WHEN I first signified my intention of publishing the following sheets, I was told by my friends it would draw on me the resentment of the whole Faculty. As I never could entertain such an unfavourable idea, I was resolved to make the experiment, which indeed came out pretty much as might have been expected. Many whose learning and liberality of sentiments do honour to medicine received the book in a manner which at once shewed their indulgence, and the falsity of the opinion, that every physician wishes to conceal his art; while the more selfish and narrow-minded, generally the most numerous in every profession, have not failed to persecute both the book and its author.
THE reception, however, which this work has met with from the public, merits my most grateful acknowledgments. As the best way of expressing these, I have endeavoured to render it more generally useful, by enlarging the prophylaxis, or that part which treats of preventing diseases; and by adding many articles which had been entirety omitted in the former impressions. It is needless to enumerate these additions; I shall only say, that I hope they will be found real improvements.
THE observations relative to Nursing and the Management of Children, were chiefly suggested by an extensive practice among infants, in a large branch of the Foundling Hospital, where I had an opportunity not only of treating the diseases incident to childhood, but likewise of trying different plans of nursing, and observing their effects. Whenever I had it in my power to place the children under the care of proper nurses, to instruct these nurses in their duty, and be satisfied that they performed it, very few of them died; but when, from distance of place, and other unavoidable circumstances, the children were left to the sole care of mercenary nurses, without any person to instruct or superintend them, scarce any of them lived.
THIS was so apparent, as with me to amount to a proof of the following melancholy fact: That almost one half of the human species perish in infancy, by improper management or neglect. This reflection has made me often wish to be the happy instrument of alleviating the miseries of those suffering innocents, or of rescuing them from an untimely grave. No one, who has not had an opportunity of observing them, can imagine what absurd and ridiculous practices still prevail in the nursing and management of infants, and what numbers of lives are by that means lost to society. As these practices are chiefly owing to ignorance, it is to be hoped, that when nurses are better informed, their conduct will be very different.
THE application of medicine to the various occupations of life has been, in general, the result of observation. An extensive practice for several years, in one of the largest manufacturing towns in England, afforded me sufficient opportunities of the injuries which those useful people sustain from their particular employments, and likewise of trying many and various methods of obviating such injuries. the success which attended these trials was sufficient to encourage this attempt, which, I hope, will be of use to those who are under the necessity of earning their bread by such employments as are unfavourable to health.
I DO not mean to intimidate men, far less to insinuate that even those arts, the practice of which is attended with some degree of danger, should not be carried on; but to guard the less cautious and unwary against those dangers which they have it in their power to avoid, and which they often, through mere ignorance, incur. As every occupation in life disposes those who follow it to some particular diseases more than to others, it is certainly of importance to know these, in order that people may be upon their guard against them. It is always better to be warned of the approach of an enemy, than to be surprised by him, especially where there is a possibility of avoiding the danger.
THE observations concerning Diet, Air, Exercise, &c. are of a more general nature, and have not escaped the attention of physicians in any age. They are subjects of too great importance, however, to be passed over in an attempt of this kind, and can never be sufficiently recommended. The man who pays a proper attention to these, will seldom need the physician; and he who does not will seldom enjoy health, let him employ as many physicians as he pleases.
THOUGH we have endeavoured to point out the causes of diseases, and to put people upon their guard against them, yet it must be acknowledged that they are often of such a nature as to admit of being removed only by the diligence and activity of the public magistrate. We are sorry, indeed, to observe, that the power of the magistrate is seldom exerted in this count for the preservation of health. The importance of a proper medical police is either not understood, or little regarded. Many things highly injurious to the public health are daily practised with impunity, while others, absolutely necessary for its preservation, are entirely neglected.
SOME of the public means of preserving health are mentioned in the general prophylaxis, as the inspection of provisions, widening the streets of great towns, keeping them clean, supplying the inhabitants with wholesome water, &c.; but they are passed over in a very cursory manner. A proper attention to these would have swelled this volume to too large a size; I have therefore reserved them for the subject of a future publication.
IN the treatment of diseases, I have been peculiarly attentive to regimen. The generality of people lay too much stress upon Medicine, and trust too little to their own endeavours. It is always in the power of the patient, or of those about him, to do as much towards his recovery as can be effected by the physician. By not attending to this, the designs of Medicine are often frustrated; and the patient, by pursuing a wrong plan of regimen, not only defeats the doctor's endeavours, but renders them dangerous. I have often known patients killed by an error when they were using very proper medicines. It will be said, the physician always orders the regimen when he prescribes a medicine. I wish it were so, both for the honour of the Faculty and the safety of their patients: but physicians, as well as other people, are too little attentive to this matter.
THOUGH many reckon it doubtful whether medicines are more beneficial or hurtful to mankind, yet all allow the necessity and importance of a proper regimen in diseases. Indeed the very appetites of the sick prove its propriety. No man in his senses ever imagined that a person in a fever, for example, could eat, drink, or conduct himself in the same manner as one in perfect health. This part of medicine, therefore, is evidently founded in Nature, and is every way consistent with reason and common sense. Had men been more attentive to it, and less solicitous in hunting after secret remedies, Medicine had never become an object of ridicule.
INDEED this seems to have been the first idea of Medicine. The antient physicians acted chiefly in the capacity of nurses. They went very little beyond aliment in their prescriptions; and even this they generally administered themselves, attending the sick, for that purpose, through the whole course of the disease; which gave them an opportunity not only of marking the changes of diseases with great accuracy, but likewise of observing the effects of their different applications, and adapting them to the symptoms.
THE learned Dr. Arbuthnot asserts, that by a proper attention to those things which are almost within the reach of every body, more good and less mischief will be done in acute diseases, than by medicines improperly and unreasonably administered, and that great cures may be effected in chronical distempers, by a proper regimen of the diet only. So entirely do the Doctor's sentiments and mine agree, that I would advise every person, ignorant of physic, to confine his practice solely to diet, and the other parts of regimen; by which means he may often do much good, and can seldom do any hurt.
THIS seems also to have been the opinion of the ingenious Dr. Huxham, who observes, that we often seek from Art what all-bountiful Nature most readily, and as effectually, offers us, had we diligence and sagacity enough to observe and make use of them; that the dietetic part of Medicine is not so much studied as it ought to be; and that, though less pompous, yet it is the most natural method of curing diseases.
TO render the book more generally useful, however, as well as more acceptable to the intelligent part of mankind, I have, in most diseases, besides regimen, recommended some of the most simple and approved forms of medicine, and added such cautions and directions as seemed necessary for their safe administration. It would no doubt have been more acceptable to many, had it abounded with pompous prescriptions, and promised to great cures in consequence of their use; but this was not my plan: I think the administration of medicines always doubtful, and often dangerous, and would much rather teach men how to avoid the necessity of using them, than how they should be used.
SEVERAL medicines, and those of considerable efficacy, may be administered with great freedom and safety. Physicians generally trifle a long time with medicines before they learn their proper use. Many peasants at present know better how to use some of the most important articles in the materia medica, than physicians did a century ago; and doubtless the same observation will hold with regard to others some time hence. Wherever I was convinced that medicine might be used with safety, or where the cure depended chiefly upon it, I have taken care to recommend it; but where it was either highly dangerous, or not very necessary, it is omitted.
I HAVE not troubled the reader with an useless parade of quotations, from different authors; but have, in general, adopted their observations where my own were either defective, or totally wanting. Those to whom I am most obliged are, Ramazini, Arbuthnot, and Tissot; the last of which, in his Avis au Peuple, comes the nearest to my views of any author which I have seen. Had the Doctor's plan been as complete as the execution is masterly, we should have had no occasion for any new treatise of this kind soon; but by confining himself to the acute diseases, he has, in my opinion, omitted the most useful part of his subject. People in acute diseases may sometimes be their own physicians; but in the chronic, the cure must ever depend chiefly upon the patient's own endeavours. The Doctor has also passed over the Prophylaxis, or preventive part of Medicine, very slightly, though it is certainly of the greatest importance in such a work, He had, no doubt, his reasons for so doing, and I am so far from finding fault with him, that I think his performance does great honour both to his head and to his heart.
SEVERAL other foreign physicians of eminence have written on nearly the same plan with Tissot, as the Baron Van Swieten, physician to their Imperial Majesties; M. Rosen, first physician of the kingdom of Sweden, &c.; but these gentlemen's productions have never come to my hand. I cannot help wishing, however, that some of our distinguished countrymen would follow their example. There still remains much to be done on this subject, and it does not appear to me how any man could better employ his time or talents than in eradicating hurtful prejudices, and diffusing useful knowledge among the people.
I KNOW that some of the Faculty disapprove of every attempt of this nature, imagining that it must totally destroy their influence. But this notion appears to me to be as absurd as it is illiberal. People in distress will always apply for relief to men of superior abilities, when they have it in their power; and they will do this with far greater confidence and readiness when they believe that Medicine is a rational science, than when they take it to be only a matter of mere conjecture.
THOUGH I have endeavoured to render this Treatise plain and useful, yet I found it impossible to avoid some terms of art; but those are, in general, either explained, or are such as most people understand. In short, I have endeavoured to conform my style to the capacities of mankind in general; and, if my Readers do not flatter either themselves or me, with some degree of success. On a medical subject, this is not so easy a matter as some may imagine. To make a shew of learning is easier than to write plain sense, especially in a science which has been kept at such a distance from common observation. It would, however, be no difficult matter to prove, that every thing valuable in the practical part of Medicine is within the reach of common abilities.
IT would be ungenerous not to express my warmest acknowledgments to those Gentlemen who have endeavoured to extend the usefulness of this Performance, by translating it into the language of their respective countries. Most of them have not only given elegant translations of the Book, but have also enriched it with many useful observations; by which it is rendered more complete, and better adapted to the climate and the constitutions of their countrymen. To the learned Dr. Duplanil of Paris, physician to the Count d'Artois, I lie under particular obligations; as this Gentleman has not only considerably enlarged my Treatise; but, by his very ingenious and useful notes, has rendered it so popular on the Continent, as to occasion its being translated into all the languages of modern Europe.
I HAVE only to add, that the Book has not more exceded my expectations in its success, than in the effects it has produced. Some of the most pernicious practices, with regard to the treatment of the sick, have already given place to a more rational conduct; and many of the most hurtful prejudices, which seemed to be quite insurmountable, have, in a great measure, yielded to better information. Of this a stronger instance cannot be given than the inoculation of the small-pox. Few mothers, some years ago, would submit to have their children inoculated even by the hand of a Physician; yet nothing is more certain, than that of late many of them have performed this operation with their own hands; and as their success has been equal to that of the most dignified Inoculators, there is little reason to doubt that the practice will become general. Whenever this shall be the case, more lives will be saved by inoculation alone, than are at present by all the endeavours of the Faculty.