LETTER XI

MONTPELLIER, November 12.

DEAR DOCTOR—I flattered myself with the hope of much amusement during my short stay at Montpellier.—The University, the Botanical Garden, the State of Physic in this part of the world, and the information I received of a curious collection of manuscripts, among which I hoped to find something for our friend Dr. H—r; all these particulars promised a rich fund of entertainment, which, however, I cannot enjoy.

A few days after my arrival, it began to rain with a southerly wind, and continued without ceasing the best part of a week, leaving the air so loaded with vapours, that there was no walking after sun-set; without being wetted by the dew almost to the skin. I have always found a cold and damp atmosphere the most unfavourable of any to my constitution. My asthmatical disorder. which had not given me much disturbance since I left Boulogne, became now very troublesome, attended with fever, cough spitting, and lowness of spirits; and I wasted visibly every day. I was favoured with the advice of Dr. Fitzmaurice, a very worthy sensible physician settled in this place: but I had the curiosity to know the opinion of the celebrated professor F—, who is the Boerhaave of Montpellier. The account I had of his private character and personal deportment, from some English people to whom he was well known, left me no desire to converse with him: but I resolved to consult with him on paper. This great lanthorn of medicine is become very rich and very insolent; and in proportion as his wealth increases, he is said to grow the more rapacious. He piques himself upon being very slovenly, very blunt, and very unmannerly; and perhaps to these qualifications be owes his reputation rather than to any superior skill in medicine. I have known them succeed in our own country; and seen a doctor's parts estimated by his brutality and presumption.

F— is in his person and address not unlike our old acquaintance Dr. Sm—ie; he stoops much, dodges along, and affects to speak the Patois, which is a corruption of the old Provencial tongue, spoken by the vulgar in Languedoc and Provence. Notwithstanding his great age and great wealth, he will still scramble up two pair of stairs for a fee of six livres; and without a fee he will give his advice to no person whatsoever.

He is said to have great practice in the venereal branch and to be frequented by persons of both sexes infected with this distemper, not only from every part of France, but also from Spain, Italy, Germany, and England. I need say nothing of the Montpellier method of cure, which is well known at London; but I have some reason to think the great professor F—, has, like the famous Mrs. Mapp, the bone-setter, cured many patients that were never diseased.

Be that as it may, I sent my valet de place, who was his townsman and acquaintance, to his house, with the following case, and a loui'dore.

Annum aetatis, post quadragesimum, tertium, Temperamentum humidum, crassum, pituitarepletum, catarrhis saepissime profligatum. Catarrhus, febre, anxietate et dyspnoea, nunquam non comitatus. Irritatio membranae piuitariae trachaealis, tussim initio aridam, siliquosam, deinde vero excreationem copiosam excitat: sputum albumini ovi simillimum.

Accedente febre, urina pallida, limpida: ad akmen flagrante, colorem rubrum, subflavum induit: coctione peracta, sedimentum lateritium deponit.

Appetitus raro deest: digestio segnior sed secura, non autem sine ructu perfecta. Alvus plerumque stipata: excretio intestinalis minima, ratione ingestorum habita. Pulsus frequens, vacillans, exilis, quandoquidem etiam intermittens.

Febre una extincta, non deficit altera. Aliaque et eadem statim nascitur. Aer paulo frigidior, vel humidior, vestimentum inusitatum indutum; exercitatio paulullum nimia; ambulatio, equitatio, in quovis vehiculo jactatio; haec omnia novos motus suscitant. Systema nervosum maxime irritabile, organos patitur. Ostiola in cute hiantia, materiei perspirabili, exitum praebentia, clauduntur. Materies obstructa cumulatur; sanguine aliisque humoribus circumagitur: fit plethora. Natura opprimi nolens, excessus huius expulsionem conatur. Febris nova accenditur. Pars oneris, in membranam trachaealem laxatam ac debilitatam transfertur. Glandulae pituitariae turgentes bronchia comprimunt. Liber aeri transitus negatur: hinc respiratio difficilis. Hac vero translatione febris minuitur: interdiu remittitur. Dyspnoea autem aliaque symptomata vere hypochondriaca, recedere nolunt. Vespere febris exacerbatur. Calor, inquietudo, anxietas et asthma, per noctem grassantur. Ita quotidie res agitur, donec. Vis vitae paulatim crisim efficit. Seminis joctura, sive in somniis effusi, seu in gremio veneris ejaculati, inter causas horum malorum nec non numeretur.

Quibusdam abhinc annis, exercitationibus juvenilibus subito remissis, in vitam sedentariam lapsum. Animo in studia severiora converso, fibre gradatim laxabantur. Inter legendum, et scribendum inclinato corpore in pectus malum, ruebat. Morbo ingruenti affectio scorbutica auxilium tulit. Invasio prima nimium aspernata. Venientibus hostibus non occursum. Cunctando res non restituta. Remedia convenientia stomachus perhorrescebat. Gravescente dyspnoea phlebotomia frustra tentata. Sanguinis missione vis vitae diminuta: fiebat pulsitis debilior, respiratio difficilior. In pejus ruunt omnia. Febris anomala in febriculam continuam mutata. Dyspnoea confirmata. Fibrarum compages soluta. Valetudo penitus eversa.

His agitatus furiis, aeger ad mare provolat: in fluctus se precipitem, dat: periculum factum spem non fefellit: decies iteratum, felix faustumque evasit. Elater novus fibris conciliatur. Febricula fugatur. Acris dyspnoea solvitur. Beneficium dextra ripa partum, sinistra perditum. Superficie corporis, aquae marine frigore et pondere, compressa et contracta, interstitia fibrarum occluduntur: particulis incrementi novis partes abrasas reficientibus, locus non datur. Nutritio corporis, via pristina clausa, qua data porta ruit: in membranam pulmonum, minus firmatam facile fertur, et glandulis per sputum rejicitur.

Hieme pluviosa, regnante dolores renovantur; tametsi tempore sereno equitatio profuit. Aestate morbus vix ullum progrediebatur. Autumno, valetudine plus declinata, thermis Bathoniensibus solatium haud frustra quaesitum. Aqua ista mire medicata, externe aeque ac interne adhibita, malis levamen attulit. Hiems altera, frigida, horrida, diuturna, innocua tamen successit. Vere novo casus atrox diras procellas animo immisit: toto corpore, tota mente tumultuatur. Patria relicta, tristitia, sollecitudo, indignatio, et saevissima recordatio sequuntur. Inimici priores furore inveterato revertuntur. Rediit febris hectica: rediit asthma cum anxietate, tusse et dolore lateris lancinanti.

Desperatis denique rebus, iterum ad mare, veluti ad anceps remedium recurritur. Balneum hoc semper benignum. Dolor statim avolat. Tertio die febris, retrocessit. Immersio quotidiana antemeridiana, ad vices quinquaginta repetita, symptomata graviora subjugavit.— Manet vero tabes pituitaria: manet temperamentum in catarrhos proclive. Corpus macrescit. Vires delabuntur.

The professor's eyes sparkled at sight of the fee; and he desired the servant to call next morning for his opinion of the case, which accordingly I received in these words:

"On voit par cette relation que monsieur le consultant dont on n'a pas juge a propos de dire l'age, mais qui nous paroit etre adulte et d'un age passablement avance, a ete sujet cy devant a des rhumes frequens accompagnes de fievre; on ne detaille point (aucune epoque), on parle dans la relation d'asthme auquel il a ete sujet, de scorbut ou affection scorbutique dont on ne dit pas les symptomes. On nous fait scavoir qu'il s'est bien trouve de l'immersion dans l'eau de la mer, et des eaux de Bath.

"On dit a present qu'il a une fievre pituitaire sans dire depuis combien de temps. Qu'il lui reste toujours son temperament enclin aux catharres. Que le corps maigrit, et que les forces se perdent. On ne dit point s'il y a des exacerbations dans cette fievre ou non, si le malade a appetit ou non, s'il tousse ou non, s'il crache ou non, en un mot on n'entre dans aucun detail sur ces objets, sur quoi le conseil soussigne estime que monsieur le consultant est en fievre lente, et que vraisemblable le poumon souffre de quelque tubercules qui peut-etre sont en fonte, ce que nous aurions determine si dans la relation on avoit marque les qualites de crachats.

"La cause fonchere de cette maladie doit etre imputee a une lymphe epaisse et acrimonieuse, qui donne occasion a des tubercules au pomon, qui etant mis on fonte fournissent au sang des particules acres et le rendent tout acrimonieux.

"Les vues que l'on doit avoir dans ce cas sent de procurer des bonnes digestions (quoique dans la relation ou ne dit pas un mot sur les digestions) de jetter un douce detrempe dans la masse du sang, d'en ebasser l'acrimonie et de l'adoucir, de diviser fort doucement a lymphe, et de deterger le poumon, lui procurant meme du calme suppose que la toux l'inquiete, quoique cependant on ne dit pas un mot sur la toux dans la relation. C'est pourquoi on le purgera avec 3 onces de manne, dissoutes dans un verre de decoction de 3 dragmes de polypode de chesne, on passera ensuite a des bouillons qui seront faits avec un petit poulet, la chair, le sang, le coeur et le foye d'une tortue de grandeur mediocre c'est a dire du poid de 8 a 12 onces avec sa coquille, une poignee de chicoree amere de jardin, et une pincee de feuilles de lierre terrestre vertes on seches. Ayant pris ces bouillons 15 matins on se purgera comme auparavant, pour en venir a des bouillons qui seront faits avec la moitie d'un mou de veau, une poignee de pimprenelle de jardin, et une dragme de racine d'angelique concassee.

Ayant pris ces bouillons 15 matins, on se purgera somme auparavant pour en venir an lait d'anesse que l'on prendra le matin a jeun, a la dose de 12 a 16 onces y ajoutant un cuilleree de sucre rape, on prendra ce lait le matin a jeun observant de prendre pendant son usage de deux jours l'un un moment avant le lait un bolus fait avec 15 grains de craye de Braincon en poudre fine, 20 grains de corail prepare, 8 grains d'antihectique de poterius, et ce qu'il faut de syrop de lierre terrestre, mais les jour on ou ne prendra pas le bolus on prendra un moment avant le lait 3 on 4 gouttes de bon baume de Canada detrempees dans un demi cuilleree de syrop de lierre terrestre. Si le corps maigrit de plus en plus, je suis d'avis que pendant l'usage du lait d'anesse on soupe tous les soirs avec une soupe au lait de vache.

"On continuera l'usage du lait d'anesse tant, que le malade pourra le supporter, ne le purgeant que par necessite et toujours avec la medecine ordonnee.

"Au reste, si monsieur le consultant ne passe les nuits bien calmes, il prendra chaque soir a l'heure de sommeil six grains des pilules de cynoglosse, dent il augmentera la dose d'un grain de plus toutes les fois que la dose du jour precedent, n'aura pas ete suffisante pour lui faire passer la nuit bien calme.

"Si les malade tousse il usera soit de jour soit de nuit par petites cuillerees a casse d'un looch, qui sera fait avec un once de syrop de violat et un dragme de blanc de baleine.

"Si les crachats sent epais et qu'il crache difficilement, en ce cas il prendra une ou deux fois le jour, demi dragme de blanc de baleine reduit on poudre avec un pen de sucre candit qu'il avalera avec une cuilleree d'eau.

"Enfin il doit observer un bon regime de vivre, c'est pourquoi il fera toujours gras et seulement en soupes, bouilli et roti, il ne mangera pas les herbes des soupes, et on salera peu son pot, il se privera du beuf, cochon, chair noir, oiseaux d'eau, ragouts, fritures, patisseries, alimens sales, epices, vinaigres, salades, fruits, cruds, et autres crudites, alimens grossiers, ou de difficille digestion, la boisson sera de l'eau tant soit peu rougee de bon vin au diner seulement, et il ne prendra a souper qu'une soupe.

Delibere a MONTPELLIER
le 11 Novembre.
F—.
Professeur en l'universite honoraire.

Receu vingt et quatre livres.

I thought it was a little extraordinary that a learned professor should reply in his mother tongue, to a case put in Latin: but I was much more surprised, as you will also be, at reading his answer, from which I was obliged to conclude, either that he did not understand Latin; or that he had not taken the trouble to read my memoire. I shall not make any remarks upon the stile of his prescription, replete as it is with a disgusting repetition of low expressions: but I could not but, in justice to myself, point out to him the passages in my case which he had overlooked. Accordingly, having marked them with letters, I sent it back, with the following billet.

"Apparement Mons. F— n'a pas donne beaucoup d'attention au memoire de ma sante que j'ai on l'honneur de lui presenter— 'Monsieur le consultant (dit il) dont on n'a pas juge it propos de dire l'age.'—Mais on voit dans le memoire a No. 1. 'Annum aetatis post quadragesimum tertium.'

"Mr. F— dit que 'je n'ai pas marque aucune epoque. Mais a No. 2 du memoire il trouvera ces mots. 'Quibusdam abbinc annis.' J'ai meme detaille le progres de la maladie pour trois ans consecutifs.

"Mons. F— observe, 'On no dit point s'il y a des exacerbations dans cette fievre ou non.' Qu'il. Regarde la lettre B, il verra, Vespere febris exacerbatur. Calor, inquietudo, anxietas et asthma per noctem grassantur.'

"Mons. F— remarque, 'On ne dit point si le malade a appetit ou non, s'il tousse ou non, s'il crache ou non, en un mot on n'entre dans aucun detail sur ces objets.' Mais on voit toutes ces circonstances detaillees dans la memoire a lettre A, 'Irritatio membranae trachaealis tussim, initio aridam, siliquosam, deinde vero excreationem copiosam excitat. Sputum albumini ovi simillimum. Appetitus raro deest. Digestio segnior sed secura.'

"Mons. F— observe encore, 'qu'on ne dit pas un mot sur la toux dans la relation.' Mais j'ai dit encore a No. 3 de memoire, 'rediit febris hectica; rediit asthma cum anxietate, tusse et dolore lateris lancinante.'

"Au reste, je ne puis pas me persuader qu'il y ait des tubercules au poumon, parce que j'ai ne jamais crache de pus, ni autre chose que de la pituite qui a beaucoup de ressemblance au blanc des oeufs. Sputum albumini ovi simillimum. Il me paroit done que ma maladie doit son origine a la suspension de l'exercice du corps, au grand attachement d'esprit, et a une vie sedentaire qui a relache le sisteme fibreux; et qu'a present on pent l'appeller tubes pituitaria, non tubes purulenta. J'espere que Mons. Faura la bonte de faire revision du memoire, et de m'en dire encore son sentiment."

Considering the nature of the case, you see I could not treat him more civilly. I desired the servant to ask when he should return for an answer, and whether he expected another fee. He desired him to come next morning, and, as the fellow assured me, gave him to understand, that whatever monsieur might solicit, should be for his (the servant's) advantage. In all probability he did not expect another gratification, to which, indeed, he had no title. Mons. F— was undoubtedly much mortified to find himself detected in such flagrant instances of unjustifiable negligence, arid like all other persons in the same ungracious dilemma, instead of justifying himself by reason or argument, had recourse to recrimination. In the paper which he sent me next day, he insisted in general that he had carefully perused the case (which you will perceive was a self-evident untruth); he said the theory it contained was idle; that he was sure it could not be written by a physician; that, with respect to the disorder, he was still of the same opinion; and adhered to his former prescription; but if I had any doubts I might come to his house, and he would resolve them.

I wrapt up twelve livres in the following note, and sent it to his house.

"C'est ne pas sans raison que monsieur F— jouit d'une si grande reputation. Je n'ai plus de doutes, graces a Dieu et a monsieur F—e. " "It is not without reason that monsieur Fizes enjoys such a large share of reputation. I have no doubts remaining; thank Heaven and monsieur Fizes."

To this I received for answer. "Monsieur n'a plus de doutes: j'en suis charme. Receu douze livres. F—, &c." "Sir, you have no doubts remaining; I am very glad of it. Received twelve livres. Fizes, &c."

Instead of keeping his promise to the valet, he put the money in his pocket; and the fellow returned in a rage, exclaiming that he was un gros cheval de carosse, a great coach-horse.

I shall make no other comment upon the medicines, and the regimen which this great Doctor prescribed; but that he certainly mistook the case: that upon the supposition I actually laboured under a purulent discharge from the lungs, his remedies savour strongly of the old woman; and that there is a total blank with respect to the article of exercise, which you know is so essential in all pulmonary disorders. But after having perused my remarks upon his first prescription, he could not possibly suppose that I had tubercules, and was spitting up pus; therefore his persisting in recommending the same medicines he had prescribed on that supposition, was a flagrant absurdity.—If, for example, there was no vomica in the lungs; and the business was to attenuate the lymph, what could be more preposterous than to advise the chalk of Briancon, coral, antihecticum poterii, and the balm of Canada? As for the turtle-soupe, it is a good restorative and balsamic; but, I apprehend, will tend to thicken rather than attenuate the phlegm. He mentions not a syllable of the air, though it is universally allowed, that the climate of Montpellier is pernicious to ulcerated lungs; and here I cannot help recounting a small adventure which our doctor had with a son of Mr. O—d, merchant in the city of London. I had it from Mrs. St—e who was on the spot. The young gentleman, being consumptive, consulted Mr. F—, who continued visiting and prescribing for him a whole month. At length, perceiving that he grew daily worse, "Doctor (said he) I take your prescriptions punctually; but, instead of being the better for them, I have now not an hour's remission from the fever in the four-and-twenty.—I cannot conceive the meaning of it." F—, who perceived he had not long to live, told him the reason was very plain: the air of Montpellier was too sharp for his lungs, which required a softer climate. "Then you're a sordid villain (cried the young man) for allowing me to stay here till my constitution is irretrievable." He set out immediately for Tholouse, and in a few weeks died in the neighbourhood of that city.

I observe that the physicians in this country pay no regard to the state of the solids in chronical disorders, that exercise and the cold bath are never prescribed, that they seem to think the scurvy is entirely an English disease; and that, in all appearance, they often confound the symptoms of it, with those of the venereal distemper. Perhaps I may be more particular on this subject in a subsequent letter. In the mean time, I am ever,— Dear Sir, Yours sincerely.