TREATMENT 
OF 
FEVER AND INFLAMMATION. 
AN ESSAY 
/ 
ON THE 
TOPOGRAPHY AND PREVAILING DISEASES 
OF 
JSEW HANOVER COUJNTY, JS|. C.] 
READ BEFORE THE ANNUAL MEETING OF THE 
jtWtlt ifarolma fflcdical Societn, 
HELD AT 
WILMINGTON, N. C., MAY 25, 1870, 
* ly BY 
S. S. SATCHWELL, A.M., M.D., 
OF 
NEW HANOVER COUNTY, N. C. 
Published by order of the Society. 
YJWWTPF’ N. p. : 
ENGELHARD A PRICE, STEAM POWER PRESS PRINTERS, 
JOURNAL BUILDINGS. 
1870. ERRATA. 
On page 15, line 5, country should read county. On same page a 
period should occur after the word common, in line 8, and the word 
while should begin a new sentence. On same page, line 18, the word 
Trachsales should read Tracheales. 
On page 17, line 14 from bottom, a period should occur after the 
word condition, and the word while, which follows, should begin a new 
sente ace. After the word soils, on sime page, line 10 from bottom, a 
comma should follow, and the following word it should not begin with 
a capital. 
On page 19, line 1, the word revolution should read resolution. 
On same page, line 15 from bottom, the word generate should read 
general. 
Ou page 21, line 17 from bottom, the name Brunet should read 
Bennett. On same page, line 10 from bottom, the word is should 
read as. 
On page 22, line 26, from top, the word course should read 
cause. On same page, line 12, from bottom, a period should follow 
the word community and the following word more should begin a 
new sentence. 
On page 24, line 9, the word get should read yet. 
On page 33, line 9 from top, the word offered should read op- 
posed. On same page, line 6 from bottom, the word offered should read 
opposed. 
On page 38, line 11, from top, the words even played should read 
employed. 
On page 39, line 11, from bottom, a period should occur after the 
word better, and the following word numerous should begin a new 
sentence. 
On page 42, last line, the word prevented should read perverted. 
On page 44, line 21, from top, the word expedient should read 
expectant. 
On page 49, line 25, from top, a comma should take the place of a 
period after the name Manson. 
Other typographical errors occur in different portions of the Essay, 
which it is hoped the reader will recognize to be such, as he proceeds, 
and make accordingly the proper allowance. TREATMENT 
OF 
FEVER AND INFLAMMATION. 
AN ESSAY 
ON THE 
TOPOGRAPHY AND PREVAILING DISEASES 
OF 
JIEW HANOVER COUNTY, fi C., 
BEAD BEFOKE THE ANNUAL MEETING OF THE 
orth (| arolina j|efat Sodetij, 
J J J J 
HELD AT 
WILMINGTON, N. C., MAY 25, 1870, 
BY 
S. S. SATCHWELL, A.M., M.D., 
B 
NEW HANOVER N. 0. 
Published by order of the Society. 
N. p. : 
ENGELHARD & PRICE, STEAM POWER PBESS PRINTERS, 
JOURNAL BUILDINGS. 
1870. [APPENDIX C.] 
ESSAY 
Bead before the Medical Society of the State of North Carolina, 
at the Annual Meeting iy Wilmington, May 25th, 1870 ; 
BY 
S. S. SATCHWELL, A. M., M. D 
OF 
NEW HANOVER COUNTY, N. C. 
Mr. President: 
During each of its annual meetings, for the last three 
years, this Society has honored me with a request to report 
upon the Topography and Prevailing Diseases of New 
Hanover County. The laborious duties incident to an ar- 
duous country practice, conjoined with those constant in- 
terruptions and sacrifices, which since the late war, more 
than eVer, attend the life of the true Physician and Surgeon 
of this war-stricken Southern land, have prevented my res- 
ponse to this generous call. And even now, the continuance 
of these demands upon me enforce the conviction that I can 
only hope to perform the task assigned me in a manner 
incomplete and unsatisfactory to myself. To remain longer 
silent, however, with the invitation still extended, would 
argue, what I cannot acknowledge—either insensibility to 
duty on my part, or an indifference to the high claims of 
the medical profession upon the members of this.Association 
to contribute, each his mite, to that medical fabric, broad* 
strong and enduring, which the Society has been building up iii North Carolina for tho last eighteen years of its exis- 
tence. Nor do I propose to allow the occasion to pass 
without some allusions to certain well known heretical doc- 
trines in relation to the modern treatment of congestive 
fevers, acute internal inflammations and other inflammatory 
diseases, which, through the medium of our Transactions 
and other sources, have been of late so industriously pro- 
mulgated to the medical world. But while, in the latter 
part of this paper, I shall interpose some objections to the 
extreme views of Todd, Bennett and others of their disciples 
in this and other States and countries, I may remark that 
my main purpose is to perform the more legitimate work 
assigned me by the Societ}\ as just referred to. Tho views 
I have to offer upon points discussed in this notice of the 
prevailing diseases of this Southeastern portion of the State, 
where most of my medical life lias been spent in active 
practice, are not claimed to be novel or original. They are 
such, however, as my knowledge, experience and observa- 
tion enable me to honestly entertain, feebly though I shall 
express them. No little obscurity has always attended tho 
cause, nature and treatment of disease, in spite of the sure 
advances and brilliant triumphs of the ever-progressive art 
and science of our always noble profession. With all tho 
floods of light which the progress in general culture and 
knowledge of this age have shed upon the advancing civili- 
zation of the world, it is strange that nothing scarcely seems 
to bo received as settled in morals, science, art, politics or 
religion. It is mainly by a faithful collection and compari- 
son of facts that principles are established and medical 
science advanced. It is by these moans that such knowledge 
is acquired and such legitimate deductions drawn as will 
best enable us to attain the great practical end of medical 
life—correct diagnosis and successful treatment. And it is 
gratifying to know, that if we are to have in North Carolina 
a Medical Digest worthy to serve as our best guide to prac- 
tice, its best materials will be sought in the accumulated and 
accumulating facts and contributions of local Medical History. 
TOPOGRAPHY. 
Now Hanover County embraces an area of about one 
thousand (1,000) square miles, and contains, outside of 
Wilmington, a population of about twenty thousand (20,000) 
inhabitants. Besides the Ocean on the East, it joins Onslow, 
Duplin, Sampson, Bladen, Columbus and Brunswick coun- 
ties. It presents important meteorological, mincrological and 
agricultural conditions and relations. Its climate, natural "resources, products, facilities for rapid and cheap transpor- 
tation to the best markets, and admirable adaptation to the 
production upon her generally fertile soil, of almost every 
variety of agricultural and liorticultual products, render 
New Hanover not merely a desirable home for those already 
here, but attractive to those of other portions of our own 
and of other States and countries beyond the seas, who seek 
new homes with a view of bettering their condition. "While 
thus of interest and attraction in a commercial, manufac- 
turing and agricultural point of view, such is the range and 
variety of its climate and other conditions, that it gives 
origin to no inconsiderable number and variety of diseases; 
and the medical enquirer can here find much to interest 
him. Large navigable streams, known as North East, North 
West and Black rivers, together with their numerous 
tributaries, intersect and divide up the county and empty 
their waters into the Cape Fear river. These various 
streams present the usual borders, bottoms, swamps, lagoons 
and unhealthy sites that here, as in similar situations, are 
attended with those terrestrial exhalations, termed malaria 
and productive of malarious diseases. We have the customary 
intermediate uplands, in some places constituting extensive 
sand ridges, stretching, in some instances, to long distances. 
The growth of timber is diversified, consisting principally of 
oypress, sweet and black gum, poplar, oak, hickory, ash, 
bay, pine, reed cane, dogwood, &c., with the exception of 
her barren sand ridges, low prairie bottoms and gall-berry 
thickets, the soil of this county is generally fertile and finely 
adapted, in its general character, to the production of the 
great Southern staple—cotton. The sub-soil is mostly clay, 
some of it silicious, other portions mixed in these respects. 
A large belt of country, known as Rocky Point, divided by 
that great artery of our trade, vitality and prosperity, the 
Wilmington and Weldon Iiail lload, is as rich and produc- 
tive as any portion of the State, and noted for its advance- 
ment and prosperity in agriculture. In its adaptation to 
agriculture and horticulture, New Hanover is scarcely ox - 
called by any county in North Carolina. Good marl exists 
in abundance on almost every man’s plantation, and conven- 
ient to the surface, while the natural resources for compost- 
ing and otherwise enriching the land universally exists in 
the greatest abundance. Nor is there wanting evidence that 
extensive beds of phosphatic deposits, similar to those 
near Charleston, South Carolina, exist in our County.—- 
Besides the almost universal distribution of marl beds and of 
actual phosphatic deposits in certain localities, very exten- G 
sive layers of lime rock exist in many parts, capable of 
manufacturing immense amounts of excellent lime. The 
eyes of science are now directed more earnestly than ever to 
these formations and remains of the violent efforts and 
upheavings of nature in olden times, in these near ap- 
proaches to old ocean. The new' impetus given within the 
last fewr years to the cause of agriculture in the County, is 
having the happy effect of changing the pursuits of many of 
the inhabitants from the precarious business of naval stores, 
lumber, shingles, <fcc., to the surer support and more sub- 
stantial prosperity to be found in the cultivation of the 
generous soil. Its beneficial results are seen, too, in the im- 
provement of the health of the County, by these onslaughts 
upon malaria, wdiicli the clearing of forests, drainage and 
.good farming always make. 
The climate is temperate. The latitude is between 34 and 
35 and the longitude between 77 and 78 degrees, the mean 
temperature being about 50 degrees. That of winter is about 
80, and that of summer about 50 degrees. The breezes from 
the ocean in summer are greatly prized, especially by the 
inhabitants in more immediate proximity to the coast; com- 
mencing about the middle of the forenoon, ■when the heat of 
the day generally begins to be oppressive, they are not only 
cordially welcomed, but are absolutely delicious. Snow is 
seldom seen and rarely remains on the ground longer than a 
few hours. So that while the climate is temperate and tho 
summers warm, the winters, sometimes variable, are gen- 
erally mild. 
Wilmington is situated on the East bank of the Cape 
Fear river, at the confluence of the North East and North 
West rivers, and about twenty-five (25) miles from the 
ocean. Opposite the city is a large Island, composed of tho 
sedimentary deposits of the river, and formerly under suc- 
cessful rice cultivation. The city is more elevated, ascending 
from the margin of the river in sand hills of various heights, 
tho highest point being 8G feet above the level of the sea. 
Tho North East and South sides of the city are encircled, to 
a great degree, by creeks and rivulets with marshy borders, 
many of them have been filled up in the progress of im- 
provement, but too many yet remain for the good health of 
the neighboring inhabitants. The opposite Island alluded 
to. five miles long and two miles wide, is covered to a con- 
siderable extent, with tho original growth, cypress, ash, 
black gum, bay and other trees, with an undergrowth of 
flags, reed and aquatic plants. It is flooded by tide w'ater, 
except a small strip on the river margin opposite the city, 7 
artificially elevated by the construction of wharves. The 
same description is applicable to tin river margin on its 
Western side below the city, the whole constituting what is 
called “ tide swamp.” The soil is sandy, underlaid by a 
limestone formation. The city is supplied with water fiom 
springs and wells, and much of it inferior in quality. This 
is greatly improved, however, in summer, by the addition of 
ice, large quantities of which are consumed in Wilmington. 
The filling up of the low, swampy places, which heretofore 
existed in some parts of the city, has largely contributed to 
the public health and encouraging to further efforts in this 
direction. What influence the turpentine distilleries hero 
have upon the general health is a matter of speculation, it is 
true, but my observations here and elsewhere, inclines me to 
the conviction that they are very desirable auxiliary conser- 
vators of public health. During the late war, it is conten- 
ded that it was more sickly in autumn in the vicinity of 
turpentine distilleries, here and elsewhere in our lower Capo 
Eear, where their operations were temporarily suspended, 
than it was before and since, during such distillation of this 
extensive commercial staple. 
In a city like Wilmington, so promising for tlie future, and 
so justly noted for its enterprise and increase in population 
and wealth, there is a lamentable want of parks and public 
squares. These necessary appendages to every city, consti- 
tuting in fact its very lungs, were sadly overlooked in the 
earlier days of Wilmington. It is hoped and expected, how- 
ever, that a substitute, to a great extent, for this obvious 
dofect and continued want, will be found at an early day, in 
these ornamental grounds and public squares that are 
springing up contiguous to the city upon the soil of the 
Cape I ear Agricultural Association. This institution, which 
though an infant in age, is bounding forth in giant strides 
an herculean power in its noble mission of improving the 
commerce, mechanics and agriculture of Eastern North Caro- 
lina, promises to supply, very materially, the comforts and 
benefits that would flow from the existence of such conven- 
iences more in the heart of the city. The population of 
Wilmington, in 1850, was about seven thousand, now it is 
believed to be about fifteen thousand inhabitants, and is 
therefore the largest city in the State. 
CAUSES—rKEDISrOSING AND EXCITING. 
At the very threshold of our Etiology looms above all 
others for repetition, the old familiar tale of bad air as the 
most potent agent of disease. It is the atmosphere of ter- 8 
cstrial exhalations bearing the specific poison of malaria that 
makes more work for the physicians of this section, either in 
its more rapid and direct or in its slower and indirect 
influences than most all other causes of disease combined. 
Besides the list of periodical fevers that its absorption into the 
system produces, it modifies nearly all the diseases of the 
different seasons, gives the character of periodicity to many, 
and introduces its great adversary, quinine, into a majority 
of all our medical prescriptions. Malaria has been a more 
fruitful theme of medical discussions—has been the occasion 
of more theories, fanciful and reasonable, logical and illogi- 
cal, and the publication of more and larger volumes, than 
almost any subject in the whole range of medical literature, 
and yet its analysis and true nature continues to elude inves- 
tigation. Besides the great practical knowledge of its effects 
and the fact that the constituents of the air of malarious 
localities are found, without doubt to be different from those 
where this poison does not exist, but little is really known 
that can stand the test of our inductive system of medicine. 
Nearer approaches, however, in my opinion, are being made 
now than ever before, in the eager search after its 
hidden nature. I believe that the brilliant triumphs of med- 
ical progress will not much longer permit its derisions and 
reproaches at the science of chemistry and medicine. The 
footprints of its haunts are seen on the whole habitable globe, 
wherever there are condititions favorable to its production. 
Nor is its universality, more marked than the uniform period- 
icity of the fevers it engenders. It prefers such localities 
and regions as would otherwise be the choicest of God’s 
lioritage. Prevailing in all ages, it is the same deleterious 
agent and specific poison, except in degrees of virulence, 
whether it appears upon the borders of Ganges or the Nile— 
upon the Pontine marshes or in the Mississippi valley; upon 
the island of Crete, the slopes of the Atlantic coast, or along 
the border and tributaries of our own cherished Roanoke, Tar 
Ncuse and Cape Pear rivers. In these innumerable places 
it comes forth every spring, summer and fall, in giant 
strength but invisible form. With stealthy steps it lurks 
around our homes and altars, producing more sickness and 
mortality in its immediate or remote influences than any 
other cause known. Not alone in the production of the 
various forms of malarial fever, in the shape of intermittent, 
remittent and congestive fevers, are its ravages recognized, 
but in their sequaele as manifested in the multifarious 
■chronic diseases that in some way have a malarial origin and 
character do we see the destructive influences cf this agent 9 
Upon human health, life and happiness. Sometimes they aro 
presented in the shape of jaundice, hepatitis, and other 
chronic derangements of the biliary organs so generally 
observed in malarious localities, and so often tho forerunners 
of dropsies, diseases of the stomach, bowels and other organs. 
At other times the strength of the constitution of some 
persons, and their capacity to resist for a longer or shorter 
time malarious influences, enable them to reside in such locali- 
ties without any special attack of malarial fever. Few there are, 
however, who, living in these regions, do not present that sal- 
low hue and malarious physiognomy which always character- 
izes the inhabitants of malarious regions. In other instances 
these malarial manifestations are observed in that large list of 
nervous diseases that are seen in those cases of spinal and 
cerebral hemiplegia, sciatica, hysteria neuralgia and like 
annoying affections which are more numerous in malarious 
than in regions free from its influences. Tho literature of 
malaria is destined to be still more enriched with the results 
of the experience yet to be proven and the discoveries yet to 
bo made in its production of the family of nervous and 
spinal diseases. But in whatever form this prolific cause of 
disease may act, or however labarynthian its ways, it is the 
conclusion of my long medical experience in the malarious 
regions of Eastern North Carolina, that once introduced into 
the system, it is very difficult to bo eradicated. I repeat tho 
important fact, that residence in these malarious localities 
engenders, sooner or later, either an acute attack of malarial 
fever or those slow derangements of functional action and of 
the nervous and vascular systems which produce some 
chronic lingering disease, or some gradual undermining of the 
general health, most generally attended with a lowering of 
the vital forces and a depression of spirits. The inhabitants 
of such localities are noted for more languor of body and 
debility, and have less desire to enjoy the innocent pleasures 
and amusements of life, than those residing in healthier 
districts. 
Hepatic derangement constitutes, in the main, the basis of 
these troubles, however much the doctrine may be ridiculed 
by those who have never resided in a malarious region or 
treated a malarial fever. Sometimes they are manifested ill 
that failure of the appetite, furred tonge, constipated bowels, 
feeble pulse and general debility, with that saffron hue of 
countenance and dejected eye which meet us in our daily 
professional walks. In other cases, we find conjoined to this 
torpid condition of the liver such a relaxation of the alimen- 
tary canal and general debility as produce or co-exist with 10 
chronic gastritis, gasto-enteritis, chronic diarrhoea, «fcc., that 
only make up another feature of this common disease in 
these lower counties. In all these hepatic and splenic affec- 
tions so intimately related to those slow and exhausting com- 
plications, that, without efficient treatment, gradually under- 
mine physical healthy and destroy human lire, I find united, 
more or less, depression of spirits and perversion of feeling, 
sometimes even closely approaching insanity. The residents 
of the purer atmosphere and more elevated regions of tlio 
hills and mountains of our State are in their more elastic 
steps, more vigorous frames and more buoyant spirits, not 
only more healthy, but more happy and contented than are 
the same number of population in the swamps and flat coun- 
ties of these Eastern shores, whose sallow countenances, 
enervated movements and dejected spirits, correspond with 
tlio enervating influences of the atmosphere and general 
physical surrounding of the soil. One general remark as to 
the treatment of these troublesome diseases. While the 
claims of mercury are not to be ignored, I have been par- 
ticularly gratified at the results of the use of nitro-muriatic 
acid. Its action upon the liver is undoubted, and in doses 
of from five to ten drops, repeated several times a day, I have 
found marked benefit in the treatment of the various forms 
of these chronic complaints. I find it useful, whenever di- 
gestion is enfebled or nutrition is impaired, and whether the 
bowels are constipated or too loose. It seems to operate, 
not alone as a stimulant to the liver, causing generally an 
increased flow of bile, nor yet alone is it a tonic, acting as an 
auxiliary to the functions of nutrition and assimilation, but 
it also exerts, in my opinion, an alterative action upon the 
mucous surface of the stomach and bowels and upon the 
blood. In jaundice, dropsical accumulations and general 
cachepia it acts well. Of course I need not speak of the well 
known caution to be observed of not administering nitro- 
muriatic acid with mercury, from the poison of corrosive 
sublimate formed by their joint administration at the same 
time. 
In that form of chronic malarial diseases known as obsti- 
nate and protracted intermittent fever, in which quinine has 
failed, I know of no remedy so effective in breaking up and 
permanently curing the disease, as a combination of iron, 
quinine and strichnine. When the chill and fever continues 
to recur in spite of all the quinine, arsenic and other means, 
you Avill lind a certain cure and preventative of the return in 
a pill, administered three times a day, of two to five grains of 
quinine, a liko quantity of carbonate of iron, combined with 
from one-fifteenth to ono-tWelfth of a grain of strichnine. IT 
But it is pleasing to know that the cause of these diseases 
can be modified and removed. The industry and science of 
man, which in all departments of life are more than ever 
removing the difficulties to human progress, can circumscribe 
this fell-destroyer, malaria, and not merely modify his 
power, but rout him entirely from his strongholds. In this 
very county, as before intimated, the advancement of agri- 
culture, in the clearing of forests, drainage and other physical 
improvements, have made and are still making, many of our 
hitherto most sickly places the most healthy. Thus are the 
profits and improvements in agriculture made to correspond 
with the improvement of health and the prolongation of 
human life. 
But there are other than physical causes operating in 
this section with more than ordinary force in the production 
of disease. I refer to those emotions and to those harrassirig 
cares and crushing anxieties connected with the existence 
and results of the late war. Herein are causes which have 
already placed beneath the sod many of our oldest citizens, 
and which are preparing others for premature graves.— 
Anterior to that period, we did not meet upon the streets of 
our cities and on the byways and highways so many with 
haggard eyes, dark frowns, pale faces, and discontented 
weariness of body and mind, as we now meet in increased 
numbers at every turn. Nor did the physician liave then, as 
now, upon his list of patients, so many of those long suffering 
victims of nervous, dyspeptic and organic diseases. I can 
discover in my own practice the cause in the war and its 
results; and the effects in a much larger number of these 
cases, especially of heart disease. Never have I seen so 
much comparatively of paralytic disease or nervous affections 
generally, and of functional and organic derangements of the 
heart, as I have witnessed since the war. These influences 
upon health and longevity are as marked, in my observation, 
as they are lamentable. These causes, however, are not to 
be mistaken for or confounded with imperfect food, bad 
clothing, violent exposures, <fec., or with those other influ- 
ences that arise from the atmosphere, soil and other physi- 
cal characteristics of our low flat country, which either in 
their direct influence upon the human organization, or in 
their indirect operations, so act upon the mental and physical 
powers as to lower the action of the vital forces and produce 
disease. But these causes in relation to the war are sepa- 
rately marked by those profound impressions of the mind 
and body that attend disappointments, blasted hopes, woun- 
ded sensibilities, and the inroads of the canker-worms of 
penury and want. Upon no class have these disastrous ‘12 
results of the war been so marked as upon the medical pro- 
fession/ Not only have they made the true medical man 
poorer, from his humane disposition to respond to every call 
for his services, and to extend the credit system, when he is 
about the only man in the community who does it at all, but 
the increased wear and tear legitimately upon his mental 
and physical system, in every respect, since the war, more 
than that upon other professional men, have produced and 
continues to produce more haggard looks, more gray hairs, 
a greater tendency to functional and organic disease, and a 
more general and premature decay, physically in him, than in 
the follower of anv other occupation or profession among us. 
The changed relations of our colored population have given 
a new interest to our tables of health and mortality. While 
tin? vexed question of their capacity for self-government 
politically, is left as a problem to be solved by themselves 
and the politicians and statesmen of the country, it has 
already been demonstrated, that in this period of their 
progress in freedom, they are, as a class, incapable of taking 
ordinary care of their health. Prior to their emancipation, 
under the kind attention and fostering care of their former 
masters, which, in sickness as in health, they received, their 
general health was as good and their mortality as small as 
those of the whites. But sickness prevails more generally 
now among them than the whites, and death is making sad 
havoc in their ranks. Disease in its acute stage or chronic 
form, often of scrofula and consumption, is sweeping them 
off by thousands, almost every month, in these Eastern 
Counties. While they can better stand the sunshine and 
heat of our summers than the whites, they cannot so well 
resist the rigors of winter, and the African succumbs more 
readily than the Caucasian lo severe congestions and high 
inflammations. The latter bears depletion much better, and 
requires less of stimulation. Naturally improvident and care- 
less, obliged to assume the responsibility of providing for 
themselves, they are dying in large numbers, from exposures 
and from the want of cleanliness, clothing, food and medi- 
cines. They are living upon good terms, generally, with the 
whites, especially their former masters; and the whites are 
doing all in their power to aid them. But in consideration 
of their number and the amount of their suffering and sick- 
ness, true philanthropy and genuine Christianity, so fond of 
going beyond distant seas in search of the poor and idola- 
trous heathen, would do well to look more closely to our 
own shores as missionary fields worthy of the dissemination 
of the blessings and moans of the cause of missions. Since 13 
their emancipation, this race (previously so prolific in num- 
bers,) have but few children, comparatively, and many of 
them are given to the crime of abortion. The mortality 
among them is very great and alarmingly on the increase.; 
and I now suggest to this Society tlio importance of taking 
special steps to secure more accurate statistics of their mor- 
tality. If this progresses for the next fifty years, in the 
same ratio as it has done within the last five, this unfortu- 
nate race, destined to remain among us, endowed not only 
with the claims of humanity but with equal rights of citi- 
zenship, and so worthy of the sympathies and assistance of 
every lover of humanity and friend of civilization, will, long 
before this period expires, have become not alone greatly 
degenerated in physical endurance and longevity, but, sad 
to say, vastly diminished in numbers. 
I will allude to but one other prevailing cause of disease 
among us. It is not that of imperfect food and clothing, 
which since the war has been so seriously felt among 
white and black, operating as a constant source of disease 
and death. Nor do I refer to any every-day exciting cause, 
originating from excess of passion, or fatigue, or food, or of 
sudden reduction of temperature, suppression of perspira- 
tion, violent exposure, Ac., but I refer to that infliction upon 
the health of the community which is produced in the 
alarming amount over all preceding years, of cheap, loiv, mean 
ardent spirits, dispensed by the multifarious grog shops and 
drinking saloons which have sprung up and are springing 
up among us. Nearly all the abominable, adulterated, in- 
flammatory, poisonous liquids in the shape of whiskey, gin, 
brandy, rum, &c., that the ingenuity of man can manufactuie, 
and which, from their poisonous and fatal effects, can no 
longer be imposed upon the Western, Eastern and Northern 
markets, are now from their cheapness, and the too generous 
credulity of Southerners, Hooded upon this poverty stricken 
land. The opinions of mankind are too often based upon 
their appetites and inclinations, as well as their supposed 
interest. When there is a fondness for drinking ardent 
spirits, the thousand excuses and arguments therefor are 
always ready, even if reason and experience teach that sick- 
ness and death are the legitimate results. And they aro 
now productive of a greater amount of injury, not only in 
causing disease, but in aggravating all forms of fevers and 
epidemics, where the patient has been previously addicted 
to an excess, than is generally acknowledged by those 
unacquainted with the very largo amount of cheap whiskey 14 
that our people consume in this day. It is time that our 
law makers and conservators of the public health had risen 
in their power and in defiance of the demands of the grov- 
eling appetites and prejudices of these demoralizing times ; 
and armed with the panoply of truth, humanity and science, 
had enacted and enforced more strongly sanitary and 
other laws that will stay this tide of corruption, sickness 
and death which is filling so many new made graves, and 
crowding our prisons, hospitals and insane asylums. I take 
the libert}- of appealing to the Board of Public Charity of 
North Carolina, whose important services in the cause of 
li nhanity in our State are of so much interest to all classes 
and occupations, to address themselves with renewed energy 
to this important feature of their labors, and to give to the 
subject its merited prominence in their next report to the Leg- 
islature. And I also appeal to the proper authorities every- 
where, to the municipal authorities of every town and city, 
to the board of commissioners of each county, to the trus- 
tees of the poor, to the guardians of public health all over 
the State, to men in office and out of office in every com- 
munity, who have bosoms that glow with the generous emo- 
tions of State pride or warm with the love of humanity, to 
come, one and all, to the rescue of our people and State from 
this maelstrom of destruction to the health and lives of our 
fellow citizens. The great decrease of population among the 
colored people already referred to, their habits of indolence, 
vice and crime, and the awful destruction of human health 
and life of both the African and Caucasian races of our State, 
by this alaiming increase of grog shops, liquor saloons, and 
whiskey drinking, is enough to stir the hearts and nerve the 
arms of every patriot, philanthropist and Christian. No man 
who is able to estimate the blessings of health and virtue, 
or to appreciate the relations of population to the welfare of 
the community, or the prosperity of the State, can hesitate 
to admit the magnitude of this question. Every man versed 
in political economy, knows the importance of health and of a 
good population and of good order to the industrial pursuits 
and general welfare of every community. Every legislator, 
who loves his race and State more than party, and who 
allows reason, justice and conscience to guide him, rather 
than prejudice, ignorance or passion, will not hesitate to 
listen considerately to the voice of lamentation and sorrow 
that now comes in pleading tones from every quarter of our 
State for more effectual means and measures, moral and 
legal, to stay this sweeping tide of misery and destruction. 15 
PREVAILING DISEASES. 
It has been unusually healthy in this locality, as I think it 
has been generally in the South Eastern pait of the State for 
several years past. An epidemic of Variola, in 1860, and 
another of Diptheria, in 1869, appeared in this city. With these 
exceptions, no general epidemic of the whole country has 
appeared since the war. Our endemic diseases of summer and 
fall have been milder in form, and fewer in number than 
common, while the ravages of war have decimated our 
numbers, desolated our fields, and paralized our industrial ope- 
rations, it would seem that Providence, in mercy at the woes 
and sufferings of this afflicted land during the last decade 
has, within the last few years, interposed His mighty arm of 
deliverance in protecting our people, in their noble efforts.at 
recuperation, from the usual amount of sickness. tStill there 
lias not been an entire absence of the diseases more peculiar 
to the different seasons and always of interest to the progress- 
ive physician. In the winter we have the customary inflam- 
mations of the respiratory apparatus. Cynance Trachsales, 
Pneumonias, Bronchites, Pleurites, Ac., together with 
Rheumatisms, Neuralgias, and other diseases, acute and 
chronic, of these Eastern shores. In the Spring wre have 
a continuance of these inflammations and chronic derange- 
ments, together with influenzas and diseases of the stomach 
and bowels, more particularly of children. It is in these 
months and later in the Summer, that we have more preva- 
lent, that terror of parents and fruitful source of mortality— 
Cholera Infantum. The Spring, too, is often marked by an 
aggravation of that numerous class of nervous diseases in the 
shape of Neuralgias, Neuralgie Rheumatisms, Spinal affections. 
Sciaticas, and other nervous affections, which in their tormen- 
ting nature love to linger here a large portion of the wdiole 
year. In their causes, however obscure, I do not consider it 
bad medical logic to attribute a large share to these anoma- 
lous influences of malaria upon our nervous organization, 
and other structures. True, the distressing maladies may, 
in this moist climate, be owing in no small degree, to the influ- 
ence upon the organization of those sudden vicissitudes of 
temperature observed in this locality. The thermometer 
often falls or rises forty degrees and upwards in less than 
twenty-four hours, during the winter and spring, and I cannot 
admit with some, that these great changes are unattended 
with injury to the health. Still I believe that observations 
which have been and will be made in the yet inviting field of 
malaria will disclose valuable facts in their relations to these 
nervous and other diseases, which in their number and 5G 
severity are, as already stated, more common to malarious 
than other localities. 1 repeat my conviction that this taint of 
malaria modifies most of our diseases, not merely those of 
acute inflammation, but is influential in the cause and modi- 
fication of very many of that numerous family of chronic 
diseases, splenic and hepatic derangements, subacute inflam- 
mations of the stomach and bowels, dropsies, stomatitis 
materna, and other lingering complaints, more numerous and 
obstinate in malarious than in more favored sections as 
regards health. Nor is this influence of rapid change of 
temperature and of malarious taint, more to be considered in 
tracing the cause, than in adopting the corresponding treat- 
ment, of this extensive class of diseases, acute and chronic, of 
malarious portions of the country. Inflammation of the 
bowels, I have already remarked, is prominent among our 
ordinary diseases of spring and summer. I have known it to 
prevail extensively and violently here in an endemic and 
epidemic form also, and in despite of the best medical 
treatment, hurrying many adults, as well as children, rapidly 
to the grave. In the shape ©f an epidemic dysentery, a 
malignant disease of the bowels prevailed over a limited 
section of the county about one year ago. There were 
numerous cases in and about the vicinity of the town of 
Lillington, in this county. It was one of the most difficult and 
dangerous forms of bowel disease which I ever encountered. 
It seemed to select from preference the borders and bottoms 
of adjacent streams. Some of the eases seemed periodical in 
character giving force to the opinion that the terrestrical 
exhalations from these bottoms were connected with the 
cause. It occurred in that season when these bottoms and 
streams were dry, and when the cool nights and warm days 
denoted those vicissitudes of temperature, that so sensibly 
impress the skin and produce a want of balance in the circula- 
tion. The influence in contracting the capillaries and smaller 
arteries, and impelling an immense quantity of blood through 
the internal and lesser resisting vessels, disturbing the 
equilibrium and nervous and vascular power, was likewise 
.attended with other abnormal changes and intestinal irrita- 
tions so well known to produce diarrhoea and dysentery. It 
spared neither age nor sex. It was generally ushered in by a 
chill, followed with fever, severe pains in the bowels, head 
and other parts, with mucous and bloody discharges. To a 
constant nauseu and irritability of the stomach, thirst, and 
other ordinary symptoms of bowel complaints, there was 
added early and rapid prostration, continued high fever, and 
a persistent discharge of bloody and dark coloured matter, IT 
which resisted, with remarkable success, all attempts to change? 
its character or reduce its quantity. Its general character 
was inflammatory and confined chiefly to the lower bowels. 
As the type of the disease seemed to contra-indicate the use of 
the lancet, I found a free administration of mercury, if the case 
was seen early, the most potential remedy in subduing the 
disease. This followed with such smaller doses combined! 
with opiate and astringents as circumstances indicated, using 
sudorifics when they could be retained, poultices, Ac., consti- 
tuted the main treatment, modified according to the varying 
symptoms and changes of this truly formidable disease. 
But of all our Spring and Summer diseases, none is so 
frequent and so fatal as “ Cholera Infantum,” or the “ Summer 
Complaint,” as it is commonly called, from its chief preva- 
lanco during that season. Of all our prevailing diseases* 
none so stings the hearts of anxious parents and friends— 
none is more trying to the metal of the physician, and none 
enters more largely into our mortality than this dreaded 
enemy of infantile life. I may say, with an emphasis, 
that is based upon a long observation of the sad and pro- 
verbial want of proper attention to the diet and regimen of 
children, that no disease demands more than this correct 
dissemination and intelligent appreciation from the family as 
well as the medical attendant, of the true principles of food,, 
clothing and general hygienic treatment necessary for them. 
Insidious in character often this scourge of childhood is too* 
frequently allowed to approach a fatal termination, under 
that temporizing domestic management based on the want 
of correct views as to the cause, nature and pathology of the 
disease. If the bowrels can only be checked, the anxious- 
mother too often rests satisfied that the child is improving 
and the danger is over, while in fact the slumbering fires 
beneath are only aggravating the actual condition—while the 
main predisposing cause is so generally found in the 
changing temperature and other conditions of the atmos- 
phere, modified more or less by emanations from contiguous- 
soils. It is to be regretted that there does not prevail a more 
general appreciation of the laws of what I shall term infant 
hygiene, as related to the attendant circumstances and condi- 
tions found—indentition, improper clothing, unnecessary 
confinement within door from the health-giving influence of 
the sun and air, violent exposure at other times, bad food, Ac.,, 
that not merely excite but aggravate this disease. It annu- 
ally bears its thousands and tens of thousands of victims to' 
premature graves—New Hanover County and Wilmington 
furnishing their sad quota. Let the suggestions of common 18 
sense amt of philosophic medicine be more generally heeded 
by the community, and more, many more, of our children, 
will live to bo sources of joy to parents and friends and bless- 
ings to the community. In the diet, clothing and general 
hygiene of their children, will not our mothers consent to 
heed less the allurements of fashion and false pride and 
listen more to the demands of reason, experience and 
humanity'? Would they save their darling offspring from 
diarrhcea, cliolara infantum, etc. ? If so, let them take more 
warning from the soiem truth, which needs to bo more 
profoundly impressed upon them all, that not alone do 
sudden atmospheric changes and bad air contribute to the 
production of tlmse diseases and of oth< r congestions and 
inflammations of children, but that their ignorance and false 
pride, in adhering to practices unreasonable and customs 
ruinous in the feeding and clothing of their children, are 
not less potential in causing infantile disease and mortality. 
Let children be taken in good weather, from the unwhole- 
some air of pent up abodes into the more invige rating life of 
the out-door air and sunshine of Heaven. The accumula- 
tion of a litle dirt and sun-burn will readily yield to soap, 
water and time. Let us teach these fashionable mothers 
liow it is that their devotion to low neck dresses, bare arms 
and legs causes such a loss of animal heat, such defective 
circulation in the parts exposed, and such an excess of blood 
to the internal organs as often ends in their congestion'and 
inflammation, not unfreqiiently ending in death. Mothers 
who so often wilfully disregard the plainest laws of health in 
these respects, of raising their children, would shiver and 
suffer from such exposures of their own persons and expect 
to be sick therefrom, ai d yet they can stand such treatment 
with far less danger than do their tender infants. The symp- 
toms of the formidable disease in question are much the 
same hero as elsewhere : pulse small and quick ; fever higher 
at first, assumes the lower grade as it progresses ; irritability 
and frequent evacuations from the bowels often attended 
with nausea and vomiting; thirst more or less urgent; 
discharges, at first, more of undigested feculent matter, 
mixed with bile, become more of a combination of mucus 
bile and serum, greenish in color and offensive. The serous 
portion is more easily absorbed by the diaper .of the child, 
leaving the green mucus discharges more visible to the eye. 
When these discharges change to those more putrid exhala- 
tions from the mucus coat of the intestines, the dancer is 
of course increased and the symptoms more aggravated,— 
sometimes, even in cases which seem to be extreme, the 19 
disease is checked and tends to revolution and ends in 
recovery. Too often, however, do encouraging symptoms 
exist, but to delude and disappoint. The heart of the fond 
parent is thrilled into joy to-day, only to be more deeply 
plunged in anguish, as on the morrow more fatal symptoms 
than ever supervene. The child, however, lives on. It be- 
comes more and more reduced to a mere skeleton ; the skin 
becomes more loose and flabby ; the face more shrunken and 
pale, indicating still more suffering and distress ; the signifi- 
cant turnings of the head takes its place with other bad 
omens- The evacuations from the bowels in these fatal 
cases, suspended though they may be for a time, break forth 
with renewed power—other untoward symptoms complicate 
the case. There is a general failure of the vital forces. 
The disease, in defiance of all the powers of nature and the 
best medical aid, lays the little sufferer in the grave. To 
detail the treatment is but to repeat an old familiar tale, as 
its recital by different persons give to it its changing hue and 
various shades. Small doses of mercury, in the early stage 
especially, with the various combinations of opiates, astrin- 
gents ancl antacids, I have found most beneficial. As the 
case progresses, subnitrate of bismuth, Dover’s powders, 
acetate of lead, alternated as indicated, with the various 
other adjuvants, external and internal, with a constant at- 
tention to proper food and to the general support of the 
system, enter into the established principles of treatment in 
this section. 
Our sickly season commences in July. It generally appears 
with so much regularity, that the physician expects and 
prepares for it with as much certainty, as does the farmer 
arrange his ground for corn in the spring, or for wheat in the 
fall. It brings with it a crop of diseases more generate than 
any other, in the shape of malarial fever. Here it is that 
until a few heavy frosts in the fall come to our relief, 
our medical men battle with and generally vanquish that 
varied type of fever known as remittent, intermittent and 
congestive. Commencing most generally with simple inter- 
mittent, it increases in severity and obstinacy, with the ad- 
vancing season, and is succeeded by remittent or congestive. 
Under the disturbing influence of some exciting cause, the 
intermittent form is ushered in by the usual cold or chilly 
stage, followed by sick stomach, pain in head, back and 
limbs, furred tongue, accession of fever, <fcc. This mild form 
is followed later in the season with that higher grade of 
bilious fever, wherein there is an aggravation and exaltation 
of all these symptoms. Tho system is more prostrated and 20 
restless, pulse quicker and stronger. There is more or less" 
gastric or cerebral disturbance according as the gastric or 
cerebral form of the fever predominates in different seasons. 
Add to this grade, and you have sometimes, as the weather 
becomes warmer, the season more advanced, and the amount 
of sickness on the increase, cases of bilious congestive fever. 
These are more striking still in violence and danger. It is 
now that the faithful interpreter of nature and of the laws of 
disease must come to the rescue. Not alone with the reme- 
dies suggested by enlightened experience and science, but 
with the caution, firmness and decision of the true physician. 
With antiphlogistic remedies and antiperiodic medicines 
must he, in this critical hour, battle with opposing forces, or 
else this high congestion and raging paroxysm will maintain 
the victory unto death. When promptly and properly treated 
these autumnal fevers, however variant the type in different 
seasons, are generally cured. When neglected, or impro- 
perly treated, they are apt either to terminate fatally, or to 
run into a slow and tedious, and sometimes fatal, form of 
typhoid fever, more less complicating with the original 
bilious remittent. Indeed this blending of the types of fever 
either at first, or from the. cause just named, is a feature 
sometimes of our autumnal fevers not to be forgotten, either 
in diagnosis or treatment. There is more or less of it every 
year, and whenever- or wherever it appears, demands fine 
discrimination and very careful treatment. Leaving out of 
consideration the question of uncomplicated typhoid fever 
which often appears sporadically, and otherwise, in this 
locality, we have to that in wdiatever form or compli- 
cation malarial fever presents itself—whether as a simple 
intermittent, remittent, or blending of types, or in a bilious 
congestive form, with that prostration, high fever, delirium 
and yellow bilious tinge, peculiar to the skin, tongue and 
eyes, and incident to the danger and critical condition of a 
high grade of fall fever—the treatment must correspond with 
the indications and severity of the case. In the usual course 
of uncomplicated malarial fever, I have not only found 
quinine indispensable, but mercury in quantities and doses, 
to suit the grade of fever, a most important auxiliary means. 
Its action upon the liver, wdiicli is so greatly involved in this 
disease, is very necessary in those cases, and I have seen 
deplorable results follow the neglect of its use therein. If 
those physicians of Great Britain and elsewrhere, who, by 
their experiments upon dogs, have concluded that calomel 
has no specific influence upon the biliary secretions, and that 
it is not entitled to be ranked among the cholagogues, could 21 
make their observations upon the human subject in the 
diseases of these high Southern latitudes, where the liver is 
so evidently engorged, and calomel so strongly indicated, 
they might be induced to be less peremptory in their express- 
ions, and a little more charitable to those who differ with 
them as to the action of calomel and the treatment of 
disease. I will discuss this question at more length, how- 
ever, when I enter upon the more elaborate subject of the 
treatment of internal inflammations, and of the high conges- 
tive fevers of this southern latitude, as I shall do in my last 
division of the General Treatment of Disease. 
Quinine, in larger and repeated doses, I administer with 
impunity, whenever its prompt influence upon the system is 
necessary. An important disease of increasing interest in 
our eastern section has presented me with a number of cases 
during the past few years. I refer to it the more readily 
because in proportion to its importance, the allusions to it 
in our standard books and journals, are too brief and in- 
definite as respects tho relative value of its pathology and 
treatment. I allude to the disease known as “ Puerperal 
Anaemia,” or “ Stomatitis Materna,” or more popularly 
known as the “ Nursing Sore Mouth.” It has been known to 
prevail as an epidemic in the great Mississippi valley, where 
it has mostly existed in this country. It seems to prefer 
malarious regions. Here, the cases presented are sporadic 
mainly, if not entirely. This disease of pregnancy and 
childbed seems to be an inflammation per se, presenting a 
depraved state of tho blood, attended with such a preponder- 
ance of white corpuscles and deficiency of red particles as 
make up an anmrmie condition, or Brunet’s “ Leuccemia of 
Pregnancy,” as it is called. The fact that it occurs but 
seldom in the lower classes, being chiefly confined to women 
of fine intellectual endowments, delicate organizations and 
nervous temperaments, who remain close at home and avoid 
exercise in the open air during pregnancy, point to these 
defects in functional action and hygienic measures, and this 
condition of anmrmia is favorable to its production. In- 
sidious in its approaches and deceptive in its symptoms, it 
is often so mild in its progress in early pregnancy as to fail 
to attract marked attention, or is mistaken for some other 
disease. Hence weeks and months of golden importance 
have been too often allowed to pass before proper treatment 
is commenced. Then it becomes so grave as sometimes to 
render tho approach of the full term of gestation truly 
alarming. And, occasionally after childbirth, the case runs 
its course to fatality. The importance then of proper treat- 22 
ment in the very incipiency of this increasing disease among 
us cannot be over estimated. Taken in time, suitable medi- 
cation generally effects a cure. I have found the best treat- 
ment to consist in an administration of those constitutional 
remedies found in chalybeate tonics, alteratives, astringent 
bitters, good food and generous support, which strike at the 
root of the disease and effect the necessary change of the 
fluids from their abnormal to their normal condition. The 
alarm created by the appearance of those secondary symp- 
toms of aphthous ulcerations appearing on the tongue and 
travelling downwards through the whole alimentary canal, 
and attacking the mucous surfaces of other structures, often 
attract such attention and local treatment to these coexistent 
lesions as to cause the general treatment to be neglected 
until too late. 
Among onr most common diseases, and one that seems to 
be alarmingly on the increase in this county, is “ Pulmonary 
Consumption.” My observations do not corroborate the 
opinion that either a moist or a malarious climate lessens its 
liability. Nor have I observed any facts to justify the too 
common opinion that this dreadful malady is nearly always 
hereditary or intimately connected with certain climates. 
This error, conjoined with a popular belief, too often fixing 
itself upon the attending physician, that the disease is 
always incurable, is exerting a deleterious influence upon the 
course of medical science and the claims of humanity. I see 
cases every year that could be traced to neither of these 
causes, but were dependent upon excess in sedentary occu- 
pations, too much confinement within doors, over anxiety of 
mind, bad air of apartments, disregard of other hygienic 
laws, and more especially for the want of clothing during 
our winter months, and of sufficient food the year round, 
which render their victims so susceptible to disease, and 
which, in the present day, causes so much suffering in the 
community, more than ever in this section in this want of 
food and clothing, not alone a prolific source of acute affec- 
tions, but of those gradually consuming diseases of Scrofula 
and Consumption. And when the important fact is borne in 
mind that this frequent disease of Pulmonary Consumption 
is so generally fatal, although dependent so often upon 
causes which may be modified and sometimes removed by an 
application of the ordinary motives and principles of pru- 
dence, philanthropy and science, it is high time that our 
profession should more generally arouse, in conjunction with 
other non-professional philanthropists of the day, and ad- 
dress themselves with increasing vigor and faith to the 9 Q 
•Li O 
blessed work of more correctly understanding and removing 
the causes of this most fatal disease of the whole country. 
I may remark that my medical observations and experience 
as a Surgeon in the Confederate army during those late four 
years of bloody war, justifies me in the opinion, that most 
of those who left their homes for its active service with weak 
lungs and tendencies to “ Phthisis Pulmonalis,” and even 
sometimes incipient tubercles and who escaped other dangers 
and diseases of that conflict, returned home either greatly 
improved or entirely restored. I have nothing new to offer 
as to treatment, excepting to express my concurrence with 
the established opinion of the great superiority of the 
modern building-up treatment of tonics, alteratives, stimu- 
lants, good food, out door physical exercise, &c., over the 
old plan of diet, depletents, &c. I have found more general 
good to follow the use of arsenic when the condition of the 
stomach and bowels will tolerate it, than from any other 
single remedy. When the digestive organs are not impaired it 
seems to act most favorably upon the functions of nutrition, 
furnishing new life to the countenance, more animation to 
the eye, a better appetite and more general strength and 
flesh to the languishing patient. The recent observations of 
some of the most illustrious physicians of Paris, that its use 
in this disease also acts happily on the mucous membranes 
of the lungs are sustained by my experience. The inhabi- 
tants of lower Austria, Styria and the Tyrol, frequently make 
use of arsenic even in health, because it enables them to 
breathe more freely in climbing up their rugged mountains. 
But whether arsenic is to be used when indicated, or the 
different preparations of iodine, iron, vegetable tonics, good 
diet, stimulants, cod liver oil, &c., according to the stage of 
the disease, tolerance of the stomach, or the general condi- 
tion of the patient, and the attendant circumstances. I 
choose not to be of those physicians who honestly prefer a 
voluntary abandonment of consumptive patients, either to 
the powers of unaided nature, or to those swarms of medical 
sharks who, in their unprincipled course and with their 
captivating paraphernalia of consumptive remedies, infest 
every community. These medical imposters, whose flaming 
advertisements are seen in every newspaper and public 
place, rely upon meanness for a living, and fatten upon the 
ill-gotten gains which they extract from the unfortunate and 
sinking subjects of this chronic and wasting pulmonary 
malady, and who, as is so natural, are so generally liable to 
become the injured victims of the glittering hopes held out, 
and the lying promises made. My conceptions of duty to 24 
myself and of a common obligation to my profession and 
humanity, do not encourage me, of my own accord, to abandon 
these trying and touching cases to the various snares thus 
set for them, nor even to rest satisfied with the ordinary 
palliations of regular treatment, except in the last stage. 
Bather do I elect to work on and to hope on in the faith of 
curing the disease by legitimate means. While its relative 
mortality i3 so fearful and discouraging to friends, and so 
many in our own ranks get much, very much, of this vast 
amount of disease, and death may be prevented by the exer- 
cise of more persistent faith and more skilful management, 
especially in its earlier development and inception. The 
progress of medical science finds mo a believer in the 
prophylactic treatment of this formidable disease. Judi- 
ciously applied, I regard it as not only capable of preventing 
much suffering, but able to snatch from premature graves 
many a darling son or daughter—the delight of parents and 
the ornament of the social circle, and from the consumptive’s 
death, many a father and mother—the pride, hope, and 
dependence of the family and the joy of admiring friends. 
Let me proceed to explain : This thing of tubercle, and how 
it is deposited in the lungs, <fcc., has long been unsettled. 
The most popular theory has been that it is an abnormal 
•exudation from the blood. As we all know pathologists 
recognize two forms of tubercle, the gray miliary and the 
yellow, cheesy tubercle. Whatever the origin or nature of 
this tubercular deposit, its. tendency, unless removed, is of 
course to suppurativo abscess, and destruction of the tissues 
involved, with a gradual wraste of the entire physical system. 
J. H. Bennett stands most prominent among those who 
contend that tubercle is an exudation or abortive development 
of the plasma of the blood. That great microscopist, 
Yirchow leads those who make a distinction between the 
grey and yellow tubucle, getting a clue therefrom, it is said, 
for liis well known doctrine of cell growth. Ho and his dis- 
ciples contend that the gray tubercle is but a progressive 
development of cells from a parent cell, and that the yellow 
tubercle is only the result of a fatty degeneration and disinte- 
gration of other tissues, perhaps of the gray deposit itself, or 
of pus, or of carcinoma and the like. They hold that this 
gray tubercle may cause what they denominate acute 
phthisis, with constitutional symptoms, not unlike those of 
typhus fever, for which it has been sometimes mistaken, but 
that this form of pulmonary disease is unlike that old 
fashioned form of chronic Phthisis Pulmonalis, which by its 
slow and wasting ravages daily lays its thousands in the 25 
grave, and that is caused by tlie yellow or cheesy tubercular' 
deposits. It is contended that this yellow material comes, 
not as an exudation from an altered state of the blood, but 
from the worn out epithelial cells of the air vesicles. That 
instead of being removed by the vital actions of the part, 
they are allowed to remain as sources of irritation, and by 
gradual accumulation render that portion of the lung untit 
for respiration. The advocates of the epithelial origin of the 
common yellow tubercle, argue that their theory explains 
satisfactorily difficulties and problems that cannot be solved 
by the admission of the doctrine of exudation from the 
blood—that the advocates of the latter cannot show how it 
is that these cheesy deposits are so uniformly found on the 
apex of the lungs, and are so long restricted to one side of 
the lungs, after being deposited. They contend that no 
chemical or microscopic test has ever discovered any proof 
of that peculiar morbid condition or alteration of the blood 
claimed as necessary to the production of the deposit in 
question. Virchow says that he “ found a series of tubercular 
deposits in different organs, never at any time exhibited a 
discernible exudation, but always, during the wdiole course 
of their development, presented organized elements, without 
its being possible to observe either in them, or before they 
existed, any stage in which amorphous, shapeless matter 
was present.” He also says that “ nuclei and cells are found, 
in great abundance, though they afterwards break up, and 
directly supply the material for the final accumulation of 
cheesy substance.” Upon such and similar grounds are* 
founded their argument, that this material is not a morbid; 
product of exudation from the blood, but that it is more of a 
normal constituent, which, failing to be excreted in time, 
remains as a foreign body to be softened and excreted by 
expectoration or otherwise removed from the system. They 
reason that this deposit is not found in those lower and 
more depending portions of the lungs where movement is so* 
free and easy, but in those upper parts where the bony 
structures and harder parietes do not admit of that full 
motion and play of the lungs necessary to the full ingress- 
and egress of air. It is in these portions of imperfect and 
restricted respiratory action, except at great muscular effort,- 
that these deposits are almost wholly found, and it is held 
that these accumulations would never occur if there was 
sufficient force to prevent it. It is claimed that this force or' 
agency exists in the pressure of the air vesicles, and in the 
power of respiration to press out their contents, and that 
such power mainly depends upon the vigor of the respiratory 26 
action. That while the peristaltic action and passing s - 
stances of the alimentary canal are competent to throw 
from the mucous surface the worn out epithelium, the cilia, 
currents of the bronchi are not ahvays thus competent, and 
that as an auxiliary therefore, a free and full action of the 
respiratory apparatus is necessary. Adducing such reasons 
in support of their conclusions, those men not only contend 
that consumption is curable, but, that as a disease, it is not 
hereditary. They admit* that the tendency to pulmonary 
consumption may be transmissible in the physical formation 
or mental temperament of the offspring, but that the disease 
itself is not handed dowrn from parent to child, and does not 
claim its victims at birth. The celebrated Dr. Walshe says, 
after a careful investigation of the family history of four 
hundred and forty-six (446) patients with this malady, that 
“ phthisis in the adult hospital population of Great Britain 
is to a slight amount only, a disease demonstrably derived 
from parents.” 
Not to pursue any further the reasoning of the advocates 
of this plausible and more pleasing theory of the origin, 
nature, and curability of this destructive disease, should wo 
not feel encouraged to have more faith, and to use more 
perseverance, in the propliylatic measures so naturally sug- 
gested by the theory presented ? As is a man’s faith so will 
he be, as he thinks and resolves so will he put forth his 
efforts and continue in his hopes and energies. 
There is encouragement, I repeat, in these cases of pulmo- 
nary consumption. The great, golden rule is to sustain and 
bring up the general strength. The entire physical system 
should he raised to the highest possible vigor. In the young 
physical cultui'e is the safeguard, against consumption. Incipient 
phthisis is always preceded by debility. This debility 
engenders like feebleness of respiration, and this accom- 
panies or rather produces insufficient pulmonary excretion 
with its consequent accumulation of this epithelial debris. 
The forerunner of debility may arise from inadequate nutri- 
tion or deficient food, protracted sickness, overburdening 
mental cares and anxieties. I have often thoilglit that this 
alarming increase of consumption here, especially since the 
war, was in all probability owing mainly to the general 
and well known prevalence, since then among us, of these 
very causes. The deficient clothing and food and general 
suffering, as I before said, of our colored population, doubt- 
less bears an important part in the production of a greatly 
increased mortality from consumption among that race in 
the Southern States. 27 
Drive off thin actual or threatened accumulation of tubercular 
deposit by all those means which will add to the flesh and general 
strength, and by all those measures which ivill give the greatest 
vigor to the respiratory act and add to the fullest expansion of 
the entire lungs. Special and methodical attention to full 
respiratory action and to a development of the respiratory 
muscles—active muscular exercise in the open air—a free 
use at all times of fresh air—a diet nutritious and digestible 
-—suitable protection to the skin—united to a habitual exer- 
cise of hope and cheerfulness, will not alone insure general 
health to the lungs and body, but will, in a large majority of 
cases, prevent the formation and secure the removal of those 
pulmonary deposits, upon which the ravages of consumption 
are based. Why do children enjoy such a happy immunity 
from its attacks ? Because the activity of their habits, the 
energy of their respiratory movements, and their love, when 
well, of the open air, which gives them a plenty of oxygen 
and a full expansion of their lungs, are safeguards to the 
accumulation of tubercular material. The waste and repair 
of tissue in children is very rapid, and were it not for the 
energy and efficiency of their habits and love of play and 
exercise, they would not be blessed with this fortunate 
exemption. But when they arrive at the age of puberty 
their pleasures and habits change. The boy is confined at 
home or at school, and hours which should be given to play 
or the exercise of his lungs, finds him at his books or at some 
other close occupation that denies exercise to his body and 
expansion to his lungs. It is the same with the girl. She 
no longer romps over the fields, or sings gladsome songs as 
she glides rapidly along wherever she pleases. But she is 
placed under the restrictions of fashion and under the dis- 
cipline of home and school, which regards too little the 
claims of health and good lungs. She is imprisoned in 
tight dresses, her neck and arms perhaps bare, and is denied 
the merry laugh, the running gait, and other exercises so 
much needed to give form and grace to her body and expan- 
sion to her lungs. Can we wonder soon to see that prom- 
ising boy and that charming girl yielding to those seeds of 
consumption engendered by the unnatural and cruel ch ange 
to which unwise regulations of home and unphilosophical 
rules of school subject so generally the youth of our 
country? The wild beast, confined within his iron bars, 
often dies with consumption, while the parents continue to 
roam their native forests to an extreme old age, and die from 
some other cause. 
The remarkable benefit derived by our consumptive 28 
soldiers during tho late war, from the fresh air and tough 
living of army life can never be forgotten while memory 
reverts to those trying days, or history shall transmit their 
unequalled heroism to future ages. They left home, hosts of 
them with feeble lungs, often bearing incipient tubercles. 
Others, actually were wasting away with night sweats and 
profuse expectoration, and were, on this account, never 
expected to return. A decided improvement seems to have 
been the result in nearly every instance, and complete 
recovery followed most of those unpromising cases. Those 
who, with weak lungs and newly formed tubercular deposit 
were able to escape other casualties of war, returned home, 
as I before said, always greatly improved and generally 
restored. If such examples and facts do not bear their 
valuable lessons of wisdom and of warning to us all, then 
may we turn a deaf ear to the teachings of experience or the 
deductions of observation. It is good fresh air, then, and not 
confinement in ceiled houses with closed doors that our 
people should value, especially those who dread, or have, 
consumption. Muscular exercise, free and persistent, with 
that all-important attention to the functions of nutrition—to 
digestion and assimilation, will save our patients from con- 
sumptive graves, if, with living faith in the means suggested, 
we can in time have the entire management. 
To provide for the physical education of the children 
around us, is as much a duty, sadly though it is neglected, 
as is the education of their morals and minds. He whose 
children and wards are liable to this fell-destroyer of so 
many of the human race, should especially bear in his bosom 
at all times an enduring consciousness of the duty which 
this solemn truth suggests. As conservators of the public 
health, let us on all appropriate occasions, impress upon 
every parent, guardian, and instructor of youth, the vital 
importance of protecting children with warm clothing—of 
securing for them an abundance of frc sh air and snn-light; 
that all their rooms and apartments be well ventilated ; that 
bathing bo made a family arrangement; that the diet bo 
plain and nutritious; that proper habits of self-control in 
eating be acquired, and that exercise sufficient to develop 
all the muscles be regularly observed. Due attention to 
these things is not alone necessary to the health, comfort 
and usefulness of the child, but essential to the happiness of 
parents and to the general good and prosperity hereafter of 
the whole State and country. 29 
OENERAL TREATMENT OF FEVERS AND ACUTE INTERNAL INFLAMMA- 
TIONS. 
He is the wise physician who, bringing to his daily prac- 
tice a mind untrammelled by prejudice or preconceived 
ideas of earlier training, follows the teachings of observa- 
tions and the legitimate deductions of science. Such a 
practitioner, while informing himself of the views of others 
and the doctrines of his profession at different epochs, will 
at the same time carefully observe for himself. Thus armed 
he will go forth to battle with disease in that spirit of inde- 
pendence and self-reliance which forms a material attribute 
of every truly successful physician. He treats his patients 
upon general principles, modified not only by the sugges- 
tions of each particular case, but by the surrounding 
circumstances and prevailing tendencies and indications. 
Profiting by the observations "of every case, and the expe- 
rience of the changing seasons and years, he heeds on the 
one hand neither the extreme views of blind devotees of the 
past, nor on the other the assumptions of the ultra advocates 
of the innovations and reforms of the present. But 
gathering as a philosopher from the past, as well as the 
present, avoiding those Scyllas and Charybdes of his pro- 
fession that have always existed, he becomes, in truth, the 
genuine eclectic in its true sense, learned and unprejudiced 
while conservative and successful. Pursuing such a course 
of common sense and enlightened experience, he cannot 
fail to consult as guides the great Books of Nature and the 
Laws of Disease. This accustoms him to follow the methods 
suggested by the changing forms and types of diseases of 
the different seasons and years, modified by the locality, 
climate and varying indications of each individual case. 
From such stand points arises the general treatment of 
every physician, who, leaving routine and pre-existent 
partialities and prejudices to such inferior minds as will not 
study and think, is governed by his own knowledge and 
observation as connected with the broad and established 
Principles of his profession. Such a course may not win for 
im the admiration of shallow minds or the sensational 
applause of the fickle multitude so prone to be captivated 
by attractive novelties and the bold innovations of extremists. 
But instead thereof he will avoid the injury which such men 
do to science and humanity. He will, in addition, justly 
.secure the more enviable reputation of skill and success m 
practice.. He will gather around him the sincere friendship 
and lasting esteem of the learned, the sensible, and the 30 
appreciative. When ultraists and extremists have gone 
down in ridicule, or are forgotten in their graves, his memory 
will be fondly cherished, and remain to illumine the pages of 
Medical History. 
In this section of the State, we treat disease according to 
indications. In one or more seasons the asthenic type is so 
prevalent, the tendency so strong to the typhoid form, that 
in acute inflammations and fevers we apply the antiphlo- 
gistic treatment with much caution. In such years we 
seldom use the lancet, except in occasional instances of 
violent inflammation and severe congestive fevers. At other 
periods we find the disease more sthenic in character—the 
inflammatory symptoms of a higher range—cases more 
violent and hurry more rapidly either to resolution, if 
properly aided, or to a fatal end if neglected or improperly 
treated. Under such indications it becomes our duty to 
apply with a bolder hand the antiphlogistic treatment— 
sometimes using the lancet, more generally those mercurial 
purgatives, blisters, local depletion, diaphoretics, and de- 
pressants which in this locality cannot be dispensed with 
when our ordinary congestions and acute inflammations 
assume an aggravated character. So that our treatment 
depends upon the prevailing type and individual indications. 
This is the result of my observation and experience, based 
upon a laborious practice for the last twenty years in 
Eastern North Carolina. Earlier in my medical life the 
sthenic tide was up and my lancet was often used. For a 
number of years past it has become somewhat rusty, because 
the asthenic waves have prevailed, though it remains in my 
pocket case as a necessary companion. Well do I remember, 
as my note book shows, the high grade of many of my cases 
treated in earlier life, and I used the lancet freely and often 
and with marked benefit. It was indispensable that I should 
open the batteries of my antiphlogistic treatment in order to 
save human life. But in more recent years the indications 
are changed—the type is lower, and I bleed more rarely 
and deplete less freely. I am aware that Markham, Watson 
and other distinguished medical men maintain the contrary 
theory, but the great majority of the master minds of the 
profession are united with the great masses of active prac- 
titioners in support of the belief that diseases change in 
their type. If we could discard the word type and regard 
the discussion as between sthenic and asthenic forms and 
dispositions much embarrassment would be prevented and 
extraneous matter avoided. But wo must take the question 
as it stands: that nature is powerful and 'often efficient to 31 
throw off disease 'iio one will deny ; that the expectant 
system will sometimes answer, cannot be disputed. No 
judicious practitioner ever fails to call to his aid all tho 
conservative strength that is possible from this source. 
Perhaps tho truth more generally lies between the extreme 
advocates of the phlogistic and antiphlogistic systems. 
Each correct under certain circumstances, both in error 
under other conditions. Especially do they seem to bo 
wrong in the uncompromising tenacity with which they hold 
to their peculiar views, unmodified by circumstances. How- 
ever this may be, lot us, I repeat, maintain ourselves free 
from prejudice and passion in the contests of those rival 
theories that have so long divided the medical world, and 
with the single aim of medical truth follow observation and 
the legitimate deductions of medical logic whithersoever 
they may lead. 
These sentiments do not create any sympathy in me for 
that, wholesale proscription and sweeping denunciation of 
the antiphlogistic system so generally indulged in by the 
followers of Todd, "Bennett & Company. It has becomo 
too fashionable to denounce as old fogies and as enemies to 
true medical progress those who refuse to join the ranks of 
these proscriptive men. Our medical students, who go to 
more northern medical colleges every year for instruction, 
are taught by professors who never saw a case of malarial 
fever or treated a case of our high grades of internal inflam- 
mation, that it is suicidal to bleed and ignorance to give 
calomel, and they are taught to regard as behind this 
enlightened ago those Southern practitioners who presume 
now to use in any case these antiphlogistics. I conceive it 
a duty, therefore, to speak out on this subject now, as these 
onslaughts upon truth and the practice and writings of a 
very large majority of the great, leading medical minds of 
all ages and countries, are not conducive to the interests of 
medical science or to humanity, so long as their heresies 
remain unanswered and are not exposed. I am the more 
disposed to discuss this question, because of the industrious 
efforts being made, within a recent period, to spread in our 
own State these dangerous doctrines of Todd, Bennet & Co. 
Their followers are earnestly soliciting their acceptance, by 
the profession of our good old State, so uniformly unwilling 
of her own clioico to accept heresies of any kind, whether 
medical, political or religious. One of our own sons, a 
gentleman of talent and promise in his profession, a 
prominent member of this Society, bearing an honored 
name, which, by its high accomplishments and bright pro- 09 
rJJJ 
fessional lustre, has illumined the medical annals of the 
State, has fallen from grace, and now stands forth among us 
as the representative man in North Carolina of this mis- 
chievous doctrine. I need scarcely say that I allude to 
William A. B. Norcom, M. D., of Edenton, -whose Annual 
Address before this Body at Warrenton, in May, 18G8, has 
atttracted much attention, and deserves to bo noticed, in our 
general allusions, to the sentiments of those whom he quotes 
and endorses. However ungracious the task, it is due to 
science and the profession that such sophistry should be 
exposed, and such false premises and illogical deductions 
overthrown. Dr. Norcom’s address is ingenious and well 
put together, but untenable and injurious upon medical 
practice. It is the more surprising and to be regretted that 
he has fallen into these errors, because his whole life has 
been passed amid disease that has presented indications I 
respectfully submit, calling for different treatment than that 
he now advocates. Unlike those noted authors whom he 
quotes, scarcely one of whom knows anything practically of 
of the nature, grade, and demands for treatment, of our 
Southern acute diseases, he is one of our own physicians, 
daily in contact, from his location, with malarious fevers and 
acute internal inflammations, demanding, as I insist, a more 
rational treatment than ho atmlies. 
The opponents of blood-letting and mercury assume, as 
tlieir premises, that the progress of medical science and the 
revelations of truth have subverted the antiphlogistic 
system, *and, in place thereof, have substituted alimentation, 
stimulants and similar remedies. That blood-letting, mer- 
curial purgatives and other depletants and lowering remedies 
are injudicious and uncalled for, and that they prolong, 
rather than shorten disease—increase, rather than decrease 
mortality. Respectable medical authorities, not novel to 
the profession, are quoted in support of these statements. 
Some of the very authorities, quoted in support of the posi- 
tion taken, may bo arrayed in opposition thereto in other 
portions of their writings. When Dr. Norcom mentions one 
prominent author, in vindication of his views, he might have 
named dozens equally high in authority against himself. 
He fails to acknowledge that the grade of fevers and inflam- 
mations of this latitude generally produce such disturbances 
and indications, as to demand a more vigorous treatment 
than do the acute diseases of the regions embraced in the 
fields of practice of his learned supporters in Europe and 
elsewhere, who wage this war against the lancet. There the 
observations of those authors are based in the main upon 33 
Hospital and Dispensary practice, when most of the 
treated have passed from the acute to the chronic stage 
beforo admission, and, of course, rendering blood-letting 
inadmissible. Most of their eases are asthenic in character 
and different from the acute diseases of our latitude that are 
more phlogistic and demand a moro active treatment. 
“ Distance,” too, “ lends enchantment to the view,” andnames 
arrayed here as distinguished lights in the profession and as 
offered to all lowering treatment, will be found by Dr. Nor- 
com to be more transcendental extremists, patronised but 
little at home and more respected abroad. They will suffer 
in comparison with the scores of those successful and 
illustrious men in all ages, who maintain adverse views, who 
were sensible and practical, and who contribute to adorn tho 
brighest. pages of Medical History. 
Dr. Norcom sets out with the emphatic declaration that 
“ great progress and improvement hate taken place in oiut 
profession,” and says that “ nowhere is this more apparent!; 
than in the treatment of Acute Internal Inflammations.”’’ 
The improvement on this point is questionable. There is; no; 
fact to prove that the treatment of acute internal inflamma- 
tions has improved. For thousands of years thfr anti- 
phlogistic treatment was employed successfully bv the 
greatest physicians—the founders of the science of medicine, 
to whom it owes everything, commencing with Hippocrates 
and running down its illumined pages to Watson,. Aitkin* 
Wood, and others of the present day. The efiSeaey of the 
anti-phlogistic plan has been attested by the experience and 
observations made upon millions and myriads of cases* 
Until the new lights can show better and more numerous, 
authorities for the superiority of their so-called novelties, 
(but really not) the improvement is not established. 
He next says: “ Foremost in importance stands the 
enforcement of the study of their Natural History and a 
revival of the Hippocratian doctrine of a greater reliance 
upon nature rather than of a perturbatory and loioering 
treatment and the substitution of a proper and sufficient 
alimentation for low diet—yes we may say starvation.” 
The promulgation of this statement is founded upon a 
total misconception or misapprehension of the doctrines 
and practices of Hippocrates. So far from being offered to 
lowering or anti-phlogistic treatment, he was one of its 
most constant and enthusiastic supporters, in fact one of its 
very founders. It is true he employed it judiciously and 
wisely, but on all proper occasions, especially in the treat- 
ment of acute internal inflammations, he was one of the 34 
boldest practitioners the world has ever known. This is 
proven by the following quotations from his works, within 
the reach of every physician. I quote from the translation 
of Dr. Francis Adams, published by the Sydenham Society 
of England, London 1849 : 
“ 1st. Bleed in the acute affections, if the disease appears 
strong and the patients be in the vigor of life, and if they 
have strength. 
“ 2. Again : Hypochondria not from retention of flatus, 
tension of the diaphragm, checked perspiration, with dry 
orthopnoea, when no pus is formed, but when these com- 
plaints are connected with obstructed respiration, more 
especially strong pains above the diaphragm—diseases con- 
nected with a collection of humours—all these diseases do 
not admit of resolution if treated first by medicine, but 
venesection holds the first place in conducting the treatment. 
“ 3. Again : When a person suddenly loses his speech, in 
connection with obstruction of the veins, if this happen 
without warning or any other strong cause, we ought to open 
the internal vein of the right arm and abstract blood, more 
or less, according to the habit and age of the patient. 
“4. Again : Patients seized with Epilepsy or Apoplexy 
are immediately to be bled at the commencement. 
“ 5. Again: In peri-pneumona and pleuritic affections, 
bleed largely and boldly, if the pain be acute, so as to bring 
on delinqum animi. 
“ 6. Again : When Pneumonia is at its height the case is 
beyond remedy, if he is not purged. In Quinsy, bleed in tho 
arm and open the sublingual veins. 
“ 7. Again: In Dropsy, if he labors under difficultly of 
breathing, if it is in the summer season, and if he is in *tlio 
prime of life, blood should be abstracted from the arm. 
“8. Again: The most important point of regimen to 
observe and be guarded about in protracted diseases, is to 
pay attention to tho exacerbations and remissions of fever, 
so as to avoid the times when food should not be given, and 
to know when it may be administered without danger. This 
last season is at the greatest possible distance from tho 
exacerbation.' 
“ 9. Again: If you think expedient to let blood, see that 
the bowels bo previously settled, and then bleed. Conjoin 
abstinence, and forbid the use of wine, and complete tho 
cure by means of a suitable regimen and wet fomentations. 
“ 10. Again: For extreme diseases, extreme methods of 
cure as to restriction are most suitable. When the disease 
is very acute, it is attended with extremely severe symptoms 35 
in its first stage, and, therefore, an extremely attenuating 
diet, must be used. When this is not tho case, but it is 
allowable to give them more generous diet, we may depart in 
so far from the severity of regimen as the disease by its 
mildness is removed from the extreme. When the disease 
is at its height, it will then be necessary to use a more 
slender diet. We must retrench during paroxysms, for to 
exhibit food, would be injurious. And in all diseases having 
periodical paroxysm we must restrict during tho paroxysms.” 
How unjust then to the memory of this immortal Father 
of Medicine, the very author of blood-letting and rigid diet, 
that Dr. Norcom should refer to him in support of the theory 
of a greater reliance on nature rather than upon a perturba- 
tory, and lowering treatment. True, Hippocrates relied 
much, as all sensible men do, upon the powers of nature in 
the treatment of disease, but we see from the above and 
similar quotations .that might be given from him, that, when 
treating severe inflammations and high fevers, he used 
additional means as do judicious practitioners at this en- 
lightened day. From these passages it will be clearly seen 
that Hippocrates was one of the prime originators of the 
lowering treatment, bleeding his patients freely and as largely 
as they would bear, and following it by rigid diet. Ho even 
forbade the use of barley water until the inflammation was 
arrested. How little support do such or any of the writings 
of Hippocrates give to the plan pursued by Todd, who says ; 
“ there is no necessity for having recourse to violent anti- 
phlogistic measures in cases of pneumonia [Clinical Lectures 
Phil., Ed. page 271] and who in “ rapidly spreading 
pneumonia” gave “half an ounce of brandy every hour,” 
[page 266 ibid] and in another case of laryngitis, with 
pneumonia and delirium, gave half an ounce of brandy every 
half hour. It is true the patients recovered, but have they 
not recovered after the worst treatment ever invented ? How 
different the treatment of Hippocrates and that of Dr. Nor- 
com, who, to a child eight years old, with a severe pneu- 
monia, with pulse 140 and respiration 70 to the minute, gave 
three pints of milk, one and a half pints of rich soup, with 
little alcoholic stimulus every twenty-four hours'. Dr. 
Norcom’s treatment is neither that of Hippocrates or Todd. 
Leaving Hippocrates, we find that all the greater classics 
of antiquity advocated judicious anti-phlogistic treatment in 
acute internal inflammations. Celsus recommended both 
venesection and cupping—[Edinburg Ed. 1814, pp. 60-64.] 
in pestilential and ardent fevers, he says, “ if the strength 
will admit it is best to let blood.” [Page 103.] In the caso 36 
of a semi-tertian he says : “ unless there is some important 
reason against it, blood ought to be let in the beginnig.” In 
pleurisy he says: “Now the cure of a violent and recent pain 
is letting of blood.” [Page 161.]—of pneumonia and its 
cure he says : “ It is fit if the strength will admit of it to let 
blood.” Of the disease of the liver and its cure he says, 
[page 1641] “ in the beginning the best thing is to let blood, 
then the bowels must be opened—if this cannot be done 
otherwise by means of black hellebore.” “ In ileus the cure 
is letting of blood.” 
If we turn to the pages of Galen we find that he is a 
strenuous advocate of anti-plil ogistics in all acute internal 
inflammations. Thus in his books on Therapeutics, ad- 
dressed to Glaucus, he says: MWe will say then that it is 
necessary to consider the age of the patient, the season, the 
country, the actual condition of the air, the strength of the 
patient, his complexion, his habits, and even the state of the 
disease. In fact you will ascertain from these whether it is 
necessary to evacuate or not, and when and how it ought to 
4e done, for example in the diathesis in question. Thus if 
the determination is to the knee, the joint suddenly swelling 
greatly, if the whole body is redundant with blood, the 
patient vigorous, the disease occurring in the spring in a 
very temperate climate, and the subject a youth or young 
man, it will require an evacuation of blood from the upper 
parts, and to select from the veins of the fore arm—the 
internal or median vein. If one of the superior parts are 
affected the blood must be drawn from the inferior region.” 
[Vol. 11, pp. 746-50.] Also in inflammation of the uterus, 
ovaries, spleen, liver, angina, affections of the head, Ac., 
bleeding is enjoined and the mode in which it is to be em- 
ployed and the locality of the operation minutely described— 
[vol. 2, pp. 755-6.1 
If we consult Aretams we find him endorsing the treatment 
advocated by Hippocrates and Galen. He recommends 
bleeding in apoplexy [page 259] and cupping [page 265] in. 
tetanus moderately, abundantly in Cynanche with light diet, 
[page 270.] In pleurisy repeated bleedings [page 286] and 
cupping [291] are recommended. Repeated bleedings in 
pneumonia [pnge 296] in persons of plethoric habits, in ileus, 
in acute affections of the liver [page 335] and in fact in all 
acute diseases attended with fever and inflammation. 
Tlio observations of Panins iEgineta, [Syd. Soc. Ed. 
1844, London,] one of the most celebrated writers after 
Galen, proves that blood-letting was the universal practice 
among the leading authorities of his and previous times. 37 
At the same time ho employed it judiciously just like all 
men of good senso uso everything—cautiously when doubtful 
and withholding it when injurious. Paul of Egina says that 
“ if the peripneumonia wTas the original affection and the 
strength admit we must open a vein, or if not we may cup, 
proportioning the evacuation of blood to the pow'ers of the 
patient, but if the disease originate from the conversion of 
other diseases into this (secondary pneumonia) wre must not 
have recourse to venesection, more especially if the disease 
be of a chronic nature, and if blood had been previously 
drawn.” What admirable rules! In all ages wo see that 
those who employed bleeding boldly, yet in many cases 
withheld it altogether. Indeed many things now promul- 
gated as new more properly belong to the men and ages of 
the past. Among the Arabians who treated pneumonia like 
flie Greeks, and which Haley Abbas describes as a hot 
inflammation of the lungs, for which he recommended 
bleeding, cooling and diluent drinks, <fcc. We still find 
Ilhazes describing a species of pneumonia which was treated 
with tonics, wine, &c. [Commentary Paulus Egineta 
vol. 1—482.1 
If we come down to Sydenham wTe find that in acute 
internal inflammations—pleurisy for example—“ the fever 
and its most dangerous symptoms were best relieved by 
bleeding in the arm, applying blisters to the neck and giving 
injections every day.” Change in the character of disease 
wras even then sometimes observed. He says : “ Now though 
I conceive that a true and essential pleurisy, which, as shall 
hereafter be observed, happens indifferently in all constitu- 
tions, does in all years equally indicate repeated bleeding; 
yet it sometimes happens that the peculiar epidemic fever of 
the year, from some sudden alteration of the manifest 
qualities of the air, readily throws off the morbific matter 
upon the lungs and pleurae, whilst the fever, notwithstanding, 
continues exactly the same. Wherefore, in this case, though 
bleeding may bo used to abate the symptom when it is very 
violent, yet, generally speaking, little more blood ought to 
bo taken away than is required by the fever whenever this 
symptom depends.”—[Sydenham’s Works, London, 1788, 
vol. 1—339.1 
Tlio great Cullen, whose authority was for a long time 
recognized throughout the whole medical world, was, as is 
well known, an advocate of the antiphlogistic treatment in 
acute internal inflammations and fevers. He says : “ Nothing 
is more evident than that blood-letting is one of the most 
■powerful means of diminishing the activity of the whole body, 38 
especially of the sanguineous system, and it must, therefore, 
be the most effectual means of moderating the violence of 
reaction in fevers. Taking this as a fact, I omit enquiring 
into its mode o.f operation, and shall only consider in what 
circumstances of fever it may be most properly employed. 
"When the violence of reaction and its constant attendant, a 
phlogistic diathesis, are sufficiently manifest, when these 
constitute the principal part of the disease and may bo 
expected to continue throughout the whole of it, as in the 
case of synocha, then blood-letting is the principal remedy 
and may be even played as far as the symptoms of the 
disease may seem to require and the constitution of the 
patient will bear. It is, however, to be attended to, that a 
greater evacuation than is necessary may occasion a slower 
recovery ; may render the person more liable to a relapse 
or may bring on other diseases.” He then states under 
what circumstances blood-letting is to be used in fevers and 
inflammations, and they are as follows : 
“ 1st. The nature of the prevailing epidemic. 
“ 2. The nature of the remote cause. 
“ 3. The name and climate in which the disease occurs. 
“ 4. The degree of phlogistic diathesis present. 
“ 5. The age, vigor, and plethoric state of the patient. 
“ G. The former diseases and habits of blood-letting of the 
patient. 
“ 7. The appearance of the blood drawn out. 
“ 8. The effects of the blood-letting that may have been 
already practised.”—[Yol. 1, pp. 58-59.] 
To these names may be added those of Booerhave, Andral, 
Chomel, Lamnec, Louis, Grisolle, McIntosh, Yalleit, 
Gintral, Stokes, and the great Trench medical philosopher, 
Bouillaud, whose directions to bleed freely in acute diseases 
I have heard from his own eloquent lips, as I followed him 
through his wards in the celebrated de la charite hospital at 
Paris. In fact there are but few physicians of note who 
cannot be quoted as authority in support of the antiphlo- 
gistic treatment in acute internal inflammation. And yet 
these great men are charged with being guilty of a reckless 
and profligate waste of human blood. They lay down the 
rules by which this treatment is to be guided, and these rules 
are as good now as they ever were. If our acute internal 
inflammations of the present day were attended by a hard, 
full pulse, headache, delirium, redness of face and ardent 
fever, we would bleed as much as ever, but this is not 
usually the case. The grade of reaction is lower ; the type 
■usually typhoid or asthenic, and we have, therefore, adopted 30 
a more moderate treatment, just precisely as they advised, 
and even commanded. By no means would wo underestimate 
the importance of improvements in physiology and pathology 
in the diagnosis and treatment of disease, but the employ- 
ment of remedies is to be guided by results, and surely -we 
arrogate to ourselves undue importance in assuming that 
we of to-day are better judges of results than the long list of 
illustrious names before us. The mass of the profession 
indeed began to employ bleeding with more caution long 
before the great lecturers said a word about it. Men of 
practical common sense in the backwoods, remote from the 
centres of learning, and who never read a medical book or 
journal, recognized this change of disease and demand for a 
change of treatment just as soon as this new party, so-called, 
of Todd, Bennett & Co. Men of common sense, who are 
not ,led off by the power of prejudice or the charms of 
novelty, will profit by the lessons which these facts teach. 
Every physician, endowed with powers of common observa- 
tion, who is conversant with the history of medicine, has a 
good share of clinical experience, and refuses to allow' his 
mind to be confused by narrow circumscribed theories, is 
aware of them and has always been and always will be guided 
by them. Men may fulminate against mercury, tartar 
emetic and blood-letting, still the judicious and discrimina- 
ting practitioner will ply them with success and snatch his 
patients from the jaws of death, at the same time that he 
guards against their improper use and bad effects. Ho will 
also seek constantly for such efficient aids and substitutes as 
observation, accident or experiment are constantly offering 
to his notice. He will learn something of the Natural 
History of Disease from Hahneman, of the use of cold wrater 
from Priestnitz, of the expectant method from the French, 
and of the capacity to endure alimentation and stimulants 
from Todd & Company. He will be ready to learn, but will 
not discard good remedies until others are proved to bo 
better, numerous, repeated, prolonged trials are necessary 
before he gives up Buies of Art established for centuries. 
Again, says Dr. Norcom : “ Let ns bear id mmd that there 
are no foreign forces to be attacked, nor is there an excess 
of vitality but a deficiency of the powers which naturally 
reside in the organism. Indeed it may be that the cause of 
the attack, which demands an aid, is an already deficient 
vitality. I am every day more and more convinced that a 
recognition and observance of these important facts must 
form the basis of successful practico. Bather than being 
too intent upon driving out the enemy, let us busy our- -10 
selvcs, as Dr. Bennett says, to secure the safety of the 
fortress—let us try to bring the individual up to his physi- 
ological status. In a word, let us help him to restore his 
natural powers. This support can only be given by food. 
As Dr. Hewett says, nutrition is the basis of the treatment 
of disease and no other is possible for a rational system of 
medicine.” 
Tlie plain English of this paragraph, and the gist 
of the whole address, is, that disease arises from 
inanition, is always asthenic Tn type, and always requires 
the same treatment—“ which can only be given by 
food. This is not only erroneous, but downright absurdity— 
not only unsupported by facts, but in direct antagonism to 
facts, and the daily observations of every correct medical 
observer. Let us give an instance : A man in the vigor of 
life, after having partaken of a full dinner and washed it 
down with brandy and wine, falls from his chair in a fit of 
apoplexy, shall we give him more food to cure him ? Shall 
we attempt to induce him to eat another dinner and drink 
more wine, or relieve the oppressed brain by bleeding and 
purgatives, cold applications to the head, Ac. ? 
A young man of full liabit, (if these toddyists will admit a 
man can possess a habit too full) who has not missed a full 
meal for years, is suddenly seized with acute asthenic 
pneumonia, agonizing pain in the side, full bounding pulse, 
intense headache, difficult breathing, with a sense of weight 
and oppression in the chest, nausea and vomiting, what 
must we do ? Give brandy and food ? Can he digest it 
even if he can retain it upon his stomach ? Can any sane 
man say that nutrition can be accomplished in the condition 
of that man’s system ? On the other hand, is it not known 
as positively as any thing in medicine can be, that a free 
bleeding has relieved this condition of things, in some 
instances, as if by magic, more slowly but surely in others ? 
Are not cases of this kind cut short by antiphlogistic treat- 
ment ? Is not human life saved by such means ? Let the 
great lights of medicine answer. Says Andral [Cours de 
Pathologic Intern, Tome 11, p. 31—Paris, 1848.]—“ For 
many centuries the treament of pneumonia has been nearly 
the same, and it may be and has only varied in degree. 
Blood-letting has constituted its basis. The advantages 
which it here produces is much more direct than in other 
inflammations, for in diminishing the quantity of blood 
traversing the lung in a given time, it diminishes the activity 
of its functions—a result which must assist in the most 
efficacious manner in the cure of pneumonia.” “ Yencsec- 41 
tion is the method to which we ougiit principally to liavo 
recourse. This especially at the commencement of pneumonia, 
when the lung is only engorged that a copious bleeding often 
suffices to remove the disease. It is then a heroic means 
whose advantages can be rarely appreciated in hosjDitals, 
where the patient only arrives some time after the invasion, 
but which, in civil practice, cannot be too highly recom- 
mended. Sometimes bleeding does not remove the disease, 
still it is not less happy in its results. As the blood flows, 
the patient feels his respiration less obstructed, expectora- 
tion becomes easier, the sputa less viscid and less rusty. 
Then the pneumonia resumes its course, and, if the bleeding 
is repeated, a new amelioration results.” 
Valleit sums up the use of bleeding in a few words, and as 
follows: “ If the pulse is strong, full and hard, bleeding 
ought to be insisted upon ; if it, on the contrary, becomes 
feeble, small and contracted venesection should be re- 
nounced.” 
Louis, who certainly cannot be accused of any undue bias 
towards the antiphlogistic treatment, thus sums up his 
observations : 1st. That blood-letting has a happy influence 
in the march of pneumonia; that it shortens its duration, 
but that this influence is much less than usually imagined ; 
that the patients who are bled in the first few days recover, 
all other things being equal, four or live days sooner than 
those who are bled afterwards. 2nd. That pneumonia 
cannot be jugulated by means of bleeding, unless it is in the 
first days of the disease. 3rd. That tartar emetic given in 
haute dose when bleeding, appears to have no influence, and, 
therefore, the cases are grave—has a favorable action and 
appears to diminish the mortality.” 
Lsennec, whose nice ear followed the increase and sub- 
sidence of pneumonia, says : “ I treated, in 1824, at the 
clinic of the Faculty, with tartar emetic, twenty-eight cases of 
pneumonia, either simple or complicated by slight pleuritic 
effusion. All the patients were cured except a cachectic 
septuagenary, who had already fallen into senile dementia, 
and who took but little antimony because he supported it 
badly, yet, nevertheless, the most of these cases were very 
crave.” 
No little of this antagonism of doctrine and practice seems 
to arise from the fact that the opposing parties are speaking 
of two different things—one seems to be writing of sthenic 
and the other of asthenic pneumonia—diseases as far apart 
as the antipodes. The reaction in the one case is vigorous— 
in the other weak. They require, of course, opposite 42 
methods of treatment. The disagreement, moreover, some- 
times arises from the fact, too often disregarded, that in 
malarious districts a form of disease is recognized of which 
malaria is an important element—a disease arising not so 
much from deficiency or redundancy of blood as from 
poisoned blood, which deranging the forces regulating the 
circulation of the part, gives rise to hyperemia and inflam- 
mation. In this disease, bleeding can only be moderately 
employed with safety, and then in the exacerbation. Nor 
does it, like all other malarial diseases, bear alcoholic 
stimuli well, as is well known to practitioners in malarial 
regions, but is mainly controlled by a remedy which, though 
sedative in largo doses, has an action sui generis in removing 
the local determinations and arresting the course of the 
febrile malady, of which they are the local expression. 
But this new party, as they term themselves, though their 
doctrines are as old as Arabian medicine, are not content 
with advocating their treatment as applicable to the diseases 
of the present. They desire to cast odium upon the past 
history of therapeutics, thinking thereby to glorify them- 
selves. According to their views, disease has never changed 
in the character of its reaction, and never will; that inflam- 
mation is always, and ever will be, the same,—a position 
totally untenable as regards the past, and merely hypotheti- 
cal in reference to the future. It need not excite surprise, if 
in a few years, they are found advocating bleeding, tartar 
emetic and calomel. They certainly must, if the pulse again 
becomes full, hard, bounding and resistant as described by 
the old authors quoted : Note it is soft, compressible, contracted 
and frequent. 
But in claiming that the recovery of their patients is due 
to nutriment, they forget that in the first stage of acute 
internal inflammation, nutrition is impossible. The patient 
loathes food, and, if it is forced upon him, his stomach cannot 
digest it, and it remains there a foreign body, or is rejected 
by vomiting. The very fact that digestion returns after- 
wards, is a proof of convalescence, not of cure induced by it. 
When healthy appetite returns, disease is fleeing, and the 
capacity for nutrition is a consequence, not a cause of the 
recovery of the patient. In how many cases of acute internal 
inflammation can you succeod, in inducing the patient to 
take food or even stimulants, without marked aversion if not 
rejection ? Nearly all fevers and inflammations commence 
with nausea and vomiting, furred tongue, anorexia, more or 
less epigastric tenderness, constipation or unhealthy stools ; 
the secretions are arrested, diminished or prevented, the 43 
gastric fluids especially, thus rendering assimilation difficult 
or impossible. Do not these facts annihilate the theory of 
the stuffing and stimulating treatment? Does not the 
physiology of digestion combine with the enlightened 
experience in disease of every unprejudiced physician in 
announcing the falsity of the doctrines of this so-called new 
party ? Do not physiology and pathology unite with 
therapeutics and medical experience everywhere in over- 
whelming Dr. Norcom’s misapplied strength of alimentation 
and stimulation in acute internal inflammation ? True, the 
period arrives under all methods of treatment, or under none 
at all, when the patient requires nourishment. Then, also, 
does he, as a general rule, desire it. But I repel the 
tation upon the great men of our profession in the past, that 
they starved their patients, and did not have sense enough 
to recognize the importance of “ support,” when the proper 
time came for it. That physician must indeed have read 
the past records of medicine with but little profit who has 
not found that all judicious men seized with avidity the first 
opportunity for building up their patients, when the proper 
period came. Although bleeding, &c., may have been the 
main remedy, yet they prescribed it under certain wise rules, 
diminishing it, suspending it, and even rejecting it altogether, 
when circumstances of age, climate, country, locality, consti- 
tution, complications and anterior conditions were opposed 
to it. The change in the character of disease bearing the 
same name, is recognized by the great masters at every 
period in the history of medicine, and their treatment was 
varied according to circumstances. In epidemics of acute 
fever and inflammation of an asthenic character, bleeding 
was renounced by physicians a thousand years ago, and a 
corresponding medication adopted. History denies the 
right of any one to pronounce it new, and repudiates those 
who novr claim credit for originality. 
The fear of bleeding has become a 'phobia of the day. 
As before intimated, swarms of young medical graduates 
come forth every Spring, from Northern Medical Colleges, to 
settle in this Southern land, their minds filled with prejudice 
at their institutions against venesection, calomel, &c., and 
boasting of the superior remedies of alimentation and 
stimulation in the treatment of our Southorn fevers and 
inflammations. It is time for the South to ask whether duty 
to science and to ourselves does not require a change in this 
respect—whether we should not cease to patronize medical 
heresies and to seek to turn the tide of medical pupilage to 
our own languishing schools, whose professors, not less able 44 
nor skilful than tho ablest of tho North, teach doctrines 
generally more in unison with the laws of Southern diseases 
and the experience and practice of enlightened Southern 
practitioners. Under the constant influence of these false 
teachings, and such like causes, it has so much become the 
fashion not to bleed, that cases imperatively demanding it 
often suffer and die from its neglect. Men d© not die so 
easily from a small loss of blood as these terror-stricken 
alarmists imagine. Look how many cases of protracted 
typhoid fever began to improve after copious hemorrhages 
from the nose and bowels! Every day we see spontaneous 
hemorrhage improving the condition of patients, even those 
suffering from tubercular consumption. Every fall, during 
the prevalence * of those high congestive fevers of malarial 
character that are every sickly season, more or less com- 
mon in these eastern counties, do I meet with cerebral 
congestion relieving itself by hemorrhage from the nose, 
when proper depletion has been neglected in the outset, and 
without which depletion or spontaneous hemorrhage death 
would have resulted. 
In regard to the expedient method of treating disease, or 
what amounts to the same thing, Dr. Noreom’s plan of 
treating acute internal inflammation, there is every reason 
to believe that this was the first plan adopted in the infancy 
of the art or even before art existed. Men of course were led 
to seek for remedies because of the results of non-treatment. If 
the poioers of nature alone had been found efficient to control 
and cure disease, of course no one would have ivislied for more. 
But it must have been because this- was not the case ; it must- 
have been owing to the fearful and fatal results of disease 
when left to the unaided powers of nature that men eagerly 
sought for remedies. Therefore the animal, vegetable and 
mineral kingdoms were diligently explored to find relief from 
pain and protection from death. 
It is fashionable to- talk about a neglect of the study of the 
Natural History of disease being prevalent, but from the 
commencement of medicine this has been the object of the 
greatest physicians, from Hippocrates down to Louis. 
What better or more numerous examples could have been 
wanting than in the thousands of patients placed upon the 
gum water treatment of Brouissais and the wholly do-nothing 
treatment of Hahnemann! And yet what rational, scientific 
man of the present day is content with the results of their 
treatment? What admirable pictures of the Natural History 
of diseases were given by Hippocrates, is attested by every 
author who has perused his works. What masterly delinea- 45 
tions of the same were given by Celsus Aretieus, and Gtilen, 
and in our day who complains of the clinical histories of 
disease as given by Louis, Andral and Trousseau ? In cases 
of pneumonia we have seen that Hippocrates first used 
simple fomentations before bleeding. Was not this great 
man able to discover the relative value of expectation and 
venesection? Did it require a greater genius than his to 
determine such a plain matter ? It was clearly because men 
were appalled at the view of the Natural History of Disease, 
and the fatal results of inaction that they were induced to 
look for remedies. Moderate bleedings were often tried and 
failed, when subsequently copious bleedings were attended 
with manifest good results. We haw clear examples of this 
fact in the case of Clegliorn, army Surgeon and lecturer of 
anatomy in the Universy of Dublin, in his universally 
admired and classic treatise on the Diseases of Minorca. He 
says : “ When these Pleurisies first became epidemic their 
quick Progress and uncommon mortality surprised me 
greatly. I attempted to cure them by bleeding once or 
twice a Day if the Complaint were violent, as I had always 
used to do in Inflammatory Fevers. But the Remissions in 
the mornings sometimes induced me to omit the operation, 
and the Cessation of the symptoms, which generally hap- 
pened about the third day, made me imagine the Danger was 
over. So that before the Patients were blooded above Twice 
or three Times, the Exacerbation came on upon the fourth or 
fifth Days, and defeated all attempts by Bleeding, Blistering, 
or otherwise to relieve them. 
“ These unforeseen Events startled me greatly, and led me 
again to review the whole Progress oi the Disease, its Symp- 
toms and Issue. I had observed that some escaped by means 
of Expectoration and purulent Urine without much assistance 
from Phlebotomy; and, considering the periodical Revolution 
of the Fever, the quick Transition of the stitches, from one 
Part to another, together with the prevailing Color of the 
Blood as well as that of the Spitting and other Excretions, I 
■was apprehensive that these w~ere what Authors call bilious 
Pleurisies, which they alledge are exasperated by large 
Evacuations, particularly Duretius who exclaims with great 
vehemence against those Physicians who trust principally to 
Bleeding in the cure of these Diseases without waiting for 
the natural Evacuations. These motives induced me to use 
the Lancet with more caution, and to rely chiefly on the 
speedy Application of Blisters for restraining the Symptoms. 
But this management proved less successful ban the 
former, and I was convinced in a short time that instead of 46 
too much, too little Blood had been taken away in the 
beginning, having been sometimes misled by the insidious 
Intervals of the Disease, at others having trusted too much 
to the faint Attempts which Nature made to relieve herself by 
Expectoration and Urine, the latter, after becoming crude on 
the fourth day as the Delirium advanced, though it had 
promised favorably on the second or third, the former 
frequently being checked about that Period of the Disease by 
the immoderate Heat of the Lungs, rendering the matter 
viscid, globular and not to be discharged but with the utmost 
difficulty. I then began to bleed more plentifully, and 
repeated it so as to take away thirty or forty ounces within 
the three first days of the Distemper; and endeavoured by 
bathing the legs and blistering them on the third Day to 
prevent the fatal symptoms from coming on about the fourth 
or fifth, giving Nitre at the same Time liberally and Camphire 
in small Doses to promote the thinner Secretions. This 
method succeeded well in several cases—Expectoration and 
Urine being thereby increased,” 
This treatment, however, did not satisfy this eminent 
practitioner, and he at last adopted the following, as given 
in his own words: If I was called, for Example in the 
morning, the patient was immediately laid in a horizontal 
position and bled at the Arm until his pains abated or he 
began to faint, neither of which commonly happened before 
sixteen, twenty, or twenty-four ounces were taken away. 
If the Symptoms continued, I ordered about the same 
quantity to be taken from the other Arm in the Afternoon 
without regarding the urine. Expectoration or Appearances 
of the Blood, next Morning, though there might be a great 
Alteration for the better, vet if there was the least room to 
suspect that any Obstruction remained in the Head or Breast, 
the Bleeding was repeated. And, by carefully weighing the 
Blood, I found that between forty-eight and fifty-four 
Ounces were frequently taken away the first four and twenty 
Hours of my Attendance. This sudden, copious Evacuation 
commonly produced a cessation of all violent Symptoms, 
and afforded an Opportunity to give an antiphlogistic Purge 
the next day. But if the Symptoms did not cease, or if the 
Pains and difficulty of Breathing returned the day after the 
Purge had been given, or if there was room to suspect from 
the Head-aclie, Giddiness, Tingling of the Ears and disturbed 
Best that the Brain was in danger of being affected, I had 
again immediate Becourse to Bleeding, taking away at 
different Times to the amount of t-welve, eighteen, or twenty- 
four Ounces in the space of a day, cither by the Lancet or 47 
Cupping glasses or both, as occasion required; by which 
means the impending Storm was happily averted, and as 
soon as the Commotions were quelled the Purgative repeated 
every other Day for three times unless somo of the critical 
Evacuations appeared with such visible good effects as 
rendered it unnecessary. In this manner I found with 
Sydenham that Pleurisies of the most fatal Tendency might 
be happily cured in the space of a few days, and with as 
much certainty as any Distemper whatever. And it was no 
less remarkable to observe how quickly the Sick recovered 
their usual Health and Strength notwithstanding the great 
loss of Blood they had sustained, while many who had been 
bled more sparingly, continued in a languid, infirm state for 
month, without being able to get rid of the Cough and Pains 
in the Breast.”—(Third London Edition, 1768. The Extract 
is verbatim, the initial letters of the names being printed in 
Capitals in the old English Text, as it now continues to be 
in the German.) 
Dr. Norcom denies (page 25 of his address) that there lias 
been any change of type in disease. He cannot be a reliable 
witness in the trial of this important cause as the change 
occurred before he began to practice. What physician of 
acute observation, and who has grown gray in 'medical 
service, does not know that Dr. Norcom is in error ? Who 
that is conversant with the History of Medicine can deny 
the fact of this change ? Is not an ordinary autumnal Fever 
less severe in character and of shorter duration than 
formerly ? Where is the respectable' syphilographer who 
will deny that syphilis is a njild disease compared to that of 
former days? The same may be said of Small-Pox. Is it 
not well known that even Asiatic Cholera is much more fatal 
at particular times than at others, as proven by statistics ? 
Does not every respectable author on the subject know that 
Yellow Fever is sometimes a very benignant, and at other 
times a very malignant disease ? Of the latter, witness the 
epidemic at Norfolk and Portsmouth, which defied all treat- 
ment, which baffled the skill of the illustrious Warren Stone 
as well as others of the most distinguished physicians of 
New Orleans, Savannah, Mobile and Charleston, as com- 
pletely as it did the efforts of the merest tyro of the profession. 
Does not the habitual endemic of this and of Dr. Norcom’s 
own region assume various types and degrees of violence ? 
Most readily will the practitioners of twenty-five years 
experience in all our malarial regions answer this question 
in the affirmative. Do we not see it in some seasons 
attended with a short cold stage and prompt vigorous 48 
reaction, and in others ushered in with a cold stage of days 
duration and followed by imperfect reaction? Does it not 
assume the intermittent, remittent and continued forms? 
Do "we not meet in some malarial seasons more than at 
others with that high and alarming grade of cerebral conges- 
tion, attended with that condition of pulse so apt to mislead 
and deceive the unwary and inexperienced, and cause the 
medical attendant perhaps to neglect the golden opportunity 
for rescuing and saving his patient by bold and decided 
treatment ? That physician who lives in these eastern 
counties and does not admit this and such as this, will do 
well to commence and learn over again the alphabet of his 
Art, or begin it for the first time. Was not the pulse of the 
pleurisies and pneumonias of former days as described by 
the great masters of medicine hard, full and resisting ? 
Would they have continued to bleed if the lowering treat- 
ment had been attended with such deplorable results as 
described by Dr. Norcom. Authors who wrote on pneumonia 
twenty-five or thirty years ago, describe the pulse as either 
hard or full and resisting and bearing venesection well. Did 
not Cullen, Sydenham, Boerha'ave, Chornel and Andral, and 
hosts of other observers and writers in ancient and modern 
times, have as keen perception of the results of treatment as 
Bennett, Todd and Company ? To ask these questions is to 
answer them. Let Dr. Norcom observe as intelligently and 
closely and laboriously as these men, and his reputation is 
made. They were no idlers nor dreamers, but practical, 
sagacious, acute observers, whose pictures of disease 'will 
forever be esteemed as master pieces, for they were ,drawrn 
from Nature. 
Diseases are not units. Tlie same disease undergoes 
radical changes. Change is written over the pages of 
creation. It is a part of the sublime S}rstem of our Heavenly 
Father for governing the Universe and disposing of events. 
The changing seasons, and all that pertains to the heavens 
above and the earth below proclaim this wisely ordained 
and universal law of Nature. The science and art of our own 
profession, as attested by its records, makes no exemption to 
the law. It teaches the true physician not alone to look at 
the name of disease, or its anatomical seat, but also at the 
patient as influenced by age, sex, temperament, diathesis, 
idiosyncrasy, climate, locality and seasons. He does not 
bleed all his patients or starve them all, or stimulate them 
all, but is guided by the actual condition of the patient at 
the time of prescribing. He varies his treatment according 
to circumstances, and is not overruled in his judgment by 49 
any exclusive theory or blind adherence to authority. God, 
as a general rule, has given every man the capacity to judge for 
himself as well as to receive ideas from others, and he is an 
unprofitable servant ivho does not make use of it. 
The authorities in favor of the change of type theory of 
disease are almost innumerable and their arguments are 
Unanswerable and overwhelming. It would be a work of 
supererogation on an occasion like this, and an unprofitable 
consumption of your valuable time to array, before you the 
hosts of medical philosophers and able and successful prac- 
titioners, who bear -willing testimony to its truth. Among 
those who have presented the subject in its clearest and most 
convincing light, and whose arguments are most conclusive 
may be named the distinguished Dr. Aitkin, the able author 
of the Science and Practice of Medicine, in volume first, page 
one hundred and thirty-nine and following. I will, in addi- 
tion, cite the testimony of a former practitioner of our own 
State, now a prominent physician of Baltimore and well 
known to this Society as one of the able Professors of the 
Faculty of Medicine in the University of Maryland. I alludo 
to Professor William T. Howard. In a controversy with 
another eminent medical gentleman formerly of our State 
also, but now a leading physician of Richmond and one of 
the most distinguished Professors in the Richmond Medical 
College—Professor Otis F. Manson. Professor Howard, in 
an article published several years ago in the North Carolina 
Medical Journal, remarked as follows: “ Since the time of 
Hippocrates, blood-letting has been regarded by a multitude 
of physicians as the remedium magnum in pneumonia—to be 
used with proper discrimination and judgment; and during 
all this lengthened period, observing and reflecting men have 
practised it largely, moderately, or refrained from it entirely,, 
according to the status of the vital forces in each individual 
case. Like everything else, however, blood-letting has been 
used in every age to great excess; and it has often happened' 
that a profuse and preposterous expenditure of the vital fluid'* 
has driven some, who witnessed its destructive effects thus 
practised into the opposite extreme, of abandoning it alto- 
gether. Every one knowrs, that within a few years past, a 
great change has taken place in the treatment of inflammatory 
diseases, especially in the practice of bleeding; and that,, 
although formerly it was the rule to bleed in such affections, 
it has now become the exception and is rarely resorted to. 
This change in practice, admitted on all hands, has been 
differently accounted for by different observers. We have, 
first, Professor J. Hughes Bennett and his party contending 50 
that the great revolution in treatment has resulted naturally 
from the great advances made in modern times in diagnosis 
and pathology. Secondly, The late Professor Alison and 
his party contending that the type of disease having changed 
from a sthenic to an asthenic character, the practice has 
very properly changed accordingly; and third, Doctor 
Balfour and his party contending that the change has 
originated from neither of these circumstances, but has been 
forced on all alike by the results of a successful empiricism. 
Although the controversy involves the treatment of inflamma- 
tion in general, yet, practically, it has turned almost entirely 
on the treatment of pneumonia by blood-letting.” 
It is beside our purpose to discuss these questions here. 
“ Suffice it to say that with Kennedy we believe that both 
animal and vegetable life is subject at times to epidemic 
influences, which at oho period raise and at another depress 
the standard of health; that pneumonia, like fever, alters its 
type at certain times, and that no single plan of treatment 
can, therefore, possibly meet the ever Varying shades of 
disease, pneumonia among the rest; or, as Watson has 
expressed it, we are fully persuaded both by our own obser- 
vation and the records of medicine that there are waves of 
time through which the sthenic and asthenic characters of 
disease prevail in succession ; and that we are at present 
living amid one of its adynamic phases.”—(N. C. Medical 
Journal, March 1860. 
Again : At the same time Professor Howard continues, as 
follows, after comparing the results of twenty-four cases 
of pneumonia treated by M. Grisolle, in eleven of which 
bleeding Avas not employed, and in thirteen of the number it 
was used : “ It seems to mo that no one can compare these 
tAvo series of cases together without admitting the efficacy of 
blood-letting on those in which it was employed. Having so 
often Avitnessed in suitable cases the influence of bleeding in 
reducing the force and frequency of the pulse, in diminishing 
the heat of the skin and rendering it moist, relieving 
delirium, calming restlessness, relieving head ache, lessening 
dyspnoea, and removing or greatly moderating the pain in 
pneumonia, for us to doubt its utility would be wholly to 
discredit the evidence of our own senses.” 
Dr. Nor com publishes liis Reform doctrines after and not 
before the Reformation. Why denounce with such noisy 
clamor the antiphlogistic treatment, and especially blood- 
letting, when it is so sparingly used, and I may say timidly 
employed by the great mass of the profession now, and lias 
been almost abandoned by a great majority of physicians ? 51 
As evidence of this change and of a correct appreciation of 
this reactive stage of disease, I may refer to its general 
recognition by those who commenced their career years 
before Dr. Norcom commenced his. Well do I remember 
my early recognition of this important medical truth and of 
my corresponding shape of treatment. Let us refer to high 
authority in the profession of this and of other States in 
corroboration of this statement. 
Professor Manson, already referred to, and recognized by 
this Society as one of the ablest and most accomplished 
physicians of the whole country, makes the following state- 
ments in a communication to the Stethoscope and Virginia 
Medical Gazette of February, 1851: “Called to a patient in 
the exacerbations of remittent fever, venesection is practised 
in every case where tho pulse will justify it, but it is rarely 
that this is called for. In fact the general experience of myself 
and confreres is adverse to the use of the lancet in this affec- 
tion. The pulse, though often full and apparently tense, is 
generally compressible. Local bleeding by cups and leeches 
will usually be sufficient, and if there is tenderness on 
abdominal pressure or other symptoms of visceral complica- 
tion these should be freely applied. Should symptoms of 
cerebral irritation be present, a copious flow of blood will be 
obtained by cups to the mastoidal regions.” 
In an article on malarial pneumonia, published in our 
Transactions for the year 1857, and written for the Society 
by the same careful observer, he says : that “ the pulse which 
had been very frequent and contracted in the chill becomes 
expanded, acquires force, and sometimes, though rarely, 
becomes full or tense. The term compressible applies to the 
usual condition of pulse and the idea entertained on its 
careful examination is that the heart is acting with only a 
seeming force and not with real vigor.” When speaking of 
the treatment, he remarks as follows : “If the pulse is hard, 
full or tense, as it is in rare and exceptional cases, or if tho 
patient is robust or previously healthy and possessing 
ordinary vigor, and the pain or dyspnoea is very intense and 
the character of the pulse or other symptoms do not decid- 
edly contraindicate its employment, then a moderate quantity 
of blood may be taken from the arm. In this disease 
general blood-letting should be employed with a view only to 
moderate and not with an expectation to cut short tho disease; 
nor should it be employed except in the instances referred 
to. In cases where this is not followed by marked relief, 
and in those where venesection is inadmissible, the local 
abstraction of blood by cups or leeches should be resorted to 52 
and may be used as freely as considerations of safety will 
permit. The time at which bleeding by any mode should be 
practised, is that period when the exacerbation has reached 
its acme, which is almost invariably in the afternoon or 
evening.” 
These and other extracts that might be given from other 
authors show how careful blood-letting was used twenty 
years ago, when but few, if any of us, who were then coming 
upon the stage of action had ever heard of the doctrines of 
Bennett, Todd & Co. 
As to the employment of the expectant treatment, and the 
use of stimulants in malarial fevers, and their complications 
—the endemic affections of Dr. Norcom’s own immediate 
region—I feel authorized to warn the practitioner against 
the habitual application of such practice. Except as a tem- 
porary means of support after these fevers have been broken 
up, or as an auxiliary in sustaining the vital forces in some 
cases of neglected treatment, while other efforts are being 
made to induce the action upon the system of more curative 
remedies, I do not believe there can be found a single expe- 
rienced and judicious practitioner who will uphold the gene- 
ral employment of stimulants, even in those cases in which, 
from the very outset, there is prostration of the vital pow- 
ers. If a physician gives brandy in the cold stage of con- 
gestive fever, it will end fatally in a large majority of 
cases; and, as to alimentation in *the cold or hot stage, 
that is but little less than preposterous. Rather ’do I agree 
with the lamented Dr. Drake, so justly regarded in his 
day as the Nestor of the profession in the Northwestern States. 
Guided not only by his own observation, but by that of near- 
ly every physician of note from the Great Lakes to the Gulf 
of Mexico, we have his high authority against the use of 
stimulants in these instances. In his celebrated work on the 
“Diseases of the Interior Yalley of North America,” second 
series, he remarks, page 86,in treating of “ internal stimu- 
lents ” in “ malignant Intermittent Fevers,” that “ almost 
every kind of excitant and norcotico-stimulant has been ad- 
ministered internally in the cold stage. In this stage of the 
paroxysm of malignant intermittent fever, wrine, brandy, 
whisky, and other alcoholic drinks have been liberally given ; 
but the results have not been such as to commend them. 
They probably act upon the brain unfavorablv.” 
I have seen patients in the protracted cold stage of remit- 
tent fever, with clay-cold skin and feeble pulse, become colder 
and colder under the influence of stimulants. When reaction 
followed their use I have seen them die in apopletic convul- 53 
sions. Were we to be guided by any a priori theory, de- 
duced from physiology, in our treatment of malarial fever, 
we should certainly expect stimulants to be useful in those 
cases where the vital powers "were prostrate and the pulse 
flagging; but every sensible practitioner is perfectly aware 
that they are either generally inert or hazardous. If the young 
men coming into practice in the malarious regions of North 
Carolina, depend upon stimulants and alimentation in tho 
treatment of Periodical Fevers, they will soon be compelled, 
like the followers of Jack o’ Lantern, to find themselves in a 
bog, and their patients in premature graves. 
Other vulnerable points in Dr. Norcom’s Address consist 
in liis omission to make any distinction in his views as to the 
sthenic and asthenic states in inflammation. We look in 
vain for an exposition of his sentiments as to the treatment 
of many of our every-day acute diseases. How would he 
treat cholera infantum, comatose remittent fever, or Asiatic 
cholera? Would he bring to bear his batteries of food and 
brandy ? How long would his patients live under such 
treatment ? How would he treat acute gastritis, entiritis, 
nephritis, or cystitis ? With food and brandy ? Would not 
the grave soon claim and receive them under such manage- 
ment ? How would he treat iritis or retinitis ? With food 
and brandy ? How long would his patient be able to grope 
his way out of perpetual darkness ? Why should Dr. Nor- 
com, at this late day, declaim against wholesale blood-letting 
and the abuse of calomel and antimony, as such treatment 
had been abandoned before he graduated by every correct 
medical thinker and accurate observer ? Let him take heed, 
clever man as he is, that he does not allow himself to be 
ranked among that too numerous class of the present day, 
who set up men of straw for the glory of knocking them 
down. Is he aware that his onslaughts upon anti-plogistic 
remedies contain unmerited strictures upon the practice of 
his own honored and lamented father, Dr. James Norcom? 
He, too, resided in Edenton, in this State, was a gentleman 
of profound erudition and high accomplishments, and one of 
the most distinguished physicians in the whole country, as 
he certainly wras one of the most successful practitioners. I 
cherish a peculiar pride and gratification in the belief that 
at, and for many years prior to, his death, he was at the head 
of the profession in North Carolina. What w'ere his views of 
disease before the rolling in upon us of the “ adynamic 
waves of the change of type?” Listen to what he says in 
some “ Observations on the Influenza, as it appeared at 
Edenton, N. C.,” in a letter to Dr. Rush, of Philadelphia* 54 
published in the Philadelphia Medical Museum in 1808, vol- 
ume five, page 118. “ Since I returned to North Carolina I 
have been engaged in business with Dr. Sawyer, and have 
had a respectable practice, and enjoyed a greater degree of 
success than I ever before experienced. In the Influenza, 
which prevailed here from the last of September until the 
beginning of the year, I hardly lost a patient. The disease, 
in its form and character, resembled very nearly that which 
you have described in your Medical Inquiries. It was uni- 
versally inflammatory and uniformly yielded to depletion. 
“ There appeared to mo to be in the course of the season a 
greater proportion of cases with pulmonary determination 
than is common, and some of the most inflammatory I ever 
saw. One patient I bled seven times largely in forty-eight 
hours, and another three times in eight hours. The event in 
both cases was favorable. It was my happy lot to be instru- 
mental in saving the life of an amiable woman through 
a series of relapses by, I am sure, not less than fifty bleedings. 
Bleeding, I found, in all cases of violence, an antidote to the 
disease, and in milder cases less direct and less active evac- 
uants never failed to cure. 
“ The most fatal consequences of the fever, when it was 
not properly treated or speedily cured, wore dropsy and 
consumption. Few of these have fallen to my share for a 
reason I have assigned already. In the dropsies that have 
occurred within my observation, my practice has been 
happy. The lancet, purging, nitre and sage tea, cream 
of tartar and mercury, have been my remedies. And in con- 
sumption I have cured and relieved more patients than 
I over saw cured, according to the number I have attended. 
My remedies have been the lancet, opium, camphor, hore- 
liound and salivation.” Thus do we introduce against Dr. 
Norcom, and in favor of the change of type theory, not alone 
the conclusive and overpowering testimony of his own dear 
father, but we could go on and pile authority upon authority, 
equally strong and convincing, in support of the positions we 
have taken in this paper. We have introduced our wit- 
nesses, not to advocate the propriety of their practice at this 
day—for, were they now in practice, they would make it cor- 
respond to the indications of the prevailing character of the 
diseaso—but our main object is to show how idle are 
the fears of those who condemn moderate and judicious 
venesection. 
Iii relation to the general character of Inflammation, 
Dr. In or com seems to differ in his views with those of 
standard authors and the ablest writers. Assuming that it is 65 
unnecessary to diminish the amount of blood in an inflamed 
tissue, he asks : “ Can general blood-letting diminish the 
amount of blood in an inflamed part ?” In inflammatory 
action of the contents of the three great cavities of the head, 
chest and abdomen, it is found, according to high authority, 
that blood-letting not only diminishes the quantity of blood 
circulating in the vessels, but at the same time calms 
the turbulent action of the heart and arteries. It is admit- 
ted that in external inflammation, so liable to be diffused, the 
lancet should be used with great caution, lest by too free 
a detraction of blood the constitutional symptoms already 
existing may be converted into fever of a different type or 
character. Blood-letting in internal inflammations not only 
diminishes the mass of circulating fluids, but is advantageous 
in the inflammation of external parts by drawing blood Irom 
the larger vessels going fmore immediately to, or returning 
from, these parts. It is here that the salutary influence 
of venesection is sure, and docs not act, as Dr. Norcom 
insists, by materially weakening the force of the heart’s 
action. A true interpreter of vital phenomena, a judicious 
observer, a stranger to the exactions of mere party systems, 
and unseduced by the subtleties of the schools, clearly 
understands that, when the excitability of the sanguineous 
system is carried to a very high degree, blood-letting not 
only diminishes the amount of Rood, but in other respects 
proves highly beneficial. His assertion that during in- 
flammation the vessels lose their contractile power, and 
are distended with blood, and that stasis, owing to adhesive- 
ness of the corpuscles, occurs, and is followed by exuda- 
tion, will not be accepted. The vessels do not lose their con- 
tractile power from this cause, but during inflammation, the 
blood ceases to undergo its changes to the proper extent 
from arterial into venous, and the functions of nutrition and 
secretion are to a very great extent suspended. On tho 
inner surface of the walls of the dilated vessels colorless 
corpuscles are said to collect sometimes ; but there are no 
new formations called forth by this change—they already 
exist in the blood, and when the velocity of the current 
is materially increased they mingle with the red corpus- 
cles, and are carried along with them. It is not established 
that stasis is followed by exudation, for the reason that 
new canals are formed by globules of blood bursting through 
the sides of a vessel, and forcing a passage for them- 
selves through the cellular texture into another vessel. A 
considerable number of new canals are sometimes formed by 
this process of nature through which the blood continues to p* * 
circulate. It is surely not rational or philosophic to apply 
to these varied phenomena any other hypothesis than the 
one of increased or diminished action. It appears also in- 
correct to describe vessels which performed their functions 
efficiently during health, as affected with direct debility 
because they are unable to perform double their usual labor 
with equal efficiency in disease. It cannot be denied that, 
unless under peculiar circumstances—forming exceptions to 
the general rule—the action of the vessels is at first greatly 
and powerfully increased; and it is only when they become 
clogged and over-distended by an excess of blood, and that, 
too, thinner and more fluid than that which they contain in 
health, which being no longer able to contract, become 
passive ; but it is not occasioned in consequence of injury to 
the vaso motor nerves of the part as, he contends. Adhesive- 
ness of the corpuscles cannot, therefore, be correctly admit- 
ted as the cause of the distension of the vessels—'thereby 
causing debility—since we only perceive this to occur as a 
secondary effect. Weak and relaxed vessels are themselves 
susceptible of increased action, and often in a much greater 
degree than vessels in an opposite state; for it is well known 
that constitutions in which the fibre is lax and delicate are 
generally characterized by a much higher degree of mobility 
and irritability, and are much more predisposed to inflamma- 
tion than constitutions endowed with a more firm and rigid 
texture of the solids. While delicate and sensitive vessels 
are easily roused into excessive action, they are less able to 
sustain it, and are, therefore, more readily overcome by the 
increased flow of blood, and more quickly affected with 
inflammation. 
Nor will Dr. Norcom, in the assumption that there is no 
direct anastomosis between the surface vessels and the 
inflamed part, and therefore that cupping in inflammation 
is not profitable, secure the concurrence of his professional 
brethren. Let us see how this is. When a stimulus is 
applied to a living part, the first effect produced is an excite- 
ment of the sensibility of the part and a consequent degree 
of pain. The necessary result of this morbid excitement of 
the sensibility and contractility of the vessels is a more rapid 
fiow of blood to the part, which acting as a stimulant tends 
still more to quicken the circulation. There is, consequently, 
a considerable influx of blood in all the vessels, capillaries 
and veins, to the amount of double the usual quantity. This 
is precisely the action which takes place in inflammations— 
the surface vessels in most cases anastomosing with those of 
the inflamed part. His opposition, therefore, to cupping rrr 
o7 
Cannot be sustained, and is founded upon an anatomical 
error, in part, because, while it is in some parts of the sur- 
face true, that the vessels from which the blood is withdrawn 
have no anatomical connexion with those inflamed beneath, 
it is equally untrue as respects other parts. In all these 
cases of cupping, howrever, let it not be forgotten, whether 
there is or is not any direct anastomosis, that there is a 
sympathy existing through the great organic nervous centres, 
between the outer and inner surface or organ, by which any 
impression made upon the former is communicated to the 
latter. Herein consists a conservative law of useful results- 
that the experience of every enlightened practitioner must 
have observed.* It is recognized in the fact that, amid all the 
fluctuations of general blood-letting, the local abstraction by 
leeching and cupping has maintained its ground with more 
consistent uniformity. Local bleeding is an invaluable 
remedy under various circumstances of disease. When there 
is not much general excitement, but troublesome local con- 
gestion or inflammation; in other cases when general 
depletion has reduced the fullness of the pulse and moving 
forces of the blood with still a co-existent local inflammation ; 
and again, wliero the reasons for and against the use of the 
lancet are so equal that it is difficult to determine as to its 
use, as in many cases of fever attended with inflammations; 
in these and similar circumstances we can often use cupping 
with the happiest results, even restoring health and saving 
life thereby in certain cases. No one conversant with the 
effects of both general and local bleeding will deny, that a 
certain quantity of blood taken from an inflamed part or 
near by, has decidedly more effect on the disease than a like' 
quantity abstracted elsewhere. 
Not more unsparing and persistent have been tlie attacks 
of Todd, Bennett & Co., upon venesection than are their 
denunciations of the various forms of Mercury. If calomel 
deserves one-tliousandth part of the anathemas which these 
and other extremists have so long hurled against its use, 
surely it should long since have been expelled from the 
Materia Medica. After all its ups and downs in professional 
appreciation, the “ much abused Mercury” still maintains its 
stronghold upon the profession. True, it has been more 
sparingly used in the Southern States, within the last twenty- 
five or thirty years, and for the following reasons: The 
prevailing endemic and epidemic diseases wrere, before and 
since that time, of malarial origin, yet the powers of quinine 
CALOMEL. 58 
were not so generally known as now. In the simple inter- 
mittents with a stage of complete apyrexia and in the benign 
forms of remittent fever, in which the remissions were 
decidedly manifest, quinine in small doses was administered 
by physicians generally ; but in the violent cases in which 
the remissions were not evident, and in which symptoms of 
cerebral or gastro-entcric irritation, congestion, and inflam- 
mation, were either singly or unitedly present—in the large 
majority of cases quinine, except by a very few physicians, 
was usually withheld. In these cases, mercury was almost 
universally given. It is well known that the patient was 
usually pronounced “ safe” as soon as ptyalism in the 
slightest degree presented itself. It was objected to the 
mercurial treatment that it was too slow and uncertain in 
the rapid and malignant cases, and was attended with the 
injurious consequences often of ptyalism, nevertheless, the 
mercurial treatment proved highly successful in the hands 
of experienced and judicious practitioners. The malignant 
cases which defied its powers were not so numerous as might 
be supposed, while the evil consequences of mercurialization 
were in many cases exaggerated, the majority of cases soon 
recovering from its effects entirely. Even after the intro- 
duction of the use of large doses of quinine, calomel continued 
to be necessary in completing the cure, and is still regarded 
as a most valuable adjuvant. 
In pneumonia calomel is regarded as a most excellent 
remedy in skilful hands. In all my practice I can, with 
truth, say that I have seen but few cases of pneumonia die 
where the patient was clearly and timely brought under its 
influence. I have also seen its great beneficial influence in 
Dysentery, Diarrhoea, Cholera Infantum, and many others 
of our endemic diseases. The best, the ablest, the most 
successful practitioners of this and every other portion of 
the South have always regarded mercury as a useful and 
most important remedy in our Southern diseases generally. 
In Syphilis, though for a time it fell into some disrepute 
under the opposition of prominent men, yet, it still holds 
its place in the therapeutics of nearly every modern 
Syphylographer. 
Even tlie French, who have the greatest prejudices against 
it of any other people, have been compelled to return to its 
use in true chancre. Ricord still recommends it as the 
principal remedy. It is true that the use of mercury, even 
in moderate quantities, is sometimes attended with unpleas- 
ant and injurious consequences. It is true that the habit 
which too many of our farmers and others still pursue of 59 
keeping calomel in their houses by the pound, and of dealing 
it out to their families* and themselves profusely, even 
sometimes by the teaspoonful, and for almost any and every 
complaint, is highly injurious and amounts to a deplorable 
evil; for, by the disintegration and disorganization of the 
blood frequently induced by such mal-practice, the constitu- 
tions of their children are often undermined and ruined, and 
other bad consequences entailed. But this is the abuse 
and not the proper use of this potent remedy. The same 
can be said of nearly every other active agent in the Materia 
Medica. Opium, Arsenic, Strychnine, Iodine, Chloroform, 
&c., are sometimes not only injurious but fatal in their effects 
in the best of hands. But we are unable to discard them 
until better agents are provided. Of one fact we may be 
fully assured, and that is, neither food or whiskey can ever 
supply the place of calomel or the other remedies in a larger 
majority of cases of disease we are called upon to treat. 
When the soi-distant Modern Kevolutionists in Medicine 
supply us with better remedies than those we have we will 
discard them, and not until then. While I am ready with Dr. 
Norcom to concede it as “ certain that improvements in 
pathology must follow in the wake of an advancing physi- 
ology,” yet, in the face of ail the discoveries and improve- 
ments that have been made in these departments, I utterly 
deny that the treatment of Acute Internal Inflammations 
can be based upon our present knowledge of them. Decry 
empiricism as we may, yet, the knowledge of the great value 
of thereapeutic agents is chiefly due to experience and obser- 
vation. Vaccination, quinine, opium, arsenic, iodine, 
mercury and a host of other remedies—the best ice have 
indeed—were never, and could never have been, indicated or 
dreamed of by physiologists or pathologists. And they will 
continue to be employed by all endowed with common sense 
until greater experience and larger observation have given 
us better. With all our boasted knowledge of Inflammation, 
yet, after all, how little do we really know of its essential 
nature ? Do the microscopic phenomena, as observed in the 
web of the frog’s foot, tell you anything of the specific nature 
of the varieties of inflammation, of the causes or cure ? How 
idle then to attempt to base the art of medicine upon 
Physiology or Pathological Anatomy! They are simply 
accessories—aids—but not the corner stones of Therapeutics. 
Dispute as we will about the modus operandi of medicines, 
yet, quinine still as certainly annihilates malarial diseases, 
opium relieves pain and produces sleep, and mercury cures 
inflammation and syphilis. Tho art of medicine is based 60 
upon the accumulated tacts and observations of ages. Its 
rules and principles are simply derived from these sources. 
Call it empiricism, or what you will, it is the nearest approach 
to Truth bequeathed to us and can never be superseded by 
the Cook and Distiller of the theory of Alimentation and 
Stimulation. It is as irrational to declaim against the use of 
bleeding, mercury and tartar emetic because they are some- 
times injudiciously employed, as it is to denounce food and 
wine and whiskey, because their abuse leads to gout, intem- 
perance, delirium tremens, paralysis and death. 
The high claims set up by the friends of mercury, as to its 
beneficial effects in subduing inflammation and other 
diseases, and its adaptation especially to malarial fevers and 
affections of the liver, are disputed by its opponents. They 
deny it has any cholagogue action, most of them, and will 
not admit the of its absorption into the system. Todd, 
Bennett & Co. are noted for their opposition to calomel in 
those relations, and the boldness of their denial of its reputed 
virtues in inflammatory diseases and in acting upon the 
liver is very injurious to the cause of medical truth, especially 
in the case of many young and inexperienced members of 
the profession. Committees of prominent European medical 
men have been appointed to make special investigations of 
the action of these mercurial preparations upon the human 
system, and to enquire into the important question of their 
absorption. After elaborate enquiries and protracted labors 
directed to a knowledge of the action of mercury upon dogs 
Rnd other inferior animals, and as far as possible upon man, 
embracing the feature of absorption, these gentlemen report- 
ed very unfavorably as to its action and value. It is even 
denied that it is absorbed into the human system, and the 
denial is willingly caught up by the opponents of calomel, 
and they are seeking to get up a greater hue and cry than 
ever before against it. Their experiments upon inferior 
animals are very fine illustrations of their devotion to physi- 
ology, and their fine spun theory as to the impossibility of 
introducing into the system by absorption, or any other 
possible way, globules or particles,, however small or 
minutely reduced, of any preparation of mercury, reads well 
enough on paper, but unfortunately for their reasoning and 
conclusions, are overthrown by innumerable and overwhelm- 
ing facts to the contrary. Let us apply the test of medical 
logic and of scientific induction to this question, and proceed 
to examine it fairlv and clearlv. 
I have often seen under the operation of calomel almost 
apparently pure bile discharged by stool, and often have I 61 
seen bile discharged by vomiting in largo quantities during 
the purgative action of the same mercurial; and how any 
one, conversant with this tendency, undisputed until recently, 
of calomel to increase the secretion of bile, I am utterly at a 
loss to conceive. How, if it is not absorbed, can you account 
for its action on the gums, or the dissolution of plastic 
deposits, its removal of serous effusions, its power of rapidly 
healing chancre, its unquestioned ability to cure iritis? 
How can we otherwise account for salivation produced by 
mercury introduced into the system by inunction or hypo- 
dermic injection ? Let us summon to the stand as a witness 
of great reliability and experience the distinguished Head- 
land, than whom there is no higher authority in our profes- 
sion. In his admirable work “ On the Action of Medicines 
on the System,” this great light states that “ Mercury is 
absorbed into the blood and particularly tends to the liver, boioels, 
salivary glands and skin.” He classes it among the “ true 
cholagogues.” He says that “ Mercurials increase more or 
less all the secretions, and even if we had no direct proof of 
their action on the liver we might almost have affirmed that 
they especially increase the secretion of bile from the obvious 
way in which bilious symptoms yield to their action. But 
we have direct 'proof of this. M. Bucklein has made some 
careful experiments on a dog. Having given it Mercury, he 
cut down upon the hepatic duct and collected the secretion 
and subsequently analyzed it. He found that the bile was 
increased and that mercury was found in it.”—[Pag© 297.] 
Again he says: “ Mercury, sulphur and iodine have been 
chemically detected in the perspiration. It has happened 
when a course of mercury has followed the administration of 
sulphur that parts of the skin have turned black from the 
formation of sulphuret of mercury.”—[Page 301.] He also 
says that “ mercury has been detected in the urine.”— 
[Page 306.] 
Let us now consult another learned and high authority, 
Pereira. He states, in his great work on Materia Medica 
and Therapeutics—[American Edition, 1852, volume 1, page 
773]—that, “ By the external or internal use of Mercury 
this metal becomes absorbed, and is subsequently either 
deposited in some of the solids of the body, or throion out of the 
system by some of the excretories. The accuracy of the 
statement is proven by the following facts : 1st. Mercury 
has been detected in the blood by Zeller, Buckner, Schubarth, 
Colson and Dieterich. It appears to be in such intimate 
combination with the vital fluid that it cannot be recognized 
by the ordinary tests. Destructive distillation is in most 62 
cases necessary for its detection. 2nd. Mercury has been 
found in the secretions, viz: in tha perspiration, in 
the saliva, in the gastro-intestinal secretion, the bile, 
the urine, and in the fluid of ulcers. 3rd. Mercury has 
been found in the organic solids, viz : in the bones, brain, 
synovial capsules, pleura, humours of the eye, cellular tissue, 
lungs, &c. In what part of the system reduction is effected 
has not been made out.”—[Volume 1, pp. 773-74.] 
“ The secretion of bite (by mercury) is promoted.”— 
[Page 774.] 
Who has not seen in the old treatment of Remittent 
Fevers, that just as soon as the gums were touched by mer- 
cury the liver poured out large quantities of blackish, green, 
viscid bile, which invariably denoted a favorablo solution of 
the disease ? But let us go on with the authorities. Our 
own illustrious American Professor, Wood, remarks as 
follows, in his able work on Therapeutics and Pharmacology 
—[2nd vol., page 243]—“ That mercury is absorbed is 
proved by the following facts : When rubbed upon the skin 
it in parts appears. After administration it has been de- 
tected by cliemica ltests in the blood, saliva, perspiration, 
bile and urine, and is said to have been found in a metallic 
state in the brain, bones, cellular tissue, lungs, &c. Infants 
affected with syphilis are asserted to be treated effectually 
by the administration of mercurials to the nurse, &c. The 
hepatic secretion is often energetically stimulated, especially 
when the medicine is administered internally. There is no 
cholagogue which approaches in efficiency some of the 
preparations of mercury. A true cholera morbus, with 
copious vomiting and purging of bile, is not unfrequently 
induced by a large dose of calomel.” 
atille, in his Therapeutics and Materia Medica (Yol. 2, p. 
731), cites numerous and convincing proofs of the absorption 
of Mercury. After mentioning the experiments of Schobarth 
and Zeller, before mentioned, he says: “ Oesterlen found 
minute globules of Mercury in the pancreas, liver, spleen, lungs, 
heart, mesenteric glands, kidneys, &c., and also in the urine, bile, 
milk and saliva,” (p. 782). “ Among the proofs of mercurial 
absorption by man, the following may be selected : In 1810 
Brickmann published an account of a lady who, a year after 
being salivated, having become heated by violent dancing, 
mercurial stains appeared on her breast, and metallic mercury 
was found in her linen. In 1813 Jourda collected a quantity 
of mercury from the urine of a syphilitic patient who was 
taking this remedy.” tStille quotes other authorities to simi- 
lar facts, and treats at length, fully and clearly, of the effects 63 
of medicinal doses of mercurial remedies, their action—sim- 
ilar to that given by others—producing liquid and billious 
discharges, &c.” I might go on and cite additional authori- 
ties, numerous and high, in corroboration of the observa- 
tions, experiments and statements of those I have given ; but 
can any honest and unprejudiced man require further proof 
of the position that mercury is absorbed into the blood, and 
is a cholagogue ? 
The following additional quotations from Headland are 
well 'worthy of introduction here : “As hematic medicines 
mercurials have a double action. They counteract in- 
flammation in general, and the poison of syphilis in particu- 
lar (p. 325). On account of the durable and effectual nature 
of its action, mercury is of groat use in preventing the 
process of effusion, and in causing the absorption of effused 
products. It is thus employed in pleurisy, and in other mem- 
braneous inflammations. Next to these it is most useful in in- 
flammations of the liver and brain. It is inferior to antimo- 
ny in fevers and rapid inflammations, because slower in 
operation, and without any direct action on the nervous sys- 
tem. In cases of primary syphilis mercury is by far the 
best medicine with which we are acquainted. It should 
be used in all cases, except where there is deep-rooted scrof- 
ula or marked debility, or a sloughing and irregular con- 
dition of the primary sore. It should always be given in 
Iritis ” 
“ Mercury, being unnatural to the blood, passes at length 
out of the system through the glands, and acts as an elimi- 
native. Like antimony, it tends to increase all the secre- 
tions in the body. But whereas, antimony acts especially 
on the secretions of the skin and pulmonary membranes, 
Mercury tends particularly to excite the functions of the 
liver and bowels, being cathartic and cholacjogue.” 
On another occasion Headland writes as follows : “Another 
remedy, of a different kind, has been used in all the diseases 
in which quinine is admissible, proving in some cases superi- 
or, and in other instances second only to it in its beneficial 
action. This is mercury ; and in remittent and yellow fever ; 
of the first importance in dysentery ; employed by Dr. Bail- 
lie in ague, and pronounced by him to be superior in some 
cases even to quinia. In small doses it is frequently of use 
in cases of debility and scrofula. And mercury is a chola- 
gogue, i. e., an agent which is known to have the effect 
of promoting the secretory function of the liver. Thus 
we may conceive that mercury, not given in excess, or 
to salivation, may operate in a different way to produco 
the same effect as quinine. G4 
If the connection betwreen tonics and the bile wrere actually 
■established, then we should bo enabled to explain a mat- 
ter which otherwise wrould seem difficult to understand—how 
it is that small doses of mercury may sometimes act as tonics, 
though we know that the ultimate action of the medicine, 
like that of other catalytics, is to deterioate the blood. Even 
in scrofulous and enfeebled cases small doses of blue pills or 
calomel are often signally useful, and not prejudicial, as 
is sometimes stated by those who confound their application 
with that of mercury, given in salivating doses. Under such 
a course, wdien judiciously enforced, we may see the dilated 
pupil contract to its normal size, and the pale, enervated 
countenance become rosy and lively, and feel the weak and 
compressible pulse to become hard and firm. Perhaps mer- 
cury in such a case may be indirectly tonic, by restoring to 
the blood the natural tonic principle of the bile.” 
The reactions in the history of this valuable but much 
abused remedy of calomel, the fluctuations of professional 
.appreciation of its importance and value, have been greater 
than attach to any other remodial agent of the whole p rofes- 
.sion. But when we remember that our best remedies are 
those wdiich have been most abused, shall we reject the good 
which this powerful agent is capable of producing, because 
its abuse has been so great ? To yield to the unfoun- 
ded prejudices and noisy clamor against the use of calo- 
mel, which are becoming even traditional, that to use it 
in efficient doses places a practitioner in the ranks of 
old fogyism, and behind the rapid strides of medical science, 
is neither manly, philosophical, nor scientific. That physi- 
cian is wanting in the stamina of real manhood, and in the 
sustaining power of true professional devotion, wrho allows 
.any storms of surrounding circumstances, or any prejudice 
or tradition, however honored by time or authority, to stand 
between himself and a judicious trial of legitimate means, 
whether of ancient origin or modern growth, in combatting 
•disease and saving life. I admit that much prudence and 
discrimination should be exercised in the administration 
of mercurials* I confess that I have often seen them 
used to such an excess in the bowel complaints of children, 
and other diseases of infancy and adult age, as to produce 
that deterioration of the system, that disintegration and dis- 
organization of the blood, that entailed dropsy, consump- 
tion, and other protracted and wasting affections, which 
either greatly injured the constitution or ended in death. 
Such ignorance and mal-practice in the use of this effective 65 
weapon, while inexcusable, have contributed greatly io that 
discrepancy in the results of its administration which has 
made the calomel treatment objectionable to so many good 
men. But when we learn, as learn we must, more of its 
mode of action, as well as of its remarkable capabilities and 
most valuable adaptations in subduing many of the most 
fatal diseases of the human system, it is reasonable to 
suppose that less ignorance wall guide, and less prejudice 
and danger attend, its use. The authentic accounts from 
high authorities of the happy effects of large doses of a 
scruple and upwards of calomel in cholera morbus, epi- 
demic dysentery, cholera, Ac., are only equalled in striking 
import by the well-attested records of the cure of that terri- 
ble enemy of infantile life, membraneous croup, by similar 
doses, during the last twenty years, in the practice of most 
distinguished physicians of New York city and elsewdiere. 
The introduction of the calomel treatment in croup has been 
credited to Dr. Bay, of Albany, New York ; but Dr. Hamil- 
ton, in his work on mercury, published early in the present 
century, regards it simply as the American treatment, and 
says it spread from America to England. This celebrated 
author, who has written more strongly against the gen- 
eral use of calomel than almost any writer prior to those 
Modern Revolutionists, Todd, Bennett & Co., extolled its 
action in large doses nevertheless in genuine croup. He 
says that “ no relief whatever has been afforded by that 
medicine (calomel), unles copious, dark-green colored stools, 
like boiled spinach, have been discharged," and that it 
requires large and repeated doses of the medicine to 
produce that effect. Eor example, to a child seven yeara 
old, one hundred and thirty-three grains were given within 
sixty hours.” He says, moreover, that “ in the only cases in 
which this medicine has failed under the author’s direction 
(being in the proportion of four out of fifty), no evacuation 
through the bowels could be produced.” “ It is extremely 
difficult,” remarks Professor Hamilton, “ to explain, in tho 
first place, the safety with -which a hundred and thirty-three 
grains of calomel could be given in this climate (England) 
within sixty hours to a child of seven years. Secondly, the 
relief which has invariably followed the discharge of the 
dark-green colored evacuations.” 
.Nowhere have 1 known or seen recorded such remarkable- 
success in the treatment of croup, nor the necessity So 
strongly enforced of a pre-requisite to success of a con- 
tinuance of the treatment until relief follows, or until there 
appears those free evacuations of the stools just described, GG 
I am told that scruple doses, and larger, are common in New 
York among the best practitioners, who treat croup success- 
fully, although no published allusions are made to such treat- 
ment, owing to the prejudice against large doses of calomel, 
both within and without the profession. 
The administration of heroic doses of this mineral under 
suitable cases and stages of disease reoeived a revival in the 
example and endorsement of the illustiious James Johnson. 
He contracted a violent attack of dysentery while hunting 
on the banks of the Ganges. His medical attendants put 
him upon the usual treatment of small doses of calomel, 
combined with opium, together with mercurial inunction. 
This was continued for two days, but he constantly grew 
worse and worse. He says, in his own graphic account, that 
at this stage : “ The Surgeon endeavored to cheer me, with 
the hope of ptyalism, which, lie assured me would alleviate 
my sufferings. I then had no local experience in the com- 
plaint myself. As the night advanced, all the symptoms 
became aggravated, and I was convinced that a fatal termi- 
nation must ensue unless a speedy relief could be procured. 
I had no other hope but on ptyalism, for my medical friend 
held out no other prospect. I sent for my assistant, and 
desired him to give mo a scruple of calomel, which I instantly 
swallowed, and found that it produced no additional uneasi- 
ness ; on the contrary, I fancied it rather lulled the tormina. 
But my sufferings were great—my debility was increasing 
rapidly, and I quite despaired of rocovery ! Indeed I looked 
forward with Impatience to a final release! At four o’clock 
in the morning I repeated the dose of calomel, and at eight 
o’clock (or between sixt}r and seventy hours from the attack) 
I fell, for the first time, into a sound and refreshing sleep, 
which lasted till near midnight, when I awoke. It was some 
minutes before I could bring myself to a perfect recollection 
of my situation prior to this repose; but I feared it was still 
a dream, for I felt no pain whatever ! My skin was covered 
with a warm moisture, and I lay for some considerable time 
without moving a voluntary muscle, doubtful whether my 
feelings and senses did not deoeive me. I now felt an 
uneasiness in my bowels and a call to stool. Alas, thought 
I, my miseries are not yet over. I wrapped myself up to 
prevent a chill, and was most agreeably surprised to find, 
that with little or no griping, I passed a copious, feculant 
billions 8tool, succeeded by such agreeable sensations—acqui- 
sition of strength, and elevation of spirits—that I ejaculated 
aloud the most sincere and heartfelt tribute of gratitude to 
Heaven for my deliverance.” 67 
In addition to the slower and alterative action of calomel 
in minute doses, there seems to be a growing belief that 
when given in larger and purgative doses it is attended with 
very decided sedative powers. Dr. Learning and others claim 
for it distinct sedative virtues, and the power to produce a 
profound and favorable impression through the sympathetic 
system of nerves upon those violent forms of disease common 
to Southern localities. But whether it acts mostly through ab- 
sorption into the blood, or in no small degree, according to the 
theory of the reflex action enunciated by Marshall Hall, and 
which, through the investigations of Brown Sequard and 
others, have solved many intricate physiological and patho- 
logical problems, as many are assured, it cannot be denied, 
that, whether given in smaller or larger doses, as existing 
indications and changing circumstances should always 
decide, its use is indispensable in the treatment of a large 
number of the prevailing congestions, inflammations and 
other affections of this latitude. 
Finally, in relation to the modern treatment of fever and 
inflammation, I have yet to learn of a single advocate of the 
depletory system who denies the influence of the conservative 
powers of nature in disease, or rejects the judicious adminis- 
tration of food and brandy. No considerate physician has 
ever denied that, when high fevers have been.removed and 
inflammatory action subdued and other indications are 
favorable to alimentation, or when the system is much re- 
duced either by acute affections, or slow, lingering diseases, 
suitable food and stimulation is not only proper but neces- 
sary. But that food and stimulants, except in limited 
quantities, are contra-indicated under opposite states and 
conditions, is a fact sustained by the general voice of the 
profession in this country and in Europe. The sensible 
physician never opposes, but always seeks, the aid of nature; 
the expectant system has its comparative value, and its 
remedies are sometimes appropriate and sufficient; and ali- 
mentation and stimulation have their subordinate and proper 
positions in the catalogue of remedial agents ; but singly, or 
in any combination, such influences and agents, when 
brought to bear upon concentrated malaria, or directed 
against the higher grade of our congestive fevers and 
inflammations, are nothing more than mere “ medita- 
tions upon death.” The disciples of a judicious antiphlo- 
gistic treatment are among the foremost in recognition of 
the influences named; they are ever ready and anxious 
to consult with nature, and to admit its full power in 68 
the class of self-limited diseases, and that under this self- 
limitation numerous cases will progress to recovery without 
medication. But all this is no evidence that, even in self- 
limited diseases, judicious treatment is not indicated—not 
alone to cut short, modify, and control disease, but also to 
prevent unnecessary complications, and sometimes to save life. 
If the medical profession has no higher functions to per- 
form than a mere skilful manipulation of the Liquor 
Distillery, as some have doubtless concluded who have read 
Dr. Norcom’s address, it is a mere mockery to the community, 
and our science, instead of being humane and noble, as we 
have claimed it to be, is worthy of no higher devotion than 
such as the cook and distiller can bestow. If the views we 
have honestly sought to combat are correct, better, much 
better, would it be to disorganize all our medical organiza- 
tions, break up our Medical Schools and Universities, and 
burn up our Medical Journals and Books. And then, in 
penitential sorrow for the offences of our past professional 
devotion, to come forward, in a spirit of humiliation and 
mortification, to admit, that the advancement of medicine 
and the reputed glories of our profession are eclipsed 'ey the 
triumphs of the kitchen and the achievements of the distil- 
leries and drinking saloons. 
While, with good feelings towards Dr. Norcom, I am 
pleased to admire the ingenuity and ability of his Address, 
yet, I am induced to offer these opposing views and ar- 
guments from a sincere conviction that his doctrines are not 
in accordance with the teachings of medical truth, and of 
true medical progress; that they tend to throw discredit 
upon this Society, and upon the experienced practitioners of 
the State; that their tendencies are to bring the art and sci- 
ence of medicine into contempt with the ignorant and vul- 
gar; and are pernicious in their influences upon the minds 
of the younger men of the profession. 
He only is a true medical philosopher who alike interprets 
wisely the instructions of Nature and the indications of dis- 
ease, and then pursues with patience and firmness the- path- 
way illumined by their radiant beams. Let him shun equally 
the dogmas of those extremists in medicine whose enthu- 
siasm or prejudices are so liable to lead them from the true 
paths of legitimate practice. Pursuing the even tenor of 
his way, seeking only for truth, let him reject no doctrine be- 
cause it is old, nor adopt any theory because it is arrayed in 
the captivating charms of novelty. Such a course may be 
slow to secure public attention and patronage, and may not 69 
strike the admiration of the fickle multitude ; but in the 
end it will secure that kind of permanent success which no 
sneaking detraction or envenomed envy can shake, and which 
the superficial and wily medical demagogue never attains. 
His name will be enrolled high upon the list of noble and 
faithful physicians, and will go down as a rich and proud in- 
heritance to his children and family. Such a conservative 
course, always to be united surely with personal integrity 
and honor, may not satisfy the ambitious aims of those who 
are not content with the gradual advancement of themselves, 
and the sure progress of a well-settled science. It may not 
serve to calm the restlessness of those who are ever on the 
alert, either to weave new theories themselves, or to adopt 
the new-fangled doctrines of others—sometimes for lack of 
judgment, but too often from a love of gain and notoriety. 
But, founded upon the rock of principle rather than expedi- 
ency, he who takes this rough but alluring pathway, and 
pursues it with honesty and persistent industry, will surely 
reach that higher and more enduring basis of prosperity and 
renown that are the rewards of a high course, and which 
constitute the true ends of effort and the noble objects of 
life These transcendental extremists may not do as much 
injury to society and medical science as those cunning, un- 
dermining, despicable, medical demagogues in our own regu- 
lar ranks, who, under the authority of an ill-gotten diploma, 
smear their filthy slime on their daily ways of humbuggery 
and evil. Their motives are superior to those of these pests 
of the profession ; but, whatever their purposes, they do more 
real harm to science and the profession than those irregulars 
who come out openly against us, and boldly pitch their tents 
outside the garrison of Legitimate Medicine.