WBjB (623 * i *\ f; >■■ JkUu fiT.j AN V EXAMINATION STRICTURES IW THE NEW-ENGLAND JOURNAL FOR OCTOBER, 1823, AND IN THE vORTH-AMERICAN REVIEW FOR OCTOBER, 1823> ESSAYS ON FEVERS, &c. ^^*^ .'.V '< IB* •. . ..•->, fe*7tf BY -'____ P THOMAS MINER, M.D. T0M- 7 AND WILLIAM TULLY, M.D. TANTJENE AWIMIS COELESTIBUS IRJE: MIDDLETOWX, (COJVJV.) PRINTED BY E. & H. CLARK. 1823. Extract from Essays on Fevers, $>-c. ••It is proper to notice a common error, which is prevalent among a certain good sort of people, who are little acquainted with medidjy subjects. The v atFect to consider, that there is some truth. and soffie mistake, on either side, which physicians have taken, in the ih%uagement of modern Typhus. The fact is, that no com- promise is admissible. It is a question of guilty, or not guilty— a dispute respectingyWuZaraewta/ principles and facts. Do Spot- ted-fever, and other sinking diseases [which are attended with a dangerous deficiency of vital power, through their whole course! ever admit of depletion, or reducing agents, in any stage? This is an all-important point. There is no question, that evacuations are often indispensable, in some typhoid diseases ; but arc they indicated, because they reduce, or because, while removing a p. ti- cular symptom, their counteraction overbalances their reducing efiects ? Every human being is liable to mistake, in the application of true principles; yet such principles are as firm and immoveable, as the rock of ages. Was the Spotted-fever of Hartford to be cur- ed by depletion and reduction ? Did the Yellow-fever appear in Middletown, in 1820 ? Does regular Typhus admit of resolution ? Are our late Fevers phlogistic, in any stage ? There can be no com- promise, no splitting the difference, upon such questions. The maxim in medio Veritas, however applicable it may be, in many cases of practice, has no bearing upon questions of mere fuctt and upon fundamental principles. " A physician, therefore, who is ever boasting of his candour upon these essential points, or who values himself for having no decided opinion upon such vital questions, or upon pursuing an in- termediate course, can be considered in no other light, than as a timid and inert practitioner; or as an artful, time-serving man, who is ever ready to sacrifice the life of a patient, for the sake of pre- serving a little temporary popularity. " When important facts and fundamental principles are concern- ed, timid friends, who are afraid of offending by taking a decided part, do more to injure the cause of truth, than its open enemies. We know, on what ground to meet the attacks of the latter ; whereas, the former are ever tantalizing us with private approba- tion, without daring to give us open support. JV«,? tnlibva am- dnsS* \ AN EXAMINATION, attaquer une reunion de savans, e'est en- gager un combat inegal; e'est irriter un guepier." We understood hu- man nature too well, ever to flatter ourselves, that we should be able to convince those, who had long adopted gross errors, or committed them- selves by publicly defending them. In such, truth and reason are at va- riance with their personal interests and reputations, and the lives and health of the community, as with Sangrado, are of secondary consequence. These are heavy charges, yet they can be abundantly established. We had no expectation of making a permanent impression upon that descrip* lion of physicians, against whom these allegations are so frequently, and so confidently made. We well knew, that no man was ever convinced, by attributing to him improper motives, however justly he merited hav- ing them exposed. The more he deserves censure, the more callous are his feelings, and the less likely is he to be reformed. But all men are not like mere theorists, and cold-blooded reviewers, who have set truth and candour at defiance. The community in general are wedded to no system. They have the highest concern, to know the principles and practice of those, who assume to themselves the prerogative of guiding and regulating the public taste and judgment, as well as of those, who pro- fess to be guardians of their lives and health. However, we have not, by any means, cast the first stone. The attack did not begin, on our side. What, we inquire of the reviewer, has been the spirit manifested by those American writers, who maintain the phlogistic character, and inculcate a purely antiphlogistic treatment, of Spotted-fever, and Pneumonia-typho- des? What the civility or the candour, which they have manifested to those practitioners, who were educated in the school, and continue in the doctrines of Cullen, and his immediate successors ? Who first brought the charge, that the severity and mortality of many of our late epidemics, have been owing to the practice, rather than the malignity of the disease? What was the usage, and what the ingratitude, that the physicians of Hartford experienced, for their philanthropic and skilful exertions, during the prevalence of Spotted-fever, in 1809, the most deadly typhoid dis- ease, that ever appeared in New-England, of which there is any record? What were the decisions of the medical men, of some of the large towns at a distance, where the disease had never appeared, respecting the prac- tice of the Connecticut Physicians, some of whom have had the management of two thousand cases of the disease ? What was our own reward, for hazarding our lives in the Yellow-fever of Middletown ? What, this very year,, has been the usage of the physicians of Berlin, Connecticut, and the adjoining towns, notwithstanding their success has probably been much greater, in proportion to the number and severity of the cases, than has ever before been witnessed ? Or to look across the Atlantic, how does Dr. Welsh treat his illustrious predecessors in Edinburgh ? There has never been any scruple of raising the cry of Brunonianism, and indis- criminate stimulation, or of charging us with mal-practice. Our oppo- nents can themselves violate the confidence of medical consultation, they can dexterously evade, or even defy, the regulations of the medical police, they can distort our principles, and most grossly misrepresent our prac- tice ; and yet, when any of their doctrines are controverted, when the re. suits'of their practice are scanned, when their management and intrigue are exposed, this is slander and persecution ! Thus it appears, that in censuring and accusing us of needless asperity, they convict themselves. 8 When next they demand justice, let them come into the court with clean hands. " Hypocrita, ejice primum trabem de oculo tuo." But though so much abuse and obloquy, have, in some publications, been heaped upon those, who have practised, in such low typhoid diseases, upon a counter- acting and supporting plan, yet, our brethren at a distance from the scene of action, can have but a faint idea, of the private bitterness and malice, which have been so unsparingly vented. The review, now under conside- ration, is a striking example of the abusive treatment, that a certain class of physicians usually bestow, upon those who do not subscribe to all their dogmas, and will of itself, stand as a decisive proof of the justice of our assertions. The determination to criticize, without studying the work, and the disposition to reject its principles, without putting them to the test of experiment, may be considered as a fair specimen of the class of writers and practitioners, "to which we refer. " The human mind feels restless, and dissatisfied, under the anxieties of ignorance.'''' " It longs for the repose of conviction; and to gain this purpose, it will often rather precipitate its conclusions, than wait for the tardy lights of ob- servation and experiment." Without an explicit assertion to that effect, the reviewer, by a pretend- ed or real ignorance of many of the facts to which we refer, insinuates, that they are not correct. Is it possible, that he can really be ignorant, that any author has asserted, that the Bark is rarely serviceable in our fevers; that blisters to the head are of no use in typhoid affections of the brain ; that Opium, in regular and repeated doses, during the stage of fe- brile exhaustion, is inadmissible ; that the mercurial action, when mode- rately excited during the preparatory stage, is of no other service, than as a test of the natural mildness of the disease; or, that continued fevers are never cured by resolution ? Has he never read the last American edition of Wilson Philip on fevers, of Thomas's practice, or even Welsh on the fever of Edinburgh? The reviewer has placed himself in a com- plete dilemma, from which no sophistry or equivocation can extricate him. If he is really unacquainted with the common text-books of our medical students, and young practitioners, he is the most presumptuous writer, who ever attempted to direct the public judgment. On the other hand, if from sinister motives, he has intentionally concealed his know- ledge of the most notorious facts, no language can be too severe to stig- matize such a bare-faced prevarication, which it must be in the power of every tyro in medicine to detect. It would be sufficient for us to stop here, and close with the reviewer's remarks upon our preface. Every candid and impartial man, must at once see, than no reliance can be placed, either upon the accuracy of the statements of such a critic, or the impartiality of his conclusions. After proving him guilty of such gross ignorance, and such palpable misstate- ments, his remarks and comments, must cease to have anv influence., 9 with those who ever take the trouble of investigating for themselves. Indeed, we would stop here, were it not, that too many of mankind, arc strongly inclined to take their opinions upon trust, and that slander, how- ever improbable and inconsistent, will injure any reputation, unless it is thoroughly exposed. " Tardiora sunt remedia quam mala." Our friends, therefore, will excuse us, for dwelling more upon this review, than its intrinsic merits, by any means, demand. The object of the critic is evidently, neither the investigation nor the propagation of truth, but merely to prevent, per fas aut nefas, the circulation of an individual work, and the diffusion of the principles and practice which it inculcates. Notwithstanding the critic affects to consider the commencement of the Essay on the resolution of fevers, as a mere rhetorical flourish, we do still contend, that " in one form or other, febrile diseases destroy much the greater portion of the human race." Were the assertion of the critic of any authority, we should be happy when we find, that he agrees with us, that the majority of cases may be broken up, in their first stage. His usual ignorance, however, attends him upon this occasion. He would be thought not to know, that a popular professor, who has lectured in various places, and probably had more pupils than any other medical teacher in New-England, has long and indefatigably inculcated, both in his private instructions, and through the medium of the press, the con- trary doctrine. He has even had the civility to tell one of us, that our assertion, that we frequently succeed in breaking up Typhus at its access, was a falsehood. Whether he will have the hardihood to repeat this opinion, in his work on Typhus, in opposition to this redoubtable review er, is a problem. Thus critics do not better agree with popular instruc- tors, than with authors. The reviewer's remarks upon this subject, are all of a piece with his strictures upon the preface. So far from claim- ing this, as any discovery of our own, as he asserts, we expressly state, that, " every powerful agent is occasionally found to break up dis- ease;" and in another place, we mention the several means, which have been occasionally found to produce this effect. In fact, so careless is he, in his zeal for misstatement, that within a very few pages, he himself ob- serves, that we remark, that bleeding, emetics, cathartics, &c. no doubt occasionally succeed. It is our process only, that is original. The critic, with his usual consistency, has quoted from Dr. Warren, the practice of giving repeated fidldoses of Calomel, in a different variety of Typhus, to prove, that we are not original, in our method of slow and moderate purging with small doses, in our disease. However, by the omission of the fact, that antimonials and blisters were superadded to this use of Calomel, he has even misstated Dr. Warren. He has further quot- ed Dr. Warren's use of small and repeated doses of Calomel and Opium, in a different fever from ours, to produce " copious evacuations from the bowels" a practice not confined to the early stages, ajid not expected to 10 produce resolution, and likewise the use of "afete doses of Calomel," in the secondary stages, " to excite the system," to prove, that our method of practice, at the access of Nervous-fever, has long been common ! The fact, that the reviewer cannot see, but that all this is "precisely similar,v is demonstrative evidence, of the superficial manner, in which he has read our work, if indeed, he has read at all, any more of it than he has quoted. He represents us as maintaining, that " bleeding, emetics, and active cathartics, are all, not only useless, but dangerous, in the beginning of an acute disease !" It seems, he did not even read the whole of our preface, as he would there have found, that " the author readily grants, that there are various plans of medication, which are usually attended with conside- rable success ;" nor indeed, a considerable portion of the first Essay, in which we speak of abstinence, sweating, cold-affusion, bleeding, emetics, ca- thartics, narcotics, and factitious strangury, as all having been occasional- ly successful, in producing resolution, as having sometimes removed every symptom of Typhus, and as having different degrees of merit, and diffe- rent circumstances in their favour. In the subsequent parts of our work, much pains is taken to specify the particular cases, in which bleeding, emetics, active cathartics, cold-affusion, antimonials, the refrigerant salts, and vegetable acids, are not only proper, but absolutely indispensable. Indiscriminate practice, is the last accusation, that we should ever have anticipated. The whole tenour of the work, is in direct opposition to this very thing; and we repeatedly and constantly urge, that no medicine should ever be given, without a definite and precise object in view. We do not hesitate to assert, that no work in the language, is more precise on this subject. The critic could not have misunderstood us. He must wit- tingly and wilfully have misstated and distorted our whole meaning. We are next represented as pretending to cure a disease, which is often fatal in six hours, by retaining Calomel in the stomach and bowels, for twelve hours. He certainly never could have published such a glaring falsehood (we do not hesitate to call things by their true names) had he ever read the work. The cases which are exceptions to our use of Calo- mel, are repeated again and again, and we expressly say, that " the oc- currence of such extreme cases, is very common of late years;" and in the preface, it is stated, that " a primary object of this publication, is to give precise rules, for the administration, the abstraction, and the non- employment of Calomel." The critic next attempts to apologize, for not making any further analy- sis (as he is pleased to term it) of the volume, for not furnishing any further abstract of its contents; and his excuse is, that it is not worth the trouble. But, are the subjects of diathesis, type, stage, crisis, pulse, in- dications, experience, counteracting and coinciding agents, inflammation, &c. even though they might be indifferently treated of, of so little consos; 11 quence, as not to deserve notice, in a review of this length ? It might reasonably be supposed, that a work not worthy of an analysis, or an ab- stract, would not be worth noticing at all; and yet, so inconsistent is he, as to occupy twenty-eight large octavo pages, of a fine type, with misrep- resentation, cavilling, invective, and unfair extracts, in reference to this very work. He concludes his apology by declaring, that " the book is filled with rash and unfounded assertions, extravagant theories, and the most gross and unwarrantable aspersions upon the profession, mixed with a large share of self-complacency and arrogance." As these charges rest exclusively upon the credit of the reviewer, being en- tirely unsupported by any statement of facts, or chain of reasoning, and ai we have already shown, how little confidence is to be placed in any of his statements, or even quotations, it might be sufficient to reply, that the work does not contain a single assertion, that is not founded on the am- plest observation, or the most conclusive testimony; that not a single theory is advanced in the whole book ; and that there is not a single charge brought against any individual or body of the medical profession, which cannot be supported by the clearest evidence, and indeed, most of them have actually fallen under our own immediate observation. The charge of libelling the whole medical profession, is as unfounded, as his other sweeping accusations. The tricks of the venal and ignorant part, it is true, are exposed in the strongest, but at the same time, in the justest colours. Nor are we at all inconsistent, when we caution against the occasional failings of the most able men of the faculty; for practitioners of medicine, in common with every other profession, have their " esprit de corps" with their peculiar virtues and defects, arising from the motives and temptations, that are peculiar to the situation, in which they are placed. No body of men, unless they are upon a con- stant guard, are so apt " to row one way and look another," to talk, and apparently act, with the vulgar, however correctly they may think with the wise. Is it possible, that any proqfs can be wanting, to substantiate these assertions ? Who has ever read the surreptitious editions of Cub- len's clinical and other lectures, and has not seen, that his private prac- tice was much more efficient, than he chose to avow, in his acknowledg- ed works ? From unquestionable private authority, we could mention instances of the same kind, even in some of the living authors in Lon- don. Among our personal acquaintance, and those whose general prac- tice and views perfectly coincide with ours, in every essential point, there are many, who think it quite inexpedient to defend publicly, the very- treatment, which they employ every day, in low, cool, typhoid diseases. We have stated in our work, that in one county of Connecticut, we do not know of a single antiphlogistic practitioner, in the diseases which have prevailed of late; nor, in the whole course of our lives, did we ever know an individual, who was able to treat such diseases with success. 12 by antiphlogistic means. We have seen many attempt it in the begin- ning of an epidemic, but like the ingenuous Dr. Miller, whose commu- nication we have analyzed, they have invariably relinquished it, in the progress of every severe disease. These things ought not so to be, in a scientific age. The mystery and legerdemain of the dark ages, are still, by no means, entirely discarded, by some of the ablest members of our body. Notwithstanding these free, but at the same time, literally just remarks, it is obvious, through our whole work, that we are enthusiasti- cally attached to our profession. In the words of one of our reviewers, we do indeed " love our brethren, with all their vices and follies." The decided manner, in which we enforce the necessity of learning, industry, and more especially, moral integrity, and in which we expose ignorance, indolence, and all kinds of juggling, can never displease any honest man. None but physicians of the description of our cavilling, prevaricating re- viewers, can be offended. This, as we have elsewhere stated, is no more than was anticipated. We could specify facts enough, to substantiate abundantly, the correct- ness of our remarks, upon the state of large cities. Some of them must have fallen under the immediate eye of ihe reviewer. We will ask Mr. Critic himself, whether those who write the most, have the most extensive practice? We would inquire, whether the professor, who has now in the press a treatise on Typfeus, has been extensively engaged in family prac- tice, for at least the last ten years of his life ? We might further very properly inquire, how many cases, during that time, he has witnessed daily, through their whole progress, from the access to the termination ? Happily, in Connecticut, the truth can never be considered as a libel. Whatever time-serving authors may say to the contrary, we know it to be a well substantiated fact, that from the era of Hippocrates, to the present day, no physician ever practised with success, in alow and malignant, cool typhoid disease, in which there was a great deficiency of vital ener- gy, unless he met the symptoms of exhaustion, in a similar manner to ours. Upon this point, we claim no originality. We have only en- deavoured to be more precise than our predecessors. Alcohol, Opium, Ammonia, Arsenic, Camphor, Cantharides, Capsicum, and the essen- 'tial oils, individually, or variously combined, or articles of similar tenden- cy? together with the more permanent tonics, must not only be used but used with energy, for exciting and supporting the vital powers, or everv malignant epidemic, soon becomes a devastating pestilence. Whatever may be said to the contrary by closet men, it is the only successful prac- tice of all ages. We have however, endeavoured to recommend an ear- ly counteraction, which in a great measure, may preclude, in regular Nervous-fever, the recourse to such Herculean means; and on this im- portant point we think, that we have made great improvement • but vhen the exhaustion is excessive, whether it exists when wo are fuv 13 called, or takes place after the lapse of one or two weeks, every physi- cian is necessitated to resort to them, or his patient dies. The diffusible excitants must be used with considerable freedom, in such epidemics, whenever they would' be successfully treated. We have observed, that many of the antiphlogistic practitioners themselves, when they use these articles in extreme exhaustion, do it with vastly more freedom than we. There is this prominent difference between us. They treat the stage of re-action in Typhus, as if it were sthenic inflammation instead of mere ir- ritation, and thus sink their patients so low, as to make much more me- dicine necessary, in the latter stages, to produce the same effect. Those great physicians who succeeded Cullen, strikingly illustrated these prin- ciples, though, as we have said of their master, it is very evident, that they were cautious of entering into minute details. Moore,* Townsend, and a few others, were perhaps exceptions. The difference between the apparent weight of disease in Europe, and the consequent apparent im- becility of practice, which we stated in the Essays, should also be taken into the account, in order to do perfect justice, to those eminent authors, who so much improved the principles of medicine, and to whom, our pro- fession is so much indebted. These remarks, whatever a captious critic may say to the contrary, are not at all inconsistent with the respect and veneration, which we have ever entertained, and which we have repeatedly expressed in our work, for the general practice of Huxham, Cullen, Dar- win, Beddoes, Ferriar, Currie, Fordyce, &c. As respects the practice of authors in general, most reviewers and compilers of periodical publica- tions, usually know experimentally, whether those physicians who write the most, have commonly the most extensive practice. One of us is repeatedly accused by this reviewer, of rejecting all regard to symptoms, of giving no descriptions of disease, of making only a few desultory remarks on the general character and type of diseases, and of founding his practice on mere speculative principles. This has just as much foundation in truth, as the rest of the critic's assertions. It is true, Dr. M. does not write upon any particular epidemic, and of course, does not specify the peculiarities of any one; but of the symptoms of simple ty- phoid diseases in general, as they exist among us, and of the peculiarities of the several varieties of these, he has, in the eleventh Essay, given the most minute detail, that is any where to be found. The terms diathesis, with its division into sthenic and asthenic, type, including the nervous and sub-nervous, the putrid and sub-putrid, as well as stage, crisis, &c. are all accurately explained, and not in theoretical expressions merely, * Dr. Moore observes, " As I am told, this pari of my work will be exposed to cen sure fake Lhat tice 14 but by actual and minute specifications of that aggregate of symptoms, which constitute them. We do not pretend to consider these terms, in any other point of light, than as signs of such aggregates merely, and sub- stitutes for them. In no part of the review, are we more palpably and wantonly misrepresented, than when we are accused of disregarding symptoms. If the critic had merely read us, in the most superficial man- ner, he could never have ventured, even to make such a suggestion. We again insist, that we are uncommonly minute and precise upon this sub- ject. We repeatedly mention, not only the manner in which symptoms are to be met, as for example, not merely by prescribing to their names; but we show, that by considering them in connexion, the same symptom often requires a different treatment, according to the diathesis, type, stage, &c. as well as the known obstinacy, and general character of the prevail- ing disease. We again declare, that there is not a single-"tfyeory or hy- pothesis, in the whole of our volume, and we cannot -"f-JTaf "" express- ing our astonishment, that any man should have the effrontery and auda- city, to make assertions to the contrary, before that public, to which our work is committed. It can be accounted for in no other way, than by what is doubtless the fact, that the reviewer had never read the work, or that he supposed, he could prevent any one else from reading it. Notwith- standing our challenge, he has not even attempted to produce a single fact, in opposition to our statements, respecting the diathesis, not only of our own diseases, but of every wide-spreading and devastating epidemic, which has ever occurred. We indeed hoped, that some candid man would take the field in opposition to us, as we are desirous that the sub- ject should have a thorough discussion. It is an all important point, to ascertain, whether those diseases, which we term sub-putrid, are really sthenic in their first stage; or whether most of the subsequent phenomena, which are supposed to support this opinion, are not entirely the results of the most common practice adopted ; or, in other words, whether asthenic ir- ritation is not usually mistaken for sthenic inflammation ? The facts upon this subject, though long familiar to physicians in this quarter, seem just beginning to attract attention in Europe, as would appear, by some late- essays, in the London Medical Repository, on the effects of great loss oi blood. We have, however, principally confined our work, to a variety of r*o brile disease, very different from the sub-putrid, and one, about the asthe- nic character of which, at least as far as we know, there has never been a reasonable question. We boldly assert, without the least fear of any well supported contradiction, that a vast majority of our fevers invariablv exhibit, a greater or less degree of deficiency of vital energy, from their very access to their termination. As we have so frequently declared, the heat of the surface seldom rises to the standard of health, during the great- est exacerbations. That this is not owing to an oppressed state of the 15 system, is abundantly evident, by its being accompanied with every symp- tom, which indicates primary exhaustion, as well as by the effects of all sorts of treatment. The difficulty is, that those physicians, who live at a distance, and are conversant only with diseases of the sub-putrid type, or the very mildest of the nervous sort, can never be made to realize, the perfect accuracy of our statements. It is a great misfortune, in regard to me- dical subjects, that the belief of physicians, is too apt to be confined to their own experience, whether it is right or wrong. The strongest testimony, when opposed to their own impressions, has rarely any influence ; and when they make trial of any proposed plan, which is in opposition to their own method of thinking, it is usually so imperfectly executed, as to produce no satisfactory result. The instances, in which gentlemen of considerable talents cannot, or rather will not, employ Opium, Cantharides, Arsenic, &c. to any useful purpose, are innumerable. Were it not an invidious task, many names might readily be specified. Any man, who supposes that a malignant disease, or such a one, as from its access, is attended with a dangerous deficif **of vital power, may be cured by bleeding, or evacuations as such, can never have witnessed a low typhoid epidemic, whatever he may imagine to the contrary. Nor, if he has only seen ever so many light cases of the same name, can he ever be convinced, that the disease is necessarily more dangerous, in a malignant form. Occasional sporadic cases, that terminate suddenly, are commonly misfldien for Apo- plexy, Hydrocephalus, Tetanus, or more vaguely, for some sort of Fit. and consequently afford no true experience. Even when such a practi- tioner resides in the same town, where an epidemic prevails, if his business is contracted or limited, he will give no credit to the statements of others. Many instances in our vicinity, might be specified, in which one or two popular physicians of a town, have had more business in an epidemic, than they could well attend to, while the remainder insisted, that the place was uncommonly healthy. With too many, their own limited business, their own confined experience, is made the standard, by which the busi- ness and experience of others are to be tried. It should, however, be re- collected, that the whole of such experience, is of the negative kind, and has not the weight of an atom, in the balance of truth.- Had the size of our volume admitted of the publication of all the Essays. which we at first proposed, our reviewer could not have had an opportu- nity to plead his entire ignorance of the whole of the cases of preposter- ous practice, to which we refer. Nor can he now plead it in truth, if he has been in the habit of reading most of the popular journals and treatises of the last twenty years. He must assuredly recollect General Washing- ton's case. Hale's, is to be found in the Philadelphia Medical Museum, volume 2d, pages 7th and onward. La Roche's, in Chapman's Philadel- phia Journal, volume 5th, pages 369—382. Johnston's Purpura-ha- morrhagica, as he absurdly calls it, is republished in the New-England 16 Journal, volume 12th, pages 83,84; and we would refer him to Kemper's case of Rheumatism, in Chapman's Philadelphia Journal, volume 6th, No. 12, to W'elsh on blood-letting, in the fever of Edinburgh, to nearly tico hundred victims of depletion, mentioned by Dr. Miller, &c. &c. The principal indications, that are supposed to justify this mass of absurd practice, with which not only the preceding cases abound, but which is to . be found in almost every periodical publication, have again and again been proved to result from the practice. See, Bonner and Lucas, on the state of the pulse, after profuse haemorrhage, and Copland on cerebral excitement, in the London Medical Repository. The critic sneers at our assertion, that those efficient agents of the Materia-medica, which from their prominent operative effects, furnish accurate tests of the extent to which they can be safely employed, do vast- ly less harm, in the hands of the skilful, than the more common articles, in the practice of the indiscriminate, the immediate tests of which, are less obvious. Though it is impossible to refute a sneer, yet it should be recol- lected, that a sneer itself refutes nothing; and4wtoyithstandinghe winces at our charge of ignorance, if he really misunderstands us, we will repeat it; and if he intentionally misrepresents us, he merits the application of a much severer term. His cavilling suggestion, .that some of our doses of medicine are " rather large," we have just anticipated, when we stated, that such phytfcians judge of the experience of others, by their own limit- edpractice.* * With respect to the repeated personal insinuations, which are thrown out at a venture, against one of us, that the results of his practice, have had an unfavoura- ble influence, upon his individual fortune, &c. &c. &c. we will observe, that tho critic has entirely mistaken his aim. Dr. M. is neither a misanthrope, nor one who has been disappointed in ambition; nor is he at war with any of the Phvsi- eians around him. The only professional collisions, in which he has ever been enrag- ed, were with two medical surgeons. For aught that he knows, he is on lood terms with every other member of his profession, with whom he is ever liable to come into contact; of which, their repeated and unsolicited marks of confidence and friendship, are the highest evidence. His field of consultation with other* il more extensive, than his greatest ambition ever aspired after. Nor has he anv reason to complain of neglect, or disrespect, from a very great mn jority of the po- pulation, with which he is surrounded (whatever exceptions he might make ?,, regard to a very few individuals) nor has ke ever had reafon to comp ffn o?a wan of his full share of the business and emoluments of his profession, in compare, with his brethren in general, in this State. Thoughfond, almost to enthSn o his profession, still (except that he would wish to be engaged in some usenlland humane employment) he l3 utterly indifferent, whether h! h, ever again i, h£ life, called to prescribe for a single patient. Though he entertains Uiehghe regard for the opinions of the discerning and impartial part of the community yt no man feels, or actually ,s, more independent of public frowns or applauV This the reviewer might have easily discovered, from the whole tenor of W? wrR- ings. But perhaps it may be some gratification to the benevolent critic, to"V informed, that whatever may be the fate of our work, it will produce no embar- rassment in a pecuniary point of view, either to the authors or published How Tri'7e ft "° T8?8 ,W,Sh to intrude our Private con°em9 upon our reader" and 17 The critic appears to be offended at our assertion, that the practice oj physic generally, has not been improved, since the time of Cullen, and his immediate pupils and successors; but yet, he does not advance a single argument, or state a single fact, in opposition. We uniformly admit} {hat the auxiliary branches are much improved, but still, without advantage tc, thepwre practice of medicine, especially in fevers. It js well knowna tha| thirty years ago, in serious epidemic febrile diseases, out of those cases, which went through a regular course, one in twenty, in family practice3 and one in ten, in that of hospitals, was the average loss in England « and from satisfactory information, we venture to say, \tt this country too, But, what are the results of modern practice, as stated by Armstrong, and others of the same school ? From him it appears, that of late, under a plan similar to his, one in about three, dies in hospitals, during the worsf epidemics, and one in about twelve, in the mildest ones.* We would likewise inquire of oqr reviewer, how much the proportion* al mortality of Yellow-fever, has been diminished, within the last twen- ty years, in New-York, Savannah, New-Orleans, Natches, Pensacola,&c. ? What likewise has been the relative number of deaths, under the fash. * It is truo, that Welsh's statement, would seem, at first view, to be more fa- vourable to the modern practice; but several things are to be remarked, in refer- ence to his results. 1st. His disease was a very mild one, never becoming at all aevere, except from neglect, or palpably bad management. 2djy. His numbers include, not only those which went through a regular course, but those which ter- minated in their early stages. 3dly. Welsh proves too much; for if the moderate mortality in the fever of Edinburgh, is to, be ascribed to the treatment, it will go tq prove, that the most indiscriminate practice, ever adopted, is the most successful. 4thly. It would show, that the great body of the physicians of Great-Britain, are abso- lutely bad practitioners; for, Welsh himself says, " (he practice he recommends, though certainly not novel in books, has still a large majority of the most eminent me- dical practitioners decidedly opposed to it ; and a vast number of others, who look to experience, and a kind of universal consent of the profession, as the signal for sub-' mitting io trial, a practice which they consider as hazardous" And again he aays, *' In this city, howBrer," (Edinburgh) "the practice" (which he advocates) "A«n made but slow progress; and as for large bleedings, as they are called, that is, from twenty to forty ounces, they are still viewed with rooted aversion, by the greater part of private practitioners." Dr. James Johnson, in reference to the fevers of India, says, " bleeding, I know, is seldom employed; but lean state, that three other surgeons on the station, beside myself, had recourse to venesection, in the fevers of India, with the greatest benefit:'' " This is a small band, opposed to the host of aniiphleboto mists '' &c. Sec. " In the first place, a great proportion of practitioners will be deter i red from the use of the lancet, entirely by the current of prejudice:' Precious con- fessions these, even from the very advocates of the practice! Jt is a remarkable fact that almost all the noise and clamour in the world, arise from minorities. Those who follow the fashion strictly, are very few. This is precisely the case with our profession. A highly respectable proportion of physicians are still men of common sense, and common honesty. They however attend to the business pf their profession, without making any bustle. We do not know a single physiciaft in Connecticut, who attempts to treat a case of low cool typhus, upon the plan of Clutterbuck, Armstrong, Welsh, and Beddingfield; and we have the amplest tes- timony, that their practice is not generally adopted in England. YVhy our re- viewers should take it so much in dudgeon, because we have exposed the absurdi- ties of this class of writers, it is difficult to conceive. We have even the amplest proof, that one at least of these very author?, does not practice upon theprmnplej ♦hat he recommends. 18 ionable treatment of the epidemics of Spotted-fever, Pneumonia-typhode>; malignant Dysentery, common T3'phus, &c. in the United States ? Dr. Miller's able essay, had the reviewer studied it, might have given him some light on this subject. What is the truth with respect to the mor- tality from Consumption ? The facts in support of our assertions on this point, are too numerous, and too notorious, to admit of question or denial. Even the avowed principles of our reviewer, afford a striking il- lustration of our statements; for, although he pretends to object to pre- scribing to the mere names of diseases, yet he seems to have no idea of deducing his indications, from any other source than the mere names of symptoms In our work, we contended, in company with Cullen and his successors, (and we still contend, however unfashionable it may be,) that the latter method is full as absurd as the former. It is from symp- toms in their connexion and aggregate, and not in an insulated form, that the only correct indications can be deduced. Thus, diarrhoea, in certain connexions, can be well treated only by emetics and cathartics; in others, these are injurious, and astringents and Opiates are indispen- sable, even from the access. Pain in the head, when in certain connex- ions, requires depletion and evacuations ; when in others, it is greatly ag- gravated by these means, and requires a directly opposite treatment. Heat and dryness of the skin are sometimes relieved, but at others, are ag- gravated, by the internal use of the refrigerant salts. It is likewise well known, that in some instances, they are best relieved by the diffusible excit- ants ; and at others, greatly aggravated by their use. Instead of absurd- ly pretending to specify what treatment, each symptom in the abstract requires, we insist that Cullen and his successors were right, in adapting their practice to certain aggregates, which they specified under the de- nominations of temperament, diathesis, type, diagnosis, &c. &c. and which, following them, we have detailed, under the same heads (except that we have no essay on temperament,) with greater minuteness, than is any where else to be found. We have repeatedly stated, that all these aggregates or groups of symptoms, are always to have their due weight, in the regulation of practice f and though we have no distinct essay upon diagnosis, yet this is a subject that runs through our whole work. In one place, where this is enforced, we illustrate by stating the well known fact, that distinct Small-Pox, and active acute Rheumatism, in proportion to the degree and intensity of those symptoms, which mark diathesis, type, stage, &c. require a much more rigorous antiphlogistic regimen and'treat- ment, than Measles and Gout; and yet, our reviewer has the hardihood to say, that we almost entirely neglect the distinguishing symptoms of each disease. Had the critic considered our work as a whole, as we so evi- dently intruded, he would have had still less pretext for his cavils. He would then have found all our important principles illustrated, in their application to the diseases of which we have treated. That our review- 19 er, who would wish to be a popular writer, should so often and so strenu- ously object to this method of deriving indications, and should, either designedly or unconsciously, express such ignorance of the correctness of this method, is conclusive evidence, of the state of facts on this subject, at least, in our own country. We have repeatedly anticipated the critic in stating, that the auxilia- ry branches, and even surgery, were very greatly improved; but we de- nv, that the pure practice of medicine, especially in fevers, is likewise improved. The attention, at this day, is distracted by minute and tri- fling circumstances, without any correct view of the whole, in their con- nexion. These opinions are brought up against us by the reviewer, as if they had been hitherto unheard of, and were exclusively peculiar to our- selves ; but we maintain, that the same conclusion has been adopted by several of the ablest authors, with respect to the genius of the present age, and we shall therefore dismiss this subject, with the following quotation, with which, (our critic to the contrary notwithstanding,) we perfectly co- incide. " The great vice of the present day, is a presumptuous precipi- tancy of judgment ; and there is nothing from which the cause—of ge- neral knowledge has suffered more severely, than from that impatience of investigation, and that confidence of decision, upon hasty and partial views, which mark the literary character of an age, undeservedly ex- tolled, for its improvements in reasoning and philosophy." We are repeatedly accused of having an hypothesis, that every disease is asthenic. We deny, however, that we have any hypothesis at all, and least of all, one of this sort. We expressly recognize, and even specify the opposite cases, and we in fact combat the fashionable opinion, that it is immaterial, whether such cases are treated by depletion and evacua- tions, or by oil of Turpentine, and other articles which are supposed to be stimulants. This absurd notion, when contrasted with the prevailing doctrine of late writers, that Typhus is to be principally treated by de- pletion and evacuations, may be considered as a glorious specimen of modern improvement and discrimination ! In no instance do we assert, that a disease is asthenic, without showing that it has that assemblage of symptoms, which constitutes that diathesis. Had we even employed the ,*ms sthenic and asthenic, nervous and putrid, &c. in a new sense, (and we contend we have not,) we have been so minute in the specification of what constitutes these slates, that there can be neither mistake, nor mis- understanding. If in fact, we are in an error, in our decision respecting the asthenic character of every wide-spreading and devastating epidemic, except of the Exanthemata, we should feel under great obligation to our critic, to point out a single well attested instance to the contrary. For this purpose, he surely will not have recourse to such epidemics as the pestilence of Athens, the Plagues which spread terror and desolation m Europe, in the time of Boccace and Petrarch, the Sweating-sickness in 20 the days of Henry A II., the Pestilence which swept off the Indians of Massachusetts, two or three years previous to the landing of our forefa- thers in Plymouth, the great Plague of London, the modern Plague of the Levant, the Cholera of India, or the Yellow-fever of 1820, in Savannah. Dr. Good, in his Study of Medicine, seems, though indjrectly, yet very clearly, to be of the same opinion with us, concerning the typhoid nature of wide-spreading epidemics. The critic says, " although Dr. M. sometimes speaks of the indiscri- minate use of bleeding, 8fc. as being the practice he condemns, yet it it obvious from the ivhole tenor of his work, that it is the indiscriminate rejection of them only, that will satisfy him." Had the reviewer stu- died to make an assertion, which should be the most completely in opposi tion to all the specifications, and the whole tenor and scope of our work, he could not have hit upon one so palpable, or have been guilty of a great- er violation of truth. Our rejection of depletion, and the cautions against profuse evacuations, are expressly and repeatedly, and throughout the whole volume, confined to cases of deficiency or exhaustion of vital ener- gy, while these measures are uniformly maintained to be indispensable in the treatment of diseases of an opposite character. But, let us examine the practice of that class of physicians, who so falesly bring this charge of indiscriminate practice against us, that we may see, whether it can- not be with the utmost truth, retorted upon themselves, without being in the least uncharitable. Dr. Welsh, who appeals to be at the head of an important institu. tion in Edinburgh, says, that " emetics are dangerous in their opera- tion,"—that " their operation is very uncertain,"—that " they have lit- tle effect in violent fever, and frequently occasion those who depend on them, to lose time in the mildest." He adds, " emetics we have never seen of much service, and of course, they have been but seldom employ- ed." " Purgaiives are likewise uncertain in their operation,"—" they require some time also for their full operation,"—" the patient was often in a state of convalescence, from the use of the lancet, even before a pro- per system of purgation could have been brought to act upon the bow- els ;"—and yet in another place lie affirms, that " purgatives have al- ways had the best effects ; and if there were any mode of cure, that could with justice be substituted for venesection, it would be purgatives !" He says, " sudorifics have been but little tried at Queensbury house"—" the objections against diaphoretics have been stated so strongly by Sydenham and Cullen, that it appears useless to insist further on them here"—" they are uncertain, slow, and disagreeable, even where they succeed ; they are unmanageable, and often disappoint the wishes, of the practitioner; and above all, can always be most certainly compensated for, by the use of the lancet, which is by far the safest diaphoretic." To these remarks, we add those of Dr. James Johnson, on the same class of remedies' '■' Now that the principles which govern the perspiratory process. »~ bet- 21 ter understood, the long and endless farrago of sweating medicines is re- duced to a few neutral salts, as Citrate of Potassa, Acetate of Ammonia, accompanied occasionally with small doses of Antimony." " These, with cool diluent drinks, are the only safe or salutary diaphoretics in fe- ver." We would barely observe, that if these are all the diaphoretics, which are at present employed by these gentlemen, in typhoid fevers, we are not at all surprised, at the result to which Dr. Welsh has arrived. Dr. Welsh, on the subject of cold water, says, " as to the cold bath," (inclusive, as appears, both of affusion and sponging) " it maybe remark- ed, that very seldom indeed, has it appeared to be of any service, and of course, it was little employed."—" Every one of the good effects sup- posed to be derived from the use of the cold bath in fever, can be pro- cured with much more facility, certainty, and safety, by a free use of the lancet." I Ic says," with regard to Mercury, I doubt extremely, whether it has any effect at all, in diminishing fever; but as nobody believes that it cuts it short," (this seems to be at variance with the infallibility of several of our reviewers) " and the evidence in its favour, is so eminently ambigu- ous, I hope I shall be excused, if I pass it over, without further discussion." Dr. Welsh continues, "our readers, by this time, will be able to guess, that we do not lay much stress on the other remedies," (beside blood-letting) " which have'been employed in fever." " In short, the activity of the remedy we treat of," (blood-letting) " compared with the others, is so preponderant, that I should not have encroached upon the reader's patience, by this comparison, short as it is, did it not seem proper, that prejudice should have an opportunity of viewing itself in various direc- tions/' &c. # As respects the indications for this universal remedy, bleeding, Dr. Welsh informs us, that he bleeds to abate fever, change type, and shorten duration ; to lessen mortality, protract life, and promote convalescence; to mitigate heat, uneasiness, ov pain ; to remedy all irregular action, and local affection, such as spasm, subsultus, singultus, delirium, coma, ischu- rv, dysury, constipation, cuticular constriction, oppression, and conges- lion; to change temperature, and lessen the frequency of the pulse; to calm respiration, diminish thirst, and improve appetite, to check nausea, retching, and vomiting; to assist catharsis, restrain diarrhoea, and pro- mote sleep. He says, that neither youth, nor old age, nor the long con- tinuance of the disease, nor the hopelessness of the case, are any objec tion or impediment to bleeding. Indeed, he considers it as of the greatest benefit in the most hopeless cases ; but its utility, he thinks, depends al- most solelv, on its being practised very copiously. He asserts, that it may be employed, not only with impunity, but with great advantage in fevers to five times the quantity, that has been heretofore believed admis- sible The benefit of bleeding, he thinks, is almost always in direct pro- portion to the quantity taken. His rule is, to bleed till relief of all 22 symptoms, or some injurious effect takes place. Its past failure, he says. has been owing to deficiency in the quantity taken. Excess, he sup- poses, is attended with little harm. Less than sixteen or twenty ounces. from an adult, he affirms, never does any good. He again inculcates, that strength, fulness, frequency, and sharpness of pulse, alwciys indicate it, and weakness,.quickness, and irregularity, are no sort of objection to it! Coma, whatever may be the accompanying symptoms, is said al- ways to indicate the freest depletion ! Dr. Welsh gives a specimen of the extent of his bleeding, in some of his cases. Cecil Smith, aged 25, he bled 136 oz. (more than a gallon) and ap- plied ten Leeches, during one attack. Case Grove, aged 24, he bled 110 oz. (about seven pints) 31 Leeches. Joseph Burket, aged 28, he bled 108 oz. 12 Leeches. William Marshall, aged 18, he bled 104 oz. Janet Neilson, aged 18, he bled 102 oz. 20 Leeches, &c. &c. and all this in Typhus ! In reference to the above abstract from Dr. Welsh, we shall take the liberty (however we may be accused of illiberality by our critic) of adopting a judicious remark of Dr. James Johnson, himself an advocate for very profuse bleeding. " Indeed, we have frequent occasion to de- plore the ultra-depletory tncnia, tohich has seized some weak brains of the present day, and much fear it will bring a character of rashness and danger, on a most important remedy, when judiciously managed." Dr. La Roche, in Philadelphia, in a case of Colic, in which he evident- ly mistook the irritation, that almost every step of his process had a ten- dency to produce, for inflammation, took at least five quarts of blood from his patient, to say nothing of the most unparalleled evacuations from the stomach and bowels. Dr. Watson, of Pennsylvania, in the case of Mr. Hale, which was sub- acute Pneumonia, or perhaps merely Catarrh, bled his patient every day, for at least nine days, if not more, till he was so reduced, that he was una- ble to change his position in bed. After this, he was kept forty-two days under a mercurial course, during which time, he took a large quan- tity of Calomel into the stomach, at the same time, having it rubbed into the mouth and gums; and having applied externally, by friction and bandages, thirty ounces of mercurial ointment, which consisted of almost equal parts of the blue oxyd and lard. Subsequent to this, he was sali- vated seventy-two days. From 8th April to 11th May, the daily quantity of saliva discharged, is specified, amounting to a hundred and thirty-nine pints, or more than seventeen gallons. From further statements, though the exact quantity is not mentioned, it is unquestionable, that a moderate esti- mate for the remaining thirty-nine days, must make the whole amount to about thirty-three gallons, or more than a barrel! Our critic may still sneer, and plead ignorance to such facts, if he pleases. . Surely, without 23 any very great criminality, we may be allowed to say, that this great cure was only a great escape.* The same physician details another case, in which he salivated a de- licate female, more than four gallons ; but this, in comparison with a bar- rel, is too trifling to be insisted on. The genius of Moliere, or Le Sage, would bestow a much more appropriate chastisement, upon the authors and abettors of such practice, than the best talents of any serious writer. Hamilton on purgatives, is so universally, in every medical library, that we imagine, even our critic will not plead ignorance of its contents; and if we cannot be allowed to make any objections of our own, to the practice which this work inculcates, we humbly hope, that we shall be permitted, to adopt language from high European authority. " Hamilton's recom- mendation of purgatives in Typhus, only proves what blunders, and absurd methods of treatment, the human body can, in certain circum- stances, withstand." Wre say the same, concerning gallons of blood ! ! ! We might compile volumes from popular authors, and the common pe- riodical works of the day, not excepting even the New-England Journal. of practice nearly as absurd. The editor will recollect, that for the sake of commending a popular work, he reviewed it twice ; though the author was so indiscriminate, as to mistake the struggles of the dying for sthenic diathesis; and most of his deductions were made from a set of peurile, wan- ton, and barbarous experiments upon living animals, which are a dis- grace to the age we live in. But why all this clamour, on one side only ? What do gentlemen mean, by accusing us of libelling the whole profession, * Some of our friends, who are not much conversant with the writers of the last twenty years, or who are not in the habit of summing up such statements, were apprehensive, that we had used too strong expressions, in our zeal for exposing the rash practice of our opponents. Salivation by the barrel, end bleeding by gallons, startled them. We, however, contend, that no language can expose it, in too >lo\vin<* colours. We claim it, not merely as a right, but we consident as a duty, which we owe to humanity, and the age we live in, to make a public, solemn pro- test, against such indiscriminate, murderous practice. The more fashionable it i= the°'tron°-er is the obligation of every good man, to meet it with expressions of his most decided disapprobation and abhorrence. It was our endeavour to be li- terally correct in our estimates, and to venture no assertions, for which we had not the most ample documents. Wc have watched, ever since we have been in rractice the effects of indiscriminate bleeding-, after casualties, jfo, hysteria, &c. and in typhoid fevers, and other diseases, attended with a prominent deficiency of vital power, and we do not hesitate to say, that annually, two persons in a thou- sand, is a very low estimate, in the United States, of the victims of injudicious bloo'l-lettin*. From twenty to thirty thousand, is the necessary result, for our Dooulation !° If such is the proportion in Europe, it is evident, that the lancet slays more than the sword. We could specify abundance of names and instates, in justification of our calculations. The best things, when perverted, cause the great- est evils. Let no one, therefore, misrepresent us, as being enemies to the proper u«e of the lancet. We have never questioned, that it is the sheet-anchor, in every violent phlogistic disease. We inculcate its vigorous employment again aS aJato, in various places in our work, as any one who will take pains to read us wdl readily see. This will show the public, with what cautions, they must rece e the false allegations, of a set of superficial, partial, and malignant rev.ew- ers. To undf.rstand°the nature and tendency of our work, « hsez veus-memes et juges," read it yourselves, and then judge. SM- and ol using unpaulonabie asperity of language, in reprobating such prac- :ice ? Why are they so sensitive, when any attempt is made, to expose fcuch errors. Why after all this, is it such an inexpiable crime, to main- tain j that the fashionable practice of physic in febrile diseases, when com- pared with that of Cullen and his successors, is deteriorated? Why do many of the Journal writers feel such a horror of stimulating practice, in Ihe exhaustion of Typhus, and at the same time, remain so callousj in re- ference to such a waste of all the powers of life ? Why do they continue to publish such preposterous practice, without note or comment, and ma- hifest such violent opposition, to every contrary doctrine ? Why do many Physicians, whose private practice is substantially the same with ours, still publicly censure the very method^ Which they daily employ, and pre- end to approvb and recommend a course, that neither their consciences) nor their reputation in business, will allow them to execute? Why is the Whole fry of petty writers and compilers, so clamorous, in misstating the hialteij and cavilling at the manner, of what they have either not read, or ■\re Incapable of understanding ? Will it be pretended, that the works to Which we object, are the most proper, to teach students practice ? If so, why are we not met with opposite facts, instead of scurrility and abuse ? After nil this, we may well ask, are We not amply justified, in our asser- tion in our preface, that uil i* of immense importance, that the present Confusion of the practice of physic> in the treatment of acute febrile diseases, Should be known," and that " some author is rieeded, of so much independence of mind, that he is not afraid to hazard his popu- larity, by publishing a true statement, of the most important facts'* We again take occasion to observe, that all the statements in our work, in regard to this subject, are literally true, and are capable of being sub- stantiated, in the most unequivocal manner. Indeed, we can actually refer to case?, in support of every important circumstance, which we have mentioned. There is but one point more, in the review in the New-England Jour- nal, which deserves notice, and that is the declaration, that " the proper wriodfor bleeding, in all cafes, where there can be the least doubt as to its propriety, is always short,"—and " we do say with much confi- de?ice; that the cases are frequent, where if bleeding be not practised in the beginning of the disease, no subsequent efforts can repair tht ni* thief f which the Omission has caused to the system, so as to give the pa- tient an equal chance for a favourable recovery." These assertions we hold to be altogether groundless. In a genuine and pure phlogistic disease 'he progress is not so rapid, the range of depletion is not so limited • U almost always extends to two or three days, and more frequently, beyond this period. We have ourselves bled, with decided benefit, (when deple- Tl M, I ^r13: °mUted' bCCaUSe il Was before considered as doubtfully indicated,) as late as the ninth day of asthenic Pleurisy Thi* 25 is a point; to which our attention has long been turned, and we are confi- dent, that in those cases which are alluded to, by the critic, depletion should always be omitted entirely j as they may be treated much more ef- fectually and safely, by other means. Whenever blood-letting succeeds, (and we agree in our Essays, that it occasionally does) in such a case of disease, it is upon the principle, that drenching with hot Spirit and water, occasionally breaks up a Synocha; and the measure in question, is attend- ed with equal disadvantage, and equal hazard, provided it fails. Oiu reviewer, evidently has not read us with sufficient attention to discover, that we have amply discussed this very subject, in our work. People in general, do not know upon what point, the question concerning the pro- priety of bleeding turns. In cool Typhus, or regular Nervous-fever, cool Pneumonia, cool Cynanche-maligna and Croup, cool Yellow-fever,—in a word, in nineteen twentieths of the cases of the febrile diseases, which for a number of years past, have prevailed, in our section of the country at least, there cannot possibly be any dispute, among rational men. In such cases, efficient depletion is always disastrous, and often fatal. In the whole of these cases, there is evidently, a greater or less deficiency of vital energy, from their access, to their termination. It is only in the hot cases of febrile disease, that there is any room for controversy. In Fevers and Phlegmasia?, attended with the genuine Synocha of Cullen, when the symptoms are urgent, all the World (the modern exceptions, in point of number, are too insignificant to deserve mention,) agrees, not only to the propriety, but even to the necessity of efficient depletion, and evacua- tions. Such diseases do not occur among us, at the present day But there is a kind of fever, called Synochus, by Cullen, (the moderate sub-* putrid-fever of our work; said to be the most common fever of Great Britain,) which though it is not attended with the urgent symptoms, of the more highly putrid-fever of authors, has yet daily exacerbations of heat, for a considerable time. These are the cases, about the early ma- nagement of which, there is so much controversy. This is almost the only point, on which we are very essentially at variance, respecting de- pletion merely, with most of the popular authors of the day. In the Es- says on type, Yellow-fever, and more particularly, in our analysis of Dn Miller, this subject is amply discussed. As the critic has not opposed our doctrine, by a single fact or argument, but only met us by mere as- sertions, we shall not here beat the air, or attempt to fight the battle over again. It is an important question, and we sincerely recommend those parts of our work, in which it is examined, to the studious attention of every member of our profession. We shall only add, that the cases to which our critic refers, are evidently the violent and rapid instances of this sort of fever.* * The Boston critics, by their publication in the North-American, have appeal- ed from the medical profession, to the literary and scientific part of the communi- 16 A few remarks only, will suffice for the North-American review. We an assure the writer, that we most cordially concur in the sentiments Contained in his preamble; and we have Inculcated them, throughout the whole course of our work ; that" we have no medical system to sup- port or overthrow," that " we are wedded neither to the lancet and hot water, on the one hand, nor to Opium and Brandy-toddy, on the other," that "we believe in all, or either, in their proper times and places, and arc ready to admit, that there is a proper time and place for each." From Boerhaave, we have adopted as a fundamental maxim of our work, " nullum ego cognosco remedium, nisi quod tempestivo usufiat tale ;" and we expressly insist, that " true medication is not a bed of Procrus- tes, to the length of which, every person must be either stretched or short- ened; but on the contrary, it is a couch adjusted to the dimensions of the patient." Though our principles are " nullius in verba magistri," and we are unfettered by the dogmas of any medical school, yet with jus- tice, we claim a place among that class of "writers to whom the desig- nation o/vitalists more strictly applies; a sect which may be charac- terized, as professing to deduce all their opinions, from the correct ob- servation, of the essential powers, and faculties, of the living body, without the assumption of any hypothetical principles, or the introduc- tion of any agents, for the sole purpose of explaining phenomena." The North-American has evidently had better success, in obtaining some glimmerings, of one of the objects of our work, than his brother in the New-England Journal; though in common with him, he has »m-applied ty We have no question, that this reference will ultimately produce a °ood ef- feet by calling he attention of gentlemen of general reading, to the stote of the practice of physic ,n our country. It has already caused an inquiry after our work, among this respectable class of citizens, who have no Sdfces to sX Z^^S^^iT^ ^"^ WK~n *■ liv'esS health of themselves and others. More than one gentleman, who is not of the facultv in our" defence Tho^'^TT "T^6"' **" -lunteeredVeir able pe'ns n our detence. Though we intended our work exclusively for Physician* L w* should not so generally have clothed it with technical lan4a J7and esocciaUv e^thTJntalleSf '"V" ^^^1™™' ^et *™ti™L\7 to h£ ma ter if treaU ^S^^l^J^JT ^V""*^ to the weighty £n^gS^ tion, every gentleman can make himself acmfaTntedwitriLT,M- r* ^ By reading the reviews of the E*savs /™3 ,i outlines of our plan. with our work,) he wineewhatTr'e he f' 1^ ^ re,C°mm,em1' in co™™ion who pretend todirecT thepublic Zl Jif }■■ f ' ^ *** ^^ of lho^ with the medical profession.P I eiul aho dLSJf^lS^ "^ ^^ C°nneCted to themselves a talk, to which, the'/aretoth mSyt,l^^^*^ tent In hus referrng the subject to gentlemen of gLeral hterature ^ ^to^ the North-Americai!; not^ttC X^^^/ WcT'" " ^ ^vToS^ 27 our strictures, respecting the indolent and the ignorant, the indiscrimi* nate and the rash, to the whole profession. We do sincerely hope that our labours will have some " tendency" to destroy "public confidence" in such practitioners, even though it may affect " their reputation, their very livelihood." With respect to the accusation, that we " deal too much in assertion to be very convincing" we have only to say, that the bare results of observation and experience, must always be expressed in assertions, which we contend, can never receive much support, from theo- retical reasoning. The truth and validity of such assertions, can easily be confirmed or overthrown, by a repetition of the trials and experiments, which first led to them. Surely the critic cannot sincerely imagine, that it is of any consequence, sb far as respects the accuracy of the facts and principles, which the work contains, or its utility to the public, whether the Boston reviewers ever had, or had not, heard of the name of its authors. From a determination to sneer, the critic totally misrepresents what we have stated as fact, concerning the extent of our opportunities for ex- perience. Our friends well know, that our practice has not been limited, to the City, (or incorporated village,) or even to the township of Middle- town. We expressly state, that we have had several epidemics, within the circuit of our practice. Besides, we have each of us practised for years, in other towns in Connecticut. But this is the last subject, upon which we are disposed to insist, as we contend, that length of years, and number of cases, do not necessarily confer true experience. Dr. Hun_ ter's four thousand cases, are no proof, that he was an eminent practi- tioner in fever. But our reviewer allows, that our " method is a very good one, in many cases of typhoid fevers" though he seems to take much credit for discovering, what we have again and again declared and inculcated, in various parts of our work, that it is not" the only one ad- missible." He even appears to have a higher opinion, of our general me- thod more particularly as relates to the use of Calomel, than we have ourselves ; for we have been very particular in specifying numerous ex- ceptions, in which we consider it as inadmissible. The critic's sneer at our insisting so much upon what is contained in the maxim, " morbo incipiente, currite medico," does not merit any se- rious notice. His insinuations, that it would be more for the emolument of the profession, were this maxim universally adopted, shows him to be totally ignorant of the subject; as every practical physician knows, they are entirely unfounded. Without doubt, the greater half of the business and profits of the profession, arises entirely from popular tampering with medicine, and injudicious delay in applying for regular medical advice. Let us hear the New-England Journal upon this subject, which surely our critic in the North-American Review, will not attempt to controvert. '•'An hour lost at the commencement of a disease, will often prove to be 21} a day lost, in the time of ils termination." " There is no such thing at getting over the evil consequences produced by a delay, in the applica- tion of the proper treatment." See N. E. J. Vol. 12th, p. 38th. How do reviewers disagree among themselves ! The palpable misstatement, (to use no harsher or more appropriate term) that we have " never failed in more than one instance, to cure Consump- tion, when a fair opportunity has presented itself" ought not to pass, without the severest animadversion. We expressly confined our state- ment, to two of the several varieties. None but a reviewer, who had the vanity to imagine, that he had influence sufficient to suppress a work, could have dared to hazard such an obvious perversion of an author's words and meaning. In reference to the pulse, we have invented no new terms, but have merely adopted such, as we found in common use. However the critic may dislike the denominations, had he quoted their accompanying defi- nitions and explanations, we claim, that no room would have remained, either for cavil or objection. With respect to our Essays on Yellow-fever, we do not pretend to any- very extensive practice or experience, in the disease which is their sub- ject; yet we still insist, that thirty or forty cases, which occurred in 1820, and former years, the origin and progress of most of which, we had op- portunity to watch with the minutest attention, may contribute somewhat to elucidate the history of this important disease, and do assuredly entitle us, to contribute our mite, to the general mass of facts upon record. Not having any theories to support, in relation to this disease, we trust we shall be acquitted, by every candid reader, of any disposition to con- ceal a single circumstance; and we take this occasion to declare, that we have stated every thing, of which we could obtain any knowledge, which- ever way it might tend. The only point, on which we have drawn any inference, as respects its cause, is, that with us it was not of domestic ori- gin. We expressly waived the discussion of this point, as it concerns our southern cities. This is all that we claim, from the history of the disease in Chatham. Whether our cases were all Yellow-fever, the medical pub- lic will decide. We insist, that they were all of a common character, and differed materially, from any of our ordinary fevers. We however be- lieve it in vain, to contend with those, who have not frequently witness- ed the disease. We cannot too often insist, that no description, of Yel- low-fever, Spotted-fever, malignant Pneumotiia, malignant Dysentery malignant Typhus, and every other malady, that from its very access is attended by a dangerous deficiency of vital power, can ever be realiz- ed, by those who are not conversant with such cases. We will say one word of the last Essay, which our critics have scarcely- condescended to notice, although the subject is a disease, (Pneumonia typhodes) which has spread desolation through our country, and which 29 uppeais to have confounded physicians, as much as Yellow-fever itself. Had this Essay, we insist, received any attention, it would have been found to contain a minute illustration, of most of our ideas, concerning principles and practice, and would have been found to anticipate and ob- viate most of the cavils and objections, in either review. With respect to the critic's remarks upon our spirit and manner ; his //us-application of our strictures upon the exceptionable members of our profession, to the whole body ; his objections to the originality of our method of curing fevers by resolution; the insinuations, that our practice is indiscriminate ; his accusation, of our want of respect to particular venerable names ;—we have already treated upon these subjects, in our reply to the review in the New-England Journal, and even had repeated- ly anticipated them in the work itself. Nearly " every ignorant objec- tion, and every rash and petulant observation, has been taken up, and commented upon." Even every insinuation, that can be deemed by any one, at all worthy of observation, has now been directly, or indirectly, re- marked upon. In fact, we believe an apology is due to our friends, for the notice of so many trifling cavils, which it would be an insult to their common sense, not to suppose too palpable, to require refutation. Upon the perusal of these two criticisms, it struck us instantly, that their authors had just been reading the Edinburgh Review, upon the sub- ject of periodical publications, and had availed themselves of most of the unfair means, which are there so minutely described, as the resort of those booksellers, and others, who combine to prevent the circulation of a new work, that opposes their prejudices or interests. The Edinburgh writer, while reprobating such arts and practices, could never have anticipated, that his details would furnish the means of perpetuating the management, which he so properly and forcibly censures. The reading public of Ame, rica is, however, very differently situated, from that of Europe. Here, authority is of no weight, any further than it is just. Every man prides himself, upon thinking and acting, according to his own judgment. Our critics have adopted neither the plan of analyzing our work, so as to af- ford their readers a summary of the principles which it contains, followed by comments of their own, on its correctness and tendency ; nor that of attempting to write better essays of their own, upon the same subjects ;— the only two methods, as far as we know, by which a critic can either in- struct, or enlighten the public. The New-England Journal, it is true. makes numerous detached extracts, but they are done in such a manner, as to afford not the least accurate conception of the work ; and many of his misrepresentations are so gross, as not to be accounted for, upon any other principle, except the certainty, that he had never read it with such attention, as to discover its most obvious meaning. No man, from his statements, can form the most distant idea, of the real scope and tenour of the volume. The North-American professes not to care much about the matter, or rather, he seems to agree with us, in most of 30 »iic essential points; he only cavils at the manner, without entering ml nutely into any of the subjects. In one respect, our work differs from most other professional treatises The authors show the greatest ardour for the improvement of their profes sion, and they strenuously insist, that physic should not be a mere trade, thai it is necessary for the medical faculty, to be honest and conscientious men, that they should be highly sensible of their moral accountability; and every practice, that has a contrary tendency, is reprobated, in the strongest terms. Is it possible, that such sentiments can offend these gentlemen reviewers? Our work is a collection of facts, and deductions from facts. Not one of our assertions has been disproved, or shown to be incorrect, by either of these critics. They appear to have been fully sensible, that it was invulnerable to this method of attack; or at least, they have shown themselves to be both morally and intellectually incapable of such an undertaking. Neither of them has hazarded the proposition of any better plan, or ventured to re- commend and support an opposite method of practice, in the particular diseases of which we treat. They seem merely to have aimed at fore- stalling public opinion,to have attempted to make the work unpopular,— and they have endeavoured to prevent an investigation of the important principles which it contains. We never knew, in our country, of an in stance, in which all the principles and ends of genuine criticism, were so openly and wantonly violated, in a periodical work, that made any pre- tensions to respectability. What work that treats of subjects, in which all mankind have the greatest interest, was ever before attempted to be si- lenced, by captious exceptions to its manner and spirit ? When was there ever such railing at an author, without any serious attempt to refute his doctrines and facts ? On the whole, we cannot but believe, that by every impartial man, these reviews will be considered to be the highest possible commendation of the accuracy and fidelity of our work. " L'on peut acquerir une bonne reputation de deux manieres ; lorsque les honnetes gens disent du bien de nous, ou que les coquins en disent du mal. L'on doit, cependant, s'attacher de preference a la premiere, parce qu'ony trouvera Pautre, sans le moindre doute. Quand les coquins disent du mal de nous, c'est le plus grand bienfait que nous puissions en recevoir; et de plus, c'est le seul ser- vice qu'ils nous rendent, pour rien." " All that art could devise, all that malice could invent," has not hitherto been able to point out a single inaccuracy in our statements. Our countrymen are an inquisitive people, who will not found their judgment upon the mere ipse dixit of an anony- mous reviewer. Here, the mind is not so enslaved, that two or three critics, can prevent the reading of a new work, or suppress the circula- tion of its doctrines, when they are grounded on reason and truth. Witl the public, the only question is, whether our principles and inferences de- pend upon facts. If they prove to be true, when tested by experience. they will finally prevail, in defiance of all opposition. NEW-YORK MEDICAL AND PHYSICAL JOURNAL. Wc u turn with pleasure from that barren waste, in which no salutary plan? takes root, no verdure quickens." After tiring our readers and ourselves, with endeavouring to trace the various " ramifications of fraud, error, and delusion," which have been exposed during this examination, it is quite a relief to the mind, to be able to reverse the picture, and to notice briefly a critical review of a very different stamp. We have still many able physicians; nor is there a deficiency of candid and impartial reviewers. Two of the most respec- table editors of our country, have given the strongest testimony in favour of the general principles and practice, which are recommended in our work* They do not allow some doubts, that they entertain with respect to the manner, to bias their judgment, and prevent them from giving the most ample credit to the all-important matter which it contains. In No. 7 of the New-York Medical and Physical Journal, edited by Drs. Francis and Beck, our readers will find a review of the Essays on Fevers, which is written in a very different spirit from the criticisms, which we have just been considering. The urbanity and candour of these gentlemen, afford a striking contrast, to the rudeness and partiality of the Boston reviewers. We are happy to find, that these physicians per- fectly agree, as to the correctness of our principles, in application to our diseases. Our remarks, upon the undue preference which is commonly given to surgery, we think, are much enforced by an extract, which they have made from a very respectable author. Though they evidently do not appear to have read us with minute attention, or to have distinguish- ed with sufficient accuracy, the peculiarities of our method of using Calomel, yet they entirely coincide with us, as to its general effects, and they remark, " we think it but justice to Dr. Miner to say, that his treatment in general seems to have been very successful, and to be regulat- ed by soundprac'ical views r and, that the Essays on Pulse, Type, Crisis, and Stage of Fevers, " are full of practical information, and merit attentive perusal" They have even strengthened our remarks on Ex- perience. They further recommend to their readers, " an attentive pe- rusal of the volume, and the adoption of Dr. Miner's practice, in ali cases that are asthenic and attended with exhaustion." They con- clude their review with the following remarks, in explanation of the stric- tures, which they have made. « We hope, that neither of these very intelligent physicians will miscon^ .true our motives, in thus freely animadverting upon their opinions of the 32 practice of ethers. They are mistaken, if they suppose for a moment, thai we undervalue their labours, or mean to throw any reflection upon the in- telligence, the ability, and the vigour of thought, which they have displayed in the composition of these Essays. Writh the exception of the one fault, to which we have just adverted, [this exception, the authors conceive, they have satisfactorily removed in their reply to the eastern critics] we must express our unequivocal approbation of the general spirit, and the manly diction, which pervade their writings, and which, we hope, will not fail to inspire our professional brethren in the country at large, to imi- tate the example of our enterprising friends. " On taking leave of this interesting volume, we beg permission of the authors, to urge them to the promised continuation of their Essays. We have long known Dr. Tully ; and from the ardour and talent which he has evinced, on various occasions, for scientific investigation, we augir most favourably and pleasingly from the continuation of his labours.'' Middletown. (Cqnn.) Dec, 24, 1823. NLM041404530