Sunday, 16 February 2014

24 March 1900 - 'A Little Strengthening Medicine' by 'The New Doctor'

In which The New Doctor rails against people who use bitters and tonics when he thinks they don't need to, and a veterinary surgeon's treatment of a lady's dog is questionable. 

 A certain lady brought her pet lap-dog to a veterinary surgeon. “Poor dear Fido,” she said, “has quite lost his appetite of late. He will scarcely eat anything, and is very depressed and listless. I have tried to tempt him with every dainty I could think of, but it is all to no purpose. The poor dear cannot eat. Yesterday he could scarcely manage the breast of a fowl which he had specially cooked for him. I am afraid that he must be very ill indeed!  Do you think that you can cure him?  Cannot you give him a little strengthening medicine to improve his appetite?”

“Yes, madam,” replied the veterinary surgeon; “I think I can cure him, but I am afraid you must leave him with me for the next three days. If you will call again on Thursday, I hope to be able to restore dear Fido to you quite cured.”

“Oh dear!” exclaimed the lady, “I am very, very sorry to leave poor dear Fido, but I suppose it is necessary.  Now be sure to give him everything he wants to eat, and do not on any account stint anything that he may fancy. Remember that expense is of no moment.”

“Very well, madam. I will do my very best to cure him! Good morning.”

And the lady departed quite at her ease, but had she lingered a few moments longer, she would have heard what would have much troubled her peace of mind, and might have been very unfortunate for the health of her dog. As soon as she had gone –

“Bob,” cried out the veterinary, “take that dog and chain him up in the yard, and remember to give him nothing whatever to eat till Thursday.”

Having seen to her favourite, the lady turns her attention to her own case. She also is suffering from loss of appetite, headache and lassitude. She also wants a little strengthening medicine. So she calls on her family doctor. She tells him her symptoms, ending up with the phrase which is ever ringing in the medical ear, “Could you give me a little strengthening medicine, please, doctor?”

The answer she gets to this question and the treatment she will be advised for her complaint will vary a good deal with many circumstances.

Had she lived half a century ago and consulted a celebrated surgeon, f whom a certain kind of biscuit takes its name, she would have had a very warm quarter of an hour, and she would have left his consulting-room in a very bad temper, with no bottle of strengthening medicine in her bag, and with curt suggestions as to treatment with which she would have been far from pleased. She would have determined never again to enter the house of this impertinent, ungentlemanly man. But if she had carried out his treatment, she would have been cured in a few days.

But too often she will leave the consulting-room smiling, with a very tempting bottle of strengthening medicine and pleasant suggestions about more dainty dishes, and a very little old port wine after lunch and a small glass of liqueur after dinner; and she remembers for many a long day her charming interview with that delightful and clever doctor.

And a few days later she repeats her visit, and continues her visits for weeks, months, years, her whole life, and she never gets cured.

And as time goes on she begins to think something serious is the matter with her, and thinks of cancer or some other extremely unlikely catastrophe, and she goes on feeding herself up and eating and drinking more and more to keep up her strength. And she gets worse and worse, and weaker and weaker, till she dies of apoplexy or some such thing.

And if you ask us what causes all this, we reply, unhesitatingly, it is the little strengthening medicine and the advice which goes with it, which has done it all.

It is the little strengthening medicine which has given the kind-hearted doctor a well-paying, life-long patient. It is the refusal to grant the little strengthening medicine which has lost the great surgeon the same influential patient.

On Thursday, the lady calls for her dog, and instantly he perceives her he rushes to her arms. And the poor darling little Fido has quite recovered his appetite, and is quite his own self again.

In her walk, or rather drive (for the lady we are describing does not approve of so tiresome an exercise as walking), she ponders over the complete cure of her dear little Fido, and she can scarcely help comparing his case with he own, and the greater knowledge of the veterinary over her own doctor.

But is this fair?  Is it fair to compare the results obtained by a veterinary surgeon, who deals with subjects who are unreasoning and who cannot rebel against his treatment, with those obtained by the family doctor hampered by conventionality and crushed by the whims of a reasoning but unreasonable patient, who will not carry out any of his instructions, save such as conforms to her own wishes?

Both this lady and her lap-dog are suffering from the same complaint, caused by the same thing – overeating. This lady has probably been eating and drinking too much, and stuffing her dog at the same time, until both are ill, and both need the same very simple treatment, which the dog can get, but the human being cannot, or rather will not.

We have before told you that we thoroughly disbelieve the opinion held by so many that evey Englishwoman overeats herself. And we firmly believe that anyone who eats until her appetite is satisfied, and then leaves off, will not take into her stomach more food than is necessary, provided she takes a mixed diet, that she takes a reasonable amount of exercise, and that she does not artificially stimulate her appetite in any way.

It is to this last factor, the artificial stimulation of the appetite, that we are directing your attention. The right and natural method of stimulating the appetite, which is exercise, may be, nay, should be, indulged in by everyone, whether she be health or ill. But the artificial stimulation of the appetite which is affected by bitters, tonics and strengthening medicines, requires very great deliberation and judgment before it is justified.

We have said that the appetite should be satisfied. It is the stomach’s call for nutriment. So long as the stomach is not filled the appetite is present. When the stomach is  satisfied the appetite fails. But it is possible to pervert the appetite. It is possible by careful and systematic overeating to create an appetite which is not readily satisfied, and which persisted after the stomach is filled.

The careful training of the digestive organs to withstand chronic abuse in the way of overwork has long ago reached a high state of development, and is now one of the most respected and popular of the fine arts.

Now let us study the ways by which we can pervert our appetites.  Unfortunately, all the measures which enable us to overeat stimulate the digestive organs to digest more than necessary. If only they made those who took them sick afterwards, they would not do so much harm. But they overwork the organs to digest too much nutriment and to throw the excess of food into the blood stream, whence, as it is unnecessary, it has to be discarded, and this throws excess of labour on to the excretory organs, mainly the liver and the kidneys.

The result of all this is obviously that the body of the gourmand is doing too much work, work which is useless, namely, the preparation and assimilation of useless food which has to be immediately thrown out of the body.

And so the body gets worn out before its time. It is working too hard. It is living at too high a tension, and consequently its life is short. The gourmand dies young; the chronic port-drinker dies young. Yet both of these die of old age, of degeneration. They have, as it were, lived their lives too rapidly; they have been burning the candle at both ends, and they die of degeneration of the arteries, of the heart, of the kidneys, and of the liver. And what are these but the signs of decay, of old age, and of death? The arteries are worn out, not by years of steady normal strain, but by excessive activity and abnormal use.

The agents which enable the body to assimilate too much food are either medicinal agents, or substances present in the food itself. 

Of the latter there are soups, which, though in themselves innutritious, are powerful stimulants to digestion, highly-spiced entrees, and all the alcoholic beverages.

The medicinal agents are bitters and strengthening medicines.

We do not say that bitters are to be universally condemned, nor that strengthening medicines are always harmful. It may be necessary to produce an appetite by artificial means when the natural call for food is absent through disease. And in some diseases, such as consumption and hysteria, systematic overfeeding will do more to cure the patient than anything else. And we have drugs which will produce or increase the appetite, and will stimulate the organs to digest the excess of food.

But the gourmand has found this out. And he says to himself, “If acids and bitters after meals, or bitters and sherry before meals, will increase the appetites of those who are sick, will it not enable me to increase my capacity for gorging?” And he tries sherry and bitters for the purpose.

Bitters are terrible poisons and few persons who take an occasional bitter before an extra good dinner really know that they are laying for themselves a path which may lead them to a life of constant misery, of ill-health, of moral weakness, and of early termination. What a lost is meant by that short phrase, “I want a little strengthening medicine, please, doctor.” How much misery and ill-health is connected with it! Yet the strengthening medicine is taken by many persons, a few for whom it is necessary or advantageous, a vast number for whom it is poisonous.

Most persons have an idea that when they are “run down”, a bottle of strengthening medicine will pull them together again in a very short time. And many persons also have the insane notion that the feeling of lassitude and general debility is usually caused by insufficient food, whereas in truth not one case of debility in a hundred is due to insufficient nourishment. The vast majority of cases are due to too little exercise.

A concrete example will often emphasise a point when a host of theoretical arguments fail to impress themselves. So we will give you the history or one of the very many thousands of sufferers who yearly ruin their health by strengthening medicines.

The Rev. Mr. ____, thirty years of age, consulted a celebrated physician last year for generally debility, lassitude, loss of appetite, and, as he expressed it, complete “run-downness.”

Three years previous to the interview he was a country curate doing a great deal of work with plenty, perhaps excess, of exercise, and had consequently developed a very large appetite. He was, as are most persons who lead an active outdoor life, perfectly healthy. But having come into a considerable fortune from an unexpected source, he gave up his country curacy and came to London, where he lived an indoor life of great mental study. He found that his appetite was beginning to fail, as of course it should, now that he no longer lived an active life, and was much alarmed to find that he could only eat a comparatively small amount.

He managed to put himself into the hands of a not over-careful or brilliant medical man, who told him that he wanted feeding up, and gave him some strengthening medicine to increase his appetite.

For two years he continued steadily eating more and more and getting worse and worse. Consequently he had an interview with Dr. ____, and at that time his dietary was as follows:-

9 a.m. Breakfast. He had little appetite for breakfast, but managed a little ham and eggs, or a fried sole and a cup of tea.
11 a.m. A glass of port wine and a sandwich.
1 p.m. A lunch of two or three courses, with claret and a glass of port wine afterwards.
4 p.m. Tea and toast.
6 p.m. An elaborate dinner, with various wines and dessert.

10 p.m. A glass of hot wine.
11 p.m. A little spirits and water before retiring.

He used to take bitters before the chief meals, and acids and gentian afterwards.

When Dr. ____ saw him he was suffering from absolute misery, and said, “Doctor, I cannot eat anything further.”  Dr. ____’s first step was to thoroughly examine him, and in the first place he discovered that the unfortunate curate’s teeth were in a lamentable condition. The treatment advised was as follows: A visit to the dentist. No medicines to be taken, save a small dose of calomel every second morning. Five miles at least to be walked every day. Lastly, and most important, the diet must be as follows:-

Breakfast: One boiled egg, toast and butter, and tea.
Lunch: A little fried fish, milk-pudding, bread, etc.
Dinner: A moderate dinner of two courses only.
All his wine and spirits were cut off.

The reverend gentleman was horrified at this, and said he would be starved to death on such a diet. But he followed Dr. ____’s advice, and was perfectly well in a fortnight, and has remained so to the present day.

We have laid aside our pen for a time, and the first patient we see asks us for “a little strengthening medicine, please, doctor.” Are we never to hear the end of this miserable sentence? Are we doomed throughout life to hear this self-same call of the surfeited for stimulation to further excess?

Yes, madam, we will give you a little moral strengthening medicine. Don’t eat so much; sell your carriage and use your legs; stop your snacks and glasses of curacoa; live a sensible life, and think of something else than your alimentary canal!

Undergo the treatment that the veterinary surgeon gave to the lap-dog, or that which Abernethy gave to your grandmother: “Live on half-a-crown a day, and earn it.”

But do you think she will take our advice? Not she! She will go round to every doctor in the neighbourhood till she comes to one who will order her more to eat and give her the beloved bottle of strengthening medicine!