WB M883* 1844 MORROW . - - i- FEW THOUGHTS ON XtCbS^iTY OF MEDICAL REFORMATION \ % >? ^ /g2 Al LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF ME IAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF ME C ! >^G)C / * \ 1W JO ARVRRI1 1VNOI1VN INDIQiW JO ADVIIII1 1 V N O 11 V N 3NIDIQ1W JO UVIll'l IVN iW JO AoVRSIl 1VN0I1VN 3NI3I03W JO UVmil 1VNOI1VN 3NIDI03W JO AlVlail IVN S AX/ i \/\ •: MS I \JP&. i ,#V AL IIRRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MED V^>' I V>\ I yV .* : -zv ,/X I A *- : \->. /\ try' WESTERN MEDICAL RE FORMER,-EXTRA. FiW TiOISIT OX THE NECESSITY OF MEDICAL REFORMATION IN A LECTURE wDEJUVERED \ V. MORROW, M. D. Before the ClasB of the Reformed Medical School of Cincinnati, Ohio* November 6, 1S43. . -'"IF „'l» PUBLISHED BY THE SPECIAL REQUEST OP THE CLASS. CINCINNATI: " '■" # PRINTED BY A. DERROUGH, FRONT STREET. - ' , 1844 REFORMED MEDICAL SCHOOL OF CINCINNATI, OHIO. The Spring and Summer course of Lectures commences here on the First Monday in March next, and continues from three to four months. A course of Lectures, (from three to five daily,) will be given on Anatomy, Physiology, Materia Medica, Therapeutics and Pharma- cy, Obstetrics, Diseases of Women and Children, Surgery and Theory and Practice of Medicine. (£rThe aggregate cost of all the Tickets for the course will be only #25 00. O^rGood Boarding may be had for $2 00 per week. Any person wishing further information will please address,postpaid T. V. MORROW, M.D. In Behalf of the Faculty. Cincinnati, Ohio, Jan'y 25, 1844. LECTURE. Gentlemen:— I x taking a survey of the condition of the Healing Art as it exists, at present, among the various nations of mankind, we are forcibly struck by the multiplicity of systems and fragments of systems into which the art of medicine is divided, each claiming for itself some peculiar ex- cellence which is not shared with it in common by others; nor does a retrospective examination of its history, as it has descended down to us through the lapse of preceding ages, afford a greater degree of uni- formity in the modes and means on which it has depended for the alle- viation of human ills, or a more cheering spectacle to the medical philosopher: for, as he glances along the line of its progress, he per- ceives an instability in the duration and effects of former systems which overwhelm the mind with considerations of profound astonishment and surprise. Such aie the ever varying changes to which our science has been subjected, that one system has scarcely clothed itself with the habila- ments of its successful prevalence before it is supplanted, in part or alto- gether, by another, which in its turn is destined only to enjoy an evan- escent triumph to give place to a short lived successor. Thus have the annals of medicine been marked by changes and fluctuations which afford conclusive evidence of the truth of one or the other, or perhaps to some extent, of both the following propositions: Either that the various schemes that have been proposed for the acceptance and adoption of mankind have not possessed those constituent elements of merit which would justify their more permanent prevalence; or, that the frame of the human mind is so constituted as never to rest sat- isfied with such improvements and conditions of the art as would be justly commensurate with the proper demands of enlightened reason and a matured experience. There can scarcely exist a doubt that both have, to a greater or less extent, exercised an influence in the pro- duction of this result; but by far a greater share is attributable to the former than to the latter cause or condition. No one duly qualified for the task, can examine the whole field of medical science as it presents itself now, or as it has hitherto existed, without feelings of profound mortification and regret. The multiplied acknowledgments of its most distinguished votaries, of the present as well as former ages, all bear testimony to what is here asserted. A faithful examination unfolds to our view features of imperfection and error of the most staitling complexion, calculated in their consequences more materially to affect the happiness of mankind than any cause of a temporal character. Notwithstanding all thi«, we observe a strange and unaccountable perversity and disinclination manifested, by the great body of the guardians of the public health, to an impartial and candid examination of such attempts as may have been made for the improvement of the science, or as have been suggested by a comprc- 4 LECTURE ON THE NECESSITY hensivc examination of its multiform defects and evils by those who are from education, observation, and-experience, amply qualified to form a correct judgment in the premises. l\ fact, it has become pro- verbi:il, (hat too many of the medical profession, with all their boasted learning, their boundless benevolence, and high-wrought sympathy for the sufferings of their fellow men, are nevertheless among the most in- tolerant and pjoscriptive classes of mankind, when any thing is propo- sed which is materially different from the acknowledged doctrines of their art, especially when it bears on its front the avowed impress of a revolutionary measure. In vain do they too often attempt to excuse them?elves at the bar of an enlightened public opinion, on the ground of their superior intelli- gence, for having, without proper examination, too hastily denounced a professional brother whose observations and researches, in his profes- sional capacity may have led him to adopt views and opinions at vari- ance with those that may happen to be regarded as the received dog- mas of what may be looked upon as the regular profession of medicine. Does a medical man deviate from the beaten track, and especially if he have the boldness and independence to avow his convictions touching the defective character and dangerous consequences result- ing from a profession which has recognized among its leading and cherished doctrines, principles which in their practical operation, are productive of much mischief to society; he is at once denounced by the infatuated sticklers for orthodox infalibillity, as a fanatic and en- thusiast, more commonly, without even extending to his views the small courtesy of an examination—the faithful are appealed to to discard him from their professional confidence and friendship—to denounce him as an intruder on the sanctity of what they arc pleased to denom- inate "time honored usages and venerated principles." It matters but little what ma}' have been his previous standing in the profession. The most splendid talents and extensive learning are often attempted to be immolated on the same ungracious altar with presumptuous and daring ignorance. Things which have no affinity whatever are unna- turally brought together in order that the just odium which attaches to the one may be transferred to the other. All who are not willing to yield implicit obedience to the imperious mandates of an inflexible code of medical ethicks, adopted expressly to sustain the waning for- tunes of a system of practical medicine, in many respects at least, un- worthy of public confidence, are denounced; and all this must be done at the great expense of a sacrifice of freedom of thought and independ- ence of action. Thus the medical energies and enterprise of our com- mon country have been hitherto paralyzed, to an extent which has exer- cised aninauspicious influence in retarding the march of improvement; an unaccountable aristocracy and tyranny of opinion, have alas, too long swayed the destinies of this noble profession. It has already been too long borne down by the accumulated weight of this withering curse. But it must be conceded that, among the most favorable indications of the times, we perceive that a difference of opinion on medical subjects begins to be treated with a much more respectful tolerance, by many of the most enlightened members of the profession, as well as by the people in general. The once potent charm of denunciation falling OF MEDICAL REFORMATION. 5 from the lips of those who assume to give direction to public opinion, on all medical subjects, seems, in a good, degree to have lost its influ- ence. The community begin to understand, that men of science, skill, worth, and talents, may be found among the adherents of nearly all the conflicting systems of medical practice: and, that thorough medi- cal attainments and qualifications are far from being confined to those who so graciously assume to themselves the cognomen of " regular phy- sicians,'' which indeed has long since ceased to be an infallible passport to public favor, especially among those who are properly enlightened on the subject of practical medicine. Successful results are, without doubt, the best criteria by whieh we can judge of the value of any system of medicine, and fortunately for the cause of truth and science, the great body of mankind begin to feel it their duty to bring every system, as well as each practitioner to the righteous tests of this impartial ordeal, either to be sustained by the encouraging smiles of public approbation or sink beneath the irre- sistable force of its condemnation. No assumption of exclusive claims to public confidence, no high wrought pretensions to superior skill, can avail the candidate for prac- tice, at this enlightened day of this truly enterprising age. The period has long since passed, when the instruments of denunciation, ridicule, and abuse, can be made available, to any great extent, in supplanting a rival practitioner. The credentials demanded by the public are moral worth, respectable and sound attainments in medicine, with suc- cess in practice. These are the only sure passports to public favor ; and perhaps ever will remain the true foundation on which a lasting reputation is built and secured for the benefit of the possessor. No candid examination instituted for the purpose of ascertaining the comparative merits, advantages and disadvantages, of the prevailing practice of medicine, can result, it is thought, otherwise than in the production of the humiliating conviction that its whole results are even more injurious than beneficial to mankind; at least so far as they may be dependent on the use of some of its most prominent means. . That it possesses features which fit it in many respects better for the destruction than the preservation of human life, which can never be sustained but at the fearful expense of the lives and health of millions of our race, who fall willing victims to a misplaced confidence in a class of means which in many instances ought never to have had a place in the Materia Medica. The defective and imperfect state of medicine, as it exists at least in the western portion of our Union, has been admirably portrayed by a distinguished Professor now of the Medical Department of Transyl- vania, Lexington, Ky., in a discourse delivered some years since in this city on "Medical Eclectism," in which he says : -My task is now performed, and in concluding, let me express the hope, that disenamor- ed of particular theories, unseduced by the blandishments of system, you will go forward with me in the footsteps of the great apostle of Ec- icctism which I have endeavored to point out to you, and do for this beautiful and magnificent country what he with his noble disciples is to nobly achieving for France. Your profession i3 in the hands of th« (5 LECTURE ON THE NECESSITY Philistines; they have crushed its energies; they have blasted its pros- pects; they have covered it with disgrace, and it is now overspread with the dark and drearv night of desolation. Pause not till you have rescued it from their unhallowed keeping: rest not till you have ac- complished its regeneration; sleep not till you have redeemed it from under the yoke of ignominous bondage." It does indeed seem to be true, that the mbdieal profession is in the " hands of the Philistines, who have crushed its energies and covered it with disgrace."' insomuch that a very large proportion of the community have in reality very little confidence in the ordinary resources of the Healing Art. They have seen too many of their fellow citizens, perhaps, once a- moni,- the most distinguished ornaments of society, in all the prime of youthful vigor and promise, in the pleasing anticipation of many years of health and happiness, sinking down into a premature grave, under the double weight of disease and medicine, with all the endear- ing recollections of their early associations of friendship and youthful affection, under circumstances which clearly show that their cases, un- der any thing like a rational course of treatment, would have easily been successfully managed. They have, also, seen too many of their friends on their recovery from a slight attack of disease, come out with constitutions ruined'with medicine; and perhaps no medicines play a more important part in this work of destruction than the various pre- parations of mercury; the effects of which are so vividly portrayed in the following language of Professor Chapman, of Philadelphia: "If you could see what I almost daily see, in my private practice, persons from the South, in the very last stage of a miserable existence, emaciated to a skeleton, with both plates of the skull almost completely perforat- ed in many places, the nose half gone, with rotten jaws, and ulcerated throats, with breaths more pestiferous than the poisonous Bohon Upas, with limbs racked with the pains of the Inquisition, minds as imbecile as the puling babe, a grievious burthen to themselves and a disgust- ing spectacle to the world; you would exclaim, as I have often done, O the lamentable ignorance which dictates the use (as medicine) of that noxious drug Calomel. It is a disgraceful reproach to the profes- sion of mediciue—it is quackery, horrid, unwarrantable, and murder- ous quackery. What merit do physicians flatter themselves they pos- sess by being able to salivate a patient? Cannot the veriest fool in Christendom give Calomel and salivate? But 1 will ask another ques- tion: Who is there that can stop the career of Calomel when once it has taken the reins into its own possession? He who resigns the fate of his patient to Calomel is a vile enemy to the sick, and if he has a tolerable practice will in a single season lay the foundation for a good business for life, for he will ever afterwards have enough to do to stop the mercurial breaches in the constitutions of his dilapidated patients. He has-thrown himself in close contact with Death and will have to fight him at arms' length as long as one of his patients maintain a miser- able existence." Such is the picture which the distinguished Professor, in question has sketched out for the edification of those who are instrumental"" the continuance of those evils, by countenancing the use of these OF MEDICAL REFORMATION. 7 medicines in any way whatever. Nor does the above sketch cover the whole ground. We see those who may have had the misfortune to come under the mercurial influeuce, at least, many of them, rendered much more susceptible to the influeuce of the ordinary causes of dis- ease—every approaching change in the state of the weather can be foretold with a great degree of exactitude; ulceration of the gums, and loosening of the teeth, a coppery or metalic taste in the mouth, restless anxiety, general debility, and a very distressed and irritable state of the whole system; stiffness of joints, ulceration of the bones, swelling and soreness of the tongue, palate and gums; an indescriba- ble state of uneasiness and lassitude, which disqualifies the individual for every enjoyment in life. These are a few of the legitimate and unavoidable fruits of the mercurial practice. Leaving out of the question that vast multitude of invalids whose lives have been made the sport of its magic powers by the destruction of a large proportion of the face, as well as the corrosion and dismemberment of a great proportion of the inferior jaw-bone, being forced to drag out a miser- able remnant of existence in this deplorable condition, or with other disorganizations even worse, unfit to be received into the social circle, 1 shunned by former friends and associates as the pitiable and unfortu- r nate outcasts of society, whose subsequent pilgrimage on earth is but one continued scene of misery and pain, rendered doubly insupporta- i ble from the consideration that it arises in most cases from no fault of their own, but from a too confiding creduiity in the efficacy and just just adaptation of one of the prominent remedies of the popular prac- 1 tice of the day. ! But we are gravely told by the advocates of this course of manage- ment, that these disastrous results are indeed nothing but the abuses of the article in question, and that inasmuch as it is capable of producing [beneficial effects it would therefore be improper to reject it entirely as a remedial agent. 1 These men contend strongly for what they are pleased to denomin- ate its judicious use. This, however, involves the consideration of the ' question: Is it possible so to use mercurials as to avoid these unpleas- ant consequences and obtain their beneficial effects? as well as the ''following question: Can the mercurial medicines be successfully sub- stituted by others, that are entirely safe in their application, and capa- ble of accomplishing every salutary effect which has ever been claimed 'for them? £ A most ample experience in the treatment of nearly every conceiv- able modification and form of disease incident to this country, for the t last seventeen years has most thoroughly convinced me that the former of these questions may be safely answered in the negative; and the lat- ter unhesitatingly in the affirmative. i In proof of the negative, so far as the first query is concerned, it is only necessary to refer to the well known fact, that in their opeiation ton the human system, the mercurials are exceedingly uncertain: some- times operating with dangerous violence, and occasionally producing fatal consequences, at others producing no perceptible effect whatev- ier, even when administered under the direction and in accordance >wj'th the views of the most experienced, learned, and eminent member* 8 LECTURE ON THE NECESSITY of the profession. They often salivate when no such effect is intended, and again prove incapable of producing that effect when it is anxious- ly looked for and desired. . . It is believed that no one pretends to be sufficiently discriminating to detect the hidden states of the system on which these unexpected and contradictory results depend, in truth, such a discovery will per- haps forever elude the most profound researches of human investigation. The uncertainty and confusion which have hitherto proved an in- superable obstacle to the establishment of any fixed therapeutical principle for the government of its administration, still exist with all their force, notwithstanding every minute circumstanee connected with its operation on the animal economy has been marked with an industry, zeal, and patient investigation, worthy of a better cause. Still there are many who arc pursuing the hopeless examination of this subject, as if they regarded the success of all improvements in medical science to depend on the discovery of new properties and principles of application in the various combinations of this metal, closing their eyes to the evils which it occasions, as well as to the su- perior claims to their attention and confidence presented by many other articles cf the Materia Medica, the excellent curative qualities of which entitle them to an infinitely higher rank in the scale of useful- ness than the one under consideration, without being exposed to the just objections which must forever rest against this, as well as all other mineral poisons, as curative agents. It is by no means my object to say that mercurials are incapable of producing apparently good effects in the treatment of disease. Can- dor, as well as a disposition to do justice in this matter, leads me to make the concession that they operate actively, and in many cases, appear to exert a salutary influence; but these characteristics are in- sufficient of themselves to justify the use of any agent whatever as a medicine, when it is unavoidably liable to produce injurious effects in its operation on the hnman frame, as has been abundantly shown to be the case with that class of remedies under consideration. The true matters of enquiry to be made in the selection of a suita- ble medicine, at all times, are, first, is it capable of acting efficiently for the fulfilment of the proposed indication, without the liability to any bad effects from its operation? Secondly, are there any salutary ef- fects arising from the action of the mercurials on the human system, indispensably necessary for the cure of any given case of disease, which cannot be produced by other and safer means? The second question has been already satisfactorily answered in the negative and an array of evidence might be produced which could not fail to convince every candid examiner of the truth of this conclusion. The doctrine which has been for many years so emphatically and confidently inculcated " that the mercurials are the best and most certain remedies known to the profession in the treatment of certain forms and modifications of disease," is, we are fully convinced, from the most ample opportunities of experience, an error of the grossest and most destructive character calculated to exert a most pernicious influence in paralyzing the spirit of inquiry which should, in every suitable way.be encouraged, for the improvement of the resources of the art. OF MEDICAL REFORMATION. 9 The results of my own experience for the last thirteen or fourteen years, in the practical duties of the profession, as has already been sug- gested, have fully confirmed my convictions on this subjeet. During the whole of that period lhave not used a single particle of any mer- curial medicine, either externally or internally, in the treatment of more than thirty thousand cases of disease, and the success has been such as to prove to a demonstration, at least to my mind, that there is no form of disease that may not be treated more successfully without than with the use of mercurials: and that too without danger of any injury to the sub- sequent health of the patient; which indeed, is a desideratum of no incon- siderable moment. Recoveries take place much more rapidly; the constitution being un- impaired by the means used, returns to the standard of health with a fa- cility and promptitude truly surprising. However, it is claimed by the advocates of the] mercurial practice, that their preparations exert a more decided control over the action of a torpid liver, than any other known medicine. Notwithstanding the general prevalence of this opinion, we are abundantly convinced, that there are numerous preparations used in the Reformed practice, which possess the capacity of arousing the torpid liver to a proper state of action, with as great a degree of certainty, and with infinitely more safety than the preparations of mercury. But, for the sake of argument, let it be admitted that the superior power of the specific action of mercury, as claimed for it by its advocates, is true, yet it does not by any means prove the indispensableness of these prepara- tions in the treatment of Hepatic torpor, nor that they are even the most suitable for these cases. It has been erroneously concluded by many, that those agents which possessed the most striking capacity to arouse into immediate and power- ful action, the particular organ of the body which appeared to be the most prominently affected, were therefore the most suitable to be given in such cases, irrespective of their tendency to injure the stamina of the constitu- tion by the permanent impairment of the future health of the patient. In order to place this matter in a proper point of view, it would be only necessary to recollect that well known and universally conceded fact, that the liver as other organs of the body, has an extensive range of sympa- thies, and is altogether dependant on the other orgaus and tissues for its capacity to perform its functions. In other words, the human body is one grand whole, and in order to change the existing condition of any of its parts from a state of disease to health, it is in some degree necessary to operate through the medium of the general system. A strong and violent specific excitation of any particular part produced withont other parts with which the diseased organ sympathises, being suitably affected, would not tend in the most efficient manner to the re- moval of the disease. This observation is especially true when the effect of excitation is the effect of the action of a mercurial poison, as is abun- dantly evident from an examination of the cases of those who have been the subjects of that description of treatment. In such cases it is often ob- served that the super-excitation of the part, often has the effect of causing it to relapse into a more completely torpid state than it was before; most- ly on account of failing to produce a suitable impression on the sympa- thizing surfaces, but to a great extent owing to the character and qualities 10 LECTURE ON THE NECESSITY of the agent used. Hence the failures of an ultra course either of purga- tion or stimulation, especially when the ordinary irritating cathartics ol the old school practice is depended on. . Who has not seen numberless instances of gastro-intestinal irritation and inflamation produced by a course of this kind? The observance of this evil undoubtedly gave birth to the doctrines of the French Physlol°" gical school, which are so zealously and ably advocated by the celebrated Broussais, the master spirit of the French schools of the 18th century, which although in many of their aspects, are ultra and chimerical, never- theless contain much that is valuable, resting as they do on the immutable basis of truth. He seems in too general a way to have attributed the ef- fects he observed on the mucous membrane, to the action of purgatives as a class, without recollecting the important fact that these effects resulted more particularly, from the action of" the favorite irritating, drastic purga- tives of the old school practice, among which the mercurials stand con- spicuously prominent. Activity of purgation is not necessarily liable to this charge, except on- ly when it is produced by those agents that possess corrosive, acrid, and very irritating properties. Such effects are not generally justly attributable to the agency of the vegitable cathartics. They seem to have a degree of congeniality in their nature to the human system, which adapt them, in a peculiar manner, as remedies for the alleviation of the diseases of the human species. Had Broussais' observations been made on those who had used the mild, safe, salutary, and efficient cathartics of the Reformed school, he never would have acquired the prejudices against the use of cathartics he seems to have entertained, especially when such a eourse of evacuation was accom- panied with that activity of operation on other and especially the strongly sympathizing surfaces, recognized by all enlightened reformers, as neces- sary to a successful course of medication. I am led from this point very naturally to the consideration of another prominent and most glaring defect in the prevailing mode of treating dis- eases, which seems, unlike the one we have just been examining, rather to be a sin of omission than of commission. Allusion is here made to the management of that very sensitive, extended, and strongly sympathizing surface, the skin. Notwithstanding the great extent of influence which this tissue is capable of exerting, by its varied conditions of health and dis- pase, over all the other vital organs of the body, and their universal de- pendence on it for their capacity to perform their offices, is, with entire unanimity, acknowledged by all well educaied medical men, still we find it, in the management of disease, strangely and unaccountably neglected, not only in acute but also those of a chronic nature. They seem to have forgotten that the production of a salutary impression on this great surface would by virtue of its extent of sympathies exercise a controlling influence over the condition of the internal organs, both in a state of health and disease. Thousands of patients are prostrated under the influence of burning fe- vers, and inflammatory attacks, with a hot, dry, and constricted skin, load- ed with a large amount of offensive, sebacious, oily matter, in a dry, ad- herent, and concrete state, acting as a source of irritation, paralizingthe superficial vessels, and driving the circulating fluids on to the internal OF MEDICAL REFORMATION. 11 organs, producing congestions and inflamations, as well as many other unpleasant and disastrous consequences. Under circumstances of this kind, watch the movements of the common practitioners, and see what description of attentions is rendered to the skin. Recall to your memory the numerous instances you have witnessed, and ask yourselves, if the means depended on to affect the state of this great tissue were adequately adapted to the fulfilment of the important indica- tions presented by the state of this part? Nay. even go farther, and explore the pages of the standard authors, and what do you there find recommended ? Comparatively, little or no- thing at all. Notwithstanding the clearly acknowledged necessity that there exists, for the use of appropriate means, not alone for the re- moval of the spasm of the superficial vessels, and the consequent ne- cessity that exists for the production of an equal state of the circula- tion, but the removal of the lodgments of matter which overspreads the cuticular tissue, which acts as sources of irritation, and paralizes the capillaries, which is urged on our attention by every considera- tion of science, as an object of the very first importance. It mnjht be readily snpposcd from the very feeble and ineffectual attentions awarded to the surface, that medical men had forgotten that it possess- ed any capacity whatever to receive remediate impressions, or that they had determined to inflict on the stomach and bowels, the onorous burden of bearing the whole brunt and force of medical treatment, and thus deprive themselves of nearly one half the advantages which might accrue to the patient, by taking a more enlarged, scientific and correct view of the treatment proper for the case. In truth, it may with much propriety be asserted that there are not a few cases of dis- ease in which the proper management of the cuticular tissue, is of more importance to ultimate success, than every thing else that can be done beside. It then becomes a matter of the highest possible moment, that the practitioners of the Healing Art should avail themselves, to the fullest extent, of the splendid benefits resulting from a course of medica- tion which is urged on their attention by every consideration of sci- ence, as well as demanded of them by the strongest interests of their suffering patients. They would then find it a comparatively easy and delightful task to remedy many of those ills, incident to the human body which are now generally regarded as hopelessly incurable, under the ministrations of the present defective, irrational, und deplorablv disease-creating system, and with a facility which would challenge the admiration of the most sceptical and almost cause them to doubt the evidences of their own senses. A new era would succeed in the history of practical medicine, even by the adoption of this solitary principle of enlightened medical re- formation, which is sustained by every consideration which can be drawn from the acknowledged pathology of disease, as well by the known laws of animal life. But it is much more powerfully confirmed by the invaluable benefits it is capable of conferring, when carried to the proper extent, at the bedside of the patient; although silent and im- perceptible in its effects, it is none the less certain to produee those that afford, sooner or later, the most unquestioned manifestations of its salutary influences, not only in removing a present attack, but in pre- 12 LECTURE ON THE NECESSITY venting any subsequent mischief, which otherwise might accrue to the patient from the means used for his relief. , Among the effects which it is well calculated to produce, are that it removes completely all that coating of extraneous, irritating, sebace- ous matter, which adheres so firmly to the surface by virtue of it uni- ting chemically with the article used as a wash, it imparts a gently stimulating influence, relaxing all the superficial vessels, and improvel the freedom, or the circulation in them, tending of course, to equalize it. This generally relaxing and stimulating influence,is transmitted through the medium of sympathy, to all the internal secretory and excretory surfaces, and takes off the spasm, and renders them much more suscep- tible to the influence of such medicines as may be given internally, and thereby greatly enhances the success of their operation. It also removes all tendency that may exist to the formation of congestions or inflamations. Such being the facts, it must be abundantly clear, that these effects are all of the very first importance, demanded by the existing condition of the patient, and in strict accordance with the soundest principles of science. Nor will this be doubted by any one who is in possession of a sufficient amount of medical knowledge to distinguish truth from error. But, instead of these salutary effects being obtained by practitioners generally, how often do we see the unfortunate patient subjected to a long course of treatment, with scarcely any adequate management whatever for the skin, while the stomach and bowels are dosed with strong and irritating drugs, which are calculated to determine tne cir- culating fluids to the internal organs and, concentrate the excitability there, and consequently withdraw them from the surface, and tend to produce an inequilibrium in the harmonious balances of the system, which is any thing but desirable. This is far from being a vain and imaginary flight of fancy, but it is one of the realities of sober and unvarnished truth, attested by the observations of all who have had an opportunity of witnessing, to any considerable extent, the practice of medicine as it is now generally pursued. Much, however, of the pertinacity with which the humbler members of the profession cling to the predominant errors, is unquestionably, justly attributable to the influence of the opinions of some of those who are looked upon as the larger lights of the science, who perhaps occupy prominent positions in some of the schools, and whose au- thority may be invoked with a much greater degree of confidence than it justly merits, in the settlement of disputed points, especially by many of their too obsequious and confiding disciples. An instance, not an inapt illustration of many other similar attempts to revive exploded and dangerous doctrines, coupled with an offensive denunciation of the opinions of those- who cannot conscientiously subscribe to the dogma attempted to be enforced, may be found re- corded on pages 218—19, volume ii., No. 5, of the "Western Lancet," in a paper purporting to have been read by a distinguished professor of the Ohio Medical College, [John P. Harrison, M. D.,] before a medical convention assembled and in session at Lancaster, Ohio, in OF MEDICAL REFORMATION. 13 the month of May last, on the pathology and treatment of Bilious Remittent Fever, to which I would very briefly ask the liberty to direct your attention. In speaking of the objections which have been urged against the mercurial practice!, the professor discourses as fol- lows: "The unthinking and prejudiced tirade against the article, (mer- cury,) may pass for what it is worth among the reflecting, and the interested vaunts of ignorance, in favor of an exclusive parturbating practice in preference to the mineral remedies, is only to be despised as the feculence of a depraved mind. That the mercurial plan has been much abused by a reckless exhibition of calomel in bilious fever, is, we feel well assured, a fact stamped in shame and cruelty upon the doings of many an ignorant physician. Still there is so much cer- tainty and such entire safety united with the surprising efficacy of the mercurial practice in bilious remittent fever, that after an experience of twenty-four years in the Western country, we rely most confi- dently upon this great alterant as in many cases the most safe and most rapid means of arresting the inflammatory stage of the malady." And a little further on it is added, as a guide to produce the constitu- tional influence of mercury at a proper time, ';But after a partial sub- dual of the vascular action by the depletory measures already insisted on, and there is persistence of fever with alarming symptoms of local inflammation, in the head, chest or abdomen, the most assured way of arresting disorganization of the tissues affected, is to put the system under the mercurial influence. This can be accomplished safely and in most instances readily, by repeating the calomel every two or three hours, in two, three or four grain doses." Surely the assembled wis- dom of the medical profession of the great State of Ohio must have been very much instructed, as well as greatly edified, to be assured from so distinguished a source, that this old, exploded, destructive and antiquated doctrine, was to be dug up from the darkest depths of that ignominious grave in which its disgraceful remains rested in loath- some repose, to be revived in the land to do its deadly work, especially inasmuch as the announcement of the wonder-working powers of mer- cury was couched in language so pre-eminently chaste and so irrepres- sibly pure in sentiment, as well as so completely free from inconsis- tency and contradiction. In order to show in what light this doctrine is viewed by many of the members of the profession, whose orthodoxy on most subjects can not be doubted, I will here take the liberty to make a few extracts from a paper which was published some years since, in the Transyl- vania Journal of Medicine, under the caption of "Remarks on Saliva- tion in Fevers, by J. C. Cross, M. D., Professor in Transylvania Univer- sity " &c, which are as follow: "We purpose in these hasty remarks, merely to prove, if possible, how unwise and dangerous it is to rely on the constitutional influence of mercury as a curative means. Dr. John McCabe says, in reference to the Epidemic Fever which pre- vailed in Trinidad in 1817, that the action of mercury there on the system, there may be seen frequently patients dying of fever, while under the influence of mercury; the fatal termination of the disease will then be observed during any stage of the effects of the medicine from a slight soreness to the more saturated stage of ptyalism." 14 LECTURE ON THE NECESSITY Dr. Cartwright also remarks that he has seen as many patients die whose mouths became sore early, by one or two doses of calomel, as he ever saw recover. . , "In those cases where salivation has seemed to be of service, the close observer has been able to ascertain that the abatement in the symptoms has preceded the development of mercurial action and con- sequently the salivation is rather an effect than a cause. This is the opinion of Bancroft, Sheppard, Jackson, Dickson, Mawther, Mortimer, and many other physicians, while that of Dr. Johnson does not appear to be very different." "The comparative results of different modes of treatment are cer- tainly opposed to the saturation of the system with mercury. Indeed whether we judge from personal observation, or draw our conclusions from the recorded testimony of those who have studied its effects on a large scale, we shall find that no treatment of fever can be more un successful than that which consists in efforts to produce salivation." At one period we were, says Dr. Cross, so unfortunate as to repose confidence in this practice, and were induced to abandon it only be- cause its results were so unsatisfactory, and one of the most unsuc- cessful physicians with whom we were ever acquainted, relied on it exclusively. His confidence in the constitutional influence of mer- cury amounted to infatuation, for in despite of the great mortality of his practice, he persevered in it with an obstinacy as stupid as it was destructive. Dr. David Grant states, in his essay on the Yellow Fe- ver of Jamaica, that all who were treated by mercury died, and that there were even more victims to the mercury than the fever. It may be properly urged against salivations, that some individuals are remark- ably soon brought under the constitutional action of mercury, and when that happens even in mild cases, it does more harm than good. In conclusion, among other things, Professor Cross says: "The in- fatuated mercurialist can only hope to cure only those cases of fever whieh can be cured much sooner and more safely by other modes of practice than salivation. Nor are we disposed to enlarge on the mis- eries commonly entailed on those who, it is said, have been cured of fever by the constitutional action of mercury. It is sufficient to say that few individuals have recovered from a severe attack of fever after having their systems saturated with mercury, without being indebted to it for a much injured, if not a totally wrecked constitution." The above extracts constitute a small portion of the mass of testi- mony contained in the admirable paper from which they are taken, and afford us a clue to what may be understood to be the sentiments of some of the most eminent and distinguished members of the old school practice, who, although they do not exclude mercurials entirely from their practice, nevertheless place the seal of their condemnation on the practice of salivation in fevers, which, it will be recollected, is the favorite practice of the author of the paper on Bilions Remittent Fever, as quoted from the Lancet, under modifications therein before mentioned, and which he is induced to regard as so very safe and suc- cessful. But what does all this amount to, touching matters of such intense interest, upon which the issues of life and death depend, as well as OF MEDICAL REFORMATION. 15 much of the temporal happiness of man, and how are we asked to re- gard it? Why, forsooth, in the polished tones and elegant and finished diction of this inimitably polite disciple of jEsculapius, all this "is only to be despised as the feculence of depraved minds." What an exhibition of courtesy and liberality do we have here manifested towards those who differ with him in opinion, in the respect of being opposed to salivation in fevers, as well as all those who are opposed to mercurials as remedial agents altogether, and to the use of every other agent which, under the ordinary circumstances of its use, is liable to produce injurious effects, so as to impair the future health of the patient. But above all, is it not truly a matter of astonishment that any man, being in possession of an ordinary capacity of discriminatien, should have practiced for the last twenty-four years, and been unable to find anv better and safer mode of treating fevers than by salivation. One of the most singular features of this altogether surprising production is, that which insists that the mercurial influence can be accomplished sa'fely. This opinion seems to be so universally contradicted by the observation and experience of nearly all mankind, that it would really seem to require a larger share of self-confidence and reckless presump- tion to make it than usually falls to the lot of erring mortals; for in- deed the very identical practice insisted on is that, above all others, which has covered the medical profession with disgrace, which has made it a by-word of reproach, and a disgrace to the intelligence of the ao-e in which we live,—which has already conducted millions of our race, to "that country from whose bourne no traveler returns,"— which ruined the health forever of a large proportion of those whohave once come under its influence, and who are now prepared to linger out the remnant of their existence with the sad evidences of its des- tructive influence inscribed on their physical systems, in characters too legible to be misunderstood. _ Look around you, in every town, city, village, hamlet and neighbor- hood in the Union; behold the multitude of cripples, whose ghastly countenances, whose stiffened limbs, whose disfigured faces and ruined constitutions clearly indicate that they are prematurely hastening down to that common destiny which awaits all animated lite. En- quire carefully into the causes of their declining health, and you will find in a very large majority of cases, that it is distinctly referable to the constitutional influence of mercury, which, perchance, may have been given, with no intention whatever to have it followed with sali- vation? but which took place altogether contrary to the wishes of the prescriber The only safe position that can be sustained with suc- cess in our humble estimation, is the one assumed by reformers, m re- sard to the choice of remedies, and that is, never to countenance the use of any one which, under the ordinary circumstances of its admin- istration, is liable to produce disastrous consequences. This position has for the last few years, been most triumphantly sustained m this country by hundreds and thousands of well educated reformers in medicine And I call on all who desire to see the noble science of medicine emancipated from that depth of degradation to which it has been reduced, by the misguided and eviUhougn doubtless well meant, 16 NECESSITY OF MEDICAL REFORMATION. counsels of those who have controled its destinies, to come forward and aid us in elevating it to that high point of usefulness, of which it is capable, so that its legitimate ends and aims may be ultimately ac- complished, and that the whole human family may be made to rejoice in the full fruition of its glorious achievements; that, instead of being the instrument by which these frail tenements of ours are precipitated with fearful and premature rapidity down to the confines of that nar- row house appointed for all living, that it may be made capable of con- ferring those lasting benefits and exercising that splendid control over disease, which God and Nature designed that it should. Go forward in this great work of rescuing the noble profession of your choice, from the dominion and unholy keeping of those who have so signally failed in directing its cultivation aright. It is an object al- together worthy of your best exertions, and will, in the end, afford you the proud consolation of having contributed your humble mite toward the final consummation of this great end. But in doing so, be careful never to disgrace yourselves and the cause with which you are identi- fied, by telling those with whom you differ in opinion, that on all points in which you differ with them, their opinions "are only to be despised as the feculence of depraved minds.'''' 111 IVNOUVN 1NDI01W JO ilVHIl IVNOUVN JNI3I03W JO ilVllll IVNOUVN ] ■' b r* a ,"~" ■■ OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE N , 1^7 [ X II IVNOUVN 3NI3I03W JO A a V X « I 1 IVNOUVN 3NI3IQ3W JO A « V * 8 I 1 IVNOUVN 3| OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE N , Ill IVNOUVN 3N I 3 10 3 W JO ADVItll IVNOUVN 3NI3IQ3W JO ADVB8I1 IVNOUVN J | OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE N ■■■■£ • »^U f .C& * 111 IVNOUVN 3NI3IQ3W JO A X V « « I 1 IVNOUVN 3NI3I03W JO A « V « S I 1 IVNOUVN 3h y * 5. * OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE N , IxM Ill IVNOUVN 3NI3I03W JO A «V « • I 1 IVNOUVN 3NI3IQ3W JO A1VIII1 IVNOUVN 3r '■?■ NATIONAL LIBRARY OF MEDICINE NLH 03277^76 2 NLM032779782