Remarks explanatory of certain Dietetic maxims, and established notions or prejudices, illustrative of the physical constitution and domestic habits of the Limenians. In Lima there are certain opinions and rules, relating to the nature and cure of diseases, so very popular and well received among the vulgar, and at the same time so habitually countenanced by many of the native practitioners, that, for any one who proposes to practise in that part of the world, and hopes to be honourably acquitted by the jury of nurses and attendants who are always numerous about the sick, it may be worth while to consider the tenor of the following remarks: I. No conoce nuestro clima.—It is affirmed by native doctors, but not always acceded to by the vulgar, that there is something occult in the climate of Lima, which only a Limenian or Creole physician can sufficiently comprehend. Hence the prejudiced objection, “No conoce nuestro clima,”—that is, “he knows not our climate,”—is sanctioned by high professional authority; and this much hackneyed caveat is usually laid at the threshold of every European doctor who desires to make himself professionally useful in Lima. Every one, we think, will admit that the practice of medicine must be modified, or considerably altered, according to the topography of any particular country; for it is observed, that difference of locality affects not only man, but plants and animals, in a striking degree as we extend from the Equator towards latitudes far to the north or south of it. Yet, if there be any who understand either the botany or zoology of Peru, or who endeavour The only lover of natural history we have the honour to be acquainted with in that country is Don Mariano Rivero of Arequipa; and, though their tranquil sky might be imagined to allure Limenians of a philosophic turn of mind to the contemplation and study of the heavenly bodies, yet to Dr. Gregorio Paredes alone belongs, in the present day, the merit and high distinction of keeping the sublime vigils of the astronomer. Now this dearth of native science is not confined to these general branches of natural history and philosophy, but affects very sensibly the practice of medicine. The very manuals of primary medical instruction put into the hands of medical students in the capital of Peru are foreign and European. And thus it is plain that they have no peculiar and national digest of medical knowledge—no local It is indeed to be hoped that no respectable physician in Peru will hereafter indulge in the folly of maintaining that Europeans are neither fit to practise in that country, nor able to comprehend the peculiar influences of the climate of Lima. This climate, like every other on the known face of the globe, is open to the investigations of the meteorological observer, whether he be a native of the Old or New World. The laws of physiology, we may further observe, like those of gravitation, are the same in Peru as in other parts of the world; and the aphorisms of Hippocrates, generally founded on accurate observations made more than two thousand years ago, are at this day equally true as when first embodied, and applicable to man’s physical constitution all II. Tomar dulce para bever agua a las horas de la comida.—This is a standing dietetic rule observed at the close of a meal or repast, which means that sugar, or some Should a Limenian in perfect health, who thus drinks water at stated periods, feel thirsty shortly after a meal concluded, as usual, with sugar or some sweet-meat and water, he is taught to endure the inconvenience rather than bring on himself indisposition by indulging his thirst. To understand this, it is requisite to know, that, until three hours have elapsed after the taking of the last meal, no one is supposed to drink even water, which is the most common beverage of the natives; for to commit such an irregularity would, it is believed, be to occasion a fit of indigestion or to hazard health. This may appear a ridiculous prejudice to those who are accustomed to quench their thirst, as often as it naturally arises, without When a person suffers from acute febrile disease, and is only allowed very spare and tenuous diet, such as chicken soup, panada, tapioca, or arrow-root, &c.; then, from one meal to another, the regular interval is five hours; three hours after each meal, water, or some medicated drink, is given; and, two hours after this drink, the allotted aliment, Nurses, and very kind and obliging friends, usually attend so strictly to the above order in giving food and drink, that, though the poor patient be burning with thirst, he can During the exacerbations of intermittent fevers, so prevalent in Peru, the state of the stomach is usually much disturbed; and in such circumstances, instead of alternating food and drink without regard to the condition of the digestive functions, we have taken pains to persuade the sick to deviate from the order established by custom, and allowed our patients the inexpressible comfort III. Prepararse para tomar purga.—Many practitioners of the venerable Boerhaavian school have died in Lima in course of the last few years, but several of this stock are yet remaining; and, in their professional harangues at consultations, they are heard to talk learnedly of the malignant, adust, crude, and corrosive, &c. state of the humours of the human frame, without, as it always appeared to us, being able to affix any precise and practical ideas to these hypothetical expressions. And though the junior doctors of modernized opinions are generally found to indulge in some theory of the abstract solidists, yet they are obliged to respect the prejudices of the vulgar, and talk in a way that is agreeable to those whom it is their business to persuade. Patients, IV. Empacho.—This famous Limenian mischief-maker is supposed to lurk concealed under almost every form of chronic or intractable disease, and means, in the most usual In a large proportion of cases where this cause of mischief is supposed to exist, it has, in fact, no place or existence except in the mind that conceives the notion of it; and, in It would, indeed, be a hopeless task for the regular practitioners in Peru to reason a Limenian doctress out of her reveries on the subject of empacho, which, when viewed by her as the exciting cause of disease, assumes a Protean character, and is visible to her imagination in mostly every case of ailment, which she, true to her favourite opinion, offers to cure in her own way. The evil effects of a farrago of nostrums, or untimely and inappropriate medicaments applied by the help of the doctress, the educated physician is often called, but sometimes too late, to correct; and the fatal abuses thus arising have, on various occasions, called forth the public and earnest remonstrances of the highest medical tribunal of the country,—but So universal, indeed, is the credit of the LimeÑa quacks, or curanderas, of whom La SeÑora Dorotea is the chief, and so general is the use of the instrument called jeringa, (through the medium of which the principal ingredients of this seÑora’s materia medica are confidently applied,) that it constitutes an essential and conspicuous article of domestic utility. And the great consideration in which this auxiliary is held, as a sine qu non in the treatment of empacho, and almost every disease, renders it a topic of never-failing conversation. As a familiar example of the abuse of the jeringa, may be mentioned the vulgar practice of resorting to it in disorders attendant on dentition. Sometimes the increased action of the bowels is indiscreetly stopped by astringents thus adhibited, and a fatal determination of blood to the head ensues; but it We have heard the physician offer this consolation to a weeping mother in the higher ranks of society. He softly assured her that her pretty babe would pass through Purgatory to Paradise without as much as scorching a finger in the transit. In the lower and middle ranks especially, V. Sangria sobre el empacho.—To bleed a patient affected with empacho is, by the common consent of the vulgar, declared to be a most unpardonable blunder; and this is the meaning of the expression, “Sangria sobre el empacho!” when ejaculated in the apartments of the sick. It will be readily imagined that, in numerous instances coming under the vulgar denomination of empacho, the subtraction of But to avoid the unjust criticism of uncharitable members of the profession, who are always ready to turn to their private advantage, any popular prejudice which can be called in to humble the name of fellow-practitioners more respectable than themselves, and also as a mean either to acquire or to preserve the confidence of the sick, the prudent physician will not overlook the natural effects of any known prepossession regarding blood-letting. He will so far accommodate his practice to the ideas of those who are most interested in the issue of his treatment, as to order at least one enema, when the empacho is firmly believed to exist, before he proceed to the further discharge of his professional duty, No time or advantage is lost by such a concession to the preconceived and inflexible opinion, that bleeding is particularly hurtful in those cases of illness connected with undue accumulations in the bowels: but one very important end is gained by it; since, by agreeing with the sick and their friends on an indifferent point of practice, they will more willingly submit to the application of other remedies necessary for the safety of the patient. VI. Cosas frias y calientes.—All articles of diet, and medicaments, are by the Peruvians vulgarly divided into cold and hot; or, as the words on which we are about to comment express it, into “cosas frias y calientes.” When the physician prescribes any particular diet or physic to a patient in Lima, Besides professed sick-tenders, zamba housekeepers or head-servants, some women in the middle and humbler ranks, such as manteras, chocolateras, tenderas, cigareras, picanteras, pulperas, changaneras,—that is, female shopkeepers, chocolate and cigar venders, with a subordinate gradation of publicans, &c.—are always ready to talk, with confounding fluency and volubility, without knowledge, concerning qualities and temperaments; and they display a natural acuteness of metaphysical capacity, with a truly peripatetic nicety of discrimination, when, in a moment of oratorical excitement, they assign to certain mixtures and drinks ideal measures and degrees of the elementary qualities. Women skilled in such mysteries, and omniscient charlatans, run over the various combinations of the cold and hot, dry The particular temperament of the patient his intimate friends are supposed to know perfectly; and the doctor’s reply to any question that may be proposed to him on this subject will be considered, in many instances, as no bad test of his penetration and professional knowledge in other matters with which they do not presume to be themselves so well acquainted. In conformity with such prevailing impressions, when nurses are to be selected for the children of delicate mothers, preference is given to the black women, as their blood and Colour is looked upon as an indication of constitutional temperament even in the lower animals. Thus, when one in town labours under hectic fever, or consumption, he is recommended to go to the country, and drink warm milk from a black cow, because it is allowed to be more cooling and febrifuge In case of a rheumatic swelling of a joint,—the knee, for instance,—or some tumefaction in any of the glands, it is taken for granted, that, whatever other remedy be applied, the envelope for the limb or part affected must be of a medicinal colour, and consist of black wool, or something of a dark woollen texture. In short, so far has this general idea concerning the antiphlogistic nature of black been carried, that few natives dispute its accuracy: nor are we prepared to say that it may not have some foundation in fact and observation (though often laughed at by strangers as a puerile prejudice); for it is well known to scientific men, that the free radiation of heat is much influenced by the differences of colour in the radiating surfaces of bodies. With respect to food and drink, the division into cold and hot is never overlooked. A “traguito,” or little dram of Italia, a colourless brandy made on the coast, the old men consider as fresco, or cooling, when taken immediately after dinner; and when they take the “traguito,” which they do not every day, it will probably facilitate the digestion of the greasy food which they are commonly accustomed to eat, and in this manner deserve the name of a fresco. But, again, though at their entertainments they allow wine to be a safe and good drink after the “helados,” or ices, which they like exceedingly, still they use wine sparingly on other occasions, as they consider it too heating for general use. There are fruits after which the natives do not think it safe to drink either wine or spirits; of this sort is the short plantain, called “platano de guinea,” after which a mouthful of spirits would be considered quite poisonous. Foreigners do not seem to attend to this strict rule observed Various kinds of fruit and vegetable juices, which are considered cool in their qualities, are not rarely most heating in their effects, according to the condition of the system when taken. The melon is in reputation for its cooling nature; but, though the impression made by it on our alimentary organs is at first very refreshing, the muleteer who journeys from the Cordillera to the coast, and has but once in his lifetime been attacked with a gastric tertian, in consequence of cooling his parched fauces by eating of the melon, can give a lively account of the internal heat, agitation, and oppression experienced by him on the occasion. There is no cooling fruit safer than the granadilla, which is most grateful and refreshing to the feverish patient, or thirsty traveller in Fowls are reckoned to be infinitely cooler in their temperament than sheep or oxen, and their flesh is also considered as very safe and cooling; hence the almost universal use of the former, and prohibition or disuse of the latter, in the dietary of a delicate invalid. This distinction will appear still more strongly marked, when it is observed, that to prescribe beef-tea in any acute disease would be deemed an act of rashness and ignorance; but chicken-tea is held to be the most cooling of diluents, and very eligible in the most inflammatory diseases and in the warmest weather. This chicken-tea, called “agua de pollo,” is commonly prepared in the proportions of three cupsfull of water to one half of a little unfledged chicken, with the addition of a It is needless to remark that, in general, plain water or toast-water, or a ptisan of barley decocted with some of the subacid fruits of the country, would answer very agreeably the purpose of the agua de pollo; but when the latter is preferred, it should be remembered that in warm weather it decomposes rapidly, and then acquires irritating properties. As a purgative, in gastric disorders, the old physicians in Lima extol almond oil, which is often of inferior quality; and they take some pains to arm the minds of the credulous VII. Los acidos son malos para el pecho.—No class of remedies is in more general use in Lima than vegetable acids in the bilious disorders of daily occurrence; but in affections of the chest, whether simply catarrhal, or of the more serious forms of pneumonia or phthisis, it is a generally received and settled opinion that acids of all sorts are injurious, which they make known by such expressions as these: “Los acidos son malos para el pecho,”—acids are bad for the breast; “Los acidos cierran el pecho,”—acids shut up the breast. This opinion seems to have partly originated from a notion, once entertained by the doctors, that acids coagulate the animal fluids, and so produce obstructions and disease. Not only the vulgar, but some of the professional characters, appear to be impressed with the notion that the blood is thickened or curdled by acids, whether mineral or vegetable; and that the delicate circulation of the lungs is consequently impeded, and the respiratory pores clogged. This opinion appears to be expressed in the very common remark, “El enfermo tomo fresco de lemon, y con el acido se le ha tupido el pecho,” which means that the patient drank cold lemonade, and with the acid the breast was stopped up. We are well persuaded that there are instances, especially among delicate females, It is only in this manner we can account for the fact, as frequently stated to us by patients, that, as certainly as they did take anything cool and acidulated, they were speedily affected with a tightness about the chest, and felt as if they had actually caught cold. On such occasions their usual observation was, “El acido me ha cerrado el pecho,”—the acid has locked or closely shut the breast. A complicated ailment which is vulgarly conceived to be seated in the chest, is often In such disorders, the gastric and hepatic functions may be suspected of some irregularity; and, when in any case this is explained to the patient, the disease may be treated as one seated in the organs of digestion, and frescos or cooling acidulated drinks often do wonders. Not only diluted in cold water, but with the addition of ice, the various vegetable acids of the season are given with the best results. They break up the whole chain of morbid symptoms; and the patient, thus encouraged and refreshed, completes convalescence by cold sea-bathing, Throughout the entire year, but more particularly during the warmer months, great use, and no small abuse, is made of all sorts of frescos, or cooling and acidulated drinks, with or without the addition of ice, and other ingredients of a very opposite nature, as pimento and spices, which latter render the same drink heating to the stomach, that, by ice, is rendered cool on the lip. There are no beverages which the vulgar misapply more than their frescos. The most approved of these, as tamarinds and whey, or the juice of the apple and quince, &c. diffused in water and sweetened with sugar, are sometimes so long continued with a view of cooling and purifying the blood, that they finally relax and weaken the stomach; of VIII. Acido sobre la leche es malo.—It is particularly worthy of notice that, shortly before or after milk happens to be taken pure as a drink, or mixed up in some culinary form as an article of diet, it is believed that no acid can be safely received into the stomach; it being thought necessary that the interval between these incompatible ingredients should be seven hours at least. In illustration of the fact here stated, it may be mentioned that we were once called to see a lady in Lima who had been ailing “A year ago, on my arrival from Valparaiso, I called in Dr. ——, a French physician, who ordered me to confine myself to a rice and milk diet alternated with lemonade. I felt so greatly shocked at this gentleman’s extraordinary error in prescribing such treatment, which every one knows to be most hurtful, not only to the infirm, but to the sound and healthy, that I resolved at the time to leave my complaints to nature, rather than expose my life to the greater indiscretion of some other doctor of less fame.” In this instance the error, for which the French physician was blamed, consisted in his having overlooked the popular rule universal in Peru, and probably not unknown in Chile, that “acido sobre la leche es malo,” viz. that acid after milk is hurtful. According to this rule in Peruvian dietetics, IX. Los olores son malos para las recien paridas.—It is one of the social customs of Peru, sometimes attended with great inconvenience, that friends and visitors, moved by feelings of kindness, crowd into the rooms of the sick, when not perhaps in a fit state to enjoy company or conversation. During their confinement ladies are not sufficiently exempted from this friendly intrusion, or neighbourly attention. The only Parturient women are very subject to a sensation of languor and exhaustion at stomach, attended with a feeling of faintness, which they call “fatiga.” On ordinary occasions, when this feeling or sensation is experienced by females not similarly situated, it is usual to resort to cordials and odoriferous draughts containing lavender, hartshorn, &c. and also to stimulating embrocations applied over the seat of the stomach, which usually consist of a camphorated mixture, or perhaps Cologne water, and other such remedies applied in common cases of weakness and faintness referred to the stomach; but, under the circumstances to which our rule refers, all applications of this sort are inadmissible. When there is a feeling of sickness and faintness, with a disconsolate sensation (called “un desconsuelo”) at the epigastrium or scrobiculus cordis, they are allowed on all occasions to apply to the stomach, as a popular X. Tomar agua fria encima de colera.—To drink cold water immediately after a fit of anger, which is the meaning of the words in our text, is a frequent cause of ailment, and one which the practitioner every day hears of as the origin of the worst cases of visceral obstructions or hepatic disease. Unfortunately, the occasions of such attacks are of ordinary occurrence; for the temper of those who suffer from them is rarely under proper control, and, as a necessary consequence of the existing state of society, provocations to anger are common in every situation. We were once consulted by a curate of an irritable disposition, and an epicure in his taste, on account of an induration and very prominent enlargement of the liver, which some time after ended in a fatal abscess. This gentleman assigned, as the exciting cause of his malady, his having drunk cold water when angry, or on occasion of a quarrel he had with his cook, a Zamba girl, who we may suppose must have spoiled some favourite sauce. This was the first time we were consulted on an ailment said to arise from drinking cold water when angry. But afterwards, as we had engaged in more general practice, we were called upon to listen to very many statements of the same sort; and, on such multiplied and independent evidence, we are compelled to believe that this is indeed one of the usual causes of hepatic derangement very prevalent in Peru. During these fits of anger the brain appears We may remark, that ice and iced water are only considered safe (even by the vulgar, who use them daily with a view to restrain the excessive flow of bile consequent on an angry or choleric fit,) when they are given after the violence of the commotion is over, and after the stomach, if it happen to be loaded, has, by drinking warm water or otherwise, been freed of its contents; but in hot weather, when the skin is more relaxed, and the bilious secretion more plentiful and redundant than common, ices are much used, and iced water forms the usual drink at the hour of meals. We meet with persons who never experience the smallest annoyance or approach to anger, without being affected by some corresponding movement in the bowels; and XI. Si se puede lavarse con agua fria.—In almost every case of lingering illness in either sex, it is vexatious to witness the reluctance to ablution that prevails in the capital; and this prejudice, with the dread The Limenians are fond of seasonal bathing and the pleasures of a watering-place, which they know how to enjoy for three months in the year. Chorrillos, three leagues to the south of Lima, is the favourite watering-place, much frequented during the sultry summer months by gambling parties, and persons of rank and fashion from town. It is only a small village of fishermen, and constructed of cane and mud. The Indian owners of the shades, and neatly constructed houses or ranchos, let them to the bathers at a high rate during the bathing season; and some persons either take these for a term of years, or construct other light summer houses for themselves, During the raw, damp, and foggy months of July and August in Lima, Chorrillos enjoys a clear sky and a genial air. The south-westers laden with heavy clouds spend their strength on the friendly Moro-Solar, (on which burst the only thunder-storm witnessed by the Limenians in the memory of any one now living,) and divide into two currents: the one pursues the direction of the village of Mira-flores, and the other the hacienda of San Juan, leaving Chorrillos The salutary practice of bathing in the sea was in former times confined chiefly to those affected with cutaneous diseases; but within the last forty or fifty years, as we are told, sea-bathing has been preferred to river-bathing, or to the cold baths by the old Alameda, and fountain of Piedra-lisa. The women are usually cleanly in their persons; but, however congenial cleanliness may be to their sex, they, like the sick and bearded men, seem to be greatly afraid of ablution in hectic fever, and some thoracic diseases with which they are often visited. Of the Indian in the interior we need not speak in the same breath with his brother in the capital, or with the maritime Indian, whose ordinary occupation in fishing, or more delicate engagement of safely conducting the ladies over the surf during the bathing season, especially at Chorrillos, necessarily leads to cleanliness. But the indigenous mountaineers never perhaps in the whole course of life wash their bodies thoroughly; and their skin (at least in the warm valleys) is habitually covered with a thick coating of perspirable matter and extraneous dirt, which it is not easy to wipe off. In very many cases of acute disease, the warm bath is, with the natives of the coast, a favourite and most valuable remedy, rarely neglected; but its application is usually forbidden in affections of the chest. It will be readily imagined that the frames of those who fly from impressions of cool air and hazy weather, which, with all their care As evidence of the evil results arising from the vain endeavour to avoid the impression of the common physical causes to which, through life, every one must be occasionally exposed, we would particularly notice the peculiar delicacy of the delicately reared Limenian. When somewhat weakened by bad health, or a slight indisposition which confines him to his apartments for a few days, should he happen to shave and wash the face with cold water, he is thereby put in danger of being visited by a spasmodic affection of one side of the mouth, or affected, as is more likely to take place, We need not therefore be surprised to hear the often reiterated query of the convalescent in the words, “No me hara daÑo lavar y afeytarme?”—will it not do me harm to shave and wash? Nor should we indulge in a smile at his expense, as we see him gradually venture on the first degrees of ablution, by rubbing over the hands and face with a cloth dipped in tepid water sharpened with aguardiente, or the common spirits of the country. XII.—Morir en regla. This expression, which means to die according to rule, is one When a physician visits a patient, and finds him in a doubtful or critical state, he must never omit to warn the patient or his friends of his real situation, with a view to enable them to call a medical consultation, and allow time for testamentary preparations and spiritual confession. The neglect of this precautionary measure would, in the event of the disease terminating fatally, bring great blame on the physician; but, after he has notified what he considers to be the patient’s real condition, then, whether the parties interested in such communication choose to act upon his advice or not, he has acquitted himself properly; and when the patient, previously confessed and sacramented, The great medical juntas in Lima, by which we understand consultations where more than four or five doctors are met together, are remarkable occasions of oratorical display. The warmest discussion frequently turns on the dose, composition, or medicinal operation of some common drug; and all the learning, method, and criticism, sometimes discovered at these solemn debates, terminate not unfrequently in the most simple practice, by which the nurse is enjoined to have recourse to the jeringa, and the patient told he must drink “agua de pollo,” or chicken-tea, until the return of the junta. In former times such consultations were called oftener than necessary, because a great junta became a sort of ostentatious exhibition, A sample, on a little scale, of such fashionable follies, is familiar to the Limenian in the well-known local story of the two doctors, who, for a month or more, daily met in consultation at the house of a family in town, where, as they retired to the supposed privacy of a consulting-room, the one would clear his throat, and ask the other, “Come el enfermo hoy?”—May the patient eat to-day?—to which the second doctor would reply, “Como no? si, comera.”—Why not? yes, he shall eat. Thus, day after day, began and ended the consultation, as far at least as its topics of discussion concerned the patient; while the good old doctors spun out a regular allowance of time before they rejoined the patient, or his attendants, serenely to announce the well-matured result of their conference. A medical junta in Lima is commonly continued morning and evening, and from day to day, till the patient is pronounced to be out of danger. As the junta breaks up after each separate meeting, it is customary for the president of the meeting, or one of the physicians, to say, as he leaves his seat, “Vamos a consolar al enfermo,”—Let us go to console the patient; and then all the doctors present re-enter the patient’s apartment to soothe and to console him; and after this one of the number steps forward After all the care possible bestowed on the part of doctors, it often happens that, when the patient recovers, San Antonio, or any other saint after whom the individual is named, has all the credit of the cure; but, when the case is unprosperous, then all the evil is ascribed to human agency. In Lima, as elsewhere, it will readily enough be admitted in general terms that One common consequence of this mode of thinking is, that, by a single fatal case in practice, all the former success of the practitioner is overlooked, at least for a time; from which it follows that various medical advisers are sure to replace one another often in those families where death is a frequent visitor. We seldom meet in families that shyness or reserve in divulging bodily ailments which can render them reluctant to change their family physician; and no physician, though Owing in a considerable degree to the comparative poverty of the present times, medical juntas are by no means so frequent as they used to be; but yet it is a common saying on serious occasions, where the assistance of more than one medical adviser is thought necessary, that more is seen by four eyes than by two.—“Mas se ve con cuatro ojos que con dos.” By multiplying skill according |