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by Vitruvius, inspected the livers of the animals of a country in order to judge of the salubrity of its soil and productions. They did not act without reason. But our authentic registers of mortality afford a still surer guide; and I can hardly avoid wishing that they had been more frequently consulted for this purpose. Such a measure would surely be more rational than sending the sick all promiscuously to the sea, or, as Dr. Gregory has somewhere said, from one foolish watering place to another foolish watering place. In these things, however, fashion has been more powerful than principle; and so it may be expected to continue.
It is obvious, from many considerations, that the quantity of mortality is quite inconsiderable when compared to the general quantity of sickness; though this is a subject on which it is impossible to form a calculation. Men are not always shortlived because they are unhealthy, nor is great and apparently very dangerous illness, in different stages of life, incompatible with arriving finally at old age.* Little dependence, therefore, can be placed upon solitary observations with regard to the effect of particular habits, or modes of treatment. Few are duly qualified to form a just estimate of such things. I am apt to think that, in this respect, even the sage Cornaro deceived himself. It becomes then of the first consequence to view mankind as much as possible in the mass, and to obtain, as far as it is in our power, general results.
If, in fact, it is established by such observations that our diseases are the offspring of our habits, and of the circumstances in which we are placed, it must follow that of those who are placed in the same circumstances, however various are the forms and external appearances of disease, there must be an absolute identity in its essence. This must, I think, be correctly true of all those diseases which arise, as it were, spontaneously in the habit, independently of accidental circumstances. Nor can I exclude from this class the acute inflammations which are commonly regarded as a species of accident, produced by some foreign circumstance recently applied, as severe cold. The inflammations require a peculiar state of the constitution for
• A remarkable example of this may be found in the Commentaries of the elder Heberden. "That very eminent physician, Sir Edward Wilmot, before he had completed his twentieth year, labored so severely under a consumptive disorder, that, as he himself told me, not only his relations but the most skillful physicians despaired of his recovery; he lived, notwithstanding, and enjoyed good health beyond his ninetieth year."—Hehtritn Commentarii, p. 324.
their production, as well as an immediate external cause; and they have their seat in various organs, according to the different time of life in which they occur. It is highly probable that when the acute inflammations prove fatal, the vitality of the system is destroyed, as it were, before the attack. Such persons should be considered, therefore, to be as completely worn out as if they had died of a lingering disease : of dropsy, or of consumption.
In a system like that of the human body, consisting of a congeries of different organs, each independent, and endued with peculiar powers and actions, but each likewise connected with the whole, and conspiring to a common end, there can be no difficulty in comprehending how the same agents should, upon different individuals, produce dissimilar effects. Nature, or the supreme wisdom which has formed, sustains, and animates the universe, seems to delight, if we may venture so to speak, in conjoining the most admirable simplicity with the most astonishing variety. From a few elements, and which our ignorance probably makes more numerous tlian they are in. fact, we see living beings, whether vegetables or animals, so diversified that human life is too short to permit us to become acquainted with their various forms and properties. Is it then improbable that a few agents should produce various effects upon the bodies of men—a race of beings no two of whom are alike, and of whom not one individual preserves an absolute identity for two successive days, or even for two successive moments? A familiar example may render this truth more evident. How variously does wine affect different individuals? One can bear two or three bottles, another is giddy with half a glass-full; one becomes jocund, another splenetic; one wakeful and sprightly, another heavy and sleepy; one good-humored, another is driven to madness. What we see in the effects of wine, we can readily suppose of other agents.
If this were a simple matter of speculation it would be of little moment. But I have dwelt upon it on account of the practical inferences to which it obviously tends. If we can show that the antecedent causes of various diseases are the same, though the immediate symptoms may demand various remedies, yet the radical treatment may and ought to be the same, however opposite the apparent forms of the disease may be. This evidently, is to remove the antecedent causes as much as it is possible. Then, if the radical and inherent powers of the system have not been destroyed, it may be expected, if not wholly to recover, at least to show a constant tendency to recovery. In what degree this can take place it is in vain to speculate, independent of experiment. Each case will have something distinct and peculiar. The bow which has been long bent will, when the string is cut, tend to regain its straightness; but it may ever retain some marks of the /orce impressed upon it. Suppose this bow to be the branch of a living tree, the result may be still the same; but the cases will be more parallel. When we say that the phenomena resulting from the action of the same causes must be deemed to be essentially identical, we must limit ourselves to the strict terms of the proposition, and by no means conclude that no morbid appearance can arise in the body which may not be distinctly traced to such causes. It must be considered that an animal body is a machine endued with internal and inherent self-moving powers, which it preserves, and which are in action as long as life continues. Changes take place from the operation of these inherent powers, whieh, if they are attended with pain, and a derangement of the ordinary functions, are considered as diseases. The teething of children is an instance of this. In like manner acute diseases may frequently be suspected to be natural processes, taking place, perhaps, in morbid bodies. In the present state of our knowledge, and the great obscurity in which these subjects are involved, as it would be the height of presumption to affect to explain all the phenomena of life, so would it be captious and uncandid to object every accidental and unforeseen occurrence. We must content ourselves with approximating to what appears, upon the whole, to be the truth. Anomalies and difficulties must be expected to arise which, perhaps, we may never be able to elucidate; and the explication of which must be left to time and the industry of future inquirers.
These few remarks, which appear naturally to follow from the facts established with regard to the laws of human mortality, may be sufficient to render probable the general principle, that the efficient causes of constitutional diseases and premature death are to be sought for in the action of the substances which are applied to and affect the body. But to gain useful information we must enter into a more particular examination of what these really are.
Now any substance whatever which produces a change either in the composition, in the sensations, or in the motions of the body ; in a word, which affects it as a living system, may be justly called an agent, and as such must conspire toward the general result either of healthy or diseased action. As such, the effect of all such matters, of every kind, ought to be taken into the account, and their action distinctly considered. But this is a task, the proper accomplishment of which cannot at present be hoped for. Man, in the wantonness of power, or under the caprices of appetite, makes almost every thing he can lay his hands on subservient to his real or artificial wants. We must therefore of necessity confine ourselves to those agents which are most universally applied, and which appear to be the most effective.
With regard to the generation of constitutional diseases, we may, I think, safely confine ourselves to four principal agents. These are, 1st, impure air; 2d, impure water; 3d, improper aliment; and, 4th, fermented liquors. These ar« the things which appear really and effectively to produce the great bulk of the reigning diseases, or at least to form the morbid constitution out of which these diseases spring. I always except those which are produced from contagions. Each of these agents is of itself, perhaps, under certain circumstances, powerful enough to produce disease, and even death; and very commonly men are exposed to them simultaneously. In a systematic treatise each ought to be separately considered. But as my own immediate object is principally to confirm the propriety of the treatment I myself proposed in constitutional disease, I must confine myself to what I deem more directly connected with this end. On air I have nothing to say. On water I have nothing further to add to what I have already laid before the public. Some observations on the utility of vegetable regimen, the mischiefs of the regimen in common use, and a few remarks on fermented liquors, is all that I propose to add to the introductory part of my present undertaking.
The power of Habit.—Diseases exasperated by a full diet.—Illustrations
of the beneficial effects of abstemiousness.—Dr. Bar wick. Francis
Fechi.—Wood, the miller of Billericay.—Apologia du Jeune.—Estimate of the powers of Vegetable Regimen.
However pernicious any substance or application may be, we find that use in a certain degree reconciles us to it; that which was at first offensive may become at length agreeable; and what was at first manifestly injurious may become apparently indifferent, or even salutary. Such is the influence of habit, by which the constitution is rendered insensible of constant irritations, if they possess only a moderate degree of force; and a craving or appetite is formed for things hurtful in themselves and most foreign from our proper nature. But this habit, if considered in the body itself, must consist of a series of motions and actions, the seat of which is the sensorium; which motions must have an opposite direction to, and so counteract the effect of the irritating cause. In this way only, according to the known properties of the nervous system, is the power of habit conceivable. But however it be, the body must be under the constant influence of a foreign and external force; this force must subvert the natural actions of the system, and warp them from their proper objects, which must ultimately produce effects proportionable to the magnitude and duration of the irritations applied.
We deceive ourselves, then, if we think that any thing which is wrong in itself can be made right by habit, or that what is hurtful, if done seldom, will become innocent by being constantly repeated. By this repetition we may become insensible to the momentary irritation, but only to suffer with the more severity ultimately.*
The use of animal food is one of these habitual irritations to which most persons, who have it in their power, voluntarily subject themselves. Nothing need be said to show that this custom produces a great change in the system in its ordinary state of health. This is a change which, as long as health continues, is commonly thought to be for the better. But omitting wholly that consideration, it seems certain that it predisposes to disease, and even of those kinds the immediate origin of which may be traced to other causes.
It has been observed that the laboring negroes of the West Indian islands are almost wholly exempt from the scourge of the yellow fever, which has cut off such numbers of the other classes of the residents. Upon this observation it was proposed, when the same disease invaded Philadelphia, and was
* It may be observed, that when by habit we have conquered any dislike or formed any appetite for any substance, however unnatural, the dislike does not appear to return by relinquishing the habit. Tobacco is at first abominable; but let a man once become fond of it, the relish will continue for life. He may cease to smoke or to take snuff, because he thinks it wrong or hurtful; but the original disgust never returns. So it is of olives, fermented liquors, and other things. This shows the impropriety of giving children wine, or any thing else which it would be better that they should never like.