THE Cincinnati Medical News. Vol. X. No. 119. Old Series. November, 1877. Vol. VI. No. 11 New Series. Original Contributions. Brief Rejoinder to some Recent Articles by Dr. Roberts ,/ Bartholow. By Dr. J. J. Woodward, U. S. Army, Washington, D. C. In September, 1876, I delivered an address in Phila- delphia, before the section of Medicine, International Medical Congress, on the subject, “ Typho-malarial Fever: Is it a Special Type of Fever?” This address was prepared in response to a special invitation from the Committee ot Arrangements, and, as my views on the subject in ques- tion had been misunderstood in certain quarters, in others intentionally misrepresented, I took the precaution to print it in pamphlet form, and distributed copies to the members present immediately after its delivery, in order that there might be no honest mistake about what I really said and meant. In the course of this address I thought proper to re- spond, in a temperate and courteous manner, to the only published criticisms of my opinions with regard to typho- malarial fever that had been brought to my notice. Notwithstanding some slanderous insinuations to the contrary, I had never claimed any exemption from criti- cism, and certainly had shown no particular sensitiveness on the subject of the two criticisms to which I replied, for one of them had been made ten years, the other two years, before, and I had never previously opened mv mouth with regard to either. I have always recognized the undoubted right of others to object to my views, to criticise or controvert them, if they appeared inaccurate or erroneous; but I also claim to excercise the equally 744 REJOINDER TO DR. BARTHOLOW. undoubted right to reply, when and where I please, to criticisms that appear to me unjust, self-contradicting, or untrue, and I hold that critic up to public scorn who, having first struck a blow in fancied security, pleads the. statute of limitations in bar of a return. Nor did my reply to my critics constitute any considerable portion of my u Address,” which was devoted to much weightier matters ; it occupied less than four pages out of more than forty, for each of the two critics named was a witness against the other, and one of them contradicted himself, so that a long reply seemed quite unnecessary. One of the critics thus answered was Dr. Roberts Bartholow, whose objections seemed important to me only because of the prominence given to them by their publication in the very excellent medical volume of the “ Memoirs of the U. S. Sanitary Commission,” New York, 18G7. That I had not noticed this criticism before was due solely to the fact that I had published nothing on the subject since it appeared, and did not consider it sufficiently important to call for a separate publication. In my reply I showed that my critic supported his attack by advancing views which were contradicted by the statements he himself had made in other parts of the same volume. I complained that in an important par- ticular he had gone “ to the extent of misrepresenting my views,” and I actually spoke of his attack as having been made with u a good deal of acrimony.” This temperate reply appears to have set my critic be- side himself with rage. An annonymous letter published in his journal, The Clinic, a week or two after, (Septem- ber 23, 1876, p. 1.' 0,) devoted to me a paragraph in which coarse attempts at ridicule were enlivened by falsely representing me as making sundry absurd claims which I never made. Yery shame seems to have pre- vented the writer from appending his name to this article. The same journal, March 17, 1877, contained a brief article headed u Personal,” this time signed by Dr. Bartho- low, who complains of the reply in my address, and says: “ I propose to pay my respects to this aggressive individ- ual, who fights from behind the Surgeon General’s bureau, but who very humanely informs those who differ from him, that he is a ‘ terrible fellow in a controversy.’ ” I never knew before that it was aggressive to reply to an aggressor, and do not understand what is intended by the REJOINDER TO DR. BARTIIOLOW. 745 words “ fights behind the Surgeon General’s bureau,” which I suppose to be simply a puerile attempt to excite prejudice; but the statement with which the quotation concludes, I pronounce a wanton invention, which has no shadow of support in any written or spoken word of mine. Finally, Dr. Bartholow has published a series of articles, entitled “ Typho-malarial Fever and the Opinions of Dr. Woodward, U. S. A., in 1863 and 1877,”—The Clinic, Sept 8, 15 and 22, 1877,—in which he attempts a formal reply to the part of my Address that refers to him; but apparently, feeling the weakness of his case, spices his disjointed arguments with many offensive and unjust personalities, which I will leave, without further notice, to the censure of those who may chance to read them. Nevertheless, inasmuch as the writer in these articles has thought proper to reiterate the misrepresentations of my opinions, of which I complained in my Adress, I have thought proper to publish the following rejoinder to what, out of courtesy, I will call the argumentative part of the articles. These articles maintain four propositions : First, that the original attack by Dr. Bartholow in the' Memoirs of the Sanitary Commission, was not acrimonious ; Second, that the several essays do not contradict each other as I said they did; Third, that the one complained of did not misrepresent my views ; and, Fourth, that I now hold very different views from what I held in 1863, and, there- fore,‘that his criticisms of my original views were just. I propose to show that no one of these propositions is sus- tained by the record. 1. Dr. Bartholow denies that his original attack was “ acrimonious”—The Clinic, Sept. 8, p. 110. It certainly seemed so to me, and I ask the reader to examine especi- ally Chapter 2, p. 192-207 of the Memoirs cited, and judge for himself whether the expression, “ a good deal of acrimony,” was not well applied. Dr. Bartholow him- self inadvertently acknowledges, with regard to it, a little further on,—The Clinic, Sept. 22, p. 133—“ The especial purpose of my note on Camp Fevers was to em- phasize the fact, that Dr. Woodward’s teachings exerted a mischevious influence.” But he affects to think that he carried out this benevolent purpose in a most compli- mentary manner, and, to give force to his statement, does not hesitate to disclose that his criticisms, of which he 746 REJOINDER TO DR. BARTHOLOW. gives a few examples, “ are not equal in number and warmth to the complimentary terms in which I have ex pressed my sense of Dr. Woodward’s great merits,” etc.,— The Clinic, Sept, 8, p. 110—a statement which would be very civil if it were true.; but I challenge Dr. Bartholow to point out any such “ complimentary terms ” in the papers complained of. 2. Whether Dr. Bartholow contradicted himself in the Memoirs of the Sanitary Commission, is a simple ques- tion of fact, In my Address I not only pointed out some of the contradictions, but gave the page on which each of the sentences 1 quoted can be found. Dr. Bartholow does not even pretend that I have misquoted him, but asserts that I only “ take a sentence here and there,” and so do him injustice. He adds : “ This is an old trick of controver- sialists, which Dr. Woodward will learn is not successful, because I will lay before my readers all that I have writ- ten on the subject in question.” But this he takes very good care not to do. I need waste no words to sustain the criticism I made in Philadelphia; I simply ask those who care to know the facts, to examine pp. 40 and 41 of my Address, and compare the several articles by Dr. Barth- olow in the Memoirs of the Sanitary Commission with each other. AVith regard to these articles Dr. Bartholow appears to be quite sensitive, at which I do not wonder. He seems to wish them to be forgotten, and cries: “ AVhy exhume the opinions of ten years ago and give them life by airing them? It would have been better for Dr. Woodward not to disturb the ashes of a dead past,” etc. etc.—The Clinic, Sept 15, p. 121. I do not wonder that Dr. Bartholow should wish these articles to be forgotten, and I suppose that fortune will grant his wishes in due time. But since he employed the publicity which the publication of the Memoirs afforded him, to make an elab- orate attack upon views which I believe to be true, he has no right to complain that I reply when and where it is most convenient to me. 3. Dr. Bartholow not only declares that he did not misrepresent my views, but he reaffirms his misrepresent- ation : “ I now reaffirm that his published opinions indi- cate the conviction which he entertained, that there were really no cases wholly typhoid, or wholly remittent in the army.”—The Clinic, Sept. 22, p. 133. This was the very misrepresentation of which I complained in iny Address. REJOINDER TO DR. BARTHOLOW. 747 In reply, I stated that “ I had distinctly affirmed the occurrence of such cases in all my publications on the subject.” Dr. Bartholow now flatly contradicts me, and “ reaffirms ” his misrepresentation. Is his affirmation in a accordance with the facts, or is mine? Now, previ- ously to the Address, I had made but three publications on this subject. In the first, in Circular No. 15, Surgeon General’s Office, September 8, 1863, I said, page 4, that although in my opinion the majority of the camp fevers of the army where of a mixed character, “ a certain amount of uncomplicated enteric and remittent fever certainly did occur.” In my second publication, “ Out- lines of the Chief Camp Diseases,” etc., Philadelphia, 1863—which Dr. Bartholow must have had before him when he wrote, for he quotes it—I commenced the chapter on Camp Fevers, Chap, 3, p. 74-5, with the fol- lowing paragraphs : “ Under the designation of camp fevers may be in- included all the continued fevers occurring in the army. Passing by typhus fever, which has been the scourge of European armies, and yellow fever, which is the peculiar epidemic of the Gulf coast, neither of which has, however, prevailed to any extent during the present war, these fevers may be divided into three principal groups: ty- phoidfever, with or without scorbutic complications; ma- larial remittent fever, with or without scorbutic compli- cations ; and a vast group of mixed cases, in which the malarial and typhoid elements are variously combined with each other and with the scorbutic taint, and for which the author proposed the name of typho-malarial fever, which was adopted by the Army Board before al- luded to as having prepared the statistical form of Sick Report at present in use in the army. u Typho-malarial fever is the characteristic camp fever of the army at the present time, and has been so since the commencement of the war. Cases of ordinary typhoid fever, unattended with malarial phenomena, do, un- doubtedly, occur. Much more frequent are malarial fevers, which in their course assume a continued form, without presenting the abdominal symptoms of true ty- phoid disease, and without exhibiting, in fatal cases, the characteristic intestinal lesion; but in the great majority of cases the well-marked enteric symptoms are compli- cated by malarial and scorbutic phenomena, which pro- 748 11EJOINDER TO DR. BARTHOLOW. duce decided modifications in the course of the disease, and in the mode of convalescence which follows it, and which requires a treatment modified in accordance with the individual conditions of each case.” In the third publication, in Circular No. 6, Surgeon- General’s Office, 1865, I was equally explicit. I declared: “ Undoubtedly, cases of simple enteric and simple remit- tent fevers did occur ”—p. 109. These extracts are suffi cient to show how careful I have been to guard my readers against supposing that I believed none other than mixed (typho-malarial) fever cases to have existed during the war. I said, also, and I still maintain the opinion, that I believe the typho-malarial cases to have been more frequent in our camps than the uncomplicated forms; I said, and I still maintain the opinion, that I believed them to have constituted the majority of our camp fevers. It would have been legitimate for Dr. Bartholow to have controverted this view, and to have tried to show, either that I exaggerated the frequency of these mixed cases, or even that there were none such. But this honest course did not suit his peculiar rhetoric. He has preferred to misrepresent my views, and, having had the injustice pointed out to him, to “ reaffirm ” the misrepresentation. Just what his affirmations are worth I leave the reader to judge, ex uno disce omnes. 4. Dr. Bartholow endeavors to show that I now hold very different views from those I maintained in 1863. Now, it is true, that in my Philadelphia address I indi- cated certain errors into which I had fallen in interpreting my early observations with regard to the intestinal lesions in typho-malarial cases. I pointed out these errors with a completeness and frankness which appears astonishing to my antagonist, to whose nature scientific honesty is so entirely foreign, that he offensively declares that “ the experienced observer will see in this effusively frank re- cantation only the perfection of art.”—The Clinic, Sept. 15, page 123. But the “ experienced observer ” who reads my Address will, I think, also see that while I willingly “recanted” certain errors of detail, because I believed them to be incorrect, I held fast to the general doctrine, as I originally advanced it, because I still believe it to be true. In my book on “ Camp Diseases,” I declared that typho- malarial fever is “ not to be regarded as a new disease,” but rather as a “ hybrid of old and well-known pathological 749 conditions,” pp. 110 and 111. In my Address I advocated the very same opinion, and, after it was concluded, offered for discussion thp following proposition, which embraces, in a few words, the views I have always held: “ Typho-malarial fever is not a special or distinctive type of disease, but the term may be conveniently applied to all the compound forms of fever which result from the combined influence of the causes of the malarial fevers and of typhoid fever.” This proposition, after a debate, in which almost every speaker expressed himself as fully in accord with me, and in the course of which Dr. Bartholow, who was present, was patiently heard, was adopted, notwithstanding his objections, by an overwhelming majority as the sense of the Section of Medicine of the International Medical Congress. In conclusion, I may allude to one other point. Dr. Bartholow says (The Clinic, Sept. 22, p. 133): “It is with great reluctance that we now exhume facts which indi- cate that even the term typho-malarial is hardly new ”— and then goes on to make remarks and citations in illus- tration of the views of the distinguished Dr. Daniel Drake, which he borrows unblushingly from my Address (pp. 32 and 33). It was I who “ exhumed” the facts, and whoever will compare the passage in the Address printed in 1876 with that in The Clinic, printed a year later, will recognize my critic to be in this connection a mere bor- rower. And with this 1 take leave of Dr. Bartholow. I decline in advance to notice any further misrepresentations or personalties in which he may hereafter think proper to indulge. I feel quite willing to leave an offender of this kind to the judgment of the medical public; but inasmuch as he has printed his articles in The Clinic in pamphlet form, and informed his readers that any one can obtain a copy “ free of charge by asking for it”—The Clinic, Sept. 22, pp. 134—I have sent some copies of my Address to the editor of this journal, of whom it can also be obtained “ free of charge ” by any one who cares to see for himself how fully the views I now hold agree with those advanced in 1863 in my book on “ Camp Diseases.” REJOINDER TO DR. BARTHOLOW.