ABSTINENCE. 



ABSTINENCE. 



26 



patience or skill could surmount. This obstruction proceeded from a 

 Bchirrous tumour, which, gradually increasing at first, diminished the 

 passage, and at length closed it wholly. 



On the evening of the 17th of October, a sudden increase of the 

 obstruction came on, and from this time he was able to swallow only a 

 table-spoonful of liquid at a time, and at long intervals. It was with 

 difficulty that he got down seven or eight spoonsful of strong soup in 

 the day, and this quantity gradually diminished. On the thirteenth 

 day from this sudden increase of the obstruction, the passage appeared 

 to be wholly closed. 



The patient himself, to the last, was far from despairing of his 

 recovery ; and the affectionate friends around him, though they could 

 not but see the issue of the case, yet desired that his life might be 

 prolonged to the uttermost. The following plan was, therefore, 

 adopted with this view. Every morning a clyster was administered, 

 consisting of eight ounces of strong broth, made chiefly of the mem- 

 branous parts of beef, these being considered the most nutritious, into 

 which were rubbed two yolks of egg, and to which were added forty 

 drops of laudanum. This was repeated in the afternoon, and again in 

 the evening, previously to which, in the evening, he was placed up to 

 the neck in a tepid bath, of which one-fourth was milk, and the rest 

 water; the whole quantity amounting to twenty -four gallons. The 

 temperature was fixed at 96, to accommodate his sensations, and the 

 time of immersion was gradually prolonged from forty-five minutes to 

 HI hour. 



After a few days it was found that the retention of the rectum 

 improved, so that the clysters were enlarged to ten ounces of broth, 

 and three yolks of eggs each ; to which were added eight ounces of 

 white wine, and the laudanum, which was added to the evening 

 clyster, was gradually increased from sixty to two hundred and fifty 

 drops. Thus the whole of his nutriment for twenty-four hours con- 

 sisted of thirty ounces of broth, "twenty-four ounces of wine, nine 

 yolks of eggs, and from 250 to 380 drops of laudanum, and ad- 

 ministered by clyster; with what liquid might be supposed to be 

 taken up in the bath by the absorbents of the surface of the body. 



When in tolerable health, at the commencement of his complaint, 

 this gentleman, who was a tall man, and naturally corpulent, weighed 

 240 Ibs. Before the obstruction had become complete, imperfect 

 nutrition had reduced him to the weight of 179 Ibs. In twenty days, 

 from the period of the sudden increase of the obstruction, he was 

 reduced to 154 Ibs. ; on the twenty-fourth day he had lost 5 Ibs. more ; 

 ami at the period when his delirium commenced, that is on the thirty - 

 secoud day from the night that he ceased to swallow, he weighed 

 1 38 Ibs., having lost upwards of 100 Ibs. of his original weight. He 

 lived four days longer, that is, thirty-six days from the period when 

 the obstruction was supposed to be complete ; but during these last 

 four days, no nutriment, in any form or of any kind, was administered ; 

 for the rectum no longer retained the clysters, and the administration 

 of the bath appeared, under these circumstances, to be wholly useless. 



For a month after the total obstruction of the passage the tem- 

 perature and the pulse were natural ; but on the thirty-second day the 

 pulse became small and frequent ; on the following day the eyes lost 

 their common direction, the axis of each being turned towards the 

 . he complained that he sometimes saw double, but the sensibility 

 of the retina was increased rather than impaired ; for, on the admission 

 of the light of the window, he screamed out, though he had before 

 been accustomed to this light. On the next day there was considerable 

 incoherence of mind ; this incoherence passed rapidly into delirium, 

 during the prevalence of which there was a perpetual and indistinct 

 muttering, with great restlessness and agitation ; the skin and the 

 extremities were sometimes of a burning heat, and sometimes clammy 

 and cold ; the pulse became feeble and irregular ; the respiration, 

 which hitherto had been singularly undisturbed, became laborious; 

 and in ninety-six hours after the clysters and all other means of 

 nutrition had been abandoned, he ceased to breathe. 



During the whole of this melancholy progress to inevitable death, 

 this unfortunate gentleman complained very little of hunger : occa- 

 sionally he expressed a wish that he could swallow, but not often nor 

 anxiously ; and, when questioned on the subject of his appetite, he 

 always declared that he had no hunger which occasioned any uneasiness. 

 The clysters evidently relieved the sense of hunger, and the opium 

 they contained seemed to have a- powerful share in producing this 

 relief. It occasioned quiet and rest after each clyster, and allayed 

 very kind of desire or appetite. Neither was he much disturbed with 

 thirst. This sensation was, indeed, troublesome during the first days 

 of liis abstinence ; but it abated, and, as he declared, was always 

 removed by the tepid bath, in which he had the most grateful sen- 

 sations. His spirits were uncommonly even, and his intellect perfectly 

 nound. He occupied himself a good deal in his private concerns ; and 

 a* usual, interested himself in public affairs. In order to husband his 

 strength he was confined a good deal to bed ; but, till the last few days 

 of his life, he dressed and undressed himself daily, and walked, not 

 only about hi* room, but through the house. His nights were quiet 

 nil sleep sound, and apparently refreshing. Just before his delirium 

 set in he had very lively dreams, which were all of a pleasant nature ; 

 and, in the last conversation he had with his physician, he told him he 

 had had a very gay evening with two Yorkshire baronets whom he 

 named ; that they had pushed the bottle about freely ; that many 



jokes had passed, at the recollection of which he laughed heartily, a 

 ,hing uncommon with him ; but it was observable that he was unable, 

 onger than a moment or two, to distinguish this scene which had 

 jassed in sleep from a real occurrence ; and this state of mind lapsed 

 nto delirium from which he never recovered. At this period he was 

 so weak as to be scarcely able to turn himself in bed, to which he had 

 jeen entirely confined several days, previously to his death. 



The second case, which is no less interesting, occurred to Dr. Willan. 

 [t was that of a young man of studious and melancholic turn of mind, 

 who being affected 'with indigestion, undertook voluntarily to live 

 without food. He drank nothing but water flavoured with a little 

 irange juice. He was seen by Dr. Willan on the sixty-first day of his 

 fast : at that time he was emaciated to a most astonishing degree ; the 

 muscles of his face were entirely shrunk ; -his cheek bones stood pro- 

 minent and distinct, affording a most ghastly appearance ; the abdomen 

 was concave from the collapsed state of the intestines ; the limbs were 

 reduced to the greatest possible degree of tenuity, and the processes 

 of their bones were easily distinguishable. His whole appearance 

 suggested the idea of a skeleton prepared by drying the muscles upon 

 't in their natural situations. His mind had become imbecile. 



Unfortunately the treatment adopted was injudicious, the quantity 

 of food allowed him being much too large ; yet, for the first few days, 

 he appeared to improve, regaining flesh and strength, and acquiring 

 firmness and even cheerfulness of mind ; but on the night of the fifth 

 day he was sleepless and restless ; on the morning of the sixth, he 

 began to lose his recollection, and before midnight he was quite frantic 

 and unmanageable ; at the same time his pulse was increased in fre- 

 quency, with considerable heat of the skin, and tremors. During the 

 following day he continued raving, and talking very incoherently, as 

 he had done during the preceding night. He remained nearly in the 

 same state, scarcely ever sleeping, and taking very little nourishment, 

 his pulse becoming daily smaller and feebler, and beating at length 

 120 strokes in a minute, and his emaciation still increasing, until the 

 eleventh day from the period that he began to take food and medicine, 

 and the seventy-second from the commencement of his abstinence, on 

 which day he died, quite exhausted. 



There is no authentic case on record in which the duration of the 

 abstinence was as long as this, and both these cases taken together, 

 afford an excellent history of the disorder of the functions, and the 

 exhaustion of the powers of life on the total and continued abstraction 

 of food. The mind in the first case was naturally firm and strong ; in 

 the second it was supported by an enthusiasm amounting to insanity. 

 When the mind is feeble, and especially when it is under the influence 

 of fear, anxiety, despondency, or any other depressing cause, the 

 duration of life is greatly abridged. It is instructive to observe the 

 absence of severe suffering from hunger and thirst; the absence of 

 all acrimony of the fluids ; the absence of all violence and turbulence 

 of mind until delirium set in, the precursor of death. 



From the powerful influence of abstinence on the system, it is 

 obviously capable of becoming a most energetic remedy in various 

 diseases. When the mass of the fluids and solids of the body is too 

 abundant, abstinence is capable of reducing them to almost any extent 

 that can be required ; and if the abstinence be judiciously commenced 

 and conducted, not only is it unattended with any diminution of the 

 strength or injury to the health, but it contributes to the improve- 

 ment of both. Numerous instances are on record which place this 

 fact beyond question. The case of Cornaro the Venetian nobleman, 

 and that of the Essex miller, which afford evidence of this more 

 complete than it would be easy to invent, are universally known. The 

 body, whatever be its bulk or weight, provided the health be in other 

 respects sound, may be reduced to almost any degree of thinness, and 

 kept at that point by an appropriate regulation of diet and exercise. 

 The physician, at his pleasure, can make no one fat, but he can make 

 any one as thin as he chooses, frequently improving at the same time 

 the health and vigour both of body and mind. Seldom is he called 

 upon to put this art into practice, and seldomer than he ought does he 

 insist upon carrying it into practice ; but it is something to know that 

 the resources of his art place this in his power. 



In all acute diseases, such as the various forms of fever and inflam- 

 mation, abstinence is a most powerful remedy, not only because the 

 abstraction of nutriment diminishes the mass of the fluids and solids 

 (since the process of absorption goes on though the supply of new 

 matter is stopped), but also because it withdraws one of the main 

 stimulants of the system, and consequently subdues the increased 

 actions which accompany, and which for the most part constitute, 

 acute diseases. 



In some chronic maladies, especially in that large class which depend 

 on what is termed plethora, that is, too great a quantity of solids and 

 fluids, particularly in the plethoric state of the blood-vessels of the 

 brain, predisposing to and producing apoplexy, in some morbid 

 affections of the stomach itself, in some derangements of the liver, and 

 in several diseases of the heart, abstinence is an invaluable remedy. 

 In other chronic diseases it is injurious, as in diseases of debility, in 

 diseases which depend on irritation in contradistinction to those which 

 depend on inflammation, and in various nervous maladies. 



Abstinence is not equally borne by all persons, nor at all times by 

 the same person. By the corpulent and plethoric it may be endured 

 longer, and can-led farther, than by the thin and the spare ; in the 



