THE MIASMATIC REGISTER

Being a Complete Account of the Ailments of This Realm and of Their Single Cause, Which Is the Air, Together With Their Treatments, Which Work.

Compiled, at his own considerable expense and with no assistance whatsoever from the profession, by Doctor Tolbert Ebbrell, of Murkminster, M.D. (asserted), Physician in Ordinary to three houses of quality and in extraordinary to whoever can pay.

A PREFACE, WHICH THE READER IS ADVISED NOT TO SKIP

The whole of medicine in this realm is one sentence long and I discovered it in my second year, which has made the subsequent forty a formality.

It is the air.

Everything is the air. The ague is the air. The chest is the air. The flux is the air, the shakes are the air, the child that will not thrive is the air, and the melancholy that comes on a household in Arrears is the air in the particular form I have named — and I did name it, whatever Sowden says — the Low Grey Miasm, which lies along the ground of a wet valley at the height of a man's knee and rises to his chest by evening.

I have set this out at three meetings of the profession at Murkminster. I have been heard. I have not been adopted. I attribute this to the well-known conservatism of a body of men who have not read my paper, and I attribute that to the fact that I have not published it, and I attribute that to the printers, who require money.

Nevertheless. The realm may take my treatments, which are correct, and may come round to my cause in its own time. I am seventy and I can wait.

Each entry: The Ailment · The Cause · The Treatment · A Word On My Rivals. The last of these is not strictly necessary and I include it as a service.

I. THE CHEST

The Ailment. The commonest killing thing in this valley. It comes in Arrears, it takes the old and the very young, and it takes the peat-cutters at an age when they ought to be sitting down.

The Cause. The air. Specifically the Low Grey Miasm, entering at the knee and rising, which is why the cutters get it — they stand in it all day to the thigh.

The Treatment.

1. Get the patient up off the floor. A bed, or two chairs, or a door on trestles. Off the floor.
2. Fire, and keep it in all night, and I do not care what it costs; I have paid for peat out of my own

purse for a household that would not ask and I mention it only so that it is on record.

1. The window open a hand's breadth on the leeward side. Not the windward. This is the entire art.
2. Broth, hot, hourly, and the patient sat up to take it.

A Word On My Rivals. The wise-women get them up off the floor as well, and light the fire as well, and have done both for six hundred years without a theory to justify it, and their results are as good as mine and in the low houses somewhat better. I have thought about this and I have concluded that they are doing the right thing by accident, and that a practice without a cause behind it is a lucky habit and not a science.

II. THE WATER, SO CALLED

The Ailment. The summer flux. Whole lanes at once, always in Dust, always the children.

The Cause. The air over standing water, which is the worst air there is, being the Miasm at its thickest and closest to its source.

The Treatment. Boil everything the patient drinks. Twice if there is fuel. I am absolutely immovable on this and have been shouted at about the cost.

A Word On My Rivals. Here I must record, with some annoyance, an exchange at Mucklecombe.

The midwife Sowden — a woman of no training whatever and, I am obliged to say, of better numbers than mine — asked me why boiling the water should answer, if the trouble is in the air. I explained that the water holds the Miasm in suspension and that boiling drives it off, which is obvious.

She said: "Then why boil it? Why not just stand it in the sun."

I said that the sun in this realm was a matter of theory.

She said: "Aye. So's your air."

I have not been able to improve on my answer, which was to leave. I record the exchange because it does me no credit and because she has since told it at two suppers with embellishments and I would rather the plain version stood.

III. THE FEET

The Ailment. Rot, ulcer, and the general ruin of the feet, which in this realm is not a complaint but a condition of employment.

The Cause. Not the air. I am a scientist and I will say plainly where my system does not reach: this one is the wet, and the wet is not the air, and I have looked for a way to make it the air for eight years and I cannot get there.

The Treatment. Dry the feet. Two pairs of stockings, worn in turn, one drying while the other is worn. Grease. And the boots off in the evening even when it is cold, which is the instruction most often disregarded and which does more good than anything else in this book.

A Word On My Rivals. None. Nobody else takes feet seriously. The profession considers feet beneath it, which is a joke I have made at three meetings and which has never once been laughed at, and I maintain it is a good joke.

IV. THE MELANCHOLY OF ARREARS

The Ailment. It arrives in the last quarter, in the wet, in households where nothing is wrong. No fever. No pain. A person simply goes quiet and stops mending things.

The Cause. The air, in its winter form: heavier, and standing in the house rather than the field.

The Treatment. I prescribe, in this order, and I have never varied it:

1. Light. Whatever can be had. Shutters back even in the wet.
2. Out of the house once daily, on any pretext. Fetch something. Return something. Complain to

somebody about a gate.

1. Company at a table, not company standing about. A table and a task.
2. A job of work with an end to it — a mended chair, a cleared ditch. Nothing that cannot be finished.

A Word On My Rivals. The parish does all four of these without prescribing them, by means of its kistomary, its Bog Nights, its endless quarrels about hedges and its habit of getting people out of doors to shout at them. I have watched it work for forty years on people I could not shift.

I have wondered lately whether the parish is treating the melancholy on purpose.

I have decided that it is not, and that it is the air, and that the parish is simply fortunate in its customs.

V. WHAT I HAVE NOT BEEN ABLE TO CURE

The Ailment. The Committee.

The Cause. Unknown to medicine.

The Treatment. Beyond me. I attended a member for a chest in Sog and he would not have the window open until it was minuted, and by the time the minute was taken he was worse, and I put on the account "attendance, and one minute," and was paid for both.

A Word On My Rivals. On this one occasion I had none, and I have never enjoyed anything less.

THE PHYSICIAN'S CLOSING NOTE

Forty years. Six hundred and some patients. Every one of them treated for the air.

I am told, chiefly by the wise-women, and chiefly at suppers, that my cause is nonsense and my treatments are sound, and that I am a good doctor with a foolish reason. They say it fondly and they say it in front of people and I have decided to take it as the compliment it is three-quarters of.

But I will set this down for whoever has my practice after me, because it is the only thing I know that is worth more than the fee.

Get them up off the floor. Keep the fire in. Open the leeward window. Boil the water. Dry the feet. Get them out of the house once a day and sat at a table with something they can finish.

Do those six things and you will do more good in this valley than any physician who has ever charged for it — and if you should happen, in some better-lit century than mine, to work out why they answer, I would take it as a courtesy if you would write it in the margin of this book, so that the argument can be settled at last, and so that Sowden's grand-daughter cannot go on telling that story about the sun.

— T. Ebbrell, Murkminster. In good health, thank you, having always been careful of the air.