Part 4

The Marquis of Mirabeau.

"An old Roman, who was always ready to return to the Cultivation of his Field, subsisted himself and his Family from one Acre of Land. A Savage, who neither sows nor cultivates, consumes, in his single Person, as much Game as requires fifty Acres to feed them. Consequently Tullus Hostilius, on a thousand Acres, might have five thousand Subjects: while a Savage Chief, limited to the same Extent of Territory, could scarcely have twenty: such an immense Disproportion does Agriculture furnish, in Favour of Population. Observe these two great Extremes. A State becomes dispeopled or peopled in that Proportion, by which it recedes from one of these Methods, and approaches to the other." Indeed it is evident, that wherever there is an Augmentation of Subsistence, an Increase of Population will soon follow; which again will still further facilitate the Increase of Provisions. In a State thus circumstanced Men will abound, who, after they have furnished sufficient Numbers for the Service of War, of Commerce, of Religion, and for Arts and Professions of every kind, will further also furnish a Source for Colonies, who will extend the Name and the Prosperity of their Nation to distant Regions. There will ensue a Plenty of Commodities, the Superfluity of which will be exported to other Countries, to exchange for other Commodities, that are not produced at home; and the Balance, being received in Money, will make the Nation rich, respectable by its Neighbours, and happy. Agriculture, vigorously pursued, is equal to the Production of all these Benefits; and the present Age will enjoy the Glory of restoring it, by favouring and encouraging Cultivaters, and by forming Societies for the Promotion of Agriculture.

I proceed at length to the fourth Cause of Depopulation, which is the Manner of treating sick People in the Country. This has often affected me with the deepest Concern. I have been a Witness, that Maladies, which, in themselves, would have been gentle, have proved mortal from a pernicious Treatment: I am convinced that this Cause alone makes as great a Havock as the former; and certainly it requires the utmost Attention of Physicians, whose Duty it is to labour for the Preservation of Mankind. While we are employing our assiduous Cares on the more polished and fashionable Part of them in Cities, the larger and more useful Moiety perish in the Country; either by particular, or by highly epidemical, Diseases, which, within a few Years past, have appeared in different Villages, and made no small Ravages. This afflicting Consideration has determined me to publish this little Work, which is solely intended for those Patients, who, by their Distance from Physicians, are deprived of their Assistance. I shall not give a Detail of my Plan, which is very simple, in this Part; but content myself with affirming, I have used my utmost Care to render it the most useful I possibly could: and I dare hope, that if I have not fully displayed its utmost Advantages, I have at least sufficiently shewn those pernicious Methods of treating Diseases, that should incontestably be avoided. I am thoroughly convinced, the Design might be accomplished more compleatly than I have done it; but those who are so capable of, do not attempt, it: I happen to be less timid; and I hope that thinking Persons will rather take it in good part of me, to have published a Book, the composing of which is rather disagreeable from its very Facility; from the minute Details, which however are indispensable; and from the Impossibility of discussing any Part of it (consistently with the Plan) to the Bottom of the Subject; or of displaying any new and useful Prospect. It may be compared, in some Respects, to the Works of a spiritual Guide, who was to write a Catechism for little Children.

At the same time I am not ignorant there have already been a few Books calculated for Country Patients, who are remote from Succour: but some of these, tho' published with a very good Purpose, produce a bad Effect. Of this kind are all Collections of Receipts or Remedies, without the least Description of the Disease; and of Course without just Directions for the Exhibition, or Application, of them. Such, for Example, is the famous Collection of Madam Fouquet, and some more in the same manner. Some others approach towards my Plan; but many of them have taken in too many Distempers, whence they are become too voluminous. Besides, they have not dwelt sufficiently upon the Signs of the Diseases; upon their Causes; the general Regimen in them, and the Mismanagement of them. Their Receipts are not generally as simple, and as easy to prepare, as they ought to be. In short, the greater Part of their Writers seem, as they advanced, to have grown tired of their melancholy Task, and to have hurried them out too expeditiously. There are but two of them, which I must name with Respect, and which being proposed on a Plan very like my own, are executed in a superior Manner, that merits the highest Acknowlegements of the Publick. One of these Writers is M. Rosen, first Physician of the Kingdom of Sweden; who, some Years since, employed his just Reputation to render the best Services to his Country Men. He has made them retrench from the Almanacs those ridiculous Tales; those extraordinary Adventures; those pernicious astrological Injunctions, which there, as well as here, answer no End, but that of keeping up Ignorance, Credulity, Superstition, and the falsest Prejudices on the interesting Articles of Health, of Diseases, and of Remedies. He has also taken Care to publish simple plain Treatises on the most popular Distempers; which he has substituted in the Place of the former Heap of Absurdities. These concise Works however, which appear annually in their Almanacs, are not yet translated from the Swedish, so that I was unqualified to make any Extracts from them. The other is the Baron Van Swieten, first Physician to their Imperial Majesties, who, about two Years since, has effected for the Use of the Army, what I now attempt for sick People in the Country. Though my Work was greatly advanced, when I first saw his, I have taken some Passages from it: and had our Plans been exactly alike, I should imagine I had done the Publick more Service by endeavouring to extend the Reading of his Book, than by publishing a new one. Nevertheless, as he is silent on many Articles, of which I have treated diffusively; as he has treated of many Distempers, which did not come within my Plan; and has said nothing of some others which I could not omit; our two Works, without entering into the Particulars of the superior Merit of the Baron's, are very different, with Regard to the Subject of the Diseases; tho' in such as we have both considered, I account it an Honour to me to find, we have almost constantly proceeded upon the same Principles.

The present Work is by no means addressed to such Physicians, as are thoroughly accomplished in their Profession; yet possibly, besides my particular medical Friends, some others may read it. I beg the Favour of all such fully to consider the Intention, the Spirit, of the Author, and not to censure him, as a Physician, from the Composition of this Book. I even advise them here rather to forbear perusing it; as a Production, that can teach them nothing. Such as read, in order to criticize, will find a much greater Scope for exercising that Talent on the other Pamphlets I have published. It were certainly unjust that a Performance, whose sole abstracted Object is the Health and Service of my Countrymen, should subject me to any disagreeable Consequences: and a Writer may fairly plead an Exemption from any Severity of Censure, who has had the Courage to execute a Work, which cannot pretend to a Panegyric.

Having premised thus much in general, I must enter into some Detail of those Means, that seem the most likely to me, to facilitate the beneficial Consequences, which, I hope, may result to others, from my present Endeavours. I shall afterwards give an Explanation of some Terms which I could not avoid using, and which, perhaps, are not generally understood.

The Title of Advice to the People, was not suggested to me by an Illusion, which might persuade me, this Book would become a Piece of Furniture, as it were, in the House of every Peasant. Nineteen out of twenty will probably never know of its Existence. Many may be unable to read, and still more unable to understand, it, plain and simple as it is. I have principally calculated it for the Perusal of intelligent and charitable Persons, who live in the Country; and who seem to have, as it were, a Call from Providence, to assist their less intelligent poor Neighbours with their Advice.

It is obvious, that the first Gentlemen I have my Eye upon, are the Clergy. There is not a single Village, a Hamlet, nor even the House of an Alien in the Country, that has not a Right to the good Offices of some one of this Order; And I assure myself there are a great Number of them, who, heartily affected with the Distress of their ailing Flocks, have wished many hundred Times, that it were in their Power to give their Parishioners some bodily Help, at the very Time they were disposing them to prepare for Death; or so far to delay the Fatality of the Distemper, that the Sick might have an Opportunity of living more religiously afterwards. I shall think myself happy, if such truly respectable Ecclesiastics shall find any Resources in this Performance, that may conduce to the Accomplishment of their beneficent Intentions. Their Regard, their Love for their People; their frequent Invitations to visit their principal Neighbours; their Duty to root out all unreasonable Prejudices, and Superstition; their Charity, their Learning; the Facility, with which their general Knowlege in Physics, qualifies them to comprehend thoroughly all the medical Truths, and Contents of this Piece, are so many Arguments to convince me, that they will have the greatest Influence to procure that Reformation, in the Administration of Physick to poor Country People, which is so necessary, so desirable, an Object.

In the next Place, I dare assure myself of the Concurrence of Gentlemen of Quality and Opulence, in their different Parishes and Estates, whose Advice is highly regarded by their Inferiors; who are so powerfully adapted to discourage a wrong, and to promote a right Practice, of which they will easily discern all the Advantages. The many Instances I have seen of their entering, with great Facility, into all the Plan and Conduct of a Cure; their Readiness and even Earnestness to comfort the Sick in their Villages; and the Generosity with which they prevent their Necessities, induce me to hope, from judging of these I have not the Pleasure to know, by those whom I have, that they will eagerly embrace an Opportunity of promoting a new Method of doing good in their Neighbourhood. Real Charity will apprehend the great Probability there is of doing Mischief, tho' with the best Intention, for want of a proper Knowledge of material Circumstances; and the very Fear of that Mischief may sometimes suspend the Exercise of such Charity; notwithstanding it must seize, with the most humane Avidity, every Light that can contribute to its own beneficent Exertion.

Thirdly, Persons who are rich, or at least in easy Circumstances, whom their Disposition, their Employments, or the Nature of their Property, fixes in the Country, where they are happy in doing good, must be delighted to have some proper Directions for the Conduct and Effectuation of their charitable Intentions.

In every Village, where there are any Persons, of these three Conditions, they are always readily apprized of the Distempers in it, by their poor Neighbours coming to intreat a little Soup, Venice Treacle, Wines, Biscuits, or any thing they imagine necessary for their sick Folks. In Consequence of some Questions to the Bystanders, or of a Visit to the sick Person, they will judge at least of what kind the Disease is; and by their prudent Advice they may be able to prevent a Multitude of Evils. They will give them some Nitre instead of Venice Treacle; Barley, or sweet Whey, in lieu of Soup. They will advise them to have Recourse to Glysters, or Bathings of their Feet, rather than to Wine; and order them Gruel rather than Biscuits. A man would scarcely believe, 'till after the Expiration of a few Years, how much Good might be effected by such proper Regards, so easily comprehended, and often repeated. At first indeed there may be some Difficulty in eradicating old Prejudices, and inveterately bad Customs; but whenever these were removed, good Habits would strike forth full as strong Roots, and I hope that no Person would be inclined to destroy them.

It may be unnecessary to declare, that I have more Expectation from the Care and Goodness of the Ladies, than from those of their Spouses, their Fathers, or Brothers. A more active Charity, a more durable Patience, a more domestic Life; a Sagacity, which I have greatly admired in many Ladies both in Town and Country, that disposes them to observe, with great Exactness; and to unravel, as it were, the secret Causes of the Symptoms, with a Facility that would do Honour to very good Practioners, and with a Talent adapted to engage the Confidence of the Patient:--All these, I say, are so many characteristical Marks of their Vocation in this important and amicable Duty; nor are there a few, who fulfil it with a Zeal, that merits the highest Commendation, and renders them excellent Models for the Imitation of others.

Those who are intrusted with the Education of Youth, may also be supposed sufficiently intelligent to take some Part in this Work; and I am satisfied that much Good might result from their undertaking it. I heartily wish, they would not only study to distinguish the Distemper (in which the principal, but by no means an insuperable Difficulty consists; and to which I hope I have considerably put them in the Way) but I would have them learn also the Manner of applying Remedies. Many of them have; I have known some who bleed, and who have given Glysters very expertly. This however all may easily learn; and perhaps it would not be imprudent, if the Art of bleeding well and safely were reckoned a necessary Qualification, when they are examined for their Employment. These Faculties, that of estimating the Degree of a Fever, and how to apply and to dress Blisters, may be of great Use within the Neighbourhood of their Residence. Their Schools, which are not frequently over-crouded, employ but a few of their daily Hours; the greater part of them have no Land to cultivate; and to what better Use can they apply their Leisure, than to the Assistance and Comfort of the Sick? The moderate Price of their Service may be so ascertained, as to incommode no Person; and this little Emolument might render their own Situation the more agreeable: besides which, these little Avocations might prevent their being drawn aside sometimes, by Reason of their Facility and frequent Leisure, so as to contract a Habit of drinking too often. Another Benefit would also accrue from accustoming them to this kind of Practice, which is, that being habituated to the Care of sick People, and having frequent Occasions to write, they would be the better qualify'd, in difficult Cases, to advise with those, who were thought further necessary to be consulted.

Doubtless, even among Labourers, there may be many, for some such I have known, who being endued with good natural Sense and Judgment, and abounding with Benevolence, will read this Book with Attention, and eagerly extend the Maxims and the Methods it recommends.

And finally I hope that many Surgeons, who are spread about the Country, and who practice Physic in their Neighbourhood, will peruse it; will carefully enter into the Principles established in it, and will conform to its Directions; tho' a little different perhaps from such as they may have hitherto practiced. They will perceive a Man may learn at any Age, and of any Person; and it may be hoped they will not think it too much Trouble to reform some of their Notions in a Science, which is not properly within their Profession (and to the Study of which they were never instituted) by those of a Person, who is solely employed in it, and who has had many Assistances of which they are deprived.

Midwives may also find their Attendance more efficacious, as soon as they are thoroughly disposed to be better informed.

It were heartily to be wished, that the greater Part of them had been better instructed in the Art they profess. The Instances of Mischief that might have been avoided, by their being better qualify'd, are frequent enough to make us wish there may be no Repetition of them, which it may be possible to prevent. Nothing seems impossible, when Persons in Authority are zealously inclined to prevent every such Evil; and it is time they should be properly informed of one so essentially hurtful to Society.

The Prescriptions I have given consist of the most simple Remedies, and I have adjoined the Manner of preparing them so fully, that I hope no Person can be at any Loss in that Respect. At the same time, that no one may imagine they are the less useful and efficacious for their Simplicity, I declare, they are the same I order in the City for the most opulent Patients. This Simplicity is founded in Nature: the Mixture, or rather the Confusion, of a Multitude of Drugs is ridiculous. If they have the very same Virtues, for what Purpose are they blended? It were more judicious to confine ourselves to that, which is the most effectual. If their Virtues are different, the Effect of one destroys, or lessens, the Effect of the other; and the Medicine ceases to prove a Remedy.

I have given no Direction, which is not very practicable and easy to execute; nevertheless it will be discernible, that some few are not calculated for the Multitude, which I readily grant. However I have given them, because I did not lose Sight of some Persons; who, tho' not strictly of the Multitude, or Peasantry, do live in the Country, and cannot always procure a Physician as soon, or for as long a Time, as they gladly would.

A great Number of the Remedies are entirely of the Country Growth, and may be prepared there; but there are others, which must be had from the Apothecaries. I have set down the Price at which I am persuaded all the Country Apothecaries will retail them to a Peasant, who is not esteemed a rich one. I have marked the Price, not from any Apprehension of their being imposed on in the Purchase, for this I do not apprehend; but, that seeing the Cheapness of the Prescription, they may not be afraid to buy it. The necessary Dose of the Medicine, for each Disease, may generally be purchased for less Money than would be expended on Meat, Wine, Biscuits, and other improper things. But should the Price of the Medicine, however moderate, exceed the Circumstances of the Sick, doubtless the Common Purse, or the Poors-Box will defray it: moreover there are in many Country Places Noblemens Houses, some of whom charitably contribute an annual Sum towards buying of Medicines for poor Patients. Without adding to which Sum, I would only intreat the Favour of each of them to alter the Objects of it, and to allow their sick Neighbours the Remedies and the Regimen directed here, instead of such as they formerly distributed among them.

This oeconomical Information was doubtless very proper, where our judicious and humane Author published it; but notwithstanding his excellent Motives for giving it, we think it less necessary here, where many Country Gentlemen furnish themselves with larger or smaller Medicine Chests, for the Benefit of their poor sick Neighbours; and in a Country, where the settled parochial Poor are provided with Medicines, as well as other Necessaries, at a parochial Expence. Besides, tho' we would not suppose our Country Apothecaries less considerate or kind than others, we acknowledge our Apprehension, that in such Valuation of their Drugs (some of which often vary in their Price) might dispose a few of them, rather to discountenance the Extension of a Work, so well intended and executed as Dr. Tissot's; a Work, which may not be wholly unuseful to some of the most judicious among them, and will be really necessary for the rest. K.

It may still be objected, that many Country Places are very distant from large Towns; from which Circumstance a poor Peasant is incapable of procuring himself a seasonable and necessary Supply in his Illness. I readily admit, that, in Fact, there are many Villages very remote from such Places as Apothecaries reside in. Yet, if we except a few among the Mountains, there are but very few of them above three or four Leagues from some little Town, where there always lives some Surgeon, or some Vender of Drugs. Perhaps however, even at this Time, indeed, there may not be many thus provided; but they will take care to furnish themselves with such Materials, as soon as they have a good Prospect of selling them, which may constitute a small, but new, Branch of Commerce for them. I have carefully set down the Time, for which each Medicine will keep, without spoiling. There is a very frequent Occasion for some particular ones, and of such the School-masters may lay in a Stock. I also imagine, if they heartily enter into my Views, they will furnish themselves with such Implements, as may be necessary in the Course of their Attendance. If any of them were unable to provide themselves with a sufficient Number of good Lancets, an Apparatus for Cupping, and a Glyster Syringe (for want of which last a Pipe and Bladder may be occasionally substituted) the Parish might purchase them, and the same Instruments might do for the succeeding School-master. It is hardly to be expected, that all Persons in that Employment would be able, or even inclined, to learn the Way of using them with Address; but one Person who did, might be sufficient for whatever Occasions should occur in this Way in some contiguous Villages; with very little Neglect of their Functions among their Scholars.

Daily Instances of Persons, who come from different Parts to consult me, without being capable of answering the Questions I ask them, and the like Complaints of many other Physicians on the same Account, engaged me to write the last Chapter of this Work. I shall conclude this Introduction with some Remarks, necessary to facilitate the Knowledge of a few Terms, which were unavoidable in the Course of it.

The Pulse commonly beats in a Person in good Health, from the Age of eighteen or twenty to about sixty six Years, between sixty and seventy Times in a Minute. It sometimes comes short of this in old Persons, and in very young Children it beats quicker: until the Age of three or four Years the Difference amounts at least to a third; after which it diminishes by Degrees.

An intelligent Person, who shall often touch and attend to his own Pulse, and frequently to other Peoples, will be able to judge, with sufficient Exactness, of the Degree of a Fever in a sick Person. If the Strokes are but one third above their Number in a healthy State, the Fever is not very violent: which it is, as often as it amounts to half as many more as in Health. It is very highly dangerous, and may be generally pronounced mortal, when there are two Strokes in the Time of one. We must not however judge of the Pulse, solely by its Quickness, but by its Strength or Weakness; its Hardness or Softness; and the Regularity or Irregularity of it.

There is no Occasion to define the strong and the feeble Pulse. The Strength of it generally affords a good Prognostic, and, supposing it too strong, it may easily be lowered. The weak Pulse is often very menacing.

If the Pulse, in meeting the Touch, excites the Notion of a dry Stroke, as though the Artery consisted of Wood, or of some Metal, we term it hard; the opposite to which is called soft, and generally promises better. If it be strong and yet soft, even though it be quick, it may be considered as a very hopeful Circumstance. But if it is strong and hard, that commonly is a Token of an Inflammation, and indicates Bleeding and the cooling Regimen. Should it be, at the same time, small, quick and hard, the Danger is indeed very pressing.

We call that Pulse regular, a continued Succession of whole Strokes are made in equal Intervals of Time; and in which Intervals, not a single Stroke is wanting (since if that is its State, it is called an intermitting Pulse.) The Beats or Pulsations are also supposed to resemble each other so exactly in Quality too, that one is not strong, and the next alternately feeble.