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CHAPTER XLII
DYING FROM MERE FILTHINESS

The family of a wealthy farmer came under my hands, as physician, one autumn, in circumstances peculiarly painful and trying. Several of them had been taken suddenly and severely sick, and one or two were almost dead before they were fairly aroused to a sense of danger. They lived, however, quite remote from any village, and were strongly prejudiced against both physicians and medicine. But a fearful foe, in the shape of typhoid dysentery, now assailed them, and handled them so roughly that they laid aside their prejudices for the moment, and cried aloud for help.

I was soon on the spot, but, oh, what a scene presented itself! As I have more than intimated, two of the family were already beyond hope. Others seemed likely to die. What was to be done for them, as I saw plainly, must be done quickly. On nearly every countenance I met with, both within the family and beyond its precincts, were the marks of consternation, and on some, of despair.

In these circumstances – for desperate cases require a desperate remedy – I sought the counsels of an older physician. He came immediately and took a survey of the dreadful field of slaughter. On retiring with him for consultation, he immediately said; "There must be some local cause or causes for all this. Have you," he added, "been into the cellar?" When I replied in the negative, he said, "Then we must go there immediately."

On speaking to the lady of the house, who was among the sick, by the way of asking permission, she objected, and with a good deal of promptitude and spirit. However, she at length yielded, and we made a thorough examination. The results of this examination were such as to confirm our suspicions. "We need not search further for the causes of a deadly disease," said Dr. B., and I thought so too.

I have said already that the family was wealthy; but wealth need not include negligence, and still more filth. It was now September; and I am quite of opinion that the cellar had not been cleaned in one year, perhaps not in two. I had seen many farmers' cellars before, but I had never seen such an one as this. Nor do I believe my consulting physician ever had, though he was some twenty years older in medical practice than myself. Nor am I certain that what I may state will appear to you wholly reliable.

In the first place there were, in abundance, cabbage leaves and stumps in a semi-putrid state. Next there were decayed potatoes, turnips, beets, and apples. Then there were in various parts of the cellar remnants of cider and vinegar, and cider lees – the latter in a most offensive condition. Finally, there were remnants of barrels of beef and pork, in a bad state – to say nothing of other casual filth – the whole contributing to such a stench as I had never before perceived in a cellar.

The old physician who accompanied me had said, "We need not go farther;" but our determination was, on full and mature reflection, to know the worst and the whole, and we governed ourselves accordingly.

Close to one corner of the kitchen was the well, the water in which was very low, and near to that the sink. And if the contents of the sink did not find their way, from day to day, into the well, thus adding impurity to putridity, it must have been in virtue of some unknown law which stood opposed to the great law of specific gravity and attraction. It is true that many speak of the earth as having a cleansing power in such cases; but I know of no power which it possesses of cleaning sink water, while the latter is passing only five or six feet through it. The coarser parts may be strained out, but the essence must remain.⁶

But our work was not yet finished. The vault, greatly neglected, was not far from the well; and so of the pigsty. Nor was it easy to resist the conviction that there was an underground communication between them. Then, finally, the house instead of standing on an elevation, greater or less, – a very common mode of building in New England, – stood in a sort of concavity, which contained also the barn and barnyard and woodpile; – connected with both of which was a large amount of decayed and decaying animal and vegetable matter.

Now after such a review as this, he who could remain in doubt with regard to the cause of existing disease, especially on its assuming the form of bowel complaint with typhoid tendencies, must be much more ignorant of the laws of health and disease than I was. In fact the signs were unmistakable.

We immediately made our report to the heads of the family, and recommended a most thorough cleansing, at once. It was easy to see that we gave great offence; indeed we had anticipated such a result. But we were not at all intimidated. We insisted on a work of immediate expurgation, which was finally effected, only we could not put pure water into the well. But we could and did require that the well water should not be used for any thing except washing clothes.

The result was a decided and almost immediate improvement in the condition of the family, except the two already spoken of, and a very young child. These three died. Some of the rest lingered for weeks, and one or two for months; but they finally recovered.

It is worthy of remark, moreover, that of the people of the neighborhood, though they had been excessively frightened and had not at first dared to come near the house, at least without holding their breath, not a person among them sickened. The disease began and ended over the foul cellar I have mentioned; nor has a similar disease ever since broken out there. The fair presumption is, that they have never since suffered such foul accumulations to remain through the hot season, on their premises.

My honest and truly honorable course of conduct, in this instance, cost me something. Though I was a means of saving their lives, the survivors never thanked me for the exposure I made of their slovenliness. Perhaps I was wrong in reporting it abroad; but it was next to impossible to conceal the facts; and I, for once, did not attempt it. Physicians sometimes thus stand between the living and the dead, and must expect to give offence. They are, however, in duty bound to keep the secrets of their patients' faults as long as they can, unless the greater good of the public demands an exposition.

But while I lost reputation in this particular family, I have not a doubt that I gained a strong hold, by this adventure, on the public mind and feelings. In truth, despite of even some trifling errors, I deserved it. I had, moreover, during the adventure, acquired a good deal of practical knowledge, of which, in the progress of my course as a medical man, I was glad to avail myself.

This was doubtless an extreme case of disease from filthiness; but cases of the same general character are quite numerous. I have sometimes wished the public could have a history of these cases. There is an immense amount of neglect in the departments of cleanliness and ventilation; and the consequent suffering in the various forms of disease, is in similar degree and proportion.

I will conclude this chapter with a single anecdote, which, were it necessary, could be substantiated by a very great number of living witnesses.

Some fifteen or twenty years ago, a severe disease was accustomed to visit one of our New England factory villages, and to carry off more or fewer of its inhabitants. So regular and certain were its yearly visits and ravages, that not a few were disposed to regard it as a sort of necessary evil, or, perhaps, as a divine infliction. At length a very shrewd old gentleman told the people that the troublesome visitor was of human and not of divine origin; and that if they would attend properly to their cellars, sleeping-rooms, wells, etc., it would no more be heard of. At first, they were disposed to laugh at him; but the matter was talked of and agitated, till a work of general purgation was actually attempted and finally accomplished. The disease has never re-appeared. Was all this the result of mere accident? Do our diseases spring out of the ground? Are they the result of chance or hap-hazard? or, are they not the heaven-appointed penalties of transgression?

CHAPTER XLIII
TAKING THE FEVER

A large family, not much more careful of their habits or cleanly about their premises than the family alluded to in the foregoing chapter, had sickened one autumn, and one of them had died. Anxious to save the rest, I again acted as physician and nurse both, and effected my object; or, at least, appeared to do so. The rest of my patients ultimately recovered.

But while thus watching these patients, by night and day, standing in the very front of the battle, I suddenly sickened. The circumstances, as nearly as I can recollect them, were the following: —

Among the sick of this afflicted family was one unmarried man of rather eccentric and very unsociable habits, and exceedingly negligent both of his person and dress. His linen, and I think also his bed-clothes, were hardly changed once a month; at least as long as he was well. And then he had, of course, extended the same neglect to his sick chamber. Added to this, moreover, was a species of necessity at this juncture; for so much distressed were the family, and so difficult was it to procure aid in the neighborhood, that a part of the neglect to which our old bachelor was subjected seemed unavoidable.

I took notice of the neglect, spoke of it repeatedly, and labored assiduously to correct the evil. But the case seemed an almost forlorn one. I was morally obliged, as I then felt, to do a thousand things for him that usually fall to the lot of nurses and assistants. In some instances, I passed even whole nights in the family, in attendance on him and the other sick persons.

My task was the more severe from the fact that a similar fever was prevailing in other parts of the town, and my labors beyond the precincts of this family were exceedingly fatiguing and severe. In truth, I was, in the end, greatly overworked and debilitated, and my system most admirably prepared for the reception of disease.

For various reasons, some of which, have already been named, I often assisted in turning my bachelor-patient in his foul bed. It is true the process was so offensive that I avoided it whenever I could; but on occasions, I yielded to the pressure of necessity.

One night, when I was greatly fatigued and exhausted, and at the bottom of my condition, – utterly unfit for exertion, even in a pure atmosphere, – I was stooping over Mr. V., to turn him in his bed, when I suddenly felt a sensation like that of receiving a blow externally on the chest and stomach. The thought struck me as quickly as the imaginary blow did – have I not taken the disease? I knew the laws of contagion; the only question was whether any contagion had been generated. My opinion was to the contrary; nevertheless, I could not wholly suppress my fears.

A sensation of oppression which followed the imaginary blow, soon gradually passed away, though I felt, each succeeding day, more and more debilitated. Many a resolution was made to leave my patients, so far as personal manual care was concerned, and be much more than I had been, in the open air, though it was only made for a time – to be broken. At length, however, principle prevailed over sympathy and inclination, and I did as I ought to have done long before. It was, however, rather late, for the die was already cast. I was taken sick, and the symptoms of my disease were precisely like those of Mr. V.

Perceiving now, most clearly, my condition, and that I was engaged in a war from which there could be no discharge, I made preparation for a long and severe sickness. First, I calmly and deliberately adjusted all my domestic concerns of a pecuniary kind, and made such arrangements as would, in case of my demise, render every thing intelligible. Then, in the second place, I made up my mind to submit, as cheerfully as I could, to my condition. I determined to keep quiet, and not indulge for a moment in any undue anxiety. I employed a physician, – my old master – but steadfastly, and almost obstinately determined not to take much medicine; – nor was there much prescribed.

My disease proved to be much milder than was expected; but it had its regular course. I never wholly lost my muscular strength or my appetite. While I was sick, several of my nearest friends and patrons sickened in a similar way, only more severely; and one or two of them died. On my recovery, however, or about the same time, the most of them began also to recover, and the disease in general abated.

Now, when I came to reflect coolly and carefully on the whole affair, I could not help perceiving that I richly deserved all I suffered. It was the just penalty of transgression. I had been fully and repeatedly warned not to watch with my patients, as those who turn back to Chapter XXIII, and those too who remember its contents, will perceive. It was fit, therefore, that I should feel the rod, even if I could not kiss the hand that had appointed it. The only wonder with me now is, that my punishment was not more severe.

CHAPTER XLIV
BLESSINGS OF CIDER AND CIDER BRANDY

Some of these blessings have been alluded to in Chapter XXXVI. But the subject is one of too much importance to be left in an unfinished state, and I have concluded to make it the principal topic of a separate chapter.

A man came to me, one day, with sundry grievous complaints about his head and stomach. It was easy to see, at once, that they were not of mushroom growth, and that they could not be removed either in an hour or a day. However, I did the best I could with him, and charged him to follow, implicitly, my directions, which he promised faithfully to do. I told him, even, that he was in danger of a severe disease, but counselled him to do his utmost to escape it, if possible.

He was, in the first place, a New England or Yankee farmer. Not quite satisfied with the products of his farm from the labors of the day, he coupled with them the night labors of managing a saw-mill and a distillery. And not satisfied with even these, he sometimes burned charcoal, which also involved more or less of nocturnal labor. In truth, these employments and avocations kept him up a great many nights during a considerable portion of the year, and were evidently wearing him out prematurely; for, though less than forty years of age, he had the appearance of being fifty or sixty.

This severe tasking of his system, had led him greatly into temptation. Not only had he acquired the habit of chewing tobacco, as a solace in his seclusion and toil, but also of drinking very freely of cider and cider brandy; the last two of which, as might naturally be inferred from what has been said, he was accustomed to manufacture in large quantities. He was not a great eater, though I have no doubt he ate too much. But he did not take time to eat – he did not masticate any thing; almost every thing was swallowed in masses, and washed down with tea, coffee, or cider. Then, lastly and finally, he ate, as it were, by the job, when he did eat; for his meals were very irregular and sometimes very infrequent.

Another thing should be noticed. His cider and perhaps his tobacco, having leagued together, took away his appetite. Cider, as is well known, practically and in a gradual way, takes away the appetite, and so does coffee. Many a farmer will tell you that it is a matter of economy to give his laborers cider or coffee, since they will not eat so much. It is highly probable that brandy, and indeed all extra stimulants, have the same appetite-destroying effect.

And as the result of his various irregularities and abuses, his digestive and nervous systems had become very much deranged and disordered, and I could hardly help foreboding evil concerning him. I prescribed for him as well as I could, and requested him to call on me in two or three days, and "report progress."

On the next day but one, I was summoned to his bedside. My medicine had indeed appeared to afford him a little temporary relief, but it was only temporary. He was now much worse than ever before. I prescribed again; but it was with similar effect. Nature, somewhat relieved, as I then vainly imagined, seemed disposed to rally, but was unable. Every successive effort to rally, showed more and more clearly how much she had been crippled. At least she seemed to succumb either to the treatment or the disease, which last became in the end quite formidable.

But though Nature had yielded, apparently vanquished, she still made occasional faint efforts, every two or three days, to regain the supremacy, or, in other words, to set things right; and sometimes we were led to indulge in hope. But the remissions of disease and of suffering were only temporary, and were succeeded, in every instance, by a worse condition of things than before. I called for sage medical counsel, but all to no permanent purpose. Downward he tended, step by step, and no human power or skill seemed likely to arrest his progress.

In this downward course his constitution held out – for he was by nature exceedingly tenacious of life – till about the twenty-third day, when the vital forces began to retreat. He died on the twenty-fifth.

One practical but general error deserves to be noticed, for want of a better place, in this very connection. Notwithstanding the great difficulty of convincing a person who habitually uses extra stimulants, narcotics, or any medicinal agents, all the way from rum, opium, and tobacco, down to tea, coffee, and saleratus, that they are injuring him at all, as long as he does not feel very ill, yet it ought to be clearly and fully known that every one who is thus addicted to unnatural habits, and being thus addicted is seized with disease of any kind and from any cause whatever, is certain to have that disease with greater severity than if his habits had been, from the first, perfectly correct or normal. Nor is this all. Medical aid, whenever invoked under these circumstances, is more questionable as to its good tendencies. No medical man of any skill or observation but must feel, in such a case, most painfully, the terrible uncertainty of that treatment of the living machine which is quite enough so when the habits have been most favorable, by being most correct.

One caution of quite another kind may be interposed here. My patient above had neglected to call on me for several days in the beginning of his disease, under the very general impression of ignorant people, that if he called a physician he should certainly be severely sick; for if he was not already very sick, any efforts to prevent disease would only serve to make him so.

Now this is, as a general rule, a very great mistake. It would be much more safe to call a physician very early, than to wait till Nature is so much embarrassed and even crippled that we can place very little reliance on her efforts. Worse still is it for the physician, when called late, to load down the enfeebled system with medicine by way of atoning for past neglects. Thousands have made the mistake here alluded to, and have thus been a means of hastening on a fatal termination of the disease. It is not by any means improbable that such was the result in the foregoing instance.

CHAPTER XLV
THE INDIAN DOCTOR

A little child about two years of age, severely afflicted with bowel complaint, came under my care during the first year of my medical practice, and proved the source of much difficulty.

She was the child of a mother who had been trained to delicacies, in the usual fashionable way, and who had begun to carry out the same wretched course of education in her own family. In addition to a generally wrong treatment, the child had been indulged, for many weeks before I was called, with a large amount of green, or at least very unripe, fruit.

It was at a season of the year when both children and adults were suffering from bowel complaints much more than at any other; but as the hot days and nights were expected soon to give way to the cooler and longer nights of October, I fastened my hopes of the child's final recovery, very largely, on the natural recuperative effects of the autumnal season. I did not attempt to give much medicine. My reliance was almost wholly on keeping up what I was wont to call a good centrifugal force, or in keeping the skin – the great safety valve of the system – in proper and healthful activity. Much that I ordered was in the way of bathing, local and general, especially warm bathing.

The parents of the child were among my most confidential, not to say influential, friends. If there was a family within the whole of my medical circuit with whom my word was law, it was this. Yet after all they were ignorant, especially of themselves; and such people always were and always will be credulous. They would open their ears, not only to the thousand and one insinuations of malice and envy, which at times are ventured against a young physician, – especially if he is going ahead, and as they say "getting rich" too fast, and thus securing more than they believe to be his share of public popularity; – but to the still larger number, if possible, of weak criticisers in his practice.

My friend's residence, moreover, was in a neighborhood contiguous to quacks and quackery, in the pretensions to which there were many believers. These dupes of ignorance and assurance were ever and anon filling the heads of my "patrons" with their stories of wonderful cures, in cases almost exactly like that of my own little patient, and urging the poor half-distracted parents to try something new – either medicine or physician. They would appeal to their feelings by asking them how they could be willing, as parents, – however great might be their confidence in me as a physician, – to let a darling child lie, day after day, and yet make no extra effort to save it.

Their appeals were not wholly ineffective; indeed, what else could have been expected? My first suspicion of any thing radically wrong, arose from a decidedly unexpected effect from a little medicine I had previously ordered. It seemed quite clear to my mind that a neutralizing agent had been at work somehow, by design or otherwise. And yet I shrunk from making an inquiry. In the end, however, I found myself morally compelled to do so. The results were very nearly what I had feared, and what might have been expected.

One of the reliabilities of the wise ones of the neighborhood went by the name of the "Indian" doctor. Whether in addition to a very little Indian blood he was half or three-fourths Spanish, Portuguese, or Canadian, I never knew, for I never took pains to inquire. But he had Indian habits. He was at times intemperate and vicious. No one who knew him would have trusted him with a sixpence of his own honest earnings, at least any longer than he was within his sight or reach. Yet many people would and did trust him with their own lives and the lives of their children.

There was one redeeming circumstance in connection with the history of this Indian doctor. He would never prescribe for the sick when in a state of intoxication. He knew, in this respect, his own weakness. But then it must be confessed he was not often free from intoxication. He was almost always steeped in cider or spirits. He was seldom, if ever, properly a sane or even a steady man.

On pressing the parents of the sick child more closely than usual, they frankly owned that though they had not of themselves called in the Indian doctor, they had permitted Mrs. A. B. to invite him in, and had permitted the child to take a little of his medicine.

The secret was now fully revealed, and it was no longer a matter of wonder with me, why poison did not work well against poison. The wonder was why, together, we had not killed the poor child. And yet it was by no means certain that the Indian's prescription was of much force, save the few drops of alcohol which it contained, for all his medicine was to be taken in alcohol.

I stated to the parents the probable issues – that unless the child possessed more than ordinary tenacity of life, it must ultimately sink under the load it was compelled to sustain. But to our great surprise – certainly my own – it survived; and, though it was suspended for weeks between life and death, it finally recovered.

The most mortifying circumstance of all was, that this miserable mongrel of a man had the credit of curing a child that only survived because it was tough and strong enough to resist the destructive tendency of two broadside fires – mine and his own. But medical men are compelled to put up with a great many things which, of course, they would not prefer. They must take the world as it is – as the world does the corps of physicians. They must calculate for deductions and drawbacks; and what they calculate on, they are pretty sure to experience. But, like other men with other severe trials, they have their reward.