of the year 1814, a nail came off one of the fingers. There was no accident; but it exfoliated, and, in course of time, was reproduced. Of course, this was not unattended with pain and suffering.
Now what happens on the surface, we must, of necessity, suppose may happen in any other part of the body. A part may have naturally imperfect powers of conservation. It may, therefore, perish, and be reproduced. This would be a disease; and, further, it would happen in defiance of any regimen or any method of treatment whatever. Was it some such event as this that caused the derangement of health which occurred in Case III., mentioned at p. 165 ?
Pulmonary Consumption. If we except the first of the preceding cases, the facts which I have hitherto related are of young people, the general state of whose health rather indicated a feeble and defective constitu
tion, than disease completely formed. They are not, as I apprehend the less valuable on that account; for as many diseases, in their perfect form, exclude all hopes of relief, it is the more important to attend with care to the symptoms which are the precursors of them. In those cases which are to follow, the symptoms of disease, for the most part, were more definite and strongly marked.
The difficulty of an investigation, such as is the object of this work, is greatly increased by the endless varieties of the human constitution, which produces a corresponding variety in the symptoms and progress of diseases. If, for example, I cite in evidence of the justness of my own conclusions an instance of a patient with a large ulcerated cancer having lived four years, it may be answered that the same disease has continued a longer time in persons living according to the common fashion of the country. 'And it is indeed certain that this species of evidence can have little weight, except as applied to the particular case in question; the extent of the disease, the stage in which it was taken up, the habit of the patient, and other circumstances applicable to this case, and to no other, make the deductions from the duration of the disease either just or nugatory; and our reliance upon them depends more upon our opinion of the judgment of the observer than upon the fact itself.
The same variety makes it almost, if not quite, impossible to fix upon certain and definite pathognomic signs of diseases, and more particularly in their early stages. But if these diseases are such as to afford very slight hopes of success to any method of treatment whatever in their more advanced and exquisite form, it is more especially incumbent on us to observe attentively their incipient stages, and to attempt to arrest them at this period.
Pulmonary consumption is such a disease. As it is, when arrived at a certain stage, necessarily fatal, this stage should be regarded as the extreme effect of the morbific causes applied to the body.
These extreme effects, when they are such as commonly precede dissolution at no very remote period, it is in vain to expect to remove by the removal of the remote causes of disease. In such cases the vitality of the body is radically impaired, and the powers of restoration are destroyed. This I apprehend to be universally true, whatever is the form of the disease ; though the signs of this impaired vitality may be highly diversified, and in some cases may be hardly cognizable by the senses. II a
In conformity with this doctrine, it is incumbent upon me to acknowledge that in every case of pulmonary consumption which I have deemed à confirmed case, death has ensued, notwithstanding the most exact attention to regimen upon the principles I have laid down. In some, the benefit for a time, even for three or four months, was so striking as to give great hopes that the patients would receive a cure. But new symptoms, which it is needless to relate, supervened ; and the issue was as I have said. It is right, however, and indeed it is necessary to add that none of these patients lived a twelvemonth. They were therefore very far gone before they came under my care. It by no means follows, then, that the same fatal issue would have taken place had they been treated at an earlier period.
I think it right also to acknowledge some change of sentiments with regard to symptoms, from what I have expressed in my Inquiry into the Origin of Constitutional Diseases. With the general doctrine which I have there maintained, that consumption is a constitutional disease of the whole body, and not a local disease confined to the lungs, and that the symptoms indicate the system to be under the influence of a constant and preternatural stimulation, I continue to be contented; and the more so, as it has been approved by enlightened men. But I have said (p. 137 of that work) that the symptoms of increased fever, and highly rapid pulse toward the close of the disease, is an index that the vitality of the body or sensorial power is not destroyed at this period. I suspect, however, that this is a mistaken view; and that, in particular, a pulse habitually raised much beyond its natural standard of rapidity, must be deemed an index of vital powers impaired, or nearly destroyed. It is certain that in this case no diet, however anti-stimulant, will bring the pulse down to its natural standard.
There is often much difficulty in recognizing pulmonary consumption in its earlier stages; and at this period, the subjects of this disease are so little aware of their danger, that they are too often on the verge of the grave before they think themselves seriously ill. This renders it difficult to show that regimen possesses even a preventive power over this disease. The most convincing argument in its favor is that, under the regimen of vegetables and pure water, the chest takes a more perfect and expanded form. A contracted chest is the strongest of all the external signs of a consumptive tendency. If it become expanded, the pulmonary circulation must become more strong and full, in which, in most, perhaps in all, cases of consumption, there is a radical and constitutional weakness. There are likewise strong indications that this weakness is not confined to the pulmonary circulation, but that it pervades the whole arterial system ; as is obvious from the general frame of body of those who are predisposed to the disease, and might be illustrated by a more particular examination of the symptoms.
But as the pulmonary consumption, like the cancer and other chronical diseases, which prove ultimately fatal, is subject to great variety in respect to the violence of its symptoms, and the length of its duration, opportunities can be of no rare occurrence, in which the disease may be so strongly marked as to admit of little doubt with regard to its nature, and to be at the same time in so early a stage as to afford a rational prospect of arresting its progress. Such a case is the following, the subject of which was a young woman under my own roof, which will, I hope, be considered as affording very satisfactory evidence on the subject.
September the 8th, 1813.-M. W., aged about thirty-three, had lived in my family some years as a female servant. She came to me when about twenty, and seemed to have no particular delicacy or defect of constitution. She was subject, however, to convulsive affections of the nature of hysteria. On the decline of the convulsions, I generally observed a degree of tension and soreness of the abdomen, and I therefore gave her aperient medicines, and she used soon to be well again. She was also subject to cough occasionally.
She came with my family to town, in 1803. She used the distilled water for her tea, and in other liquids, but did not put herself under any restraint as to fermented liquors. However, she continued to enjoy pretty good health, as she said, better in London than she had done in the country.
Toward the end of 1807, there appeared in this young woman strong signs of failing health. She lost her color, and looked wretchedly, though there appeared no fixed or determinate complaint. The appetite failed, and the muscular strength was impaired. I advised her to adhere strictly and solely to the pure water, and to renounce animal food. She excused herself on the plea that she could eat so little ; that this small quantity therefore could not hurt her. But continuing to look extremely ill, she promised to go entirely without it every second day; and I believe that she conformed in some degree to this rule for about six months.
In November, 1808, she became extremely ill, so as to ex