A 
TREATISE ON FEVER: 
ITS 
CAUSE, PHENOMENA AND TREATMENT, 
WITH 
9 
AN APPENDIX, 
CONTAINING 
VIEWS ON SOME FEMALE DISEASES, SOME 
DISEASES OF CHILDREN. ETC. 
B Y 
REZIN THOMPSON, M. D., 
NASHVILLE, TENN. 
MEMPHIS: 
SOUTHWESTERN PUBLISHING COMPANY, 361 MAIN STREET. 
1869. Entered, according to Act of Congress, in the year 1859, by 
RE ZIN THOMPSON, 
in the omce of the Clerk of the District Court for the Middle District 
of Tennessee. CONTENTS. 
PAG3 
Introduction 13 
CHAPTER I.-Capillary Circulation 27 
CHAPTER II.-General Circulation 35 
CHAPTER III.-Fever: its nature and phenomena 61 
CHAPTER IV.-Causes of Fever 90 
CHAPTER V.-Treatment of Fever 95 
CHAPTEPt VI.-Theories of Fever 112 
Humoral Theory 112 
Spasmodic Theory .*. 114 
Sympathetic Theory 116 
Phlegmasian or Broussain Theory 118 
Cooke's Theory 120 
Thompsonian Theory i . 122 
Present Theory 126- 
Modes of Cure 
CHAPTER VII.-Mysteries connected with Fever 130 
Why is the remote cause of Fever more operative at' 
night ? 1*4Q 
Why do paroxysms of Intermittent occur principally 
in the day ? 146 
How account for evening exacerbations in continued 
Fever? 147 
How Fever terminates in health 151 
How Fevers cure other diseases 156 
How Tartar Emetic acts in aiding to produce a crisis 158 
Of delirium in Fever 160 
Critical days 163 
How Inflammation may cure a Fever.... 168 
How do contagious diseases secure an immunity from 
the disease thereafter ? 170 
III IV 
PAGE 
Does the continued action of the remote cause, after 
the occurrence of Fever, increase its intensity or 
interfere with the cure? 174 
How does Quinine cure Intermittents ? 182 
Of topical remedies 186 
How do Spirits of Turpentine act beneficially in 
Typhoid Fever? 190 
Why do Mercurials act injuriously in Typhoid Fever? 194 
CHAPTER VIII.-Particular Fevers 199 
Preliminary Observations 199 
Typhoid Fever 212 
Bilious Fever 240 
Pneumonia 247 
Yellow Fever 253 
Dysentery 260 
Cholera Infantum, or Summer Complaint 292 
CHAPTER IX.-Eruptive Diseases 290 
Variola, or Small-Pox 296 
Scarlatina 301 
Rubeola, or Measles 314 
CHAPTER X.-Concluding Remarks on Fever 319 
CONTENTS. 
APPENDIX. 
CHAPTER I.-Some Female Diseases 337 
On the use of the extract of Hyoscyamus and Oil of 
Sassafras in some of the misfortunes attendant 
on Pregnancy. 337 
Slippery-Elm 350 
CHAPTER II.-Some Diseases of Children 369 
Strophulus-Red-Gum-Hives 369 
Cynanchia Trachialis-Croup 375 
Ophthalmia 377 
Index 383 
Notices and Experience of others 389 PREFACE. 
The author feels profoundly thankful to the all- 
wise and beneficent Disposer of events, and very 
grateful to an intelligent and liberal profession, 
that the present edition of this work will appear 
under much more favorable auspices than did the 
first. Then the author was quite unknown; and 
coming forward, as he did, with views on some 
subjects at variance with received opinions, and 
proposing to do some things which the profession 
had decided could not be done; by remedies, too, 
which had been always known, and supposed to 
possess but little power over diseased action, and 
therefore wanting the fascination which ordinarily 
attends the introduction of new remedies-pur- 
porting to accomplish by the use of third-rate 
remedies what others had failed to accomplish with 
the most potent articles of the materia medica-it 
was but natural to suppose that he would be con- 
sidered a visionary dreamer, and his work cast 
V VI 
PREFACE. 
aside, as not meriting the attention necessary to 
ascertain whether he was dealing in facts or fancy. 
Having a very vivid conception of these things, 
it required the exercise of a greater amount of 
moral courage than any other act of the author's 
life to sustain him in his resolution to bring out 
his work at all; but feeling that he had a mission 
to perform, he resolved on doing his duty; and now 
he has the high satisfaction of knowing that he 
has been the means of doing much good; and that 
his little work, though unattractive in its appear- 
ance, and containing many errors in typography, 
has been highly appreciated by many of the most 
enlightened of the profession, and a second edition 
now earnestly called for. 
The author returns his sincere thanks to his 
brethren in the profession who have so nobly come 
forward with their approbation to sustain him in 
his work; and although some who have written 
to him have not had the entire success in the use 
of his plan of treatment which others have realized, 
he highly estimates their candor in reporting, and 
hopes to be able in this edition to point out the 
secret of their partial failure. 
The arrangement of the present edition will be 
found somewhat different from the first: the author 
had it in his mind to leave out the chapters upon PREFACE. 
VII 
the circulation, but has been advised to retain 
them, and add a condensed view of the nervous 
system; because it is thought that a review of these 
things will do the old practitioner no harm, and 
that, as many persons not connected with the pro- 
fession may be induced to read this work, a plain, 
comprehensible view of the circulation and the 
nervous system would not only be interesting, but 
of real advantage; for it is now well understood 
that the more correct information the people have 
upon the truths of medical science, the better 
they are prepared to appreciate " honorable medi- 
cine," in contradistinction to pretence and quackery. 
Other alterations in the arrangement of the work 
have been made, grouping together such parts as 
had a particular relation to each other, so as to pre- 
sent a more systematic treatise. 
In carrying out this idea, dysentery and cholera 
infantum have been assumed to be febrile diseases, 
I which they really are,) and are accordingly classed 
■with particular fevers; and what is said of female 
diseases, and diseases of children, etc., has been 
thrown into an Appendix, so as to make it suitable 
to simplify the title of the work, it now being 
"Thompson on Fever, with an Appendix." This 
arrangement was not determined on until the work 
was partly stereotyped, and hence the old title of VIII 
PREFACE. 
"Thompson on Fever, Dysentery, etc.," occasionally 
occurs in the first part of the work. 
Inquiry has been made by several why the author 
quotes so much more freely from Fordyce upon 
the subject of fever than from any other author; 
the answer is, that in Fordyce the author finds 
nearly all that has since his time been said upon 
the subject, and he preferred the "pure wine un- 
diluted." In the first edition the author said that 
this is a transition period, when physicians were dis- 
posed to abandon the extra debilitating treatment, 
and adopt a milder and safer plan of treatment, 
many inclining to the use of remedies of a more or 
less decided stimulating character. Since then this 
tendency has become more decidedly manifest, even 
the late writers of France and England having modi- 
fied their treatment materially, almost abandoning 
the antiphlogistic treatment in fevers and inflam- 
matory diseases; so that the author's plan is now 
"in harmony with the tendency of the age," and 
will the more readily get an impartial hearing. 
Upon a very careful review, the author has not 
found it necessary to change or modify any of his 
views upon the science of diseased action; yet his 
further observations, and the suggestions of others, 
have enabled him to clear up many difficulties 
which had presented themselves to him, and to the PREFACE. 
IX 
minds of others, with regard to the phenomena 
which disease occasionally presents in its progress, 
and the variations of treatment which may become 
necessary under different circumstances. And al- 
though he is fully aware that no system of practice, 
however simplified, can ever be presented to the 
public which will enable the people to become their 
own physicians, and supersede the necessity of the 
services of the regular professional educated phy- 
sician, and, consequently, has made no attempt to 
operate outside of the profession, yet as many 
planters and others have procured his book, and 
have managed their own cases of sickness with very 
good success, he has in this edition tried to present 
such rules as will enable them to do so more under- 
standingly. 
Physicians need have no apprehensions that a 
reduction of practice will follow a free introduction 
of this work among their patrons; on the contrary, 
the better informed a community is upon the sub- 
ject of medicine, the readier it is to avail itself of 
scientific skill: it is only the quack and the nostrum- 
vender that need to dread the light. True, fami- 
lies who have this work may often ward off threat- 
ened attacks of sickness, and even manage uncom- 
plicated cases, without the aid of a physician, but in 
all grave cases the doctor will still be sent for: the X 
PREFACE. 
author's best patrons are those best posted as to his 
peculiar mode of treatment. He would, therefore, 
advise every one to study his book carefully, so that 
he may be able to do something understandingly in 
the absence of his physician, and be better prepared 
to appreciate his skill when called on. 
The Introduction to the first edition is retained 
entire, because it shows the author's feelings at the 
time, and is a good expose of the general objects and 
aims of the work. 
In this edition will be found about fifty pages of 
original matter, comprising some thoughts on 
inflammation and functional derangements, and the 
author's treatment of scrofula, including white- 
swelling and chronic ulcers. Also some notices 
of the second edition, reports from other physi- 
cians, etc. gtlritatioii. 
To W. K. BOWLING, M.D.: 
Influenced by a desire to manifest an appreciation of the high 
reputation which your merits and attainments have won for you in 
our Profession, and the noble position you have ever maintained in 
defence of "honorable Medicine," as well as by the many personal 
and professional courtesies received at your hands, the Author re- 
spectfully inscribes to you this work. And while not expecting his 
views and opinions to escape criticism, yet, if characterized by that 
spirit of candor and amenity for which you are distinguished, he 
will be satisfied, though some of his ideas and theories be regarded 
rather as the productions of fancy than developments of scientific 
truths. 
Prof. W. K. Bowling: 
Dear Sir : For the reasons given in the above dedication, and for 
the further one, that to you, more than any one else, the author is 
indebted for the favorable reception of the first edition of this work- 
for you not only kindly apologized for the unworkmanlike manner 
in which the book was gotten up, and for the many typographical 
errors which remained in spite of the author's best efforts to the 
contrary, but, looking alone to the real merit of the production, you 
drew attention to such features in it as you thought were worthy of 
commendation; and though you neither embraced his theory of 
Fever, nor endorsed his plan of treatment, yet for years past you 
have, in your Lectures, set your face as a flint against the murderous 
practice of excessive bleeding and purging in Southern diseases, and 
especially against the use of mercurials in Typhoid Fever; and in 
this way hundreds of minds had been prepared to give an impartial 
hearing to doctrines going still farther in the same direction - he 
therefore respectfully dedicates to you the present edition, hoping 
that your life may long be spared to further on the cause of honor- 
able medicine. INTRODUCTION. 
In this age of multiplication of books, when the 
only reason thought necessary for bringing out a 
new one is that the author can write something 
which others will read, it may be thought super- 
fluous that any apology should be offered for pre- 
senting another work to the reading public. But as 
the writer of the following pages is not courting 
literary fame, nor does he design to fix up the wares 
of his imagination for exchange for money, still less 
would he pander to a depraved taste for reward; 
having no party to defend, no clique to uphold, and, 
at present, advocating no great moral reform, it may 
be proper enough that he should in advance tell 
why he has written at all. If we consider the 
human family with regard to their wants, their 
nature, their capabilities, and their destiny, we 
would naturally come to the conclusion that their 
eternal interest would claim their first and greatest 
attention; next to which, as essential to enjoyment 
of comfort in this life, that the preservation of 
health should rank in importance. The third in- 
terest in rank would be the laying by means for 
13) 14 
INTRODUCTION. 
securing physical comforts; and, lastly, the present 
gratification of the wants of their mental or animal 
nature. But observation abundantly proves that 
generally this order is reversed ; present gratification 
being considered first, and eternal interest last; and 
the mode of preserving health, and the means for 
removing disease, so utterly uncared for, except when 
suffering comes, that did not men study them as a 
means of making money, they would be forgotten 
from the earth, and man in this respect would 
speedily relapse into barbarism, having no science 
to direct him and no means at hand by which to 
relieve the misfortunes of the flesh except such as 
nature furnishes ready prepared and at the place. 
Every individual of sane intellect knows that he 
must some time die, and that be will probably be 
sick more or less before that event; but these are 
merely entertained as abstract facts and probabilities, 
without having the least effect upon present con- 
duct; consequently, there is not one in a hundred but 
would spend a dollar for something rich and rare 
to gratify the animal appetite, a theatrical perform- 
ance to minister to the gratification of the passions, 
a new work of fiction to satisfy a morbid desire for 
mere excitement, rather than expend it for a know- 
ledge of means for preventing or curing a disease, 
which he may never suffer, or for preventing pre- 
mature death, when he already believes that dreaded 
event a long way off. 
The author has not, therefore, written his book 
for the purpose of pleasing or entertaining, or any INTRODUCTION. 
15 
way directly benefiting the people in general, be- 
cause his subject, being the best mode of over- 
coming disease-which they do not intend to have, 
and do not intend to think about until it comes-is 
one which they will not consider, and therefore they 
will probably never read his book. 
But there is a body of men whose business it 
especially is to attend to these matters, who make 
their living (often a poor one) by attending to them, 
and it is for them that these pages are written- 
written because the author believed they would 
offer facilities for contending successfully with at 
least some of the more formidable difficulties they 
have to grapple with in the warfare they are waging 
with human diseases. But, notwithstanding the 
author has addressed himself particularly to the 
medical profession, yet he has endeavored to make 
his reasoning so plain, and has encumbered his lan- 
guage so little with technicalities, that any intelli- 
gent person can read it understandingly, and he 
hopes with pleasure and advantage. Having been 
assiduously engaged for a period of about thirty 
years in the practice of this profession, and having 
made diseased action his constant study during that 
period, ever striving to trace the signs or symptoms 
of disease to the particular departure from healthy 
action from which they arise, among the many 
things which he has found to be obscure, the author 
had his attention particularly drawn to the mystery 
which has ever rested upon what is called the 
"febrile movement." The nature of the particular 16 
INTRODUCTION. 
condition of the system which gives rise to the 
group of symptoms which the profession as well as 
others call fever, is confessedly not well understood. 
The author read much that has been written upon 
this subject, both by the ancients and moderns, 
much of which he considered absurd, much contra- 
dictory, much visionary, and nothing entirely satis- 
factory. In fact, many of our most talented and 
popular writers have honestly acknowledged that 
they did not understand the subject. Dr. Fordyce, 
whose treatise on fevers has formed the source from 
which all other writers have drawn their description 
and most of their ideas of this disease for the last 
half century, says: " Every man who has read the 
various descriptions of fever which have been given 
by authors, ancient and modern, of one country 
or of another, becomes immediately sensible that 
neither its causes, rise, progress, nor termination, 
are thoroughly known or perfectly described; and 
of this he will be more fully persuaded if he has 
frequently had occasion to see the disease. The 
history of fever, therefore, is by no means thoroughly 
understood. That its treatment is not, appears 
clearly, as the practitioners of different countries 
who attend patients in this disease, nay of the same 
county, district, and even town, although of great 
learning in medicine, employ very different modes 
of cures." 
Again he says: " In short, fever is a disease the 
whole of the appearances of which have been in no 
ways accounted for." INTRODUCTION. 
17 
Again he adds: " These sensible appearances in 
fever seem so very independent upon one another, 
that they can only be considered as symptoms of 
some alteration of the system which has not hitherto 
been investigated." The ingenuous Doctor, then, 
frankly acknowledges that he is unable to show up 
the connecting links so as to present an unbroken 
chain of causation, but admits that such a chain 
does exist, and hopes, that some future investigator 
may succeed in demonstrating it. 
A writer in the Transylvania Medical Journal 
says: " But notwithstanding the immense labor that 
has been devoted to the investigation of fever, the 
annual number of its victims is a sufficient evidence 
that the disease is not yet understood, at least so far 
as treatment is concerned." 
Another, in a late number of the Boston Medical 
Journal, terms this disease, " That embodiment of 
transcendentalism which we call fever." 
Professor Cross, of Transylvania, says: " No 
topic has been more earnestly discussed than the 
nature and treatment of fever, and yet few points 
have been settled less to the satisfaction of the 
generality of physicians." 
Dr. Cooke says: "When we seriously consider 
the striking difference, not to call it positive opposi- 
tion, which marks the different theories of fever, 
and the modes of treating it, and again consider 
the mass of testimony, equally voluminous, and 
apparently alike reputable, in favor of each, we are 
puzzled not a little to decide how far it is safe to 18 
INTRODUCTION. 
confide in human perception." Since Fordyce, but 
very little light has been shed upon the subject by 
any writer. 
The author is, therefore, warranted in saying that 
the profession is yet ignorant of the real cause of 
the phenomena of fever. 
Some years since, while the author was watching 
the disease at the bedside, as it then manifested 
itself in the various forms of Dysenteric Fever, 
Intermittent and Remittent Fever, and Typhoid 
Fever, all in the same neighborhood, at the same 
time, his mind was drawn to inquire what could be 
the nature of the cause which produced such various 
manifestations. And while meditating upon the 
subject, an idea of the probable nature of the re- 
mote cause of fever presented itself, which was 
entertained only for a moment, and then dismissed; 
but it recurred again and again, each time associated 
with increased evidence of probability. Finally it 
was deliberately entertained, and a searching train 
of inquiry and investigation instituted, which re- 
sulted in an entire conviction of its truth. But as 
it could not be demonstrated to be absolutely true, 
and as no practical benefits were perceived which 
would arise from its establishment, it was only 
received as a satisfactory means of accounting for 
many of the otherwise unexplained circumstances 
connected with the rise and spread of febrile 
diseases, and nothing was said about it or ever 
would have been by the author, but for the circum- 
stance that it was the occasion of directing his mind INTRODUCTION. 
19 
to inquire still further into the series of causations 
producing fever, this being the first link in the 
chain. This inquiry was prosecuted until the 
author believed he had unravelled the whole series, 
and could with great distinctness perceive Aow the 
first cause produced the second, and it the third, and 
so on until the chain, in doubling back upon itself, 
terminated where it began, in a restoration of 
healthy action, or was suddenly broken by dissolu- 
tion. The series of causations once clearly per- 
ceived, it appeared so plain and natural, that it 
seemed surprising that it should not have been un- 
derstood long ago. It reminded the author of the 
circumstance, that in a certain part of North Caro- 
lina the cottagers had been for half a century or 
more filling the cracks in their log tenements with 
clay, rich in gold-dust, But yet remained ignorant 
of their wealth; but when discovered, the evidence 
of its existence could be easily recognized at various 
points. So when the true condition of the system 
was understood, out of which the various groups of 
symptoms arise which characterize fever, the evi- 
dence of its reality was soon perceived to be abund- 
ant : memory furnished a thousand incidents which 
had occurred in past practice which, though at the 
time of their happening not well understood, now 
all pointed with distinctness to the existence of this 
condition. Authors were now re-read upon the 
subject, and it was interesting to find how much 
evidence they furnish of the correctness of the 
above view, without having perceived it them- '20 
INTRODUCTION. 
selves. Many striking examples of this will be 
given in the work. 
Having traced out the conditions of the system 
out of which the symptoms of fever arise, the next 
natural inquiry was, What is the most natural mode 
of removing them ? Here the author's experience 
in the use of remedial agents, and his habit of 
closely scrutinizing their mode of operation, gave 
him great advantage in making a judicious selec- 
tion of the particular means which would be most 
likely to accomplish the desired result. Articles 
were selected with whose mode of action he was 
perfectly familiar, and which, though simple in their 
properties and perfectly innocent to the constitution, 
were known to possess great power to accomplish 
the precise thing wanted to, be done. Accordingly, 
the first case of plain, uncomplicated fever which 
presented itself was treated upon this plan: it suc- 
ceeded promptly; the next, and the next, were simi- 
larly treated, and yielded as by enchantment; all 
the varieties of fever common in this climate were 
similarly treated, with such variations as to suit 
accidental complication or peculiarities, and it suc- 
ceeded in all, but not with equal promptness: in 
that form of fever which has been the most stubborn 
in its character, viz., the typhoid, it succeeded more 
speedily and with more certainty, without collateral 
aid, than in plain common chills and fever. But, 
with the aid of other means to meet particular 
symptoms, it proved equal to the contest with all. 
After pursuing this plan for three years, in a tole- INTRODUCTION. 
21 
rably large country practice, without calling atten- 
tion to it in any way-for it was thought best to 
multiply evidences of the superiority of the plan 
of treatment beyond the possibility of being mis- 
taken before subjecting it to public scrutiny-but 
being now fully convinced that his unusual success 
was not accidental, the author thought best to 
choose some location where he could have a better 
opportunity of demonstrating the truth of his dis- 
covery, and for that purpose moved to this city, 
where he has been successfully pursuing the same 
plan of treatment in all the febrile cases which have 
come under his charge, and they have been pretty 
numerous; for besides other practice, he purposely 
sought and obtained the management of many 
charity cases, among which, as is well known, the 
most unmanageable cases of fever are usually found. 
But notwithstanding this disadvantage, in a practice 
extending through more than three years, he has 
lost but one patient laboring under any" form of 
febrile disease in this city, and that was the result 
of a cause outside of the fever. But he has not 
only not lost his patients, but they have almost uni- 
formly recovered in an incredibly short time; not 
more than one in fifty has failed to be decidedly 
convalescent before the fifth day of treatment; and 
the author classes among his fever patients all those 
laboring under Pneumonia, Dysentery, Cholera In- 
fantum, as well as the various forms of Bilious and 
Typhoid Fever. He is, therefore, confident he is 
not mistaken in the opinion that he has discovered 22 
INTRODUCTION. 
the true nature of the febrile movement, and has 
instituted a plan of treatment which very materially 
shortens the period which it usually runs, and in a 
still larger proportion lessens the mortality; in view 
of which he believes it to be his duty, both to his 
God and to his country, that he should take the 
proper steps to place this discovery fairly before the 
world. 
If he had consulted his own feelings, or his pri- 
vate interest, he would have kept this matter con- 
cealed in his own mind, for he has ever felt a repug- 
nance to making himself conspicuous in any respect; 
and his private interest would certainly have been 
better served by quietly pursuing this plan in his 
own practice, and gaining character by superior 
success. Besides, he was not ignorant of the fact 
that the world is not well pleased at being shown 
that it has all the time been in error, and no part 
of the world less so than the Medical Profession. 
He therefore expected to meet with the condemna- 
tion of the prejudiced, the contumely of the shallow 
and the self-conceited, as well as the rigid scrutiny 
of the prudent seekers after true medical know- 
ledge ; but having decided what was his duty in 
the premises, he resolved to perform it. 
He accordingly, as a kind of introduction, pre- 
pared a treatise on Dysentery, which was published 
in the March number of the Nashville Journal of 
Medicine and Surgery, 1853 ; and although in that 
he said nothing about fevers in general, yet, as all 
scientific physicians very well know that dysentery INTRODUCTION. 
23 
is a formidable disease only in consequence of the ma- 
lignity of the fever which attends it, it was supposed 
that the peculiar success of the plan of treatment 
therein detailed would lead some to inquire whe- 
ther the same plan, modified according to circum- 
stances, might not be equally successful in other 
forms of fever. But this idea did not seem to strike 
the profession ; for although many physicians in 
the South and West adopted this plan of treating 
dysentery with signal success, as is evidenced by 
letters received from them, yet no one appeared to 
have thought of carrying out the idea of adapting 
the same, or a modification of the same plan, to 
other febrile diseases; so, the next year, the author 
brought the subject more directly before the public 
in some articles published in the State Sentinel and 
Tennessee Organ, of which he was editor. In these 
articles he set forth, in a concise manner, his views 
of the philosophy of the febrile movement, and his 
method of treatment. Again, in the winter of the 
same year, he delivered some Lectures before the 
Medical Class of the University of Nashville upon 
the same subject, and was requested by that body 
to publish them. Again, in the spring of 1855, he 
read a paper before the Tennessee State Medical 
Society, containing an abstract of the principal 
topics discussed in the Lectures, which that body 
referred to a committee of investigation, to report 
at its next annual meeting. During the past sum- 
mer the author has received many letters from phy- 
sicians who had read his articles in the Sentinel, 24 
INTRODUCTION. 
and from young men who heard his Lectures and 
had since gone into practice, requesting him to 
write out his views more extendedly, and present 
them in some form suitable for reference. A num- 
ber of them state that they had adopted the author's 
plan of treatment as far as they could recollect it, 
particularly in typhoid fever, and found it unu- 
sually successful. The author, therefore, feels him- 
self almost compelled to accede to this request; and 
while " making a book," he has concluded, by way 
of making it more interesting and useful, to add 
some views on several other subjects. The contents 
of the present little volume will, therefore, he found 
to be as follows : 
1. Capillary Circulation. 
2. General Circulation. 
3. The substance of his Lectures to the Medical 
Class, embracing a pretty full exposition of his 
views of the theory of fever and its treatment, com- 
mencing with the remote cause, and showing how 
it first impresses the system; then, how this first 
impression brings about that condition of the system 
out of which grow the particular manifestations by 
which we recognize this disease; then, showing 
how this cozuZ/itzon may be removed by the spontane- 
ous efforts of the inherent powers of the system, 
and how art may be brought to aid in this work, 
when nature is likely to prove inadequate to the 
task; explaining fully the means which the author 
has found best adapted to do this, and what have 
been his reasons for selecting these particular INTRODUCTION. 
25 
means, and the philosophy of their action. Also, 
a general view of all the principal theories of fever 
and of diseased action that have obtained in past 
time, showing that all that is true in each agrees with 
and corroborates the peculiar views of the author. 
4. Several subjects which have been acknowledged 
to be mysterious connected with the febrile move- 
ment, or the modus operandi of remedial agents used 
in its management, will be considered, and, the 
author thinks, explained upon rational principles 
according to what he has embraced as the true 
nature of diseased action, thus affording strong evi- 
dence of the truth of his positions. 
Dr. Smith, of the London Fever Hospital, says: 
"When the theory of a disease collects, arranges, 
and points out the true relation between all the phe- 
nomena, there is good reason to conclude that that 
theory is sound; but when it moreover directly leads 
to that treatment of the malady which experience 
shows to be most safe and most efficient, its truth is 
established by every test that can be applied to it." 
The explanations above to will be in the 
form of answers to the following interrogatories: 
Why does the remote cause of fever act most 
potently at night? 
Why do paroxysms of intermittent fever occur 
oftenest in the day ? 
And how account fop evening exacerbations in 
continued fever? 
How do feyers have a natural tendency to termi- 
nate i.P L\e.alth ? 26 
INTRODUCTION. 
How do fevers cure other diseases ? 
How does emetic tartar act in aiding or producing 
a crisis in fever ? 
I n what does the delirium of the first stage of 
fever differ from that in the second and third 
stages ? 
How account for critical days ? 
How does inflammation sometimes cure fever ? 
How do contagious diseases prevent subsequent 
attacks ? 
How do topical remedies act? 
Does the continued action of the remote cause, 
after a fever has been set up, render it more difficult 
to manage or dispose to relapse? 
How does quinine cure intermittents ? 
How does turpentine act in typhoid fever? 
Why are mercurials injurious in typhoid fever? 
5. He will then take up each form of fever com- 
mon in this country, separately, and give the varia- 
tions of treatment necessary in each, and the colla- 
teral aids best adapted to secure the success of the 
main treatment. 
G. An article on Dysentery. 
7. His method of managing some of the misfor- 
tunes incident to pregnancy. 
8. His mode of treating some infantile diseases. 
9. His plan of treatment for catarrhal and scrofu- 
lous ophthalmia, chronic ulcers, etc. 
10. Reports from a number of practitioners in 
the South and West who have treated fevers and 
dysentery upon the plan set forth in this work. A TREATISE 
UPON 
FEVER, DYSENTERY, ETC. 
CHAPTER I. 
CAPILLARY CIRCULATION. 
As the theory of fever, and the modus operandi of 
the remedies by which I profess to break up that 
disease, involve the idea of independent capillary 
action as an essential element in their explanation, 
I have thought that this subject demanded a more 
extended notice than it has received in the body of 
this work, and I now propose to devote a separate 
preliminary chapter to the investigation of this par- 
ticular subject. I am aware that much difference 
of opinion exists among physiologists with regard 
to the circulation in genera], including this particu- 
lar part of it. Many contend that the whole is per- 
formed by the vis a tergo of the heart alone; that the 
momentum the blood receives from the contraction 
of the left ventricle carries it through all the rami- 
fications of the arteries, through their capillary ter- 
minations, into the capillary commencement of the 28 
ON fever: 
veins; then, through the countless ramifications of 
the small veins, into the venous trunks, and along 
these to the right side of the heart, by which it is 
impelled, in like manner, through the pulmonary 
circulation, back to the left side, again to take the 
round of the general circulation. Other physiolo- 
gists have thought that this was assigning too great 
an effect for the amount of the power, and have 
gone to work to hunt up some force which might 
aid the heart in this heavy task. Accordingly, some 
have thought they had found this collateral aid in 
muscular contraction of the arteries, others in gene- 
ral muscular action outside, but exerted on the 
blood-vessels, by which the vessels are squeezed, 
and as the blood cannot go backward on account of 
the peculiar arrangement of the circulatory appara- 
tus, it must of necessity move forward. Others, 
again, have imagined that they had found in the 
lungs, connected with respiration, a power which is 
not only capable of assisting the heart to carry on 
the circulation, but of actually relieving it of that 
duty, and that the heart only acts a secondary part, 
merely filling the minor office of marking time. In 
other words, that in the lungs is the great motive- 
power, and that the heart merely acts as a regulator, 
by measuring out the blood into parcels. 
Now I believe that neither of those notions is 
entirely true, but that each contains some truth, 
though they altogether fall short of embracing the 
whole truth. The heart was never constituted by 
nature such a powerful muscular body for the mere CAPILLARY CIRCULATION. 
29 
purpose of acting the part of a regulator. The com- 
mon sense of mankind points to it as the great 
agent in arterial circulation, and the painful sensa- 
tions produced by its contractions in fever of a high 
grade, would itself convince the sufferer that a force 
is exercised by this organ of no insignificant power. 
But the very fact that wise men have brought them- 
selves to believe that the great motive-power by 
which the blood is circulated through the body is 
connected with respiration, is proof of itself that 
there are good reasons for the belief that the exer- 
cise of the peculiar function of the lungs does, in 
some way, contribute to the accomplishment of the 
business of getting the blood conveyed through its 
"mysterious rounds." It is equally certain that 
the arteries themselves, by independent action, do 
also assist in producing the grand result; else how 
can we account for the superior momentum given 
to the blood in an inflamed limb, over that of the 
corresponding sound one ? Many other reasons 
could be given for the belief that arteries exert an 
independent propelling force in the circulation of 
the blood through them, but, as it is not necessary 
to establish this in order to accomplish the object 
of this chapter, it will not be dwelt on. The same 
reason renders it unnecessary to say any thing con- 
cerning the agency of general muscular action in 
aiding the return of the blood through the veins; 
and, without being further tedious, the main object 
which formed the motive for writing this chapter 
will now be considered, viz.: that the capillaries cir- 30 
on fever: 
culate the blood through themselves by their own 
independent action. This is proven, first, by the 
fact that arterial and capillary circulation are often 
found in very different degrees of activity at the 
same time. 
When the system is in good health, and there is con- 
sequently a corresponding activity of all its powers, 
there will always be harmony of movement among 
all its parts. But, in disease, this correspondence 
of action is always more or less broken up; other- 
wise there could be no disease, but either a strong 
or a weak development of the phenomena of life; 
it is only when there is a broken balance, a want of 
correspondence between the activity of the arterial 
and capillary circulations, that manifestations of dis- 
ease are observed. In some instances there is in- 
creased capillary action, without any corresponding 
activity of the arterial circulation. Blushing is a 
familiar example; the erection of certain tissues, 
constituting what is termed orgasm, is another; and 
the increased activity of the circulation in the secre- 
tory organs during the period of the active exercise 
of their functions presents another. The florid hue 
of the surface, and the increased cuticular exhala- 
tion which usually succeeds active exercise, and con- 
tinues after the activity of arterial circulation has 
subsided to the natural standard, or even sunk below 
it, as is proven by the diminished force of the pul- 
sations, presents another very striking example of 
the exaltation of capillary circulation, without a cor- 
responding increase of the power of the heart's CAPILLARY CIRCULATION. 
31 
action, showing that the former is in some measure 
independent of the latter. But do we meet with 
any examples of the reverse of this in health, where 
the arterial action is greater in proportion than that 
of the capillaries ? I know of no such instances. 
But, in disease, this condition is not only frequently 
but uniformly present; in fact, it constitutes a sine qua 
non to the very existence of disease; a condition which, 
being absent, disease is absent; and being present, 
disease is present also. In very low and collapsed 
conditions of the system, when the heart beats 
feebly and there is little force in the arterial pulsa- 
tions, but profuse discharges from the cuticular and 
raucous surfaces, it might be thought that capillary 
action exceeded that of the heart and arteries; but 
it is not so. Bor, though the latter is weak, the for- 
mer is still weaker; and these discharges are not 
vital secretions, but mechanical exudations, the action 
of the capillaries being so entirely suspended, and 
their coats so relaxed, as to suffer the more fluid 
parts of the blood to pass through without check; 
and sometimes even the more solid constituents, the 
red globules themselves, transuding without any rup- 
ture of continuity. I once saw a very interesting 
instance of this. A colt had been foaled on the 
margin of a ditch containing water, and in scuffling 
had rolled into it, where it remained from twelve to 
twenty-four hours, entirely submerged, with the 
exception of its head. Evidences of life were barely 
perceptible, but, under the influence of stimulants, 
the heart's action revived and increased to consider- 32 
on fever: 
able force before there was a corresponding return 
of vitality in the capillaries; the consequence was, 
that the vis a tergo sent the blood through them 
unchecked, and bloody exudation took place from 
all the mucous surfaces and the more delicate parts 
of the external surface, as the eyes, ears, lips, etc. 
External stimulation, by means of warmth and fric- 
tion, however, soon restored sufficient capillary 
action to prevent exudation, and finally restored the 
animal to health and activity. 
Inflammations furnish another example in which 
arterial action is in excess, and capillary action defi- 
cient. Here we find the blood flows rapidly to the 
part, but passes slowly and sluggishly through it. 
This is also the case in the beginning of the hot 
stage of fever, almost to the same extent. 
Secondly: capillary circulation commences before 
the existence of arterial action. We have an exam- 
ple of this in the development of every individual 
animated existence. In the embryo of the chick we 
can see the blood circulate before there is any heart 
or main arteries formed. Carpenter, upon this sub- 
ject, says: "The first rtiovcment is towards instead 
of from the centre; and even for some time after 
the circulation has been fairly established, the walls 
of the heart consist merely of cells loosely attached 
together, and can hardly be supposed to have any 
great contractile power. The last of these facts 
may be said not to have any direct bearing on the 
question whether the 'capillary power' has any 
existence in the adult condition; but the phenomena CAPILLARY CIRCULATION. 
33 
occasionally presented by the foetus at a later stage 
appear decisive. Cases are of no very unfrequent 
occurrence in which the heart is absent during the 
whole time of embryonic life, and yet the greater 
part of the organs are well developed. 
"It is evident that a single case of this kind, if 
unequivocally demonstrated, furnishes all the proof 
that can be needed of the existence, even in the 
highest animals, of a capillary power, which, though 
usually subordinate to the heart's action, is suffi- 
ciently strong to maintain the circulation by itself 
when the power of the central organ is diminished. 
"It has occasionally been noticed that a gradual 
degeneration in the structure of the heart has taken 
place, to such an extent that hardly any muscular 
tissue could at last be detected in it, but without any 
such interruption to the circulation as must have 
been anticipated if this organ furnishes the sole 
impelling power." 
Thirdly: it continues after arterial action ceases. 
The capillaries in the higher order of animals are 
not so directly dependent upon nervous influence as 
the heart for their action; consequently, they con- 
tinue to circulate the blood for some time after it 
has ceased its motions, especially in sudden deaths. 
This is proven by the return of the natural color of 
the complexion, and often the florid hue of the sur- 
face, which is witnessed an hour or so after the 
patient has ceased to breathe, and all motion of the 
heart has been stilled. It is proven also by the con- 
tinuance of some of the secretions for some time 34 
ON f e v E i:: 
after death, and by the removal at times of ah traces 
of inflammation which had been sufficiently active to 
destroy life, so that a post mortem, some hours after 
the demise, will reveal no evidence of its having 
existed. And, lastly, by the fact that the arteries 
are uniformly found empty, and the veins full, after 
death. No sophistry of reasoning' can break the 
force of this stubborn truth; for if the capillaries 
did not continue to act after the heart ceases its 
motions, the blood would remain divided between 
the arteries and veins, exactly as it was when the last 
contraction left it-except, perhaps, an inconsider- 
able reduction might be made in the arteries by the 
elastic contraction of their coats. But, in order to 
make it look reasonable that this elastic contraction 
emptied the arteries of blood, it would have to be 
shown that it extended so far as to obliterate their 
cavity, or nearly so; but we find them in fact of 
nearly the usual size, but still empty. The evidence, 
then, of the independent circulation in the capilla- 
ries is, that in health it is often increased without 
any corresponding increase of the force of the heart's 
action; that in disease it is always slower and weaker 
in proportion to the arterial circulation; and that it 
begins before the heart is formed, and continues for 
some time after its contractions have ceased. GENERAL CIRCULATION. 
35 
CHAPTER II. 
GENERAL CIRCULATION. 
Though not absolutely necessary to a correct 
understanding or successful defence of my views of 
the nature of the febrile movement or its manage- 
ment, yet, as it has a bearing upon them, I have con- 
cluded to present a general outline of the manner in 
which the blood circulates through the general sys- 
tem, and point out the forces which 1 believe com- 
bine to propel it through its "mysterious round." 
In doing this, I will make the general capillary 
system the beginning point, and let what has been 
said suffice, at least for the present, upon the sub- 
ject of capillary circulation. 
The next stage of movement is the passage of the 
blood through the veins from the capillaries to the 
right side of the heart, which will be now considered. 
But as the general reader (and I hope to have 
many such) cannot be expected to have a sufficient 
anatomical knowledge of the parts immediately con- 
cerned in the circulation to follow me understand- 
ingly in my efforts to explain the nature of the forces 
and the manner of the movements involved in the 36 
ON FEVER: 
description, I will, therefore, before proceeding far- 
ther, give a hasty outline of the parts concerned in 
this interesting process. The veins are membranous 
tubes, having no muscular coat, and possessing but 
little elasticity, which, arising from the capillaries 
and uniting to form larger branches, finally termi- 
nate in the right auricle of the heart. In most of 
the veins, particularly those which are exposed to 
the pressure of muscles when contracting, we find 
what are termed Wm, a kind of membranous sep- 
tum, or partition wall, so disposed as to admit the 
blood to flow easily forward, but offering resistance 
to a backward movement. The right auricle, or, as 
it may be considered, the first chamber of the heart, 
is a membranous bag containing a few muscular 
fibres in its walls, which gives it some independent 
action of its own. It has no well-defined valve at 
the point of its connection with the great venous 
trunk, to prevent the blood from flowing back into 
the veins when the auricle contracts; but this office 
is performed by valves in the veins a short distance 
back. It communicates directly with the right ven- 
tricle of the heart, by an opening in the walls of the 
latter sufficiently large to allow the blood to have 
free ingress into it while in the act of dilating, and 
during the contraction of the former. The right 
ventricle, is a muscular sack, whose cavity constitutes 
the second chamber of the heart, and receives, as we 
have seen, the blood from the auricle. The capacity 
of this chamber is much greater than that of the 
auricle, and its walls are many times thicker. It is 37 
GENERAL CIRCULATION. 
furnished with a valve which prevents the backward 
motion of the blood into the auricle during its con- 
traction. 
The right ventricle communicates directly with 
the pulmonary arteries, through the ramifications of 
which the blood is conveyed into every part of the 
lungs, and finally emptied into the pulmonary capilla- 
ries ; which, by their infinite divisions, bring the 
blood into such close contact with the air in the 
cells of the lungs, that gases are enabled to pass 
from one to the other, and so affect the blood as to 
change it from a dark to a bright sparkling red 
color, and perform whatever other changes are 
necessary to prepare it for the various purposes for 
which it is needed in the animal system. The pul- 
monary capillaries, by uniting into larger trunks, 
form the commencement of the pulmonary veins, 
which give passage to the blood from the lungs back 
again to the heart; opening into the left auricle, 
which is similarly constructed and answers a like 
purpose with its fellow of the right. The blood from 
this auricle passes into the left ventricle, by which, 
by a similar arrangement to that we have noticed 
in the right, it is passed on through the arteries 
back to the general capillaries, the place of our begin- 
ning. The left ventricle of the heart, however, dif- 
fers from the right in possessing much thicker mus- 
cular walls; the difference is estimated to be as 
three to one. The arteries of the general system 
also differ from all other blood-vessels in having 
much thicker and stronger walls, and possessing 38 
ON FEVER! 
more elasticity, and having a distinct muscular coat, 
more or less perfect in different parts. 
Having now given a general outline of the course 
of the blood in the circulation, and a bird's-eye view 
of the machinery used for its conveyance, the gene- 
ral reader will be better prepared to understand 
what may be said with regard to the forces which 
are concerned in carrying it on, which will now be 
considered. 
And first: Of the forces concerned in the general 
venous circulation. 
Several very distinct and independent forces are 
brought to bear upon the blood in the veins, which 
all jointly cooperate in causing it to flow from the 
capillaries to the heart. But the most efficient, as 
I conceive, of these, is the suction power of the heart, 
and this will be first considered. I am aware that 
this power is wholly denied by some physiologists ; 
and by others, though acknowledged to exist, is 
supposed to exert but very little power : among the 
latter is found the justly celebrated and standard 
medical philosopher, Dr. Carpenter. 
Carpenter admits that the dilatation of the heart 
may exert some effect in aiding the circulation of the 
blood in the veins, but contends that this power 
must be of very little force, as it "is doubtful how 
far the auricles have such a power of active dilation 
as that which would be required for this purpose." 
Now, I admit that the auricle has not this power, as 
it is little more than a membranous bas', a mere 
arrangement of the terminus of the great vein, by GENERAL CIRCULATION. 
39 
which, the blood maybe collected for the purpose of 
more easily filling the ventricle when it dilates. In 
the dilatation of the ventricle resides the real suction 
'power. But howr, it may be asked, can the ventricle 
act upon the blood in the veins when their valves 
are shut by the contraction of the auricle? But 
these valves are not interposed so as to prevent the 
exercise of this force, as will be seen when wre con- 
sider what Carpenter himself says upon the action 
of these parts: "The contractions of the ventri- 
cles, and that of the auricles, alternate with one 
another, each taking place (for the most part, at 
least) during the dilation of the other. But there 
is a period during which the auricles and ventricles 
of both sides are dilating together. This occurs 
during the first part of the ventricular diastole; for 
at the conclusion of the systole, the auricles are far 
from being completely filled, and they go on receiv- 
ing an additional supply from the great veins, (a 
portion of which, however, passes immediately into 
the ventricles,) until after the middle of the ven- 
tricular diastole, by which time they become folly 
distended, and immediately contract. The contrac- 
tion of the auricles is, therefore, synchronous with 
only the second stage of the ventricular diastole, 
and their dilation is going on during the whole 
period of the ventricular systole. Thus, while the 
entire period that intervenes between one pulsation 
and another is nearly equally divided between the 
systole and diastole of the ventricles, the division is 
very unequal as regards the auricles; scarcely more 40 
on fever: 
than one-eighth of the whole being occupied in 
their contraction, and the remainder being taken 
up by their dilation." Thus we see that during 
more than half the time occupied in the dilation of 
the ventricle, the auricle is dilating also, and the 
valves being open, the whole force of the suction 
power of the ventricle is exerted upon the entire 
mass of venous blood. And let it be observed fur- 
ther, that it is during the first half of the dilation 
of the ventricle that this free access is admitted, 
the very time when the action of the ventricle is 
the most powerful; for within the first half of the 
whole amount of a muscle's capacity to contract, 
the power it can exert is vastly more than within 
the second half. It would seem, therefore, that 
this peculiar arrangement, which did not escape the 
observation of Carpenter, (but for which he assigns 
no object,) was planned by the great Author of our 
existence for the very purpose of giving the 
greatest possible efficacy to the suction power of the 
heart, acting as a vis a fronte in drawing the blood 
towards it. 
But Carpenter, with others, insists that this suc- 
tion power can be of little force, for " acting upon a 
tube having membranous walls will cause the sides 
to collapse at no great distance, and thus destroy 
the power." But the veins are not in the condition 
of disconnected membranous tubes; they are every- 
where externally joined to the parts through which 
they pass, which would prevent this collapsing of 
their sides. GENERAL CIRCULATION. 
41 
Carpenter admits the forcible dilatation of the 
right ventricle. He says : " The diastole of the ven- 
tricles, according to Cruvilhier, has the rapidity and 
energy of an active movement triumphing over 
pressure exercised upon the organ, so as that the 
hand closed on it is opened with violence. This is 
an observation of great importance; and it concurs 
with observations made upon the heart when 
emptied of blood, to show that the diastole is not a 
mere relaxation of the muscular fibres, permitting 
the cavity to be distended, but is effected by some 
power inherent in the walls themselves." 
Another force which is often brought to bear very 
efficiently in aiding venous circulation, is general 
muscular contraction. Carpenter says, " One of the 
most powerful general causes which influence the 
venous circulation is doubtless the frequently recur- 
ring pressure of muscles upon their trunks." Every 
one has seen the effect of working the fingers in 
augmenting the flow of blood from an orifice in the 
vein of the arm in ordinary venesection. 
"Another important agency," (continues Carpen- 
ter,) " has been found by some physiologist in the 
respiratory movement; this is supposed to draw the 
blood of the veins into the chest, in order to supply 
the vacuum which is created there at the moment 
of the descent of the diaphragm. That the move- 
ment in question has some influence on the flow of 
the venous blood into the chest, is evident from the 
occurrence of the respiratory pulse, long ago described 
by Haller, which may be seen in the veins of the 42 
on fever: 
neck and shoulder in thin persons, and in those 
especially who are suffering from pulmonary dis- 
eases. During inspiration the veins are seen to be 
partially emptied; whilst during expiration they 
become turgid, partly in consequence of the accu- 
mulation from behind and of the check in front; 
and partly, it may be, in some cases through an ab- 
solute reflux from the veins within the chest. On 
the other hand, the expiratory movement, while it 
directly causes accumulation in the veins, will assist 
the heart in propelling the blood into the arteries; 
and by the combined action of these two causes is 
produced, among other effects, the rising and sink- 
ing of the brain synchronously with inspiration and 
expiration, which is observed when a portion of the 
cranium is removed. Several considerations, how- 
ever, agree in pointing to the conclusion that no 
great efficacy can be rightly attributed to the respi- 
ratory movement, as exerting any general influence 
over the venous circulation." The circumstances 
which he refers to are the tendency of suction to 
produce a collapse in a membranous tube, which 
has been answered; and that, as the pulmonary cir- 
culation is within the walls of the chest, therefore 
suction, or the pressure of the atmosphere, can have 
no action in affecting the pulmonary circulation, 
■which I think can be answered presently. The 
blood is then returned through the general venous 
circulation to the heart by the following forces : 1. 
The impulse received in passing through the capil- 
laries by their own proper action, or by the vis a GENERAL CIRCULATION. 
43 
tergo of the heart in certain conditions of the capil- 
laries. 2. The pressure of the muscles while con- 
tracting. 3. The combined suction power of the 
diastole of the right ventricle of the heart, and the 
expansion of the chest in inspiration. 
The blood, having reached the right ventricle of 
the heart, is, by the force of its contraction, sent 
through the pulmonary arteries into the lungs; re- 
ceiving also, perhaps, some additional impulse from 
the elastic and muscular contraction of the arteries 
themselves. 
But as the right ventricle has not nearly the mus- 
cular power of the left, as is evident from its having 
much thinner walls, and from the fact that the im- 
pulse of its contraction is so much loss than that 
produced by the left that we are not sensible of it 
at all, it is therefore almost certain that there is yet 
some other power concerned in sending the blood 
into the lungs besides those already named. It is 
true that the distance which the blood has to be 
propelled is not so great in the pulmonary as in the 
general circulation ; yet, when we consider the im- 
mense number of bifurcations which take place in 
the pulmonary arteries, so as to bring the blood into 
a state of division suitable for entering the minute 
capillaries which expose it to the action of the air 
through the delicate walls of the air-cells, it must 
be confessed that the power necessary to propel the 
blood through the pulmonary round in a given time 
cannot be much less than that required to carry it 
round the circle of the larger circulation. 'For it is 44 
on fever: 
not so much the distance which causes a loss of 
force of momentum in a fluid, as the interruption 
it may receive from the frequent division of its cur- 
rent occasioned by a multiplicity of bifurcations in 
its channel. 
We are therefore forced to the conclusion that 
nature has prepared some additional force in aid of 
the heart and arteries. 
Now, this force must necessarily be found con- 
nected with, or growing out of, the exercise of the 
function of respiration. Lately a theory was ad- 
vanced by a distinguished lady, and adopted and 
defended by some medical writers of considerable 
distinction, which not only finds in the function of 
the lungs a power equal to any deficiency which 
may be found in the action of the heart and arteries 
to carry on the pulmonary circulation, but equal 
to the task of performing the whole business of that, 
and the general circulation also, with but little assist- 
ance from any quarter. But, independent of this 
theory, there is still reason to believe that the lungs 
do act some considerable part in the pulmonary cir- 
culation ; and I think that the manner of this action 
can be quite easily made apparent and explained 
upon well-established philosophical principles. The 
act of respiration itself, as has been shown in an- 
other place, will necessarily have a tendency to pro- 
duce a flow of blood to the lungs as a purely me- 
chanical result. In inspiration the cavity of the 
thorax is dilated by active muscular power. This 
is done'by certain muscles attached to the shoulders GENERAL CIRCULATION. 
45 
and other fixed bony points at one end, and taking 
hold of the ribs and cartilages composing the ante- 
rior walls of the chest by the other, in such a man- 
ner that a shortening of their body will necessarily 
elevate the ribs and increase the capacity of the 
space within them. This enlargement is also much 
increased by the contraction of the diaphragm, 
which is a muscle of immense power, the fibres of 
which are attached to the back and the lower margin 
of the inferior ribs, the cartilages and breast-bone, 
and, converging toward the centre, terminate in a 
strong tendinous substance, so as to form a com- 
plete division, between the cavity of the chest and 
that of the abdomen. But this muscular partition 
is not stretched across the body like the head of a 
drum, but is quite too large for the space when the 
muscle is at rest, and has its centre pushed up into 
the chest in the form of a cone. This arrangement 
is such that when the fibres of the muscle contract, 
the centre of the diaphragm is drawn downwards, 
producing the same mechanical effect as the moving 
of a piston. The action of all these muscles pro- 
duces a considerable increase of the space contained 
within the walls of the chest, which is occupied by 
an immediate expansion of the lungs, causirg a 
rush of air to take place into the air-cells, consti- 
tuting the act of inspiration. But the muscular con- 
traction almost immediately subsides, and the elas- 
ticity of the walls of the thorax brings them back 
to their former position, expelling the air and con- 
stituting the act of expiration ; which, however, when 46 
0 N F EV e R: 
at all difficult, or desired to be forcible, is aided 
materially by the contraction of the abdominal 
muscles, which, by being attached to the ribs, draw 
them forcibly down, and at the same time, by com- 
pressing the contents of the abdominal cavity, push 
its movable contents forcibly up against the dia- 
phragm, causing it again to act upon the principle of 
a piston by encroaching upon the cavity of the chest. 
Now, it is just as certain as any truth in philoso* 
phy, that the expansion of the chest will exert pre- 
cisely the same force in causing blood to flow into 
the cavity as it does upon the air, and that the con- 
traction of the thorax will also exert the same pro- 
pelling force upon the blood, and expel it with the 
same power that is brought to bear upon the aerial 
fluid; that is, that the expansion and contraction 
of the chest, by which the air is drawn in and 
forced out, must, by a physical necessity, produce 
the very same effect upon the blood. How great this 
power is, cannot be accurately estimated. In cpiiet 
respiratory movements the power exerted is very 
little, but in laborious breathing it is very consider- 
able ; and the same causes which call for rapid and 
extensive movements in connection with the true 
respiratory function, will also call for the same 
unusuaHefibrts in aid of the circulatory function; 
in other words, whenever there is a necessity 
for the use of mzzcA air, there is a like necessity for 
much blood in the lungs ; so that it is a happy arrange- 
ment that one set of motions 'will serve both pur- 
poses at the same time. GENERAL CIRCULATION. 
47 
It may be objected that as the movements of re- 
spiration and the action of the heart do not take 
place synchronously, the first being much slower 
than the latter, therefore these forces cannot agree 
in producing the same result. But this is a mis- 
take which can be removed by a moment's reflection. 
During inspiration, the blood is forcibly impelled 
along the pulmonary arteries into the expanding 
thoracic cavity, independent of but in aid of the 
force it has received from the contraction of the 
right ventricle of the heart; while the blood in the 
pulmonary veins, though feeling the same power, 
cannot be drawn backward, by reason of the valvu- 
lar construction of the vessels which contain it. But 
when the chest is contracted in the act of expiration, 
the air is not only expelled from the lungs, but the 
same pressure which forces it out, also operates with 
equal power upon the blood contained in the pulmo- 
nary vessels; but as the blood cannot be made to 
flow backward in the arteries, it must flow forward 
in the veins, and lessen by so much the whole 
amount contained in the thorax, making room for 
a fresh supply to be driven in by the next expansion. 
It may be objected that this arrangement will make 
the influx of blood into the lungs very unequal. But 
that is precisely what wrc might expect of the circu- 
lation in the lungs, a fortiori: nature always does 
things right, and at the right time. The only object 
for getting the blood into the lungs at all being that 
it may be brought into contact, or at least into very 
close proximity with the atmospheric air, so as to 48 
ON FEVER: 
have certain changes performed essential to its use- 
fulness in the business of ministering to the wants 
of the system, consequently it is not wanted in the 
lungs except at the precise moment when the air is 
there too, ready to meet it. And the instinctive 
feeling which prompts to unusual inspiratory effort, 
is doubtless as much owing to a sense of want of 
blood in the lungs as it is from a feeling of lack of 
air, and is at times occasioned principally from one 
cause, and at other times mostly from the other. In 
a very rare or very impure atmosphere, and when 
the ingress of the air is impeded by bronchial ob- 
structions, these unusual efforts are owing to a call 
for more air; but in incipient syncope, in prostra- 
tion from hemorrhage, in capillary obstruction in 
febrile diseases, and in atrophy of the heart, the 
call is for more blood, rather than more air in the 
lungs. And the benefit derived from forcible infla- 
tion of the lungs in restoring suspended animation, 
must be accounted for principally by its direct effects 
upon the pulmonary circulation. 
Having read the preceding observations on the 
forces concerned in the pulmonary circulation to a 
medical friend, he observed that he could not see the 
justice of the conclusion that dilatation and contrac- 
tion of the cavity of the thorax must necessarily influ- 
ence the circulation of the blood through the lungs. 
He said he could readily perceive how the expansion 
of the cavity of the chest must cause the air to rush 
in, because it has direct access through the medium of 
the bronchia into this cavity; but th at the blood is dif- GENERAL CIRCULATION. 
49 
ferently situated-that it is excluded from the real 
cavity of the lungs, being confined in the vessels. I 
replied that his objection was imaginary, and founded 
in a misconception of the philosophy of the effect 
of the vacuum ; that the pressure from without being 
equal on every part, if an empty bladder were placed 
in the receiver of an air-pump, and a tube arranged 
so as to connect it with a fluid without, the exhaus- 
tion of the air would cause the fluid to rush into 
and distend the bladder, causing it to occupy the 
space in the receiver made by the displacement of 
the air; and that if there were a hole in the re- 
ceiver at the same time, the working of the pump 
would cause the fluid to still flow into the bladder 
with exactly the same force with which the air 
pressed in through the aperture in the receiver; but 
that I could refer him to a striking example, which 
to him must be quite familiar, of the effect of a 
vacuum upon fluids contained in vessels, viz.: the 
dilatation of the blood-vessels under the cupping 
instrument, when performing the operation of dry- 
cupping ; and though I freely acknowledged that in 
the act of inspiration there is no vacuum formed in 
the lungs, yet there is an attempt to form one, which 
is prevented by the rushing in of blood as well as 
air. Now, although it is plain that the force ex- 
erted on the blood is not nearly so great as if the 
cavity of the chest had no external opening, yet it 
is & physical truth that the external pressure is just as 
operative in forcing the blood into the pulmonary 
vessels, during the expansion of the chest in the 50 
on fever: 
act of inspiration, as it is in propelling the air 
through the bronchial tubes into the pulmonary 
vesicles. These explanations silenced my friend, if 
they did not convince him. 
Thus we see that the conclusion is incorrect that 
the respiratory movement can have no effect upon 
the pulmonary circulation. But, as I have already 
admitted, this power can have but small force in 
ordinary quiet breathing, yet it is a most important 
resource which may be called on in case of difficulty, 
and affords our only chance of starting the blood 
again after the circulation has been suspended by 
strangulation or asphyxia, or in still-born infants. 
But still, this falls far short of furnishing the amount 
of force which we have seen is lacking to carry on 
the pulmonary circulation, and we must therefore 
yet push our inquiries for further aid. Now, the 
theory of Mrs. Willard presents us with the very 
power which we are seeking. Iler theory seems to 
be substantially this : That in the act of inspiration, 
the play of chemical affinities which takes place be- 
tween part of the constituents of the blood and of 
the air causes an amount of latent caloric to be set 
free sufficient to expand the blood in the capillaries 
so as to force it into vigorous motion; and as this 
motion cannot be backward, it must be forward. 
Now, that heat is evolved by the action of the 
function of respiration, is held to be a fact by most 
physiological writers of any eminence, and that heat 
produces expansion is a philosophic truth, and that 
expansion of a fluid contained in a vessel must pro- GENERAL CIRCULATION. 
51 
(luce motion is equally undeniable; so that this con- 
stitutes a moving force upon the blood in the pul- 
monary vessels, is just as certain as that heat is an 
expanding agent. But the measure of this force 
will be difficult to estimate even proximately, as it 
will depend upon the amount of heat evolved, which 
is itself an unknown measure ; but that it is con- 
siderable, is more than probable-sufficient at least 
to supply the lack of power of the other forces. 
Whoever has seen the smoke arise from a stream 
of arterial blood, as it spouted from the subclavian 
or aorta, will not be ready to sneer at the idea that 
part of it has been converted into steam: boiling 
water, issuing from the spout of a tea kettle, does 
not throw off near the same amount of vapor. The 
reason why steam, escaping from arterial blood, 
affords a denser vapor than that arising from boiling 
water, is plain: it is simply because the former has 
less heat to lose before condensing than the latter. 
Water boils in vacwo at 78°; hence, as the blood is 
in vacuo in the lungs, steam may be formed very 
readily at the usual temperature of the human body; 
but when it escapes into the air, it becomes instantly 
condensed; hence the fog which arises from a stream 
of arterial blood. 
I presume Mrs. Willard never saw the murder- 
ous knife plunged into the chest of the squealing 
porker, or she would not have failed to notice this 
strong evidence of the truth of her theory. But 
she is not lacking of proof, as any one will find who 
reads her modest-looking little book. The scoff of 52 
on fever: 
incredulity proceeds alone from those who never 
read it. 
I would dwell longer on this circulating force, but 
that I have already more than occupied the space I 
allotted to the subject of the circulation, and must 
therefore close, after taking a very brief view of the 
general arterial circulation. 
The blood, in obedience to the forces enumerated, 
reaches the left auricle, or third chamber of the 
heart, from which it is drawn into the left ventricle, 
or fourth chamber, during its dilatation ; and, by its 
contraction, aided to some extent by the clastic con- 
traction of the arteries, and iierliaps by some real 
muscular contraction of the arteries themselves, and 
by the expulsive force of the respiratory movement, 
and whatever impulse it receives from colorific ex- 
pansion, is made to pass from the heart through the 
various ramifications of the general arterial system, 
until it reaches the capillaries. 
I cannot dismiss this subject without taking some 
notice of the positions assumed by Neil Arnott, M. 
D., in his "Elements of Physics," which is now a 
standard work in our colleges. He assumes the 
broad ground that the blood is driven the entire 
round of the circulation by the vis a iergo of the 
heart, and talks quite snee.ringly of the want of a 
knowledge of the physical laws by those medical 
writers who hold a different opinion. Now let us 
for a moment examine his reasonings, and point 
out some of the absurdities of his conclusions. 
After stating, in unqualified terms, that the heart GENERAL CIRCULATION. 
53 
alone is concerned in propelling the blood, when he 
comes to capillary circulation he admits, with Car- 
penter, that these vessels control the passage of the 
blood through them, and that they have independ- 
ent action, and refers to the act of blushing, of the 
turgescence of the erectile tissues, of the increased 
flow of blood to the glands when actively secreting, 
etc., for evidence; and yet, in the next breath, as it 
were, asserts that the blood is forced back through 
the veins by the impulse it had received from the 
contraction of the ventricle of the heart. Now by 
what law in physics can he recover a lost impulse 
without a renewal of the force ? As well might he 
contend that a ball projected along the ground 
until it reached a stream of water, and then carried 
for a time by the current "whithersoever it would," 
could leave the water and return to the place of 
starting without the intervention of any new force: 
the idea is too absurd to merit a serious refutation. 
Again, by way of proving that the blood returns 
to the heart, in consequence of the impulse it re- 
ceived at starting from it, he says that the experiment 
has been tried of dissecting up the companion artery 
and vein of the leg, and placing a ligature around 
the limb, so as to prevent the passage of blood in 
other vessels, and one around the insulated vein, 
and making a small opening below; then, by press- 
ing upon the artery with the thumb and finger, and 
so compressing it as to prevent the passage of 
blood, it was observed that whenever such pressure 
was made, the blood ceased to flow from the orifice 54 
on fever: 
in the vein. Poor Richard's saying, that "always 
taking out of the meal tub, and never putting in, 
will soon come to the bottom," will explain this 
experiment sufficiently. Again he says, that if a 
ligature is applied to a vein, as in bleeding in the 
arm, the blood is seen to How with force from a 
puncture below it; but did he not know that all 
admit the force of capillary action in propelling the 
blood into the small veins ? and that muscular 
contraction, and even rigidity, powerfully aids it in 
the extremities ? He forgot, too, to notice the fact 
that when pressure is made upon a vein, the blood 
above the point of pressure, and below the nearest 
valve, will soon disappear, and the vein become 
empty, showing that there is a vis a fronte acting 
upon it. He also denies the power of the respira- 
tory movement in aid of the circulation, and, for 
proof, refers to the experiment of the action of a 
pump upon yielding tubes; which I have already 
answered, by denying that the veins, in a living 
body, are in the condition of unsupported mem- 
branous tubes, but that they are kept expanded 
and held in situ by their connections with con- 
tiguous tissues, especially in deep-seated parts, 
while on the surface, and especially in the extremi- 
ties, they possess walls of considerable firmness. 
Arnott himself admits that the superficial veins of 
the leg have nearly the firmness of the arteries. It 
will not avail to say that veins arc found collapsed 
after death; for then the surrounding parts have 
lost their vital tonicity, and are themselves relaxed : GENERAL CIRCULATION. 
55 
so that this much-noticcd experiment proves no- 
thing at all. Arnott admits the suction arrangement, 
and says it might be equal, in quiet breathing, to a 
force sufficient to raise the volume of blood one 
inch, and in laborious breathing it might amount to 
twelve inches. Now this is as much as I contend 
for in health, and when the body is at rest, other 
forces are folly sufficient; it is only during active 
exorcise, and when the other forces are deficient 
from disease, that the aid of the respiratory move- 
ment is needed, and a force equal to the task of 
raising the volume of blood twelve inches is more 
than equivalent to the power needed to do the 
entire business of circulating the blood in the 
recumbent position, and equal to about one-third 
of the power needed in the erect position. So that, 
after all his efforts to disparage the attainments of 
others as to their knowledge of the laws of physics, 
as applicable to this subject, he at last grants all 
that can be reasonably claimed by any one, besides 
having displayed a good deal of egotism, and a 
little fallibility of judgment. 
It is true, he only admits the existence of the 
suction arrangement, but infers that it is not exer- 
cised, because, if it were, it would produce collapse 
of the veins. But is it not physically certain that 
this arrangement must of necessity exert suction 
force upon the blood equal to its mechanical capa- 
city? and is it not also certain that the veins are 
not collapsed by the operation of this force ? It 
follows, therefore, that they are not in the condition 56 
on fever: 
of unsupported membranous tubes, and that the 
respiratory movement does perform the part in the 
circulation of the blood which it, as a mechanical 
operation, is calculated to do according to estab- 
lished physical laws, for Arnott says that " nature 
does nothing in vain." 
Arnott refers to certain experiments which prove 
that the blood flows through the arteries with a 
power equal to four pounds to the square inch ; and 
taking it for granted that this power is all exerted 
by the left ventricle of the heart, and estimating 
the cavity of this ventricle to be equal to ten square 
inches, he comes to the conclusion that it contracts 
with a force at least equal to forty pounds. Now 
let it be remembered that the heart is suspended 
in the cavity of the chest, so as to admit of free 
motion, and that its fibres are so arranged, that 
when they contract, the lower end is drawn upward 
and to the left, with a force equal to the power of 
contraction, and that this organ is closely invested 
by its sack, which is in immediate contact with the 
lungs, and that, consequently, the whole force of 
its motion must be received by the lungs; and I 
would suggest that the reader contemplate for a 
moment the effects of a forty pound hammering 
upon any of the tissues of the body. 
The arm or leg can be struck hard enough by a 
common tallow candle to cause great pain and 
soreness, if the tapping be continued long, showing 
that human nature could not stand a continual beat- 
ing of a forty pound power. And this is the esti- GENERAL CIRCULATION. 
57 
mate of the ordinary force of the arterial circula- 
tion. What must it then be while " running race," 
or in high grades of fever ? I think this Doctor of 
Physics must, upon "sober second thought," admit 
that it is much more reasonable that the respiratory 
movement, and the evolution of caloric during that 
process, do produce their natural effects, as me- 
chanical and chemical powers in aid of the heart's 
action in circulating the blood, rather than that the 
thoracic walls can be hammered with a forty pound 
force, and not become sore or complain. 
This multiplicity of forces is a most beneficent 
arrangement, by which the chances of human exist- 
ence are greatly increased; for as life must inevita- 
bly be lost by even a momentary entire stoppage of 
the circulation of the blood, had its continuance 
wholly depended upon any one force, any accident 
which would, even temporarily, interfere with the 
performance of the function of the particular organ 
in which this force resided, would put an instanta- 
neous end to vital existence. But by the present 
arrangement of division of service, any one of the 
forces may be materially deficient or wholly sus- 
pended for a time, and yet the circulation be car- 
ried on by the others until the machinery can be 
repaired, and the balance of duties again adjusted. 
This is not merely a plausible conjecture, but is 
seen actually occurring under the eye of the physi- 
cian in many instances. 
If the circulation, for. example, had been carried 
on by the force of the heart alone, every disease of 58 
on fever: 
that organ would immediately jeopardize life; but 
we fiud that persons have not only lived, but expe- 
rienced a tolerable degree of the enjoyment of life, 
with a condition of the heart which would seem to 
be wholly incompatible with its ability of being in 
any degree useful as an.agent for propelling the 
blood. Post mortems have revealed the fact that 
the heart had for a considerable time been little 
more than a hollow bone, the walls being as im- 
movable as a well-ossified skull; or that, by a pro- 
cess of softening, the integrity of its muscular 
structure had been so completely broken down, 
that it could have been no more useful as a pro- 
pelling agent than a bundle of fat. I once saw 
an instance of this myself, in which the heart was 
so soft that the finger could be thrust through it 
with the ease with which it would penetrate a 
well-boiled turnip. The case was a negro man who 
had fallen dead in the act of walking through the 
house, while in the discharge of his ordinary busi- 
ness, and was brought by his master to the anatom- 
ical amphitheatre in Lexington, in order that a post 
mortem might reveal the cause of his death. Now 
with this condition of the heart, which certainly 
rendered it incapable of aiding in the circulation, 
Lis master informed us that, though rather short of 
breath, he had been able to attend to the common 
duties pertaining to a house-servant up to the 
moment of his death. Again, had the circulation 
depended wholly upon a force connected with the 
pulmonary function, its stability, not to say its GENERAL CIRCULATION. 
59 
existence, would have been put to hazard by every 
interruptio- . in the respiratory movement. But we 
know that respiration may be performed very im- 
perfectly, and yet the blood flow on with but little 
interruption. A very interesting case once came 
under my observation, illustrative of the facility 
with which nature enables a cooperating organ to 
perform its own share assigned to it in a partner- 
ship operation, and also do the work of its partner 
when it chances to be unable to do its duty. A 
gentleman had lost almost the entire right lung by 
a pulmonary abscess, causing that side of his thorax 
to shrink, and the shoulder to drop down very per- 
ceptibly, but the circulation went on about as usual, 
and in the course of a few years had increased to 
an extraordinary vigor. At this time I found his 
pulsations much stronger than natural, and the 
action of the heart evidently greatly increased in 
force. lie appeared to be in perfect health, and 
was able to endure an unusual amount of fatigue. 
I informed him that, in consequence of the loss of 
so much lung, the heart had more work assigned to 
it than common, and that it, like the blacksmith's 
arm, had grown stronger by the increased labor, 
and that I feared it was acquiring a dangerous 
degree of power, which might end in apoplexy or 
hemorrhage of the lungs. But he did not profit 
by my advice to avoid heat and fatigue, and a few 
months thereafter fell insensible in the harvest 
field, and died in a few hours. Now I suppose, 
had nature formed the heart with sufficient power 60 
on fever: 
to drive the blood by its unaided force through the 
entire round of the circulation, it would indeed 
have been a dangerous monster, which would have 
threatened the integrity of the system every time 
it happened to become unusually aroused. Then 
again, had the circulation been entirely dependent 
upon the force of the heart or the lungs, or both, 
cooperating, every momentary suspension of the 
action of these organs from syncope, concussion, 
etc., would have terminated life, no power in that 
case remaining by which those organs could again 
have been excited to action. For did not the 
capillaries continue to circulate the blood for some 
time after respiration and the heart's action ceases, 
the blood would at once be arrested in the vessels, 
no nervous power could be manufactured, and the 
whole machinery of life must inevitably stand still 
for want of motive-power; but the capillaries, by 
acting as a balance-wheel, keep the machinery in 
motion until the great driving forces, the heart and 
the lungs, can be again brought into exercise. In 
viewing this wonderful arrangement for the main- 
tenance of life, one is almost forced to exclaim, 
0, the wisdom and goodness of God I ITS NATURE AND PHENOMENA. 
61 
CHAPTER III. 
fever: its nature and phenomena. 
Febrile diseases have, in every age and country, 
formed the principal outlet of human life. Syden- 
ham estimated that in his day ttvo-thirds of the hu- 
man family died of fevers. At this time, I suppose 
the mortality from this cause is not so great; per- 
haps not more than one-half now die of fevers. But 
this is sufficient to give the subject paramount im- 
portance in the eyes of the physician ; and any plan 
which would materially lessen the mortality, we 
would reasonably suppose, would be seized on by 
every one who had a spark of philanthropy in his 
composition. 
Suppose a plan were adopted which would stop this 
outlet to human existence: it would save in one year, 
in these United States alone, at least half a million 
of lives; a number greater than that which com- 
posed the entire belligerent forces in the Crimea. 
But a plan which would save half of this amount 
would in all fairness entitle the discoverer to be 
classed among the prominent benefactors of man- 62 
on fever: 
kind. And this, yes, more than this, I profess 
to have discovered, and propose to explain. I will 
not only speak of the means used, and present the 
evidence of their success, but trust that I shall be 
able to prove, by sound philosophical reasoning, that 
there is a fitness between the means and the end; 
and that the remedies ought to do exactly what I 
have proved by experience that they will perform. 
But whether this important discovery will be duly 
appreciated, is yet to be ascertained. 
I am aware that we are all slow to acknowledge 
any thing to be great which is the work of a con- 
temporary, and especially of a fellow-citizen and an 
equal: it requires the charm of distance, of time, 
or space, to throw around any great discovery that 
prestige which commends it to our acceptance. 
But, of all ages of the world, this is the time; and 
of all places, this is the locality, in which we might 
most reasonably look for something great to ori- 
ginate ; for I shall not deal much in the imaginary 
when I say that this is the most enlightened age of 
the world's history, and these United States contain 
more intelligence than any other country which the 
sun looks upon; and Tennessee is the centre State 
of this great Republic, and Nashville is the senso- 
rium commune of Tennessee. 
But, without further preliminaries, I will proceed 
to the subject of this chapter. 
In order to a correct understanding of any de- 
rangement in complicated machinery, it is essen- 
tially necessary to possess a thorough knowledge ot MS NATURE AND PHENOMENA. 
63 
its construction, and the philosophy of its opera- 
tions. With regard to the mechanism of the human 
system, and the manner of its natural movements, 
I shall presume that the reader is already well in- 
formed ; and will therefore only stop to give a gen- 
eral summing up of the most important points. 
For example, we have the osseous system, form- 
ing the framework ; the fibro-cartilaginous system, 
to invest the bones and tie them together; the 
muscular, whose office it is to act upon the bones 
and other parts, and put them in motion; the 
glandular system, to prepare material for ingress 
and excretion ; the circulatory, by which material 
for reparation is carried to every part, and the 
wornout particles conveyed from every part; the 
cerebrum, where thoughts are manufactured and 
sensations recognized; the organs of sense, which 
serve to put this thinking apparatus into connec- 
tion with the world; the cerebellum and its spinal 
prolongation, where motive and other powers are 
generated for propelling all this complicated ma- 
chinery ; the nerves, which serve as electric wires 
to transmit intelligence or influence to the great 
mental or sentient emporiums, and return the pro- 
per responses; then we have the cuticular system, 
which forms a covering for the whole, and a lining 
for all the hollow viscera which have an external 
opening; and, lastly, we have the cellular system, 
which serves the important purpose of connecting 
all the other parts together, of filling up irregular- 
ities and unoccupied spaces, and giving to the whole 64 
on fever: 
the proper form and pleasing contour which is pre- 
sented by a well-developed human body. 
Now, in order that we may have a perfect manifes- 
tation of the phenomena of life, all these parts must 
be fully developed, and in a healthy condition, and 
each perform its function well. It is evident that if 
any part be preternaturally developed, or act with 
unwonted power, a loss of harmony must be the 
consequence, and the whole machinery be caused to 
work imperfectly or unnaturally. If all should work 
with increased power, we would certainly have a high 
development of the phenomena of life; and if all 
should act with diminished energy, we would have a 
weaker development of life; but so long as there 
remained harmony of action between the various 
parts, in neither case would we have disease. I wish 
to impress this particularly upon your attention, for 
some important inferences will be drawn from it. I 
therefore reiterate, that neither increased nor dim- 
inished action constitutes disease, so long as there is 
harmony maintained between the various organs. 
Example : take a young man whose system is fully 
developed ; place him under the influence of the 
various excitants addressed to each organ and sense; 
let his stomach be stimulated by the most savory 
food and exhilarating viands; his hearing enrap- 
tured by exciting music; his smell regaled by the 
most delicious odors; his eyes wander over a gal- 
axy of captivating beauty; his touch vibrate to 
the magic influence of contact with the embodiment 
of female loveliness; his muscles strung to their ITS NATURE AND PHENOMENA. 
65 
> 
highest tone by the whirling dance; his sexual or- 
gasm thrilled by the uncovered developments of 
feminine charms; his intellect excited to its highest 
capacity by sallies of wit, sentiment and humor from 
his bewitching partner. Look at him! His eye 
flashes light; intelligence and zest of enjoyment 
beam from every feature; his whole form is full 
from centripetal action; his step is as elastic as the 
steel bow; his heart beats vigorously, and sends the 
red current coursing through the minutest vessels. 
Is he sick? He never could feel better. But will 
not disease ensue from this state of excitement as a 
consequence ? It may, or it may not. If his stamina 
is good, if his organs are well balanced, this state 
of high excitement may be indulged in a thousand 
times with impunity; but if there should be some 
weak point, some imperfectly developed organ, it 
may suffer under the pressure, become exhausted by 
the excessive tension, and afterward be incapable of 
performing well its part; disturbance in the play of 
the machinery of life be the consequence, and disease 
be set up, more or less dangerous in proportion to 
the importance of the suffering organ to the con- 
tinuance of life. By this disturbance in the play of 
the vital forces, resulting from the broken harmony 
among the organs, some are thrown into increased 
action, but others are debilitated. There is never 
general increased action; for then would there be 
harmony in the working of the machinery, and a 
high state of life would follow, and not disease. 
But it is philosophically certain, that no one organ 66 
on fever: 
can act with unusual power for a considerable length 
of time without exhausting its energies, and occa- 
sioning subsequent debility in itself; and also, by 
breaking up the harmony, and calling upon the 
general supply for more blood and more vital in- 
fluence than are allotted to it, either the whole sys- 
tem must feel the shock, or, what is more common, 
some other organ, from accidental or constitutional 
weakness, will suffer in particular. I grant that in- 
creased action in any one part does not, in itself, 
constitute disease; it is only when over-action has 
produced debility in itself, or some other important 
part, that disease may be said to commence. This, 
then, narrows down the matter to a single point, 
that disease consists in debility in one or more organs, 
and that there can be no disease without debility; 
and that this debility must of necessity be partial. 
A general feebleness does no more constitute disease 
than general power. The machinery may be quite 
fragile ; have but little momentum; afford but feeble 
resistance ; but as long as there is correspondence 
among all its parts, there will be harmony of its 
movements. So of the human system: so long as 
the various organs work in harmony, so long there 
can be no disease. The individual, though capable 
of little mental effort, of trifling muscular exertion, 
having weak perceptions, and small manifestations 
of desire or passion, yet has a feeling of well-being; 
has neither pain, nor sickness, nor fever, nor any 
other manifestation of disease ; and this will con- 
tinue to be the case, though the powers of life should ITS NATURE AND PHENOMENA. 
67 
continue to become more and more feeble, until the 
machinery stops its motion. We would then have 
a case of natural death, but not a case of disease. 
This view of the nature of disease in general 
forms the key by which I propose to unlock the 
mystery of the febrile movement in all its forms, 
and it is upon the theory based upon this platform 
that I have built a mode of practice which has suc- 
ceeded in my hands, and may succeed in others, in 
divesting this formidable family of maladies of 
nearly all its terrors. But I am not content with 
knowing that I can abort all the forms of fever com- 
mon in our country. I wish to know how the thing 
is done, and to be able to point out a philosophical 
adaptation of the means to the end. I beg indulg- 
ence, therefore, for being a little tedious in the de- 
fence and illustration of the first principles upon 
which my plan is founded. And here I will observe, 
that I shall not stop to point out what part of the 
views I shall present is original, and what part is 
borrowed, but will give them as a whole; and if 
you should perceive them to be altogether patch- 
work, still I think you will concede that the parts 
fit well together, and form a fabric sufficiently ex- 
pansive to cover the whole ground. 
I repeat, that all disease is dependent on, and has 
its very existence in, debility; general disease arising 
from debility in some general tissue or system of 
organs; local disease, from debility in one or more 
of the structures of which the part affected is com- 
posed. For illustration, I -will refer to a familiar 68 
on fever: 
example, viz., local inflammation of the cellular 
tissue. From observations macle under the inspec- 
tion of the microscope, the following phenomena 
have been observed to follow the application of 
stimuli or irritants to any part suitable for observa- 
tion-increased action of the capillary vessels, and 
increased momentum of the blood; and if the irri- 
tation be now removed, the parts soon return to 
their natural condition, showing clearly that disease 
or disordered action does not necessarily follow in- 
creased action. But if the stimulation be contin- 
ued, the capillaries soon have their vitality so much 
exhausted that they fail to respond to it, but, on the 
contrary, dilate mechanically to the expansive force 
of the blood, admitting a much larger amount than 
usual, which flows on slowly and sluggishly; and if 
the stimulation be now increased, instead of quicken- 
ing the action of the vessels, they become entirely 
torpid from exhaustion, and the blood stagnates and 
presents the well-known phenomena of gangrene. 
Carpenter says, "If whilst we watch the movements 
of blood in a companion artery and vein, we draw 
the point of a fine needle across them three or four 
times, without apparently injuring them or the 
membrane over them, they will both presently con- 
tract and close; then, after remaining for a few 
minutes in a contracted state, they will begin again 
to dilate, and will gradually increase in diameter 
until they acquire a larger size than before the 
stimulus was applied. When in this condition, they 
will not again contract on the same stimulus as ITS NATURE AND PHENOMENA. 
69 
before; the needle may now be drawn across them 
much oftener and more forcibly, but no contraction 
ensues, or only a trivial one, which is quickly 
followed by dilation : with a stronger stimulus, how- 
ever, such as that of great heat, they will again con- 
tract and close, and such contraction may continue 
more than a day before the vessels open and permit 
the blood to flow through them." We see, then, 
that notwithstanding the pain, soreness, swelling, 
throbbing, all seem to indicate over-action in inflam- 
mation, it is nevertheless essentially a disease of 
debility; and all these concomitants can easily be 
accounted for consistently with that fact; more 
than that, they all grow out of it, are produced by 
it. The redness is the consequence of the accumu- 
lation of blood, which we have seen is occasioned 
by the debility of the vessels, causing them to yield 
to the pressure of the blood. This engorgement 
produces the swelling; it also causes the pains; for 
the nerves in the coats of the vessels are necessarily 
stretched by the enlargement, and those in the in- 
termediate cellular tissue are necessarily compressed, 
and of course pain and soreness are the consequence. 
The engorgement also occasions the throbbing; for 
the blood, not finding a vent through the capillaries, 
is accumulated in the small arteries, and a concus- 
sion more or less powerful in proportion to the 
heart's action is felt during every pulsation. The 
obstruction also causes the heat: any of you can'at 
once prove to yourselves that a simple obstruction 
to the circulation of the blood causes heat, by draw- 70 
on fever: 
ing a ligature around any of your extremities, so as 
to obstruct the return of the blood. 
The rationale of the curative means most relied on 
for subduing inflammation, also goes to establish 
this view of its nature : 
1. Equable pressure obtained by the roller band- 
age, by which the quantum of blood flowing to the 
part is lessened, and the coats of the vessels sup- 
ported, and thus enabled to react and assume their 
former size. 
2. The application of cold and other astringents, 
which produce the same effect in a different mode. 
3. Stimulation, by which the vitality of the capil- 
laries is aroused, and they made to contract upon 
their contents. 
A stimulus of a different kind from that which 
produced the debility, or even a milder application 
of the same kind, will often prevent an inflamma- 
tion, or speedily arrest it when set up. Example, a 
frozen extremity: the application of ice-water will 
often restore the suspended animation ; and it is 
well known that a degree of heat a little less than 
produced a burn will "draw out the fire," in com- 
mon parlance; that is, it prevents the inflammation 
which would otherwise follow. Spirits of turpentine, 
camphor, and other stimulants act upon the same 
principle. We all know the efficacy of cayenne 
pepper in subduing inflammation of the throat; of 
creosote, oil of cloves, etc., for allaying inflamma- 
tion of a carious tooth; of strong alcoholic spirits 
for alleviating mercurial inflammation of the mouth, ITS NATURE AND PHENOMENA. 
71 
or for superficial erysipelas. But why multiply ex- 
amples ? The common sense of mankind has in all 
ages led them to cure inflammation by stimulation. 
But, says an objector, how will you account for the 
soothing effect of emollient poultices, upon this view 
of the subject? Very easily. The tension of the 
parts causes the pain, and the irritation of the pain 
causes an increased flow of blood to the part; the 
poultice relaxes the skin and subjacent cellular tis- 
sue, enabling them to yield to the pressure of the en- 
gorged capillaries, thus taking off the pressure from 
the nerves which caused the pain; less blood flows 
to the part, as a consequence, and the inherent vitality 
of the capillaries returning enables them to resume 
their usual calibre and regain their natural action in 
circulating the blood. 
Perhaps it would be well for me here to make a 
few observations upon what I mean by the capilla- 
ries, and their office. You no doubt have been 
already taught that they form the connecting link 
between the arteries and the veins; they also are 
the secretory vessels which separate the various ma- 
terials intended for the use of the system, or for 
excretion from the system ; they also separate from 
the blood the material for building up the system in 
its various parts; also separate the worn-out parti- 
cles from the various tissues, and convey them into 
the veins or lymphatic vessels, to be forwarded to 
the appropriate organs of excretion. In short, the 
capillaries do every thing that is done in the way 
of building up or taking down the system. 72 
on fever: 
But to return. Having shown that inflammation is 
essentially a disease of debility, it will be easily de- 
monstrated that fever is also ; for fever is, " to all 
intents and purposes," an incipient inflammation. 
Common observation indicates, and the microscope 
demonstrates, that the condition of the capillaries 
in fever, and the first stage of inflammation, is 
identically the same. We have but to observe the 
phenomena of a case of fever, and analyze the 
symptoms as they consecutively occur, to become 
assured that this, as well as inflammation, has its 
foundation in debility-begins in it, continues with 
it, and sinks under it, or ceases with its removal. 
Let us, for illustration, take a case of common 
symptomatic fever, and consider its cause, its incep- 
tion, its development, and its cessation, and see if 
we cannot show up the footprints of debility 
throughout its entire march. A boy runs heed- 
lessly over rocks, and bruises his heel; inflammation, 
and, of course, swelling ensue ; but the hard inte- 
gument will not yield, and the consequent pressure 
upon the nerves, with which the part is abundantly 
provided, causes intense suffering; and the cellular 
tissue, being here dense and fibrous, suppurates 
slowly, so that the case is protracted long enough 
for the painful impression carried by the nerves to 
their spinal origin to stimulate that organ so as to 
occasion debility in its structure; .which, as in in- 
cipient inflammation, is attended with engorgement 
of the capillaries which enter into its composition, 
causing a retarded circulation of the blood through ITS NATURE AND PHENOMENA. 
73 
its vessels; the nervous matter is pressed by the 
distended vessels, and its energies cramped, so that 
it sends out deficient or morbid nervous influence, 
which is manifested as follows: The boy feels list- 
less, weak, and mopish; complains of aching in his 
back and limbs, soreness of the flesh, and rigidity 
of the muscles, which make him averse to move; 
the organs of secretion work languidly and unnatu- 
rally ; there are fitful sensations of heat and chilli- 
ness ; his appetite is capricious, feeling hungry, but 
refusing food when presented; his heart beats lan- 
guidly or rapidly, with a weak and variable motion ; 
the congested capillaries give a duskiness to the 
surface; his eye is watery, weak, and lustreless, 
and his intellect clouded. But the blood, not find- 
ing a ready passage through the congested capilla- 
ries, necessarily accumulates in the large vessels; 
the heart is soon made to feel the stimulus of dis- 
tension, and is excited to increased action; but, 
though it labors with augmented force and fre- 
quency, and throws the vital fluid bounding to the 
surface, the engorged capillaries offer an obstruc- 
tion, and it reacts still further upon the heart. The 
patient now complains of heat, restlessness, head- 
ache, throbbing of the temples, dryness of the skin, 
mouth and throat, nausea, or sickness of the stom- 
ach ; in short, of all the distresses usually attendant 
on a well-developed case of fever; every feeling, 
every sensation is unnatural; every function is de- 
ranged ; every secretion is morbid. 
Here let us pause a moment, and consider the 74 
o n fever: 
real condition of onr patient. Has he too much 
blood in his system ? Not an ounce more than he 
had a few hours ago, when he was laboring under 
the period of depression. Is his blood charged with 
some poisonous matter that is fretting the heart 
into this tumultuous action? It is the same blood 
that flowed tranquilly through his veins a few nights 
since, when he slept as quietly as an infant, and 
breathed so softly that a feather would not have quiv- 
ered from its force; the same that, in his waking 
hours, gave buoyancy to his feelings, and filled him 
with the zest of young life's enjoyment. There is, 
then, not too much blood; neither is his blood poi- 
soned ; but it is obstructed in its circulation ; and the 
proper method of relief is, not to lessen its quantity, 
nor to purge away part of its constituents, but to 
stimulate the capillaries, restore their vital activity, 
make them contract upon their contents, and thus 
remove the obstruction to the onward current of the 
blood; and the heart, being relieved from the stimu- 
lus of distension, and the nervous matter from the 
stimulus of compression, all the over-action will 
quietly subside, all the morbid sensations will disap- 
pear, and the machinery of life run on smoothly again, 
without having sustained any loss of power by the 
means that have been used to set it right. But the 
first consideration in this case should be to remove 
the cause; for, while it is still operating, it will be 
very difficult to keep down the effects. Every one 
would agree that the abscess should be opened to 
relieve the tension, and poulticed to allay the irrita- ITS NATURE AND PHENOMENA. 
75 
tion ; and then, if the system had been previously 
healthy, it will perhaps return again'by its own in- 
lierent powers to its former state of well-being. 
And, I presume, it will be conceded that it would 
be just as important to remove the cause in every 
other form of fever as in this, if it could be done; 
and I hope to be able to show that the cause of at 
least some other fevers can be as certainly and as 
speedily destroyed as the one we have considered. 
But to progress with the matter immediately 
under consideration ; that is, that all fevers are de- 
pendent on debility. The next most appropriate 
form of fever that presents itself for illustrating 
this position, is child-bed or puerperal fever. In 
this case the whole system has received a severe 
shock; there has been exhausting muscular effort, 
severe and perhaps protracted suffering, and a con- 
siderable drain of the vital fluid-all calculated to 
produce general debility and irritability. An im- 
portant organ has suffered a serious lesion, and its 
capillaries, by being debilitated, have become con- 
gested, which readily runs into the stage of actual 
inflammation. The already excited uterine nerves 
convey the morbid impression to their spinal ori- 
gin, and there produce stimulation which is felt 
through the medium of the nerves throughout the 
entire system. And here, at the commencement 
of this disease, we have the opportunity of witness- 
ing the very first febrile movement; I mean the 
excitement felt throughout the whole system from 
stimulation of the nervous centres. Who, that has 76 
ON fever: 
had experience in puerperal fever, has not marked 
that, just before the onset of the disease, the lady 
felt unusually well? She enjoyed with a zest the 
society of her friends; dallied with her infant; 
took nourishment with a relish; and was buoyant 
under the confident anticipation of a speedy re- 
covery. But the philosophic and practiced eye of 
the physician could see through these deceptive 
manifestations of vital energy, and perceive that 
they all arose from undue excitement, sent to the 
nervous centres by a suffering organ; and the same 
eye will also be able to perceive other changes 
which are silently taking place: over-excitement 
in the nervous centres is producing debility, and 
the debility engorgement; the first manifestation 
of which, perhaps, is, that the lady complains of 
feeling tired, and falls asleep, from which she is 
aroused by regular rigors. The whole system now 
feels the shock; the head, back, and limbs ache ; 
the heart beats laboriously; the lungs play with 
difficulty, and there is restlessness and sighing; 
but the blood soon accumulates in the great vessels, 
so as to excite the heart by the stimulus of disten- 
sion to increased action, and the blood is sent with 
power to the periphera; but the weakened, torpid, 
congested capillaries do not transmit it freely, and 
hence soon follow heat, throbbing, pain, restless- 
ness, and all the other concomitants of febrile 
excitement, complicated with inflammation of a 
most important and sensitive organ. All this is 
very unexpected to friends who were misled by ITS NATURE AND PHENOMENA. 
77 
the deceptive excitement of the first stage, and 
all are ready to give a reason. She was too smart, 
they say ; sat up too much; talked too much to 
the baby; ate more than was proper, etc., etc.; 
never imagining that all these were done under the 
excitement of the disease itself. 
The common sense of the profession has led it to 
adopt a plan of treatment for this disease which 
corresponds very well with the views here ex- 
pressed of its nature. The remedies mainly relied 
on now are blisters to the abdomen, and the inter- 
nal use of opium and spirits of turpentine. Now 
opium, we know, is directly a powerful nervous 
stimulant, and indirectly an equally powerful general 
stimulant, and turpentine is directly a most potent 
stimulant, only a little less severe than fire itself, 
when applied to a sentient or raw surface, and, 
hence, is much used as an application to burns to 
"draw out the fire." It does act beneficially, and 
upon the same principle that heat does; that is, 
when a part is debilitated by the action of a power- 
ful stimulus, one a little less powerful will keep up 
the action of the capillaries until they have time to 
regain their tone. The other leading agent referred 
to, viz., the blister, acts upon the very same prin- 
ciple, it stimulates the external capillaries immedi- 
ately over the infiamed organ, which, by being 
intimately associated with those within, causes 
them to act also; just as we arrest an internal 
hemorrhage by dashing cold water upon the sur- 
face. There is, therefore, a fitness between these 78 
on fever: 
remedies and the object to be attained; and the 
practice is, consequently, reasonably successful. 
But there is a better means for producing stimula- 
tion, which I will give in full in the proper place. 
The next disease which I will refer to, for illus- 
tration, is inflammatory fever; and I should sup- 
pose if I can clearly show this to be a disease of 
debility, you will find little difficulty in following 
me in the application of this term to all the rest of 
the febrile family. 
A young man, unused to active exercise, con- 
cludes to amuse himself with a hunt, and, shoulder- 
ing his heavy double-barrelled fire-arm, sallies forth 
on a sultry afternoon: he sees game, but it eludes 
him; yet, stimulated by the hope of ultimate suc- 
cess, he pursues on, forgetful of the unusual tax 
which he is imposing upon the vital forces; but, 
finally, his tired muscles complain so urgently, that 
he is obliged to give heed; and now, yielding to 
the impulse, he throws himself upon the ground 
beneath the wide-spreading branches of a forest 
tree, and drops to sleep; on waking, he finds his 
limbs numb and stiff, and his muscles obey the 
will with difficulty; but by an effort he reaches 
home and retires to bed. In the night he awakes 
out of unquiet slumbers, and finds his tongue 
parched; his throat as dry as his powder-horn ; his 
temples throbbing; back and limbs aching; gene- 
ral heat of the surface ; restlessness, etc. Now let us 
analyze these symptoms, and refer each to its 
appropriate cause. The heat and unusual muscn- ITS NATURE AND PHENOMENA. 
79 
lar exertion produced a real, general, temporary 
debility, which, if he had returned slowly home, 
and retired to his own comfortable couch, would 
have subsided of itself, without leaving any un- 
pleasant consequences; but to the debility from 
exhaustion of vital energy, he superadded that 
arising from a protracted exposure to cold; for 
however powerfully a sudden application of cold 
may act as a stimulus, its protracted influence is, 
most certainly, a decided debilitant; and in this 
case, the whole sum of vital energy having been 
lessened by exhaustion, the capillaries were unable 
to retain their tonicity, and, giving way under the 
onward pressure of the blood, became engorged 
beyond their ability to make efficient contraction. 
Now, this engorgement is all that we need to ena- 
ble us to understand the why of his soreness, stiff- 
ness, and listlessness on waking. The cause was a 
general one, acting upon the whole system; and 
the capillaries everywhere became debilitated and 
engorged, and everywhere produced an unnatural 
condition, which was manifested in each part 
according to its nature and office. The cerebrum 
is engorged, and, as a consequence, the intellect is 
dull and beclouded; the other nervous centres are 
engorged, and the supply of nervous influence is 
deficient and of a morbid quality, causing deficient 
or morbid action in every part; the capillaries of 
the nerve-matter, of its investitures, of the cellular 
tissue in which it is imbedded, the muscular fibres, 
are all engorged; and of course the nerve-matter 80 
on fever: 
everywhere is compressed and stretched, so that 
every contraction of a muscular fibre, every change 
of position, causes suffering; and even when the 
body is kept motionless, this compression and ten- 
sion of the neuramilla are sufficient to cause that 
indescribable sensation, known as "a sense of ill- 
being." But, say you, there is no controversy 
here: all agree that this stage of fever is one of 
debility, but we deny that the subsequent one, that 
of reaction, is. 
Well, I will now proceed to examine it, and see 
if I cannot trace the marks of debility through it 
also. 
I have already alluded several times to the man- 
ner in which the reaction-the hot sta<jc of fever- 
is brought about; viz., that the blood, by meeting 
with difficulty in its passage through the capilla- 
ries, accumulates in the heart and arteries, and 
stimulates them to increased contraction: now if 
the capillaries did not re/nam debilitated and inac- 
tive, and thus continue to offer resistance to the 
momentum of the circulation, what prevents the 
heart from relieving itself from the stimulus of 
the accumulated blood ? What prevents an imme- 
diate return of all the parts to a natural, quiet con- 
dition? In mild cases, this desirable result often 
does take place, in consequence of a reaction of 
the capillaries from their innate vigor, coinciding 
with the general reaction, or by the assistance of a 
timely exhibition of some of the domestic reme- 
dies, which the common sense of mankind, or ITS NATURE AND PHENOMENA. 
81 
rather of womankind, has led them to adopt, such 
as a warm ginger-stew, aided by the stimulus of a 
hot foot-bath, etc. 
But suppose these timely remedies be neglected 
or prove inadequate: the symptoms go on increasing 
in inveteracy; the throbbing carotids drive the blood 
into the vessels of the brain with tremendous force, 
but the capillaries are torpid, congested, and do not 
transmit it freely; every available space is therefore 
crowded to the full, and the medullary substance so 
compressed that it cannot perform its functions well; 
the numerous nerves in its investing membrane are 
compressed, until they give out the sensation of 
pain, more or less intense; association between the 
faculties of the mind is lost, and the patient has wild 
vagaries and talks incoherently : a little more pres- 
sure, and mental action ceases entirely, and the pa- 
tient sinks into coma, and is dead to all thought or 
sensation. 
Similar events have been taking place in other 
parts of the system ; the capillaries of the stomach 
have been weakened and congested, and caused com- 
pression of the gastric nerves, which at first, per- 
haps, only gave the sensation of hunger, but which 
food would not satiate; an increased pressure will, 
however, cause them to complain in their usual way, 
viz. : by nausea, sickness, and perhaps vomiting. 
The same pressure upon the nerves of ordinary sen- 
sation, in the coats of the stomach, causes pain and 
soreness. The liver suffers in the same manner: at 
first, perhaps, the congestion only increases its na- 82 
on fever: 
tural secretion ; a higher degree depraves it; and a 
still greater suspends all secretion, and distends its 
substance so as to present an evident fulness exter- 
nally, with more or less soreness, pain, and sense of 
weight. All the other organs suffer in like manner, 
and complain in a way suited to the office and sensi- 
bility of each. The skin being exposed to the im- 
mediate inspection of the eye, we are enabled to 
examine its condition more readily and more accu- 
rately than any other organ. Now what are the de- 
velopments presented ? In the hot stage of fever, 
we see its vessels are evidently distended with blood, 
but it does not present the ruddy glow which we 
see follow active exercise in health ; but it is dusky, 
like that presented by passing a ligature around a 
limb, so as to partially obstruct the return of the 
blood in the minute vessels. 
But it may be objected that this view of the na- 
ture of inflammatory fever is not consistent with 
the known character of the agencies by which it is 
successfully treated; that these are blood-letting, 
active purgation, nauseants, etc., all of which are 
debilitants. 
But an analysis of the modus operandi of these 
remedies in this particular case will show that their 
success harmonizes well with this theory. We will 
take venesection as a type of the class: it will be 
conceded, I suppose, that there is no actual increase 
of the quantum of blood over what was in the sys- 
tem immediately preceding the attack, or a few hours 
ago, when our patient was laboring under the period ITS N AT U RE A N D PHENO ME N A. 
83 
of depression ; then there appeared to be an actual 
want of blood, judging from the pallid countenance 
and the shrunken surface; there cannot, therefore, 
bo too much blood, but there is an obstruction to its 
circulation, and what is wanted is not a reduction 
of its quantity, but a removal of this obstruction, so 
that the heart may be able to relieve itself without 
exerting such unusual force. This can be effected 
in two ways. First, directly by stimulating the ca- 
pillaries, and causing them to resume their usual 
action in passing the blood, which, finding a free 
passage, soon relieves the heart of the stimulus of 
distension, and it quiets down to its usual force of 
action ; or, secondly, the same thing can be done 
indirectly, by the use of such means as will lessen the 
heart's action ; for by lessening the force by which 
the blood is pressed into the capillaries, they are 
allowed time to regain their usual contractibility, 
and resume their function. This can be done by 
abstracting blood from a vein ; the supply to the 
heart being reduced, it is enabled to relieve itself 
of the stimulus of distension, and of course acts with 
less power; or it may be done by acting upon the 
heart through the medium of the nerves: for ex- 
ample, nauseants and veratrum viride, by their de- 
pressing influence on the nervous centres, diminish 
nerve-power generally; and less nervous influence 
being sent to the heart, and it made less sensitive 
to the stimulus of the blood, it will act with less 
force under the same amount of stimulation. 
But venesection, nauseants, veratrum viride, 84 
ox fever: 
drastic purgatives, and all that class of remedies, 
relieve the obstruction by producing positive general 
debility, and necessarily make convalescence pro- 
tracted and uncertain; whereas, by the first mode, 
that is, by direct stimulation of the capillaries, relief 
is obtained without any loss of general strength, 
without any shock to the vital powers, and convales- 
cence is consequently direct and complete. But I 
will dilate more upon this at the proper time. 
I will now take a hasty view of miasmatic fever, 
and sec how well its symptoms harmonize with the 
general theory I have advanced. 
But it will amount to little more than a tiresome 
repetition of much that has been said, to go into a 
detail of its symptoms, and an explanation of the 
condition out of which they arise. We have here 
the same evidence of nervous and capillary debility 
in the forming stage which has already been de- 
scribed, with this difference: the cause having acted 
a longer time in bringing about exhaustion of vital 
energy, the manifestations of debility and morbid 
nervous influence are greater, and the functional de- 
rangement in the various organs is also usually more 
decided, so that we have, along with the listlessness, 
languor, muscular weakness, etc., more headache, 
pain in the back and limbs, greater disturbance of the 
stomach, bowels, and liver, and a more decided sense 
of chilliness. But still it must be acknowledged 
that the symptoms of the first stage of all fevers, 
whether sympathetic, malarial, or contagious, are so 
nearly similar that the most experienced practitioner, ITS NATURE AND PHENOMENA. 
85 
when consulted at that period, is often wholly un- 
able to determine what form it will assume when 
fully developed. And, fortunately, it is generally 
of the least possible consequence that he should de- 
termine, provided he have a clear comprehension of 
the condition of the system out of which the symp- 
toms have grown : a hot mustard foot-bath, frictions 
along the spine, with some stimulating liniment, 
and a mild nervous stimulant, resorted to in this 
stage, will often so effectually arouse the capillaries, 
and quiet the morbid nervous excitement, that the 
physician is never able to learn what kind of a fever 
would have been developed, had the case been left 
unmolested. 
But to return to the case : after this stage of de- 
pression has continued for some time, a reaction is 
brought about in the manner already described, and 
differs nothing from the reaction in inflammatory 
fever, except that it is usually not so perfect; for, 
owing to the very gradual way in which the stage 
of depression has been brought about, the debility 
is more profound, and the vital energies are, conse- 
quently, not so readily aroused. In some cases the 
exhaustion of the vital energies is so complete, that 
the patient dies in the stage of depression; in 
others, it takes place very imperfectly, not amount- 
ing to more than a mere throbbing of the heart, 
with but trifling increase of force, the extremities 
still remaining cold. But in whatever degree re- 
action does take place, it is always attended with 
the symptoms of capillary obstruction and morbid 86 
ON fever: 
enervation ; showing that debility is a prominent 
feature of this stage also. Perhaps there is no one 
fact connected with this stage that points so con- 
clusively to debility as constituting its most promi- 
nent character as this, that notwithstanding the 
reaction, there is no increase of strength: on the con- 
trary, the more powerful the heart's action, the more 
utter is the feeling of prostration ; unless, indeed, 
the brain becomes maddened by inflammatory ac- 
tion, causing frenzied demonstrations of power. 
After this state of excitement has continued for 
some hours, it begins to abate, and we have an in- 
termission, or at least a remission, which appears to 
be brought about in the following manner: The 
heart, being nothing more than a great muscle, is 
subject to the laws governing muscles in general. 
One of these is, that when they are made to contract 
with more force than usual, they become tired, or 
have their vitality exhausted. Accordingly, the 
heart, after acting with unusual power for a few 
hours, becomes weary, and gradually assumes a 
more moderate action, under the same amount of 
stimulus ; and besides, the capillaries react in some 
degree during the excitement, and, by passing the 
blood on, lessen the stimulation of the heart. But 
there is still another way in which a remission, or 
at least a subsidence of actual excitement, may be 
brought about. At the termination of each capil- 
lary, whether it communicates with a vein or an 
absorbent, or opens into an excretory duct, or per- 
forms a secretory office, or opens externally through ITS NATURE AND PHENOMENA. 
87 
the skin or into the howels, there resides a peculiar 
sensibility which acts as a kind of sentinel over the 
passage of the contents, and refuses to allow any 
constituent of the blood to pass, except that which 
nature designed to pass. But in cases of great de- 
bility this guard leaves its post; in other words, the 
sensibility becomes so deficient, that the. mouths of 
the capillaries relax so as to suffer the more fluid 
parts of the blood to pass out unchanged and un- 
checked, and a wasting colliquative sweat or diar- 
rhoea lessens the heart's action, and at the same 
time wTastes the energies and resources of the sys- 
tem. 
If the intermission be perfect, and the vital ener- 
gies of the system not much exhausted, the system 
regains nearly its usual healthy condition, the sensa- 
tions become more natural, and the secretions more 
or less restored, showing clearly that debility was 
the cause of both inaction and reaction. But the 
cause is still in operation, and the capillary inaction 
only partially removed ; and, after a certain period, 
another paroxysm is set up in the same way as the 
first. Now, in case the debility in the capillaries is 
greater and more persistent, in place of a perfect 
intermission succeeding the reaction, there will only 
be a remission; and this will be more or less per- 
fect, exactly in proportion to the degree in which 
the capillaries can be aroused by the stage of ex- 
citement. 
Now, all will be ready to admit that the lowest 
cases, such as prove fatal in the first stage, and such 88 
on fever: 
as arc attended with a feeble reaction, are charac- 
terized by debility. Well, according to the fair 
analysis which has been given of the various stages 
of fever, it is plain that these lowest cases are 
founded in the very same morbid changes which 
gave rise to the slighter and most open forms; the 
only difference being the greater intensity of the 
debility occasioned by a more powerful action of 
the remote cause, or from its acting for a longer 
time, or on a system debilitated by some other 
cause. 
I will now hastily sum up what I think have been 
proved to be the essential circumstances connected 
with, and constituting, a case of fever. 1st. Morbid 
impressions made upon the nervous centres. 2d. 
Weakened and vicious nervous influence sent out 
through the whole system. 3d. That this weakens 
the action of the capillaries, and causes them to 
dilate under the pressure of the blood, while, at the 
same time, the sensibility of their mouths is so 
altered by having been supplied by morbid nervous 
influence, that they refuse to let the blood pass; 
just as the neck of the bladder, when irritated, re- 
fuses to give passage to the urine,, though of a 
natural quality, thereby retarding the blood in the 
capillaries, and obstructing the circulation. 4th. 
That the accumulation of blood in the laro-e vessels, 
from this cause, occasions the heart and arteries to 
be unduly excited by the stimulus of distension, 
thus producing the reaction which constitutes the 
hot stage. 5th. The pressure and tension occa- ITS NATURE AND PHENOMENA. 
89 
sioned by the engorgement of the capillaries, give 
rise to all the unnatural phenomena which attend 
a case of fever throughout its several stages, viz., 
the increased, depraved, or suspended secretions, 
painful and unnatural sensations, inflammatory com- 
plications, etc. 6th. It is only by a partial restora- 
tion of the natural action of the capillaries that an 
intermission, or remission, is obtained; and only 
by permanently restoring this action can the disease 
be broken up. And lastly, if capillary action is not 
restored, the patient dies. 90 
on fever: 
CHAPTER IV. 
CAUSES OF FEVER. 
We now have but one more point to examine, 
and we will then have a plain, practical, common- 
sense view of the whole subject; that is, the origi- 
nal cause, the agency by which the deleterious im- 
pression is made upon the nervous centres. In 
symptomatic fever, we know that the remote cause 
is morbid impression sent by a suffering organ to 
the brain and its appendages. The remote cause 
of inflammatory fever is known to be the depress- 
ing influence of a protracted exposure to cold upon 
a system exhausted by fatigue; but the remote 
cause of other idiopathic fevers is not so well under- 
stood, but it is certain that it must be something 
that is capable of floating in the atmosphere, and 
that it is either organic or inorganic, and that it 
either acts upon the nerves of the sentient surfaces, 
as the skin and alimentary canal, or it enters the 
circulation and acts immediately on the nervous 
centres. Now, it does not appear to be reasonable 
to suppose that it acts primarily upon the surfaces ; CAUSES 
91 
for then those parts should first show signs of dis- 
ease before they could send morbid impressions to 
the nervous centres, so as to bring about the debility 
which characterizes the first stage of all fevers. 
But we know that there is no previous manifesta- 
tion of irritation in these surfaces; then the cause 
must enter the circulation, either through the lungs 
or along with the ingesta, and reach the nervous 
centres through the blood, and, when there, act 
either as a mechanical irritant or a narcotic stimu- 
lant. My views of the whole subject are briefly as 
follows: That the cause of all malarious epidemic 
and contagious fevers is organized existences-in- 
finitesimal animalcules or sporules which float in 
the atmosphere, and are inhaled with it into the 
lungs, and, permeating the lining of the air-vesicles, 
enter the blood, and by it are carried to the nervous 
centres, where they act as narcotic poisons. 
This view of the subject will enable us to explain 
many of the facts connected with the spread of 
febrile diseases, which no other theory can. It also 
enables me to give a rational explanation of the 
mode in which one of the remedies which enter 
into my plan of treatment operates in arresting 
fevers, which I otherwise cannot explain. But whe- 
ther organic or inorganic, it most certainly acts as 
a narcotic stimulant, or nerve poison : the nature of 
the first symptoms indicates this most unmistakably. 
Fordyce says: "One of the symptoms of fever is 
diminution of the sensibility of the skin; of this 
one great instance is its insensibility to heat, which 92 
on fever: 
has been so great in some instances that no sensa- 
tion has been impressed on the mind when hot 
bodies have been applied so as to coagulate the 
scarf skin. This insensibility to heat is not from 
the sensation of coldness, for it extends to the sensi- 
bility of the skin of every kind; it is a degree of 
what is called numbness or indistinctness of the 
ideas which are obtained by the feel of the figure 
of bodies, their smoothness or roughness, their hard- 
ness or softness, etc. It is extended to other means 
that give pain, as stimulating applications, the prick- 
ing of sharp instruments, etc. The degree of this 
numbness or want of sensibility of the skin takes 
place in various degrees, but exists in almost every 
case of fever." He also describes as common, "a 
sense of weight, fulness and uneasiness about the 
breast and pit of the stomach, similar to what is pro- 
duced by fear, grief, and other depressing passions." 
Persons sometimes die in the first stage of fevers, 
and the symptoms show that the cause of death was 
purely a powerful nervous impression. Fordyce 
says: "When the first attack is fatal, it sometimes 
kills in less than five minutes ; sometimes it requires 
half an hour, seldom a longer time. While the 
patient is yet sensible, violent headache with great 
sense of chilliness takes place, the extremities be- 
come very cold and perfectly insensible; there is 
great prostration of strength, he becomes pale, his 
skin is of a dirty brown, and he is soon insensible 
to surrounding objects," etc. He adds, that "when 
in any paroxysm of fever rigor and horror take CAUSES. 
93 
place, the patient is never carried off by that pa- 
roxysm." The reason of this is obvious: these 
rigors are evidence that the nerves are not totally 
overwhelmed. When reaction takes place in the 
nervous system, there is great exaltation of sensi- 
bility; hence the patient complains greatly of heat, 
although the actual heat of the body may not be 
greater than in health, or even much less. Fordyce 
says upon this subject: "The heat over the whole 
body seems intense to the patient, yet, upon the ap- 
plication of the thermometer, it is found even less 
than it was when the patient felt himself cold." 
This exaltation of the sensibility also accounts for 
the extreme restlessness experienced by patients in 
this stage. The reaction of the heart sends the 
blood with force to the capillaries, but they, being 
debilitated, do not transmit it freely, and become 
distended so as to press upon the interstitial nerves, 
whose sensibility is now greatly augmented, giving 
that indescribable sense of suffering and restlessness 
all have experienced who have endured the hot 
stage of a paroxysm of fever, producing a sense of 
"prolongation of time," so that a minute will 
appear an hour, and an hour an age. Fordyce fur- 
ther says : " It happens often, at the beginning of an 
attack of fever, that the patient has a sensation as 
of some light body moving over the hairs that arise 
from the skin, as if, for instance, a number of little 
insects were walking the points of these small 
hairs." The above is exceedingly suggestive of the 
nature of the cause of fever, for what but a narcotic 94 
on fever: 
could produce this peculiar sensation? All who 
have taken opium will recognize this description as 
answering admirably for the sensations occasioned 
by that drug, the impression of insects running 
over the surface being often very distinct and very 
annoying after being narcotized to a certain extent, 
or fully impressed by alcoholic potations. 
That the cause of fever, be it what it may, acts 
primarily upon the brain and appendages, has been 
fully acknowledged by the best authorities. Dr. 
Smith says: " The immediate cause of fever is a 
poison which operates primarily and specifically upon 
the brain and the spinal chord. The diseased state 
into which these organs are brought by the opera- 
tion of this poison, deprives them of the power of 
communicating to the system that supply of stim- 
ulus (nervous and sensorial influence) which is 
required to maintain the functions of the economy 
in the state of health." A superabundance of 
authority could be arrayed in support of the posi- 
tion, that the impression is first made upon the 
brain and nerves, but no one appears to have been 
led to perceive that this impression was that of 
narcotism; but still, without having this idea be- 
fore the mind, authors, as above, in describing the 
manifestations of the operation of this poison, have 
unknowingly traced out a good description of the 
effects of narcotic stimulation. This point being 
settled, the field of investigation is at once open for 
means to neutralize the poison or counteract its 
effects. TREATMENT. 
95 
CHAPTER V. 
TREATMENT OF FEVER. 
I have now dwelt long enough upon the cause of 
fever, its nature and phenomena, and have doubt- 
less convinced all whom I shall be able to convince, 
that the theory I have offered is the true theory. I 
will, therefore, leave this part of the subject, and pro- 
ceed to give the plan of treatment which has grown 
out of these views, and which in my hands has 
proved successful beyond any parallel of which I 
am informed. 
According to the foregoing views, there are four 
points to be met in the treatment of every case of 
fever. 
1. To remove the cause. 
2. To allay the nervous disturbance. 
3. To restore the action of the capillaries. 
4. To allay over-action and equalize the circula- 
tion. 
And first: To remove or neutralize the remote 
cause. In symptomatic fever, it is obvious that 
our first efforts should be directed to the removal 
of the local irritation which has given rise to it. If 96 
on fever: 
it be from a protruding tooth, we should remove 
the tension of the investing membrane by dividing 
it. If worms in the alimentary canal, expel them. 
If local inflammation, use such means as will as- 
suage it, etc., etc. The same thing should be done 
in idiopathic fevers-that is, those which are pro- 
duced by the direct action of the remote cause 
upon the nervous centres; for as long as the cause 
is still acting, it will still keep up the effect. But how 
is this to be done ? It had never been attempted, 
so far as I am informed, until I attempted it. 
Having come to the conclusion that the cause of 
all idiopathic fevers is a something possessing the 
property of a narcotic poison, I believed that the 
oil of sassafras would destroy or counteract, or 
neutralize it. I had tried it for these purposes a 
thousand times, successfully, in other analogous 
cases. For example: Iliad tried it repeatedly for 
destroying insect life, and found it immediately 
fatal to every kind ; had also tested its powers upon 
the infusoria in impure water, and saw it destroy 
them instantly. I therefore felt assured that if the 
cause was really the presence of minute animalcules 
disturbing the nervous centres, this would be con- 
veyed by the circulation in sufficient strength to 
destroy them at once. I also knew that it would 
as certainly destroy or neutralize any poison which 
they might have infused into the system, for I had 
tested its power fully in destroying the poison of 
insects and reptiles, such as mosquitoes, fleas, 
spiders, bees, wasps, etc.; and, on one occasion, TREATMENT. 
97 
had an opportunity of testing its powers over the 
venom of the snake known as the copper-head, and 
found it to succeed promptly. I also knew, from 
repeated experiments, that it would destroy or pre- 
vent the effects of vegetable narcotics, such as 
tobacco, henbane, etc.; I therefore judged that, 
should I be mistaken in the cause of fevers being 
animalcules, it must of course, then, be a poisonous 
gas; and, believing, from observing its effects, that 
it must be of the narcotic kind, I had good reason 
to infer that the oil of sassafras would succeed, 
should this be the case. I therefore expected it 
would meet the first indication, and was not dis- 
appointed. I have seen its exhibition followed, 
again and again, with as sudden a disappearance of 
the febrile movement as I ever saw follow the open- 
ing of an abscess, when the fever originated from 
that cause. 
The second indication, to allay the disturbance in 
the nervous system, I believed could be best met 
by the use of valerian, it having the property of 
quieting the nerves, easing pain, and procuring rest, 
without any of the unpleasant effects of opium, and 
most other narcotic stimulants upon the brain, 
having, too, no tendency to suspend the secretions, 
as they have, but, on the contrary, being a very 
good diuretic, a valuable consideration in selecting 
remedies for fever, the urine always being scanty 
and depraved. 
The third indication, that of restoring the action 
of the capillaries, I believed could be met more 98 
ON FEVER! 
effectually and pleasantly by the use of piperin than 
by any other known agency. I had often used it as 
an adjunct to quinine, in interrnittents, and discov- 
ered that it not only produced a fine capillary action 
in the surface, but it evidently aroused the capilla- 
ries everywhere, as all the suspended functions 
were usually restored without the aid of any other 
means. I liked it because, although it produced a 
fine action on the surface, it rarely excited per- 
spiration ; on the contrary, checked it when present, 
if of the passive kind. It is also recommended by 
the fact that it is borne well by the stomach, and 
has a good effect in quieting the nausea, so often 
distressing to the patient in fever. Its cousin, 
cayenne pepper, is of too fiery a nature to be borne 
well by the stomach, or readily imbibed by the 
absorbents ; the piperin has, in my hands, answered 
the purpose so finely, that I have had no reason to 
desire a better remedy. 
The fourth indication, that of quieting the 
heart's action, and equalizing the circulation, is in a 
great measure met by the means already enume- 
rated ; for by removing or neutralizing the cause, 
quieting the nerves, and exciting the capillaries, 
the condition of things is removed which gave rise 
to the disturbance, and it, as an effect, consequently 
subsides. Still there are many other minor means 
which may be appropriately called into requisition to 
aid the former and facilitate their action, such as 
sponging the surface with water of a temperature 
suited to the degree of general or local heat. For TREATMENT. 
99 
example, when the head and trunk are hot, and the 
extremities cold, apply cold water to the first, and 
hot water to the latter; and when there is restless- 
ness rather from nervous excitement than over- 
action, tepid water will answer the best. The 
bowels should also be kept moderately loose, so as 
to remove the debris, which is constantly accumu- 
lating in every case of fever. For this purpose I 
choose rhubarb, on account of its certainty of 
action, while it rarely acts too much, and, also, 
because it operates without producing debility, but, 
on the contrary, is tonic and bracing in its effects. 
A considerable source of irritation in fevers is an 
accumulation of sour phlegm in the stomach and 
bowels, to remove which I choose sup. carb, of 
soda. I also fo*und much advantage from friction 
along the spine with some kind of liniment con- 
taining both stimulant and anodyne properties; cl 
course, many adjuvants have been resorted to, from 
time to time, to meet particular symptoms; but the 
above forms a general catalogue of the means by 
which I attempted to subdue the most potent 
enemy that has ever assailed our race, and with 
them I have succeeded, not occasionally, not gene- 
rally, but uniformly and promptly. These means, 
though simple, as regards any unpleasant effects 
they can have upon the system, have proved as 
powerful in the contest with disease, as did the 
pebble which David used in his hostile meeting 
with the uncircumcised defier of Israel. 
For the sake of convenience, and to obtain an 100 
on fever; 
eligible form in which to administer the remedies, 
I formed them into a syrup after the following for- 
mula : Take half a pound of common rhubarb-root, 
and after breaking it coarsely, add half a gallon of 
water; place it over a slow tire, and keep it near the 
boiling-point for three hours, then strain: there 
will now be about a quart; to this add five pounds 
of loaf-sugar, and set it on the fire until it simmers; 
to this, after it has cooled a little, add half an ounce 
of oil of sassafras, one and a half drachms of pipe- 
rin, and two ounces of sup. carb, soda, first having 
rubbed them well together in a mortar, with a few 
ounces of water; stir the whole together well, and 
then add one pint of saturated tincture of valerian. 
There are two things to be particularly remem- 
bered and observed in making this compound: the 
sugar must be the crystallized white sugar; if the 
common brown sugar be substituted, and the pro- 
portions used that I have directed, it will form a 
candy rather than a syrup. I have heard of some 
having made this exchange, and of charging me 
with giving a formula that was unpharmaceutical, 
they not knowing, I suppose, that crystallized 
white sugar, containing so much more water of 
crystallization than the brown, requires a smaller 
amount of water to give it fluidity. 
When I make a prescription to be filled at a drug 
store, I make it as follows: 
Syrup Rhubarb, § iv.; Tinct. Valerian, 5 ij. ; Oil Sassafras, 
drops, xx. ; Piperin, gr. x.; Sup. Carb. Soda, gr. xx. Mix. 
The other point to be observed is, that the piperin TREATMENT. 
101 
and oil of sassafras must be intimately mixed with 
the syrup before the tincture of valerian is added; 
otherwise the compound will be so pungent that it 
cannot be swallowed; after having been well com- 
bined with the syrup, the alcohol in the tincture 
does not unite with them so as to produce this pun- 
gency. I formerly used the infusion of valerian in 
order to avoid the pungency, but water docs not 
extract the full strength of that article, and having 
fallen upon the above method of avoiding-the diffi- 
culty, I now use the tincture in preference. Those 
who have seen recipes for making this compound 
which differ from this, will recollect this change, 
and also, that in this formula there is less piperin 
and oil of sassafras, it having been ascertained that 
less of these articles would produce the effect de- 
sired. 
In the course of the foregoing observations, I re- 
ferred to the advantage of rubbing the spine with 
stimulating liniments for the purpose of relieving 
irritation of the spinal marrow. Much of the suf- 
fering experienced in fever arises from this cause; 
the back itself not only complaining, but pains and 
distress of various kinds are felt in different parts, 
which have their origin in spinal irritation, and can 
be relieved in a few minutes by the right kind of 
local application to the spinal column. I have used 
various compounds for this purpose, such as cam- 
phor and turpentine, volatile liniment, etc., but by 
far the best that I have ever tried, not only for this 
purpose, but also for pain or aching of the head, dis- 102 
on fever: 
tress of the stomach, or in fact any other distress 
of whatever kind or wherever seated, so it be of 
nervous origin, is the following.: 
Sp. Nit. Dulc., 3 iv.; Aqua Ammonia, 3 i.; Oil Juniper, 3 j ; 
Oil Sassafras, 3 J; Gum Camphor, 3 J; Chloroform, 3 i.: when the 
Chloroform is not at hand, Sul. Ether answers pretty well. 
But although I give the above syrup in every 
case of fever I am called upon to treat, and in many 
cases give nothing else and do nothing else, yet, as 
I have before intimated, I do not always rely on it 
exclusively, but, in bad or obstinate cases, call into 
requisition every other means which I think will aid 
it in meeting the indications I have pointed out. 
For example: In intermittents I often give a dose 
of some strong nervous stimulant to aid the syrup 
to break up the chill; quinine or some preparation 
of opium is preferred. After the chill is prevented, 
and the periodicity of the disease by this means de- 
stroyed, I depend upon the syrup alone to restore 
the system, and prevent a return. If there is so 
much torpor of the liver that the syrup, aided by a 
mustard-plaster to the right side, does not arouse it, 
I give a blue mass pill every three or four hours, 
until I obtain a bilious discharge, still continuing 
the syrup to aid it, so that the effect may be ob- 
tained without mercurializing the system ; and if 
there should be deep congestion in any part, or 
actual inflammation, I apply a fly-blister, and let it 
stay until its full effect is obtained : then have it 
dressed with an emollient poultice, without break- 
ing the cuticle more than is necessary to afford an TREATMENT. 
103 
escape to the serum, the object of drawing the blis- 
ter being to obtain a powerful stimulation of the 
capillaries during the process of drawing, and not 
to set up a drain. I therefore endeavor to get rid 
of it as soon as possible, and for this purpose apply 
soothing applications, in order to hasten the forma- 
tion of a new cuticle, which, under proper manage- 
ment, is generally obtained in forty-eight hours. 
An irritable blister I dread as I do a salivation: 
both add to the debility by increasing the irrita- 
bility of the system, and thereby retard the re- 
covery. But it is not only a dread of salivation 
that causes me to be chary of the use of mercu- 
rials in fever; I am equally fearful of their irritating 
effect upon the stomach and bowels, when there is 
any tendency to inflammation in these organs, or 
even considerable irritation. 
Consequently, I resort to mercurials only when 
the case is urgent; and it would be surprising to 
those who have been in the habit of looking upon 
them as the only means of stimulating the liver, so 
as to incite the secretion of bile, to find how much 
they have been mistaken. It is very seldom indeed 
that the simple means which I have laid down for 
stimulating the capillaries in general, fail to also 
excite those of the liver, sufficiently to cause it to 
secrete bile of a good quality, and in sufficient 
quantity. But I do not, as I once did, expect to 
see my fever patients improve, as a matter of course, 
because I have obtained consistent bilious dis- 
charges, or that they must of necessity die, if such 104 
on fever: 
are not obtained. On the contrary, I merely look 
upon the liver as one of the many organs whose 
office is essential to health. Persons may live many 
months without any secretion of bile. In fever, all 
the secretions are deranged or deficient, and health 
cannot be regained until all are restored to a natu- 
ral condition; but I do not look upon the restora- 
tion of the biliary secretion as of such paramount 
importance as to warrant me in being in a feverish 
hurry to accomplish it, for, as I have said, by exer- 
cising a little patience, I usually find the liver and 
all the other secretory organs return to the perforni- 
ance of their appropriate functions under the influ- 
ence of the prescribed general treatment for restor- 
ing the action of the capillaries in general. 
I have yet said nothing about bleeding as a colla- 
teral aid; I seldom bleed, yet there do cases occa- 
sionally arise which imperatively demand it. In cases 
complicated with active local inflammation, in which 
general inflammatory action is considerable, there is 
often so much contraction of the mouths of the 
capillaries, that it becomes absolutely necessary to 
relax them by bleeding or nauseants, or both, before 
a proper capillary circulation can be set up. Pleu- 
ritic fever and pleuro-pneumonia present good ex- 
amples of such cases; here the heart's action must 
be first partly controlled, and the spasm of the ca- 
pillaries relaxed, before the syrup can act efficiently 
in bringing about a healthy action of these vessels. 
It is true that in such cases the convalescence can- 
not be so speedy as though no debilitants had to be TREATMENT. 
105 
used, but if they are pushed no farther than is 
actually necessary to relieve the spasm, and the 
means then used to act directly on the capillaries, 
there will only be a few days' difference in the time 
of recovery. 
The remarks which have been made apply to 
fever as a class, and are consequently applicable to 
all its forms; it might be expected, therefore, that 
according to custom I should now proceed to treat 
of each form particularly; but I think the view I 
have given of the unity of the febrile movements 
renders this almost unnecessary; my theory em- 
bracing the conclusion that all the forms of fever 
consist in similar derangements of the same parts 
and organs, differing only in the extent or intensity 
of that derangement, and a tendency to affect more 
injuriously particular organs, occasioned, I suppose, 
by the remote cause acting with the greatest force 
upon the particular part of the brain, or other nerv- 
ous centres, from which the nerves supplying that 
part originate, or from the accidental cooperation 
of some other remote cause, acting at the same 
time upon a particular organ, as cold upon the sur- 
face, worms in the bowels, a determination of blood 
to the head, from a debauch, disturbance of the ali- 
mentary canal, from improper ingesta, etc.; which, 
by weakening the vital energies of a particular 
part, will cause the debility occasioned by the re- 
mote cause of the fever to be more profound in that 
organ than in other parts, and disqualify its capilla- 
ries from reacting with the same facility ; and hence, 106 
ox fever: 
when a remission occurs, this organ does not re« 
cover its functional movements as perfectly as the 
rest, which circumstance has often led the observer 
to look upon the fever as originating there, and as 
being a disease essentially of that particular organ. 
But notwithstanding these differences and compli- 
cations, all fevers consist essentially of the same 
derangements in the same parts; and it follows, as 
a consequence, that the same mode of treatment is 
equally applicable to all, only requiring such other 
means to be occasionally called into use as may be- 
come necessary to meet these accidental differences. 
This view of the subject, you will perceive, cuts off 
the necessity of going into a detail of the treatment 
of particular fevers. It also saves the practitioner 
the necessity of making nice discriminations at the 
bedside as to the particular name of the fever he 
may have to contend with-a discrimination which 
the most astute and experienced are often unable to 
make. The only call for the exercise of judgment 
upon my plan, is to decide upon the amount of 
stimulation that may be required in any given case, 
in order to arouse the dormant capillaries, and to 
call into use such means as may be necessary to 
meet accidental complications. And if there should 
be any doubt as to the amount of stimulation re- 
quired, we have only to watch the effect of the 
medicine, and increase or diminish the dose, accord- 
ing to the effect produced. 
But, says one, I thought you would at least go 
into a detail of your method of managing typhoid TREATMENT. 
107 
fever, as that is the disease which I heard your plan 
was particularly successful in breaking up. This is 
a mistake: it arrests and breaks up all the other 
forms of fever common in this country, with the 
same promptness that it does the typhoid ; and the 
only reason why particular attention has been drawn 
to this more than others, is that they arc usually 
successfully managed upon other plans, and this is 
not-at least, not aborted, broken up, and cut short 
in its progress. So firmly has the idea taken hold of 
the medical mind that typhoid fever is a self-limited 
disease, having a determinate course to run, which it 
will run, in spite of all efforts to the contrary, if the 
patient should live so long, that a contrary idea is 
looked upon as heterodox, and the expression of an 
opinion that it can be arrested, is taken as evidence 
of ignorance, or of a wild imagination. All of this 
I knew, and had counted the cost of, before making 
the announcement that I claim to be able to do this 
thing; which odium I have realized in some mea- 
sure, and may yet have to endure still more; but if 
God lets me live a while longer, and the laws of 
matter and of life continue permanent, I will yet be 
able to establish that in this instance, as in many 
others, universal experience does not necessarily 
prove any opinion to be absolutely true. If it did, 
then small-pox cannot be prevented; then the arteries 
do not contain blood, but air, as their name imports: 
negative experience cannot weigh against positive. 
If all the world had, from the beginning, closed their 
eyes upon the approach of twilight, and only opened 108 
on fever: 
them again at broad day, the world would still be in 
ignorance of the existence of moon and stars; and 
should accident cause me to open my eyes, and see the 
moon in its beauty, and the stars in their brilliancy, 
would I not be as certain of their existence as though 
all the rest of mankind had seen them too ? When 
Hervey experimented upon the subject, and 
saw the blood coursing through the arteries, did not 
he know at once that the idea that they contained 
only wind was false, although the world believed it? 
Did not Jenner know that the small-pox could be 
prevented, after he had seen those who had received 
the vaccine virus exposed to its contagion, and re- 
main unscathed ? And have not I a right to know 
that typhoid fever can be aborted, when I have seen 
that result take place scores of times, under the use 
of the same means, and without ever failing? Why, 
the time has been, in the history of medicine, when 
the universal opinion of the profession was, that all 
the grades of even miasmatic fevers were self-limited, 
had a determinate course to run, and could not be 
aborted, or broken up. Even the great Sydenham 
acknowledged, in his early writings, that he knew 
of no means that would break up even the simplest 
form of intermittent fever; yet he did not think it 
impossible that means might be discovered, and says, 
that should such discovery be made, the discoverer 
could neither be a wise nor a good man if he did not 
make the means known for the public good. At a 
later day, Sydenham became acquainted with the 
powers of the cinchona, and now everybody and TREATMENT. 
109 
their wives know how to cure fever and ague. And 
typhoid fever is more easily cured than even that; 
the syrup I have described will do it alone, promptly 
and permanently, though it often fails to arrest in- 
termittents immediately without the aid of a little 
quinine or opium. 
Well, says one, I am willing to admit that you are 
sincere in what you say upon this subject, and that 
you have arrested the progress of all the grades of 
fever you have happened to meet; but it has so fallen 
out that you have never been called upon to treat a 
true case of typhoid fever. Then, I say, there is no 
truth in description, for I have contended with many 
cases bearing all the marks by which that disease is 
diagnosed: there is no certainty in memory, for I 
had seen, in other years, many cases which went on 
through the regular and tedious course which char- 
acterizes this disease, some continuing unto death : 
there is no uniformity in nature, or I could not have 
had a practice for several consecutive years, in the 
midst of a population in which typhoid fever was 
prevailing, and yet all the case's to which I was called 
happen to be of another kind. A part of these 
years I had almost the entire management of all the 
sickness within a certain bound; other physicians, 
on every side of me, had cases which they reported 
to be typhoid fever; and yet, according to this sup- 
position, my bounds were strangely exempt, except, 
I suppose, a few cases which other physicians were 
called upon to treat within my neighborhood, and a 
few others to which I was called in an advanced 110 
ON fever: 
stage of the disease, after the rose-colored eruptions 
and the sudamina had made their appearance; all 
the other cases, which I saw early and aborted, I 
suppose must be considered mistakes. The last 
year and a half, (now near six years,) I have spent 
in this city; and although there has not been an 
abundant supply of fevers of any kind within its 
limits in that time, yet I have heard of cases of 
typhoid fever, and some which proved fatal. Now 
I admit that I have not visited as many patients as 
some other practitioners in the city, yet I have treated 
a goodly number, many of whom were of that class 
which is most exposed to the causes of fever, and 
would be the most likely to contract the worst forms: 
persons destitute of all the luxuries and most of 
the comforts of life ; and yet it must be assumed 
that none of them had contracted typhoid fever, for, 
if they had, I aborted it: no fever case to which I 
have been called in the city has lasted over five days, 
except the case of a very feeble, ancient lady, who 
relapsed and remained sick ten or twelve days. But 
perhaps the inquiry may arise, Why have not other 
physicians obtained the same results from the use 
of the same means? that, as I published a compend 
of my plan of treatment many months ago in the 
State Sentinel, some other practitioners have had 
the curiosity to try it, but have not been so success- 
ful as I profess to have been. But I deny that any 
one has tried my plan; at least, not in a way to in- 
sure success; many may have half-way tried it, but 
half-measures always fail; better by far do like the TREATMENT. 
111 
homceopathists-give nothing, or the representative 
and depend upon the inherent powers 
of nature, aided by diet, rest, and appropriate ex- 
ternal means. I am now fully satisfied that this do- 
nothing system will succeed better than any plan 
that reduces the system by improper depletion. It 
is not at all surprising, then, that a combination of 
my plan with depletory remedies should fail; if my 
theory is true, it must fail. But if others would re]y 
upon my plan as I do, and not frustrate it by coun- 
teracting means, they would obtain the same re- 
sults. I am no seventh son; I use no hocus-pocus; 
the cure is not performed by me, but by the means I 
administer, and these are at the command of every 
one. (The experience of others, received since this 
was written, will be found at another place.) 
I do not claim for this theory of fever much origi- 
nality; most of the truths on which it is predicated 
had been perceived by great minds long ago, but 
not with the distinctness necessary to enable them 
to deduce therefrom a correct plan of treatment. 112 
ON FEVER: 
CHAPTER VI. 
THEORIES OF FEVER. 
HUMORAL THEORY. 
The symptoms of nervous disturbance, and of ca- 
pillary debility and congestion, attracted the attention 
of the very earliest cultivators of medical know- 
ledge ; but at that time, very little was known of 
the office of the nerves-most of the phenomena 
connected with innervation, whether natural or mor- 
bid, were then referred to the workings of an im- 
aginary intelligent presiding genius, called vital 
principle, or vis medicatrix natura, which, they sup- 
posed, watched over and regulated the operations 
of the system in health, and made efforts to restore 
order again when any thing went wrong. Of the 
circulation of the blood they wore "wholly igno- 
rant, for, having confined their observations to the 
dead subject, and finding the arteries empty, and 
the veins full of blood, they supposed the latter to 
be the only vessels concerned with the blood, and, HUMORAL THEORY. 
113 
consequently, there could be no real circulation ; 
but they fancied that the blood flowed out towards 
the surface in the day, and back again in the night, 
similar to the ebbing and flowing of the tide. As 
the capillaries always continue their action for some 
time after the heart and arteries cease to beat, they 
of course pass all the blood from the arteries to the 
veins, leaving the former entirely empty. The an- 
cients, therefore, not perceiving any other use that 
they could assign to these hollow tubes, supposed 
that their office was to give passage to the animal 
spirits. And believing that the blood was pretty 
much stationary, and supposing that all diseases 
were occasioned by impurities in the blood, they 
imagined that the torpor of the forming stage of 
fevers was owing to the blood being clogged in the 
vessels by its impurities, and that the subsequent 
reaction was gotten up by the vis medicatrix, in order 
to throw it off, which they imagined was done by 
getting up a commotion in the blood, similar to an 
ebullition or fermentation, by which the offending 
matter would be separated and cast to the surflice, 
as syrup cleanses itself by boiling, or wine and cider 
by fermentation. The congested state of the capil- 
laries they supposed was occasioned by the viscid 
matter which was being thrown to the surface, and 
contented themselves to wait until the fermentation 
would thin it, and prepare it for expulsion ; conse- 
quently, all that the medical attendant then thought 
could be done, was to use such means as he sup- 
posed would facilitate the fermentation, or guard 114 
on fever: 
against excess, lest there should be too much stress 
upon the vessels, and occasion a rupture. 
We may now smile at their fancies, but some of 
the greatest minds that ever illuminated a human 
body believed them, and their successors for many 
centuries were contented to take them for granted. 
Even the great Sydenham could see no farther, but 
was evidently much perplexed to account for some 
of the facts which presented themselves to his 
observing eye upon this then established theory. 
Among other difficulties, he acknowledges himself 
unable to explain how the blood of a healthy per- 
son could be rendered so impure in a few days 
after going into a sickly atmosphere, as to cause 
such grave results as he often witnessed. 
SPASMODIC THEORY. 
After the discovery of the circulation of the blood, 
and after physicians had acquired a better know- 
ledge of the nervous system, their views as to the 
cause of the phenomena of fever became some- 
what changed. Seeing that the idea of an ebulli- 
tion or fermentation of the blood, as understood 
by their fathers, was unreasonable, but still hold- 
ing on to the principal idea, that the cause was 
some offending matter in the blood, and still, too, 
retaining the notion of a vis medicatrix, they im- 
agined that the excitement was brought about in 
this way: that the morbid matter, coming into 
the extreme arteries, was then detected by a kind 
of sentinel placed at their mouths, which caused SPASMODIC THEORY. 
115 
them to contract and prevent its passage, and, con- 
sequently, refusing passage to the blood also; and 
that the vis medicatrix, perceiving this difficulty, 
raised an excitement in the heart and arteries, in 
order to overcome the contraction, and force the 
viscid humors on, nolens volens, to the secretory organs, 
where they could be eliminated. It is therefore 
evident that those embracing this theory perceived 
the nervous disturbance and the congestion of the 
capillaries; but, misunderstanding the cause of the 
congestion, were led to adopt a mode of treatment 
that was not the best. For, seeing: that the commo- 
>. . r. 
tion raised by their blind presiding genius was 
only making matters worse, by causing a still more 
profound engorgement in the capillaries, by forci- 
bly pressing the blood into them, which they did 
not transmit, and thus endangering the integrity 
of the system, they resorted to vigorous blood- 
letting for overcoming the excitement, which, 
though justifiable when nothing better can be done, 
yet is always an evil, because of the subsequent 
debility which must necessarily ensue; and still 
having the fear of lentor or peccant matter before 
their eyes, and having discarded the gross idea of a 
fermentation, they could think of no plausible way 
of getting clear of it, but by giving powerful secre- 
tory remedies to excite the organs to throw it off: 
lienee arose the famous system of active purgation. 
Now, to excite the secretory organs to resume their 
natural action is proper enough, but this over- 
action was as blind an effort as what they attributed 116 
ON e e v e r: 
to the vis medicalrix-it prostrated the patient by a 
foolish onslaught on an imaginary enemy. That 
this system was generally successful, does not prove 
that it was beneficial; for, after the doctor had bled 
and purged his patients, until he saw that he dare 
bleed and purge no more, he usually referred the 
case to the efforts of nature; which, being let 
alone, often gradually brought about a restoration ; 
and though the patient did not die, yet the system 
was so debilitated that his health was usually ever 
afterwards precarious. 
SYMPATHETIC THEORY. 
In the process of time, as the nervous system 
was still better understood, and its influence in the 
economy more clearly perceived, the attention of 
theorists was directed more particularly to it, and 
still another theory of fever was gradually con- 
cocted. It was supposed that a strong impression 
being made upon the sentient extremities of the 
nerves, would be transmitted throughout the whole 
system by sympathy - not exactly through the 
medium of the nerves, but in some other way, 
never defined, and by some other power, never 
understood; but either the same or something 
else, in the place of the ancient vis mcdicatrix 
natura. But however it was defined, or however it 
was undefinable, this class of medical theorists 
supposed that an impression, once made, would be 
continued for a definite or indefinite period: as 
the vibrations of a musical cord continue after it SYMPATHETIC THEORY. 
117 
has been struck; or like waves which widen and 
follow each other after having been set in motion 
by the contact of a pebble with the surface of a 
placid lake; or as vital action, once excited in an 
ovum, will go on until it converts the whole mass 
into an organized body, bearing the impress of the 
first cause that sprung it into motion, though that 
cause was applied but once. In some such way, 
they supposed the impression which was made by 
the remote cause upon a sentient surface, was 
continued by independent action until it spent its 
force, like the vibrations of a wire, or was stopped 
by the power of some other greater or contrary 
impression, which would set up a new form of 
action. Upon this theory was founded a new plan 
of treatment: discarding entirely the notion of 
peccant matter in the blood, the leading idea was, 
to give some medicine that would set up a different 
action ; which would swallow up or counteract that 
produced by the remote cause, and one -which they 
fancied would be less injurious to the system, and 
would subside of itself. This was an ingenious 
and beautiful theory, but, like many other beauti- 
ful things, it led its votaries astray. It was this 
theory which introduced those potent remedies into 
general use, arsenic, mercury, and some others; 
and whether the morbid action by them set up has 
sent more persons prematurely into the other world 
than the diseases they were intended to counteract 
would have done, is a problem which eternity alone 
can solve. 118 
ON EeVeR: 
So completely did this theory take possession of 
the medical mind, that, within my own recollection, 
no physician thought himself at liberty to neglect 
to mercurialize his patient, in almost every form of 
fever of the continued and remittent types; while 
arsenic was the remedy chiefly relied on for inter- 
mi ttents; since then, quinine has taken its place, 
which, though not much more certain in its opera- 
tion in arresting that disease, is greatly less objec- 
tionable in its effects. But though both are suc- 
cessful, yet the success of neither is owing to the 
truth of the above theory. 
PHLEGMASIAN THEORY. 
The next theory which obtained any general 
notoriety, was what might be properly designated 
the Phlegmasian Theory, originated bv the cele- 
brated Broussais. He believed that all fevers origi- 
nate from, or rather are identical with, inflammation 
of the stomach and bowels, and hence ignored the 
term fever, and substituted that of 7astro-enteritis. 
He argued that the condition of the system known 
as fever, whether the cause be a local injury, or 
miasm, or contagion, or any thing else making mor- 
bid impression, can never become developed till in- 
flammatory action is set up in the stomach and bowels. 
Broussais, being learned and talented, presented 
his doctrines in such plausible form, and defended 
them with so much ingenuity, and enforced them 
with such self-reliant confidence, that, supported 
by his great popularity, they swept over the civil- PHLEGMASIAN THEORY. 
119 
ized world with the force of an epidemic, so that, 
with few exceptions, all who did not fully embrace 
them were more or less impressed. What aided 
powerfully in giving currency to this theory was, 
that it presented something as a foundation 
which was readily recognized by the senses-some- 
thing that could be understood; and, as the medi- 
cal mind had become weary of abstractions, it 
embraced this with a zest. 
Now I think I have shown that fever consists in 
nervous disturbance and capillary inaction; and, 
as the capillaries of the chylopoetic viscera are 
equally involved with those of the surface and 
other parts of the system, and as they are all de- 
pendent upon the ganglionic system, or nerves 
of organic life, for nervous influence, and as 
these have their great centres in close proximity 
with the digestive organs, from which they re- 
ceive the nervous power by which their functions 
arc performed, it is not at all surprising that a 
lesion in their centres, sufficiently grave to cause 
general capillary inaction, should also develop 
marked evidence of chylopoetic derangement; 
and, as capillary debility and consequent engorge- 
ment constitute the first stage of inflammation, it 
is but a natural consequence that the symptoms 
characteristic of incipient inflammation in the sto- 
mach and intestinal canal should be evident in the 
early stage of mt>st fevers, or that actual inflamma- 
tion should afterward be set up by the disturbing 
forces. But a belief that there is gastro-enteritis in 120 
on fever: 
all cases of fever, depends upon evidence so far- 
fetched, and so little supported by fact and obser- 
vation, that it seems now passing strange that as 
good a thinker as Broussais evidently was, could 
have been led to adopt it as a foundation for a 
hazardous plan of treatment; and still stranger 
that others, not biased by the pride of opinion or 
the ambition of originality, should have been also 
misled. But argument is unnecessary, as at pre- 
sent but a few fossil examples of the genus wdzews 
retain the impress of this theory. But, though 
founded in error, this theory also sprang from the 
observance of real phenomena connected with fever, 
and its attempted defence was the occasion of 
throwing much light upon the nature of the lesions 
which take place in the digestive viscera during an 
attack of fever; as, also, to show up the sympathies 
which obtain between these organs and other parts 
of the economy. It did more ; for though in prac- 
tice it caused many a poor fellow to succumb under 
the use of the lancet, yet it effectually checked the 
more murderous practice of hypercatharsis. 
cooke's theory. 
Some twenty-five years ago, a great man, then a 
resident of Virginia, had his attention particularly 
drawn to the nervous disturbance and subsequent 
congestion which are such prominent characteris- 
tics of every form of fever, and, not being able to 
account for them upon the sympathetic theory, 
directed his strong investigating powers to the cooke's theory. 
121 
subject, and framed a very plausible theory, and 
instituted a mode of practice in accordance with it, 
which had a wide popularity for a number of years, 
especially in the Mississippi Valley, and is still ad- 
hered to by many. I refer to John Easton Cooke, 
of Transylvania. His theory was substantially this : 
First, disturbance of the nervous system. Second, 
weakened action of the heart. Third, congestion 
of the veins, and especially of the vena cava ascen- 
dens. Fourth, reaction of the heart, to relieve 
itself of the pressure of the blood. Now this 
theory came very near being true the only depart- 
ure was this, that he made the debility and con- 
gestion of the capillaries secondary to engorge- 
ment of the great veins; which one departure 
misled him, and caused him to adopt a mode of 
practice which was not the most appropriate. For, 
looking as ho did upon congestion of the vena 
cava as the cause of all the other symptoms, he only 
thought of the shortest method of unloading it; and 
knowing that the liver is the only organ which 
forms a secretion from venous blood, and therefore 
draws its resources directly from the stagnant 
fountain of all his fears, he, of course, chose that 
as the outlet through which the black blood, by being 
converted into black bile, could be discharged from 
the system. 
Cooke's theory led him to denounce the then 
fashionable practice of mercurializing fever patients, 
as useless; but as he knew of no means which 
would excite the liver to throw off black bile equal 122 
on fever: 
to calomel, he chose that as his chief reliance; not 
giving it, however, in small, salivating doses, but 
in twenty, forty, and one hundred grain potions; 
just as much, in fact, as might be found necessary 
to bring the black bile, submitting to an occasional 
bad salivation as a necessary evil. 
To calomel he added rhubarb and aloes, which 
formed his famous cava pills, and with these, and 
occasionally some other more active purgatives to 
make them operate, he proposed to do all that 
could be done in the management of all the forms 
of fever. This theory was plausible and easily 
comprehended, and the practice based on it easily 
followed: the black blood caused the disease, and 
this must be converted into black bile, and calomel 
must be given in just such quantities as would 
bring the black bile; and if the patient sunk under 
the ordeal, or died of a gangrenous mouth, why, it 
could not be helped. 
Now if this great man's mind had laid hold of 
the fact, that torpor of the capillaries causes the 
congestion of the large vessels, he would have 
directed his efforts rather to opening these sluices, 
so that the obstructed blood might flow on natu- 
rally again, rather than have attempted to empty 
the congested veins by the indirect process of 
pumping at the liver. 
THOMPSONIAN THEORY 
About the same time as. the above, another theory 
was gotten up, and a practice founded thereon, THOMPSONIAN THEORY. 
123 
which had a wide-spread popularity for a time; and 
though the author was not of the profession, and 
very few within its pale embraced it, yet as it 
made a great sensation, and especially as there 
wore some things embraced in it which pointed to 
the truth, I shall here .briefly notice it. I mean the 
theory and practice advocated by Samuel Thomp- 
son, of "number six" and steam notoriety; who, 
though not a really great man, had some of the 
elements of greatness about him, viz.: inquisitive- 
ness, some originality, great boldness, and indo- 
mitable perseverance. He, seeing the evidence of 
capillary debility and consequent want of vital 
action, and perceiving that in all fevers there are 
alternate paroxysms of heat and cold, and some- 
times both, in excess at the same time, in different 
parts of the body, conceived the idea that fever 
consisted, essentially, in this contest between heat 
and cold; and thus, by mistaking an effect for a 
cause, and considering heat and cold both positive 
entities, and investing them with a kind of fanciful 
personation, he imagined that a strife for mastery 
was always going on in the system between them; 
and that when heat preponderated, the man was well; 
when cold obtained the ascendency, the man was 
sick; and if cold triumphed, then the patient died. 
Now all that the physician had to do, according 
to trhis theory, was to assist the friendly power to 
overcome the unfriendly-to generate heat and 
subdue cold. For the purpose of generating heat 
and throwing it out, he gave many powerful stimu- 124 
on fever: 
lants, the best among which, and the one most relied 
on, was cayenne pepper, variously prepared. 
If he had stopped here, lie would have done less 
harm; but, filled with the idea that internal cold 
was the enemy he had to contend with, he went to 
work with heated rocks, and the vapor of vinegar 
and water, to drive it from its hiding-place. And 
here, for the want of a philosophic knowledge of 
the operation of the hot vapor bath upon the sys- 
tem, he worked contrary to the object intended; 
for hot vapor, though highly stimulating to the sur- 
face, when first applied, soon becomes one of the 
most debilitating measures, in consequence of the 
exhaustion it occasions of the vital energies of the 
surface, and the profuse exhalation of the serum 
and salts of the blood. But Thompson, from what 
motive is not apparent, adopted a means which 
repaired, in a measure, the mischief he had occa- 
sioned by excessive steaming: at the conclusion of 
the operation, he threw upon the patient a pailful 
of cold water, which, being a powerful stimulant 
and generator of vital energy, tonicity, and irritabil- 
ity, prevented the previous exhausting process from 
having as disastrous an effect as it otherwise would 
have had. But many a poor fellow had his vital 
powers so completely exhausted by, first, the lobelia, 
and then the protracted application of steam, that 
even the cold douche could not arouse him, and ho 
died very quickly under the eye of his steamer. 
The most intelligent of the Thompsonians soon 
discovered that the • steaming would not do, and THOMPSONIAN THEORY. 
125 
abandoned it. My chief object for noticing this 
subject, is to draw attention to the fact, that not- 
withstanding the steamers were not directed by the 
least glimmering of sound philosophy, yet the pow- 
erful stimulants they used, often proved so benefi- 
cial, in spite of the injudicious steaming, that their 
success at times was most striking-sometimes 
breaking up a disease in a single day, which, under 
the regular depleting regimen, would have required 
weeks. Such instances could not fail to draw 
attention; and had it not been for an occasional 
case which suddenly went off under the operation 
of lobelia and steam, which affrighted the common 
observer, and the ridiculous absurdities which 
abounded in Thompson's book, which disgusted 
the intelligent, this system would have spread wider 
and lasted longer. It had its day and is gone, but it 
may be said of it, which cannot be said of some other 
theories, that the world is the better for its having 
existed. It did this, at least: it raised in the public 
mind such a horror of the abuse of mercury, that 
the faculty was obliged to curtail the use of it, in 
deference to public sentiment. It did more than 
this: it satisfied many observing physicians that 
fevers could be carried to a successful termination 
by other means beside the everlasting purging of 
the liver, and that, because a man had a hot skin, 
he was not obliged to exchange it for an artificial 
cholera morbus. They saw, too, that, contrary to 
preconceived opinion, cayenne pepper did not 
always increase a fever, but that, under its influ- 126 
on fever: 
encc, the heat often subsided and left the patient 
relieved without any evacuation whatever; and 
little as the faculty may be disposed to acknow- 
ledge it, and, in fact, little as they may be gene- 
rally conscious of the fact, yet, to those who have 
been observers for the last twenty years, it is evi- 
dent that the Thompsonian theory impressed some 
of its features upon the regular practice, which was 
thereby improved. It cannot have escaped the 
observation of every physician who has been in the 
practice during the above period, that the method 
of managing fevers has, in that time, changed very 
materially. I speak generally, for there are some 
set-fasts in the profession, who, as a worthy contem- 
porary has said, "serve to designate the exact state 
of theory and practice of the period of time when 
they studied their profession, or of the particular 
school of which they took lessons." Such practi- 
tioners still salivate, give the cava pills, or bleed 
and nauseate, just as their preceptors did when 
they studied. But to the honor of our profession 
it may be truly said, that physicians are generally 
men of intelligence and discernment, and are ever 
ready to embrace truth in science, and avail them- 
selves of every better way of combating disease. 
PRESENT THEORY. 
The present seems to be a transition epoch, with 
regard to both theory and practice ; the revelations 
of science have exploded all the old theories, and 
no well-digested naw ones have yet been estab- PRESENT THEORY. 
127 
lished, so as to gain any thing like the general con- 
sent of the profession. Old modes of practice 
have also given place to means which the enlight- 
ened observation of practitioners has discovered 
to be better adapted to subdue or counteract dis- 
eased action. We accordingly find bleeding only 
resorted to in urgent cases; salivation is almost 
wholly discarded, as a means of curing fevers; 
calomel is given less often, and more sparingly; 
drastic purgatives mostly abandoned, and nau- 
seants limited to particular cases. In the mean- 
time, other means have become fashionable-almost 
all of which, I wish it to be noted, are stimulants- 
such as opium, quinine, spirits of turpentine, etc. 
This change has been brought about so gradually 
and so silently, that one can hardly tell when or 
how it was done, or point to any person in particu- 
lar who has been prominently instrumental in 
bringing it about, and many successful practitioners 
perhaps would be puzzled to give a sensible reason 
for the change, unless it should be the ever ready 
one, that diseases have changed, and the mode of 
treatment had to be varied accordingly. But this 
reason is more specious than sound; for although 
it must be acknowledged that fevers are of a lower 
grade of action in this country now than they were 
twenty years ago, still the difference is not so great 
as to sanction a contrary mode of treatment. The 
description of fevers by our oldest authors will do 
very well by which to identify them yet. Even the 
modern disease, as some suppose it, typhoid fever, 128 
on fever: 
was very accurately described by Sydenham in 
1685, under the name of stationary fever. The fact 
is, man has remained, ever since we have any his- 
tory of his characteristics, very much the same kind 
of animal: he eats and sleeps, loves women and 
wine, and other excitements, just as he did in the 
days of father Noah. The laws of nature, I sup- 
pose, have since that time undergone but little 
change, and it is fair to presume that, both remain- 
ing the same as of old, like causes would produce 
like effects still. But while the laws of matter 
and of vitality have remained the same, man's 
knowledge of them has been steadily enlarging, 
and, as a consequence, there has been a corre- 
sponding change in the means which he calls into 
requisition to correct the aberrations of vital action, 
as he has improved in the knowledge of the work- 
ings of the vital forces and the nature of their 
aberrations, and the nature of curative agents with 
regard to the relation they sustain to the vital 
forces. And I am proud to be able to say, in truth, 
for the profession of the present age, that they 
have macle larger advances in obtaining a correct 
knowledge of the laws of matter and of life, than 
were accomplished in any other, or, indeed, in many 
other centuries; and I am glad that I can say that 
the practice of the present time is not what it was 
when I studied the rudiments of my profession : 
the change has been for the benefit of mankind, as 
well as for the honor of the profession of medicine. 
But to return to the subject under consideration, PRESENT THEORY. 
129 
that the present prevailing practice is a stimulating 
one, and therefore this plan of mine is in harmony 
with the tendency of the age. I claim very little 
that is original; merely this, that I have pointed 
out, somewhat more clearly than was before done, 
the nature of the remote cause of fever, the kind 
of impression first made upon the system, and the 
effects produced by these impressions; and then 
pointed out the means by which these effects can 
be best removed. I have shown why stimulation 
should cure, and how it cures, and thus, by under- 
standing exactly what is wanted to be done, I have 
been the better able to select the exact articles best 
adapted to meet the indications. I have said that 
opium, quinine, and spirits of turpentine are the 
means now most relied on in the treatment of 
fevers, and we know that they are all powerful 
stimulants ; and I contend that it is exactly because 
they arc stimulants that they have attained their 
present popularity. But they are not the best 
stimulants for this particular purpose. Opium is 
essentially a nervous stimulant; given in moderate 
doses, it excites the nervous centres and causes in- 
creased nervous power to be sent out through the 
whole system, and in this way becomes, indirectly, a 
general stimulant. But in Large doses it overwhelms 
the brain and other nervous centres, and disquali- 
fies them for sending out their usual influences; 
hence loss of consciousness, loss of sensation, di- 
minished circulation, diminished or suspended secre- 
tion, diminished irritability-in short, diminished 130 
ON FEVER. 
vitality. And although there are occasions when 
the bringing about of this fearful state of things is 
not only proper, but imperatively called for, yet it is 
always obtained at a serious loss of vital energy, 
and should not be resorted to when less objection- 
able means will succeed. 
The same objection lies against the use of qui- 
nine. It too is a nervous stimulant, and unques- 
tionably produces its specific effects by stimulating 
the nervous centres : all who have taken it in mode- 
rate doses will testify to the pleasurable excitement 
it occasions, and all who have taken it in large doses 
can equally testify to its horrid effects upon the brain ; 
no other kind of intoxication is so insufferable. 
And although I would regret the loss of this Samp- 
son stimulant, still I would never use it for exciting 
the capillaries, by its indirect action through the 
medium of the nerves, when I could obtain a better 
result by the direct action of piperin, without any ex- 
pense to the nervous system. It is true, I give in 
my prescription a nervous stimulant, the valerian, 
but it is one of a mild nature, not capable of pro- 
ducing intoxication like opium and quinine, and 
therefore not liable to exhaust the vital energies. 
Some persons with whom I have conversed on this 
subject have seemed to labor under some difficulty 
in understanding the difference between direct and 
indirect stimulation; this appears to me to be very 
plain : direct stimulation is obtained by exciting the 
part itself, indirect stimulation by exciting the 
origin of the nerves, by which a part is supplied: PRESENT THEORY. 
131 
the kidneys may be stimulated directly by giving a 
diuretic, and they may be stimulated indirectly, by 
acting upon the brain by fear. The stomach may 
bo excited to vomiting by an infusion of mustard, 
or by presenting disgusting images to the mind, 
or by a concussion of the brain; so the capillaries 
may be excited by the direct action of piperin car- 
ried to them by the blood, or it may be done indi- 
rectly by exciting the brain and spinal marrow, and 
increasing the nervous irritability sent to them. 
But it may be asked, Why should indirect stimula- 
tion produce exhaustion rather than direct? I 
answer, first, because every unusual excitement of 
a nervous centre has a tendency to weaken its 
energies; we know that this is true, because every 
time a nervous stimulant is repeated, the dose must 
be increased, in order to obtain the same effect; this 
is true of alcohol, opium, quinine, and every other 
nerve-stimulant. And secondly, the reverse is true 
of direct stimulation: the more the senses are ex- 
ercised, the more acute they become-that is, they 
are more easily impressed by their appropriate stimu- 
lants ; the oftener emetics are administered, the less 
doses will be required to produce emesis; the oftener 
the surface is excited by friction or the cold bath, 
the more active it becomes; and so of all direct 
stimulants. The philosophy of it is, that they act 
not upon the nerves themselves, but upon the irri- 
tability of the part which the nerve has supplied. 
We must recollect, however, that even direct stimu- 
lation may be so powerful as to exhaust the irrita- 132 
on fever: 
bility of the part, when no further impression can 
be made until it is restored; thus, the skin may be 
stimulated by rubefacients until it becomes insensi- 
ble ; the bowels may be over-stimulated by drastic 
purgatives until nothing will excite them; but, unless 
carried to this stage of exhaustion, the more any 
part is stimulated by direct action, the more impres- 
sible it becomes. I think these reasons are explicit 
enough upon the subject, and show why medicines 
which act primarily upon the brain exhaust the 
system, and should not be resorted to unneces- 
sarily. 
But to return to the subject. Spirits of turpen- 
tine is the next stimulant now most relied on in the 
treatment of fevers, and is much less objectionable 
than opium or quinine, as it is a simple, direct 
stimulant; but there are objections that lie against 
it also. It is disagreeable to the taste and offensive 
to the stomach, and, in considerable doses, is too 
powerfully stimulant to be borne well by the coats 
of the stomach and bowels; and when taken into 
the circulation, it often acts so powerfully upon the 
kidneys as to produce subsequent weakness in these 
organs. In the oil of sassafras I find a less objec- 
tionable remedy; it is pleasant to the taste, grateful 
to the stomach, harmless to the mucous surface of 
the alimentary canal; it readily enters the circula- 
tion, and acts as a valuable assistant to the piperin 
in stimulating the capillaries. Besides these im- 
portant effects, as has been said before, it reaches 
the nervous centres and destroys or neutralizes the MODES OF CURE. 
133 
remote cause, thereby preventing any further inju- 
rious effect upon the system. 
MODES OP CURE. 
Some, perhaps, may think light of my system, 
because it promises to do so much by means of so few 
remedies ; but it is not more restricted in its means 
than many other systems which have at different 
periods obtained the ascendency and run the rounds 
of popularity. In fact, every theory of fever has 
suggested a certain class of remedies as the appro- 
priate means for effecting the object thought neces- 
sary to be accomplished, and these means have 
generally been few. 
The Humoralists relied upon a few bold deter- 
gents ; the disciples of Cullen and of Rush, upon the 
lancet, and a few other debilitants; the Sympathet- 
ica, upon mercury almost entirely; Broussais, upon 
the lancet and demulcents; the followers of Cooke, 
upon calomel and the cava pills; and the present 
dominant practice embraces little more than the 
trio, opium, quinine, and turpentine. 
The fact is, that this limiting of remedies is char- 
acteristic of science, and distinguishes it from empi- 
ricism. 
In the dawn of medical knowledge, when there 
was nothing to guide the practitioner but blind ex- 
perience, a doctor's prescription often embraced a 
multitude of medicines-sometimes as many as 
fifty, including those of the most diverse and con- 
trary powers; and while some of these might hap- 134 
on fever: 
pen to suit the case, others would be useless, and 
others injurious. It is the glory of the scientific 
physician of the present day, that he gives nothing 
without having a specific object in view, which he 
expects to accomplish by its exhibition; and as the 
elements of disease are always few, it follows that 
the better these elements are known and recognized, 
the fewer will be the means called into requisition 
to meet the indication. 
It would be very strange if any theory should be 
originated by a great mind, and receive the assent 
of the learned for a considerable time, unless it were 
founded upon some ascertained undeniable truths. 
We accordingly find that each of the theories of 
fever which have received the confidence of the 
medical profession at different periods, was based 
upon some of the recognized phenomena presented 
in the progress of the disease, and hence all contain 
some truth. The ancient Humoralists perceived the 
nervous disturbance and the capillary engorgement, 
and if the case terminated favorably, they saw that 
much morbid matter was thrown oft' by the secre- 
tory organs, and believed that these vicious humors 
had caused the disease. Now it is a truth that mor- 
bid matter does accumulate in the blood in every 
case of fever, but it is a consequence, and not a 
cause: the secretions being suspended by the de- 
bility of the capillaries, and the spasm or altered 
sensibility of their secretory terminations, a reten- 
tion of the excrementitious parts of the blood is the 
consequence, and a depravity of that fluid is the MODES OF CURE. 
135 
'result. But the condition of things which caused the 
fever and suspended the secretions must first be 
removed, either by art or nature, before the secre- 
tory organs can be made to act, so as to depurate 
the blood; so that the cure is actually performed 
before the expulsion of the morbid matter. 
The next theory in succession-that of spasm of 
the extreme vessels, and peccant matter in the 
blood-was based upon the observance of pretty 
much the same phenomena as the pure humoral. 
Those who embraced this theory had their atten- 
tion drawn to the spasm which evidently takes 
place in most cases of fever in some degree, and in 
high grades forms the most prominent symptom ; 
and supposing that the engorgement of the capilla- 
ries was, in all cases, wholly caused by this spasm 
of their mouths, went to work to cure the disease 
with this idea prominent above all others. But 
this spasm is not the prime cause of the-congestion 
of the capillaries, for the congestion takes place in 
the stage of depression, before there is any evi- 
dence of spasm, which only conies on during arte- 
rial excitement, and gives way when that is allayed. 
In low grades of fever, there is little or no evidence 
of spasm at any time; and in the collapsed stage of 
all grades, it is not only wholly absent, but the mouths 
of the capillaries are often so relaxed, that they 
pour out, as wTe have seen, the fluid constituents 
of the blood without check and without alteration; 
producing effusions, colliquative sweats, or diarrhoea. 
But the purple hue of the surface shows that the 136 
ON fever: 
capillary debility and engorgement are still not at all 
relieved. 
The sympathetic theory was based less upon 
truth and reason than either of those which went 
before it; still, there may be found some support for 
it in analogy: we know that a specific action does 
obtain in some forms of chronic disease, by which 
a peculiar organization is produced, and until the 
specific action of the vessels is changed, they will 
manufacture no other product ; but the action in 
fevers is not specific, but is simply too high or too 
low, and all that is necessary to be accomplished, 
in order to remove the disease, is to equalize the 
action; for as soon as this is done the fever is gone, 
though the patient may still be feeble and require 
time to regain his vigor; yet the moment there is 
harmony established between the action in the 
large blood-vessels and the capillaries, the fever is 
destroyed. 
The Broussain theory being based upon supposed 
inflammation in the stomach and bowels-a circum- 
stance which often does actually exist in many cases 
of fever, and causes that condition which constitutes 
the first stage of all inflammation, viz., nervous 
disturbance and capillary debility, followed by en- 
gorgement-had therefore many undeniable facts 
to lean upon; but as this condition of the digestive 
organs is only a part of a general condition obtain- 
ing throughout the entire system, it must therefore 
be a consequence and not the cause of the febrile 
movement; in other words, the aberrations ob- MODES OF CURE. 
137 
served in these organs being coexistent with like 
aberrations in every other part, must be referable 
to the same cause; and, in fact, all do arise from 
general nervous disturbance, which has produced 
general capillary debility. The one idea of the 
disciples of this theory was to subdue inflamma- 
tion, which naturally suggested the lancet, demul- 
cents, tisans, etc. 
The next theory considered was that of venous 
congestion: this had a most prominent phenome- 
non, one that is conspicuously observable in every 
case of fever, to rest on. But it is strange that 
the far-seeing mind of Professor Cooke failed to 
perceive that venous congestion cannot, in the 
nature of things, ever take place without capillary 
obstruction: mere weakened action of the heart 
can never be the cause of venous congestion; for 
while the capillaries continue to act with usual 
vigor, there can be no oppression of the heart, for 
we see that they pass the blood on from the arteries 
to the veins, even after the heart altogether ceases 
its motion, and if the heart acts, though it should 
be feebly, it will send the blood on and relieve the 
veins, unless there is obstruction. We often see 
those whose pulse is ordinarily so feeble that it 
can but barely be felt, and yet the individual feels 
well-there is no venous congestion; and, on the 
contrary, we often find the heart in the hot stage 
of fever beating with many times its usual force, 
even causing the whole frame to tremble under the 
shock of its power; yet there is, nevertheless, 138 
on fever: 
great venous congestion at the same time. So we 
see that Cooke was wrong in giving weakened 
action of the heart as the cause of venous conges- 
tion. Capillary inaction is the cause, and the con- 
gestion can be removed in no other way but by 
restoring the action of the capillaries. MYSTERIES CONNECTED WITH. 
139 
CHAPTER VII. 
MYSTERIES CONNECTED WITH FEVER. 
Fordyce, in his Treatise on Fever, mentions a 
number of phenomena connected with its history 
which he considered mysterious, and professed him- 
self wholly unable to explain. Subsequent writers 
have also failed to give any solution of these diffi- 
culties. Now, as I profess to have discovered the 
true condition of the system in which the febrile 
movement consists, and the nature of 'the remote 
cause which produces this condition, it might be 
expected that I should be able to point out, more 
clearly than had been done, the cause of the phe- 
nomena which grow out of the febrile movement; 
and I think I am not mistaken in the opinion that 
I can, in a good degree, succeed in meeting this 
expectation. I will, therefore, take up the difficul- 
ties as they are presented by Fordyce, and endeavor 
to show that they all are natural results, growing 
out of the nature of the remote cause of fever, and 
the condition of the system brought about by its 
ordinary operation. 
The first mystery which Fordyce points out is, 140 
on fever: 
that the remote cause is more operative in the night 
than in the day; the second is, that paroxysms 
of intermittent fever occur principally in the day; 
and the third is, that in continued fevers there 
is commonly an evening exacerbation. I will 
include the explanations of all these in one chapter, 
as they grow out of the same circumstances. 
The points upon which these explanations are 
based have been pretty fully dwelt on in the pre- 
ceding pages of this work, and will here only be 
stated, viz.: that the remote cause of fever is of 
the nature of a narcotic poison, a nervous depress- 
or; and the condition of the system produced by 
its operation is that of narcotism or nervous de- 
pression, followed by nervous disturbance and capil- 
lary debility; and that the hot stage or reaction in 
fever grows out of these, with all the other phe- 
nomena, as pains, aches, suspended secretions, etc., 
etc. 
It is a well-established fact, that exposure to the 
cause of fever in the night, is much more apt to 
bring on an attack than the same exposure during 
the day. Certain malarious districts, which can be 
visited in the day with comparative impunity, can- 
not be remained in during the night without the 
most imminent hazard of an attack of fever, and 
more especially if they be slept in. The same thing 
has been observed to be true, in a less degree, in 
every malarious district which has been made the 
subject of observation. But why this is so, has 
never been clearly accounted for. MYSTERIES CONNECTED WITH. 
141 
There probably are several cooperating causes: 
but the one most operative is, as I think I can 
show, that at night there is a lower degree of vital 
energy possessed by the system than in the day. 
That there is less vital energy at night, is evident 
from many considerations: the system is much less 
impressible-which is a beneficent arrangement of 
our Creator, by which we are better able to com- 
pose the body to sleep. The same amount of noise 
or other annoyances will not keep a person awake 
in the night that will have that effect in the day; 
and this is not because of the habit of taking 
sleep at night; for I have conversed with a number 
of men whose business required them to be awake 
all night, and forced them to take their sleep in the 
day, who all inform me that slighter causes will 
prevent sleep than did when they slept at night. 
It is not because of the stimulus of light, for per- 
sons soon acquire a habit of sleeping in a strong 
light, and often prefer it. It can, therefore, only 
be accounted for by admitting that the nerves are 
less impressible in the night than in the day. 
Many other sources of evidence that this is so 
could be given if it were necessary; for example, 
we do not digest as well in the night; are more 
subject to take cold from exposure, etc.: all show- 
ing a weak condition of nervous energy. 
Carpenter admits the fact that nervous sensibility 
is less in the night than in the day, and, among 
other evidences of this, refers to the well-known cir- 
cumstance, that a much greater effect will be pro- 142 
on fever: 
cluced by drinking a given quantity of alcoholic 
liquor in the morning than in the evening. lie 
does not attempt to account for this, but I presume 
it arises from the same cause which operates upon 
certain plants and flowers to induce them to fold 
up their leaves or petals in the evening, as though 
about to die, but which expand again in full vigor 
to greet the morning sun. Solar light, or some- 
thing in connection with it, plays an important part 
in the business of vitalization. But not to go into 
any speculation as to the cause of the deficiency of 
vital power experienced in the night, I will assume 
it as a fact conceded by the best writers, and abund- 
antly susceptible of proof. Even wagoners are fully 
aware of this fact, and hence will allow their teams 
to rest, especially in the latter part of the night, 
should they have to drive the harder in the day. 
The traveller who rises before day to press for- 
ward on his journey, will find both himself and 
steed injured by the imprudence, and both will fail, 
if the journey be long, sooner than he who takes 
his morning rest, and pushes harder in the day, even 
beneath a tropical sun. But whatever the cause 
may be, it is certain that it is less operative in the 
first than in the latter part of the night. Fordyce 
supposes that the greatest liability to be impressed 
by the cause of fever, is between the hours of eight 
in the evening and eight in the morning, and that 
the liability is much greater in the latter half of 
this period than in the first, viz., between two and 
eight in the morning. Southern planters have MYSTERIES CONNECTED WITH. 
143 
arrived at the same conclusion by observation alone, 
and hence find it better to let their hands remain in- 
doors in the early morning, and work them later in 
the evening. 
It would therefore seem, that either the supply of 
vital influence, which is generated during the sunny 
hours, lasts for some time after they have fled, or 
that the solar rays leave the air charged with vivify- 
ing power, which is operative for a time after they 
are shut off; and that it is only after the sun has 
again blessed the earth for a season, that this vital 
influence is felt in sufficient force to restore the 
nervous power to its full vigor. Hence the almost 
universal desire for stimulation in the morning, lay- 
ing the foundation of the old custom of the morning 
dram, (better broken than kept, however,) and the 
still more universal one of the morning cup of tea 
or coffee. Hence, too, the well-known fact that the 
convalescent and the valetudinarian dare not ven- 
ture abroad during the early morning hours. It is 
therefore certain that nervous sensibility and nerv- 
ous power are both less in the night than in the 
day. But the inquiry may naturally arise, If the 
nerves are less impressible in the night, and the 
cause of fevers acts upon the nerves primarily, how 
comes it that a greater effect is produced ? This 
question implies the idea that the cause of fever 
operates by producing nervous sensation. Now sensi- 
bility resides in the remote nervous expansions, and 
only there; and sensation can be excited in no other 
way but by impressions made upon these expan- 144 
on fever: 
sions. But almost all writers upon the subject now 
agree that the poison which causes fevers does not 
act by impressing the sentient nerves on the surface, 
or in the lungs, or alimentary canal, but that it 
enters the circulation, and reaches the brain and 
other nervous centres, and there exerts some influ- 
ence upon the nerve-matter, which sets up in it a 
morbid condition, and that morbid innervation is only 
a manifestation, an evidence, a symptom of this 
condition. 
Now a living organization possesses the power to 
a certain extent of preserving itself from, or resist- 
ing the action of, hurtful agents ; and this power of 
resistance is known to be in direct proportion to the 
degree of vital action that may be possessed at the 
time-and vital action, we know, is dependent on, 
or rather is the direct result of, nervous power. The 
brain and nerve-matter in general is as much de- 
pendent upon the vital action of the capillaries 
which enter into its structure for a due performance 
of its function as is the liver, or any other organ, 
and hence we can perceive a good reason why the 
nerve-matter should be more easily injuriously im- 
pressed when nervous power is deficient than when 
it is in full vigor. But perhaps some one may say, 
As you believe the cause of fever to be something 
having the properties of a narcotic stimulant, of a 
nature somewhat allied to opium, alcohol, etc., and 
as you have admitted that persons are less excited 
by these at night than in the morning, how is it 
that the reverse is true with regard to the fever poi- MYSTERIES CONNECTED WITH. 
145 
son ? This question arises from confounding nerv- 
ous impression with nervous lesion. Now, though 
alcoholic stimulants do produce more excitement in 
the morning than they do at night, yet by being 
drunk at night they prove much more injurious than 
when drunk in the day: common observation has 
decided that he that drinks in the night will not live 
long, while the belief is equally general that a 
morning dram is good for health. Now, however 
erroneous the latter conclusion may be, it is certain 
that between drinking in the night and drinking in 
the day, the odds in the injury done the system are 
all on the side of the former. It amounts then to 
this, that narcotic stimulants do not injure the sys- 
tem by the amount of excitement they produce, but 
by injury done to the nerve-matter itself, and these 
effects are not at all the same, are not even coinci- 
dent in either time or place. 
Excitement is the immediate effect of the direct 
impression of the stimulant on the sentient extre- 
mities of the nerves of the stomach. This is felt 
in full force within a few minutes after imbibing 
the potation; an hour or so later, enough of the 
stimulant has been absorbed and entered the circu- 
lation to begin to manifest its- deleterious effects 
upon the nervous centres: we now have a mixed 
effect of stimulation and intoxication. But if the 
draught has been large, in the course of a few hours 
more the direct effect made by the absorbed poison 
upon the nerve-matter so far preponderates over the 
impression made upon the nervous extremities, 146 
on fever: 
(though the stomach may be again plied with fresh 
potations,) that excitement becomes as nothing, and 
intoxication profound. 
I hope I am now understood, that stimulation is 
in the stomach, and is conveyed by nervous connec- 
tion to the brain, and sent out to the whole system 
by reflex nervous action; but that narcotism, or in- 
toxication takes place in the brain itself, and other 
nervous centres, by the direct action of the absorbed 
poison, through the medium of the blood, and that 
the torpor of drunkenness is not a seftsafebn sent out 
from the brain and spinal chord, but a want of nerv- 
ous power occasioned by a lesion of the brain matter, 
by which it is disqualified for performing its func- 
tions of elaborating nervous fluid. 
It therefore can be readily understood how this 
low state of nervous power, which has been shown 
to exist at night, should render the system more 
susceptible to the deleterious influence of narcotic 
poisons, whether alcohol, opium, or malaria, and 
that we should expect the cause of fever to more 
readily impress the system at night than in the day. 
The next inquiry is, Why do the paroxysms of 
intermittents occur principally in the day? For- 
dyce says, that so great is this tendency that a re- 
tarding intermittent, after having travelled through 
the hours of the day, in place of keeping on through 
the dark hours, will leap over the night and occut 
the next morning; and an anticipating intermittent, 
in like manner, will travel backward through the 
hours of the day, and, skipping over the night, will 51 Y S T E R I E S CONNECTED W I T II. 
147 
come on the previous evening; so that in an antici- 
pating quotidian there may two paroxysms occur in 
the same day. Now, preparatory to an attempt to 
explain this phenomenon, and give a reason for it, 
it will be well to consider what is the cause of a 
paroxysm of intermittent fever. I am aware that 
chills and rigors are supposed to be the result of de- 
pression, and so they are remotely, but not immedi- 
ately. A regularly built chill or shake of an inter- 
mittent is really the result of reason-it is the first 
unsteady rebounding of the nervous power, and the 
more vigorous the rebound is, the more violent will 
be the rigors. Fordyce gives the full weight of his 
great character as a close observer in support of this 
position, though he merely stated a fact without 
perceiving its tendency. He says that whenever 
there are rigors, the patient will not die in that par- 
oxysm-showing that rigors are evidence that reac- 
tion has commenced. Everybody in the South and 
West knows that if a fever is turned to the shakes, 
the danger is over. Is it not fair, then, to infer, as 
the fully developed rigor is the result of reaction, 
that the less degree of the same state, known as 
chill, is occasioned by the same thing, less operative? 
But I acknowledge that there are conditions, called 
chills, which are not the result of reaction,, as in low 
grades of pernicious fever ; but in them there is no 
sensation of a chill; on the contrary, the patient 
has a sensation of heat. I cannot now stop to explain 
this condition, but it is very different from the first 
stage of a paroxysm of ordinary intermittent fever. 148 
on fever: 
But though I contend that rigors are the result of 
reaction, it is not arterial reaction, but is simply a 
rebound of the oppressed nervous power, and when 
the nervous reaction becomes tolerably perfect, it 
brings about arterial reaction. We are now pre- 
pared to comprehend why the increased nervous 
power and nervous sensibility, in the day, should 
invite nervous reaction; and why it does not often 
take place in the night, when nervous power and 
sensibility are lowest. So that, while the low state 
of vitality in the night favors the impression of the 
remote cause of fever, thfe higher state of nervous 
power in the day excites the reaction which pro- 
duces paroxysms of intermittents. 
We have only now to find a solution of the 
last query. How account for evening exacerbations 
in continued fevers ? Every writer admits that 
fevers are usually worse in the evening than in the 
morning, but the cause has been an enigma, about 
which few have ventured even a conjecture. But 
admitting the conclusion, which has been fairly ar- 
rived at, that there is a lower degree of nervous 
power in the evening than in the morning, and an- 
other fact, which is generally conceded, viz. : that 
malaria enters the circulation-to these append the 
conclusion, which I think has been honestly drawn, 
that malaria is of the nature of a narcotic poison, 
we can then easily perceive that it, like all other 
narcotics, will exert an influence upon the nervous 
system, more or less readily, as nervous power at 
the time may be more or less vigorous ; and that, MYSTERIES CONNECTED WITH. 
149 
as the morbid sensations which are felt in the sys- 
tem are nothing more than symptoms of the altered 
condition of the nerve-matter at the time, it is rea- 
sonable to suppose, nay, is absolutely certain, that 
these symptoms will be aggravated just in propor- 
tion as the impression upon the nerve-matter be- 
comes more overpowering, and the resistance af- 
forded by vital action less. We would therefore 
expect, that though the continued force of narcotic 
power of the remote cause remains the same in the 
morning as in the evening, yet its effect in produc- 
ing nervous disturbance would be as much greater 
in the evening as the vital action is weaker. And 
even should the original cause have ceased to act, 
and the disease be the effect of the condition brought 
about in the nervous centres, yet it is certain that 
this condition would interfere more potently with 
the exercise of the natural function when the vital 
action was lowest than it would when more lively, 
and that greater nervous disturbance would be the 
consequence. But we have shown that the febrile 
movement is the joint result of nervous disturbance 
and capillary inaction. Now, though the action of 
the capillaries is not immediately dependent upon 
nervous influence, yet the }oower to act is certainly 
derived from the nerves, and is soon lost if nervous 
power is cut oft'; so that a lower degree of nervous 
power will soon produce a lower activity in the ca- 
pillaries also; and hence, the whole mystery of even- 
ing exacerbations in fever can be unravelled as fol- 150 
on fever: 
lows : In the evening nervous power is less, and 
vital action weaker; and, as a consequence, the 
effect of the morbid condition produced by the re- 
mote cause of fever in the nervous centres is pro- 
portionally greater in causing morbid innervation, 
giving rise to increase of pain, restlessness, throbbing 
of the heart, and other evidences of nervous dis- 
turbance. Further, capillary action is in proportion 
to nervous power, and this being weaker in the 
evening, capillary action will be weaker also, occa- 
sioning, by necessity, an exacerbation of fever, for 
fever consists in nervous disturbance and capillary 
inaction-the disturbance in the general circulation, 
equally with all the other phenomena of fever, being 
a consequence of these; for the heart being supplied 
with morbid nervous influence, and being unduly 
excited by the stimulus of distension, occasioned by 
the partial stoppage of the blood in the capillaries, 
causing it to accumulate in the large arteries, in- 
creased action is the consequence. We therefore 
have, as the* elements of an exacerbation of fever, 
increased nervous disturbance, decreased capillary 
action, and excitement of the heart and arteries ; 
manifested by an increase of the pain, restlessness, 
headache, delirium, heat of the surface, paucity of 
secretions, etc. 
But the reaction in the arterial system will, after 
a while, partially relieve the capillary torpor, and a 
better capillary circulation will cause an increase of 
nervous power ; better nervous influence will be sent HOW IT TERMINATES IN HEALTH. 
151 
throughout the system, a general amelioration will 
take place in all the symptoms, constituting the 
morning remission. 
It appears, therefore, that answers to all the three 
inquiries which form the present subject can be 
found in the same facts, and that all can be contained 
in a nutshell, viz.: the cause of fever being a ner- 
vous depressor, and nervous power being lower at 
night, and vital action of course weaker, the ner- 
vous centres are, consequently, easier impressed in- 
juriously; and that, although nervous power has a 
tendency to react after depression, yet it cannot do 
so until it gains force, or is aroused by some stimu- 
lant; therefore, no reaction takes place ordinarily 
until the stimulus accompanying the sun's rays 
arouses it; the first effect of which is manifested by 
that kind of reactionary effort of nervous power 
which produces the constriction of the surface char- 
acterizing a chill, or the irregular muscular action 
producing rigors. But sometimes this nervous re- 
action is so very slight that nothing more than a 
little shrinking and dinginess of the surface are 
perceptible ; and this, too, rather late in the day, so 
that the arterial reaction which follows is continued 
into the fore-part of the night, making the evening 
exacerbation in continued fever. 
HOW FEVER, TERMINATES IN HEALTH. 
Speaking of the natural tendency of most fevers 
to terminate, in health, Fordyce says, page 121 : 
" The author has, therefore, never seen, nor can him* 152 
on fever: 
self conceive of any cause why a simple paroxysm 
of fever should go through its three stages, (cold, 
hot, and sweating,) and terminate in health." Now, 
this does not appear to be so very mysterious; the 
whole process may be explained as follows: The 
malaria, whatever else it may be, is a nerve stimu- 
lant of a depressing kind; the nerves bear the im- 
pression for a certain time without yielding to its 
influence, or, in other words, becoming impressed; 
just as they will stand a certain amount of tartar 
emetic, (which is known to act by entering the cir- 
culation and impressing the nervous centres, par- 
ticularly at the origin of the gastric nerves,) but if 
the amount be increased, there comes a time when 
they can resist it no longer, and great nervous pros- 
tration and sickness are the consequences; just so 
the nerves or nervous centres may be annoyed by 
the action of malaria, and appear not to feel it, but 
finally they become impressed, and then the condi- 
tion of nervous prostration is at once produced which 
characterizes a chill or cold stage of fever. But, as 
we see in the case of tartar emetic the nervous de- 
pression giving place to reaction, causing violent 
contraction of the gastric and other muscles, a sense 
of heat over the whole body, and increased power 
and velocity of the heart's action, so it is in the 
other case also-the nervous system reacts, and in- 
creased nervous power or influence is sent through- 
out the whole system ; the. heart is called into in- 
creased action, the sensibility of the whole system 
is exalted, and all the phenomena of the hot stage HOW IT TERMINATES IN HEALTH. 
153 
of fever are witnessed. And were it not for the de- 
bility of the capillaries which had been brought 
about by the previous action of the malaria, either 
by direct or indirect influence, the paroxysm of ex- 
citement would be, in this case, as ephemeral and 
would do as little harm as that occasioned by the 
tartar emetic. But the capillaries offering a re- 
sistance to the passage of the blood, all the pheno- 
mena of capillary congestion are added to those of 
arterial excitement, and the hot stage is protracted 
until the excitement has aroused the action of the 
capillaries-the first evidence of which is that those 
which compose the exhalents of the surface com- 
monly relieve themselves of the congestion by pour- 
ing out perspirable matter; the other capillaries also 
go to work, but are not so immediately under our 
observation; the mouth becomes moist, dryness 
leaves the throat, the urine is again secreted, etc., 
etc. Now if the nervous debility of the capillaries 
has been but slight and of a short continuance, the 
excitement of the hot stage often restores them com- 
pletely, and unless the remote cause is continued in 
its action, there will be no tendency to the produc- 
tion of a second paroxysm ; and we often see exam- 
ples of this in fevers occasioned by mere fatigue 
and exposure. But, generally, the debility of the 
capillaries is only partially and temporarily relieved 
by the reaction, and when it subsides in conse- 
quence of the relief of congestion obtained by se- 
cretion, the debility still remaining, and the first 
cause of the nervous disturbance still in action, a 154 
on fever: 
second paroxysm is brought about, precisely as the 
first was; but as the nervous disturbance will gen- 
erally become less and less, either by the remote 
cause ceasing to act, or from the nervous matter be- 
coming less and less sensitive to its influence, the 
capillaries become more and more perfectly restored 
to their natural condition, and the paroxysms will 
cease to return, except from mere force of habit, and 
this is often broken up by the occurrence of some 
considerable mental excitement, produced by acci- 
dent or purposely planned. Thus we see that it is 
very natural and reasonable that the regular stages 
of fever should terminate in health. 
HOW FEVERS CURE OTHER DISEASES. 
Another circumstance which has been noticed by 
Fordyce and others, as often observed in associa- 
tion with the history of cases of fever, and which 
has been considered inexplicable, is that other dis- 
eases which the individual had been suffering 
under, at the onset of the attack of fever, are very 
often removed and disappear with the subsidence 
of the fever. Fordyce says, "Fever thus, and many 
other violent diseases, (which go on in a similar 
manner,) proceeding through their natural course, 
often leave the patient free, not only from the dis- 
ease itself, but also from the decay arising from 
some less violent disorder, that had not in itself a 
natural tendency to terminate in health. Perhaps 
the manner in which this happens will ever remain 
inexplicable." But when we remember that the now IT CUKES OTHER DISEASES. 
155 
elements of diseases are few, how varied their 
effects and manifestations may be, and consider, 
too, the nature of these elements, it will not appear 
strange at all that the removal of the condition 
which causes the phenomena of fever will also 
remove the condition in which various other diseases 
essentially consist. In analyzing diseased action, 
we find it resolves itself into a very few simple ele- 
ments : these are, alteration of the condition of the 
nervous power or sensibility of the local part, or 
of the whole system; diminished or capillary ac- 
tion ; and the changes of structure or morbid 
deposits, which are the results of the deviation 
from a normal condition of the nervous influence 
and capillary action. Now many diseases, which 
are very annoying, consist entirely in debility or 
perverted action of the capillaries, and it is reason- 
able enough that the reaction of the nervous influ- 
ence, which brings about the hot stage of fever, 
and the general capillary excitement which is occa- 
sioned by that hot stage, should not only arouse the 
capillaries in general into healthy action, but also 
bring up these, which were particularly concerned 
in making up the disease previously suffered, to the 
point of healthy exercise ; and thus, by removing 
the very condition out of which the phenomena of 
that disease grew, it, as a matter of course, could 
afterward have no existence. 
We will take the case of an indolent ulcer, as 
a good example for illustration. We know that 
there is want of nervous influence: its insensibility 156 
on fever: 
to applications which would produce great sensa- 
tion when applied to a recent healthy abraded sur- 
face, proves this; there is also much capillary de- 
bility, as is manifest from the congested state of 
the part and its venous color; the nervous power 
and capillary action, therefore, are too low to bring 
about a reparation of the lost parts; and when 
efforts are made, the vitality of the product is of 
too low an order, and it proves an abortion and is 
sloughed off, or is removed by destructive absorp- 
tion. Now, the general reaction in the nervous 
system, and the general excitement in the capillary 
system, characterizing a natural and well-developed 
case of fever, often extend with such efficacy to 
this local part as to bring it under the general influ- 
ence, so as to permanently elevate it into a natural 
condition; and when the process of reparation is 
fully developed, which restores the loss of material 
which is suffered in the course of every case of 
fever, this part also is included in the general re- 
parative effort, and a radical cure is the result. 
But sometimes we see the very reverse of this take 
place: instances are numerous in which the gene- 
ral powers of the system are so far exhausted by 
the ravages of a protracted case of fever, and 
especially if its vitality has been further depressed 
by the improper exhibition of mercury and other 
depressing agents, that although a reaction is set 
up in the general capillary system sufficient to 
bring about a tardy convalescence, yet some of the 
parts most remote from the centre of vital influ- 157 
HOW IT CURES OTHER DISEASES. 
cnce, or which have been more seriously debilitated 
by local applications, or possess naturally a lower 
order of vital action, fail to respond to the general 
recuperative reaction; and destructive absorption 
destroys the integrity of the part, and very obsti- 
nate ulcers are the consequence. In other cases, 
the general reaction is barely sufficient to prevent 
actual dissolution, and the whole capillary system 
remains permanently debilitated ; every function is 
performed with difficulty and imperfectly, causing 
the patient to' linger out a miserable existence, 
poorly compensating him for a brief respite from 
death. In other cases the capillaries of some im- 
portant organ, which had suffered most during the 
progress of the fever, remain debilitated, and the 
patient suffers from a want of the performance of 
its particular function. It may be the stomach, 
causing indigestion ; the bowels, producing costive- 
ness or chronic diarrhoea; the liver, spleen, or kid- 
neys, occasioning the evils resulting from an im- 
perfect performance of their office; or, what is still 
more deplorable, it may be the capillaries of the 
brain itself which remain debilitated, producing 
mental imbecility or idiocy. It is, therefore, of the 
highest importance that a case of fever should not 
only be managed so as to save the life of the 
patient, but so controlled that no permanent injury 
shall result to the system ; and, better still, that the 
nervous and capillary reaction be made so perfect 
as to swallow up, as it were, any previous local 
debility which may have been set up in the system, 158 
on fever: 
making the attack of fever prove a positive good to 
the patient, in place of an evil. 
No plan of treating fever, of which I have any 
knowledge, can be compared in efficacy with the 
one I have described in insuring the above desirable 
results. And the reason of it is plain: it removes 
the disease without occasioning any shock to the 
system, without any expense to the vital powers, 
and without exciting over-action in any of the 
organs; its action on the system being a general 
one, and one in unison with the natural efforts of 
nature, viz., by directly allaying nervous disturb- 
ance, and exciting capillary action. Since adopting 
this plan of treatment in fevers, I had seen so 
many instances of local diseases yielding during 
the progress of the cure, that I afterward acted 
upon the hint; and, in other cases, purposely 
brought about the same general capillary excite- 
ment for the removal of the local debility, upon 
which chronic diseases are mainly dependent for 
their continuance. By this means, aided by exter- 
nal stimulation, I have succeeded in this city in 
curing many cases of obstinate scrofulous, syphi- 
litic, and mercurial or fever sores, which had re- 
sisted all ordinary means for years. But I will speak 
more fully of this subject under its proper head. 
HOW TARTAR EMETIC ACTS IN AIDING OR PRODUCING 
A CRISIS. 
Dr. Fordyce noticed the effects of tartar emetic 
in producing a state of the system very similar to 159 
HOW TARTAR EMETIC ACTS. 
that in the crisis of a paroxysm of fever, and often 
availed himself of this effect of that remedy to ob- 
tain a more perfect crisis than would otherwise 
have taken place; but he was altogether at a loss 
to account for the mode of its action. lie says it was 
not owing to its emetic or nauseating properties, 
for it succeeded more perfectly in bringing about 
the condition referred to when it occasioned no sen- 
sible effect upon the stomach. These beneficial 
effects which he refers to, ho describes as follows: 
"The skin becomes softer andmoister; sometimes 
a profuse sweat; the mouth becomes moist; secre- 
tion is set up in the kidneys and intestinal canal, 
and a sense of ease is felt over the whole body." 
Now it does not appear very hard to explain these 
effects of tartar emetic; its general operation upon 
the system is certainly that of a powerful depressor 
of nervous power; its emetic effect is partly owing 
to its local action on the stomach, and partly (per- 
haps principally) to the general reaction which suc- 
ceeds nervous depression. There is, I suppose, no 
real similarity in the mode of action of the nervous 
power and that of an elastic substance, but there is 
a striking analogy in the apparent phenomena of 
these operations: the further you bend a steel bow, 
the greater will be the rebound, unless you bend it 
beyond its power of reaction, when it will either 
break or remain permanently bent. It is so with the 
nervous power: a slight depression will be suc- 
ceeded by inconsiderable reaction; a profound de- 
pression by powerful reaction; an overwhelming 160 
on fever: 
depressing influence will at once break its integrity, 
or so cripple its powers that it can never recover its 
energy. Tartar emetic is capable of producing all 
these effects. An impression may be produced by 
it upon the nervous system so depressing as to 
extinguish life at once, without an amount of reac- 
tion taking place sufficient even to produce sick- 
ness, much less vomiting; but it may also be given 
so as to impress the nerves so slightly, that even 
nausea is not occasioned; and the only appreciable 
evidence of reaction is increased capillary action, 
by which all the secretions are augmented. This 
is a most valuable property of that medicine, and 
may be taken advantage of in many cases to serve 
our purpose most admirably in our contest with 
morbid action. When there is a high state of 
general irritability or actual inflammatory action, I 
often suspend the use of my common fever syrup, and 
give emetic tartar, in sub-nauseating doses, until the 
active excitement is subdued, and then resume the 
syrup for the purpose of establishing permanent 
capillary action. The mode I prefer in which to 
administer the emetic tartar, is to add a grain to a 
common glass tumbler-full of water, and direct the 
patient to take a tablespoonful every half hour, 
until very slight nausea is produced, and then 
lengthen the interval. 
OF DELIRIUM IN FEVER 
Fordyce describes two kinds of delirium which 
often attend continued fevers. One is characterized OF DELIRIUM IN. 
161 
by hallucinations : the patient fancies he is talking 
with some person, but when spoken to this delusion 
vanishes, and he will answer correctly questions di- 
rected to him. This form of delirium is often quite 
violent in the evening and first part of the night, 
but subsides before day, and leaves the patient calm 
and quite rational. It is not attended with much 
stupor or obtuseness of perceptions, feeling, or intel- 
lect; and there is but little redness or injection of 
the eyes ; and dissection discovers no trace of injury 
sustained by the brain. The second kind has 
many of the manifestations of the first, but differs 
in this, that the patient is not so readily aroused to 
a state of consciousness, and in the morning remis- 
sion remains more stupid and insensible ; the eye is 
duller and more injected, and the countenance more 
flushed. Dissection always reveals an injected state 
of the vessels of the brain. Fordyce is disposed to 
believe the first kind is purely an affection of the 
mind; but this conclusion is arrived at merely be- 
cause he has not been able to conceive of an alter- 
ation of the condition of the brain which would 
produce it, and yet leave no trace after death. It is 
very strange that this should have presented any 
difficulty to his mind, when he must have known 
that febrile action throughout the entire system con- 
sists in merely functional derangement; and that it 
is only when engorgement takes place in a particu- 
lar part, so intense as to destroy the ability of the 
capillaries to again contract and so resume their na- 
tural size, or when actual inflammation has been set 162 
on fever: 
up, that any trace of the effects of the febrile move- 
ment can be detected after death. 
The brain is as much concerned in producing 
thought, sensation, and nervous power, as the liver 
is in making bile, or the kidneys urine; hence, a 
functional derangement of the one will just as cer- 
tainly and as naturally occasion an increased, dimi- 
nished, perverted or suspended exercise of its appro- 
priate duties as it will in the others. What the vnind. 
is, independent of organization, we have no means 
of knowing; all its manifestations are made known 
to us through the medium of organized matter; 
and as long as that connection exists, it can only 
give us healthy manifestations while the medium 
through which or by which it operates is in a healthy 
condition. It is not surprising, then, that the milder 
grades of delirium should be produced by the same 
capillary inaction and engorgement which give us 
the functional derangements which wTe continually 
see in the biliary and other secretory organs during 
the progress of a fever; or that dissections should 
be no more successful in showing an altered condi- 
tion in the one case than in the others. All are the 
result of altered action, produced by a distension of 
the capillaries, which their contractility removes 
after the heart ceases to force the blood into them, 
leaving no marks of their previous condition. But 
if the distension of the capillaries is carried beyond 
a certain limit, they lose the power of contraction, 
and, in very low grades of fever, delirium gives place 
to coma; and dissection shows the capillaries of the CRITICAL DAYS. 
163 
brain distended to their utmost capacity with black 
blood ; other organs reveal the same condition. But 
if actual inflammation is set up in the brain, or any 
other organ, such alterations are speedily produced 
as death will not entirely deface; and the second 
variety of delirium described by Fordyce is un- 
doubtedly the result of inflammation, more or less 
intense in this viscus. The symptoms indicate this, 
viz.: the throbbing of the temples, the redness of 
the eyes, the suffusion of the face, and the intellect 
remaining unrestored during the morning remission. 
CRITICAL DAYS. 
Fordyce appears to be at a great loss to account 
for the occurrence of,what are called critical days in 
fever; and, after making some very lame attempts 
at an explanation, abandons it as one of the unsolved 
mysteries connected with this disease. Now, if I 
were-to attempt an explanation, I would do it pre- 
cisely as I should the appearance of ghosts: that is, 
by denying their existence except in the imagina- 
tion of those who pretend to have seen them. The 
mere statement of the days supposed to be critical 
by those who contend for their existence is proof 
enough of their non-existence. Ilypocrates and 
others designate them as follows : The fifth, sixth, 
seventh, ninth, eleventh, thirteenth, fourteenth, 
seventeenth, twentieth, and thirty-first. These are 
the regular critical days ; then there are enumerated 
others which are called spurious critical days, as the 
eighth, tenth, and eleventh, etc. This is much like 164 
on fever: 
some of the almanacs that make prognostications 
of the weather: they will say that "rain, more or 
less, may be expected on the third, tenth, seven- 
teenth, and twenty-fourth of this month ; the day 
before, or the day after;" so that if it rains at all, it 
will come with a good deal of certainty upon one of 
those days. But the sticklers for critical days have 
left even less chance of a failure, if the fever yields 
at all, for they have embraced nearly the whole 
time consumed by an ordinary case of continued 
fever, from the period of its full development to its 
usual period of termination. 
Now all contagious fevers, we all admit, naturally 
run through certain stages-which stages consume 
nearly the same time in all cases: the duration of 
these fevers is, therefore, quite uniform ; but this 
kind of termination is not what is meant by crisis, 
and therefore the usual days on which these fevers 
terminate cannot be called critical days. If a case 
of small-pox were to terminate suddenly in conva- 
lescence on the third or fourth day upon the occur- 
rence of a hemorrhage, sweat, or diarrhoea, these 
discharges would be considered the cause of the 
sudden breaking up of the disease, and hence would 
be called critical discharges; and if it were per- 
ceived that such critical discharges were more apt to 
take place on particular days, these clays might be 
properly called critical; but the occurrence of these 
discharges in the course of contagious or 
diseases has never been known to suspend the dis- 
ease unless by causing death ; hence there arc no CRITICAL DAYS. 
165 
critical clays recognized as applying to that class of 
fevers. 
But other forms of fever, particularly those caused 
by malaria, of which common intermittents are a 
familiar example, seem to have no very definite 
period to run : if left to take their own course, they 
will continue until the powers of the system either 
sink under their influence, or react and arise above 
them, breaking the chain of morbid action which 
sustained them, or in which they consist. Now, 
whenever the vital forces obtain this ascendency, 
either by their own inherent power, or aided by ap- 
propriate assistance, then the various secretory or- 
gans at once resume their functions, and a restora- 
tion of the usual discharges of excrementitious 
matter takes place of course, and generally in greater 
quantity than in health; because, first, the vital 
powers have obtained the supremacy by reaction, 
and this reaction generally will go beyond the na- 
tural standard; and, secondly, there is more excre- 
mentitious matter to be eliminated than usual, and 
therefore the same amount of vital action will throw 
off a larger amount of appropriate secretions imme- 
diately upon the breaking up of a case of fever than 
in health. But is the return of these organs to their 
duty the cause of commencing convalescence, or is 
it the result of some anterior change, and only the 
effect of that change, and therefore not the prime 
cause of convalescence, but only a sign of its com- 
mencement? Undoubtedly it is the latter. These 
secretions can be and are often set up under the in- 166 
on fever: 
fluence of powerful remedies addressed immediately 
to the sensibility of these organs, but convalescence 
does not, as a matter of course, follow; on the con- 
trary, the general powers of the system are often 
materially prostrated by their action,-and the disease 
left still remaining in all its stubbornness. No dis- 
charge can therefore bo a critical one in the sense 
in which that word has been generally understood, 
that is, that the discharge itself carries off the dis- 
ease, either by eliminating the peccant matter of the 
ancient humoralists, or by giving vent to the black 
blood of the modern humoralists, or in any other 
way, corresponding with any other theory. And 
yet these discharges are critical in another and more 
appropriate sense : they indicate that a crisis has 
arrived, when the powers of the system have tri- 
umphed over and removed the condition in which the 
febrile movement commenced, and by which it was 
continued. If this error with regard to critical dis- 
charges had been a harmless one, it would not have 
been dwelt upon so lengthily here; but out of it 
have grown most of the errors in practice by which 
this formidable family of disease have peopled the 
nations of the dead much faster than they would 
have done under the influence of treatment directed 
by a more enlightened view of the subject, or, per- 
haps, if left to run their course without the inter- 
vention of any treatment. But what is the change 
which takes place in the condition of the system which 
gives rise to these discharges that may be called 
critical, because indicating that a favorable crisis has CRITICAL DAYS. 
167 
arrived in the disease ? It must be the removal of 
that which checked or suspended these secretions 
during the continuance of the febrile movement. 
In another place I have endeavored to prove that 
general capillary debility is the condition produced 
by the anterior causes of fever, out of which all the 
subsequent phenomena arise ; and that without this 
condition there can be no such thing produced as 
the febrile movement. Now, a general capillary re- 
action is exactly what precedes and gives rise to gen- 
eral secretory action. When nature cures a fever, 
she does it precisely in this way: the remote cause 
either ceases to act upon the nervous system, or the 
nerves cease to be impressed by it, and the nervous 
disturbance gradually subsides, and nervous power 
gradually increases until an amount is sent to the 
general capillary system sufficient to overcome the 
torpor, debility, or want of action in them, which 
has been the cause of their dilatation, congestion, 
and slowness of circulation, from which the scanty, 
depraved, or suspended secretions, and all the other 
concomitants of fever, have proceeded. Now it is 
plain enough that as soon as this is effected, as soon 
as the capillaries are permanently aroused to action, 
then, as a consequence, the secretions will all be 
again set up, and all the other phenomena which 
arose from this common cause will also disappear. 
Hence, quieting nervous disturbance, increasing ner- 
vous power, and exciting capillary action, should be 
the grand objects of every effort to break up the 
febrile movement. 168 
ON fever: 
IIOW AN INFLAMMATION MAY CURE A FEVER. 
Fordyce has observed that an inflammation, com- 
ing on spontaneously, or purposely set up in some 
part not essential to life, during the progress of a 
fever, sometimes arrests the febrile movement, but 
is wholly unable to tell how this beneficial effect is 
brought about. He very properly discards the 
notion that the cause of fever is attracted by the in- 
flammation, and through the medium of the sup- 
purative process disappears from the system; neither 
can he allow that it is done upon the principle of 
revulsion. To my mind, the modus operandi of local 
inflammation in curing fever is just as plain as that 
of any other agency. It acts precisely in the man- 
ner of every other successful means-viz., by capil- 
lary stimulation; the nervous excitement produced 
by the inflammation, by being conveyed to the brain 
and spinal marrow, and thence by the medium of 
the nerves sent out through the whole system, may, 
when the capillary action is not very great, excite 
them sufficiently to bring them up to the healthy 
standard; and these being once set in motion, the 
phenomena of fever will as certainly subside as will 
the waters of a mill-pond when the flood-gate is 
raised. But inflammation, in order to be bene- 
ficial, must not be set up in a very vital part, or be 
very extensive in parts less vital, or the nervous im- 
pression will be so powerful as to produce depres- 
sion of nervous power in place of excitement; hence 
we perceive the depressing influence of active in- HOW INFLAMMATION MAY CURE. 
169 
flammation in the stomach, peritoneum, etc.; and 
hence, also, very large blisters applied to children, 
or adults of a highly nervous temperament, some- 
times produce fata] nervous collapse. An inflam- 
mation, in order to be beneficial, therefore, must not 
be intense enough to create nervous disturbance, or 
extensive enough to produce nervous exhaustion, but 
just sufficient to occasion a gentle nervous excite- 
ment. It is, therefore, improper to blister while 
nervous excitement is high: and it is unavailing or 
pernicious to blister when the nervous power is 
very low and capillary debility profound; for then 
it will either not produce any sensation, and, con- 
sequently, no reflex action, and therefore do no 
good; or it may produce a powerful sensation aud 
occasion great nervous disturbance, and yet be 
wholly inadequate to arouse the torpid capillaries, 
and the excitement consequently occasion a further 
exhaustion of nervous power. We often meet with 
this condition of the system, particularly in cholera, 
congestive fever, and in profuse hemorrhage: capil- 
lary action seems to be wholly suspended in the 
surface and in the extremities-they are cold and 
shrunken, and of a leaden or purple hue; but yet 
sensibility is at its highest point of exaltation ; the 
ordinary warmth of a healthy person's hand often 
occasions an insufferable sensation of heat; sina- 
pisms are intolerable ; and a blister at this time will 
prove the cause of most intense agony, and aid 
greatly in deepening the collapse. I was once 
called to a gentleman who was laboring under a 170 
on fever: 
severe attack of cholera; I found him verging into 
collapse when I arrived, but by the use of judicious 
means, or by the powers of nature, his disease was 
kept in check more than ten hours. At this time 
two other physicians arrived, and upon consultation 
it was agreed to try the effect of a blanket wrung out 
of hot water and wrapped around his person. I did 
not approbate the measure, but as I had exhausted 
my resources and had obtained nothing more than 
a truce, the enemy still holding entire possession of 
the citadel, I could not reasonably object to a 
measure which two intelligent physicians thought 
would increase the man's chance for life. The 
measure was therefore carried into operation; but 
I shall never forget the awful expression of agony 
which the hot blanket occasioned. Ilis flesh was 
as cold as marble when the warmth was applied; 
but, notwithstanding the heat was not greater than 
was quite bearable to my hand, the patient com- 
plained as if it had been red-hot coals of lire. But 
he was not destined to endure long. A scream, a 
flounce or two from side to side, a few moments of 
trembling, a gasp as from suffocation, and all was 
still: the blast had been too strong; the taper was 
blown out. 
HOW DO CONTAGIOUS DISEASES SECURE IMMUNITY FROM 
THE DISEASE THEREAFTER? 
A certain class of diseases usually considered con- 
tagious, it is known, very rarely are produced a 
second time in full force in the same person. Many ACTION OF CONTAGIOUS DISEASES. 
171 
conjectures have been indulged in with respect to 
the cause of exemption. A learned professor sup- 
poses it may be that the vital sensibility which is 
enjoyed by the mouths of all the capillaries which 
afford ingress into the system, and which is placed 
there for the purpose of enabling these vessels to 
choose what is proper to enter the circulation and 
refuse that which would prove deleterious, may be 
off their guard one time, and allow this subtle enemy 
to enter; but having been once caused to suffer 
severely by this mistake, they can never be deceived 
again by the same agent. But this guarding sen- 
tinel, whose office it has been supposed is to protect 
the avenues to the circulation from hurtful in- 
truders, is itself but a figment of the brain, having 
no existence anywhere but in the imagination. Of 
this we have the most positive evidence, for we con- 
tinually meet with instances in which the most 
hurtful matters are actually taken up by the absorb- 
ents. It appears that there is no limit to absorp- 
tion, except that arising from the insolubility of 
substances and their acrid qualities. Very pungent 
or irritating matters cannot be absorbed, because 
they cither stimulate the absorbent vessels so in- 
tensely as to cause too great a contraction to admit 
of their ingress, or the impression is so powerful as 
to paralyze them and suspend all action; and of 
course all absorption ceases until a return of vital 
energy takes place. The only conditions therefore 
that are necessary to insure the absorption of the 
most deadly poison as readily as the most healthful 172 
on fever: 
nutriment are, that it be soluble in water or the 
juices of the chylopoetic organs, if introduced by 
the mouth, and that it possess no powerfully stimu- 
lating or irritating properties; or, if it be a gas, 
that it be mixed sufficiently with the atmospheric 
air to render it respirable. 
But we not only have evidence that the poison of 
contagion might be absorbed a second time, but proof 
positive that it often is. It is well known that per- 
sons who have had small-pox, by being afterwards 
exposed to the contagion, often take it in a modified 
form, and, consequently, the poison must have ob- 
tained ingress into the system ; and this is rendered 
more certain by the fact that unprotected persons 
have taken the true variolous disease by coming in 
contact with one laboring under it in the varioloid 
form. Exemption is not therefore obtained because 
the poison cannot get into the system. The only 
good reason of which I can conceive why persons 
will ordinarily take these diseases but once is, that 
the poison which causes them is a narcotic stimu- 
lant. We know that some poisons of that class will 
very rarely fully impress the nervous system more 
than once. Take tobacco, for example: few per- 
sons who have acquired the habit of chewing this 
weed but have a vivid recollection of the horrible 
sickness and nervous prostration which followed 
their first initiatory effort at using it. But though 
a second attempt, perhaps, was not made until 
years afterwards, yet no violent effects followed. I 
had a personal acquaintance with a gentleman (a ACTION OF CONTAGIOUS DISEASES. 
173 
distinguished divine) who, from motives of pro- 
priety, discontinued the use of tobacco after having 
been a constant user for some years, and continued 
this abstinence for over twenty years; but, being 
attacked with a dropsical disease, his physician ad- 
vised him to resume the use of it, and he informed 
me that he used as much the first day of recom- 
mencement as he had been in the habit of using 
when he left off the practice, and that it affected 
him no more than formerly. The same thing is true 
of opium and alcoholic drinks, but not to the same 
extent. A full impression, amounting to complete 
intoxication, cannot be reproduced but by increas- 
ing the dose taken. The very same amount of 
whiskey which will throw a novice upon his back, 
may be repeated a few days subsequently, and will 
hardly make him stagger; and if often repeated, 
will at last scarcely affect him at all. It is just so 
with the poison of contagion. The first exposure to 
small-pox will produce very violent effects ; a second 
will occasion a much milder effect; and perhaps the 
impression of the third will not be appreciated. 
But all contagious diseases are not preservative 
against subsequent attacks ; and it will be observed 
that those which are not, make their first impression 
on some external part, and are therefore not of the 
narcotic kind, are not addressed to the nervous 
centres, and therefore one attack gives no security 
against a second. 174 
ON FEVER: 
DOES THE CONTINUED ACTION OE THE REMOTE CAUSE, 
AFTER THE OCCURRENCE OF FEVER, INCREASE ITS 
INTENSITY OR INTERFERE WITH ITS CURE ? 
Fordyce thinks it does not; but, with all due 
deference to the opinion of that correct thinker 
and accurate observer, I must differ with him in 
this conclusion, and for the following reasons: 
Every physician who has had a large country prac- 
tice, embracing localities differing materially in 
their aptitude for generating malaria, could not 
have failed to observe that those cases of fever 
which occurred in the most malarious districts, and 
which remained there during the attack, were much 
harder to manage, and more apt to relapse, than 
such as happened to be removed to some friend's 
house in order to be nursed, who lived in a healthier 
vicinity. I resided for some years in McConnels- 
ville, on the Muskingum river, in Ohio, and there 
enjoyed a fine opportunity for witnessing examples 
of the advantage of removing from a sickly to a 
healthy locality, after the accession of an attack of 
fever. The country on each side of the river is 
high, broken, and well watered; the banks of the 
river high, and its current rapid, so that it would 
seem that very little malaria ought to have been 
generated; and I suppose there was not much 
formed in that particular region. But this stream 
heads up in a very rich, flat, marshy country, where 
all the materials for producing malaria abound, and 
miasmatic diseases are rife almost every year. 1 CONTINUED ACTION, ETC. 
175 
said that the Muskingum, had a rapid current, but 
there was a great difference in its rapidity at differ- 
ent points: for a mile, or perhaps several miles, it 
was very gentle, and then for a shorter distance it 
was exceedingly rapid : (I speak in the past tense, 
for at present all parts are alike, the river having 
been dammed so as to produce slack-water naviga- 
tion.) At the time I lived there, there were many 
salt-works in operation along the river, which gave 
employment to a great number of hands; who, 
added to other inhabitants, made the valley of the 
river quite populous. Now, those who worked or 
resided on the bank opposite to where the water 
ran gently, very rarely became sick; but fevers 
were exceedingly common among those who occu- 
pied a position opposite the rapids ; and especially 
after a rise of water succeeding a hot, dry spell 
of weather. As many of the operatives at the salt- 
works were young men whose relatives lived among 
the adjacent bills, it was very common to have 
them removed there when taken sick, and I dis- 
covered a very marked difference in the stubborn- 
ness of the disease in those who remained, and 
those who "fled to the mountains;" and relapses 
were very common among the former, and rare 
among the latter. I will here digress from the 
subject immediately under consideration, to pay a 
passing notice to a fact already hinted at above, 
which elucidates one of the habits of malaria which 
has not been much noticed-that is, that it may be 
absorbed by or mingle with water, and be carried 176 
on fever: 
by the current a long distance, and then set free by 
agitation and become exceedingly active. But to 
return to the subject, that the cause of disease by 
continuing to act upon the system will increase the 
violence of a fever, and invite relapses : Some 
years since, while practicing in Wilson county, I 
was called to attend on a family which resided near 
an extensive mill-pond on Round Lick Creek: one 
after another was attacked, and all proved exceed- 
ingly intractable to the influence of remedies, and 
all suffered frequent relapses, until it became quite 
evident that no effort I could make would save 
them from fatal prostration, if they remained under 
the depressing influence of that malarious atmo- 
sphere. I accordingly recommended a change of 
location, although three of the family were then 
not able to turn themselves in bed; but they were 
lifted on their beds into a wagon, and convoyed 
about four miles, to the residence of the gentle- 
man's father, which was situated in a locality pro- 
verbially clear of malaria. The change was not 
only profitable, but remarkable; and, with but 
very little further medication, all rapidly recovered. 
I could narrate many other examples equally as 
striking as the above, which have come under my 
own observation; but every observer, whether he 
is a physician or not, can doubtless furnish exam- 
ples from his own memory which will be amply 
sufficient to prove my position. 
But is this true of the action of the remote cause 
of all other fevers ? Not perhaps to the same 177 
CONTINUED ACTION, ETC. 
extent. In epidemic fevers it is equally true; but 
in contagious fevers it is not. In these, the remote 
cause, after having once set up the chain of mor- 
bid action which characterizes the peculiar disease, 
cannot, by continuing to act, set up a new series of 
morbid movements ; but it can do this : it can exert 
a depressing influence upon the system, which will 
lessen its ability to successfully bear up under the 
disease while it runs its course. It appears that 
during the progress of every febrile disease there 
is some kind of emanation proceeds from the per- 
son of the patient, which, if it does not excite the 
same identical disease in another, will at least 
prove a means of aggravating any other form of 
fever under which the individual may be laboring 
at the time. A number of fever patients, there- 
fore, in the same house, will stand a less chance of 
recovery than if they were each in a different 
house, although no two may have the same form of 
fever. This is the only rational cause that can be 
assigned for a greater mortality in hospitals than in 
private practice. It will not do to say that other 
circumstances are less favorable; that there is less 
ventilation, fewer comforts, more dirt, inferior 
nursing, or a greater lack of medical skill; for the 
very reverse of all this is generally true. 
Every physician who does a general practice in a 
city, knows that a large per cent, of his patients 
are among the poor and degraded, where there is 
neither good air, good nursing, nor good food, but 
plenty of filth, and very few comforts of any kind ; 178 
on fever: 
yet even among these he will save a greater per 
cent, of his patients than is saved in the best-regu- 
lated hospitals. The reason is, that in the hospital 
there are many fever patients, every one of whom 
is continually throwing off a peculiar malaria to 
poison the atmosphere, and depress the nervous 
power, so as to cripple the recuperative energies 
of the system, making it more difficult to struggle 
with the particular disease under which it is labor- 
ing. It is therefore evident that the remote cause 
of fever does continue to act injuriously after the 
fever is set up; and it is therefore important to the 
safe recovery of the patient, and as a means of less- 
ening the chances of those who are with him of 
taking the disease, that the remote cause be de- 
stroyed, if indeed it can be. And from a careful 
observation of passing events since I introduced 
my present plan of treating fevers, I have per- 
ceived sufficient evidence to convince me that this 
plan destroys or neutralizes the remote cause of 
fevers, as the very first step towards its cure. 
My attention was first directed to this subject 
while engaged in treating dysentery, some years 
since, on the Caney Fork of the Cumberland river. 
That disease was highly epidemic at the time within 
certain bounds, not spreading all over the country 
uniformly and at once, but commencing at certain 
points, and extending in certain directions. The 
epidemic influence was so intense that, as the cause 
seemed to extend, nearly every inhabitant was 
brought under its control, and one after another of 179 
CONTINUED ACTION, ETC. 
a family were stricken clown, until nearly every one 
had an attack. But I discovered that where I was 
called to take charge of the new eases in a family, 
and put them upon the plan of treatment which I 
believed was calculated to not only control the dis- 
ease, but also destroy the remote cause, it rarely 
happened that any other new case occurred in the 
family, and no new attack took place in any case in 
which I was called to treat the first patient that 
sickened with the disease. From these facts I drew 
the inference, that the general epidemic poison was 
only sufficient to impress the system so as to 
strongly predispose it to take on this particular 
form of disease; so that some powerful exciting 
cause being brought to bear upon a certain member 
of the family, or that member, from constitutional 
or temporary weakness, being more easily impressed 
by the remote cause or ordinary exciting causes than 
the rest, the disease became developed, producing 
the first attack in the family; and that the poison 
developed in the progress of this case, if suffered to 
run its course, being added to the general epidemic 
malaria, now became sufficiently potent to fully im- 
press other systems possessing more vital resistance, 
so that ordinary exciting causes would develop the 
disease, and thus one member of the family after an- 
other be stricken down ; but if the last case which 
had occurred, and, especially, if the first case which 
was developed in a family, was taken in the early 
stage, before the peculiar poison which it is the nature 
of the disease to generate had been formed, and 180 
on fever: 
treated in such a manner as to destroy the remote 
cause, and break up the disease before this poison 
was elaborated, then the other members of the 
family would, at least, be as little subject to the dis- 
ease as though no case had occurred; and from the 
uniform exemption which I observed to attend this 
mode of treating the disease, we are warranted in 
the conclusion, that they would be much less liable 
to an attack than the members of other families, in 
which no case had been developed. 
This can be accounted for by the natural suppo- 
sition, that the same medicine which proved effect- 
ual in destroying the remote cause within the sys- 
tem of the patient attacked, might, in consequence 
of its volatile nature, causing it to be diffused 
throughout the whole of the apartment, also prove 
sufficiently powerful to destroy the general epi- 
demic poison within the enclosure, and thereby 
increase the chances of immunity of the inmates, 
beyond others not so protected. Since that time, 
I have seen the use of the same means followed by 
the same results with regard to typhoid fever. I 
recollect of no case in which a second attack has 
happened in the same family under my manage- 
ment. In a conversation held with a medical 
student a short time since upon the subject, he 
observed that if what I said was true, it would cur- 
tail the whole amount of medical practice 'mate- 
rially ; that, by shortening the usual period of 
treating fevers more than one-half, and then pre- 
venting, in a good measure, some of the most 181 
troublesome varieties from being formed, it would 
diminish the fever practice to a ruinous extent to 
the physician. Well, let it be so. The people, I 
suspect, would hardly be willing to suffer sickness 
merely to accommodate physicians, and then it will 
work no real loss to the practitioner himself, even 
to lose his calling entirely; for I hold it to be 
certain, that any man who has intelligence, judg- 
ment, and industry sufficient to constitute him a 
good physician, can make more money at almost 
any thing else to which he may choose to devote his 
energies. I have known many physicians who, 
after scuffling for years with poverty in the profes- 
sion, at length turn their attention to something 
else, and make a rise in the world in a short time. 
But whether it increase or diminish the profits of 
the profession, will never operate as a reason for its 
rejection or adoption-this will be settled by the 
evidence of its truth ; for to the honor of the pro- 
fession be it said, it has never been backward 
in adopting every means which gave good promise 
of curtailing human misery. But I have somewhat 
wandered from the subject. I think I have given 
good reasons for believing that the continued 
action of the remote cause of fever does render 
that disease difficult to cure, and more liable to 
relapse. These reasons, in brief, are, that malarious 
fevers do not yield as readily to remedies while the 
patient remains in the infected district, as when 
removed to a locality where the poison does not 
exist, and that relapses arc much more common 
CONTINUED ACTION, ETC. 182 
on fever: 
under the former than under the latter circum- 
stances; that in hospital practice, where the appa- 
rent circumstances are much better than in pauper 
practice in a city, the mortality is generally larger, 
showing that the malaria generated by fever 
patients operates injuriously to the recovery of 
others, when a number are confined within the same 
walls. I will add, that even other than fever 
patients feel the influence of this malaria, when 
confined in the same atmosphere with a number of 
fever patients-ulcers are difficult to heal, bones 
unite tardily, the effects of capital surgical opera- 
tions are more fatal, etc., etc. 
And, further, that aborting febrile diseases, or 
breaking them up in their earlier stages, lessens 
the liability of those around them to take the 
disease. 
HOW DOES QUININE CURE INTERMITTENTS? 
It does it, either by destroying the malaria or by 
neutralizing its power, or by removing the condi- 
tion of the system produced by the action of the 
malaria, from which the fever arises. That it does 
not act in either of the first ways mentioned is 
proven by the fact that it does not always succeed. 
For it is evident that if it is capable of destroying 
the malaria, or so changing its nature as to deprive 
it of that quality which impresses the system inju- 
riously, it must do it always. Whether malaria be 
a poisonous gas or organized existence-whether 
vegetable, animal, or chemical-this would be the HOW DOES QUININE CURE, ETC. 
183 
case; any substance which unites with another 
chemically so as to neutralize it or change its 
nature, will always act thus; and any thing which 
will destroy the life of any particular species of 
animal or vegetable existence will do it every time, 
if given in sufficient quantity or applied in suffi- 
cient force. It follows, that if quinine destroyed 
the cause of fever, or was an antidote to the effects 
of that poison, it would never fail in its operation. 
But it does fail occasionally, under the best man- 
agement ; and even when it succeeds in breaking 
up the disease, it often returns again, and after the 
quinine is repeated a few times, it generally wholly 
loses its power: this would not be the case if it 
acted as a neutralizing chemical agent, or if it 
acted as a poison to the organic existences which 
compose malaria. It therefore does not act by de- 
stroying the malaria, or by neutralizing it. It 
remains, then, that it does act by removing the con- 
dition of the system produced by the malaria, out 
of which the fever arises, or in which it consists, 
for there is no other conceivable mode by which it 
can act. But the evidence of its acting in this way 
does not rest merely upon the fact that we cannot 
explain its modus operandi in any other way, but is 
based upon its perceptible effects upon the system, 
and the analogy of these effects with those pro- 
duced by other remedies, the mode of action of 
which is well understood. Now what are the 
sensible effects of quinine? I once took five grains 
of this medicine, when in good health, on purpose 184 
on fever: 
to ascertain, if possible, its mode of action on the 
system, and I found its sensible effect to be that 
of a pure nervous stimulant. It produced that 
state of the system, in a high degree, which we call 
nervousness, a sense of agitation, slight quiverings 
of the muscles, some intolerance of light, increased 
sensibility to sounds ; and even imaginary sounds 
were heard, as of distant ringing of bells. Besides 
these, there was wakefulness, and a very uncom- 
fortable restlessness ; and these sensations remained 
in force for over twenty-four hours. The reason 
such a moderate dose produced so much effect was, 
that there was no nervous depression in my system 
to overcome, as there is in fever; on the contrary, 
I am naturally of a nervous temperament, and 
easily impressed by all nervous stimulants. I have 
not given this description of the sensations pro- 
duced by quinine in my own person because they 
were peculiar, but because they are exactly what 
are described as arising from the influence of the 
medicine by others, who have taken it to break up 
a chill; showing that its effects upon the healthy 
orgasm are the very same which it produces in dis- 
ease ; and it may be noted, that if it fails to pro- 
duce these, its natural effects, in some considerable 
degree, it also fails in effecting the object for which 
it is administered. But quinine not only acts like 
other nervous stimulants, but other nervous stimu- 
lants act like it, that is, they accomplish the same 
object. It is well known that opium will prevent 
a chill, with almost as much certainty as quinine; HOW DOES QUININE CURE, ETC. 
185 
so will ardent spirits, so will the cold douche, so will 
a powerful mental excitement. These, it is true, 
are not so permanent in their effects as quinine- 
the reason for which will be given presently-but, 
as far as their sensible effects are concerned, they 
act very similarly: all produce an agitation of the 
nervous system, muscular tremors, wakefulness, 
giddiness of the head, and an exaltation of the 
senses. I mean they do these when applied in a 
certain force-all may operate with such over- 
whelming power as to suspend sensation-but all 
when operating with moderate power, like quinine, 
increase nervous power, and exalt sensibility. In 
what, then, consists the superior power of quinine 
over other nervous stimulants, in breaking up 
intermittent fever ? It is because it is not only a 
powerful nervous stimulant, but it is a permanent 
one, and nothing else. It is not evanescent in its 
effects, like the cold douche and mental excitement, 
nor does it possess, like opium and other medicines 
of that class, sedative or depressing properties, by 
which, after exciting, they depress nervous power, 
thereby increasing the nervous debility, which causes 
a chill: quinine, by bringing about a high state of 
nervous excitement, and continuing it for a consid- 
erable time, in consequence of the increased amount 
of nervous power which is sent out to the whole 
system, often causes such a perfect reaction in the 
capillary vessels, that they do not relapse again into 
torpor, and consequently a permanent cure of the 
fever is effected. But sometimes the excitement 186 
on fever: 
produced by quinine amounts to actual nervous 
disturbance, succeeded by depression, in which 
case the capillary debility is increased, and then its 
use proves an entire failure. Taking this view of 
the-subject, I am in the habit of giving but a moderate 
dose of quinine, just enough to impress the nervous 
system, say from four to six grains, and at the same 
time give my fever syrup, to keep down nervous dis- 
turbance, and to increase capillary action. In this 
way, I have generally succeeded in breaking up 
intermittent fever, with a single moderate dose of 
quinine; for, if the syrup is continued for several 
days after the chill is broken, there is little danger 
of its returning. This mode of treating intermit- 
tents has several advantages : it is more certain, it 
produces no unpleasant effects, and it is much 
cheaper. 
MODUS OPERANDI OF TOPICAL REMEDIES. 
Fordyce, (p. 304,) in speaking of tlie known bene- 
fits which often arise from cupping or leeching the 
temples, when a patient is suffering in the head, or 
in delirium during fever, observes, that it cannot be 
accounted for by the mere amount of blood drawn 
from the general circulation, or from any direct re- 
lief to the vessels immediately congested, as they 
arc situated within the brain, and there is no very 
intimate connection between the internal and exter- 
nal circulation of the head; hence he adds: "The 
reason why such topical evacuations by bleeding 
carry off or diminish the delirium or pain in the TOPICAL REMEDIES. 
187 
head, or even sometimes the whole fever, is conse- 
quently wholly unknown to the author." The same 
difficulty will present itself in accounting for the 
beneficial effects of other topical means-such as 
dry-cupping, sinapisms, stimulating liniments, blis- 
ters, etc. These often prove as beneficial as draw- 
ing a little blood by cups or leeches, and they 
undoubtedly operate upon the same principle-all 
act by producing a stimulant effect through the 
medium of nervous connection or association. Dis- 
tant parts of the body are known to be closely asso- 
ciated by nervous influence-the uterus and the 
rnammce, the parotid gland and the testes, mucous sur- 
faces and their external opening; and all internal 
parts with the external surface immediately oppo- 
site. Some of these associations, among which is 
the last, are not owing to direct nervous communi- 
cation, but are dependent upon that connection 
which exists between the nerves of the associated 
parts in the brain, spinal marrow, or some other 
centre of nervous influence, as the great plexus and 
ganglia. Why there should be a close nervous 
association between the skin and the deep-seated 
parts immediately under it, we cannot tell, except 
that it was so arranged by our beneficent Creator 
for the express purpose of enabling us to produce 
remedial effects upon parts beyond our reach, by 
applications addressed to those parts within our 
reach. This appears to be a sufficient reason for 
the association, and we can perceive no other, as 
these parts are not at all concerned with each other 188 
on fever: 
in performing their ordinary functions. The mode 
of operation of topical remedies appears, then, to be 
as follows: a blister, for example, is applied over 
the scat of an internal inflammation ; it acts as a 
powerful stimulus to the cutaneous capillaries, and 
the impression, being conveyed by the nerves of 
organic life, with which the part is supplied, to the 
nervous centre from which they take their rise, is 
sent by reflex action along the same kind of nerves 
to the deep-seated part, and becomes a stimulus to 
its capillaries and arouses them to healthy action. 
I say nerves of organic life in the above connection, 
to distinguish them from nerves of sensation, for 
these appear to have little or nothing to do with the 
beneficial operation of a blister in relieving deep- 
seated inflammation or congestion. This is proven, 
first, by the fact that blisters often draw well with- 
out producing any sensation at all, and yet produce 
their full remedial effect ; and, secondly, blisters 
often occasion intense sensation while producing 
but very slight capillary excitement in the part, and 
without any benefit to the internal inflammation or 
congestion. We are all familiar with examples of 
this kind in conditions of great capillary debility, 
connected with a high state of nervous sensibility, 
as in cholera, congestive chills, etc. My observa- 
tions liaye led me to the conclusion, that the bene- 
fit derived from a blister, or any other stimulating 
topical remedy, is always in an inverse ratio to the 
suffering it occasions the patient; and acting upon 
this idea, I am in the habit, when I think it best to TOPICAL REMEDIES. 
189 
employ them in a case in which the sensibility of 
the nerves of sensation is exalted, of subduing it as 
much as possible by opiates or anodynes; for it ap- 
pears that the same kind of impression which is 
transmitted to the nervous centre, is sent, by reflex 
action, to the associating organ or part. Hence, if 
it be increased sensafebn which predominates, the 
only effect of the local application is to increase the 
sensibility of the associating part, and, consequently, 
augment the suffering; but if the matter is so man- 
aged that but little impression is made by the topi- 
cal stimulant upon the nerv'es of sensation, and 
capillary excitement greatly preponderates, then 
the effect upon the internal inflammation is most 
strikingly beneficial; the capillaries of the part 
being roused to action, relieving the engorgement 
which occasioned the nervous suffering and other 
mischiefs referable to capillary distension, without 
any expense of suffering to the patient, or any dan- 
ger of increasing the general morbid action by 
getting up an extensive nervous disturbance. 
It was said above, that the same impression which 
is made upon any one part by a topical application, 
will by reflex action be also produced in the associat- 
ing part. This will at once explain the operation of 
every kind of remedy of that class. It is in this 
way that a soothing poultice to the abdomen re- 
lieves pain or spasm in the bowels; in this way 
chloroform liniment, applied to the surface of limbs 
tortured with the aches of the first stage of fever, 
will allay the distress in the bones, sinews, and 190 
o n F ever: 
muscles, as by enchantment; it is in this way that 
blisters or strong rubefacients, applied to the breasts 
of a female suffering from suppressed menstruation, 
will excite the capillaries of the uterus and cause it 
to perform its function ; and in this way an anodyne 
poultice, applied to the same parts, will transmit its 
soothing effects to the womb, and quiet the pains 
attendant on difficult menstruation. 
HOW DO SPIRITS OF TURPENTINE ACT BENEFICIALLY IN 
TYPHOID FEVER ? 
So many intelligent physicians have given their 
united testimony in favor of the use of turpentine in 
typhoid fever, that we are compelled to believe that 
it does possess some useful properties, suitable to 
control this particular form of diseased action, or at 
least some of its stages. 
But writers differ widely as to the time of admin- 
istering it, and the amount prescribed; but most of 
them agree in giving it in the second stage of the 
disease, when there is considerable redness of the 
tongue, irritability of the bowels, and tenderness of 
the abdomen, in small doses ; and more freely in the 
third stage, when there is low delirium, subsultns 
tendinum, etc. My views of the nature of the feb- 
rile movement in general, and the condition of the 
nervous system in particular, in this disease, as well 
as my experience, would lead me to prescribe this 
remedy, under certain restrictions, in all its stages. 
Before adopting ray present mode of practice, I re- 
lied more upon this than on any other remedy, and HOW 1> 0 E S TURPENTINE A C 1 ? 
191 
yet occasionally prescribe it, especially when called 
to a case which has already run into the second 
stage ; it therefore is pertinent that 1 inform the 
reader with what view I administer it, and what 
advantage I expect to draw from it; for I protest 
against giving any thing in disease for which I can- 
not assign a good reason. 
In another part of this work, I have said that tur- 
pentine enters the circulation and acts as a direct 
stimulant to the capillaries in general, and to those 
of the kidneys in particular; but it does more than 
this; it is a powerful stimulus to the nervous centres, 
and greatly increases general innervation. In ty- 
phoid fever, nervous power is deficient, as well as 
capillary action too low; therefore we can see at 
once that turpentine may be used in it with great 
advantage. But it does still more: in this fever, 
there is always more or less intestinal irritation, and 
often inflammation; now we know, from micro- 
scopic observation, that the capillaries are torpid in 
these states of disease, and observation has proven 
that turpentine, as a local application, is an excel- 
lent excitant to bring up the action of the capillaries 
to the healthy standard; hence it has become a 
popular application to burns and sores. Turpen- 
tine, then, acts beneficially in typhoid fever in the 
following ways: 
First. It tends to relieve the local irritation or in- 
flammation in the alimentary canal. But for this 
purpose it should not be given undiluted, or even in 
water, as by not mixing with the water it will still 192 
on fever: 
strike the walls of the stomach in its full strength, 
and injure its coats; it should always, therefore, be 
combined with syrup, or mucilage, or olive oil, so 
as to cover its acrimony. 
The second indication for which it may be given, 
is to excite general capillary action. That it has 
this effect, in a very considerable degree, is evident 
from the improved appearance of the surface which 
often follows its exhibition in very low conditions 
of the system, and the general restoration of the 
secretory action which we also often see follow its 
administration, known by the tongue and mouth 
losing their dryness, the skin becoming more pliant, 
and by a more abundant flow of urine. For this 
purpose, it should be given in small doses, largely 
diluted with some bland material, which will favor 
its absorption; for if given in too large doses, and 
especially if undiluted, it will irritate the absorbent 
vessels so as to cause their mouths to contract and 
prevent absorption, or, if it enters the circulation in 
too much force, it may over-stimulate the kidneys, 
it being specifically directed to these organs. The 
indiscriminate and almost reckless use that has of 
late years been made of this remedy in typhoid 
fever and dysentery, has led to many cases of incura- 
ble debility in the kidneys, occasioned by over- 
stimulation; so that we should recollect, that while 
we are curing a man of an acute disease, we will 
not lay him under much obligation to us if we en- 
tail on him some irremediable injury, and especially 
when all the advantages of the remedy can be ob- HOW DOES TURPENTINE ACT? 
193 
tained without any of its disadvantages. But tur- 
pentine, in the third place, acts upon the nervous 
system. That it does, is evident from its beneficial 
effects in low stages of fever, in quieting nervous 
restlessness, subduing subsultus tendinum, and re- 
lieving low, muttering delirium. That it is especi- 
ally a nerve stimulant and not a sedative, is proven by 
its increasing nervous disturbance, headache, and 
delirium, when these arise from over-action or ex- 
citement. We, therefore, should be guarded in its 
administration; withholding it altogether when 
there is evidence of over-action in the nervous cen- 
tres; and even in cases of under-action we should be 
careful not to impress the nervous centres too 
powerfully, or we may exhaust the vital impressi- 
bility and defeat our purpose, or we may produce 
so much nervous reaction as to cause nervous dis- 
turbance, which some, not being able to detect, have 
considered a good reason for pushing the remedy 
still further, until, if the patients survived the 
shock, they were permanently injured by having 
partial paralysis or other forms of nervous lesion en- 
tailed on them for life. I have thought it necessary 
to say this much upon this subject, to guard the 
younger members of the profession from running 
into an abuse of this excellent remedy, and thereby 
bringing it into odium, as some other valuable 
articles of the Materia Medica have been. 194 
on fever: 
WHY DO MERCURIALS ACT INJURIOUSLY IN TYPHOID 
FEVER ? 
I answer, because they have a tendency to pro- 
duce the typhoid condition. 
Now in what does the typhoid condition consist? 
That is, what distinguishes typhoid from other fe- 
vers ? It most assuredly is the want of nervous 
power, manifested in many ways not necessary here 
to enumerate, but in no way more strikingly than 
by a deficiency of fibrin in the blood. This material 
seems to be the most difficult to elaborate of any of 
the constituents of the system-the very highest 
effort of vital action is required to produce it; hence, 
in all cases in which nervous powTer is low, fibrin is 
found to be deficient in the blood; and in all cases 
in which fibrin is deficient, the repairing or healing 
process does not take place. Whether this is for 
want of fibrin, or from the cause which produces a 
want of fibrin, viz., a low state of vital action, is 
not known. From this cause, blisters drawn in an 
advanced stage of typhoid fever often refuse to heal; 
and from this cause ulcerations so often prove 
troublesome in the intestinal coats in typhoid fever. 
Dr. T. L. Maddin, of this city, read a paper before 
the State Medical Society last spring, (1856,) which 
was published in the May number of the Nashville 
Journal of Medicine and Surgery, in which he gave, 
as I believe, the true pathology of these ulcerations, 
viz.: that Peyers and the solitary glands of the in- ME RC U RIALS IN TYPHOID FEVER. 
195 
testines have a peculiar construction, being nothing 
more than minute vesicles formed under the epithe- 
lium of the bowels, having no orifices, and bursting 
when they become distended, and so causing a mi- 
nute lesion of continuity in the epithelium; repaired, 
it is true, with very slight effort in health, but which, 
in the typhoid condition, when nervous power is 
low, and the reparative effort at zero, serves as a be- 
ginning-point for the destructive process of ulcer- 
ation. And as these glands or vesicles, when they 
discharge their contents, become obliterated in the 
natural condition of the system, and others form in 
their place, to become full and burst in their turn, 
keeping up a regular succession, so in typhoid 
fever it is found that a like succession of ulcers is 
formed-post mortems having revealed the fact that 
ulcers in every stage of development were present 
from the size of a mustard-seed to that of a hen's 
egg, and fully perforating the coats of the bowel, 
the reparative process being entirely suspended. 
Now, what arc the facts with regard to the influence 
of the constitutional effects of mercury? Does not 
observation prove that it does the same thing ? The 
best writers acknowledge that it lessens nervous 
power; it also occasions a loss of fibrin in the blood, 
and cripples the recuperative powers so that the re- 
parative process is suspended, and ulcers will not 
heal. It is true that, when the inflammatory pro- 
cess is set up in the salivary glands, an amount of 
excitement is conveyed to the nervous centres suffi- 
cient to whip up a forced state of nervous power ade- 196 
on fever: 
quate to manufacture fibrin, but not out of the raw 
material; not from nutriment taken in, but by break- 
ing down the tissues of the body and appropriating 
the fibrin which entered into them, throwing off the 
albumen and salts at the mouth. And sapient phy- 
sicians have resorted to this destructive process to 
force a little fibrin into the circulation, but oftener 
killed their patients in trying. How much more 
philosophical it is to go to work with such means as 
will increase the nervous power and restore the ca- 
pillary action, so that fibrin may be manufactured 
from appropriate food! 
The inquiry will naturally arise, Why do so many 
really intelligent physicians persist in giving mer- 
curials in typhoid fever ? One reason is, that they 
were taught to give it-all the fathers gave it: Cul- 
len, Rush, Chapman, Cooke, and all the lesser lights, 
relied on it as the remedy in fevers in general. An- 
other reason is, that in most fevers it actually does 
do good under proper management, and physicians 
are slow to believe that a remedy which acts bene- 
ficially in other fevers will act the reverse in this. 
Mercurials possess one property of action which, 
so far as it goes, renders them exceedingly appropri- 
ate in fevers: they do increase capillary action; 
given in the proper manner, no remedies can act 
finer in this respect; hence they excite all the secre- 
tions, and those who look no farther for the source 
of mischief in disease than the most obvious effects, 
naturally enough suppose that the suspension of 
secretions is the disease, and to restore them is to cure MERCURIALS IN TYPHOID FEVER. 
197 
it. But if they would recollect that it is the want 
of nervous power that has occasioned capillary de- 
bility, and this in turn the diminished secretion, 
they would never resort to a nervous debilitant to 
remove the difficulty, but would rather call into re- 
quisition such generators of nervous power as tur- 
pentine, camphor, ammonia, etc., but especially 
sassafras, piperin, and valerian. A distinguished 
physician who witnessed the happy manner in which 
these articles control typhoid fever, (having watched 
the progress of a case under my treatment,) inquired 
of me if it was not probable that the sassafras ope- 
rated in the same way as turpentine, (he having great 
confidence in turpentine.) This conjecture was un- 
doubtedly well founded: turpentine is a nervous 
stimulant, and so is sassafras; both increase nervous 
power, and in this way both are valuable remedies 
in typhoid fever; but the sassafras is preferable, be- 
cause it is the best nervous stimulant, and be- 
cause it never acts as a nervous irritant, as turpen- 
tine sometimes does, and never acts injuriously upon 
any of the organs, as turpentine occasionally does 
upon the kidneys; and then sassafras possesses the 
rare property of destroying or counteracting the 
effects of narcotics, and in this way prevents any 
further action of the remote cause, so that between 
it and turpentine and mercury the case stands this 
way: 
Mercury increases capillary action and excites 
the secretions, but depresses nervous power, which 
is already deficient, and in this way increases the 198 
on fever: 
deficiency of fibrin, and destroys the recuperative 
powers so that the reparative process cannot be set 
up, and the patient wears out, or destructive absorp- 
tion perforates his bowels, and he dies suddenly 
from the contents entering the cavity of the abdo- 
men. 
Turpentine acts also as a capillary stimulant, and, 
in place of depressing, elevates nervous power, and 
thereby favors the production of fibrin, and aids the 
restorative efforts of the system, so that these lesions 
in the intestinal epithelium are healed, and the pro- 
cess of destructive absorption stayed. It however 
is liable to over-stimulate the nervous centres, get 
up nervous disturbance, produce over-action in the 
kidneys, and entail debility on those organs. 
Sassafras does whatever the turpentine can do that 
is beneficial, and never does harm, so that it is to 
be preferred of the two, and, with the aid of piperin 
and valerian, will do pretty much all that is required 
to be done in typhoid or any other fever. PARTICULAR FEVERS. 
199 
CHAPTER VIII. 
PARTICULAR FEVERS. 
PRELIMINARY OBSERVATIONS. 
Every writer upon the subject of fevers has been 
more or less perplexed with regard to diagnosis and 
nosology. That there are different varieties of fever, 
and that each of these varieties has some diagnostic 
symptoms by which it can generally be distinguished 
from every other, is acknowledged by all; but these 
varieties present so many symptoms in common as 
to render it no easy matter to either name them cor- 
rectly, or point out peculiarities by which each can 
be readily recognized, especially in the early stage, 
and by the young practitioner. 
The reader who has followed me thus far will 
have discovered that all fevers consist mainly in the 
same departures from healthy action, and that they 
consequently can be successfully managed by the 
same means, which renders it of small moment 200 
on fever: 
whether each kind of fever be known from every 
other kind or not. And were I writing alone for 
experienced practitioners, what has been said 
would be quite sufficient; for their knowledge of 
the laws of diseased action, and their acquaintance 
with remedial agents, would enable them to make 
such changes in the treatment, and call into use 
such collateral means, as would be found necessary 
to adapt my general plan of treatment to each va- 
riety of fever, and to each case. But, as I am not 
writing exclusively for these, but also for the neo- 
phyte in medicine, it becomes necessary that I should 
enter into particulars, and as far as possible point 
out the differences that exist between the varieties 
of fever, and especially the variations in treatment 
most appropriate to each. 
Fevers have generally received names by different 
authors significant of what they suppose to bo the 
nature of each variety, or the particular organ or 
structure apparently most involved; or of what they 
suppose to be the remote cause, or of the most 
prominent symptom presented in the course of the 
disease. The nosology of fever, founded upon the 
structure most essentially involved, has some ad- 
vantages, as it leads to practical results; and the 
least objectionable classification upon this plan is by 
our talented countryman, Prof. II. F. Campbell, of 
Georgia. The reader may find his views somewhat 
in extenso in the published " Transactions of the 
American Medical Association, vol. ii., 1858. (Ar 
tide :) Report on the Nervous System in Febrile PARTICULAR FEVERS. 
201 
Diseases, and the Classification of Fevers by the 
Nervous System. By Henry Frazer Campbell, A.M., 
M.D., Professor of Anatomy in the Medical College 
of Georgia." 
Professor Campbell, I think, very correctly classes 
fevers with the neuroses, and divides them as he 
thinks they have their origin in disturbance of the 
cerebro - spinal or the ganglionic system - terms 
answering to nerves of animal and nerves of 
organic life of Bichat. That the remote cause of 
some fevers does chiefly impress the cerebro-spinal 
system, and that the remote cause of other fevers 
.spends its force mostly upon the ganglionic system, 
will be evident to every observer who has over had 
his attention turned to the subject. For example, 
the most prominent symptoms of miasmatic fevers 
are those of disturbance of the nerves of animal life, 
while those of typhoid fever as plainly arise from 
disturbance in the nerves of organiedife; but other 
forms of fever appear to about equally involve both 
systems. The eruptive fevers, for instance, which 
Campbell classes with the ganglionic neuroses, are 
attended with nearly the same amount of disturb- 
ance in the cerebro-spinal nerves, except showing a 
less marked periodicity, as the miasmatic fevers; and 
pneumonia, which he classes with the cerebro-spinal 
neuroses, sometimes is attended with so little mani- 
festation of disturbance in the nerves belonging to 
that system, that neither the patient nor his friends 
become aware of any thing serious in the attack, 
until such organic changes have taken place as to 202 
on fever: 
place the case beyond the hope of recovery. In 
fact, the fever attending pneumonia is often purely 
typhoid, while it is in other cases as plainly bilious, 
and not unfrequently decidedly inflammatory. The 
same observation may as truly be made with regard 
to dysentery; so that all that can be established 
upon this subject is, that some fevers mainly mani- 
fest themselves in disturbance of the nerves of ani- 
mal life, while others principally show disturbance 
of the nerves of organic life, and others involve both 
systems about equally, or sometimes one principally 
and sometimes the other; so that we find Professor 
Campbell's system of nosology, though perhaps the 
best we have seen, yet, like all its predecessors, 
dividing things which should stand together, and 
grouping others that should stand apart. 
But Professor Campbell has done much for the 
science of medicine. His treatise on the nerves 
should not only be read but studied by every physi- 
cian, as it throws a flood of light upon many of the 
phenomena of diseased action, which have hereto- 
fore been perplexingly obscure to the practitioner. 
Though as a discoverer he cannot rank higher than 
Marshall Hall, yet his discoveries will lead to more 
important practical results, and his name will ever 
justly be associated with those who, in every age, 
have gone in advance of their generation in eluci- 
dating the great truths of medical science. Some 
persons are disposed to undervalue the labors of 
both Hall and Campbell, because what they have 
demonstrated to he true, had before been guessed 203 
PARTICULAR FEVERS. 
at, and more or less firmly believed, by others before 
they wrote; but all must agree that those great 
men have made plain what was before obscure, and 
proven that which was only presumed, and system- 
atized those things which before appeared to be dis- 
connected and without relationship. 
Those who have read the preceding pages of this 
work, will have discovered that I distinctly claimed 
years ago that the remote cause of fever makes its 
first impression upon the nervous centres ; but I did 
not claim this as original; but I do claim that I 
stated it more distinctly, and dwelt upon it as of 
more prominent importance, than any writer who 
preceded me had done. Neither does Prof. Camp- 
bell claim originality for the idea that the cause 
of fever first impresses the nervous system, but 
claims to point out the points of attack of different 
causes, and how the various parts of the great ner- 
vous system arc associated together, so as to sympa- 
thize with each other, and give rise to the almost 
infinite variety of morbid manifestations with which 
we meet in febrile diseases. Now, by the way, I 
claim for the capillary system a degree of what I ac- 
cord to Professor Campbell with regard to the ner- 
vous system, viz.: that I have drawn attention to it 
n ore pointedly than had before been done; and 
pointed out the essential part it plays in the develop- 
ment of every case of fever; and further, that I 
have made this knowledge of the nervous and capil- 
lary systems available not only for a clearer elucida- 
tion of the phenomena of fever, but also in devising 204 
on fever: 
a better, because a simpler and more successful, 
treatment. 
For the advantage of the uninitiated, perhaps it 
would be well to give a condensed statement of 
what is claimed as new with respect to a knowledge 
of the functions of the nervous system. 
We had been taught long since, by Bichat and 
others, that the human system is supplied by two 
distinct classes of nerves: one class, having their 
origin in the brain and spinal marrow, puts us in 
connection with the external world, by giving us 
general sensibility, as well as supplying us with 
special senses-as sight, hearing, etc.; also giving 
voluntary muscular motion, by which the senses 
can be gratified and other wants of the system sup- 
plied : these are the nerves of animal life of Bichat- 
cerebro-spinal nerves of late writers. The other sys- 
tem of nerves have their origin in the ganglia or 
little brains situated within the body, and connected 
together by nervous matter so as to form a continu- 
ous chain in front of the spinal column, known as 
the great sympathetic nerve, and supply nervous 
power by which all those silent and delicate opera- 
tions are performed by which life is preserved-as 
digestion, assimilation, circulation, etc., etc.; hence 
known as nerves of organic life, or ganglionic nerves. 
Now it had been long known that each of these 
great nervous classes contained lesser divisions- 
the cerebro-spinal nerves being naturally divided 
into nerves of motion, nerves of sensation, and 
nerves of special senses-and that the ganglionic PARTICULAR FEVERS. 
205 
nerves divide themselves into nerves of 'nutrition, 
nerves of circulation, etc., and that each of these 
lesser divisions is susceptible of further subdivi- 
sion ; for example, the nerves of secretion contain 
as many varieties as there are different secretions, 
those of assimilation as many as there are consti- 
tuents of the human body, etc. It was also known 
that besides all these there is another set of nerves 
whose office it is to connect the different classes, 
divisions, and varieties of nerves together, and 
hence called nerves of association; and it was be- 
lieved that it is by these inosculating or connecting 
nerves that the various sympathies and nice rela- 
tions that exist between distant parts of the system 
are maintained; and late investigations have tended 
to establish this belief as ascertained truth. 
It has also been well understood that each nerve 
possesses fibrils whose office is different; that some 
convey impressions to the nervous centres, while 
others transmit power or influence from them to the 
part in which the nerve is distributed. Now what 
gave Marshall Hall so much celebrity is principally 
this, that he demonstrated the existence of a class 
of nerves whose office it is to convey impressions to 
the nervous centres where motive-power is manu- 
factured, and cause influence to be sent out through 
the motor-nerves to the muscles to excite them to 
action. Example : a certain impression made upon 
the lining membrane of the nose is taken up by 
these nerves, and conveyed to the origin of the 
nerves which are distributed to the muscles con- 206 
on fever: 
nected with respiration, which causes motive-power 
to be sent out which calls into action those muscles 
by which the complicated act of sneezing is per- 
formed ; or a morbid impression is made upon the 
sentient lining of the stomach by some offending 
matter: intelligence is sent along these nerves to 
the spinal origin of the various muscles called into 
action in the effort of vomiting, and immediately 
motor-power is sent out, and those muscles obey the 
impulse; or an intense light impresses the sentient 
expansion of the optic nerve unpleasantly, and im- 
mediately intelligence is sent along those nerves to 
the origin of the muscle which supplies motor- 
power to the iris, and instantly that delicate curtain 
is drawn so as to admit less light, and so on 
throughout the countless examples where muscular 
motion is wanted irrespective of the will, often 
taking place in opposition to it, and still oftener 
unknown and unmarked by consciousness. The 
nerves performing these offices are the excito- 
motory nerves of Marshall Hall. Since the excito- 
motory system was made known by Hall, our own 
countryman has added an equally brilliant chapter 
to our knowledge of nervous action. 
Professor Campbell has clearly proven that a 
system of nerves exists which bears the same rela- 
tion to secretion that the excito-motory system does 
to muscular action, and by him appropriately named 
the excito-secretory system. A few examples 
will illustrate the working of this system of 
nerves. For instance, the odor of savory food. PARTICULAR FEVERS. 
207 
strikes the sense of smell of a hungry man, and the 
impression is instantly conveyed to the origin of 
the nerves concerned in the manufacture of saliva; 
the necessary nervous power is immediately dis- 
patched to the salivary glands, and, in less time 
than I can tell it, the fellow's "mouth is watering." 
Then again, if the man obtains his desire, the 
moment the food pleasurably impresses his gusta- 
tory nerves, an impression is sent in a like manner 
to the centre from which, the gastric nerves have 
their origin, which gives information that the 
liquor gastricos will shortly be needed, to act upon 
the material which is being masticated. And thus 
we might follow the morsel from the time that its 
pleasant odor first attracted the alimentive desire, 
throughout the entire history of its complete diges- 
tion, to the absorption and assimilation of its 
nutrient particles, and the ejection of its grosser 
constituents, and show that, in its progress, the 
excito-secretory nerves are faithful to their office, 
having a supply of the necessary secretions ready 
to meet it in its various stages. In the meantime 
the excito-motory nerves have not been idle, but 
have called for motive-power to move the material 
on, and at the exact time that a change of place was 
needed. In fact, a more beautiful and forcible illus- 
tration could not be given of the workings of both 
the excito-motory and excito-secretory nerves, than 
might be found in tracing digestion through its 
various stages. 
Now, a knowledge of the nervous system, with 208 
on fever: 
the lights which have been recently thrown upon 
it, becomes not only exceedingly interesting in the 
study of physiological phenomena, but of the 
highest importance to a correct understanding of 
those pathological developments constituting the 
symptoms of disease, and also of the modus ojjerandi 
of the means we prescribe in its management. 
For example, when the physician is called to 
examine a case of fever, and he finds his patient, 
besides presenting other evidences of a febrile 
attack, complaining of distressing pains or aching 
through the whole frame, with more or less sore- 
ness of the surface, he may know that the spinal 
origin of the nerves of general sensation is the seat 
of morbid excitement; which will at once draw his 
attention to the importance of making soothing or 
anaesthetic applications to the spinal column. If 
there be cramps or spasms, or other morbid muscu- 
lar action, he knows that irritation exists in the 
origin of the motor-nerves, and he resorts to the 
above means, with the addition of antispasmodics. 
But he will further wish to ascertain whether this 
irritation be the result of primary disturbance in 
the cerebro-spinal centres, or whether the principal 
difficulty exists in some other part, as irritating 
ingesta, or worms, in the alimentary canal, which, 
through the medium of the excito-motory nerves, 
have gotten up the morbid phenomena; if so, he 
will, besides using the means suggested in order to 
obtain present relief, also direct his efforts to re- 
moving the principal cause. But suppose the prin- PARTICULAR FEVERS. 
209 
cipal feature in the attack is a wasting diarrhoea; 
the practitioner will determine that, as all the 
secretions are performed by ganglionic influence, 
there is therefore morbid excitement in that sys- 
tem, and especially in the particular ganglia from 
which the nerves of the small intestines arise; and 
he will now consider whether this irritation be pri- 
mary or secondary. If the patient be a child, and, 
on examination, he finds that a protruding tooth 
has produced considerable irritation in the gums or 
investing membrane, he will have reason to sup- 
pose that this has acted upon the ganglia involved, 
through the medium of the excito-secretory nerves, 
and will expect advantage from letting the tooth 
free by an incision ; or, if the patient be an adult of 
delicate constitution, and living much within-doors, 
but has lately been exposed to wet or cold, or damp 
air, he may presume that the morbid impression 
made upon the surface has been conveyed by the 
excito-secretory nerves to the ganglia, as in the 
child, and a hot mustard bath, or some kindred 
appliance, will often arrest the diarrhoea without 
other medication. 
But to point out all the instances in which a 
knowledge of the excito-moiory and excito-secretory 
nerves can be of service in diagnosis and treatment, 
would fill a volume; what has been said must suf- 
fice as hints, which may serve to set the practi- 
tioner to thinking. I cannot leave the subject 
without suggesting that the labors of Hall and 
Campbell form but the first chapters in the exposi- 210 
on fever: 
tion of a general exciior nervous system ; that besides 
the excito-motory and excito-secretory, there will 
yet be added excito - circulatory, excito-nutrient, 
excito-thermal, and excito-sensatory systems of 
nerves, and perhaps others. I will very briefly sum 
up some of the evidence which presents itself of 
the existence of the last four named; and, first, 
excito-circulatory system. Examples of the physio- 
logical workings of this system may be found in all 
those sudden and partial excitations of the capilla- 
ries following impressions made upon some distant 
part or organ, as in blushing, engorgement of the 
erectile tissues, etc. These excito-circulatory nerves 
evidently also cooperate with the excito-secretory 
in causing a flow of blood to a gland during the 
period of active secretion. Pathological examples 
may be found in the flow of blood to the head 
from disturbance of the stomach, the hectic flush 
from pulmonary irritation, etc. 
Of the existence of a system of excito-nutrient 
nerves we may find evidence enough. What else 
produces those physiological developments which 
take place at puberty and during pregnancy ? In- 
stances of the morbid action of these nerves may 
be seen in induration and scirrhus of the mammae 
and uterus in the female, and enlargement of the 
prostrate in the male. Of the workings of the 
excito-thermal system we may find examples in all 
those cases of morbid sensation of heat unaccompa- 
nied with inflammatory action or even congestion, 
with which we so often meet in disease, and often PARTICULAR FEVERS. 
211 
existing without any other manifestations of depart- 
ure from healthy action. Of the existence of an 
excito-sensatory system of nerves, we also have 
abundant evidence: every ache or pain, or other 
morbid feeling, which we find located in a part not 
itself the seat of disease, is an example of its work- 
ings ; as pain in the head from gastric or uterine 
irritation, pain in the extremity of the urethra from 
irritation in the kidneys, or colic from mental dis- 
turbance, etc. 
Now I am not certain whether the above sugges- 
tions contain any thing new or not. I have not met 
with them before; but if new, I claim very little 
credit for what I have said, it being naturally sug- 
gested by the researches of those who have pre- 
ceded me. Columbus was entitled to undying 
fame for his discovery of a New World; Americus 
was also entitled to much credit for pushing dis- 
covery farther; but after them, every navigator 
could make fresh explorations. These observations 
upon the nervous system may be a little out of 
place in a work of this kind, but I hope the reader 
will find them sufficiently instructing and suggest- 
ive to compensate him for the perusal. 
Without further preliminaries, I will now take 
up the individual fevers, and point out the diag- 
nostic symptoms of each, and the variations of treat- 
ment which I have found necessary in adapting my 
general plan of treatment to each variety and stage, 
and the various minor helps which serve to meet 
complications, remove annoyances, and increase 212 
on fever: 
the efficacy of the principal remedies. And, as 
being the most important on account of its ranging 
over a wider territory, and being more intractable 
to the influence of the common remedies, I wall 
first take up 
TYPHOID F E VER. 
The forming stage of this fever is generally more 
protracted than any other. For many days, or even 
weeks, the patient is sensible of not being quite as 
well as usual; has less energy; less vivacity ; a more 
capricious appetite; has some irregularity of the 
bowels ; sleep more disturbed, and not so refreshing 
as usual; finally, pains strike him of a peculiar 
kind, often assuming the form of crick in the neck, 
or aching of the head, and soreness about its junc- 
tion with the neck. His feeling of discomfort gradu- 
ally becomes more decided; and, although he is still 
often unable to refer his illness to any particular 
point, yet he is conscious of being very sick, but 
perhaps still mopes about for a few days longer, 
expecting every day to get better. Friends fre- 
quently look upon it as an attack of common cold, 
and administer sweating remedies to throw it off; 
but although he perspires copiously, he is not at all 
relieved, and they next usually conclude to give a 
purgative to work the cold off by the bowels. This 
also operates with unusual power, and the bowels 
continue to run oft' with watery discharges long after 
the medicine has spent its force. By this time the 
patient is decidedly worse, and his friends, not know- T Y P H 0 11) F E V E II. 
213 
ing what more to do, send for a physician. When 
the doctor arrives, he will generally tind his patient, 
if a negro, closely covered up in bed, even should 
the weather be warm, and either asleep or in a stu- 
pid condition, which might be easily mistaken for 
sullenness. Arouse him and ask him what is the 
matter, and he will probably say, Nothing: ask him 
why he is in bed then? and he will say he feels too 
weak to work; if he cornplains, and you inquire 
where his misery is, he will answer, All over. If a 
white man, he will probably be found sitting with 
the family, and will apologize for sending for you 
upon so trivial an occasion; observes that he Iqis 
felt "out of sorts" for several days, and thought 
best to send for you to tell him what is the matter. 
Upon examination you will find his pulse a little 
more frequent than natural, and the surface, espe- 
cially of the body, a trifle too hot, and the extremi- 
ties rather too cool; his countenance looks tired and 
expressionless; tongue furred, and unusually white, 
as though it lacked blood, or presenting the hue of 
venous blood. Ask him if he has tenderness of the 
abdomen, and he will commonly say No; but upon 
making pressure just above the umbilicus, or a little 
to the right, you will discover that he will flinch; 
pressure along the spine will commonly detect se- 
veral points of tenderness ; his chief complaint how- 
ever is of weakness, which he attributes to the ope- 
ration of the purgative, if he has taken one. 
If the disease is suffered to progress, and you ex- 
amine him a few days later, you will probably find 214 
on fever: 
that the giddiness of the head lias been changed for 
severe pain, delirium, or stupor as from intoxication. 
There is now decided tenderness the whole length 
of the spine; the tenderness of the abdomen is also 
considerably increased, attended with more or less 
fulness; the heat of the trunk is augmented, and 
the pulse accelerated, small and wiry under the 
touch; tongue thickly coated in the middle, but 
rather clean at the edges, and of a deeper red; in 
putting it out it assumes a pointed form with a slight 
elevation of the edges, and it will often quiver like 
a leaf in the wind. The tongue is not however red 
and pointed in every case; sometimes it is unusually 
white, as though it lacked blood, and is spread out 
much broader than natural. There is usually some 
diarrhoea; at least, if any purgative has been given, 
it has run off with watery discharges. The heat, 
though not generally so great in this fever as in 
some others, is more persistent, varying but little 
for many days together. 
You who have ever seen a case of typhoid fever, 
will readily recognize the likeness I have drawn. 
Now what kind of lesion does this group of symp- 
toms indicate ? Do they not all point unmistakably 
to derangement of the nervous system, forcing the 
conclusion that this disease has its primary found- 
ation in the disturbance of the nervous centres? 
Every characteristic manifestation of this fever from 
first to last indicate this, viz., weariness, lassitude, 
cramping pains, giddiness, the wry neck, the trem- 
bling tongue, the peculiar fretful pulse, the fitful al- TYPHOID FEVER. 
215 
ternations of heat and cold, and subsequently the 
flashes of fiery heat, the delirium, subsultus tendi- 
num; and even the red tongue, the irritable bowels, 
and the rose-colored eruption, as I will show here- 
after, all grow out of disturbance of the nervous 
centres, which disturbance is evidently the result of 
the action of the remote cause, as they precede local 
disturbances, and therefore cannot be produced by 
them. Hence this disease has often been known by 
the term weryows/ever. 
The capillary debility, and consequent engorge- 
ment, being more slowly produced in this than any 
other fever, the reaction is also more tardy in taking 
place, but, when set up, is proportionally more per- 
sistent, and the disease has therefore been called the 
" continued fever." The red tongue and intestinal 
irritation have claimed the attention of others, and 
they, taking these symptoms as indicating the seat 
of the disease to be in the stomach and bowels, have 
named it " enteric fever," or gastro-enteritis. 
But these are by no means the first symptoms of 
the disease, but come on in its progress, and are 
therefore an effect of some other lesion: they are 
not even peculiar to this disease, for we find them 
fully as prominent in other diseases known to be the 
result of great nervous disturbance, such as fever 
from dentition, from intestinal worms, from painful 
or difficult menstruation, from conception, etc. 
Every practitioner of experience has seen the red 
tongue, the irritable stomach and bowels, and the 
great impressibility of the system to the influence 216 
on fever: 
of medicine, as fully developed in these and kindred 
cases, known to arise from nervous disturbance, as 
they ever have in typhoid fever. 
In the progress of this disease there often appears 
a peculiar eruption on the surface about the epigas- 
trium, and also internally in the neighborhood of 
Peyers glands, which has induced many to class it 
among the eruptive diseases, such as scarlatina and 
measles, and that, like them, it is contagious and self- 
limited. But we have many other examples of pe- 
culiar eruptions originating from great nervous dis- 
turbances, such as arise from over-doses of narcotic 
stimulants, poisonous fish, lobsters, mushrooms, etc.; 
and it is not unphilosophical to suppose that the 
eruption attending the true specific contagious dis- 
eases is the result of a similar cause, viz., that the 
remote cause of these diseases, whether animalcule 
or gaseous, is of the nature of a narcotic stimulant 
or nerve-poison, and the eruption is the consequence 
of the nervous disturbance. It will be perceived, 
therefore, that I do not deny that typhoid fever is 
an eruptive disease, or that it is contagious; all I 
contend for is, that it is the result of a narcotic poi- 
son, either organic or gaseous, acting upon the ner- 
vous centres. 
Very little appears to be decided in the profession 
with respect to this disease, either with regard to 
its nature or its treatment. 
In order to show the unsettled condition of the 
medical mind upon this subject, I will give an ab- 
stract of the present mode of treating this disease, TYPHOID FEVER. 
217 
taken from writers living in various parts of our 
own extensive country and in different European 
states, which I think will show that more light was 
needed upon this subject. I will first condense from 
the published Transactions of the American Medical 
Association some abstracts from reports of commit- 
tees on epidemic diseases, etc.: 
Dr. Barbour pursued the expectant plan; bled if 
reactions ran high; gave opium to restrain diarrhoea, 
quiet delirium, and procure sleep ; moved the bow- 
els with castor-oil and turpentine. Mercurials 
proved injurious ; quinine was also injurious in every 
case of real typhoid fever. Dr. Adair agrees with 
this. s 
Dr. Hart relied upon aperients, diuretics, diapho- 
retics, sedatives, and stimulants. 
Dr. M'Nelly gives blue-mass, ipecac, and citrate of 
potass, in a state of effervescence; restrains diar- 
rhoea with paregoric and tine, catechu ; has fre- 
quently given quinine, but without benefit. 
Dr. B. F. Stephens gives chlorine-water for the 
purpose of introducing oxygen, so as to favor the 
production of fibrin. His patients recovered in 
about three weeks. 
Dr. Sutton, of Georgetown, Ky., supposes there 
is generally a daily obscure chill in typhoid fever, 
and gives quinine, he says, with great advantage. 
Dr. Desha relies on quinine and blue-mass as an 
antidote to the diarrhoea in typhoid fever, or quinine 
alone. 218 
on fever: 
Dr. Geno gives quinine in typhoid fever to quiet 
restlessness, and equalize the circulation. 
The great objection to quinine by Dr. Grant is, 
that it always increases the restlessness, sleepless- 
ness, tinnitus aurium, (ringing in the ears,) and the 
deafness symptomatic of the disease. 
Dr. Grant and Dr. Hawkins meet the crisis with 
diffusible stimulants. 
Dr. S. Kersey, Lewisville, Henry county, treated 
three cases of typhoid fever with rhubarb, blue pills, 
camphor, valerian, quinine, and anodynes, with cold 
sponging. One died. One case treated with ano- 
dynes, quinine, turpentine, and cold sponging, re- 
covered. 
I will now give some extracts from those who have 
written books upon that subject: 
Dr. Jackson commences with an emetic of tartar- 
ized antimony, and follows it with an active cathar- 
tic. If this does not afford decided relief, he then 
uses venesection, letting the blood flow until an im- 
pression is made ; then gives tartar emetic in broken 
doses every two hours until decided nausea is pro- 
duced, restraining its action on the bowels when 
necessary with opium. Formerly gave calomel in 
frequently-repeated small doses, so as to produce 
salivation, but finally abandoned the measure as use- 
less if not injurious. 
Dr. Nathan Smith has never seen any remedy 
shorten the duration of the disease; in mild cases 
gives no medicine, but keeps the patient quiet; gives TYPHOID T E V ER. 
219 
mild drinks and nourishment. In severer cases uses 
such means as will mitigate the most prominent 
symptoms; looks upon emetic tartar as " an inap- 
propriate and unsafe remedy has known it con- 
vert a mild case into a severe one. 
Chomal, of Paris, follows the expectant plan, 
giving only mild drinks ; sponging with cold water; 
fomentations, mucillagino.us injections, etc. ; and 
in the latter stage gives tonics and stimulants; 
bleeds if the symptoms indicate it. 
Loves pursues pretty much the same plan, but 
resorts to bleeding oftener. He says that "by the 
judicious use of the three principal means-bleed- 
ing, sweating, and tonics - the disease may be 
shortened a little-a day or two at least," and 
"hopes that a more successful treatment of this 
disease will yet be discovered." 
Bouillaud bleeds freely and repeatedly, and cups 
and leeches in the intervals; does nothing else. 
De Laroque begins with an emetic, and then 
gives daily brisk purgatives throughout the entire 
course of the disease. 
Bartlett recommends the eclectic plan in a mild 
way, merely combating symptoms and taking care 
of the strength as much as possible, to enable the 
patient to bear up under the tedious course usually 
run by this disease. 
Wood commences with a mild purgative; then 
bleeds, if arterial action is high; gives refrigerants 
to moderate pain; and in the second stage gives 
mercury and turpentine to combat inflammation. 220 
on fever: 
By increasing the number of quotations from 
authors and writers in medical periodicals, the 
variations in treatment could be extended to an in- 
definite amount. In the South, physicians agree in 
hardly any thing in the treatment of this disease 
but in giving turpentine. 
It is truly painful to think of, and humiliating in 
the extreme to our professional pride, that this, the 
most extensively spread febrile disease known to the 
human family, and therefore having been seen and 
studied by every medical inquirer in the civilized 
world, should yet be so little understood that not 
only no settled treatment has been agreed on, but 
remedies the most opposite in their operation are 
relied on with equal confidence, and, so far as ap- 
pears, with about equal success-no one even pre- 
tending that the disease can be materially shortened. 
Surely, in view of this, the profession ought to be 
willing to candidly investigate the claims of a plan 
which proposes to do what all others have failed to 
accomplish, especially when a trial involves no risk 
of life, the remedies being mild in their operation, 
and involving no waste of the resources of the sys- 
tem, and their employment indicated by a rational 
view of the condition of the system in the disease. 
I can offer very little upon the treatment of this 
disease, except what could be gathered from the obser- 
vations which may be found upon this subject in 
the preceding pages; however, to bring the subject 
directly before the reader in a more condensed form, 
and enable him to understand my manner of using TREATMENT OF TYPHOID. 
221 
th? principal remedies, and the particular helps 
which should be called in by way of meeting the 
various difficulties which present themselves, from 
time to time, in the progress of a case of typhoid 
fever, I will now proceed to take up a case repre- 
senting its most usual form, and give a kind of pro- 
gramme of my method of procedure. 
All fevers, we have before observed, are very 
similar in their inception ; therefore, when I am 
called to see a case in the forming stage, I think it 
best not to decide what form I may have to treat. 
If interrogated upon the subject, I answer that the 
patient has either taken cold or is about to have 
some form of fever, and that I cannot name it until 
it is further developed. In this stage, it is usually 
best to do very little; rest, mild drinks, and a 
gentle purgative are enough to prescribe. It is 
true, a full dose or two of the comp, syrup, before 
described, will usually cut the disease short at once, 
and it will never develop itself at all; but this is 
not always to be desired, for then you would never 
know whether you had aborted a case of fever or 
not; and even if you should be satisfied upon this 
point, the patient and his friends will not be, for 
however threatening may have been the symptoms 
of a dangerous attack of fever, yet if, on your re- 
turn on the morrow, you find your patient clear of 
diseased action, you will also find that he thinks 
you were needlessly called in, and will not only re- 
fuse to award you any credit for your skill, but pay 
your pittance of a fee with reluctance. It is best, 222 
on fever: 
therefore, to temporize until you have an oppor 
tunity of diagnosing the fever, and the patient be- 
comes certain that he is sick "sure enough." But 
if the patient be of a delicate constitution, or is 
laboring under broken health from other causes, or 
is a female who is enciente, it is best to give the 
syrup at once, lest there might be risk in delay. 
Therefore, when called to see a patient whom I find 
complaining of some headache, general muscular 
weakness, alternate -sensations of cold and heat 
quickly succeeding each other, loss of appetite, etc., 
and I think best to abort the disease at once, I pre- 
scribe a tablespoonful of the syrup every two hours 
to an adult, and in proportion for a child; a warm 
mustard bath to the feet, and chloroform liniment 
or camphor and laudanum to the spine, also to the 
stomach and bowels if there is any distress in that 
region, and direct quietness and the recumbent 
position. When I call the next day, I expect to 
find ray patient sitting up, and, if a female, attend- 
ing to her amusements or domestic duties, and to 
be greeted with, "Why, Doctor, you've come too 
late ; I've got well; I was more scared than hurt; I 
feel as well as common to-day," etc. Now, you 
need not try to convince her that yesterday she was 
within the grasp of a powerful disease, and that you 
had made it loose its hold; she will not believe a 
word of it, and you will be in danger of making 
yourself appear ridiculous by trying. I know that 
physicians have as much disinterested benevolence 
as any people under the sun, but even they would TREATMENT OF TYPHOID. 
223 
rather their favors were appreciated. Therefore, 
when the constitution is sound, wait a while. People 
love to take physic when they are sick, and it is 
best to indulge them. If you have any doubt about 
the case being typhoid fever, give a dose of calomel, 
and that will decide for you by the next day. On 
inquiry, you will be told that the physic " worked 
powerfully, and brought away more bile than you 
ever saw;" but upon making closer inquiry, or, what 
is better, by seeing the dejections, you will find that 
the bile is nothing more than yellow water, present- 
ing the appearance of an egg stirred up in a gallon 
of very thin gruel. You will also find, too, that 
the patient feels generally worse : his headache has 
increased; more pain in the back; skin hotter; 
tongue covered with fine white fur, and is broader 
than natural; abdomen is more tumid, and slightly 
tender to pressure ; pulse more frequent; heat per- 
sistent. Well, if you are satisfied that you have a real 
case of typhoid fever before you, just put him upon 
the treatment that was suggested for yesterday, 
with the addition of a poultice to the bowels; but 
if you still have doubts, temporize a while longer, 
but don't repeat the calomel, as it may make the 
disease worse than you would desire. Give Dover's 
powders if you like, and order castor oil or a seid- 
litz powder, or any thing else that will not do much 
harm ; even quinine, if you think it indicated; and 
see him again in twenty-four hours. You will 
probably find that the purgative has not operated 
at all, or it has purged him profusely; there is 224 
on fever: 
more heat of the skin; greater restlessness; head- 
ache unabated; confusion of ideas; talks wildly 
when dozing; tongue more coated in the middle, a 
little red at the edges and slightly contracted, and, 
on protruding it, you may perceive a little quiver- 
ing, as though its fibres were acting " one at a 
time." 
If you will delay another twenty-four hours, these 
symptoms will be still further developed; the tongue 
will be decidedly pointed, and a deeper red at the 
edges, and will perhaps tremble with a palsied 
motion or look rigid, with its tip turned upward. 
You now have a case which will do to record in 
your note-book, "A case of typhoid fever of five 
days' standing;" for though you have only been 
treating it three days, yet it is certain that it existed 
two days anterior to your first visit. Well, I should 
commence the treatment now, just as I would have 
done at the first, so far as giving the syrup is con- 
cerned. It would be syrup every two hours, lini- 
ment to the spine, poultice to the bow'els, cold ap- 
plications to the head, and sponge the limbs with 
warm soap-suds. On my next visit I should expect 
to find but little change of symptoms, for when this 
fever gets five days the start, it wont yield in a few 
hours; it now seems to have the tenacity of life of 
the snapping-turtle, and, like it, will hold on to its 
grasp some time after its vitals are crushed. I 
should therefore feel contented to find my patient 
no worse : perhaps less headache; not quite so rest- 
less, and bowels not so excitable, etc. A very TREATMENT OF TYPHOID. 
225 
gradual, hardly perceptible improvement may be 
expected until the third or fourth day of treatment, 
when I should expect to find general evidence of 
improvement: the pulse, for example, about 90; 
skin much cooler; headache gone; sleep undis 
turbed ; tongue not so red and pointed ; but still no 
appetite, and no signs of increasing strength; per- 
haps the patient feels weaker, and will not believe 
that he is really any better. But I tell him he will 
be better to-morrow, and suggest some light diet, 
which I direct to be taken with the punctuality of 
medicine. On the next day I expect to find a de- 
cided improvement in his appearance: his coun- 
tenance looking bright; his skin filled out, and 
looking lively and glossy; his eye brighter; his 
tongue having lost some of its redness and assum- 
ing its natural shape, but yet trembling. lie now 
inquires what he may be allowed to eat, and likely 
suggests some article that strikes his fancy. If the 
tone of the bowels has not been injured before I 
have taken charge of the case, and it has not been 
of more than five days' continuance, I usually per- 
mit the patient to have a little of any diet he may 
fancy, even fried chicken or broiled bacon. But if 
purgatives have been injudiciously used, or the 
fever is in its second week when I first see it, I 
know that the bowels have been so injured that the 
utmost care will be required during convalescence. 
My usual form of administering the syrup is, to 
give it in twice its volume of water or milk. It 
should always be diluted with milk for infants and 226 
ON FEVER. 
small children ; and this is generally the best vehi< 
cle for giving it in fevers for all ages, the milk fur- 
nishing the means of sustaining the system, and 
the syrup securing its proper digestion and assimi- 
lation, and thus preventing a loss of tone in the 
stomach or much prostration of general strength. 
But sometimes the syrup, given in any way, be- 
comes repulsive to the stomach, which renders it 
imperative to devise some other form in which to 
administer the remedies. The following pill con- 
stitutes a good substitute: Recipe-Pulverized 
rhubarb 30 grains; piperin, valerianated zinc, and 
extract of liquorice, each 10 grains ; oil of sassa- 
fras, 20 drops; make 30 pills, each of which will be 
about equal to a tablespoonful of the syrup, and 
may be given at the same intervals. I often find it 
convenient and politic to substitute the pills for the 
syrup, even when the latter is taken kindly, so as 
to prevent the patient or his friends from thinking 
that too little is doing. It is generally best to give 
the pills in the night, and the syrup during the 
day. 'When the medicine is given in the form of 
pills exclusively, I have thought its effect in break- 
ing up the febrile movement was not quite so 
potent as when given, at least part of the time, in 
the form of syrup. I never have a patient roused out 
of a quiet sleep to take medicine. As soon as con- 
valescence is fairly set up, I make the intervals 
longer between the times of giving the medicine, 
making them throe, four, and six hours, and finally TREATMENT OF TYPHOID. 
227 
ordering only a teaspoonful to be taken directly 
after eating each meal. 
When called to take charge of a patient in an 
advanced stage of the disease, after active inflam- 
mation has been set up, I meet this complication 
with additional treatment. If of the brain, I ap- 
ply cold applications to the head, and a blister to 
the back of the neck, letting it extend some way 
down between the shoulders. If of the bowels, I 
first poultice, or pour a stream of warm water for 
an hour or two upon the exposed surface, and then 
poultice; and if these means fail, I then apply a 
blister: I prefer a large one; the irritation pro- 
duced by a small blister is usually transferred to 
the greater one beneath, making the disease worse 
by adding to it. 
I pay no attention to the secretions of the liver, 
knowing that, when the remedies have set up 
general capillary action, those of the liver will also 
participate in the reaction, and healthy bile will be 
secreted; and also knowing that a forced effort of 
the liver, under the goadings of mercurials, will in 
no way aid me in breaking up the febrile move- 
ment. I therefore only watch for the return 01 
healthy biliary secretions, with the same solicitude 
that I do other secretions; viewing all of them not 
as a cause, but a consequence of commencing convales- 
cence. If called in at an advanced period of 
typhoid fever, I can make no promise as to the 
time which the disease may then run ; but if there 
are no serious inflammatory complications, I usu- 228 
on fever: 
ally, even then, break up the febrile movement in 
four or five clays, but convalescence is tedious. 
I will now further illustrate my mode of man- 
aging typhoid fever, by detailing a number of cases 
treated by myself and others : 
Case 1. August 30th, 1853. - Capt. Wm. B. 
Walton's negro boy Allen. Has had constant fever 
thirty hours. Great sense of weariness, much dis- 
tress of the head, tenderness of the epigastrium, 
pulse full and throbbing, tongue covered with very 
short white fur and slightly red at the tip. Pre- 
scription : Bathe the abdomen and spine with lini- 
ment, and give a tablespoonful of syrup every two 
hours. 
31st.-Had a slight chill last night and some 
fever, but no headache or other distress. Added 
five gr. quinine with four ounces syrup, and ordered 
a tablespoonful every four hours. 
September 1st.-Appears clear of disease. Or- 
dered the medicine to be given three times a day 
for a few days. 
Case 2. September 1st, 1853.-John Stone, 
clerk at the Verandah. Has for several days suf- 
fered from a feeling of prostration, and a sense of 
heat and chilliness alternately; during the last 
night, sweat profusely and had copious discharges 
of yellow water from the bowels; abdomen tumid 
and sore, tongue furred and rather dry, substance 
of it rather dark-red, inclined to doze, and dreams 
half waking, pulse quite compressible and variable, 
constant alternations of cold and hot sensation. T R E A T MENT OF TYPHOID. 
229 
Prescription: liniment to the spine and abdomen, 
tablespoonful of syrup every two hours. 
Evening.-Pulse tolerably full and regular, skin 
warm and moist, abdomen less tense and tender. 
Continued treatment. 
2d. - Same general improvement. Continued 
treatment. 
3d.-Slowly improving; has had no passage from 
the bowels. Ordered two blue-mass pills, and con- 
tinued syrup. 
4th.-Found general improvement, consistent dis- 
charges, tongue cleaning, some appetite. Syrup 
every four hours. 
5th.-Left his room and rode out. 
Case 3.-September 18th, 1854.-Mr. Jackson, 
College street, boat-hand. Symptoms : dull, heavy 
headache, with disposition to sleep, mutters when 
dozing, skin hot on the body, extremities rather 
cool, abdomen tumid and tender to pressure, con- 
siderable diarrhoea, tongue furred in the middle, 
but dean and red at the edges, and becomes 
pointed and trembles on protruding it. 
Treatment.-A poultice of corn-meal and mustard 
to the abdomen, liniment to the spine, and a table- 
spoonful of syrup every two hours. 
19th.-Does not mutter so much in his sleep, 
bowels quiet, abdomen less tense and tender. Con- 
tinued treatment. 
20th.-General improvement. Discontinued treat- 
ment, except syrup every two hours. 
Case 4. January 1st, 1855.-Son of Mrs. Tay- 230 
on fever: 
lor, Cedar street, aged about twelve, small of his 
age and slightly formed, but usually enjoyed good 
health and was sprightly. His mother informed 
me that for about a week before I was called in, he 
had appeared unusually dull, and was inclined to 
sit about the house, and when directed to go on 
errands, went reluctantly; finally complained un- 
usually of cold whenever he left the fire; lost his 
appetite, had headache, and soreness of the abdomen ; 
diarrhoea at last set in, which for the last two days 
had been very severe, producing great prostration. 
I found him laboring under considerable headache, 
intolerance of light, abdomen tense, tumid and 
tender to pressure, considerable heat of the head 
and trunk, but extremities cool, tongue thickly 
coated with short white fur in the middle, but 
clean and shining red at the edges; in thrusting it 
out it became extremely narrow and pointed, and 
trembled exceedingly. 
Treatment.-A poultice of corn-meal and mustard 
to the abdomen, hot bricks to the feet, liniment to 
the spine, and a tablespoonful of syrup every two 
hours. 
2d. - General improvement; headache less dis- 
tressing, diarrhoea checked, stools consistent, abdo- 
men less tense and tender, tongue not quite so deep- 
red at the edges nor so pointed, but still trembles. 
Continued treatment, giving the syrup every three 
hours. 
3d.-Is still improving. Discontinued all treat- 
ment, except the syrup every four hours. T R E AT M ENT OF TYPHOID. 
231 
4th.-Is clear of all evidence of disease, appetite 
returned. Directed the syrup three times a day for 
a few days, and dismissed the case. 
Case 5. By Isaac N. Croom, M. D., Henderson 
county, Tenn. 
" Mr. C., aged 16, was taken December 29th, 1858, 
with a chill; fever continued, and I was called in 
December 31st. Found him restless; pain in the 
head, back, and limbs ; skin hot and dry; tongue 
furred in the middle and dry, red tip and edges, 
pointed and tremulous ; bowels tender, and a dispo- 
sition to diarrhoea; pulse 120. 
"January 1st.-Symptoms about the same. 
"2d.-Pulse 100; slept well; said he was nearly 
easy, but no appetite. 
"3d.-Decidedly convalescent, and recovered 
speedily. 
"The above case was treated upon your plan for 
typhoid fever entirely. A number of other cases 
could be given, which have been managed with 
equal success." 
Case 6. By J. E. Fulton, M. D., Big Oak, Miss. 
"On the 20th September, 1858, I was called to see 
Mrs. W., aged about 30, good constitution, former 
health very good. I found her laboring under 
slight fever; some headache; pain in the back; 
slight tympanites of the bowels; some soreness in 
the right iliac region ; slight diarrhoea; tongue long 
and peaked and very tremulous, edges red, and 
black scurf down the middle. She informed me 
that she had been ill-disposed for four or five days, 232 
on Fever: 
but thought it unnecessary to send for a doctor, 
and, said she, 'I don't think I am much sick nows' 
Being satisfied of what was the matter, according 
to your directions, I put her on the comp, syrup of 
valerian, a tablespoonful every four hours; and on 
the 21st visited her again: but little improvement, 
probably not so much pain in the back. On the 
22d I found her with less headache, and diarrhoea 
diminished; continued the syrup. On the 23d, 
considerable improvement of all the symptoms; 
and on the 24th, I found her sitting up in the bed 
eating; and on the 25th, I found her sitting on a 
chair rocking the babe. I dismissed the case, but 
ordered the syrup to be continued for a few days. 
The recovery was rapid and complete in a few days. 
" Such has been the termination of all such cases 
since I came in possession of your most excellent 
book." 
Case 7. By P. C. A. Moses, M. D., Eldridge, 
Ala. 
"I was called to see AV. G. AV. IL, on the 20th of 
April, 1857 ; and upon inquiry, learned that for the 
week previous he had been complaining of loss of 
appetite ; general lassitude ; inability to confine his 
mind to his business, (which was that of merchant:) 
dull pain in the head ; general feeling of soreness in 
the muscles; chilly sensations alternating with heat; 
occasioi ally cold clammy sweat, morbid vigilance, 
etc.; and at the time of visit, found all these symp- 
toms aggravated, with considerable febrile excite- 
ment; pulseabout 110; considerable thirst; tongue TREATMENT OF TYPHOID. 
233 
dry and pointed, tremulous upon protrusion ; bow- 
els slightly tympanitic, and tendency to diarrhoea; 
and during sleep constant muttering. Diagnosed, 
typhoid fever eight days' standing. 
" Commenced treatment by sponging body (which 
was dry and hot) with warm whiskey, afterwards 
applied anodyne liniment to the spine and abdo- 
men ; tablespoonful of comp, syrup valerian every 
two hours; warm poultice to bowels, etc. ; and 
without giving you the treatment for each day, 
which was nearly the same, suffice it to say, in six 
days he was convalescent. From imprudence, on 
the eighth day after convalescence, (having re- 
sumed his business and exposed himself for several 
hours in a cool draught of wind,) he relapsed, and 
when called to see him, I found him in the follow- 
ing condition: Perfect prostration, constant mut- 
tering, almost impossible to arouse him sufficiently 
to give medicine, hemorrhage from bowels, subsultus 
tendinum, impossible to protrude the tongue, bow- 
els tympanitic, picking at imaginary objects, etc. 
But with the comp, syrup valerian and some 
auxiliaries, he was again convalescent on the ninth 
day, and has enjoyed uninterrupted health from 
that time to the present." 
Case 8. By W. J. Miller, M. D., Gas Factory, 
Tenn. 
''July 9th I was called to see James W., aged 17, 
sound constitution, had never had any serious sick- 
ness ; had been complaining, for a week previous to 
my visit, of soreness of the flesh; aching of his 234 
on fever: 
bones; chilly sensations, hot and cold flushes; 
when he would cover up, would become too hot, 
and when removed, he would soon feel chilly; 
tongue coated with white fur. His father had 
given him a dose of castor oil, which had acted 
freely; considerable fever; pulse 100. I prescribed 
six grains blue-mass, neutral mixture, and spong- 
ing the body. On the 10th I found all the symp- 
toms increased, drowsiness and headache added to 
the above symptoms. I thought I had now a case of 
typhoid fever, and commenced your plan of treat- 
ment at once. It is useless to describe the treat- 
ment, as it was just as you direct. On the 11th, 
not much alteration any way. The 12th, the pulse 
had come down 12 beats, with some modification 
of skin and tongue. 13th, considerably better. 
14th, so much better that I did not visit him any 
more. His fever had all gone, tongue about clean, 
headache gone, and soreness gone." 
Case 9. Dr. T. G. Underwood, of Orange, Ga., 
writes that during the fall of 1858 he had an op- 
portunity of treating many cases of typhoid fever, 
as that disease was epidemic in that region of coun- 
try. He gives the symptoms as follows : 
"Want of appetite; giddiness and sometimes 
nausea; countenance dejected, dull heavy sensation 
in the head, and a general feeling of weariness; 
general debility; no inclination to mental or cor- 
poreal action; tongue coated with a white fur. 
These are the premonitory symptoms : after which 
slight chills in the majority of cases, alternating TREATMENT OF TYPHOID. 
235 
with heat of the body; entire disgust for any kind 
of food; pulse quick and small; mind confused; 
dull, heavy pain in the head; general mental and 
physical depression; pain in the back and limbs. 
These symptoms would last for a short time; after 
which the febrile heat would increase; the face be- 
come flushed; the pulse rise in strength; the skin be- 
come dry and the lips parched; great thirst for cool 
drinks ; tongue coated now with a brown fur; pain 
in the head, back, and limbs; increased tension 
and tenderness in the hypochondria; the brain 
more disturbed; hearing obtuse, and more or less 
delirium. Other symptoms were occasionally present. 
"All such cases treated by other physicians, not 
in possession of your plan, ran the usual course. I 
treated mine upon the plan laid down in your book, 
and the average time of treatment before convales- 
cence was from six to ten days; owing, though, a 
good deal, to what stage of the disease I was called 
in ; if in the first stage six days, and if not, ten days. 
" There was but one death, and that patient re- 
lapsed from eating pork and turnips after she was 
able to walk about the room." 
The following letter, though not from a physician, 
contains so much good sense that I am induced to 
give it entire. 
Sunflower Landing, Coahoma County, Miss., 
Marcli 12, 1859. 
R. Thompson, M. D.: 
Dear Sir:-Not being a physician, but only a 
planter, it did not seem important that I should 236 
on fever: 
give . my experience with your mode of treating 
fever; but courtesy to you, and also a wish to add 
my testimony as to its value, induce me to address 
you. 
I have used your plan constantly since the early 
part of 1857, and in no case without beneficial re- 
sults. Besides its use in pneumonia and typhoid 
fever as prescribed in your book, I have used your 
■fever syrup advantageously as a general stimulant 
for feeble persons; and in this our damp and mias- 
matic climate, I am satisfied it is very valuable in 
such cases, affording a resisting power to the con- 
stitution. In a few instances (that of my wife 
amongst others) the recurrence of chills has been 
prevented by it. But I generally first break the 
chill with quinine, and then give the syrup to insure 
convalescence. 
In our climate the constitution seems to have 
very little reacting power, even after disease has 
entirely disappeared; in other words, we get well 
slowly; and this depressing tendency of the atmo- 
sphere to keep us down when once it gets us down, 
is to be overcome by stimulation. No other stimu- 
lant appears to be equal to the fever syrup for this 
purpose. The syrup has been used on the planta- 
tion of my sister-in-law, also in this vicinity, by the 
overseer, whether intelligently or not I am not able 
to say ; still, neither there nor on my own place has 
death ensued in a single case in which it has been 
used; in other words, we have not lost a single case 
of pneumonia or typhoid fever since I became ac- T R E A T M E N T OF TYPHOID. 
237 
quainted with your plan of treatment, and we have 
had to contend with some severe ones. It is pro- 
per to say that I have also used quinine, ipecac, 
Dover's powder, and blue-mass, very moderately in 
the earlier stages, and also blistered; but have in- 
variably employed your syrup in a manner fully up 
to your directions, relying chiefly upon it. 
One of my neighbors thinks I saved the life of a 
valuable negro of his, a month or two since, by 
sending him a bottle of the syrup with directions. 
I ought to add that I have given it in cases of 
ordinary bilious fever, remittent and intermittent, 
but could not see any marked advantage until after 
the disease had been broken up by other usual 
remedies; then, as a stimulant to aid convalescence, 
it is of much value. 
Very respectfully yours, 
II. C. Chambers. 
D. C. A. Moses, M. D., of Eldridge, Ala., makes 
the following suggestions: 
" I have not confined myself strictly to your plan, 
but have slightly altered it to suit the peculiarities 
of different cases, and have also called in auxiliaries. 
For instance, when there has been great arterial 
excitement, with a tendency to cerebral derange- 
ment, I have used as auxiliaries the saline bath and 
the veratrum viride, and have also substituted the 
oil of valerian for the alcoholic tincture. Again, 
when there has been great depression of the vital 
forces, with a tendency to coagulation or stagnation 238 
on FE VEK: 
of the fluids, I have substituted the ammoniated 
tincture of valerian, because of the known power of 
ammonia to hold in solution the protein compounds 
of the blood," etc. 
Now I think well of the above suggestions, ex- 
cept the giving of veratrum viride, which I know to 
be a potent nervous depressor, and therefore in the 
end is likely to do harm. A distinguished physi- 
cian has said that veratrum viride will control in- 
flammatory action in pneumonia, but that the 
patient would not get well. I would much rather 
lessen arterial action by giving sub-nauseating doses 
of emetic tartar. 
J. D. Steel, M. D., of Charleston, Miss., informs 
me that he has treated about seventy cases of 
typhoid fever upon the plan laid down in this work, 
without a death, and that convalescence was set up 
in from three to five days. Many other physicians 
have furnished evidence that typhoid fever can be 
aborted by my plan of treatment; only one states 
that he has failed, and I am forced to the conclusion 
that the materials he used could not have been 
genuine. 
It is well known that there are two kinds of sassa- 
fras, the red and the white; now the oil obtained 
from the white is nearly inert, it has little pungency, 
and will not destroy insects. It may be known 
from the red by having a whiter color. 
One physician inquires of me if the syrup is con- 
tra-indicated in gastritis connected with fever. I 
have already said that it is, but in mere excitement T HEAT M E N T OF I Y I' II 0 1 D . 
239 
of the stomach it may be freely given, as it serves 
to allay it; and much experience by myself and 
others has proven that it may be given not only 
with impunity, but with signal advantage when 
there is inflammation either in the small or large 
intestines. In inflammation of the stomach it 
makes too strong an impression, and must be sus- 
pended. For such cases, besides poultices and 
fomentations, I give the following: 
Emulsion of Gum Arabic, giv. 
Sul. morphia, gr. iv. 
Spt. turpentine, gj. 
Comp. spt. lavender, gij. 
Mix. 
Give a teaspoonful every two hours. A free 
application of the chloroform liniment should also 
be made to the spine and epigastrium. 
A number of practitioners have complained of the 
great pungency of the syrup, which renders it diffi- 
cult to take. This must be owing to some fault in 
its preparation. No medicine is taken with less 
trouble by my patients; in fact, it is often spoken 
of as being peculiarly grateful, and if the directions 
already given (of rubbing the sassafras, piperin, 
and sup. carb, of soda first in a mortar, and then 
adding the syr. of rhubarb, again rubbing it, and 
lastly adding the tine, val.) are observed, it will 
never be unpleasantly pungent. Druggists will not 
attend to these particulars unless especially charged 
upon the subject; but if the syrup is still too pun- 
gent, order it taken in sweet milk or emulsion of 
slippery elm or gum arabic. 240 
on fever: 
This disease presents a wide diversity of grades 
and symptoms, as it is seen in different latitudes, or 
in different individuals in the same region. 
The leading symptoms as clearly indicate pri- 
mary disturbance in the cerebro-spinal centres, as 
those of typhoid fever do a morbid condition of 
the ganglionic system. But as the latter system 
must become considerably disturbed before capil- 
lary inaction can be produced, which, we have seen, 
is an essential part of every case of fever; and as 
we see the secretions all more or less depraved, 
which also are under the control of the ganglionic 
nerves ; we need not be surprised that in many 
cases it is difficult to decide, especially in the early 
stages, whether a case be typhoid or bilious. In 
elevated countries and in vigorous constitutions, 
if this disease occurs at all, it is usually character- 
ized by a high grade of action, simulating inflam- 
matory fever; whereas, in the far South, and in the 
West, in recently reclaimed alluvial districts, vital 
energy is often so completely exhausted by a con- 
tinued action of the cause of this disease, that very 
slight reaction follows the stage of depression, and 
in some instances there is no reaction at all, but the 
patient dies in the first stage. In other cases the 
reaction is considerable, but is followed by very 
slight remissions, merely a lessening of the most 
urgent symptoms in the morning, as in continued 
fever; then, again, we see well-marked remissions, 
BILIOUS OR MIASMATIC FEVER. BILIOUS OK MIASMATIC FEVER. 
241 
and in others complete intermissions, so perfect, 
that one unused to the disease would never expect 
a recurrence. 
Now it has been a matter of inquiry for many 
thousand years, what is the nature of the morbific 
agent which produces this disease, and what are 
the circumstances necessary for its elaboration. 
At one time the medical mind had decided that it 
originates in the decomposition of vegetable matter, 
but this idea is now generally abandoned; and it 
has been equally authoritatively decided, that the 
only circumstance necessary for its production is 
high temperature, acting upon a soil which has been 
saturated with moisture. But however produced, 
or whether organized or unorganized, it is cer- 
tainly a narcotic poison ; the symptoms which pre- 
cede an attack indicate this; as giddiness of the 
head, erratic pains, muscular weakness, pallor, and a 
dirty hue of the surface--just what we often see fol- 
lowing an intemperate use of tobacco, opium, and 
other narcotics-and in very grave attacks, pro- 
duced by sudden exposure to the poison in a highly 
concentrated form, the symptoms are precisely 
those of intense narcotism, occasionally causing 
death without even the nervous reaction constitut- 
ing a chill. 
Now this inquiry into the nature of the poison 
producing bilious fever is not merely interesting, 
but is of the first importance to a correct under- 
standing of my plan of curing it. For a long time 
the cinchona and its preparations have been chiefly 242 
on fever: 
relied on in the treatment of intermittent fever, 
but all agree that, notwithstanding the disease is 
very uniformly arrested by the use of quinine, yet 
it is proverbially prone to return, often making it 
necessary to cure it many times before it will finally 
stay away. Now this is accounted for by the fact that 
quinine cures intermittents by acting as a nervous 
stimulant, producing a state of nervous power in- 
compatible with that attending a chill; but the 
effect soon subsiding, it is not wonderful, therefore, 
that the disease returns. Now the oil of sassafras 
evidently neutralizes this narcotic poison; and 
hence, when it is combined with quinine, the dis- 
ease very rarely returns; but more of this pres- 
ently. 
I will now take up a case of bilious fever, and 
run it through its course, in order to illustrate my 
mode of management. 
Suppose, for example, I am called to see a case 
presenting all the common symptoms of the form- 
ing stage of fever, and almost a counterpart of the 
one which we have considered, which turned out to 
be typhoid fever, but still I am not warranted in 
deciding that this will prove to be one; perhaps 
there have been other attacks lately in the family, 
or the immediate vicinity, which have shown them- 
selves in their progress to be malarious, and I 
reasonably presume that this is of the same kind. 
But if I have determined to abort it, any specula- 
tions as to whether it is typhoid or miasmatic are 
uncalled for, as that point will never be ascertained; BILIOUS 0 R M IAS M ATI C E E VER. 
243 
for putting the patient under the same treatment pro- 
posed in the forming stage of typhoid fever, will so 
effectually break up the diseased action, that no 
trace will be left which would indicate what way 
the disease would have run. 
But suppose I try a dose of calomel, given in 
the evening, and visit the patient next morning, and 
find him much improved-the headache gone, the 
skin naturally moist, consistent bilious discharges, 
etc., etc.-I settle the case in my mind at once, 
that I had treated bilious fever in its forming stage. 
But have I aborted it ? Perhaps not, the favorable 
appearances notwithstanding; and if I do not 
guard against it, by the time I have made my 
round of calls and returned to my office, I will pro- 
bably find a pressing message to repair in haste to 
see my patient, as he is much worse. Well, I 
judge at once that he has had a chill; and so I find 
on my arrival. He is now. in the stage of reaction, 
and his headache violent; heat of the surface pun- 
gent; thirst great; stomach irritable; pulse full 
and throbbing, etc., etc. Now what are the indica- 
tions? Clearly to quiet the nervous excitement, 
and open the capillaries so as to admit the blood to 
flow on freely from the arteries, and thereby relieve 
the excitement of the heart; and I will do this by 
giving a large dose at once-two or three table- 
spoonfuls of comp, syrup valerian in a glass of cold 
water-and at the same time bathe the head, neck, 
breast, and arras with cold water; in less than half 
an hour T will have my patient quite comfortable. 244 
ON e e v e k: 
I then leave him the following prescription: Sul. 
quinine, piperin, blue-mass, each 10 gr.; oil sassa- 
fras, 5 drops; make 10 pills; give one every two 
hours until they are all taken ; then give a table- 
spoonful of the syrup, at the same interval, in half 
a glass of cold, water, and direct some additional 
purgative to be taken after the time of the chill has 
passed, provided the bowels are not pretty freely 
moved without. I usually prefer Epsom salts. 
But I very often, yes, generally, leave out the mer- 
curial entirely, and treat the case with the syrup 
alone, except a single five grain dose of quinine 
given soon after the hot stage begins to abate. The 
liver will commonly act very well without any 
assistance, except the general capillary excitement 
produced by the syrup; another formula often de- 
pended on is comp, syrup valerian, §ij ; sul. qui- 
nine, 10 gr. : a dessert-spoonful every 3 hours. If 
the chill should be prolonged, and the reaction im- 
perfect, showing that the fever is of the type known 
as congestive, I still give nothing but the syrup, 
but increase the dose largely; have given two or 
three ounces at a time, and repeated it in an hour. 
This, with external warmth, and frictions with 
some stimulating liniment, will generally soon 
bring about a fine reaction. I then treat it as a 
common case of chills, except that I think it safer 
to increase the quantity of quinine. To those who 
have been in the habit of resorting to active deple- 
tion and free evacuations, in order to subdue the 
over-action in high grades of bilious fever, the idea BILIOUS OR MIASMATIC FEVER. 
245 
of bringing down the excitement by the use of 
piperin, oil of sassafras, etc., will appear quite un- 
philosophical. But if they will recollect that the 
condition of the system in the lowest grades is pre- 
cisely the same which exists in the highest, and 
when they recollect what that condition is, they will 
cease to be astonished that the same capillary stim- 
ulant will meet both cases. 
I have had many of the high grades of bilious 
fever under my management within the last few 
years, which I formerly thought called for the use 
of the lancet, tartar emetic,. etc., but which have 
yielded kindly to my present mode of practice, and 
left the strength of the patient but very little im- 
paired, so that convalescence was rapid. But still, 
if I were called to a case in which active inflamma- 
tion had been set up in some vital organ, I should 
certainly bleed; but my experience leads me to be- 
lieve that in cases treated upon my present plan, no 
inflammatory complications will probably ever arise; 
they have not in my practice. 
Now, if there be no distinct remission, I make 
one by sponging the body with cold or tepid water, 
or applying the wet-sheet or the half-pack of the 
hydropathists, that is, a large wet towel laid upon 
the stomach and bowels, and removed as occasion 
requires. At the same time I order the following: 
R- Comp. Syr. Vai., gij 
Dov. Powder, gr. x. 
Mix. 
Dose-a dessert-spoonful every two hours. 246 
on fever: 
I will further illustrate the treatment of bilious 
fever, by giving observations extracted from letters re- 
ceived from intelligent physicians in different States. 
J. W. Steel, of Charleston, Miss., says: " The 
year 1858 will be remembered as the most sickly 
j ear within the recollection of the oldest inhabit- 
ant in this country. I prescribed for fully seven 
hundred cases of bilious fever, and as I made your 
book my guide, I lost no case, and had no protracted 
case. I very seldom prescribed any thing but the 
syrup, as it generally fulfilled every indication." 
Dr. Steel says nothing about adding quinine to 
the syrup. 
Dr. D. C. A. Moses, Eldridge, Ala., says, "Thepre- 
vailing fever with us is remittent, of a low adyna- 
mic type. I have attended within the last year some 
three or four hundred cases, and have never failed to 
arrest or abort it in from twelve to thirty-six hours. 
I follow your book with hardly any deviations." 
Dr. Moses is silent on the use of quinine as an 
adjunct. 
Case by A. D. Cutter, M.D., of Dresden, Tenn.: 
"I was called to a gentleman taken with a chill 
which had lasted twenty-four hours before I saw 
him-had a congestive chill, I would say. Gave him 
calomel in twenty-grain doses, until four doses were 
given, which procured several copious green evacu- 
ations the next day. At my first visit I had none 
of the syrup with me. At my second visit, as the 
calomel had acted freely without apparent benefit, I 
resolved to try the syrup. lie was still restless, with TREATMENT OF PNEUMONIA. 
247 
pains in the head and abdomen, sick stomach, tongue 
white, pulse one hundred and forty. Gave nothing 
but syrup, one tablespoonful every two hours in 
half a tumbler of cold water. Four ounces com- 
pleted the cure in five days. It acted like a charm." 
PNEUMONIA. 
If in addition to all the common symptoms char- 
acterizing the first stage of fever, there is added un- 
usual shortness of breathing, a hacking cough, with 
more or less expectoration of a tenacious mucus, if 
there is some pain in the chest, and the countenance 
looks flushed and mottled, I suspect at once that I 
have a case of pneumonia, and immediately examine 
for the physical signs, and if these are present, I then 
know that I have this troublesome disease to con- 
tend with. My observations have convinced me 
that pneumonia is nothing more than inflammation 
of the lungs, added to an ordinary attack of fever, 
and that this fever may be typhoid, miasmatic, or 
common inflammatory, from the influence of cold, 
etc. This being the case, the general treatment will 
be precisely the same as in a like case of fever un- 
complicated, with the addition of such means as 
will most directly reach the local difficulty in the 
lungs. The most efficient of these, both for sub- 
duing inflammatory action in the lungs, and for re- 
lieving engorgement by setting up free expectora- 
tion, is large flannel cloths wrung out of very warm 
water, and made to envelop the chest, and renewed 
every few minutes. But as example is more striking 248 
on fever: 
than precept, I will present the reader with the his- 
tory of the treatment of a very violent case of this 
disease, which I managed during the winter of 1854. 
The patient was a Mr. T. of this city, a young man 
of intemperate habits, and who had been, for some 
weeks previous to the attack, most of the time in- 
toxicated. This being the case, his friends looked 
upon his attack as nothing more than a cold, and 
neglected to apply for medical aid until the disease 
had progressed a number of days. When I saw him, 
the powers of life were very nearly overwhelmed. 
His breathing was exceedingly hurried, attended 
with an incessant hacking cough, and no expectora- 
tion whatever; his pulse was frequent, (about one 
hundred and fifty,) but had very little force or vol- 
ume ; no respiratory sounds whatever could be heard 
over the lower half of the chest; his eyes were deeply 
injected, and his face flushed, with livid blotches; 
the under side of his face, and even of his arms and 
body, presenting the appearance usually seen some 
hours after death, occasioned by the blood settling 
in the capillaries of the dependent parts ; his extre- 
mities were cold and shrunken, and altogether he 
presented a state of the system in which there can 
be but little hope of a successful reaction. But I 
resolved on making an effort, and accordingly or- 
dered hot water prepared, and a number of bricks 
to be warmed. For, although I did not presume 
that the prolongation of the life of the patient would 
pay for the smallest outlay of skill, yet, as a test of 
the powers of the mode of treatment, it might be of TREATMENT 01' PNEUMONIA. 
249 
immense value. I accordingly devoted as much 
time to seeing that the plan of treatment was duly 
carried out as was compatible with other duties, and 
thus saw that the directions were fully obeyed, 
viz., that the whole chest should be enveloped with 
the cloths wrung out of warm water, and repeated 
every ten or fifteen minutes; that the extremities 
be kept warmed by the imparted heat of hot bricks, 
etc., etc. I gave him a tablespoonful of the syrup 
every hour, in half a glass of water, and allowed 
him no other drink. After the lapse of twelve hours 
I discovered the following changes : his cough was 
not so incessant, but when he did cough, it was at- 
tended with a free expectoration of exceedingly of- 
fensive matter, such as evidently had been accumu- 
lating in his lungs for days; his pulse was less fre- 
quent, and his skin and tongue showed a little 
capillary action. On listening for sounds in the 
chest, I now discovered a distinct tubular sound. The 
same treatment was continued for another twelve 
hours, when I thought best to discontinue the use 
of the hot cloths, and cover the whole chest with a 
fly-blister. At this time, in addition to the tubular 
sound, I discovered some crepitus, and a little after- 
wards the real mucous rale, showing that the air was 
having access into not only the smaller bronchial 
tubes, but also their minute ramifications; twelve 
hours later, the blister had drawn well, and as a re- 
sult of this, and the general stimulant effect of the 
syrup, the breathing was much easier, the expecto- 
ration freer, causing little effort, the pulse had sunk 250 
ON FEVER: 
to one hundred, the countenance looked more in- 
telligent and lifelike, the skin had lost its mottled 
hue, and the lungs produced a sensible respiratory 
murmur over a part of their surface; the tongue was 
yet red and pointed, and trembled as it usually does 
in the second week of typhoid fever, the strength was 
exceedingly little, and mental effort almost nothing, 
the patient seeming, though rational, to have the 
mind of an infant. The blister, as the sensibility 
was very low, caused no suffering of consequence, 
but produced a most happy influence upon the 
irritability of the capillaries, causing those of the 
lungs to act more vigorously by direct association, 
and those of the general system to feel the impres- 
sion through the nervous centres ; the result was, 
that there was a general amendment. 
The blister, however, soon seemed to lose its ef- 
fect, and the hot cloths were obliged to be again 
resumed, to keep up that amount of action in the 
pulmonary capillaries which is indispensable to the 
performance of the function of the lungs sufficiently 
to continue life at all. But by persevering in the 
use of these means as occasion required, and a re- 
gular use of the syrup, the system was kept in that 
condition which enabled the recuperative powers to 
act with such efficiency that eventually a healthy 
action was established, and the patient slowly re- 
covered. No medicine was given internally during 
the entire term of treatment but the syrup; being 
resolved, as the patient's life was probably of no 
other advantage, to make it of value in establishing TREATMENT OF PNEUMONIA. 
251 
the fact that this medicine, with the aid of external 
means, was capable of meeting the very lowest con- 
dition of vital action compatible with life. Mr. T. 
has regained his usual health, and has been able to 
stand the effects of many drunken sprees since 
then. 
By relying so exclusively on the syrup in the 
above case, I did not suppose I was at all jeopardiz- 
ing the patient's life for the sake of experimenting, 
for I had treated many cases of pneumonia pre- 
viously upon the same plan, with entire and 
prompt success, but have not always confined my- 
self to that alone. In cases in which there is a good 
deal of spasm in the lungs, and in such as manifest 
much active inflammation, I give emetic tartar in 
sub-nauseating doses, until these symptoms are 
abated. I have not resorted to the lancet, even in 
pleuro-pneumonia, for several years, except in one 
single instance, and then I thought my patient was 
damaged by it. Since the above case I have man- 
aged many others upon the same plan, with uniform 
and prompt success, having had no cases of tedious 
convalescence, and having none to die except one, 
which I will now advert to, for I think best to state 
the whole truth. 
I very lately was called to treat four cases of 
typhoid pneumonia, all attacked near the same 
time. Three yielded kindly to treatment, being en- 
tirely relieved in a few days. The fourth also 
promised well for the first two days of treatment, 
but on the third assumed a more intractable form. 252 
on fever: 
This was the occasion: it was Christinas clay, and 
many of the bucks had become over-jolly; one had 
fancied himself insulted by another, and drawing a 
pistol threatened to shoot; the other made his 
escape, and the infuriated inebriate, in search of 
him, burst into the room in which my patient lay, 
(a timid girl,) exhibiting the rage of a demon, and 
so affrighted her that on my return I found her in 
a high state of nervous disturbance, which con- 
tinued to increase in spite of all my efforts, until it 
presented many of the characteristics of true tetanus. 
I had Professor Bowling called in consultation, but 
no efforts were availing, and she died on the 
seventh day of treatment. 
If any other apology were necessary for the loss 
of this patient, it might be found in this: she was 
of a highly nervous temperament, the disease was 
excited by exposure to wet and cold during the 
catamenial flow, causing suppression; she had been 
treated by her mother as for a cold, with stews, etc., 
for eight days before I was consulted; complete hepi- 
tization had at that time been produced in more 
than half of the left lung; still I believe I would 
have saved her but for the scare. 
J. E. Fulton, M. D., Big Oak, Miss., says: 
"During this winter (1858) I have had seven or 
eight cases of typhoid pneumonia, in the treatment 
of which I have confined myself entirely to your 
practice. No deaths; the recovery from eight to 
twelve days; and upon the whole my experience 
goes to warrant me in the conclusion that if your TREATMENT OF YELLOW FEVER. 
253 
plan is assiduously followed out in typhoid cases, 
the result will be universal success." 
J. W. Steele, M. D., Charleston, Miss., writes: 
"We have had a great deal of pneumonia this 
winter, (1858.) Most of the cases that I have had I 
believe would have been typhoid had I not aborted 
them. I have had but one case to last over five 
days, and that was an old man near seventy years 
old ; he was down about two weeks. I seldom ever 
give any thing except the syrup and nauseants. 
The syrup meets every indication. Other doctors 
lose about one-third of their patients." 
W. Kirk, M. D., Buckhorn, Miss., writes: 
" Typhoid pneumonia has been prevalent here 
this winter, (1858,) and I have succeeded in curing 
every case so far. I have always used your syrup 
when the cases have been ushered in with a chilly 
sensation, and I know of nothing equal to it in pro- 
ducing a reaction." 
YELLOW FEVER. 
Never having seen this disease, it may be con- 
sidered rather presumptuous to attempt to form any 
judgment concerning it differing from that of those 
who have studied it at the bedside. But during the 
excitement of an epidemic, physicians are usually not 
in the best frame of mind to philosophize upon the 
facts presented by the suffering and the dying. It 
is only after the battle is over that a cool survey 
can be made of the battle-field, and just estimates 
formed of the positions which the foe assumed, and 254 
on fever: 
the relative advantages of different means which 
may have been taken for repelling or circumventing 
him ; and one who took no part in the contest, and, 
consequently, has not his own actions to justify, 
will be more likely to perceive where an error had 
been committed or an advantage neglected, than those 
who were identified with the conflict. I have care- 
fully studied the history of this dreadful disease as 
given by those who have contended with it, and 
impartially compared the various modes of treating 
it which have been adopted by those who have been 
most successful, so as to be able to determine, if 
possible, upon what the success of each depended, 
and wherein all fall short of meeting the require- 
ments in the case, and will now give the reader the 
result of my reflections. 
The best description I have seen of this disease, 
and the most rational mode of treatment, attended 
with the largest success, I find in the Proceedings 
of the National Medical Association for 1854, by 
Dr. Fenner, of New Orleans. 
Dr. Fenner agrees with most other writers who 
have closely observed the commencement and spread 
of the disease, that it has a local origin, and spreads 
from the point of commencement, not by being car- 
ried by persons, but by an extension of the infected 
atmosphere; and that, when once originated, no- 
thing but a reduction of temperature will arrest its 
progress. Dr. Caldwell, upon this subject, says: 
" The fact, as here stated, is true, and the problem 
it presents is difficult of solution : when an epidemic T K E A T M B N T OF YELLOW FEVER. 
255 
yellow fever has begun its career in one of our 
large commercial cities, nothing but a termination 
of warm weather can arrest it. Local nuisances 
may be removed, the inhabitants of the city may 
fly, man may erect all his artificial barriers, currents 
of water may be macle to flow along the gutters, 
rains may fall and wash the entire streets, and the 
winds may blow and change the atmosphere of the* 
place, but all to no purpose. If the temperature of 
the atmosphere continues high, the epidemic mocks 
at resistance, until it expires under a regular change 
of season." Now, were this poison a gas, evolved 
by the decomposition of animal or vegetable matter, 
would not removing the filth stay its production? 
Would not rains wash it away, or winds disperse 
it? Bat as none of these things are so, then the 
poison is not a gas, but must be something which 
has in itself the power of increase, which can retain 
its position by its own powers in opposition to wind 
and currents of water, and which can direct its 
own course, so that when once it has obtained an 
existence, it multiplies independent of the original 
source, and travels "whithersoever it will," inde- 
pendent of currents of commerce or currents of air. 
It must then be an organized existence, having a 
will, or being directed by instinct, and increasir g 
by natural propagation. 
The cause of yellow fever therefore is, as I be- 
lieve, poisonous animalculte. The effect produced 
upon the system by this poison is much allied to that 
arising from the malaria which causes bilious fever. 256 
on fever: 
The symptoms of the first stage of yellow fever, 
as described by Dr. Fenner, are precisely such as 
we see in the same stage of high grades of bilious 
fever. The patient has felt chilly, with headache 
and pain in the back, etc. Went to bed, and cover- 
ing up warm, a high state of excitement was soon 
developed, viz.: violent pains in the head and 
back; skin burning; countenance flushed and 
swollen; eyes red; pulse frequent, full, and bound- 
ing ; thirst intense; stomach uneasy, sometimes 
nausea and vomiting; restlessness, etc. He says, 
it is evident the symptoms plainly indicate super- 
excitement of the whole system, and the principle to be 
acted on is, "to restore the equilibrium of the circulation 
and the excitement." Now there is some mistake 
here ; if there was really super-excitement of the 
whole system, there would be harmony of action, and 
there could be no necessity for efforts to restore the 
equilibrium. It is exactly because there is not a gene- 
ral over-excitement, that we are called on to interfere. 
There is great partial super-excitement, but it is not 
general, or the patient would be no worse off than 
when taking vigorous exercise in obedience to 
some strong mental impulse. The history of the 
case up to this time is as follows: a morbid agent 
has entered the system, and has produced a power- 
ful impression upon the nervous system; so power- 
ful that it has been for the time overwhelmed, and 
the usual amount of nervous influence not sent out 
to keep up the various operations of life; hence t? e 
chilliness and inclination to go to bed, etc. But TREATMENT OF YELLOW FEVER. 
257 
presently the nervous system reacts, and a power- 
ful impulse is sent to every part. The heart and 
arteries act with unusual power, and the blood, 
which had been accumulating in the large veins, is 
sent with force throughout the system; and did it 
not meet with resistance, if there were no obstruction 
anywhere, an equilibrium would unquestionably 
soon be established. But there is an obstruction; 
the capillaries have been debilitated by the same 
cause which irritated the nerves, and they refuse to 
pass the blood on with the rapidity which would be 
in harmony with the action of the heart and arte- 
ries. Hence a distension of the capillaries takes 
place, giving rise to the suspension of the secre- 
tions, swelling and flushing of the countenance, 
redness of the eyes, restlessness, etc. Now what 
does this view of the condition of the patient indi- 
cate should be done? The doctor says, truly, that 
"the overheated skin must be cooled, the accele- 
rated pulse must be retarded, the distressing pains, 
thirst, and restlessness, must be relieved. These 
desirable results may doubtless be effected by differ- 
ent means, but that is the best method which ac- 
complishes the object most promptly, effectually, 
and safely." All those indications I believe would be 
met by my fever syrup, promptly, effectually, and safely. 
By soothing the excited nerves, and restoring the ac- 
tion of the capillaries, the whole of the phenomena 
would cease at once. Why this should be so is 
plain enough: the obstruction in the capillaries to 
the onward flow of the blood is unquestionably the 258 
o n fever: 
cause of the protracted increased action of the 
heart; the dilatation of the capillaries also causes 
the pain and restlessness, by compressing the fine 
nervous expansion in their coats, and in the inter- 
stices between these minute vessels ; the heat is also 
occasioned by this congestion, so that restoring the 
action of the capillaries will necessarily remove all 
febrile phenomena. But in this, as in other forms 
of fever, if the case were obstinate, I should call to 
my aid every other appliance which could be made 
to operate in unison with the principal remedy. 
The nervous excitement could be greatly controlled 
by stimulating anodyne liniments ; the heat of the 
surface by sponging with cold or tepid water. But 
I should never think of bleeding, unless there were 
actual inflammation. Mere over-action and super- 
excitement can always be subdued by the means I 
have stated, without lessening the fountain of life 
upon which we must depend for the final restora- 
tion of health; and if the cause be a poison still 
floating in the blood, and by its continual action 
keeping up the disturbance, taking away a part of 
that fluid will not lessen the proportion that will 
be left in what remains, or materially reduce the 
whole quantity, unless it should be carried to the 
extent of the case named by Dr. Fenner, when 
near a hundred ounces had been abstracted, (one gal- 
lon ;) in this case the poison must have been pretty 
well eliminated from the system, as the man could 
have had but a small quantity of blood left to con- 
tain it. But I should by no means have been sur- TREATMENT OF YELLOW FEVER. 
259 
prised, as was Dr. Fenner, by his dying of hemor- 
rhage in the form of black vomit. Sneh a loss of 
blood and vitality ought to produce a state of re- 
laxation in the capillaries, which would allow the 
blood to pass unchecked through all the mucous 
membranes. 
I would suggest to any one disposed to test this 
mode of treatment, that, in consideration of the 
great irritability of the stomach, which is often 
present, it would be well to first apply a cloth satu- 
rated with chloroform liniment to the epigastrium, 
and as soon as it begins to burn considerably, give 
the syrup in a decided dose-say two ounces. If 
this be rejected, repeat it immediately, even to the 
third time; but when a dose has been retained, 
give no more for tw7o hours, withholding all drinks; 
by this time the medicine will have produced its 
peculiar effects, and drinks may be allowed as de- 
sired. 
Believing, as I do, that the cause of yellow fever, 
though not the same, is allied in its nature to that 
which produces bilious fever, and that the condi- 
tion of the system in both is much the same, I 
would expect to arrest it by much the same means. 
The course of treatment which has been suggested 
to my mind by the symptoms, as described by accu- 
rate observers, is as follows: 
I should bathe the spine and epigastrium with 
chloroform liniment, or laudanum, camphor, and tur- 
pentine ; give the comp, syrup of valerian in such •260 
on fever: 
quantity as the condition of the system would indi- 
cate; if vital action seemed to be very low, I should 
give it as in congestive fever, two or three ounces 
at a time; I would, at the same time, give quinine 
and blue-mass in the form of pills; apply an emol- 
lient poultice to the abdomen, sinapisms to the 
feet, and cold applications to the head. 
Under the influence of this treatment, I should 
expect all my patients to recover very rapidly, un- 
less the constitution had been previously much 
injured by other causes, or this disease had been 
suffered to run until serious lesions had been pro- 
duced in vital organs. I hope some one may be 
influenced to give this plan of treatment a trial, 
should this dreaded disease again visit our land. 
DYSENTERY. 
As Dysentery, as well as Cholera Infantum, are 
only serious diseases when attended with fever, I 
have thought best to include them as sections under 
this chapter. 
Many persons have expressed a wish that I should 
reproduce an article on Dysentery published in the 
March number of the Nashville Journal of Medi- 
cine and Surgery, 1853. As that article contains 
much important truth, and has a freshness of 
thought and accuracy of description, the result of 
a strong impression which the disease had then 
recently made upon the author's mind, he has con- 
cluded to copy it entire : DYSENTERY. 
261 
Prof. Bowling :-In the 2d volume (p. 188) of your 
Journal, you published a note from me upon the use 
of peach leaf in dysentery. Since then I have had 
a pretty large experience in that disease, and as I 
found it necessary to vary my treatment somewhat, 
I will now, with your permission, offer a few addi- 
tional remarks upon it. 
In July last the flux made its appearance on the 
southern border of my practice; and although it 
was confined to a few families, yet for a while it 
gave me a good deal of trouble. It did not yield 
readily to the influence of my favorite remedy; a 
main reason was, that there was great gastric dis- 
tress, with frequent vomiting or inclination to 
vomit, so that the tea could not be retained long 
enough to be of any benefit. 
The tongue ■was usually thickly coated in the 
middle with white fur, and red at the edges; pulse 
small and corded ; surface covered with a disagreea- 
ble perspiration, sometimes profuse and general, 
sometimes partial and alternating with a dry, hot 
surface; extremities generally rather cool, often 
quite cold; almost all complained of a burning 
sensation in the region of the sternum, commonly 
about its middle; the discharges from the bowels 
■were generally small, and composed of blood and 
mucus, and attended with tenesmus; the -worst 
case, however, had no tenesmus, and the discharges 
were more copious, and consisted of a reddish jelly. 
Finding I had a more formidable enemy to contend 
with than I had usually encountered, I had to draw 262 
ON FEV E 11 I 
upon other resources to enable me to overcome it. 
In order to make the peach leaf available, it was 
necessary to devise a form which would be retained 
by the stomach. I accordingly prepared it as fol- 
lows, after reducing the tea to a fluid extract: 1 
added a sufficient amount of sugar to make a syrup; 
to this I added sup. carb, soda, until it became 
slightly alkaline, and piperine enough to give it a 
pleasant pungent taste. I also added some of the 
oil of sassafras, for the purpose of preventing 
gangrene of the bowels, which I believed to be 
imminently threatened. 
I have long used the sassafras as an antiseptic, 
and believe it superior to any other known. I 
learned this property of the sassafras more than 
twenty years ago, while living in McConnelsville, 
on the Muskingum river, in Ohio, there being 
many salt works in the vicinity, which gave em- 
ployment to several hundred hands, many of whom 
were dissipated and reckless: shocking bad scalds 
were of frequent occurrence, by having an arm or 
a leg immersed in the boiling brine; dangerous 
sloughing was often the consequence. 
In the management of these cases, I found 
the sassafras poultice more effectual in arresting 
gangrene and restoring vitality to the parts than 
any other means, and have used it ever since in all 
cases of gangrene coming under my treatment, 
with the most happy effect. I also used it, and 
found it a valuable means of fulfilling several other 
indications, one of which is to prevent narcotic DYSENTERY. 
263 
stimulants from producing injurious effects upon 
the brain. It is invaluable for this purpose; its 
greatest power is exerted over hyoscyamus and 
tobacco. 
I found the above compound to answer my pur- 
pose finely. It was not only well retained, but 
quieted the irritation, both of the stomach and 
bowels; brought about a more uniform tempera- 
ture; dried up the cold sweat when present; in short, 
answered every purpose for which it was com- 
pounded. I kept the abdomen, most of the time, 
enveloped in a peach leaf poultice, and gave injec- 
tions of the tea, thickened with flour, to which I 
added pulverized opium in preference to laudanum: 
I found it less stimulating and more astringent. 
I have long been in the habit of exposing a piece 
of opium to the air to dry, on purpose to be used 
in the bowe] complaints of children. It is much 
less offensive to the stomach than the moist article, 
and is less narcotic and more astringent. It of 
course must be given in greater quantity. This in- 
jection usually gave the patient three or four hours 
rest from the tearing discharges, much to his com- 
fort and advantage. 
I occasionally, however, met with a ease in 
which the irritability of the bowel was so great, 
and its involuntary contraction so strong, that me- 
chanical assistance had to be rendered to enable the 
patient to retain the injection. This was afforded 
by making firm pressure upon the hip. After 1he 
lapse of ten or fifteen minutes, the bowel usually 264 
on fever: 
ceased to make any expulsive effort, and the pres- 
sure was then withdrawn. I have also met with 
cases the very reverse of the above. There was no 
tenesmus, no pain attending the discharges, which 
were tolerably copious, and composed of red jelly, 
having no foetid smell, but a peculiar odor, some- 
thing like that arising from water in which fresh 
meat has been washed, and were voided almost in- 
voluntarily. 
On examination, I found the sphincter so relaxed 
as to bring several inches of the bowel within 
view, which presented the appearance of raw mace- 
rated beef. In these the surface was always more 
or less cold, and covered with a dewy perspiration ; 
great thirst and precordial uneasiness. I treated 
these cases by throwing up cold sugar of lead water 
into the bowel, and repeating it every few minutes, 
until I saw some contraction take place; then gave 
a small injection as above, and made it stay by 
pressure. I found it best to make my injections 
very small, not over half a gill. This quantity 
would be retained without difficulty, when a larger, 
owing to the stimulus of distention, could not be 
made to stay a moment. 
By the first of August the disease-had disap- 
peared in my practice, but still prevailed south and 
east. In the neighborhood of Lancaster, and east 
of the Caney Fork, extending into a part of Jack- 
son county, the disease was attended with unusual 
mortality. At the solicitation of a Mr. Owens of 
our neighborhood, I visited his son's family, east of 265 
the Caney Fork, and found all of them very sick, 
except himself. After prescribing for them and a 
few others in the same vicinity, I went to Lancas- 
ter to see my friend, Dr. Rose, who I learned was 
prostrated with this disease. 
Here I met with Dr. Sypert, who lived a few 
miles distant, both of whom strongly solicited me 
to remain, and try to stay the destruction of human 
life, which was then progressing at a fearful pace. 
More than a hundred deaths had been reported 
as taking place within an area of ten or fifteen 
miles square in a few weeks. 
As there was no sickness of any kind in my 
neighborhood, I consented to stay, and for about 
six weeks was unremittingly employed in visiting 
the sick, except while paying a few hasty visits to 
my family. 
Some perhaps may be ready to surmise that the 
disease had abated in malignity about the time I 
commenced treating it, but that was not so, as was 
shown by the fact that patients continued to die 
beyond the circle of my practice. Only a few days 
before I left the neighborhood, I was called some 
ten or twelve miles to visit a family, where I found 
one already a corpse, another dying, a third beyond 
the influence of medicine, and died in eight hours, 
and a fourth badly attacked, who recovered. This 
family had been attended by two intelligent physi- 
cians, who, as far as I could learn, had skilfully ad- 
ministered the usual remedies. Dr. Sypert adopted 
my method of treatment, and was equally success- 
12 
DYSENTERY. 266 
on fever: 
ful with myself. Dr. Rose, unfortunately, never 
regained his health sufficiently to resume the prac- 
tice, until the disease had subsided,. I hereby ac- 
knowledge the obligation I am under to both of 
these physicians, for their gentlemanly bearing 
toward me while practicing in their vicinity. It 
was greatly owing to their influence that I obtained 
access to so large a practice. 
While in the neighborhood of Lancaster, I pre- 
scribed for more than one hundred and fifty cases 
of dysentery, many of which were attacks of that 
disease in its worst forms, and yet but two of my 
patients died, both of which cases I think were 
rendered fatal by other causes. One was a negro 
boy belonging to Wm. Lancaster, about seven years 
old ; had had the whooping-cough very badly for ten 
or twelve days before taking the flux; found him 
also full of worms-more than twenty large ones 
were expelled, and their expulsion produced so 
much prostration that he was unable to cough effi- 
ciently, and died of engorgement of the lungs ; the 
flux seemed to have but little agency in his death. 
The other case is remarkable as showing the 
power of the imagination in determining the issue 
of a disease. The patient, Miss White, of perhaps 
thirty years of age, had suffered under a complica- 
tion of female diseases many years, among which 
dyspmenorrhoea was prominent. Iler mother had 
died a few days before I was called to the family; 
three others were simultaneously attacked. I men- 
tion these facts in order to show that causes ex- 267 
DYSENTERY. 
isted calculated to produce a high state of mental 
excitement. On the second night after the three 
had been taken sick, she dreamed that she also 
took the disease, and died on the sixth day. Before 
night she had the usual symptoms, and was so fully 
impressed with the belief that the disease would 
terminate according to her dream, that it was with 
difficulty I could induce her to submit to treatment; 
in fact, it was only in my presence that she did. I 
arrested the disease several times, but found her as 
bad as ever on the next visit. And, true to her be- 
lief, she died at the precise time she had dreamed. 
Before going further into an exposition of my 
method of treatment in dysentery, I think best to 
make a few observations on its cause and nature. 
Every physician to some extent conforms his treat- 
ment to his theory, and thus errors in theory beget 
errors in practice, which I believe has been the case 
to a most lamentable extent with respect to the 
disease under consideration. Before, however, un- 
dertaking to show what I believe to be its true 
cause and nature, I will try to remove some mis- 
chievous errors upon the subject, the most import- 
ant of which I consider the opinion that it is of 
miasmatic origin, and, of course, must be treated 
as a mere modification of bilious fever. Hence 
the free exhibition of calomel and quinine, which I 
am forced to believe have aided the flux in send- 
ing more persons prematurely to their final reckon- 
ing, than would at all comport with the honor of 
the profession to be fully known. 268 
on fever: 
For a few years past, this disease has been the 
source of a greater outlet of human life in the 
United States than perhaps any other; which, I 
think, ought not to have been tlie case, and con- 
sider it highly important that the medical profession 
should look into this matter, and see if there has 
not been a needless amount of mortality. That 
dysentery has not a common origin with bilious 
fevers, I infer from the following considerations : 
First. It does not necessarily originate under the 
same circumstances, or in the same localities. I 
am aware that I have come in conflict with a host 
of very high authorities, backed by an array of 
seeming facts, which I cannot now undertake to 
investigate, but will honestly and fairly state what 
I have seen and observed upon the subject, on 
which my own opinions have been founded, and 
leave it for others, more competent, to investigate 
the whole ground. 
If I can only be the instrument of eliciting a 
thorough review of the subject, I shall have accom- 
plished much. I reiterate the assertion, that flux 
does not necessarily originate under the same cir- 
cumstances or in the same localities with bilious 
fevers; that it often does, I admit; and that it is 
often complicated with them, I also admit; which 
I presume has been the foundation of the mistake 
with regard to their being of the same family. 
Large and densely populated cities are known to 
be almost exempt from miasmatic fevers. Can this 
be said with regard to dysentery? I think not. DYSENTERY. 
269 
In many localities, which are annually visited by 
miasmatic fevers, dysentery only appears occasion- 
ally, and in others not at all. Poor, elevated situa- 
tions, such as the barrens of Warren, White, and 
Jackson counties, where bilious fevers have hardly 
ever been seen, arc as subject to dysentery as the 
Mississippi bottom. During the two past years these 
counties have been severely scourged. 
Second. Dysentery has a different manner of 
spreading from miasmatic fevers. The latter attack 
individuals over the whole extent of a malarious 
district, pretty much simultaneously ; but dysentery 
usually commences at a point, and radiates more 
or less extensively-often stops within very narrow 
limits, often spreads in one or two directions, leav- 
ing intermediate neighborhoods, similarly circum- 
stanced with regard to the production of malaria, 
and equally subject to malarious diseases, entirely 
untouched. 
I had an unusually favorable opportunity of ob- 
serving the manner in which the disease extended 
itself in the Caney Fork country the present season. 
The ridge runs for many miles almost parallel with 
the river, at a distance of about eight or ten miles; 
hollows put out from the river, and run almost 
directly to the ridge, divided from each other by high 
sharp spurs, making off from the main ridges, thus 
forming very marked natural boundaries to each 
neighborhood. In order to be better understood in 
what I shall say upon this subject, I will name the 
several hollows as they are familiarly known in the 270 
on fever: 
vicinity. The lowest one on the river, which I 
shall mention in this connection, is Dillard Hollow; 
branching off from the same mouth, is Beller Hol- 
low ; about a mile above, is Smith's Hollow; and 
something like the same distance above this, is 
Fitch Hollow; two miles farther up, we find Kock 
Spring Branch; and three miles above that again, 
we find Wolf Creek, which is as high as my obser- 
vation extended. I -will premise here, that the flux 
commenced on the west side of the river, where the 
country is not so well defined by natural bounda- 
ries, and where its manner of spreading could not 
be so well designated; but it soon crossed the river 
at several points, and we will commence by noting 
its progress after crossing opposite the mouth of 
Dillard Hollow. It took up this branch, attacking 
a few families living in the very lowest situations, 
but as it ascended, it spread up into the side hol- 
lows, and visited nearly all the poor families that 
had made a lodgment between the hills. It thus 
continued to travel upward until it reached the 
main ridge, and immediately opposite the head of 
Dillard Hollow. From here a detachment took 
down the ridge westwardly, visiting several families, 
until it reached a break which makes down toward 
what is called Hell Bend, down which it travelled, 
and visited almost every family in the bend. An- 
other detachment took along the ridge eastward ly 
several miles, and sent off a force down a break, 
making into Snow Creek, along which I learned it 
travelled to its mouth; but the main body seemed DYSENTERY. 
271 
to keep along the ridge about a mile farther, where 
it turned down a break into Smith's Hollow, at- 
tacking nearly every family, and more than half 
the individuals living in it. Now, Beller Hollow 
lies between this and Dillard Hollow, and is an 
almost exact counterpart of them, and yet it re- 
mained entirely untouched throughout. About the 
time it crossed the river into Dillard Hollow, it also 
crossed over and took up Bock Spring Branch, 
passing by Fitch Hollow, in which there never 
occurred a single case, except two families living 
immediately on the river; but it travelled up Rock 
Spring Branch to its head, not escaping a single 
family, and assailed a family living on the ridge 
directly opposite its termination. From here it 
spread over into Jackson county, beyond the sphere 
of my observations. Near the same time, or a little 
earlier, it crossed over and visited Wolf Creek, 
again skipping over Indian Creek, which remained 
unmolested many weeks. It assailed every family 
for about four miles, when it suddenly stopped, and 
the force diverged; one part taking up a side hol- 
low to the right, and spreading into the flat woods, 
and the other taking up a branch to the left, passing 
over a gap into Buffalo Valley, which communi- 
cates with Indian Creek about three miles from the 
mouth of the latter. In Buffalo Valley it lingered 
many weeks, few families, or even individuals, 
escaping; finally it extended down to where it com- 
municates with Indian Creek, and spread both up 272 
on fever: 
and down it throughout its whole extent, with 
rather more than its usual malignity. 
I must here say something more about Buffalo 
Valley, which presents some very striking peculiari- 
ties. It is about ten miles long, and wide enough 
to afford many very fine farms; is the only outlet 
for the water which falls on some sixty or eighty 
square miles, and yet it affords no branch, not 
even a gully can be found, to indicate that water 
ever runs through it, even in the wet seasons. 
This is explained by the fact that the subsoil is com- 
posed of very coarse gravel, overlaid by a stratum 
of rich loam and gravel, through which water finds 
its way as fast as it falls, and is doubtless conveyed 
to the river through a subterranean passage. Now 
is this a likely locality for generating malarious dis- 
eases ? I learned that none had ever been supposed 
to originate there, and yet here the flux made 
one of its heaviest sets. I argue, therefore, that it 
is not of miasmatic origin. 
The above is a correct history of the manner of 
the spread of this disease in the above region of 
country, as I observed it myself, and learned from 
those living in each locality. I will now ask, Is this 
the usual mode of progression observed by mala- 
rious fevers ? No one will say that it is. The 
inhabitants of the above country are well ac- 
quainted with the habits of bilious fevers. They 
commence on the river, and extend occasionally 
some distance up the hollows, but never climb DYSENTERY. 
273 
the hills, much less ascend to the summit of the 
ridge. Now if flux arises from the same cause, how 
can we account for the fact that notwithstanding 
miasmatic fevers have prevailed along' the river 
more or less every year, yet a case of dysentery 
was never seen in that country until the past 
season ? 
It has now been made evident that flux does not 
necessarily prevail in the same manner; and I now 
say, in the third place, it is not ushered in by the same 
symptoms. There is a great similarity in the first 
stage, or what are denominated the premonitory 
symptoms of all general fevers; such as lassitude, 
weariness, loss of appetite, disturbance of the head, 
aching or soreness of the limbs, etc.; few cases are 
ushered in without being preceded by some or all 
of the above symptoms, which is not the case with 
flux. It most usually has no premonitory symp- 
toms ; the first indication of the approach of this 
disease is the disease itself, viz.: the peculiar 
dysenteric discharge. Sometimes a little muco- 
serous discharge precedes it; but in the great ma- 
jority of cases which have come under my observa- 
tion, the very first intimation of an attack was a 
muco-sanguineous or gelato-sanguineous discharge, 
attended by more or less tenesmus, a sense of heat 
and general uneasiness in the lower part of the ab- 
domen, the individual feeling otherwise perfectly 
well; appetite and digestion good as usual; no 
disinclination to muscular exertion; and, uncon- 
scious of their danger, many continue to eat and 
12* 274 
o n fever: 
work as usual for a clay or two after the attack; 
general disturbance of the system seldom took 
place before the second or third day of the disease, 
and, if proper treatment was instituted in time, very 
seldom took place at all, which was the case in an 
attack which I had myself. After partaking of my 
breakfast with usual appetite, I retired, as is my 
custom, and had a natural alvine discharge, without 
any thing peculiar about it whatever; but in half an 
hour after, in attending to another call, I passed a 
considerable amount of gelato-sanguineous matter, 
entirely unmixed with any of the usual contents of 
the bowels. It was preceded by some slight pains 
in the lower part of the abdomen, and attended 
with tenesmus and burning sensation in the lower 
bowel. As this was the usual mode of attack in 
the worst cases, I lost no time in resorting to my 
usual remedies; refused to ride until in the latter 
part of the day, when, finding but little uneasiness, 
I commenced my circuit again, felt no more of the 
disease, except some uneasiness in the lower part 
of the abdomen, which continued several days. 
Many other cases could be given similar to this, 
which served to convince me that the flux is purely 
a local disease at its commcncment, and that the 
fever which follows is entirely secondary. But 
with regard to premonitory symptoms, it is true 
that some cases are preceded by more or less indis- 
position ; but as I could discover no regularity or 
similarity in such cases, I was led to look upon 
them as purely accidental, and not necessarily con- D Y S E N T E 11 Y . 
275 
nected with the subsequent attack. I saw a few 
cases preceded by the common symptoms of bilious 
fever, and several were evidently complicated with 
enteric fever. But dysentery is not only not ushered 
in by the usual symptoms which constitute the first 
stage of miasmatic fevers, but, in the fourth place, 
does not primarily or usually affect the same organs. 
For example, the liver and spleen seem to bear the 
onus of attack in bilious fever; in flux they are sel- 
dom involved, and never, I believe, except when 
complicated with the former disease. No physician 
would risk his reputation by pronouncing a case an 
attack of bilious fever, in which there was no de- 
rangement in the functions of the liver; the uni- 
versality of hepatic derangement in miasmatic dis- 
eases has given the great emulgerTt, calomel, such a 
world-wide reputation in their treatment; and a 
natural bilious discharge is as confidently expected 
to be followed by an improvement in these diseases, 
as an effect is expected to follow its cause. But in 
flux, the liver usually performs its office as in 
health, and a natural bilious discharge, so far from 
affording relief, invariably aggravates the symptoms. 
So uniformly has this been the case in every in- 
stance coming under my observation, that had it 
not been necessary for the general health of the 
patient that the liver should continue its accus- 
tomed action, I would have wished its secretions 
suspended during the continuance of the flux. 
This satisfactorily accounts for the pernicious effects 
of calomel in the disease. We all know the grip- 276 
ON FEVER: 
ing quality of what are called calomel discharges. 
They often give much torture in passing through 
the bowels in a healthy condition; how could we, 
therefore, expect any thing less than insupportable 
tormina to be the consequence of their passage 
over the abraded and inflamed mucous surface in 
dysentery, and a consequent aggravation of all the 
morbid associations which have been set up in other 
organs ? 
The nervous system often suffers an amount of pros- 
tration from this kind of over-stimulation, such as to 
lead the administrator to conjure up a congestive chill, 
and to continue the drama by the administration of 
quinine, until its finale is made tragical indeed. 
I have said that the spleen is another organ 
which principally suffers in miasmatic fevers ; henc e 
the efficacy of quinine in this treatment, which it is 
now ascertained acts specifically upon that organ; 
but it also acts powerfully upon the brain and great 
nervous centres, perhaps by direct stimulation 
through the medium of the circulation, producing 
a most happy effect in the depressed stages of mias- 
matic fevers, but a most disastrous one in the de- 
pression occasioned by excessive irritation in dysen- 
tery. 
Another organ primarily affected in miasmatic 
fevers is the stomach: loss of appetite, loathing of 
food, nausea, etc., are among the best diagnostic 
symptoms of an attack, which is not the case in 
flux. The stomach is rarely at all affected at the 
commencement of this disease; food is taken with 277 
DYSENTERY. 
as good a relish as usual, and digestion is performed 
as well as common. It is only after the local dis- 
order has continued with a sufficient intensity long 
enough to get up spinal irritation, that the stomach 
becomes involved, after which it often suffers 
severely. 
Recapitulation :-Dysentery does not necessarily 
prevail under the same circumstances or in the 
same localities with miasmatic fevers; has a differ- 
ent mode of progression; is not ushered in by the 
same symptoms; does not primarily or necessarily 
affect the same organs, and is not relieved by the 
same remedies; which reasons appear to me suffi- 
ciently conclusive that they have not a common 
cause. Others, have supposed dysentery to be the 
effect of atmospheric vicissitudes; but that any 
agency operating so universally and continually as 
these should be the cause of a disease appearing 
only occasionally and within limited boundaries, 
appears to me to be very improbable. Neither do 
I believe it to be contagious in any proper sense of 
that term. I never could trace it from individual to 
individual. Those who visited the sick did not seem 
to be more subject to an attack than others who did 
not. It visited families that lived remote from any 
others, and it often attacked those members of a 
family first who had never been from home. 
The inhabitants of the two hollows mentioned 
above, which escaped the disease to my certain 
knowledge, frequently visited the adjoining affected 
districts. The only theory which will at all agree 278 
o n f e ver: 
with the history of this disease with regard to its 
erratic mode of appearing and extending itself is, 
that it is caused by the poisonous influence of a 
species of animalculse, whose habitudes lead them to 
make a lodgment in the mucous membrane of the 
lower bowel, which is selected by them as a suitable 
nidus into which they can burrow and hatch an- 
other brood. 
It is now7 believed, if it has not been positively 
proven, that cholera is caused by an insect; and 
there are many points of resemblance between it 
and dysentery, both with regard to their manner of 
spreading, mode of attack, and the manner in 
which they affect the system. They differ, how- 
ever, in the part of the alimentary $anal in which 
the onset is made ; the cholera choosing the stomach 
and upper bow7els, and the flux the lower bowel 
alone. These and some other dissimilarities are the 
result of the different instincts or habitudes of 
different species of animalcules. 
It was when on Caney Fork, contending with the 
flux, and observing its manner of spreading and 
mode of attack, that I first conceived the idea of its 
being of animalcular origin; since which time I 
discover I was anticipated, this opinion having been 
formed and expressed by others. 
No one viewing the disease under the circum- 
stances which I did could resist the above conclu- 
sion, after once turning his thoughts in that direction. 
Its wayward and whimsical mode of progression 
is consistent alone with the fickleness of insect D Y S E N T E R Y . 
279 
migration. The most prominent characteristics 
of the disease are perfectly consistent with this 
theory, and may be beautifully explained in unison 
with it. The first discoverable symptom is that 
which might arise from the stimulation produced 
by the titillation of the mucous membrane by the 
little intruders on first taking possession of the part, 
viz.: an increase of the natural secretion; but 
presently they make an entry into the substance of 
the membrane, destroying its texture and exposing 
the open mouths of the capillaries, irritate the 
nervous extremities with which the part is so 
abundantly supplied, and, of course, get up a state 
of high morbid excitement-the result of all which 
is general uneasiness of the parts, discharge of 
mucus mixed with the blood exuding from the 
exposed capillaries, and a constant feeling as if 
something was wanted to be expelled, with spas- 
modic efforts of the bowel in making these expul- 
sive efforts, etc. This continual teasing and irrita- 
tion of the sentient nervous extremities, finally 
convey sufficient morbid impression to the spinal 
column to get up morbid excitement in it and the 
other great nervous centres, which is soon conveyed 
by the nerves* to every part of the organic structure, 
and general disease is the consequence ; each organ 
and tissue complaining according to its peculiar 
mode: the brain by disturbance of ideas, giddiness, 
vertigo, stupor, etc.; the stomach by burning, 
nausea, vomiting, etc.; the kidneys by increased, 
depraved, or suspended secretions ; the skin by con- 280 
ON EEV E K: 
striction, dryness, morbid exhalation, etc.; and the 
whole system by a sense of ill-being. This state 
of things continues until the enemy is either de- 
stroyed, expelled, or has gone through its period 
of incubation, and is expelled with the mucous mem- 
brane: provided, however, that the patient should 
escape gangrene, or the system should not sink un- 
der the pressure of so much morbid action, before 
the disease has run its course. 
That flux is not merely ordinary inflammation of 
the mucous coat of the lower bowel, I infer from 
the fact that the common symptoms of inflammation 
are not sufficiently prominent; they are rather those 
of irritation, and are not relieved by the means 
which usually subdue common inflammation. An 
abstraction of an equal amount of blood, commonly 
discharged in dysentery, from the capillaries of an 
inflamed surface, would, of itself, arrest any ordi- 
nary inflammation. Blisters, which exert such a 
powerful control over inflammation, are without 
benefit, if they are not positively injurious, in this 
disease. It is therefore evident that the disease of 
the bowel in flux is of a specific nature, gotten up 
by the agency of a specific cause; and that that 
cause is the presence of poisonous animalcuhe, is 
rendered still more probable, from the fact that 
those means which are known to be destructive to 
insect life are most effectual in arresting this 
disease. 
This is eminently true with regard to the sassa- 
fras. I have experimented pretty fully with this DYSENTERY. 
281 
article with reference to this subject, and have 
found it to be immediately fatal to all insects to 
which I have had an opportunity of applying it. 
It is perfectly amusing to witness its application to 
a woolly puppy, or a little negro's head. It will 
clear them of inhabitants in less time than I can 
toll it. A little applied to my own person has 
often made an army of bed-bugs retreat more pre- 
cipitately than Bragg's battery ever did the Mexi- 
cans. 
During the winter, I have carefully examined 
every author within my reach, and have overhauled 
old files of medical journals, and have found that 
the operation of every remedy which I can find to 
have been used with any considerable degree of 
success in dysentery, may be rationally explained 
in view of the above theory. They all seem to per- 
form their beneficial effect in one of the three fol- 
lowing ways : either by destroying the animalcules, 
expelling them mechanically, or by counteracting 
their injurious effects, enabling the system to sus- 
tain the injury until they run their race. 
The most efficient means which has hitherto been 
generally used, calculated to fulfil the first indication, 
that is, to destroy the animalculae, is spirits of turpen- 
tine. Many physicians have tested its beneficial ope- 
ration in flux. But its use is attended by a very 
serious objection. Every practitioner who has had 
much experience in this disease, has observed that 
dysuria is a very common and troublesome attend- 
ant, owing to the close sympathy existing between 282 
on fever: 
the lower bowel and the kidneys and bladder. 
The nse of turpentine serves to aggravate this diffi- 
culty, and many cases of permanent injury to the 
kidneys have come under my observation occa- 
sioned by its use, both in flux and typhoid fever. 
As this has become a very fashionable remedy, it 
would be well for the profession to look a little 
closer to the result of its improper exhibition. I 
have had unpleasant effects produced even by its 
external application, both on the kidneys and 
stomach, and was led to devise some means of 
avoiding the difficulty without giving up the use of 
so valuable a curative means, and succeeded by 
combining it with nearly an equal quantity of ammo- 
nia. In this form it is not absorbed, and its effi- 
cacy as a topical application is very much increased. 
If any one still doubts cuticular absorption, let him 
try the experiment of making friction on some part 
of his person with a flannel cloth, saturated with 
warm turpentine, and if he fails to detect the 
violet odor on his urine, it will be because he has a 
bad cold. 
The peach tree and sassafras are not only more 
effectual than the turpentine in destroying the ani- 
malculae, but are less offensive to the stomach, and, 
in place of increasing dysuria, operate as a prevent- 
ive. Kone happened in my practice. 
Another article which has been much relied on 
in private practice, and is favorably mentioned by 
several authors, is sulphur, which, no doubt, owes 
what advantage it possesses in the cure of flux to D Y S E N T E II Y. 
283 
its property of destroying insects. The same is true 
of camphor, and some other articles of less note. The 
second indication, that is, to expel the enemy per 
force, is often accomplished by active purgation. 
Many of our best writers agree as to its advan- 
lage, but differ widely in the use of the means em- 
ployed. The objection to the use of drastic purga- 
tives in this disease is, that if they fail in expelling 
the enemy, they do not fail in lessening the powers 
of the system to bear up under its subsequent 
depredations. 
The third indication, that of enabling the system 
to sustain the injury until the disease runs its 
course, will include much the largest class of means 
which have been used with advantage in this dis- 
ease ; prominent among them are the different 
preparations of opium, which act beneficially by 
lessening the irritation in the bowels, subduing the 
excessive general nervous irritability, and breaking 
up morbid associations. Next in efficiency to 
opium are poultices and fomentations, which serve 
to equalize temperature, and appease the over-ex- 
cited nervous extremities. An occasional mild 
purgative is also beneficial, by preventing any accu- 
mulation of offending matter in the upper bowels. 
Many other means have been resorted to, with 
more or less advantage in fulfilling this indication, 
but I shall not pursue the subject farther, but will 
now give my own method of treatment in a con- 
densed and connected form, so as to be better com- 
prehended. 284 
on fever: 
And first, I will give my manner of preparing what 
I call compound syrup of peach leaf. I take as many 
peach leaves as will fill a ten-gallon kettle, and 
weight them to prevent their rising, and add water 
until they are covered, bring it to a boiling heat, 
and keep it at a simmer for two hours; take out 
the leaves; strain and settle the infusion; then 
evaporate by a moderate heat, until it begins to 
thicken ; there will now be about one quart; to this I 
add five pounds of sugar, and, when it is melted, sup. 
carb, of soda until it ceases to effervesce ; then add 
one drachm of piperine, finely powdered, and one 
ounce of oil of sassafras; after stirring them to- 
gether effectually, and the syrup has considerably 
cooled, I then add half a pint of brandy. I have 
usually made use of a good article of American 
brandy for this purpose. Of this syrup, I give a 
tablespoonful every hour, until the disease yields. 
If it produces any unpleasant excitement, I lessen 
the dose, and always discontinue it during sleep. 
With regard to injections, what I have said in the 
first part of this paper is sufficiently specific, and 
will not be repeated. In most cases, by adding a 
little morphine to the syrup, a necessity for the use 
of injections is superseded; the abdomen should, 
most of the time, be enveloped in a peach leaf 
poultice, or flannel saturated with the infusion. It 
is generally necessary once in twenty-four hours to 
administer a mild purgative, in order to obtain a 
fecal discharge. I prefer epsom salts to any other 
for this purpose. DYSENTERY. 
285 
Occasional symptoms must of course be com- 
bated by such appropriate remedies as the judg- 
ment of the practitioner may decide to be indicated 
in each case. 
I have not found it necessary to be very strict 
with regard to diet; in most cases the powers of 
the stomach are but little crippled, and notwith- 
standing there may be considerable nervous irrita- 
bility of that organ, yet it generally performs its 
office of digestion very well, and I found it best to 
give it employment. I consequently allow mild 
digestible food to be taken quite freely; even a small 
piece of fried chicken has often been allowed, much 
to the gratification of the patient, by removing the 
nausea, and appeasing the craving of the stomach. 
No unpleasant consequence ever followed the indul- 
gence. Other physicians often attributed the death 
of their patients to some improper indulgence in 
food. Fatal relapses were often said to be produced 
by this cause, and perhaps justly. But I had no 
relapses, and allowed my patients great latitude in 
eating. My course of treatment, by sustaining the 
tone of the stomach and preserving the general 
strength of the system, prevented any considerable 
debility ensuing, and, consequently, convalescence 
was neither tedious nor precarious. I will here 
give a list of a hundred cases, taken in connection 
from my day-book, showing the time each patient 
required my attendance. Many were visited for a 
day or two after convalescence, and all were directed 
to continue the remedies for some days after decided 286 
on fever: 
convalescence, in order to insure its stability. The 
time embraced in the following list is that in which 
the patient was sick enough to require being 
visited. The protracted cases were all complicated 
with other diseases: 
29 cases were visited only 1 day. 
37 
u 
cc 
2 days. 
14 
a 
cc 
3 " 
7 
u 
cc 
4 " 
9 
a 
cc 
6 " 
3 
u 
cc 
9 " 
1 
u 
cc 
12 " 
One chief cause why so few visits were necessary 
in the above cases, may be found in the manner in 
which. I conducted my visits : my habit was, when 
called to a now case, if it was a bad one, to tarry 
with my patient until I had arrested or materially 
controlled the disease, even if it required several 
hours' detention ; then, by leaving full and specific 
directions, the case was often managed without 
another call. In this way I was enabled to attend 
to many more cases than I possibly could have done 
by paying flying visits, and repeating them daily. 
And though this kind of slow movement often 
kept new calls waiting until patience was well-nigh 
exhausted, yet I found that they only had to suffer 
a few additional hours, as the disease, when once 
fully formed, usually became no harder to manage 
for several days. 
Since the above period, I have kept ray self posted DYSENTERY. 
287 
as to the prevalence of dysentery in that region of 
country, and I find that a few scattering cases have 
occurred every summer, within the boundary of its 
former ravages; but that every year it has pre- 
vailed epidemically, beginning at one or more 
points near the margin of the space over which it 
had travelled the previous season. During the 
early part of the present summer it prevailed over 
a considerable space of country, commencing some 
miles west of the Caney Fork, and extending in 
the direction of Nashville. But few escaped an 
attack, and as it was attended by physicians who 
obstinately adhered to the use of calomel treat- 
ment, the mortality was fearful: over twenty deaths 
occurred in two families. This disposition of epi- 
demic dysentery to commence one season at a point 
near which it had stopped the previous year, has 
been observed and spoken of by others; several 
instances are given in reports on epidemics in the 
"Transactions of the American Medical Associa- 
tion;" but as they are not at hand just now, I 
cannot refer to the page. 
I might here close my remarks on dysentery, but 
think best to make a resume, so as to leave the read- 
er's mind distinctly impressed by the most important 
points, especially in the treatment. It is much to be 
lamented that there is still no improvement in the 
management of this disease throughout the United 
States; the yearly bills of mortality show this to be 
so; and physicians generally have not yet learned that 
the exhibition of mercurials is very generally asso- 288 
ON fever: 
dated with death in typhoid dysentery. There 
is still no approach to uniformity of treatment, even 
in recognized varieties, except so far as giving mer- 
curials is universal. 
Perhaps no disease is more variously treated in 
the United States than this. This want of uni- 
formity in its management is no doubt partly owing 
to a want of correct knowledge of the nature of 
the malady, and partly arises from the diversity of 
character which it assumes in different localities and 
at different times. The particular disease known 
as dysentery, or flux, is undoubtedly a local affec- 
tion, consisting in a certain amount of irritation or 
inflammation of the mucous lining of the lower 
bowel; but this local disease cannot exist long or 
intensely without involving the general system, 
manifested in the form of fever; and the fever will 
take on the particular form or type to which the 
system has been predisposed by atmospheric or 
epidemic influences; or the fever may have been 
first set up, and the dysenteric symptoms super- 
added afterward, or both may be developed at the 
same time by the same exciting cause. Hence, we 
find flux existing as an independent disease, unac- 
companied with any fever; and we find it associated 
with the different grades of miasmatic fever and 
typhoid fever; and we see it arising in the course 
of these fevers; and see these fevers developed ir 
the progress of independent cases of flux. The 
only sensible way, therefore, of viewing dysentery, 
is to first consider it as a distinct local disease, and DYSENTERY. 
289 
to contemplate the associating fever also as an inde- 
pendent affection; and then consider in what man- 
ner each influences the other. 
Dysentery proper consists of a peculiar kind of 
irritation in the mucous membrane of the lower 
bowel, exciting a more abundant discharge of the 
natural mucus of the bowels, attended with a sense 
of uneasiness, and more or less burning pain and 
increased contraction of the lower bowel, produc- 
ing a prolonged disposition to remain at stool, with 
more or less tenesmus or straining. As the disease 
advances, the mucus is generally exchanged for 
jelly mixed with blood. All this may take place, 
and yet the individual continue in nearly usual 
general health; having no chills, no fever, no loss 
of appetite; and, except when suffering paroxysms 
of tenesmus, no feeling of indisposition of any 
kind, showing that the disease is as yet purely 
local. In this form, and in this stage, it is very 
easily managed. For twenty years I have relieved all 
such cases in a short time by simply ordering peach 
leaf tea and injections of starch and laudanum. 
Any part of the peach tree will answer for making 
the tea, as well as the leaves. In the winter I use 
the twigs. The dose is about a third of a teacup- 
full every hour or two; an injection of half a gill 
of starch or flour gruel, with twenty to forty drops 
of laudanum, or three or four grains of denarco- 
tized opium, should be given after each discharge. 
If there should not be fecal discharges produced by 
the tea, I give epsom salts or Seidlitz powders. If 290 
on fevek: 
there is considerable tenderness of the abdomen, I 
direct a poultice of peach leaves, or, in their absence, 
a tea of the bark or twigs, thickened with wheat 
bran. But if the flux is complicated with fever, 
more than these means, which are all directed to 
the local affection, becomes necessary to be done. 
The fever must be met by such treatment as will 
control it; and a reason why so great a mortality 
has attended this disease in many parts of the 
United States, of late years, is doubtless because it 
was complicated with typhoid fever, a disease which, 
under the ordinary treatment, runs a tedious course; 
a disease which is attended in its progress with 
ulcerations of the upper bowels, which, by concert 
of action, will keep up the dysenteric inflammation 
of the lower bowel, and both, combined with the 
depressing nature of the fever, become more than 
the system can endure, and it sinks under it; and 
more especially if the depressing influence of mer- 
curials is added. Human nature was not designed 
to bear up under all these, "and it won't." By the 
aid of my plan of aborting typhoid fever, this form 
of dysentery becomes as manageable as any other. 
All that is necessary in the case is, to add a table- 
spoonful of the comp, syrup of valerian to a 
cup of the peach leaf tea, and give a third of it 
every hour. As the comp, syrup of peach leaf 
contains the essential properties of the fever syrup, 
it alone will control it, or they may be given alter- 
nately. In a few days the fever will be broken up ; 
and eyen should the dysenteric symptoms continue D Y S E N T E R Y . 
291 
a few days longer, the patient will steadily improve 
in general health. But if the fever should be of 
the bilious kind, I still do nothing more, as the 
same treatment will break that up with equal 
facility, except there should be chills, and then the 
addition of a few grains of quinine will meet that 
feature. 
The following extracts will show what success 
has attended my plan of treating dysentery in the 
hands of others: 
Dr. J. E. Fulton, Big Oak, Miss., writes: 
"I have had an opportunity of trying your plan 
of treatment in dysentery, and in my hands it has 
come fully up to your representations." 
Dr. A. M. Walls, Madison Cross Roads, Ala., says : 
"I have treated a few cases of dysentery with the 
peach leaf tea, etc., in all of which it proved suc- 
cessful." 
Dr. W. Shapard, Scottville, Ky., writes : 
"I have used your treatment for dysentery in my 
practice with great success." 
Dr. AV. M. Cook, Silver Springs, Tenn., says: 
"I have used your treatment for flux several 
years, and find it just what you represent it." 
Dr. R. Smith, Thebes, Ill., says: 
"I am much pleased with the effect of peach leaf 
tea in dysentery. ' ' 
Dr. John K. Cypert, Monterey, Tenn., writes: 
"I am highly pleased with peach leaf tea in the 
treatment of dysentery. I have derived great advan- 
tage from it, but do not consider it a specific." 292 
on fever: 
Dr. J. G. Boyd, Shady Grove, Tenn., writes: 
"Your plan of treating dysentery has been en- 
tirely successful in my hands." 
Children during the second summer often have a 
hard struggle for existence. The food which nature 
furnishes for early life being withheld, or proving 
inadequate to their sustenance, they are forced to 
depend upon other kinds not so readily assimilated; 
and not having the teeth or digestive powers to 
manage properly the ordinary diet taken by older 
members of the family, and possessing a higher 
degree of irritability than those of maturer years, 
the half-digested food often acts as a direct irritant 
to the coats of the bowels, causing increased secre- 
tion and increased peristaltic motion, constituting 
diarrhoea. Thus the food, instead of being appro- 
priated to the nourishment of the system, weakens 
it by acting as an irritant, causing the child, as it 
decreases in strength, to increase in nervous excita- 
bility, until some exciting cause, as change of tem- 
perature, or the irritation of a protruding tooth, so 
impresses the nervous centres as to get up general 
nervous disturbance, which, connected with capil- 
lary debility, we have seen constitutes the first 
stage of fever. Reaction takes place as in other 
fevers; and as the stomach and bowels in this case 
are already in a state of morbid excitement, they 
constitute the weak point, and the onus of the dis- 
ease is thrown upon them. The indications to be 
CHOLERA INFANTUM, OR SUMMER COMPLAINT. CHOLERA INFANTUM. 
293 
met in this disease are, therefore, to remove the 
excessive irritability of the stomach and bowels, to 
quiet nervous disturbance, restore capillary action, 
and then improve the tone of the digestive organs 
so as to guard against relapse. 
If the case be taken in time, before fever is set up, 
the treatment is very simple. The diet of the child 
should be restricted to such articles as are most 
digestible, least irritating, or subject to ferment- 
such as boiled milk and stale bread, rice, sago, etc. 
To improve digestion and restore the tone of the 
stomach and bowels, I prefer the following formula 
above any I have tried, viz.: good French brandy, 
half a pint; pulverized cinnamon bark and nut- 
megs, each, two drachms ; piperin, ten grains ; loaf- 
sugar, a fourth of a pound. Dose, one or two tea- 
spoonfuls, combined with four times its volume of 
milk, repeated three times a day, or oftener if re- 
quired ; or it may be added to a cup of boiled milk 
at meals. If the disease be suffered to continue 
until fever is set up, and there is vomiting, swelling 
and tenderness of the abdomen, etc., I direct a lye 
poultice to the bowels, and a grain of calomel every 
three or four hours, until bilious discharges are ob- 
tained, and then commence the treatment as before 
directed. Sometimes, however, the fever is truly 
malarious, and, besides the above remedies, requires 
a few grains of quinine. 
Sometimes the thirst in this disease is perfectly 
intolerable; in which case, though the surface may 
be cool, we may know there is great internal heat. 294 
ON FEVER. 
I manage such cases by applying a cold wet cloth 
to the abdomen, renewing it as it becomes hot; for, 
notwithstanding the cool surface, the cloth will 
soon absorb the heat from the overcharged internal 
surfaces; at the same time I administer internally 
a weak solution of epsom salts, given in small 
quantities, and frequently repeated. I usually add 
some sup. carb, soda and a little Dover's powder. 
My formula is, epsom salts, three drachms; sup. carb, 
soda, one drachm; Dover's powder, twenty grains, 
dissolved in twelve ounces of water, of which I 
direct a tablespoonful every hour. This will be 
drunk with avidity by the little parched sufferer, 
and should be continued until the vomiting ceases 
and the thirst is partially allayed, even should it 
appear to increase the purging. No other drink, or 
any thing else, should be taken on the stomach un- 
til the vomiting subsides. 
The interval should now be extended, and a table- 
spoonful of new cream given between each dose. 
The cream will not coagulate, and is exceedingly 
soothing to the irritated lining of the stomach, and 
affords the most readily assimilated nutriment that 
can be selected, which the famishing child so much 
needs. After the patient has become relieved by 
the above means, the anodyne carminative, or brandy 
mixture, should be commenced, for the purpose of 
restoring the vital powers. Sometimes the consti- 
tutional disturbance attending this disease is not 
sufficient to produce fever; the child keeps up, 
retains some appetite, though morbid, occasionally CHOLERA INFANTUM. 
295 
vomiting, and once, or oftener, in the twenty-four 
hours, has an attack of diarrhoea; which, from its 
violence, seems as though it should produce speedy 
prostration, but it stops of itself, and the little fel- 
low falls asleep, and presently awakes to cry for food. 
But emaciation goes steadily on, the abdomen be- 
comes tumid, the face and hands puff, and, if the 
disease is not arrested, the child must die ere long. 
In these cases I begin with the saline mixture 
recommended above, and regulate the diet as before 
directed, usually giving three or four grains of Hyd. 
cum Creta every night. This treatment should be 
continued three or four days, when it will usually 
be safe to commence the anodyne carminative. A 
multitude of poor little shrivelled specimens of 
humanity, whom to wish dead seemed to be benevo- 
lent, have by this means been restored to perfect 
soundness and plumpness. 
Dr. J. S. Burford, Whiteville, Tenn., writes: 
"I have a beautiful little daughter, now in the 
enjoyment of the most perfect health, who was 
brought down to the verge of the grave by that 
great baby-destroyer, 'cholera infantum,' upon whom 
every means were employed without avail, until 
treated according to the plan you recommend. It 
acted 'like a charm.' I feel that I am indebted to 
you for her life." 296 
ON FEVER: 
CHAPTER IX. 
ERUPTIVE FEVERS. 
VARIOLA, OR SMALL-POX. 
Notwithstanding the discovery of Jenner, which 
justly immortalized him, through the inattention 
of the people this dreadful disease almost yearly 
makes its appearance in our large cities, and along 
the great thoroughfares. Hence it becomes neces- 
sary that everybody, and especially every physician, 
should be able to recognize the disease, and give it 
the best treatment that the light of the present age 
affords. 
The forming stage of this disease cannot be dis- 
tinguished from that of measles, scarlatina, or, in 
fact, any other fever; it is only when the eruption 
begins to appear that it can be identified; and here 
I will hazard a statement, which will run foul of 
authority-that is, that this disease cannot be com- 
municated until after the eruption is pretty well 
formed. Much inquiry and close observation have 
fully convinced mo that this is the case; and by VARIOLA, OR SMALL-POX. 
297 
knowing this to be true, much alarm and uneasiness 
may often be prevented. I am aware the contrary 
is true of measles and scarlatina, the most con- 
tagious period of which is during the preliminary 
fever. If this were so of small-pox, the disease would, 
every time it makes its appearance, spread among 
all the friends and visitors. 
When the eruption does make its appearance, it 
can be immediately recognized by any one who 
will preserve the type in his mind, it being unlike 
any other. The first appearance is a few very 
small and exceedingly red points, scattered over 
the breast, and next appearing on the face. These 
points are smaller and of a deeper scarlet red than 
any other eruption for which it could be mistaken. 
Twenty-four hours subsequent you will find the 
number of points increased, sometimes very greatly, 
and now are more numerous on the face: hence, I 
suppose, the mistake of authors that it always 
begins on the face, the few that first appeared upon 
the breast having been overlooked. By this time 
the first points that made their appearance have 
begun to fill with a clear limpid secretion, and have 
lost their peculiar redness. As these vesicles 
enlarge, they become surrounded by a circle more 
or less red, according to the amount of fever which 
is present. 
These vesicles soon acquire a slight depression in 
the centre; but in the course of four or five days 
they again assume the rounded form, owing to the 
lymph giving place to suppuration. They now 
13* 298 
ON FEVER: 
are much enlarged, and have acquired an opaque 
yellowish appearance. 
In three or four days more, the pustules begin 
again to sink in the centre, and often part of the 
matter oozes out, yielding an exceedingly unplea- 
sant odor, and so peculiar as to be always readily 
recognized afterward. In five or six days more the 
scabs fall off, leaving deeply discolored spots, and 
often unsightly pits. 
The disease as described above is known as dis- 
tinct small-pox. Sometimes the pustules, parti- 
cularly on the face, are so numerous that they run 
together, making large continuous patches; this is 
known as confluent small-pox. Then, again, the 
pustules may merely touch without running to- 
gether, which is called semi-confluent. 
The stages of this disease are nearly as follows: 
Period of incubation, or time between receiving the 
contagion and accession of fever, twelve clays; 
period of fever before the eruption appears, three 
days; pustular stage, four days; drying stage, four 
to six days. This is true with regard to the erup- 
tion on the face and breast; that upon the body and 
extremities, by appearing later, will also be behind 
in all their stages. 
From the time that the fever commences until 
the eruption is fairly out, the patient is commonly 
quite sick; complains of headache, nausea, pains 
in the bones, considerable fever, etc.; but when the 
eruption is fairly out, all these symptoms generally 
give way very suddenly, and the patient complains VARIOLA, OR SMALL-POX. 
299 
but little, except of the surface, until the suppura- 
tive stage commences; secondary fever is now set 
up, which often runs very high, and in confluent 
small-pox often causes death. 
Treatment.-The treatment of small-pox was 
once perfectly murderous-giving hot teas and stews, 
keeping the patient shut up in a close room, and 
forbidding water. 
This same treatment is yet followed by some of 
the ignorant pretenders to whom the management 
of this disease is sometimes committed. At the 
present time the received practice is palliative; 
viz., in the first stage, while there is much fever, 
cooling drinks and very light nourishment, with 
occasional spongings of the surface with tepid water, 
and keeping the bowels gently open with Seidlitz, 
or a little epsom salts or cream of tartar, and a few 
grains of Dover's powder at bedtime, to allay rest- 
lessness and procure sleep. 
When the pustules commence maturating, if the 
fever is of rather a low type, and the pustules fill 
tardily, nourishing soups and wine should be given. 
At every stage of the eruption the patient should 
be anointed with olive oil at least once a day; and 
when the matter commences oozing from the pus- 
tules, the surface should be thoroughly cleansed 
with soapsuds, and then oiled. This treatment is 
generally successful; still, deaths are not unfrequent, 
and deformity by pitting quite common. 
Since adopting my present plan of treating fever, 
I had rather desired an opportunity of testing it in 300 
on fever: 
small-pox. My opinion was that it would prevent 
secondary fever, and, by maintaining a vigorous 
condition of the capillaries, prevent the destructive 
ulceration of the true skin, which occasions the 
pitting. 
Last winter my desires were gratified. I was 
called to treat four cases of genuine variola, and a 
number of cases of varioloid. I felt so confident 
that I would prevent pits, that I assured the friends 
that I would do it, if they would attend to my 
directions. During the vesicular stage I gave my 
fever syrup in teaspoonful doses every two hours; 
allowed plenty of cold water, with cream of tartar 
sufficient to render it pleasantly sour; sponged the 
surface when hot, and oiled it when they com- 
plained of itching. In a few days all constitutional 
disturbance subsided, and my patients sat up, were 
cheerful, and had good appetite, which was rather 
liberally indulged. When the pustular stage set in, 
I ordered the syrup to be given in half tablespoon- 
ful doses, and had the surface well washed with tepid 
soapsuds every day, and then oiled. No secondary 
fever occurred, and hardly any inflammatory action ; 
so that the areola was quite indistinct, the pus- 
tules, when in their full rounded stage, looking like 
little balls of cotton sticking on a sound surface; 
and, as I expected, when the scabs scaled off, there 
was not a mark left, except three on one little fel- 
low's forehead, who repeatedly rubbed oft the scabs. 
Now these cases were not naturally milder than 
common. A negro man who contracted the disease 301 
SCARLATINA. 
at the same time and from the same person, and 
who was not considered worse than my cases, was 
treated by another physician, and died with second- 
ary fever. One of my cases was partly confluent; 
the pustules over all the face and breast slightly 
touched each other, and in several places on the 
face ran together, making patches as large as a 
twenty-five cent piece; and yet, when these scaled 
off, it was perceived that the true skin had not sus- 
tained the slightest injury. 
I visited the family (Mr. Edmunds', of the lower 
suburbs of Nashville) about a month since, and 
found all the children as clear of evidence of having 
had small-pox as they were before having it, except 
the little fellow who rubbed his forehead, and who 
presented three slight irregular marks not at all 
characteristic of variola. While attending these 
cases I saw my friend Professor Bowling, and in- 
formed him that I intended to cure them without 
leaving marks. Some time since he informed me 
that, being in the vicinity, he had a curiosity to see 
if I had succeeded, and found that Iliad completely. 
SCARLATINA. 
Scarlet fever still continues to be the terror of 
households, and yearly furnishes its quota of be- 
reaved parents. Sometimes its ravages are fearful. 
Only last winter there lived in an adjoining county 
a gentleman and lady whose home was made glad 
by six lovely children; but the destroyer came in 302 
on fever: 
the shape of scarlatina, and in less than ten days 
they were childless ! 0 ! how desolate was that 
hearth I 
This disease has been divided into three grades: 
Scarlatina Simplex, Scarlatina Anginosa, and Scarlatina 
Maligna. And though these divisions are rather 
arbitrary-the different varieties often running into 
each other and blending in every possible manner- 
yet, as we often do meet with different cases of this 
disease presenting true types of each of the grades 
named, and as these cases must necessarily be 
treated differently, it is well to preserve these dis- 
tinctions. 
Symptoms.-Scarlatina Simplex, or simple scarlet 
fever. 
In this form of the disease there is open reac- 
tionary fever, with an abundant scarlet eruption; 
skin hot, and pulse full, strong, and rapid. The 
skin seems to be the principal seat of the disease, 
the throat not much affected. 
The reverse of this is true of Scarlatina An- 
ginosa: the throat here is the point of suffering, 
often swelling enormously, which, with a croupy 
exudation, which is frequently considerable, and 
exceedingly tenacious, often produces absolute suf- 
focation. 
In this variety, the eruption is rather later in 
making its appearance, and is not so regularly 
diffused. Sometimes no eruption whatever takes 
place, though the disease might appear in the same SCARLATINA. 
303 
family, a part of which had the eruption without 
the sore-throat. 
In Scarlatina Maligna, there is profound nervous 
prostration and great capillary torpor, shown by 
the purple hue of the surface. The fever is of a 
low type and very little eruption, and that coming 
and going as the capillary system varies in activity. 
The throat is but little swelled, but is often the 
seat of foul sloughing ulcers; sometimes the little 
patient dies in the first stage, assuming many of the 
symptoms of collapse in Asiatic cholera. 
Treatment.-In simple scarlet fever, my treat- 
ment is exceedingly simple, and uniformly success- 
ful. 
In the forming stage, which usually lasts two 
days, this disease cannot be distinguished from the 
same stage of other fevers, and I treat it accord- 
ingly ; rubbing the spine with chloroform liniment, 
and giving the fever syrup in moderate doses, say a 
teaspoonful every two hours in a wine-glass of 
sweet milk. I expect by this treatment to allay the 
restlessness, and get up such a good state of capil- 
lary action, that should the disease threaten to 
assume the anginose or malignant form, it may be 
converted into the simple variety. It is the busi- 
ness of the nerves and capillaries to manufacture 
the eruption, and I presume if they are supported 
so as to perform their office, the disease will always 
be open and simple. 
"When the eruption makes its appearance, if it is 
very profuse, and the heat of the surface great, I 304 
on fevEit: 
have the surface sponged with tepid water and 
then greased: a piece of smoked bacon rind is 
thought to answer the best for this greasing-•per- 
haps on account of the empyreumatic oil which 
it has imbibed-but any mild oil will answer 
pretty well. 
If there is great thirst, I order small and frequently 
repeated doses of epsom salts, say what you can 
lift on the end of a teaspoon-handle, given in as 
much cold water as the child will drink at one time. 
If this should operate too freely upon the bowels, 
it must be discontinued, and two or three grains of 
Dover's powder given. The eruption will begin to 
fade in four or five days, and if there have been no 
complications, the child will speedily recover. 
In besides the treatment already 
given, prompt attention must be paid to the throat; 
the inflammation must be assuaged, and the swell- 
ing of the glands reduced, or suffocation may take 
place very speedily. For the first, I use weak pep- 
per tea, sweetened to the taste, (honey should be 
used if it can be obtained,) with the addition of two 
grains of ipecac to a pint of tea: recollect that the 
tea must be weak; many are in the habit of giving 
it strong, but this has a tendency to produce dis- 
tress of the throat by checking secretion, whereas 
the weak tea merely excites sufficiently to promote 
secretion. I usually use the cold infusion, made by 
putting a few grains of cayenne or a pod of com- 
mon red pepper in a glass of cold water, removing 
the pod whenever it has imparted a slight pungency SCARLATINA. 
305 
to the water, putting it in another glass of water, 
to be ready for use by the time the first is used; 
this drink will be taken kindly, and may be used 
freely. The throat should be enveloped with flan- 
nel, saturated with vinegar which has had as much 
common salt added to it as it will dissolve. This 
should be applied as hot as can well be borne, and 
often renewed; a dry cloth, well oiled or greased, 
should be applied over the wet one, to prevent cold 
from evaporation. A teaspoonful of the syrup 
should be given every two hours in sweet milk, or 
emulsion of slippery-elm or gum-arabic, to cover its 
acrimony. As soon as the inflammation is partly 
subdued, it is best to discontinue the wet cloth, and 
use some strong stimulating liniment. Either of 
the following which may be most conveniently 
obtained will answer: Chloroform liniment; vol. 
lin.; aqua ammonia and spirits of turpentine, equal 
parts; or strong vinegar and tincture of capsicum. 
The bowels should be kept open with small doses 
of epsom salts, but no active purgative should be 
given. Under the best management, one or more 
of the glands often suppurate; when this is found 
to be inevitable, it is best to hasten the process by 
applying a lye poultice. After the abscess is 
opened, a slippery-elm poultice is best; this should 
always be covered with a greased cloth, to prevent 
its adhering. 
In Scarlatina Maligna, the general treatment must 
bo somewhat varied, and local applications wholly 
differentfrom those recommended for the last variety. 306 
on fever: 
Here we have to contend with deficiency of vital 
energy, and every thing that is done must have 
reference to the vital necessity that exists of arous- 
ing nervous energy and increasing capillary action. 
The fever syrup should be given in tablespoonful 
doses ; and if this should disagree with the stomach, 
carb, of ammonia must be substituted; a good 
formula is, Emulsion of slippery-elm or of gum 
arabic, six ounces; carb, am., one drachm; give a 
tablespoonful every hour until an effect is produced. 
As a gargle, use tine, capsicum, one ounce; muci- 
lage, half a pint, and if the patient swallow it, all the 
better; or chloroform liniment may be substituted 
for the capsicum. The throat should be enveloped 
with flannel saturated with cold water-ice water is 
preferable. If no decided change takes place for 
the better in a few hours, give the patient freely of 
brandy and water, and use the wet sheet. My habit 
is to give the brandy until some arterial excitement 
is gotten up, and then envelop the patient in a wet 
sheet, cover with one or two blankets, and apply 
hot bricks to the feet and about the extremities. As 
soon as reaction has fairly taken place, remove the 
sheet, and lay the patient between two dry blankets. 
Recollect we are striving after reaction, and do not 
want perspiration, and on this account the sheet 
should be removed as soon as it has accomplished 
this important office. If the blankets become an- 
noying, change them for sheets. It is very fashion- 
able to cauterize the throat in malignant scarlet 
fever with nitrate of silver, but I never do it until SCARLATINA. 
307 
after ulcers are formed; it then proves very benefi- 
cial, by giving a more healthy character to the 
ulcers. 
Kow my experience is, that unless the case be 
one of those terrible ones in which the system at 
once collapses under the power of the poison, a 
free use of the fever syrup in the early stage of this 
disease will convert a case that would have proved 
to be malignant, into the simple reactionary form. 
I have had no case of malignant scarlet fever for 
many years, in which I was early consulted, and I 
suppose I should have had many but for the treat- 
ment, as they have occurred yearly in this city and 
vicinity in the practice of others, some of which 
died in less than twelve hours. On the contrary, a 
plain case of simple scarlet fever may certainly be 
converted into the malignant form by improper 
treatment. A case in point occurred in my own 
practice many years ago, which made an impression 
upon my mind never to be effaced, which, as it 
presents several points of interest, will here be 
given. 
The patient was my only child, a sprightly daugh- 
ter of about six years. 
The undisputed doctrine then was to stimulate in 
the eruptive stage, in order to obtain a plentiful 
crop. She accordingly was covered up, and encour- 
aged to drink freely of warm teas. Under this 
regimen there was soon rather a surplus crop of 
eruption, and the heat and restlessness were so great 
that I was forced to allay them by covering her 308 
on fever: 
lightly, and rubbing her all over with wheat flour. 
Having obtained a period of comparative quiet, and 
considering the case doing very well, I withdrew 
my attention for about two hours. On again exam- 
ining her, I found that a change had come over the 
case: her breathing was hurried and anxious, con- 
siderable stupor, the eruption rather purple; and 
on looking into her mouth, a sight was presented 
calculated to shock parental sensibility to the 
utmost. The whole lining membrane of the mouth 
was of a mahogany color, deepening as it ap- 
proached the fauces, where it had become entirely 
black, showing that decomposition had- already 
commenced. For a moment I was past thinking; 
but rallying, I began to cast about for some means 
which might give a chance. As I had never seen a 
parallel case recover, I had no satisfactory experi- 
ence to fall back upon ; but the object to be effected 
was very evident-general reaction must be estab- 
lished, and the gangrene arrested, or death must 
ensue in a few hours. After administering some 
unadulterated brandy, and perceiving that sensi- 
bility of the glottis and fauces was destroyed, I 
ventured to put a few drops of undiluted aqua 
ammonia on the back part of her tongue, which 
was swallowed with the ease of water; I repeated 
it every few minutes, each time increasing the dose, 
until a full teaspoonful was swallowed at once-• 
taking the precaution to give freely of cold water 
immediately preceding each dose, so as to prevent 
its irritating the stomach, at the same time that the S C A 11 L A T I N A . 
309 
full stimulating effect might be received by the 
dying tissues. In half an hour I perceived a salutary 
change : general arterial action was improved, 
capillary action better, manifested by a more florid 
color of the eruption ; and, on examining her mouth 
and throat, I discovered that the mahogany color 
had faded considerably, so as to show a well-de- 
fined outline to the area of the mortification. I 
now discontinued the ammonia, and substituted 
strong pepper tea; this was discontinued in an hour 
or two, as the returned sensibility of the mouth 
and tongue caused its pungency to annoy her, and 
also because reaction was now quite satisfactory. 
A drink of the juice of green sage, diluted with 
■water and sweetened with honey, was now given. 
On the next day I had the satisfaction to see the 
blackened covering of the fauces cast off, exposing 
a very healthy but very irritable mucous mem- 
brane. Recovery was now rapid and without 
accident. 
The points of interest in this case are: first, that 
it certainly was Scarlatina Simplex at the beginning, 
but was converted into Scarlatina Maligna by im- 
proper stimulation, producing excessive eruption, 
and this causing so much nervous excitement as to 
produce nervous and capillary prostration. Second, 
that by powerful stimulation the malignant form 
was made to yield to the original type, it ter- 
minating in the ordinary happy manner of Scarla- 
tina Simplex. The third is, that it affords encour- 
agement to persevere under difficulties, and not 310 
on fever: 
give up a case because heretofore we have been 
unsuccessful. The fourth is, that it illustrates the 
fact that desperate conditions often warrant the use 
of what, under ordinary circumstances, would be 
desperate remedies. At present I would not in a 
like case depend so exclusively upon ammonia, 
and should not then, but for the fact that there was 
nothing else suitable at hand. I had often used 
the oil of sassafras alone, and in combination with 
ammonia, for arresting external gangrene, but there 
was then none in reach. At present I would rely 
upon the chloroform liniment. I will take the pre- 
sent occasion, as perhaps as suitable as any other 
that will occur, for saying something more upon 
the danger of excessive external stimulation pro- 
ducing fatal prostration. We meet with examples 
of it in all the eruptive diseases; from excessive 
blistering of young children; from extensive though 
very slight burns; and among the children of the 
poor or careless inhabitants of our hot and well- 
supplied mosquito city, I have frequently been 
called to visit babes who had been suffered to lie 
naked in order to keep cool, who presented very 
alarming symptoms of prostration of vital energy, 
and after careful examination and inquiry I could 
find no sufficient cause, except in the fact that the 
surface was densely covered with mosquito bites. 
An anodyne internally, with a little brandy as a 
soothing wash for the surface, have always proved 
sufficient to relieve such cases. In order to impress 
this subject upon the mind of my readers, I will 311 
SCARLATINA. 
give a short history of a fatal case that I witnessed 
some years ago. 
A gentleman, a mile or two from the village in 
which I then lived, called on me one evening, say- 
ing that there was a case at his house that he did 
not understand, and came to state it, that I might 
decide whether any thing was wrong. He informed 
me that on the previous day a little negro girl had 
her calico slip to take fire; but as he was near at 
hand, he succeeded in tearing it off before she was 
seriously burned; that after the first half hour she 
ceased to make any complaint of the burn, but, 
what was singular, had gone to sleep and could not 
be aroused. I told, him that his negro would cer- 
tainly die, which surprised him exceedingly; he 
insisted, however, that I should see her, and I 
did so. 
I found that the burning garment had slightly 
scorched the whole surface, but only in a few small 
places sufficiently to excite vesication; her pulse 
was scarcely perceptible, and the whole surface 
cool; respiration very slow and languid; coma 
complete. I made some vigorous efforts to stimu- 
late, but to no purpose-the system would not re- 
spond, and in two hours she died. Some persons 
may imagine that my teaching and practice upon 
the subject of stimulating in the eruptive stage of 
scarlet fever are contradictory-that I prescribe the 
fever syrup, which is a powerful stimulant. But I 
would have such to understand that the comp. syr. 
of val. is not a general stimulant, especially not an 312 
on fever: 
arterial stimulant. Its effects are to quiet the ner- 
vous system and excite the capillaries, thereby pre- 
venting that kind of morbid excitement which pro- 
duces excessive eruption. It is true I have said 
that it is the business of the nerves and capillaries 
to manufacture the eruption; but if they are pre- 
served in sound condition, they will do this as it 
should be done, neither half doing nor overdoing 
their task, and it is the natural effect of this medi- 
cine to preserve or put them in proper working 
order. The operation of the fever syrup in high 
febrile and inflammatory diseases is graphically and 
truthfully set forth in a communication from a very 
intelligent correspondent. After stating its benefi- 
cial effects in the treatment of a number of active 
inflammatory diseases, he states: 
" The only inflammation in which your fever 
syrup is contradicted is gastritis; here it acts as a 
direct irritant; but by the time it reaches the bowels, 
it is so modified as not to act injuriously; on the 
contrary, I have derived great advantage from it in 
chronic dysentery and inflammation of the bowels; 
and when it reaches the capillaries, it there sets 
every thing right again; the pain, irritation, and 
heat subside, the engorgement disappears, and all 
move on naturally and pleasantly again." 
Now, if it would act as above in active inflamma- 
tion, is it probable that it would increase febrile 
excitement? The very opposite is its legitimate 
effect. 
Sequcela of Scarlatina.-The diseases which SCARLATINA. 
313 
sometimes follow scarlet fever are often more 
formidable than the disease itself, especially as they 
are most apt to follow the mildest cases. 
This has been supposed to be owing to the poison 
not having been properly eliminated from the sys- 
tem, which I think is a rather groundless conjec- 
ture. A much more plausible reason is this: the 
disturbance in a very mild case is not sufficient to 
produce reaction sufficient to restore activity to 
the capillaries; and though capillary debility seems 
to be slight, yet it remains, and as the patient is not 
sick enough to be kept in-doors, some exposure ren- 
ders the capillary debility more intense, and it runs 
into active inflammation, or the debility becomes 
profound, and produces such a state of relaxation 
as will admit the watery part of the blood to exude 
into the cellular structure, or upon the serous sur- 
faces, causing general or partial dropsy. With this 
view of the subject, the means of relief naturally 
suggest themselves. Give the fever syrup freely in 
watermelon seed tea, and promote the secretion of 
the bowels and kidneys with salts and cream of 
tartar. Under this treatment the dropsy will speed- 
ily disappear. 
D. C. A. Moses, M. D., Eldridge, Ala., writes: 
"You say nothing in your work of using your 
fever syrup in dropsy. Now, if you never have 
used it in such cases, give it a trial-it will not dis- 
appoint you. The cases that I have used it in are 
such as are recognized by the profession generally 
as incurable, cases of long standing in the old and 314 
on fever: 
feeble, and which depend upon general atony of 
the whole system." 
The dropsy following scarlatina, we have seen, 
depends essentially upon debility; therefore the 
above is in point. 
As to the inflammations, glandular swellings, etc., 
which sometimes follow scarlatina, if they be treated 
upon th'e general principles laid down in this work, 
or according to enlightened common sense, there 
will be but little difficulty in managing them; 
though patience may become a virtue before a com- 
plete cure is obtained. After the prominent dis- 
ease has been pretty well managed, chalybeates are 
often of great service. 
RUBEOLA. 
Much that has been said under the head of scar- 
latina is equally applicable to measles, and need 
not be repeated. Its diagnostic symptoms are 
cough, suffusion of the eyes, irritation of the mucous 
membrane of the nose, fauces, and air-passages, 
causing sneezing, running at the nose, cough, etc. 
These are attended with more decided symptoms 
of fever than ordinarily accompany common ca- 
tarrh ; but nothing positive can be known until 
the eruption appears, which will be about the fourth 
day of the fever. 
The eruption appears in form of small red points, 
mostly grouped into circles or semicircles, of about 
a line in diameter; these gradually coalesce, forming 
strawberry-colored blotches, slightly elevated above RUBEOLA. 
315 
the surrounding surface; they mostly appear first 
on the face, extending to the breast, arms, body, 
and lower extremities, in order; they also invade 
the mouth, fauces, and, at times, the whole respira- 
tory tubes. The blotches are usually entirely dis- 
tinct, having more or less surface between them of 
a natural color, but sometimes they become con- 
fluent on the face, breast, and upper part of the 
arms. After the eruption fully appears, it relieves, 
in a great measure, the sickness, which at first is 
very annoying, but does not give much relief to the 
pulmonary disturbance, and the fever has no tend- 
ency now to abate, as in small-pox. In five or six 
days, both the fever and eruption begin to decline; 
the tongue, which had been intensely red, begins to 
assume a more natural appearance, the appetite 
returns, and the surface casts off its epithelium in 
the form of scales. 
Diarrhoea is a frequent attendant on this disease, 
and, if not very severe, proves salutary. 
Treatment.-In most cases of measles, very lit- 
tle should be done; bland drinks, unstimulating 
teas, such as balm, wild sage, etc., with two or three 
teaspoonfuls of the fever syrup in the course of the 
day, are all that is required. Nothing should be 
given to "strike out the measles;" no efforts will 
succeed until the proper time arrives, and then you 
cannot keep them back if you try. But injudicious 
efforts to bring out the eruption, often do much 
harm, by increasing the crop to a dangerous extent. 
If the fever he very high, and there be great heat 316 
on fever: 
of the surface, tepid sponging may be resorted to, 
and two or three grains of ipecac, added to a glass 
of cold water or mild tea, and the patient directed 
to take a swallow at short intervals. If the patient, 
on the contrary, is rather cool and restless, a few 
pretty full doses of the fever syrup, with a few 
grains of Dover's powder, will bring them to the 
right point. After the eruption is out, unless there 
are complications, I do nothing except to give the 
fever syrup in small doses; the best manner of ex- 
hibition is to add a teaspoonful to a glass of cold 
water, and allow them to drink that quantity* every 
two or three hours. The syrup undoubtedly mode- 
rates the fever, and prevents all accidents from 
•damp or cold, which are so often met with, and 
which are often serious; given in the above form, 
it enables the patient to drink a sufficient amount 
of water to supply the wants of the system without 
offence to the stomach, or injury any way. If the 
cough is very troublesome, and pulmonary distress 
considerable, add two grains of ipecac, and five 
of Dover's powder to a glass of mucilage, and give 
a tablespoonful every half hour. 
Occasionally the brain becomes deeply involved 
in this disease, and requires very prompt attention. 
In slight cases, a cold wet cloth to the forehead will 
be sufficient; but I had a case, a few years since, 
which required the whole head to bo enveloped 
with pounded ice, which had to be continually ap- 
plied for nearly forty-eight hours; the disease then 
yielded, leaving no unpleasant results. RUBEOLA. 
317 
To allay excessive itching and burning of the 
surface, wash and grease as directed for scarlatina. 
Great care should be taken, during convalescence, 
to avoid cold and exposure. If any unpleasant 
sequoela follow, they must be treated upon general 
principles. 
Recapitulation :-Time after the contagion is 
received until the disease begins to manifest itself, 
about fourteen days; forming stage, four days; 
eruptive stage, ordinarily, seven days; under the 
use of the fever syrup, from three to four days. 
Can the contagion be prevented from taking 
effect ? I think it can. 
For nearly thirty years I have been in the habit of 
using a means for this purpose which, so far as 
ever came to my knowledge, has never failed; this 
is the odor of turpentine. The manner in which I 
use it is to saturate a woollen cord, or, what is bet- 
ter, a slip of buckskin, and apply it around the 
neck, so as to fall pretty low down, resting upon 
the under garment and being hidden by the outer; 
it must not touch the skin, or it will irritate the 
sensitive surface of a child excessively. 
The first time I saw this remedy tried was on a 
crowded steamboat on the Ohio river. A case of 
measles occurred, and there were many unprotected 
persons aboard. I remained with the most of these 
long enough to know that the disease was not con- 
tracted. Since then, I have always recommended 
mothers to use this precaution when taking their 
children to camp-meetings and other public assem- 318 
on fever: 
blages, when the disease was known to be in the 
vicinity; and so far as negative evidence can prove 
any thing, trials enough have been made to settle 
the question as to its power. CONCLUDING REMARKS. 
319 
CHAPTER X. 
CONCLUDING REMARKS ON FEVER. 
There are many observations which the author 
would like to make, which did not seem appro- 
priate to come under any of the preceding chapters, 
and others which, though appropriate, were forgot- 
ten at the proper time, all of which he proposes to 
bring out under the above latitudinous heading, and 
perhaps will contrive to group the most of them, if 
not all, under a single section, giving a con- 
densed view of the various steps by which the 
author gradually departed from the strict antiphlo- 
gistic doctrines in which he was educated, and 
arrived finally to adopt the theory and practice set 
forth in this work. 
He thinks he can make this subject interesting 
as well as instructive to his readers, as it will give 
him occasion to bring into notice many curative 
means which may yet be found of advantage to fail 
back on for sake of variety, or when the articles 
now most relied on are not at hand, or are inad- 
missible from idiosyncracy, or some other cause. 
In Harrison county, Ohio, where the author was 320 
on fever: 
brought up, and in a large part of that section of the 
State, almost the only form of fever from which the 
inhabitants suffered was what was known as con- 
tinued bilious fever; sometimes a case of inflamma- 
tory fever occurred, but never chills and fever; there 
were some chills on the Ohio river, and they were 
frequent among the marshes of Still Water and 
some other sluggish tributaries of the Muskingum 
river, but the author had lived to study medicine 
without ever having witnessed the phenomenon of a 
chill. Now this bilious fever was a very formidable 
disease, and carried off a quota of our neighbors 
every year; it was ushered in with great headache, 
distressing sickness of the stomach, restlessness, 
etc., soon followed by an exceedingly hot skin and 
full, rapid pulse. The fever would slightly abate 
towards morning, but there was never any thing 
like a well-marked remission; it usually continued 
with little variation for several weeks, if the patient 
lived that long. 
The subjects were mostly persons in the vigor of 
life, and principally young men. The prevailing prac- 
tice of the day was to bleed freely at the start, then 
a vomit of emetic tartar, followed by free purgative 
doses of "calomel and jalap." On the next day 
the patient was usually again bled, and means at 
once put in requisition to produce salivation, as it 
was thought that no case could recoverthat was not 
mercurialized; but this was no easy matter to ac- 
complish, as the secretions seemed all to be locked 
up, which, with deprivation of water, (which was CONCLUDING REMARKS. 
321 
thought to be exceedingly dangerous to partake of,) 
often caused a dryness of the mouth and cracking 
of the tongue awfully distressing. Yet the doctor 
persevered under difficulties to push the mercurials, 
occasionally bleeding, often blistering until but 
little whole skin was retained by the sufferer, and 
vainly trying to allay the raging thirst and excite 
moisture, by giving sp. nit. and broken doses of 
emetic tartar. Sometimes the mercury did produce 
a local effect upon the mouth and salivary glands, 
producing a dry salivation, as it was called, which 
generally pretty soon eased the patient's sufferings 
in death; or, if he survived, terminated in deep 
sloughing ulcers, often ending in permanent mutila- 
tion. Well, this could not be avoided, said the doc- 
tor, as the mercury could not be brought to pro- 
duce its legitimate effect. But generally, after this 
system of practice had been pursued until the patient 
was emaciated, prostrated, and apparently about 
to succumb, the fever abated, moisture returned to 
the mouth, and pretty soon a profuse salivation fol- 
lowed, with all its untold horrors; but then, had 
this not been produced, the patient would certainly 
have died; so said the physician, and so thought 
the people; therefore there were no hard thoughts 
if the patient, after a tedious convalescence, got 
about with a permanently shattered constitution. 
This was the form of fever and mode of treat- 
ment with which I was familiar in my youth, and 
so was I taught to practice by Cullen and other 
writers, while studying my profession; and thus did 322 
ON f e v E K: 
the popular physicians practice under whom I 
studied. 
I was practicing in the neighborhood in which I 
was raised in the year 1830. This fever was very 
prevalent that year. I had a large practice, and 
treated my patients upon the above general plan, 
but contriving many small means of comfort, 
which of themselves were but trifles, yet served 
much toward lessening the patient's sufferings, and 
increasing the chances of the main remedy, calo- 
mel, to produce its legitimate effect; consequently, 
I was rather unusually successful, but still occa- 
sionally lost a case; and it continually occurred to 
me that there must be something wrong in the prac- 
tice that would suffer the strong man to die. About 
this time, two men in different sections of ray prac- 
tice wore attacked with this fever in its usual form; 
and as they had lost some of their friends under the 
management of physicians, and some others suf- 
fered more than death from blistering or morbid 
salivation, they resolved to trust to the efforts of 
nature, and take no medicine at all. As both were 
well known to the author, and lived in the line of 
his practice, along which he passed almost daily, he 
had a curiosity to watch the cases through their 
progress, and consequently often called; the dis- 
ease pursued the usual course, lasted the usual 
time, and then terminated by a return of secretion, 
just as all others did that recovered. I observed 
that they suffered much less than those put 
through the usual course-of treatment; they did CONCLUDING REMARKS. 
323 
not become so emaciated, and retained more 
strength, and had a speedier convalescence. The 
only means used in these cases was plenty of cold 
water drank at will, often applied to the head, and 
occasionally, when the heat was great, to the whole 
body. I was now fully convinced that ah my skill 
amounted to nothing, and that nothing was better 
than all I had been in the habit of doing. But 
should I abandon my profession, or should I seek 
to improve it ? I resolved to aim at the latter. I 
saw that the course pursued was too exhaustive, and 
assisted the disease to wear out the patient's ener- 
gies. Now I thought if I could find means that 
would accomplish the various effects which we all 
aimed to produce, that would not of themselves 
produce debility, I would be able to assist nature in 
sustaining the force of the disease, and aid in 
throwing it off. My knowledge of the virtues of 
our indigenous plants was now of service to me. 
This knowledge had not been originally acquired 
from books, but from observation and experience. 
In my early boyhood, doctors were "few and far 
between," and our mothers from necessity turned 
doctors. The author very early manifested some 
capacity and showed an inclination to wait upon 
the sick, and was soon installed as nurse in the 
family, and frequently acted as such among his near 
neighbors, always following the instructions of his 
mother, in whose skill he had great confidence-• 
who, by the way, was a woman of much good natu- 
ral sense, great prudence, and untiring energy: 324 
on fever: 
was, in short, in the proper sense of the term, a 
"strong-minded woman," and yet enjoys a green 
old age of over four-score and ten. 
In this way the author acquired a pretty good 
acquaintance with all the most useful domestic 
remedies, and it was now to this source that he 
turned in search of means by which he hoped to 
manage fever without causing exhaustion. 
Among our indigenous medicinal plants, the 
boneset {JEiipatorium Perfoliatum) was deservedly 
held in high repute; I knew it would act as an 
emetic, when given in form of a strong infusion, 
and administered freely; I also knew that it after- 
ward usually produced active perspiration; having 
also tonic properties, it left the system invigorated. 
So the next attack of fever I was called to treat I 
managed as follows: Finding a full pulse, throbbing 
carotids, great headache, etc., I thought I dare not 
omit bleeding, and perhaps it was best not to ; after 
abstracting twelve or fifteen ounces of blood, I ad- 
ministered half a pint of a very strong infusion of 
the boneset, and repeated in fifteen minutes; the 
second draught was soon followed with free emesis, 
throwing off considerable bile; a weaker infusion 
was now given, until I supposed all the bile then in 
the stomach was discharged; near a tablespoonful 
of Bateman's drops was now administered, for the 
purpose of quieting the stomach, and exciting per- 
spiration. I also gave ten grains of calomel to 
carry off the bile from the bowels, and be ready to 
act by the time the sweating process should be over. QOE 
CONCLUDING REMARKS. 
Perspiration was kept up pretty actively several hours, 
by frequent draughts of infusion of wild sage, with a 
grain of ipecac, to the pint. 
After getting my patient fairly under the sweat- 
ing process, and directing a tablespoonful of epsom 
salts administered in the morning to work off the 
calomel, I left quite pleased with the plan thus 
far. On my visit next day I found my patient 
much better, but there was still considerable fever; 
but the headache apd restlessness were much less. 
I directed a moderately strong infusion of the bone- 
set, with two grains of ipecac, to the pint, a table- 
spoonful every hour until the patient sweat or 
vomited, and then to be followed by the Bateman's 
drops, calomel, and wild sage tea, as on the day be- 
fore. On my third visit I found my patient quite 
clear of any manifestations of disease; there was 
very little prostration, appetite returning; directed 
a bottle to be half filled with equal quantities of 
dogwood, wild cherry, and yellow poplar bark, and 
then fdled with rye whiskey, (it being made in the 
neighborhood, it could be always obtained genuine,) 
the patient to take a wineglassful three times a 
day, to prevent relapse. This I looked upon as a 
great achievement-a case cured in forty-eight 
hours, which under my former treatment would pro- 
bably have lasted two or three weeks at least; and 
this without a sore mouth, and with a whole skin. 
My after experience was equally satisfactory. 
Some cases would linger a few days longer, and 
some required the aid of other means ; but whatever 326 
on fever: 
was done, the main point was kept in view, not to 
exhaust the patient's energies. Nothing was said 
about this new practice, and, therefore, the author 
escaped the odium of an innovator, and the opposi- 
tion of his professional brethren. About all that 
was said was, that " Thompson was very successful, 
and didn't give much strong medicine." The author 
pursued this practice for about six years, when his 
health failed from'excessive labor, so that he thought 
it advisable to seek a milder climate, and accord- 
ingly came to Tennessee. In the course of a few 
months his health so far improved as to warrant 
him again to commence practicing in a small way. 
Here he met with cases of the same grade of fever 
with which he had contended in Ohio; but there 
was a much greater tendency to chills; but as 
quinine had now been fully introduced, he found 
but little difficulty in the management of that 
feature. 
But he was quite at a loss concerning his favorite 
remedy, the boneset; it could not be found in the 
vicinity, and the dried article obtained at the drug- 
gists proved to be quite inert; so he was forced to 
seek a substitute, which he found in the vervine, a 
plant growing in almost every yard; he found it a 
more stimulating emetic than the boneset, but not 
quite so active; therefore a few grains of ipecac, 
-were added; ho also found in the scabish, a white- 
blossomed weed infesting small grain and clover 
fields, a most valuable sudorific. It is equally as 
powerful as the boneset, and much pleasanter, and CONCLUDING REMARKS. 
327 
Jess apt to nauseate. I now rarely bled, but still 
thought it essential to vomit, and after the vomiting 
my habit was to give ten grains of calomel with 
three of Dover's powder, and then commence with 
the infusion of scabish, adding a teaspoonful of sp. 
nit. dulc. to each draught if there were much heat 
of the skin; this was continued for several hours, 
and then followed with the infusion of wild sage, 
which I could always find. I also became ac- 
quainted with another exceedingly mild and plea- 
sant sweating remedy-the queen of the meadow. 
This is a most noble-looking plant, growing often 
fifteen feet high, with a stem an inch and a half in 
diameter; but it is rather a rare plant, being only 
found in rich bottoms untrodden by cattle; but, as 
the stem was the part I used, an inch of which 
being sufficient for a pint of boiling water, a single 
stalk would suffice for a year's practice. The tea 
made from this plant has hardly any taste, and 
when cold, is taken by patients freely during the 
highest fever, when any of the other remedies 
named would be contra-indicated, or too repulsive 
to be borne by the stomach. The tea of this plant, 
though destitute of taste, and apparently of medi- 
cinal virtues, yet often causes the fever to gradually 
abate, and a pleasant moisture to succeed. How all 
this time the author had no theory upon the sub- 
ject, further than that fever is a depressing agent, 
and requires to be met by means which will sustain 
the vital energies. About this time, what is known 
as congestive fever was first seen by the author, the 328 
on fever: 
phenomena of which impressed him still more for- 
cibly with the truth, that the cause of fever acts as 
a depressing agent. The same mode of treatment 
during the febrile stage, and large doses of quinine, 
after a remission had been obtained, enabled him to 
succeed very satisfactorily with this fever. But a 
few years later, he met with another form of fever, 
which brought him to a stand-still. lie had heard, 
for a year or two, of a fever prevailing in a distant 
neighborhood, which the physicians could not man- 
age ; it was said to go through whole families, and 
that very few recovered. One gentleman, who had a 
wife and several grown children with him, besides 
quite a number of negroes, was in the course of a 
year left alone, except a few old servants. Finally, 
I was called to a case which at first showed nothing 
peculiar, except that though the symptoms appeared 
to be quite mild, and the patient complained but 
little, yet my usual remedies did no good, and the 
disease went on as though nothing had been done. 
I soon found that my treatment was doing positive 
harm-the sweat was exhaustive, and ended in pros- 
trating diarrhoea. I abandoned sudorifics and re- 
sorted to blisters and calomel. At onetime I thought 
I bad succeeded: the liver acted well, and there 
was some appetite. Soon another case occurred, 
a brother of the first; I commenced treating him 
with broken doses of calomel, and occasionally a 
teaspoonful of salts. Both went on, alternately 
giving good hope of success, and then arousing 
all my fears, until death put an end to the strife. CONCLUDING REMARKS. 
329 
Now it was clearly evident, upon a quiet retrospect 
of the cases, that I had done no good, and I believed 
had done harm. I therefore resolved, had I other 
cases, to do nothing, and wait for light. Some live 
or six other cases occurred in the family, which, 
upon the do-nothing system, all finally recovered. 
I said I did nothing, but that is not strictly true. 
I had the surface sponged with tepid soapsuds 
whenever it was too hot, and the bowels poulticed 
when they were painful, suppositories of opium 
used when there was diarrhoea, and broken doses 
of epsom salts when they were costive. I never 
improved upon this treatment until about ten years 
ago. During the long rides I frequently took be- 
tween my home in Wilson and the Caney Fork 
country in Smith, where I was contending with 
epidemic dysentery, I carefully reinvestigated the 
whole subject of fever, and sought to analyze it, so 
as to ascertain what was essential, and what 
secondary or incidental. By this process, I ascer- 
tained that there were but two things which were 
always present; the absence of either was also the 
absence of fever; these are, as my readers know, 
nervous disturbance and capillary debility. How 
all the other symptoms of fever grow out of these, 
and how my present mode of treatment was natu- 
rally suggested by this theory, has been fully ex- 
plained in the preceding pages. 
This theory was often investigated, and the treat- 
ment proven by varied experience to be perfectly 
reliable, and of general application; for as it at- 330 
on fever: 
tacks fever by removing the condition in which it 
consists, causing the febrile movement to subside, 
as water ceases to flow when the supply is cut off, 
I expected that typhoid fever, taken at a stage be- 
fore inflammatory complications were formed, would 
yield to its power just as other fevers, and so it did, 
every case yielding in a few days. Now it is very 
improbable that I should have been mistaken in 
diagnosing the cases-I, who for many years had, 
with great care, noted the first symptoms of the 
disease, in order to avoid doing mischief by im- 
proper medication, and thus had become able to 
detect the disease in its very earliest stage, with 
very rare exceptions. I was not mistaken. Others 
have not been mistaken, and have succeeded as 
fully as I claim to have done. A few others, it is true, 
have not been so successful, but these only form the 
exceptions to the rule, that typhoid fever treated upon 
the plan laid down in this book, when taken in the incipi- 
ent stage, or before inflammatory complications are set 
up, will yield in a few days, leaving the patient very little 
weakened or injured in any way. 
Heretofore the author had kept his peculiarities 
of practice so much out of view, as to have at- 
tracted little or no attention. He now felt it to be his 
imperative duty to give the benefit of his improved 
plan to the world, how much soever he might per- 
sonally suffer. His conclusions were, that as thou- 
sands had voluntarily sacrificed even their lives, to 
procure a supposed good for their country, he could 
afford to die a moral or rather a medical death, CONCLUDING REMARKS. 
331 
especially with a strong hope of a speedy resurrec- 
tion. He accordingly removed to this city, and 
immediately embraced every opportunity that 
offered for promulgating his doctrines, and he has 
been more fortunate than he expected; he has now 
enlisted a host of true and worthy friends in favor 
of his views, into whose hands their support and 
defence could be safely trusted, were he removed 
from the field, or retire to recuperate. 
Now all the long years in which he quietly pur- 
sued the stimulating plan of treatment in fever, he 
considered himself as much alone in the world as 
did Elijah, when he had fled from the destroyer of 
the Lord's prophets; but, like him, he now finds 
that he was mistaken-that a remnant scattered all 
over our wide country have been, without concert, 
acting upon the same great principles, and adopting 
a practice corresponding to their views. True, 
none had gone beyond my conclusions arrived at 
thirty years ago, that fever was a depressing power, 
and had to be met by appropriate stimulation. 
Dr. S. A. Cartwright, then of Natchez, avowed 
this doctrine, and advocated the use of the peppers, 
many years ago, though unknown to me; but even 
his great name did not shield him from an over- 
whelming torrent of ridicule, which deterred him 
from making another hopeless attempt to bring his 
brethren to a knowledge of the truth. But I com- 
menced at a more fortunate era ; typhoid fever had 
forced the more prudent part of the profession to 
abandon extra debilitating measures, at least in that 332 
on fever: 
disease, so that, as I have said, this is a transition 
period, in which the tendency is to adopt the use 
of stimulants; and, very lately, this has shown 
itself among the high-priests of our profession in 
London and Paris. A controversy of considerable 
length, upon the propriety of bleeding, and other 
decided antiphlogistic remedies, in febrile and in- 
flammatory diseases, was carried on some time since 
between the savans of London and Paris. The 
principal champion of the opposition to the antiphlo- 
gistic treatment was M. Lois, of Paris, and his 
strongest opponent, Dr. Alison, of London; but 
the opponents of the lancet, and other exhaustive 
measures, having truth on their side, soon discom- 
fited their opponents, so that even Dr. Watson, who 
had taken an active part in the controversy, sur- 
rendered-reserving, though, in his capitulation, the 
position, that epidemic influences had so depressed 
the vital energies of the people, that their diseases 
are not now of the same grade as formerly, being 
of a lower type, and therefore less tolerant of 
venesection, etc.; but that when a case does occur 
of the former high grade, the same active deple- 
tion is called for as in former years. 
But M. Lois would not leave even this plank for 
him to stand on, but showed most conclusively 
that diseases had not materially changed, and that 
exhaustive remedies had been all the time as injuri- 
ous as they are at the present. But Dr. Watson 
not only yielded the main point, but, in doing so, 
has been guilty of such gross contradictions as would CONCLUDING REMARKS. 
333 
sink a common fame ; their effect upon him is, how- 
ever, yet to appear. Hear him and judge. He says 
in the latest edition of his work, " Years have passed 
since I have seen any instance of the disease (pneu- 
monia) which has required phlebotomy. I may say 
much the same of inflammatory diseases in general. 
They have all, as I firmly believe, been less tolerant 
of blood-letting since the cholera first swept over 
this country in 1832." 
Now hear what Dr. Watson said only three years 
before, (1855:) 
"The great instruments to be employed in the 
treatment of inflammation of the lungs, are the same 
which have so often been recommended by me in 
other inflammatory affections before-blood-letting, 
tartarized antimony, mercury. Of these, blood-let- 
ting is the chief." 
"The late Dr. Gregory, of Edinburg, was in the 
habit of saying in his lectures, that, provided he 
was called early to a case of pneumonia, he would 
be contented to dispense with all other aids than 
those of a lancet and water gruel. I am far from 
desiring you to believe that blood-letting is the 
only expedient required; but certainly the amount 
of the best experience, ancient and modern, is 
strongly in favor of its free and, I might almost 
say, prodigal employment. Very lately, one most 
distinguished French writer, M. Lois, has endea- 
vored to show that venesection has not much con- 
trol over the progress or event of pneumonia; and 
I advert to his opinion on this subject merely to 334 
on fever: 
caution you against being misled by it, as you 
might otherwise be, considering his well-merited 
reputation as an exact and faithful observer." 
Now, every man has the right of changing his 
opinion upon evidence, and it is his privilege to 
avow this change, or say nothing about it, as pru- 
dence dictates; but for a teacher of medicine by 
whose authority many thousands of practitioners 
regulate their practice, and upon the soundness of 
whose teaching the safety of millions depends, for 
a long series of years to pursue one plan of treat- 
ment in his own practice, and at the same time in- 
struct others to pursue a different treatment, and 
one, too, which he now publicly repudiates as dan- 
gerous, betrays a reckless disregard of human 
interest which amounts to nothing short of deep 
moral turpitude; or, if we choose to disbelieve what 
he says with regard to his practice in pneumonia 
and other inflammatory diseases, and put it upon 
the ground that he said this merely for the purpose 
of breaking the force of his fall, and for the purpose 
of claiming the credit of having seen and acted 
upon this supposed change much anterior to his 
compeers, then we must admit that he possesses 
small conscientiousness, and as little judgment, allow- 
ing himself to be betrayed by his vanity to make 
statements which his own writings so easily prove to 
be untrue; or that he has been knowingly a false 
teacher. But enough of this ; it is unpleasant; but 
my conscience1 would not suffer me to say less, as 
to this man thousands of physicians in our own CONCLUDING REMARKS. 
335 
country are still looking, as to "the law and the 
prophets," and having only the older editions of his 
work. 
It is evident that opposition to exhaustive mea- 
sures has become the popular doctrine in Great 
Britain and France at least. 
Hear how some of England's most popular writers 
stand upon the subject. Bennet, as is well known, 
was one of the earliest and most efficient champions 
of the new practice; he maintains that "antiphlo- 
gistic remedies in general, and blood-letting in 
particular, are unsuitable, and even hurtful, in all 
acute inflammations." Tanner, in his deservedly 
popular work on the Practice of Medicine, talks 
thus: after enumerating the objects to be accom- 
plished in successfully treating inflammations, he 
asks, "How are these desirable results to be ob- 
tained ? For very many years but one answer has 
been given to this question; viz., by the adoption 
of the antiphlogistic regimen; which consists essen- 
tially in the use of low diet, blood-letting, counter- 
irritation, active purging, mercury, and antimony. 
It is to be feared that these remedies still find favor 
with some practitioners; but I cannot help think- 
ing that the more closely disease is studied, the 
smaller will become the upholders of these antiphlo- 
gistic agents." 
Authorities could be multiplied. The above are 
sufficient to show that authority is now in opposi- 
tion to exhaustive treatment, even in the high 
latitude in which it originated. Of course it is still 336 
on fever: 
worse borne in this land of excitement, where 
excessive nervous excitability is more common than 
vigorous vital energy; and especially in the South 
and West, where all are more or less brought under 
the depressing influence of malaria. 
So now I am no innovator, and may perhaps 
shortly be denied even originality. New doctrines 
or new discoveries are generally scouted by the 
masses, but, if they work themselves into favor, 
somebody finds out that somebody else hinted at 
the same thing long ago, and presently the cry is, 
"It is but an old affair newly vamped up;" and 
many will even try to persuade themselves that they 
had all the time some such notions, and others will 
push themselves forward as its especial champions, 
treating the subject without allusion to the source 
from which they obtained their light, and thus all 
credit for originality may be filched from the right- 
ful possessor. Well, it is the way of the world, and 
we all have to submit to its decisions. 
But little more, however, has yet been accom- 
plished upon this subject in Europe, than to " cease 
to do evil;" they have not yet "learned Io do 
wellhave not yet given any satisfaction as to how 
the debilitating treatment does harm, nor have they 
introduced any efficient treatment in its stead. Now 
in this, at least, I claim to be ahead: I have shown, 
by plain, sound philosophical reasoning, why de- 
pressing agents do harm, and made it evident that 
they always did and always will do harm. APPENDIX. 
CHAPTER I. 
SOME FEMALE DISEASES. 
OF THE USE OF TIIE EXTRACT OF IIYOSCYAMUS AND OIL OF 
SASSAFRAS IN SOME OF* TIIE MISFORTUNES ATTENDANT 
ON PREGNANCY. 
Very shortly after commencing the practice of 
medicine, by a favorable state of circumstances, I 
got introduced into a pretty extensive practice of 
midwifery; and was soon led to regret the want of 
more efficient means for relieving many of the ills 
which are often associated with the pregnant con- 
dition than the medical science at that time fur- 
nished. Opiates, it is true, afforded alleviation; 
but generally at the expense of some other form of 
suffering or disadvantage, such as checking the 
natural secretions, disturbance of the head, etc. 
On one occasion, while waiting upon a tedious case 
of labor, I amused myself, along with the matrons 
(337) 338 
APPENDIX. 
present, in the enjoyment of the pipe rather freely, 
and suffered a good deal of vertigo as a conse- 
quence. In the course of the conversation which 
this incident gave rise to, one of the company 
observed that the dry bark of sassafras, combined 
with tobacco, would effectually prevent its unplea- 
sant effects upon the head. I laid this up in my 
mind, and on the first opportunity made the experi- 
ment, and found it eminently true; the sassafras 
not only preventing the injurious effects of tobacco, 
but speedily removing them when produced. I 
tested this repeatedly, by smoking in a strong pipe 
until my head was very disagreeably impressed, 
and then reloading with a mixture of sassafras 
bark; a few puffs of which invariably dispelled all 
unpleasant sensations. I now satisfied myself 
that sassafras was an anti-narcotic, so far as tobacco 
was concerned, and resolved to test its powers upon 
some other narcotic stimulants, and first selected 
the hyoscyamus. I added a drop of"oil of sassa- 
fras to every two grains of extract of hyoscyamus, 
and made it into pills by the assistance of flour, and 
tested it first upon myself. Being very susceptible 
to the influence of nervous stimulants, I began by 
taking one common-sized pill, and increased the 
dose until I took five at once, without producing 
any other effect than a most delightful sleep-such 
as I had not enjoyed since, when a child, I used 
to fall down under the shade of a tree when tired at 
play. I now believed I had obtained the desidera- 
tum for which I had been wishing; and experience F EM ALE DISEASES. 
339 
fully verified my anticipations. It acted like a 
charm in soothing the excited nerves, and saved 
my parturient patients of nearly all suffering, except 
the necessary throes of labor. For some time I 
was uncertain whether the narcotic property of the 
henbane was wholly counteracted, or only lessened 
by the sassafras ; but a mischievous little girl solved 
this, question for me. Her mother being pregnant, 
and suffering much from costiveness and erratic 
pains, I made a syrup of butternut, to which I added 
sixty grains of hyoscyamus and thirty drops of oil of 
sassafras to the half pint, and directed a table- 
spoonful to be taken often enough to keep her 
comfortable. Her little daughter, seeing her take 
it frequently, supposed it was, of course, something 
good, and, in the absence of the rest of the family, 
managed to get hold of the bottle, and finding it 
sweet, drank all that remained, which was over a 
gill, and contained at least thirty grains of hyoscya- 
mus. Her mother was at first frightened, and sent to 
the field for a boy to go after me, but, seeing no 
immediate unpleasant effects from the medicine, 
concluded to wait a while. The child, after a little, 
got into a crib and fell asleep, and slept quietly 
and naturally for about three hours, when the 
cathartic effects of the butternut aroused her. No 
injurious effects followed. I was now fully con- 
vinced that the sassafras rendered the hyoscyamus 
entirely innocent, and have ever since given it in 
just such quantity as to secure an immunity from 
suffering. I never pushed it to the extent that the 340 
APPENDIX. 
child did but on one occasion. In 1835, when the 
cholera was prevailing so fatally on Round Lick 
Creek, in Smith county, while at Mrs. Hearn's, 
where there were two corpses in the house, and 
one in the kitchen, and several more in a dying 
condition, a stout negro man, while walking across 
the yard with a spade on his shoulder intended to 
be used in preparing graves, was attacked with 
such violent cramps as to cause him to scream out. 
The spasm was of the clonic kind, making his 
lower extremities and body as rigid as if frozen. 
I happened to have a bottle of the above syrup in 
my pocket, which I had prepared for a lady who 
had been confined the previous evening, and whom 
I intended visiting in my round, and immediately 
gave him about four ounces, containing at least 
forty grains of hyoscyamus. In a few minutes the 
spasm relaxed, and he assisted all day in burying 
the dead. I don't give this as a case of cholera; 
I did not consider it as such; and yet it doubtless 
was produced by the joint influence of cholera and 
fear. I did give it, though, in genuine cases of 
cholera, and always with the effect of relieving 
the spasm, provided the stomach retained it a few 
minutes; but, unfortunately, it was often rejected 
before it had time to produce any impression. 
Having ascertained the controlling power which 
the remedy was capable of exerting over many 
forms of disease arising from morbid innervation, 
and looking upon most cases of abortion and pre- 
mature labor as originating from that cause, I ex- FEMALE DISEASES. 
341 
pected it to prove valuable in their treatment, and 
was not disappointed when I brought it to the test 
of experience. I have now used it in all cases of 
this kind happening in a pretty large practice for 
about twenty-five years, having more calls than 
usual in the same amount of general practice, my 
success having given me some notoriety in that 
line; and I recollect of no case of failure, where 
I was called in previous to the occurrence of con- 
siderable expulsive uterine contraction. But as 
cases are more impressive than mere general obser- 
vations, I will, in a very concise manner, give a few 
of the most prominent which have been treated with 
this remedy. 
Case 1.-1835, Smith county, Rev. Charles Led- 
better's negro woman, aged thirty; commenced 
bearing children at fifteen; had five in quick suc- 
cession, after which she aborted five times between 
the sixth and seventh month. Commenced giving 
the medicine, viz., the hyoscyamus and sassafras, 
at the middle of the sixth month, and continued 
it six weeks. She went to the full period, but 
had a dead child; after which she had four living 
children. 
Case 2.-1840, S. Berdine's negro woman, aged 
thirty-five; had two children when very young, and 
had aborted nearly every year since, between the 
third and fourth month. Commenced giving the 
medicine as soon as she was known to be preg- 
nant, and gave it until the period of quickening. 
She wont her full time; had a fine living child. A 342 
APPENDIX. 
year after, again became pregnant; gave the medi- 
cine with the same result, after which she ceased 
breeding. 
Case 3.-1843, Mrs. S married at fifteen ; 
had two living children, then three miscarriages in 
succession about the sixth month. Commenced the 
medicine a while before the catastrophe was ex- 
pected; continued it four weeks; did well, and 
continued afterward to bear living children. 
Case 4.-1845, Mrs. D , Wilson county, mar- 
ried young; had a living child, which died; after 
which she aborted every year for seven or eight, 
about the third month. Commenced the medicine 
as soon as pregnancy was known, and continued 
until after quickening; had a fine child at the 
full time; three years after, had another; both still 
living. 
Case 5.-Mrs. C married at fourteen; had 
two children; after which she had severe flooding 
about every six months for four or five years. She 
did not consider them abortions; said they came 
on a week or two after she ought to have been un- 
well. I requested her, in case of another attack, to 
save all that passed until I could be sent for; which 
she did. It presented the appearance of blood 
only, but upon putting it into a vessel of water, I dis- 
covered something like an organized mass, and 
placing this in a fresh basin of water, I had pre- 
sented the finest specimen of an embryo I ever saw. 
It was about the size of the chick on the eighth or 
ninth day of incubation, and very much resembled FEMALE DISEASES. 
343 
one. There was an umbilical cord of about two 
inches in length and the size of a wheat straw, and 
a placenta, perhaps two and a half inches across the 
disc, presenting on the maternal surface a most 
beautiful flocculent appearance while floating in the 
water. Gestation in this case could not have existed 
more than thirty-live days. I gave her a supply 
of the medicine, and directed her to commence 
taking it immediately after missing a menstrual 
period. She did so, and next year had a living 
child. 
Case 6.-Thomas Edwards' negro woman, aged 
about twenty-five, commenced breeding quite young, 
and had miscarried nearly every year since at about 
the fifth month. Commenced g-iving- the medicine 
as soon as she felt the child, and gave it regularly a 
month, and afterward, whenever she felt pain in her 
back. Went the full period and. did well. Has since 
had another. 
Case 7.-A sister of the last, belonging to the 
minor heirs of E. Hearn, was similarly unfortunate ; 
had had many miscarriages about the third month. 
Commenced giving her the medicine as soon as 
pregnancy was known, and continued it until 
quickening. Did well. 
Many other similar' cases could be given, but 
these are deemed sufficient. It will be observed 
that in all the above cases, child-bearing was com- 
menced quite young; and my recollection is, that 
all were of a lax fibre and nervous temperament. 
In the treatment of the above, and similar cases, 344 
APPENDIX. 
the form of the medicine was varied to suit the in- 
clination of the patient-some preferring that of 
pills, and others a syrup; and the quantity was also 
proportioned to their susceptibilities. Other reme- 
dies were also added, to meet such indications as 
presented; usually nothing more, however, than a 
little blue-mass when the liver was torpid, or but- 
ternut when there was slowness of the bowels. To 
sum up the purposes for which I give the above 
remedy: I give it in all cases of threatened abortion, 
when not caused by accidents or severe sickness. 
I use it for all the nameless pains, aches, and dis- 
quietudes attendant on conception and gestation. 
I give it to prevent, and to remove when present, 
premature and erratic pains in the latter stage of 
pregnancy. In fact, in all cases in which I am pre- 
viously spoken to, I put the patient upon its use a 
week or more before the expected confinement, for 
the purpose of removing any excessive nervous ex- 
citement of the general system, especially of the 
os uteri; thus preparing it to yield kindly to ute- 
rine contraction; and after delivery, I give it to 
soothe the excited system, and prevent those spas- 
modic contractions called after-pains. I know that 
many consider these pains to be necessary and salu- 
tary, but females with first children, when the tonic 
contraction of the uteris is good, do not have them; 
and I also know that in after-labors they have, in 
my practice, done very well without them. 
Case 1.-I will now give some cases of a differ- 
ent character from the above. In January of 1849, FEMALE DISEASES. 
345 
I was called on by a Mr. B , who had lately 
moved within six miles of me, and with whom 1 
had had no previous acquaintance, who wished me 
to cause his wife to abort. lie informed me (which 
I afterward found to be correct from other sources) 
that his wife had, the previous year, come to the full 
period of pregnancy, and that although he had the 
services of several experienced accoucheurs, they 
were unable to deliver her without literally taking 
the child to pieces, and that they informed him that 
his wife never could bring forth a living child. Ide 
also informed me that two of her married sisters 
had to have their children delivered in this manner. 
I consented to visit his wife, telling him at the 
same time that I did not expect to procure abor- 
tion. I found her a fine-looking lady, rather short 
for her weight, large muscular developments, and 
flesh unusually firm. I made an examination per 
vaginam, and found, indeed, but very little space, 
owing principally to the fulness and firmness of 
the soft parts. But my conclusion was, that there 
was bony room sufficient to admit of the passage 
of a common-sized head. I accordingly positively 
refused to procure abortion, but expressed myself 
confidently that I could put her upon a regimen 
that would enable her to have a living child. This 
was about the third month, and I requested him to 
visit me on the seventh for further instructions ; for 
the present I recommended nothing more than a 
teaspoonful of epsom salts daily, to keep her sys- 
tem cool. He called at the time directed, and I 346 
APPENDIX. 
sent tine, of valerian, with vinous antimony sufficient 
to slightly nauseate the stomach, which, besides other 
benefits, would enable her more effectually to carry 
out my injunctions of low diet. The valerian be- 
ing a good diuretic, would serve to keep up a drain 
from the kidneys, and I directed the salts to be 
taken daily, in such quantity as would secure a 
moderate purgative effect on the bowels. I also 
sent a box of the pills of hyoscyamus, to be taken 
freely during the last stage of gestation. At the 
full period I was sent for, and was pleased to find 
that my plan had worked well. There was still a 
good, deal of embonpoint, but the textures were all 
soft and pliant; and, on examination, I found a fine 
dilatable condition of the soft parts. In short, 
after a common labor, she was delivered of a 
sprightly common-sized child. It was characteristic 
of the family to have large children; and my plan 
of treatment contemplated a retarding of the 
growth of the foetus, as well as a softening of the 
textures of the mother. 
I had often witnessed this effect follow daily pur- 
gation, when brought about for other purposes. 
This was the first instance in which I availed myself 
of this means intentionally. 
Case 2.- Mrs. A , wife of Mr. A , of 
Nashville, a respectable English lady, had been 
married over twelve years, and had never borne a 
child sufficiently matured to live; had generally 
miscarried between the sixth and seventh months, 
sometimes between the third and fourth. These FEMALE DISEASES. 
347 
misfortunes finally undermined her health, and the 
usual symptoms of uterine, hepatic, and gastric 
derangements became prominent, and finally, in the 
fall of 1852, she presented the symptoms of jaun- 
dice in marked form. She obtained the advice of 
several scientific physicians, but failed to receive 
more than partial and temporary relief; and for 
several months had run the round of irregulars and 
nostrum-venders. At certain intervals her stomach 
would sympathize so strongly with the deranged 
liver and uteris, as to throw her into most intense 
suffering; and during one of these attacks I was 
consulted. I found her with great tenderness of 
the epigastrium; frequent retching to vomit; dis- 
tressing pain m/the right hypochondrium, with 
evident enlargement; extremities cold, with skin 
the color of a very dark orange; discharges from 
the bowels like white pipe-clay; urine almost black. 
She informed me that her skin had been the present 
color, with slight variations, for seven or eight 
months; and that during that time there had not 
been the least trace of bile seen in the discharges. 
Treatment: a mustard bath to the feet; a large 
blister over the liver; a blue-pill every six hours; 
and a tablespoonful of the comp, syrup of valerian 
every two hours. On the morning of the third day 
I had the pleasure of witnessing the following 
favorable symptoms: distress and anxiety entirely 
subsided; pain in the right side gone; copious dark 
bilious dejections from the bowels; free discharge 
of natural urine, etc. From this time her recovery 348 
APPENDIX. 
was rapid; in a week her skin was ciear, her tongue 
clean, and her spirits buoyant. But in order to 
prevent a relapse, the syrup was continued three 
times a day for several weeks. I now informed her 
that in all probability she would soon become preg- 
nant again ; but that if she would inform me when 
the event happened, and put herself under my 
treatment, I thought I could enable her to go 
through the period of gestation and bear a living 
child. Accordingly, in a short time Mr. A in- 
formed me that he believed his wife was cnciente, and 
on visiting her I was convinced that he was correct; 
I therefore immediately put her upon the use of the 
following formula: 
R Ext. liyoscyamus, §j. 
" butternut, §vij. 
Oil sassafras, gss. 
Sup. carb, soda, s-ij. 
Simple syrup, qt. ii. 
I directed her to use just enough of this to keep 
up a regular condition of the bowels, and to prevent 
all irregular action of the uterus. Under this treat- 
ment she got along very finely until about the mid- 
dle of the seventh month, when there was an evi- 
dent disposition manifested by the uterus to expel 
the fcetus. Believing that the organ, having formed 
a habit of expelling its contents prematurely, would 
not bear much further distension, I thought best to 
make an effort to arrest any further development 
of the fcetus; and having succeeded in producing 
this effect in several other cases in which I thought 
it advisable, by a free use of this medicine, I 349 
FEMALE DISEASES. 
directed her to increase the dose, so as to produce 
tolerably free purgation. This effect was steadily 
kept up during the remainder of the term, and no 
more unpleasant symptoms occurred. At the full 
term I was called on, and, after a rather tedious 
but not difficult labor, delivered her of a fine, well- 
formed female child, weighing five pounds. The 
mother and child both did well. In about two 
years Mrs. A again became pregnant, and, be- 
ing now in good health, thought it unnecessary to 
apply for medical advice; nothing unusual hap- 
pened until about the sixth month, when labor-pains 
suddenly came on; the foetus was expelled. Six 
months subsequent, she had the usual evidence that 
conception had taken place, and applied to me for 
aid. I placed her upon the same treatment as on 
the former occasion, giving the comp, syrup of 
butternut freely, after the sixth month, with an oc- 
casional blue-mass pill, with a view of retarding the 
development of the child, which it did as before, 
and with a like happy result. Both children are now 
living, one five, and the other two years old. 
Dr. Moses, of Eldridge, Ala., writes: 
"Your comp, syrup of butternut for the relief of 
females I have used frequently, and with not only 
the happiest results to my patients, but also to my- 
self, getting me a reputation, and large practice 
among that class of patients." 
Query: Would we not be justified in placing 
females under this treatment who habitually bear 
unusually large children, and consequently endure 350 
APPENDIX. 
severe suffering? So far as I have had experience, 
the treatment is entirely compatible with the best 
health to the mother, and safety to the child; for, 
although small, they have uniformly been vigorous 
and healthy, and grew finely. 
SLIPPERY-ELM. 
I have no intention of writing a history of the 
slippery-elm, but merely to refer to some new pre- 
parations of it which I have lately made, which I 
think are both convenient and useful, explaining the 
mode of their preparation, uses, etc. 
Of the medicinal properties of the slippery-elm I 
need say nothing-they are known to the profes- 
sion, and to the people; it is simply a cooling de- 
mulcent, and has been used from time immemorial 
as a soothing external application to inflammations, 
and as a cooling drink in internal irritations, etc. 
The value of the slippery-elm poultice to inflamed 
surfaces is well understood, but it is subject to two 
objections: in many positions it cannot be easily 
applied so as to be retained in situ, and is always 
disgusting to the nice and fastidious; then it is 
subject to dry at the edges, and adhere with great 
tenacity, often causing as much harm in its re- 
moval as it did good in its application. To avoid 
these objections, I conceived the idea of combining 
it with some non-irritating substance which would not 
easily dry, and making it into cloth, so as to be of 
easy application and not subject to dry and adhere ; 
and also avoid the opprobrium of nastiness. Chinese FEMALE DISEASES. 
351 
sugar-cane molasses seemed to possess the required 
properties, and I tried it and succeeded. By first 
wetting the pulverized slippery-elm bark with 
water, so as to make a tough mass, and then add- 
ing the molasses until it became thin enough to 
spread, I succeeded in obtaining the article desired. 
But I found this was not easily done, so as to pre- 
sent a smooth, even surface; after many efforts, 
however, I succeeded in the following manner: I 
spread smooth domestic, on a flat non-absorbing 
surface, and spread the mass on it with a broad 
spatulas as well as I could; I then laid another 
piece of cloth over it, and continued my efforts until 
I obtained the requisite finish ; then dried it in the 
sun. Afterward, by wetting the surface, the cloth 
will readily leave the composition, and it presents 
the appearance of thick, wet parchment, and can 
be applied in a moment to any part of the body by 
simply wetting one side, and has the great ad- 
vantage of adhering with sufficient tenacity to retain 
its position, and yet will never dry so as to become 
hard. It is better to allow the covering of cloth 
to remain until it is wanted for use, and then only 
remove that on the side intended to be applied to 
the inflamed surface. As many physicians would 
not wish to be at the trouble of making this pre- 
paration, however simple, I have invented machinery 
by which I can have it done with expedition, arid 
will furnish it to the druggists as the demand may 
require. 
Slippery-elm has been long occasionally used as 352 
APPENDIX. 
a bougie; its soothing properties, united with its 
great powers of expansion by the absorption of 
water, naturally pointing it out as a suitable material 
for this purpose. But the great difficulty was to 
obtain it of a suitable form. This I effected in 
the following manner; viz., I split the bark into 
fine slips, and then, when moistened, pressing them 
together, and wrapping them thoroughly with 
twine, and then drying. But this method, though 
practicable, is troublesome, and will often fail-the 
fibres not equally adhering. I have made a die by 
which great pressure can be applied, and the mass 
made to unite as perfectly as though it grew in that 
form. I make them perforate like a catheter. 
It is hardly necessary to dilate upon the advan- 
tage of this instrument ; it operates more expedi- 
tiously, and with less suffering, than any other 
appliance of which I have any knowledge. Any 
amount of dilation can be obtained by it. I have 
no doubt that the urethra can be dilated suffi- 
ciently to admit of the removal of small stones with 
ease. In stricture of the urethra its use is signally 
beneficial; it can be introduced when no other 
bougie or catheter can be passed. I will relate a 
case in point. 
A negro man, belonging to a Mr. Wade, nine 
miles below, came to the city with his master's 
team; had had gonorrhoea, and a stricture remained, 
but had not prevented urine from being voided. 
But fatigue, and perhaps stimulation, had caused 
irritation, and his urine was suppressed. An intel- FEMALE DISEASES. 
353 
ligent physician was called on, who exhausted al] 
his skill in vain endeavors to pass the smallest 
catheter; when I saw him he was in horrible 
torture, and had instinctively put himself in a 
reversed position, his feet upwards. I also at- 
tempted the use of the catheter after a full loss of 
blood and an opiate, but without success. I now 
rode back to my office for a small slippery-elm 
bougie which I had a few days before prepared, and 
with but little effort passed it into the bladder; 
after letting it remain a few minutes I withdrew' 
it, for the purpose of using a catheter; but there 
was no occasion, as the urine flowed freely, and soon 
relieved the bladder. 
A great advantage of the slippery-elm bougie over 
every other in efforts to enlarge the urinary pas- 
sages, besides its soothing properties, is, that when 
made perforate, it can be allowed to remain until 
the full effect of its expansion is obtained without 
having to be removed in order to allow the urine to 
pass. Would it not be the most suitable catheter 
to leave in the urethra after the operation of litho- 
tomy ? 
The following interesting case was read by the au- 
thorbefore the State Medical Society, April 7th, 1857 : 
CASE OF UNRUPTURED HYMEN AFTER TWELVE YEARS EN- 
JOYMENT OF CONNUBIAL PRIVILEGES. 
Mrs. , about thirty-five years of age, of usually 
robust health, had been happily married over twelve 
years, but having failed to obtain pledges of love. 354 
APPENDIX. 
consulted me as to the cause. Upon inquiry I 
ascertained that the catamenia had always been 
regular as to recurrence, but continued an unusual 
length of time, always becoming dark and fcetid 
toward the termination, and, contrary to what is ob- 
served in dyspmenorrhcea, there was no pain or con- 
stitutional disturbance at the commencement of the 
period, but these symptoms invariably supervened 
after a few days, becoming more intense toward the 
close, often extending through the second week, 
so that the period occupied near half the entire 
month. 
As these symptoms were rather peculiar, I judged 
there was an abnormal condition of the reproductive 
organs, and suggested a vaginal examination. To 
this she objected; but, after several unsuccessful 
efforts to correct the condition of things, finally 
consented, when, to my surprise, I found the vagina 
terminated in a complete cut de sac about two and a 
half inches from the vulva. As the walls felt per- 
fectly smooth and elastic, giving no evidence of 
cicatrization, and she had never suffered vaginitis, 
and especially as she averred that the parts had 
always been in this condition, I felt assured that it 
was a case of Unruptured Hymen. As the catamenia 
had found a place of exit, I knew there must be an 
aperture, but for a long time was unable to detect 
it. The speculum showed a smooth, unbroken sur- 
face; the tactus euriditus failed to detect any pro- 
minence or indentation which might indicate the 
point of connection between the divisions of the FEMALE DISEASES. 
355 
vagina. But after fully failing to discover where 
it probably was, I turned my attention to where it 
possibly might be; and finally established its posi- 
tion about midway of the parietes of the vaginal 
sac, near an inch behind the meatus urinarius, just 
where I should at first have looked for it, but was 
misled by the hymen having been thrust upward 
until it apparently formed a part of the true vaginal 
walls. Into this opening I succeeded with some 
difficulty in introducing a small silver probe, which, 
having passed the barrier, played quite freely within, 
showing that there was plenty of vagina above. 
This condition of things fully accounted for the 
symptoms attending the menstrual period; for as 
the discharge found an exit with difficulty, it col- 
lected in the posterior part of the vaginal cavity 
above the septum, and was there retained until 
partial decomposition took place, giving rise to the 
pain, feetor, and nervous disturbance attending the 
latter part of the menstrual period. The first idea 
that suggested itself was to divide the septum ; but 
as it had proved itself possessed of sufficient solidity 
to successfully resist the shocks incident to the wars 
of Venus for so long a period, I feared that its divi- 
sion might be attended with troublesome hemorrhage 
and constitutional disturbance. But feeling assured, 
by carefully watching the play of the probe, that 
the parietes were quite thin immediately below the 
aperture, I cautiously thrust a narrow bistoury by the 
side of the probe, turning the cutting edge from the 
bladder, making an aperture sufficient to permit the 356 
APPENDIX. 
passage of a common-sized silver catheter. But al- 
though the cutting occasioned no pain, and was fol- 
lowed by inconsiderable hemorrhage, yet, as I was 
satisfied that the walls of the septum increased greatly 
in thickness immediately below the incision, I de- 
sisted for the present. A few days subsequently con- 
siderable cerebral disturbance came on, whether from 
the incision, or from some other cause, I cannot say, 
but it made me fearful of again resorting to the 
knife, and I laid the case before my friend, Professor 
Bowling, who suggested that a trial be made to dilate 
the aperture by the use of slippery-elm bougies. 
As the plan appeared to be feasible, I immediately 
put it into practice, and with the most happy and 
entire success. 
Commencing with one of the size of a crow quill, 
I daily replaced it with one slightly larger, until in 
a few weeks one of an inch and a quarter in diame- 
ter could be introduced with facility. Believing 
that this was sufficient for all present practical pur- 
poses, I concluded to trust to natural processes for 
further development, which proved to be quite ade- 
quate to the task. Although the menstrual func- 
tion has since been performed with great facility, 
and without pain or nervous disturbance, and the 
uterus clear of disease, yet the main object of the 
operation has not yet been obtained, viz., fecunda- 
tion. This may be owing to the fact that the os 
tincoe had found a resting-place in the posterior por- 
tion of the sac, above the septum, and still remains 
imbedded in such a way, that it docs not correspond FEMALE DISEASES. 
357 
to the plane of the vagina, which error of position 
may probably yet be remedied. But though the 
maternal desire has not been gratified, the shorten- 
ing of the catamenial period, and the freedom from 
suffering which has been secured, amply compen- 
sate for the trifling inconvenience which attended 
the cure. 
While manufacturing the bougie, it occurred to 
me that this would be the very material of which 
to make pessaries, provided I could succeed in giving 
it the proper shape, which, after much trouble, I 
succeeded in doing; since then, I have succeeded 
in making them with less trouble, and also greatly 
increased their virtues by suitable medication. 
My usual plan and formula is as follows : To one 
pound*of flour of slippery-elm, I add four ounces 
of pulverized sassafras bark; and of Dover's pow- 
der and balsam copaiva, each, two ounces; add 
water slowly, and work the mass until it acquires 
the consistence of stiff dough; then roll it into 
balls of from an inch to two inches in diameter, 
and put them in the sun or under a stove to dry; 
when they begin to feel hard, I moisten them, and 
after some hours, manipulate them into shape, and, 
then dry again; if they crack, or assume a bad shape, 
I again moisten them, and repeat the manipulations 
until I obtain the necessary shape and smoothness. I 
have lately had machinery constructed, by which they 
can be made with considerable rapidity, and much 
neater and firmer than can possibly be done by hand, 
and expect to keep a supply with the druggists. 358 
APPENDIX. 
It is hardly necessary for me to offer any explana- 
tion of the modus operand! of the above medicated 
pessary in the cure of many female afflictions, or 
to give evidence of its usefulness, as both will be 
perceived in a moment by every one at all ac- 
quainted with the materials used, and the maladies 
In which the pessary is indicated. But this pessary 
is of advantage in a variety of cases in which other 
pessaries would not only do no good, but produce 
positive injury. I have concluded, therefore, to 
give a hasty sketch of the various ills for which I 
have used it with advantage: 
Case 1.-Soon after having made the first slip- 
pery-elm pessary, I was called to see a lady who was 
suffering from retention of urine, an affliction from 
which she had suffered much during the' early 
months of two former pregnancies-her physician 
having to visit her daily for weeks, and use the 
catheter; but as he could not be found on the pres- 
ent occasion, I was called in. Now it occurred to 
me that my pessary was the very article indicated 
in this case; and, after giving present relief by the 
catheter, I introduced one, and informed her that 
it would probably relieve her from any further an- 
noyance, which proved to be so. 
Case 2.-Soon after this, I was called to see a 
negro woman at Boyd's sale-house, who had fallen 
down stairs, she being in the seventh month of 
pregnancy. Manifest symptoms of miscarriage soon 
occurred, attended with great soreness and tender- 
ness of the abdomen. I ordered a poultice to the belly, FEMALE diseases. 
359 
and introduced a medicated pessary; in a few hours 
the urgent symptoms all subsided, and she was up 
the next day. But about a week subsequently, I 
was hastily sent for, and she informed me that she 
had miscarried, but that it was no child-she passed 
it too, she said, without pain; upon examination, I 
found it to consist of the pessary I had introduced, 
greatly enlarged; she had not been aware that I 
had introduced it all. She afterward brought forth 
a fine child at the full time, and did well. 
Case 3.-Soon after this, a stout negro woman 
was brought to the sale-house from Georgia. She 
had come all the way in the cars without stopping; 
her courses being on her, and the nights cold, sup- 
pression was the consequence, attended ■with great 
pain, acute tenderness, and considerable tumefac- 
tion of the whole abdomen, and high symptomatic 
fever. I gave her a purgative of castor-oil and tur- 
pentine, ordered fomentations to the belly, and in- 
troduced a medicated pessary. General relief fol- 
lowed very speedily. 
Case 4.-A lady who had suffered much for a 
number of years with neuralgic affections and bron- 
chitis, and who had had several premature delive- 
ries, in consequence of the uncontrollable cough and 
nervous pains, always increased by reflex uterine 
sympathies, was now in her eighth month, and im- 
minently threatened with miscarriage from the 
above causes. As she had been under the direction 
of several skilful physicians, who had exhausted all 
the usual remedies, I resolved to try the power of 360 
appendix. 
the soothing and anodyne properties of the medi- 
cated pessary, supposing that, as the lungs were 
pathologically sympathizing with the womb, I could 
make them do so curatively. It acted beyond my 
expectations, giving complete relief. 
Case 5.-A negro woman belonging to Captain 
Walton. Had dyspnienorrhoea; had been married 
for a number of years, but remained barren; her 
health continuing to decline, until she was incapa- 
ble of attending to business; had jits at each men- 
strual period. Found the womb as large as in the 
third month of pregnancy, feeling as hard as a ball 
of wood, and very heavy; great tenderness of the 
cirvex, which was of a deep mahogany color, with 
some epithelian abrasions, profuse flocculent dis- 
charge, etc. 
Introduced the medicated pessary, and put her 
upon sarsaparilla and iodide of potassium; intro- 
duced a fresh pessary every week, until three had 
been used. The uterus had now become soft and 
of natural size, tenderness all gone, general health 
much improved; has remained pretty clear of suf- 
fering, and has had no fits for over six months; 
attends to business as other negroes ; had one spell 
of suffering since, which was soon relieved by the 
use of the pessary. In this case there was not much 
prolapsus. 
Case 6.--A negro woman belonging to J. B. 
White. Had suffered with ulceration and prolapsus 
of the womb many years; had been frequently 
treated by different physicians, with only temporary FEMALE DISEASES. 
361 
benefit. She came under my care about eight 
months since. I examined with the speculum, and 
found the womb very low-much enlarged, and 
considerable abrasions; she was generally dropsi- 
cal ; feet and legs much swollen; I used the pes- 
sary, and put her upon sarsaparilla and potassium, 
as in the fourth case. Iler general health improved 
rapidly, and there has not been much complaint of 
the womb disease since, except on one occasion, 
when she had very imprudently exposed herself, 
and was suffering great pain in the back and abdo- 
men, simulating labor-pains: the pessary gave her 
prompt relief. 
Case 7.-A negro woman belonging to Mr. Har- 
ris, of this city. Had sent her to the State Hospital 
for treatment nearly three years ago, where she re- 
mained about two years; during this time, I exam- 
ined her several times, at the request of the super- 
intendent, Dr. Wharton ; her womb was very low, 
and greatly enlarged, quite hard, and adherent to 
the vaginal walls; cirvex nodulated, and frequently 
extensively ulcerated; most of the time suffered 
great torture, so that full doses of opiates had to be 
resorted to, to give partial relief; was fully treated, 
according to Bennet, with leeches, scarificator, caus- 
tics, etc. Her disease would at. times apparently 
yield, but about the time she wTould be thought 
ready to leave the hospital, would suddenly return 
with renewed force. When Dr. Wharton left the 
hospital, he said to me that he did not knowr 
what would become of Clara, as she had been 362 
APPENDIX. 
already a great expense to her kind master, and was 
not yet fit to be removed from the immediate eye 
of a physician. I suggested, that if Mr. Harris were 
willing, I would take her to my house and attend 
her there; he saw Mr. Harris, and the arrangement 
was made. I immediately used the medicated pes- 
sary, and nothing else, except an anodyne at her 
monthly period; she soon improved so as to be- 
come useful, and has, for the last several months, 
done the entire duties of our kitchen. I used per- 
haps half a dozen pessaries in her treatment; she 
still complains, at times, of erratic pains, but her 
general health is good; the womb is still rather 
low, having formed adhesions to the walls of the 
vagina, but has become accustomed to its position, 
and tolerates it. 
Such cases could be detailed unto weariness that 
have yielded to this remedy, but it is not necessary; 
a mere suggestion of the instrument, also suggests 
to the mind of the intelligent physician its advan- 
tages. It is the very thing we wanted, a means 
that will hold the womb in place, and at the same 
time subdue irritation, remove hardness, allay fever, 
and promote the healing of ulcers. 
A few words perhaps should be said as to my mo- 
tives for selecting the particular articles which com- 
pose my medicated pessary. The slippery-elm is 
the base, and without it the thing could not be made 
at all; but without the sassafras, the pessary would 
be a nuisance. A few hours' confinement in an in- 
flamed vagina, and absorbing its hot, vitiated secre- FEMALE DISEASES. 
363 
tions, will cause such a decomposition as to convert 
it into an irritating foetid mass; but the sassafras 
prevents this; it effectually stays decomposition, 
and removes foetor if already present. I distinctly 
stated this property of sassafras when treating on 
dysentery, published in the Nashville Medical Jour- 
nal in 1853, and transferred to this book. 
The balsam capaiva is added to the pessary be- 
cause of its known power over inflammation of the 
mucous membrane. Its action in gonorrhoea is 
believed not to be specific, but general; and it has 
been reported, by good authority, to cure when 
applied locally, by injection alone. I have long 
used it as one of the best means in bronchitis and 
chronic dysentery, and have lately apparently cured 
several cases of gonorrhoea in the female, with no 
other means but the medicated pessary and injec- 
tions of tepid water. The Dover's powder is intro- 
duced for the purpose of relieving present sufferings, 
but it acts not merely as an opiate-it possesses 
other powers as a topical as well as an internal 
remedy. 
As regards the application of the pessary, there 
is but little skill required; patients, with a little in- 
struction, will do that themselves. It is only to be 
remembered, that it must be dipped in water immedi- 
ately before insertion; a few minutes' delay will make 
it tenacious, and of difficult introduction; the cup- 
side must be applied to the os uteri, and the woman 
directed to remain in a recumbent position fifteen 
or twenty minutes; by that time the pessary has 364 
APPENDIX. 
adjusted itself to the uterus, so as to adhere with 
considerable force, and there will be no danger of 
its displacement, even should it be very small, and 
the vagina morbidly dilated. On this account I 
find it unnecessary to vary the size to suit the ca- 
pacity, as with other pessaries. It is best, in all 
cases, to let the pessary remain until it begins to 
disintegrate. If there is abundant secretion, this 
will take place in a few days; and if there is great 
dryness of the vagina, it is best to use tepid injec- 
tions occasionally, so as to make the pessary act as 
a poultice. DISEASES OF CHILDREN. 
365 
CHAPTER II. 
SOME DISEASES OF CHILDREN. 
I can only notice a few of the diseases incident 
to infancy and childhood on the present occasion, 
and these are noticed because I think they have not 
been well understood by systematic writers, or that 
I think I have something new to offer that is valu- 
able upon the subject. 
STROPHULUS - RED-GUM - HIVES. 
There is a certain disease well known to mothers 
and nurses, and country practitioners who have 
been some years in the practice, but the young 
physician may consult his standard works on prac- 
tice in vain for any satisfactory description. Hence, 
he will most probably deny the existence of any 
such disease as Awes, except as another name for 
croup; and yet he will presently be called to treat 
a case, occurring within the first month after birth, 
which he sees at once is not croup, but is an equally 
formidable disease, and will most probably baffle all 
his skill, the infant dying in a few hours from 
strangulation. The women tell him the child died 366 
APPENDIX. 
of hives ; and as it died, it was the hives-which 
name, fortunately for his reputation, saves him 
from all blame, as the general belief is that bold 
hives always kills. 
Upon a careful examination of authors upon this 
subject, I find the mild form of this disease is con- 
sidered as a variety of red-gum, while the graver 
form is confounded with croup. Dr. Wood so treats 
it, describing the mild form very accurately, as a 
variety of strophulus or red-gum, a general descrip- 
tion of which, including this, he gives as follows: 
" In all its forms, strophulus is, with few exceptions, 
an acute disease, generally beginning to exfoliate 
and disappear in one or two weeks, and seldom 
continuing longer than a month. It is very rarely 
attended with fever, and often occurs without any 
observable disturbance of health. When febrile 
symptoms do occur, it is not always certain whether 
they are essentially associated with the eruption, or 
proceed from some other cause. Strophulus is 
almost always an innocent complaint. Its retro- 
cession is thought sometimes to have been followed 
by serious internal irritations; but it is very diffi- 
cult always to determine, in such cases, whether 
the disappearance of the eruption is cause or effect." 
Now, from this description, we would naturally 
conclude that the disease was of not much moment 
any way; not more important than itch, nettle- 
rash, milk-scab, etc.; and yet, if you will inquire 
of country practitioners of what disease the most 
children die under six months, they will say hives. DISEASES OF CHILDREN. 
367 
I have said country practitioners, for my observa- 
tions have led me to believe that the disease is 
much more common and more fatal in healthy 
country situations than in cities; for this, a reason 
will be given hereafter. I have so frequently seen 
this disease present symptoms not described in 
the books, and assume a character so much more 
grave than is assigned it by writers, that I have 
been almost ready to doubt its being the same 
malady; but its milder forms being the same as 
described, I have concluded that some writer, cen- 
turies back, who had never seen the disease in 
its worst aspects, wrote a description of it, and 
others have merely copied without investigation. 
For some years past, I have embraced every op- 
portunity of interrogating practitioners from every 
part of our country upon this subject, and have 
ascertained that they all are familiar with the dis- 
ease in its gravest forms. I therefore take it for 
granted that it is a much more formidable disease 
throughout the world than agrees with the descrip- 
tions in the books. 
The only cause of difficulty in this disease re- 
ferred to by authors, is when the eruption is repelled 
from the surface, and the irritation transferred to 
the stomach and bowels. But I have never known 
any very serious consequence arise from this cause; 
the means they all prescribe, will usually meet the 
difficulty very promptly; viz., a warm bath, a 
gentle emetic, and a few testaceous powders. It 
is only when the irritation extends to the air-pas- 368 
APPENDIX. 
sages that the disease becomes really dangerous; 
and this form has been wholly overlooked, or con- 
founded with croup, by every writer I have had an 
opportunity of consulting. The eruption is not 
always repelled in these cases, neither do I believe 
that the irritation is even transferred from the sur- 
face to the air-passages, for I have often seen the 
rash plentifully on the skin, at the same time that 
the infant was threatened with suffocation from a 
filling up of the air-tubes by a thickening of their 
coats, and a secretion of tenacious mucus. It is 
true that the rash always fades before the child 
actually dies, because the capillary action has then 
become too low to sustain it; but a striking in of the 
eruption is not the cause, nor is a transfer, but 
an extension of the irritation from the surface to the 
air-passages. Hence the means recommended by 
writers for the relief of cases in which the disease 
has been transferred to the stomach and bowels 
will, in this, prove of no avail, but may do positive 
harm; for the means that will increase the erup- 
tion on the surface, will at the same time increase 
the irritation in the mucous lining of the air-pas- 
sages, and, consequently, increase the morbid secre- 
tion which is already threatening suffocation. Who- 
ever has tried nauseants and the ordinary warm 
bath in this disease, when there was considerable 
eruption on the surface, and the child breathing 
hurriedly, and auscultation detected very decided 
mucous rhoncus, has presently ascertained that he 
had gained nothing by the treatment, but injured DISEASES OE CHILDREN. 
369 
his patient. For although nauseants, if carried to 
vomiting, may for a time appear to have produced 
benefit, by disgorging the phlegm which was ob- 
structing the bronchia, yet the formation of it is 
actually increased by the measure, and the little 
sufferer will presently breathe with more difficulty 
than ever. A repetition will obtain a still shorter 
respite, at the expense of a still more abundant 
secretion ; and if the practitioner now resorts to the 
warm bath, with a hope of succeeding, he will find 
the advantage obtained equally deceptive. While 
the child is in the water, the inhalation of hot vapor 
will, for a time, expand the lungs, and render the 
morbid secretion more fluid, so that the air finds a 
readier passage into the air-cells, and breathing is 
consequently easier; but the bath is rapidly exhaust- 
ing nervous power, which will soon reduce the vital 
action of the capillaries, disqualifying those of the 
lungs still further for returning to a healthy con- 
dition, and lessening the ability of the respiratory 
apparatus for taking on such action as is necessary 
for freeing the lungs from the accumulating mucus; 
while at the same time the action of the bath upon 
the surface, by direct sympathy with the mucous 
lining of the bronchia, increases the amount of the 
secretion which is wanted to bo thrown off We 
see, therefore, good reasons why these measures 
which are mainly relied on, and which are so uni- 
formly successful in relieving a transfer of the dis- 
ease to the stomach and bowels, should not only 
fail to afford relief when the disease has extended 370 
APPENDIX. 
to the lungs, but aid it in its too certain victory 
over the vital powers; and the attendant will very 
soon have the mortification to see his little patient 
turning livid from a failure in the aeration of 
the blood, and still less able to make the extra- 
ordinary respiratory efforts required for forcing the 
air through the tenacious mucus, or to discharge 
it. But fortunately, while the black blood sent to 
the brain is destroying nervous power, it also de- 
stroys sensibility, and all conscious suffering is soon 
at an end; and coma, being presently followed by 
asphyxia, soon terminates the struggle. Now, as 
children who die of this form of disease always 
turn livid, presenting purple spots before they die, 
or immediately after, if convulsions have hastened 
death before asphyxia had time to do its work, 
the matrons of the land call it the bold-hives ; and 
hence, as this appearance is never presented until 
death is inevitable, or has actually taken place, the 
opinion is well founded that bold-hives is never 
cured. As children who die of croup, generally 
present this same appearance, and from the same 
cause, it is generally confounded with this form of 
hives by nurses, as well as by doctors. But they 
arc very different diseases-this is peculiar to early 
infancy; I have known of no case occurring after 
the first year, and rarely after six months, and by 
far the greater number happen within the first 
month after birth ; but croup is not a disease of 
infancy ; few cases happen under two or three years. 
Then, again, they affect different locations: croup DISEASES OE CHILDREN. 
371 
is a cynanchia trachialis, and this a cyuanchia brom 
chialis-that is, croup is located in the wind-pipe, 
and mostly at its upper extremity, while this is 
located in the minute branches, and perhaps in the 
air-cells; croup is characterized by a shrill sound, 
as if breathing through a metallic tube, or like the 
crowing of a cock, as the name implies; but this is 
known by a flat plashing sound, as of air passing 
through water, or more like gas escaping from paste 
while boiling; it resembles mucous rale in pneumonia 
more than any thing else, and is the result of about 
the same condition. 
But though croup and this form of hives are 
very different in their commencement, they run 
very near together in their termination; both 
usually kill by producing asphyxia; and croup, 
though always attacking the upper part of the 
trachea at the commencement, often extends its in- 
fluence downward, until, if protracted, it is seen to 
produce the identical effects upon the minute 
branches, and the air-cells, characteristic of hives, 
occasioning, too, the same rapid accumulation of 
morbid secretion. 
I have already hinted that this form of hives 
is probably much less prevalent in cities than in 
the country, and I now say it is more prevalent in 
the most healthy regions of country; the same I 
think will be found to be true also of croup; and 
the reason that both are the most prevalent where 
there is the highest health, is because both are dis- 
eases of high action, laying hold of the most pre- 372 
APPENDIX. 
cocious developments of the sanguino-nervous 
temperament. This being the kind of subject most 
commonly attacked by this form of hives, it may 
readily be perceived why it should be seldom met 
with in city practice, such constitutions being rarely 
found there among infants; and it also explains 
the omission of writers to notice the disease, as all, 
as far as I know, have learned disease as presented 
in cities. , 
Treatment. - The disease, then, at its com- 
mencement, being one of high action, the indica- 
tions are for the use of such measures as will 
subdue over-action; but while selecting them, we 
must remember also that our patient, though robust 
and sanguine, is also highly nervous and excitable, 
rendering the system extremely subject to collapse 
of nervous power; we must not, therefore, make 
any heavy drafts upon the source of vital energy; 
hence bold depletory measures are entirely out of 
the question; such means only should be resorted 
to as will subdue excessive arterial action, with the 
least expense to the general strength, combined 
with appropriate means for allaying nervous excita- 
bility. I am not at all certain that I have fallen 
upon the best possible measures for filling these 
indications, for all my efforts have occasionally 
failed of success, but have proved much more 
certain than the plan I was taught and practiced 
in my early professional, career. They are as 
follows: When called to see an infant, and I per- 
ceive its face flushed, eyes somewhat suffused and DISEASES OF CHILDREN. 
373 
slightly injected, considerable restlessness, not cry- 
ing as from pain, but making rather a grunting 
moan, often desiring a change of position, seizing 
hold of the breast with energy, but letting go after 
a few draws as though for want of breath, breath- 
ing rather short, and more than usual heaving of 
the chest, I suspect at once that I have this disease 
to contend with, and inquire of the mother or nurse 
if the child has had any breaking out. If I am in- 
formed that it has not, I examine still closer the 
condition of the surface, and I will perhaps detect 
the appearance of an eruption within the skin; but 
if this should fail to be detected, I proceed further, 
and, having the infant's face turned toward a strong 
light, I excite it to cry, so that the fauces and 
pharynx may be fully exposed; and if the surface 
appears to be suffused, with more or less distinct 
evidence of a fine papillary eruption, I become 
satisfied it is this form of hives, but that it has 
commenced in the air-passages, and has not yet ex- 
tended to the general surface. In this stage there 
is not much secretion from the mucous lining, 
the difficulty in breathing being occasioned by over- 
fulness of the vessels, and a thickening of the lining 
of the cells and air-passages. In. this stage I direct 
a mustard bath, as warm as the child can bear 
without occasioning positive suffering, the object 
of which is to equalize the circulation, and invite 
the eruption to the skin, so as to produce an equili- 
brium of action between the external and internal 
surfaces. This bathing should only be continued a 374 
APPENDIX. 
few minutes at a time, and the child enveloped in a 
light flannel in the interim; at the same time I 
administer, internally, grain doses of cafome? every 
hour, and a tablespoonful of catnip or hop tea every 
fifteen minutes. The mercurial is given to produce 
revulsion to the liver, and alsp to make that organ 
perform some of the labor usually assigned to the 
lungs. As soon as bilious discharges are obtained 
I discontinue the calomel, but continue the tea, for 
the purpose of quieting nervous excitement and 
maintaining the action on the liver and bowels. 
These measures will rarely fail to procure entire 
and permanent relief. But if I have been called 
in later, and find the child breathing with great 
difficulty and exhibiting the peculiar sounds indi- 
cating profuse secretion in the air-vesicles, the 
countenance anxious and distressed, the pulse hur- 
ried, etc., I adopt a very different set of means. 
In this case the excessive secretion must be dimin- 
ished, or the child will inevitably die of asphyxia; 
it cannot be thrown off fast enough, by any means 
which can be devised, to prevent a fatal accumula- 
tion. My only hope now is in the cold wet sheet. 
I order a panful of cold water, and another of 
very warm water, and dipping a large towel, or 
some other conveniently obtained cloth, in the 
warm water, envelop the child's lower extremities 
in it; and then saturating another in cold water, 
apply it around its naked body, and over it a dry 
flannel. As soon as reaction is fairly established, 
I remove the cloths, not desiring a perspiration. I DISEASES OF CHILDREN. 
375 
give nothing in this case but the teas above named, 
administered cold. A fresh application of the 
cloths should be made every hour or so, until entire 
relief is obtained; then calomel may be adminis- 
tered as before, for the purpose of revulsion, and to 
free the blood from the carbon which has accumu- 
lated in consequence of imperfect aeration. If 
given sooner, the sickness occasioned by it might 
have completed the prostration. The rationale of 
the cold application is easily given-it arrests the 
morbid secretions, just as it does internal hem- 
orrhage, by acting as an astringent; it also excites 
the surface. I deprecate a sweat, because it would 
invite an increase of the secretion in the lungs, by 
concert of action with the surface. 
CYNANCIIIA TRACHIALIS - CROUP. 
This is a disease of high action, most prevalent 
in healthy country situations, and in northern lati- 
tudes. It is seen much more frequently to the 
north of Mason & Dixon's line in our country than 
to the south. I met with ten cases of this disease 
in Ohio, in the same amount of practice, to one in 
Tennessee. Here, the great majority of the cases 
which I have seen, that were supposed to be croup, 
were nothing more than common cold in a phthisi- 
cal child; the stifled cough and wheezing respira- 
tions of which are easily distinguished from the 
ringing cough and crowing respiration of cynanchia 
irachialis. This misnaming of the disease has led 
many to look upon croup as rather a slight com- 376 
APPENDIX. 
plaint, which a warm bath, or a snuff plaster to 
relax spasm, and a little melted butter and honey 
to allay the tickling of the glottis, are fully able to 
subdue. But croup lays hold with a giant grasp, 
and demands the prompt interference of our most 
efficient measures to meet it successfully. 
In the management of the first stage of this dis- 
ease, I have never been able to improve upon the 
plan taught me by Doctors Hamilton and Judkins, 
then of Mt. Pleasant, Ohio, when a student of 
medicine; which was the warm bath, and calomel 
and ipecac, in such doses as would produce, first, 
active emesis, and then a brisk cathartic effect; and, 
at the same time, a fly-blister to the throat and upper 
part of the chest. As there is usually great insensi- 
bility to the influence of medicine in this disease, 
the dose must be very large, say from ten to twenty 
grains of each, and then made to act as an emetic, 
by free draughts of weak mustard water. This 
plan will fail in very few cases to give entire relief, 
if adopted early; but if the disease has progressed 
until it begins to assimilate the severe form of hives, 
described in the last chapter, these measures be- 
come very hazardous; and for reasons therein 
given. I treat this stage of croup just as I do the 
advanced stage of hives, to which I will refer the 
reader. I would even now, however, apply the 
blister as soon as considerable relief had been ob- 
tained by the cold cloths, in order to prevent a 
relapse. DISEASES OF CHILDREN. 
377 
OPHTHALMIA. 
When called to a case laboring under this dis- 
ease, we should consider whether it is catarrhal, 
malarious, or scrofulous, as our diagnosis must, to 
some extent, determine the plan of treatment. 
This distinction can generally be made with ease, 
but occasionally it is quite difficult. In fact, a case 
may be the combined result of several causes, and 
present a mixed character, in which it may be diffi- 
cult to determine which element preponderates. A 
person, for example, may have been impressed by 
malaria, and then exposed to atmospherical vicissi- 
tudes ; and both of these causes may operate upon 
a scrofulous constitution, and then the case might 
be both catarrhal, malarious, and scrofulous. But 
generally one of these causes so far impresses itself 
upon the disease, as to give it character, and deter- 
mine the peculiarity of treatment. Common ca- 
tarrhal or inflammatory opthalmia is usually recog- 
nized by the mode of its accession, it being ushered 
in along with other symptoms of cold. But little 
skill and less medicine are necessary to manage this 
form of sore eyes successfully, if taken at an early 
stage. A dose or two of epsom salts, a hot mustard 
foot-bath, and bathing the eyes in warm water, will 
effect very certain and speedy relief. But if the 
attack comes on after exposure to a malarious at- 
mosphere, and is ushered in with many of the 
symptoms commonly associated with an attack of 
malarious fever, such as headache, loss of appetite, 378 
APPENDIX. 
dinginess of the surface, a sense of weakness, etc., 
we may safely consider it malarious ophthalmia, and 
treat it as we would an attack of bilious fever, with 
calomel, quinine, etc., paying very little attention 
to the local disease of the eyes. But if the patient 
has had an attack of sore eyes, without any of the 
common symptoms of cold, or those of the first 
stage of bilious fever, the first indisposition being 
an unusual sensibility of the eye to light, subse- 
quently becoming a dark-red, and always being 
much relieved by shutting out the light; and 
especially if we detect other evidences of a scrofu- 
lous diathesis, we may, without hesitation, set it 
down a case of scrofulous ophthalmia, and treat it 
accordingly. The plan which has succeeded best 
in my hands in managing this form of sore eyes is, 
to put the patient upon an alterative course of medi- 
cine internally, and apply anodyne collyria to the 
eye. The best alterative course is sarsaparilla and 
iodide of potassa; and, as a local application, I 
have found nothing to compare with the following: 
Spts. nit., 1 oz.; chloroform, 1 oz.; morphine, 5 gr.; 
rose water, 4 oz.; saturate raw cotton and bind it 
to the eyes on going to bed. 
I will illustrate the effect of this treatment by re- 
porting a case. In the spring of 1854, I was called 
to see a little daughter of Mrs. Lane, South Vine 
street. I found the child's eyes so exceedingly sen- 
sitive, that it was with great difficulty I could ex- 
amine them at all. They were swelled and deeply 
injected with blood, and had to be covered with DISEASES OF CHILDREN. 
379 
several folds of some dark material to keep down 
intense suffering; yet when it was quite dark, she 
could uncover her eyes, and would play about the 
yard with as much glee as children usually do in 
the day. Iler mother informed me that she had suf- 
fered in the same way the most of the summer of '53, 
and that medical aid had been resorted to without 
benefit. I looked upon the disease as inflamma- 
tory, complicated with chylopoetic derangement, 
and put her upon strict diet, purgatives, and cool- 
ing applications to the eyes, but no benefit followed. 
And after trying my prescription for several weeks, 
it was dropped, and another physician, eminent for 
his skill, called to take charge of the case; who, 
taking the same view of the case which I had, pur- 
sued a similar mode of treatment, with a like want 
of success. She was then taken to the Springs, 
but still obtained no relief; but as the weather be- 
came cool, she gradually improved, and remained 
pretty clear of suffering all winter. Being at the 
house on some other occasion, I examined her eyes, 
and found that one had suffered but little, but there 
was considerable opacity of the cornea of the other. 
I now began to suspect that I, as well as all the other 
physicians who had attended on the child, had mis- 
taken the nature of the case; that the disease was 
not primarily inflammatory, but that the child was 
of a scrofulous habit, and that the disease first 
manifested itself by morbid sensibility of the retina; 
and that the intense irritation of light, acting upon 
this morbidly sensitive nerve, created so much irri- 380 
APPENDIX. 
tation as to set up inflammation in the organ. I 
informed Mrs. Lane that I thought I had a better 
understanding of the disease than I had had the 
previous summer, and that if the child's eyes com- 
menced getting worse, as usual, in the spring, I 
would like to watch them. I was accordingly sent 
for, and found that I- was correct, so far as the 
origin was concerned: that the morbid sensibility 
was the cause of the inflammation, and not it, as we 
all had supposed, the cause of the sensibility. I 
did nothing for a time but watch the progress of 
the disease, until it had assumed a virulence equal 
to any previous attack. I then put her upon the 
plan stated above, and in a very few days had the 
satisfaction of seeing a decided amendment; and 
in a few weeks the disease was so effectually re- 
moved, that she could run in the sun without a 
bonnet, and has remained well until now, notwith- 
standing she went through the ordeal of an attack 
of measles during the summer. The plan pursued 
was, to apply pledgets of cotton, saturated with the 
collyria, to the eye every night on going to bed; 
remove them in the morning and let them remain 
off an hour or so, and then reapply, and keep them 
on until evening; then again leave them off an 
hour or two. After considerable amendment, the 
application was only made at night; and finally, 
only occasionally. The internal medicine was com- 
posed as follows: two ounces of comp, syrup vale- 
rian, (my common fever syrup,) two ounces of comp, 
ext. sarsaparilla, and one drachm iodide of potassium. DISEASES OF CHILDREN. 
£31 
Of this I ordered a teaspoonful after each meal. I 
combined the fever syrup in this prescription, for 
the purpose of giving tone to the bowels and re- 
straining diarrhoea. 
I have treated several other cases of a similar 
kind, with the same flattering success-cases which 
were originally of the true catarrhal kind, and also 
those having a malarial origin, in scrofulous cpnsti- 
tutions. 382 
APPENDIX. 
CHAPTER III. 
SCROFULA, WHITE SWELLING, AND CHRONIC ULCERS. 
As the history and symptoms of scrofula can be 
found in extenso in every general work on practice, 
and would occupy too much space in this work, 
they will be wholly omitted: neither will we enter 
into the subject of the hygienic and dietetic treat- 
ment necessary for its prevention, for the same 
reasons, but will at once proceed to give our plan 
of treating the disease when developed in any of its 
usual forms. 
And as the disease essentially consists in per- 
verted action, the remedies most relied on are of 
course what are known as alterants, and the best 
alterative compound which I have ever used, in the 
course of a long experience, in scrofula, is the 
following: Fluid extract of sarsaparilla, six ounces ; 
tincture of valerian, two ounces; syrup of rhubarb, 
two ounces; oil of sassafras, one drachm; piperin, 
thirty grains; iodide of potassium, six drachms; 
mix. Dose, a teaspoonful three times a day, for a 
child, to be taken in milk; a tablespoonful may be 
taken by an adult. After the above quantity has SCROFULA. 
383 
been taken, the medicine should be suspended for 
a week or two, and the following given instead: 
Wild-cherry bark, elecampane, and burdock root, 
each, one ounce; good spirits, one quart; let it 
stand forty-eight hours, then strain, and add one 
pound of coarse-grained cane sugar, and heat until 
it dissolves. Dose, a tablespoonful for a child two 
or three years old, and in proportion for older 
persons; it is best to give it, and all other medi- 
cines intended to enter the circulation, after eating. 
The medicine then combines with the food, and is 
absorbed with it; whereas, if given on an empty 
stomach, it is often refused by the absorbents, and 
passes off with the dejections, and no benefit is 
derived. The principal object of changing the 
medicines is, that the system may not become 
insensible to their action by long repetition. These 
means, with the occasional use of others for meet- 
ing particular conditions, as laxatives in constipa- 
tion, prepared chalk and nutmeg, for too much 
looseness of the bowels, etc., have, in my hands, 
superseded the necessity of resorting to any other 
internal remedies for removing the constitutional 
disease; and, this being done, its local manifesta- 
tions will be easily managed, and often will dis- 
appear without the use of any external means. 
When there is much deficiency of the red globules 
of the blood, shown by the want of color on the 
surface, and a tendency to bloat, indicating dropsical 
effusion, iron, in some form, is recommended by 
every author, and its use should never be neglected. 384 
A PPENDIX. 
The best form which I have found for giving it is 
the following: Take of elecampane root, four 
ounces; water, one quart; simmer for two hours, 
strain, and then simmer it down to about half a 
pint; add one pound of coarse brown sugar while 
the infusion is hot; after it has cooled, add one 
ounce of burnt copperas, well pulverized and sifted ; 
mix thoroughly, and shake the bottle well before 
using, each time. Dose, a teaspoonful after each 
meal. 
Now, why the above form should act better than 
many other preparations of iron, I am not able to 
give a very satisfactory reason; but that it does, 
much experience has proven to my full satisfaction. 
I will relate a case illustrative of its power over 
this cachectic condition: A son of Mr. T. Mason, 
of Smith county, of rapid growth and flabby tex- 
ture, had exposed himself, along with other boys, 
by wading in the creek, catching minnows; a 
severe cold ensued, attended with enlargement of 
the glands of the throat and neck, followed by 
general bloating of the whole body; surface un- 
usually white and apparently semi-transparent, 
much resembling a frozen turnip; breathing hurried 
by the least exertion; general muscular weakness, 
and great indisposition to move ; pulse rapid; and, 
though the artery felt large under the finger, yet 
the slightest pressure was sufficient to arrest the 
current of the blood. I drew a few ounces of blood 
from the arm, in order to ascertain whether the 
peculiar whiteness of the surface was really owing SCROFULA. 
385 
to deficiency of the red corpuscles, or to the effusion 
of serum in the cellular tissue under the skin, or to 
both. I found the blood almost colorless ; it merely 
left a slight dirty-looking stain upon white linen. 
I prescribed the above formula in tablespoonful 
doses three times a day, and nothing else, except 
bathing in hot mustard water, and dry friction to 
the surface; and requested that I should be in- 
formed if no material amendment was experienced 
in a few days. I heard of him no more, until about 
three wreeks after, when I was sent for to see 
another member of the family. While there, a fine 
rosy-cheeked boy came into the room, and seemed 
unusually glad to see me; his father observed that 
I didn't seem to recognize my patient; nor could I, 
after being informed, hardly realize that it was the 
same child whom I had before seen, with scarcely 
vitality sufficient in the blood to continue the very 
lowest manifestations of life. There was now evi- 
dently an excess of red corpuscles in the blood, and, 
on examination, I found his pulse not only full, but 
also rather resisting, indicating active plethora; 
and fearing that this condition, if continued, might 
lead to the development of some form of active 
inflammation, I ordered the medicine to be discon- 
tinued and his diet restricted; no return of scrofu- 
lous or cachectic symptoms was afterwards seen. 
I will now give a very different case. The 
patient was a youth of about eighteen, but would 
have been taken for ten or twelve. So deficient 
had been the development of the physical system, 386 
APPENDIX, 
that signs of puberty were wholly wanting. His 
weight was but sixty pounds; and much the larger 
half of this was owing to a hard and tumefied 
abdomen. His skin was shrivelled, and of the 
color of pipe-clay; in short, he presented all the 
characteristic of a sample case of cachexy 
and dirt-eating. He came of scrofulous parents; 
and, out of many brothers and sisters, all, except 
one beside himself, had died of some form of the 
disease before puberty. 
Notwithstanding this patient was so emaciated, 
and had so little vitality, yet there was a constant 
tendency to fever, alternating with sweats or diar- 
rhoea. I prescribed the before-mentioned formula, 
as in the other case; and, to break up the fever, 
prevent the wasting discharges from the surface 
and bowels, and also arouse the liver, which was 
enlarged and torpid, I gave a pill every night made 
as follows: blue-mass, sul. quinine, and castile 
soap, each twenty grains; make twelve pills. 
The pills were discontinued after the twelve had 
been taken ; but the chalybeate and tonic syrups 
above-mentioned were continued alternately for 
several months; a gradual improvement was soon 
perceptible, and in twelve months the change was 
truly remarkable: from a puny-looking child, he 
had changed to quite a respectable-looking young 
man; puberty had not only taken place, but the 
new, rich blood had occasioned feelings which 
prompted him to "take to himself a wife." 
As I left that neighborhood soon after the occur- 387 
SCROFULA. 
pence of this important event in his history, I am 
unable to follow his fortunes farther; but it would 
be interesting to learn, in the event that he-became 
the father of children, whether they inherited the 
constitution of their parent as a scrofulous boy or 
as a vigorous man. I would judge the latter; " for 
thou shalt begot a son in thine own image and like- 
ness;" such as thou now art, and not such as thou 
hast been, or may yet be in the future. 
Local Treatment.-Although scrofula is a consti- 
tutional disease, and must be met by remedies 
addressed to the general system, which will remove 
the scrofulous condition out of which or from which 
the local manifestations proceed, yet much may 
often be done by means applied directly to the local 
disease. By these measures, if timely resorted to, 
the external disease maybe kept in check, and time 
gained for removing the constitutional condition, 
which it is often very important to gain, as much 
suffering and annoyance may thereby be' warded 
off, and, when seated about the neck, or other parts 
usually exposed, deformities prevented, ■which is no 
trifling consideration in the case of girls; unsightly 
scars about the throat and neck are little less 
dreaded than death by them; and this feeling, to a 
certain extent, is not only natural, but right. God 
made the beautiful as well as the useful in nature; 
and in man, and especially woman, ho exhibited 
the finest specimen of his "handiwork;" and it 
becomes our duty, as far as possible, to prevent this 
inimitable work of God from being marred, and its 388 
A P P E N D I X . 
beauty turned into deformity. But, besides this, 
the local affection reacts upon the general condition, 
and makes it more difficult of removal; and, in 
case of large suppurating surfaces, this is often im- 
possible to be done, without first lessening the 
discharge, owing to the exhaustion which they 
occasion by the heavy draught which is made upon 
the materials of nutrition ; and the nervous disturb- 
ance and want of rest which they occasion, often 
also greatly interfere with the general health; so 
that local treatment is, in many cases, not only a 
valuable assistance, but an indispensable necessity 
to the successful management of the case. 
These remedies may be properly divided into two 
classes: the first includes those which have a ten- 
dency to bring about resolution, and so prevent 
suppuration, and the formation of an abscess. The 
second embraces all those means which may be 
rendered effectual in hastening the reparative pro- 
cess by which lost tissues may be restored, and an 
abscess healed, if already formed. While upon the 
subject of general treatment, it was unnecessary to 
specify particular forms or manifestations of the 
scrofulous disease or condition; but now this be- 
comes essential, as the treatment will have to be 
varied according to the nature of the tissue princi- 
pally involved and the locality of the local disease. 
And, first, of that form known as king's evil, in- 
volving the glands of the neck and throat. Fortu- 
nately, these enlargements are usually very slowly 
developed, giving ample opportunity for the exhi- SCROFULA. 
389 
bition of constitutional remedies, as well as for the 
application of local appliances; but no time should 
be lost in bringing every means to bear upon the 
disease as soon as it is known to exist; for when 
the scrofulous predisposition or diathesis has once 
been awaked by an exciting cause, and the peculiar 
inflammatory action characterizing active scrofula 
set up, the longer it continues, the more intense 
the scrofulous condition becomes, the greater will 
be the amount of tissue especially involved, and the 
further will be the progress of structural change, 
and, of course, the greater will be the difficulty of 
restoring the natural condition again, both general 
and local. Those having the care of children, 
therefore, who have inherited a scrofulous taint, or 
who have shown any predisposition to that disease, 
should timely institute such a course of manage- 
ment as will be most likely to ward oft'the develop- 
ment of the disease, or to check it, as it were, in 
the bud. 
And while such a course is steadily persevered in, 
measures should be taken to cause the absorbents 
to remove the morbid deposits composing the 
tumors. Many authors protest against the use of 
such means, believing that the constitutional dis- 
order would be augmented by throwing into the 
system the materials of which these enlargements 
are composed, and that it is best to solicit suppura- 
tion in them, so that the tuberculous matter might, 
in this way, find an outlet. 
But as long as the scrofulous condition remains, 390 
APPENDIX. 
the material of which tubercles are formed will be 
still manufactured; and, as we have seen its pro- 
duction is always encouraged by the mischief of 
the local disease, it appears to be reasonable that 
endeavors should be made to cut off this aid to its 
production; and the results of such efforts have, in 
our hands, proved entirely satisfactory, and fully 
convinced us that the above is the true philosophy 
upon the subject. 
Therefore, when called to see a patient whose 
general appearance and history indicate a scrofulous 
constitution, and we find, besides the symptoms 
arising from the general strumous condition, en- 
largements of the glands of the neck, or the out- 
cropping of the disease in any other form, we at 
once put him upon the general treatment before 
recommended, and also make vigorous endeavors 
to suppress the local manifestations; and as all 
these manifestations are the result of inflammatory 
action, modified, it is true, by the general condition, 
and therefore properly classed as specific, yet still 
it is inflammation, and composed of the same 
elements with other inflammations, and may be 
successfully treated by the same means. Such 
means will then be proper which tend to bring 
about the first and most favorable termination of 
inflammation, viz., by resolution; and these are 
such, as ray readers have been informed, as will 
excite capillary action in the part, and thus relieve 
the congestion, and, at the same time, excite the 
absorbents to take up the morbid deposits, and thus SCROFULA. 
391 
remove or rectify the structural change. A liberal 
application of the chloroform liniment will often 
meet all these indications, but I generally prefer to 
aid its action by other means, so as to increase the 
certainty of success; therefore, after bathing the 
tumefied parts for 15 or 20 minutes with the lini- 
ment, I paint it well with tincture of iodine, and, 
when this is dry, cover all the enlargement with 
collodion. In treating of the general management 
of inflammation, we spoke of the advantage derived 
from equable pressure, obtained by the roller 
bandage; but this could not be applied to the neck 
or groin, or other parts often the seat of scrofulous 
enlargements, but I have found all its advantages 
could be obtained by the use of collodion ; the con- 
traction which takes place on drying, occasions 
very considerable pressure, and that more equably 
than can ever be done with the bandage, and by 
this means the enlarged vessels are compressed so 
as to force their contents onward, and supported so 
as to enable them to regain their tone, and the 
absorbents stimulated to take up the morbid de- 
posits; for these vessels are so endowed, that 
pressure is the natural stimulus which calls them 
into increased action; by this means foreign sub- 
stances, or dead parts, are either eaten up by the 
absorbents, or the surrounding tissues cut away, 
and the offending body loosened, and a way pre- 
pared by which it may escape, or be extracted. A 
perfectly sound limb may be made to diminish 
under the pressure of the bandage, and new pro- 392 
APPENDIX. 
ducts are always more readily acted on by the 
absorbents than the permanent tissues, which en- 
ables us to cause morbid deposits to disappear, and 
still leave the natural parts entire. 
My readers will now perceive that stimulation, to 
excite the vital activity of the capillaries, and 
pressure, to promote absorption, are the means 
which would be naturally suggested by a know- 
ledge of what is wanted to be done, in order to 
remove these scrofulous enlargements without the 
tediousness and inconvenience of suppuration and 
ulceration, and without entailing a blemish upon 
the patient. But if the disease has proceeded so 
far that a termination by resolution cannot be 
brought about, then the next best end that can be 
obtained is active suppuration. The lye poultice 
will usually assist maturation as much as any appli- 
cation that can be resorted to; and as soon as there 
is any evidence of softening in the centre of the 
tumor, it should at once be opened by making a 
free incision with a sharp lancet. The operator 
will perhaps think he has opened it prematurely, 
for, in this stage, nothing will probably escape but 
serum stained with blood; but if the part is now 
dressed with some stimulating poultice, pus will 
soon appear. These risings should be opened as 
soon as possible, for two reasons; one is, that if you 
wait for them to become ripe, like the common 
phlegmon or boil, it will consume much time, as 
they are often extremely slow in maturing; and, 
secondly, as the amount of fibrin, which chiefly S C R 0 l1 U L A . 
393 
forms the plastic lymph, by which lost parts are 
repaired, is always deficient in the scrofulous con- 
dition, if the skin is suffered to become broken by 
ulceration, or become very thin, considerable loss 
of its substance will be sustained before the repa- 
rative process can be set up, and an ugly scar will 
inevitably follow. 
But if the disease be timely attended to, the 
means recommended will rarely, if ever, fail to pro- 
duce resolution. But their daily application must 
be persevered in until the tumor has very sensibly 
diminished; then the surface may be covered by 
court-plaster, which will tend to continue the neces- 
sary support to prevent a return of the swelling. 
If, after the rising has been lanced, and poulticed 
until the centre, or core, has become detached and 
removed, the ulcer should not be disposed to heal, 
it must be stimulated; and nothing has been found 
to answer this purpose so well as the chloroform 
liniment. But used in full strength, it generally 
proves too intensely stimulating, causing more 
suffering than is necessary, and should therefore be 
modified by the addition of some bland material; 
an equal quantity of liniment and mucilage may at 
first be used, and as the sensibility becomes blunted, 
less mucilage may be added, until finally the lini- 
ment itself may be borne in full strength. But as 
it is essential that an impression should be made, 
some smarting is unavoidable ; but it only lasts for 
a minute or two, and then leaves the part more 
comfortable than it was before the application. As 394 
APPENDIX. 
soon as the ulcer appears to be in good condition; 
the use of the liniment should be discontinued-as 
its protracted use will finally render the part insen- 
sible to its influence-and the ulcer be dressed with 
pledgets of lint, saturated in cold water or whiskey: 
I prefer the latter, as it serves to keep up a gentle 
stimulation, and thus maintains the healthy tone 
gotten up in the vessels by the use of the liniment, 
and prevents a necessity of resorting to that remedy 
again. Nothing in the shape of grease should be 
suffered to come near the ulcer; hence all salves 
and ointments are to be avoided. This seems very 
strange to most persons, who have seen such appli- 
cations relied on in the treatment of every kind of 
sore or ulcer. 
I was once attending on an Irishman for a chronic 
ulcer on the leg. After several days he inquired if 
I was not going to use some kind of 'intment. I 
told him no, I should use nothing that had grease 
in it. "Well," he replied, "I never knew a sore 
cured without using an 'intment or plasther." 
We have said that a deficiency of plastic material 
in the blood renders wounds difficult to heal in per- 
sons of a strumous habit; hence the frequency and 
inveteracy of sore legs in such habits; and nothing 
but a rigid and long-continued course of the means 
calculated to remove the scrofulous condition, and 
give tone to and increase the vital energies of the 
system, will succeed in their management. But 
the above local measure may at the same time be 
used, so as to cause the improvement of the local 395 
SCROFULA. 
disease to go on, or even outrun the restoration of 
the general health. In some instances, the wasting 
discharge from a large scrofulous ulcer is so profuse, 
and its irritability so great, as to react upon the 
constitution so injuriously, that no general treat- 
ment will be availing without first getting up some 
improvement in the local disease. But how can 
this be done? As the plastic materials of the blood 
are deficient, the reparative process cannot take 
place until these constituents are increased ; and as 
their elaboration requires the very highest effort of 
the vital powers, how is it possible to obtain more 
fibrin, out of which to manufacture new material to 
supply the lost parts, and without which an ulcer 
will not heal, without first obtaining an improve- 
ment of the general health? These inquiries seem 
natural, and a few years ago I would have said 
it could not be done ; but I now know that it 
can. The difficulty originates in a mistaken view 
of the manner in which fibrin is produced, and 
where plastic lymph is elaborated. I shall not stop 
here to explain the process by which fibrin is made, 
but I will assert that plastic lymph is manufactured 
by the capillaries, and that they may be forced to 
produce it when there is hardly a vestige of fibrin 
to be detected in the blood; and hence the infer- 
ence is, that it too is manufactured by them at the 
time when, and in the place where, it is wanted. 
By way of proving that "these things are so," and 
at the same time illustrating my method of treat- 
ment of chronic ulcers, I will detail a very interest- 396 
APPENDIX. 
ing case in point, which was treated in the State 
Hospital a few years ago. A young man by the 
name of Stalkup, of decided scrofulous predisposi- 
tion, but who had never suffered from any of its 
open forms, received a kick from a mule on the 
outer side of the leg, a few inches above the 
ankle; the injured flesh sloughed out, and left an 
ill-conditioned ulcer, which all the domestic reme- 
dies which could be devised by his friends failed to 
heal; finally, a great part of the leg became in- 
volved, and his general health failed, so that it was 
thought advisable to send him to the hospital for 
treatment. But all efforts to arrest the disease 
proved abortive, until it was thought that amputa- 
tion of the limb presented the only chance for 
saving his life. Professor Eve, who had the case in 
charge, called a consultation of the physicians who 
happened to be present, to witness a capital opera- 
tion. All expressed the opinion that death in a 
very short time would inevitably take place unless 
the leg were removed, and were also nearly as 
unanimous in believing that the vital powers would 
give way under the operation. We suggested that 
if the immense drain from the ulcerated member 
could be restrained, so as to allow the system to 
recuperate a little under tonic treatment, it would 
increase the chances of the operation proving suc- 
cessful. Dr. Eve admitted this, but said the reme- 
dies usually resorted to in such cases had all been 
unavailingly tried, and inquired if we knew of any 
that would probably succeed; we replied that we S C 11 0 E U L A . 
397 
believed we did : and pointed out the remedies, and 
why we thought they would prove successful. Dr. 
Eve then asked me if I would take charge of the 
case for a time sufficient to test the value of my 
suggestions, which I did. No change was made in 
the general treatment, for that I thought was about 
as good as any I could devise; local applications 
were alone depended on for altering the condition 
of the ulcer and checking the immoderate drain. 
The condition of the limb at this time was as 
follows: at least two-thirds of the leg, from the 
knee to the ankle, presented a loose, flabby ulcer; 
most of the soft parts had sloughed away, leaving 
the bone in places exposed ; the discharge was pro- 
digious, and was exceedingly foetid; the body 
greatly emaciated; countenance haggard; colliqua- 
tive sweats, etc. A physician present remarked 
that he did not appear to have a particle of fibrin 
in his composition; of course this was not meant 
to be taken as strictly true, and yet it was evidently 
not far from the truth. I had chloroform adminis- 
tered so as partly to deaden his sensibility-for, 
notwithstanding the great want of capillary action, 
there was morbid sensibility-and then thoroughly 
washed the ulcer with chloroform liniment, made 
less pungent by using three times the ordinary 
quantity of spirits of nitre, also adding a grain of 
sul. of morphia to the ounce; the leg was then 
lightly done up with the roller bandage, the lost 
parts being supplied by lint saturated with whiskey, 
which was also ordered to be occasionally poured 398 
APPENDIX. 
upon the dressings. The first dressing had the 
effect of completely destroying the fcctor, and in 
forty-eight hours the discharge was lessened to a 
fourth of the usual quantity ; the edges of the ulcer, 
from being pale and flabby, had become hard and 
slightly red, and in place of the bottom being 
covered with the results of broken-down tissue, 
there was evidently a secretion or exudation ol 
plastic lymph. This favorable condition continued ; 
and in the course of a week the improvement was 
so great that nothing further was said about an 
amputation. New material was rapidly formed for 
filling up and repairing the lost parts, and the con- 
dition of the whole system greatly improved; appe- 
tite and digestion became good; flesh again sepa- 
rated the skin from the bones; in short, general 
restoration took place, and that under the same 
general treatment under which he was before sink- 
ing. Now the main points in this case are, that it 
proved that fibrin is manufactured by the capilla- 
ries ; and that, by proper stimulation, they can be 
made to furnish it at the particular part where it is 
wanted, and to make it, too, out of exceedingly 
poor blood. 
This case went on improving until he became 
stout and able to take active exercise; the useful- 
ness of the limb was restored so that he could walk 
very well with the aid of a stick to supply the 
deficiency occasioned by some of the muscles being 
wholly lost; the limb became of natural size, but 
there was so large a surface to be covered with skin, SCROFULA. 
399 
that the process was protracted, and Mr. Stalkup 
got tired of waiting, and left the hospital to engage 
in some business; since which time I have lost 
sight of him. 
The same general and local remedies are equally 
applicable and efficacious in that form of scrofula 
called white, swelling. This disease, if taken at a 
very early stage, can be aborted; but if the inflam- 
mation is suffered to run on until it terminates in 
suppuration, the cure is slow and difficult; for as 
the pus is generally confined between the bone and 
its investing membrane, the periosteum, and as this 
membrane is dense and fibrous, and not easily cut 
through by the absorbents, much time often inter- 
venes before the matter can find an exit. This 
confinement is the cause of much of the suffering 
usually endured in this disease. Now we know 
that the bones receive nearly all their blood, and 
are nourished, by minute vessels extending into 
them from the periosteum; consequently, when 
this membrane becomes detached by a collection 
of matter under it, that part of the bone which 
received its nourishment from it necessarily dies, 
and finally exfoliates-that is, the absorbent vessels 
belonging to the sound part of the bone cut the 
dead part loose, and it then becomes movable, and 
often finds its way to the surface. 
But this process is always carried on very slowly, 
and often takes years for its accomplishment; and 
though the violence of the suffering abates after 
the periosteum gives way under the ulcerative pro- 400 
APPENDIX. 
cess, and the matter finds an outlet through the 
other tissues to the surface, and an opening is made 
by nature, or artificially, through the integuments, 
for its discharge, yet the constant irritation which 
is kept up by the dead bone acting upon the sur- 
rounding tissues, prevents them from healing, and 
occasions an abundant secretion of pus, which, 
being usually of a bad quality, acts as a further 
source of irritation, and is a great annoyance to the 
patient by its filthiness and disagreeable odor. By 
these means the constitutional disorder is increased, 
the blood impoverished, hectic fever set up, and the 
energies of the system exhausted, so that death 
often kindly puts an end to a life of suffering. But 
if the scrofulous depravation of the blood is not 
very great, and the patient be surrounded with 
circumstances of comfort, and such as are calcu- 
lated to improve the energies of the system, the 
patient will often bear up under all these afflic- 
tions ; may even grow and mature as other chil- 
dren ; and when the dead bone finally becomes 
detached and discharged, the abscess may heal 
and no mischief remain, further than a shortening 
of the limb from retarded growth. Few cases, 
however, result so favorably; most commonly, 
even while the process of reparation may be slowly 
going on in the original seat of the disease, it 
extends to new portions of the limb, and other 
pieces of bone die and exfoliate; so that, while 
bony deposits may be made to supply the loss of 
one portion of the bone, the destructive process is SCROFULA. 
401 
going on below, or above, until in this way, in the 
course of years, almost the whole bone may be 
destroyed and escape, a piece at a time, and still 
something answering the place of a bone remain, 
though unshapely and unsightly. 
Nothing more need be said with regard to general 
treatment in white-swelling; it must be the same 
as in other forms of scrofula, except that it may be 
necessary to be longer continued; neither does the 
local disease require peculiar treatment, except with 
respect to the removal of the dead bone, which 
should always be accomplished as soon as it possibly 
can be done, for as long as this remains, no efforts 
can cause the ulcer to heal. The great difficulty is 
to get the dead part detached from the living; for 
bone having but few blood-vessels or absorbents 
entering into its composition, all the processes, 
whether of destruction or reparation, are very 
slowly carried on. But much, very much can be 
done by art to hasten the exfoliation or separation 
of the dead bone; by means of powerful stimula- 
tion, as much can often be accomplished in this 
way in a few weeks as would otherwise require as 
many years. No stimulus with which I am ac- 
quainted possesses any thing like the same power 
of quickening the action of the vessels concerned 
in the process of exfoliation as the chloroform lini- 
ment. 
Three distinct objects must be kept in view in 
the management of these cases : first, to remove 
the general scrofulous condition, which has beer 402 
APPENDIX. 
sufficiently dwelt on; secondly, to bring up the 
action of the local parts to the healthy standard, so 
that they may be able to throw off the parts already 
dead, or too much diseased to be capable of restora- 
tion ; and, thirdly, to remove these detached bones ; 
and I think I can better illustrate my manner of 
fulfilling all these indications, so that the reader 
can fully understand it, by detailing cases, than can 
be done by preceptive teaching; and will, there- 
fore, ask indulgence, should I be a little tedious in 
giving the history of a very interesting case which 
was successfully managed a few years since, and 
which will fully illustrate my method of meeting 
each of the above indications. This case is selected 
because of its suitableness, and because the gentle- 
man who was the subject of treatment is pretty 
extensively known, and suggested that his case 
should be published for the benefit of others. 
J. W. Tolson, now a commission merchant of 
Mobile, Alabama, was attacked with white-swelling 
of the right thigh when about nine years old, 
which pursued the usual course described above; 
after continuing without any permanent amend- 
ment for about six years, it made its appearance 
also on the opposite arm, above the elbow; three 
years after this he came to Nashville and consulted 
the author, at the suggestion of his brother, Dr. 
L. S. Tolson, of Richmond, Miss. 
Mr. Tolson presented the appearance and temper- 
ament thought to be peculiarly indicative of tuber- 
culous tendency, viz., fair and clear complexion; SCROFULA. 
403 
large lustrous eyes; light sanely hair; sprightly and 
vivacious, but subject to spells of low spirits and 
great despondency; intellectual above the common 
order; ardent, and rather enthusiastic in his pur- 
suits of either business or pleasure, etc., etc. His 
person was pretty well developed, and ho would 
have been of over medium height, had not his 
stature been lessened by an arrest of the growth of 
the diseased leg, and a pushing up, as it were, of 
the pelvic bones of the sound side, occasioned by 
their having to sustain the whole weight of the 
body, at a time, too, when they were in a growing 
condition, and also preternaturally yielding in con- 
sequence of a lack of bony material common to 
young persons of the strumous diathesis. His 
general health was moderately good, and he ate 
and digested sufficient aliment to have sustained a 
full habit; but so much of the nutriment was 
expended by the enormous discharges which daily 
took place from the diseased limbs, that he re- 
mained lean, and had the general appearance of 
one who lacks nourishment. On examination, I 
found several fistulous openings in his leg, scattered 
along two-thirds of the space between the knee 
and the head of the femur, each of which could be 
traced by the probe to dead bone; and, as some of 
these openings were found on each side of the 
thigh, it appeared as though the greater part of the 
bone was devoid of life, which ultimately proved to 
be the case. As Mr. Tolson was naturally rather 
fastidiously nice in his feeling, he took great pains 404 
APPENDIX. 
to avoid any show of the discharge upon his 
garments; and, besides a plentiful supply of lint 
and raw cotton, enveloped the limb with several 
yards of common domestic; yet all these would 
frequently become thoroughly saturated in a few 
hours, and had to be regularly renewed four or live 
times in the day. In his arm there were found 
three fistulous openings, two of which were a little 
below the head of the bone, and nearly opposite to 
each other, and the third within the lower half, 
nearest the elbow, showing that the greater part of 
this bone also, both in its length and substance, 
was dead, at least that the external surface was. 
The discharge from the arm was also immense, for 
besides saturating as much cotton and domestic as 
could conveniently be applied, several times in the 
day, a half pint, at least, would be each time 
emptied from a kind of pocket or sinus-which had 
been formed in the axilla. 
Now although no dead bone had ever been dis- 
charged from the arm, as the probe could be made 
to grate upon its rough surface, it was known to 
exist; and, as nothing more than small scales had 
been thrown off from the carious femur or thigh- 
bone, it was evident that the process of exfoliation 
was progressing exceedingly slow, if it was taking 
place at all. In the general treatment of this case, 
I depended exclusively upon the prescriptions 
already given, or what amounts to substantially 
the same thing, viz.: compound syrup valerian, 
[fever syrup,] and compound syrup sarsaparilla, S C K O F U L A. 
405 
each, eight ounces; iodide of potassa, one ounce. 
Dose, a dessert-spoonful after each meal. The 
chloroform liniment was exclusively depended on 
for correcting the fcetor, lessening the discharge, 
and hastening the separation of dead bone. It was 
freely injected into the sinuses three times a day; 
at first diluted with three times its bulk of water, 
but afterwards gradually used stronger. The general 
proceeding was, to first throw into the ulcers, by 
means of a half-pint syringe, as much eastile soap- 
suds as was sufficient to cleanse them thoroughly, 
then as much of the stimulant as would fill them; 
over the fistulous openings, large pledgets of cotton, 
saturated with whiskey, oontaining an ounce of 
liniment to the pint, and over these the roller 
bandage, applied moderately tight, the whole to be 
kept saturated with the whiskey and liniment. 
The discharge was soon materially lessened, and 
considerable excitement gotten up in the diseased 
limbs, so that poultices of slippery-elm had occa- 
sionally to be applied at night, and a sufficient 
amount of epsom salts taken daily to keep down 
general febrile excitement, and also serve as a 
means of abstracting the surplus amount of fluids 
from the blood which had usually been discharged 
from the ulcers, and thus prevent any plethora or 
other damage arising from so sudden a stoppage of 
such a considerable drain. The salts were some- 
times taken in full purgative doses, but generally 
in small quantities in a large quantity of water, so 
as to imitate the water of saline springs, and, like 406 
APPENDIX. 
that, operate by promoting an increased secretion 
from the kidneys; then, for a time, its use would 
be wholly suspended, just as evidence of fulness, or 
symptoms of weakness, indicated. By these means 
this immense drain, which had continued for nine 
years, was gradually dried up without occasioning 
any of those untoward events which are usually 
enumerated as apt to follow' the stoppage of a drain 
of long continuance. But the credit of this favor- 
able result is not wholly, or indeed chiefly, due to 
the use of the salts; the alterative syrup did much 
more, by changing the morbid condition of the 
system, and promoting a vigorous exercise of the 
vital powers; in consequence of which, the material 
which wras formerly thrown off in a crude state 
by the secreting surfaces of the ulcers, w7as now7 
changed into a proper form for healthy nutrition. 
In the course of a few7 weeks the beneficial effect 
of the stimulating injections became very apparent, 
as small particles and occasionally scales of bony 
matter were washed out by the soapsuds injections; 
finally, a large mass wras ascertained, by examina- 
tions with the probe, to have become at least 
partially detached, and I thought it advisable to 
prepare a means of outlet; and not being fond of 
using the knife, I resorted to the dilating properties 
of slippery-elm; at first using a bougie made of 
this material for the purpose, just large enough to 
enter the fistulous opening wrhich appeared to be 
nearest to the upper end of the loose bone ; and by 
replacing this daily w7ith one a little larger, in the SCROFULA. 
407 
course of ten or fifteen days the opening was suffi- 
ciently capacious to admit of a thorough examina- 
tion. A very large piece of detached bone was 
ascertained to exist, and efforts were made to ex- 
tract it by bringing its end to the opening, and 
twisting and pulling with strong forceps; but it 
would not come, and I requested Professor Eve to 
operate, by making a sufficient incision, which he 
kindly did, and found that a piece comprising more 
than one half of the entire thickness of the femur, 
and nearly half its length, had become detached, 
except at the end where it joined the condyle of the 
knee-joint; here no attempt at a separation of the 
dead from the living bonQ seemed to have been 
made, but they appeared to insensibly run into each 
other, so that it was impossible to determine where 
death reigned, or where life began. The connec- 
tion was finally severed close to the joint; the 
surface, however, showed that some unsound bone 
was still left; but it was thought best not to pro- 
ceed any farther, for fear of injuring the joint. 
As we availed ourselves of the advantages of 
chloroform, the operation occasioned very little 
sensible suffering; and as the loss of blood was 
trifling, no injury resulted, but a very great good 
was obtained, a large foreign body was removed, 
and the irritation occasioned by it got clear of. 
Water dressings were now used to keep down 
inflammation, and the sinuses injected, as before, 
with the liniment and whiskey. In a very short 
time the sinuses all closed by a healthy growth of 408 
APPENDIX. 
granulations, or their sides adhered by a deposition 
of plastic lymph, and that only remained open 
which led to the condyle of the knee, at which 
point, we have said, there was some diseased bone 
left remaining. But pretty soon granules of bony 
matter appeared in the discharge, and the surface 
became evidently smoother, and presently blood 
flowed from it by the slight rubbing occasioned by 
an examination with the probe, giving satisfactory 
evidence that granulations had formed upon the 
surface, and that a cure was near at hand. 
The treatment proved still more successful in the 
disease of the arm; for, soon after commencing the 
use of the stimulating injections, bone, in a state 
of disintegration, appeared in the discharge, or was 
washed out by the soapsuds injections; showing 
that a softening of the dead, bony structure was 
taking place, and giving hopes that the whole 
might thus be got rid of, without our friend suffer- 
ing the pain of an operation for its removal; and 
these hopes were not illusory, for after a few weeks 
the probe decided that granulations were forming 
upon the parts which had been divested of their 
periosteum, deciding that a cure was in progress. 
It thus proved, as was at first hoped, that only the 
outer surface of the arm-bone was altogether dead, 
and the liniment brought up the languishing action 
in the deeper parts to the healthy standard, and at 
the same time caused the dead pellicle to disinte- 
grate, or become resolved into particles, so that it 
could be forced out by the washings. 409 
8 C ft O 1? V L A. 
As soon as this bony matter ceased to appear, 
and the parts that could be reached by the probe 
were found to be well covered with granulations, a 
compress was laid over the course of the sinuses, 
and the roller bandage applied sufficiently tight to 
bring the sides of the cavities together, so that they 
might become joined by means of the plastic lymph 
which was now abundant in the discharges. Adhe- 
sions were soon formed, and all evidence of disease 
removed from the limb. 
In about four months from the commencement 
of treatment, Mr. Tolson left for his father's home, 
near Choctaw Station, Miss., in line health, and as 
clear of any evidence of the terrible disease under 
which he had labored for nine long years as he was 
before he was afflicted, except the shortening of the 
limb referred to, and a very small sore near the 
knee-joint, which soon after disappeared. 
During the progress of the disease, Mr. Tolson, 
having obtained a situation in the Baptist Pub- 
lishing House temporarily, did full service as 
clerk and book-keeper most of the time, and 
thus prevented time from dragging heavily, and 
more than cleared his expenses, including doctor's 
fees. 
It is now over three years since the cure was 
effected, and I learn that it still proves to be radical. 
A few weeks since, the author had a communica- 
tion from him, in which he says : " My old disease 
has now been well over three years. It has, during 410 
APPENDIX. 
that time, made a few slight attempts at returning, 
but has subsided of itself, or been removed by the 
efforts of nature." 
The point of interest in this case is, that it shows, 
contrary to currently received opinion, that the pro- 
cess of exfoliation may be artificially hastened, and 
that in a remarkable degree-making weeks stand 
for years, and even more than that-and that thin 
portions of dead bone may be made to disintegrate, 
and come away in granules with the other dis- 
charges. Many similar cases could be given, but 
it is not thought necessary to task the reader any 
further. 
An inquiry might naturally arise here, whether, 
after a scrofulous disease has been thoroughly 
cured, and the scrofulous condition fully removed, 
as in the above case, a taint will still remain in the 
system which can be communicated to posterity. 
Our opinion is, that no greater probability exists of 
the offspring of such person inheriting the predis- 
position to tubercular or strumous diseases than of 
those born of members of the same family in whom 
the disease had never been manifested, or even less 
probability, for the constitutional remedies appear 
in many instances not only to remove the scrofu- 
lous condition, but also the predisposition, so that 
no strumous taint is left; and, as has before been 
said, " like begets like," and it is not the likeness 
of what the parent once was that is communicated, 
but that which obtains at the present. Hence, the S C 11 O 1'' U L A. 
411 
first children of scrofulous or tuberculous parents 
rarely inherit the predisposition; but those that 
are born after the disease has been fully de- 
veloped often have the disease in actual form at 
birth. 412 
APPENDIX. 
CHAPTER IV. 
A FEW THOUGHTS ON INFLAMMATION AND FUNCTIONAL 
DERANGEMENT. 
Next to fever, inflammation is the most im- 
portant subject that can claim our attention in 
connection with the great subject of diseased action 
to which the human system is liable. A very large 
amount of the sum of human ills has its origin in 
or is the result of inflammation, either as an original 
affection, or as superinduced in the course of other 
diseases : few cases of fever terminate fatally, ex- 
cept as a consequence of inflammation having been 
set up in some important organ. Now as every 
whole must be composed of parts, these parts must 
be considered separately, in order to obtain any 
clear idea of the qualities or properties or effects of 
all when conjoined or acting together. 
In this way inflammation must be considered in 
order to be understood, and it must be understood 
as regards its causes, its nature, and its events, in 
order to be successfully managed or controlled. No 
person who has never considered the chain of 
morbid action constituting inflammation, with refer- INFLAMMATION. 
413 
ence to each link in its structure, can comprehend 
it as a compound result, or understand even its 
description, much less be able to bring into use the 
best means for its treatment in its various forms 
and stages. 
Authors have described inflammation as a disease 
consisting of increased heat, redness, pain, and 
swelling. But this definition is very imperfect, as 
it only applies to one particular form of the disease; 
in other forms, one or more of these parts are 
wanting; for example, in ivhite-swelling there is no 
increased redness, and sometimes no increased heat; 
and in chronic rheumatism we occasionally meet 
with cases in which there is neither heat, redness, 
nor swelling, and little or no pain, and yet there is 
inflammatory action going on in the limb, which is 
silently altering the structures and destroying the 
usefulness of the member. Now a definition of a 
disease should embrace only that which is always 
present, and without which the disease could not 
exist. I think such a definition can be given. 
When upon the subject of fever, I said that it was, 
" to all intents and purposes, an incipient inflamma- 
tion now what constitutes fever? It is composed 
of nervous disturbance and capillary engorgement. What 
else, then, is necessary to be added to these to con- 
stitute a fully formed case of inflammation? It is 
structural change. Inflammation may, therefore, be 
defined as a disease in which there is morbid innerva- 
tion, capillary engorgement, and structural change, and 
that its most common and prominent phenomena, 414 
APPENDIX. 
or symptoms, are increased heat, redness, pain, and 
tumefaction or swelling. 
We will now take a view of what the microscope 
has revealed as taking place in the formation or 
getting up of a case of inflammation, and see if the 
above definition be correct or not; it will also 
serve to instruct us as to the intimate nature of the 
disease, and how the symptoms are manufactured 
that characterize its progress. We will take a 
condensed view of the subject as presented by 
Boltonbrunner. Upon placing the web of a frog's 
foot under the microscope, he observed that a 
scratch from a pin, or the application of some 
irritating substance, first caused an irregular move- 
ment of the blood globules in the capillaries, they 
being pushed on for a space more rapidly than 
before, then stopping, oscillating, or moving back 
and forth; then taking a backward motion, but 
finally becoming settled, and again pursuing their 
regular course; then a period elapsed in which 
every thing seemed to be natural. Now the stage 
of disturbance just described may properly be 
termed the period of excitement, and the time of 
repose the period, of incubation, which last will soon 
be succeeded by other appearances, viz.: the blood 
is seen to suddenly flow into the capillaries with 
unusual force, and these vessels appear to contract 
upon it, so that the circulation is greatly accele- 
rated; important changes are now seen to take 
place: the blood undergoes a change, or fails to 
undergo the changes that should take place; the INFLAMMATION. 
415 
white corpuscles stick to each other, and to the 
sides of the vessels, and a portion of the blood is 
retarded. Now this may be termed the period of 
irritation; but soon the capillaries appear to lose 
their power of action, and suddenly dilate and 
become engorged with blood, which now has a 
very slow movement, or is entirely stationary, or is 
sometimes seen to even flow backward; this is the 
true period of congestion. Now all this may take 
place, and yet there is no inflammation; there is 
merely morbid innervation or nervous disturbance, 
and capillary debility and engorgement, just such 
as we have throughout the general system in fever, 
constituting its essential elements; and further, the 
departure from healthy action may here stop, if the 
cause has been a slight one, or if proper means 
have been used to allay the disturbance, and the 
torpid capillaries regain their tone and resume their 
proper vital action, by which the blood will be sent 
forward and the congestion removed. But suppose 
these favorable events do not happen, the next 
thing 'which is observed to take place is, the fibrin 
of the blood separates from the other constituents 
and unites into flakes, which, adhering to the little 
points formed by the white corpuscles having stuck 
to the sides of the minute vessels, fill up their 
cavity entirely, so that no blood can pass; the 
serum now becomes effused into the areolar tissue, 
which, with the condensed fibrin and the retarded 
blood, causes hardness, redness, and tumefaction; 
we now have structural change; inf animation is 416 
APPENDIX. 
now fully set up; so we see that nothing but this 
last movement is wanted to convert fever into 
inflammation; it is not then to be wondered at that 
inflammation is so often a consequence of fever. 
Let us sum up what has been said: Inflammation 
is a disease consisting of morbid innervation, capil- 
lary debility, and structural change; the first is the 
direct effect of the cause acting upon the nerves, 
and is manifested by the disturbance which has 
been described in the action of the capillaries; the 
second is partly the effect of the first, for the 
nervous disturbance interferes with the regular 
supply of vital energy which the capillaries con- 
stantly require to sustain them in the performance 
of their proper function of propelling the blood, 
and also of performing such changes upon it as are 
necessary to fit it for nutrition, secretion, etc. ; 
consequently, these are badly, or not at all, per- 
formed, and the blood presents an unusual appear- 
ance, and nutrition and secretion are suspended in 
the part, as it is in the same condition which 
obtains in fever. But besides this lack of nervous 
power, the capillaries may be still further crippled 
in their action by direct injury received, as me- 
chanical injury or excessive irritation. The poison 
of contagion or malaria probably reaches the capil- 
laries, and by its direct action tends to bring about 
this condition ; which accounts for the profound 
congestion which we occasionally see attend attacks 
of fever. 
This much must suffice upon the subject of the FUNCTIONAL DERANGEMENTS. 
417 
elements constituting inflammation; we would now 
hastily consider its progress, its products, its effects, 
and its modes of termination, if our limits would 
permit; but these can all be found in regular 
works, and we will, therefore, pass on to functional 
derangements. 
FUNCTIONAL DERANGEMENTS. 
A multitude of ills "that flesh is heir to," many 
of which are sufficiently grave to destroy life, con- 
sist wholly of derangement of functions ; are not 
necessarily connected with fever, or inflammation, 
or structural change, but are simply departures 
from healthy action, so that if death takes place, 
dissection will reveal no evidence of permanent 
alterations in the parts most implicated that would 
account for the fatal result. 
In treating of this class of diseases, we are neces- 
sarily thrown back upon first principles, and will 
have to revert to those laid down in the fore-part 
of this work. It is there stated that disease consists 
in a broken balance in the movements of the 
machinery of life; that while harmony of action is 
maintained, there cannot be disease; if the move- 
ments be vigorous, there will be high developments 
of the phenomena of life, and if they be feeble, 
that low or weak developments of life will be mani- 
fested ; but if there be harmony of action, no 
disease will or can be present; that the first condi- 
tion merely results in the enjoyment of the zest of 
high-toned, vigorous existence, and the latter in a 418 
APPENDIX. 
low or feeble enjoyment of life, but not connected 
with suffering-not even with a sense of weakness 
or want of vital energy : the zoophyte, which all its 
life is fastened to the rock, and receives its nourish- 
ment by imbibition, unconscious that any other of 
its species exists; or the barnacle, which fastens 
itself to the man-of-war, and only changes locality 
by the movements of the stately ship, is perfect in 
its kind, and though its enjoyments must be few, 
yet its sufferings are equally small, and, in its 
natural low degree of vital manifestations, it is no 
more diseased than the captain of the noble steamer 
and busy crew, who, in the enjoyment of young 
and vigorous manhood, and excited by his position, 
won by deeds of worth, feels life's current flow 
vigorously, and enjoys a zest of life of the highest 
order of which God has made his noblest work 
capable of enjoying. There must be a broken 
balance, a want of harmony, to constitute disease; 
some parts of the machinery must run too fast, 
while others run too slow, and a loss of harmony 
of movement produced, which must necessarily 
result in the grating of cogs, or the casting off of 
bands, causing the whole machinery to run irregu- 
larly, or cease to run. 
Functional disease, then, consists in an altered 
movement, by which the various processes or func- 
tions necessary to the well-being of the animal 
economy are imperfectly carried on, or performed 
in excess, or performed with difficulty and imper- 
fectly. Now, we have seen that though the mani- FUNCTIONAL DERANGEMENTS. 
419 
festations of vital action are manifold, and the 
results various, yet all proceed from the same 
motive-power, and are produced by the exercise of 
a few simple structures, widely distributed and 
variously combined, so as to produce apparently 
very different organizations, and present very 
diverse phenomena. The great motive-power 
resides in the brain and other nervous centres; 
the nerves are the wires or tubes through which 
they operate, and the messengers which convey 
orders and return intelligence; the capillaries are 
the workers that do all the drudgery, and are also 
the fine artificers; and the blood furnishes the 
material upon which they operate. Now, if the 
power be deficient, or be irregularly transmitted, 
or if the operatives are languid and feeble, and 
unable to perform well their task, or if the material 
be deficient, in either case the work will be im- 
properly or deficiently done-it will be over-done, 
or under-done, or not done well. 
The great principles, therefore, which lie at the 
foundation of all diseased or pathological action 
are few, and come within the comprehension of all 
who possess mind enough to comprehend simple 
causes and effects. Now, as the principles which 
govern diseased action are few, it follows that the 
means by which disease may be cured, or morbid 
action corrected, need not be numerous; and 
hence, a few remedies fitly chosen may be made to 
accomplish numerous results; which serves as a 
sufficient apology for so often bringing forward, as 420 
APPENDIX. 
has been done in this work, the same means for the 
treatment of different diseases, and for correcting 
departures from healthy action resulting in appa- 
rently very different conditions of the system. 
The author would take pleasure in following out 
this interesting subject in all its details, in con- 
nection with particular cases, but this would swell 
this volume to an inconvenient size for mailing. 
Besides, he is not yet prepared to furnish the pro- 
fession with a general practice, and perhaps never 
may be; but as there exists a valuable "unwritten 
record of medicine" floating about in the pro- 
fession, much of which is known only to those 
laborious practitioners who never write, the author 
would highly appreciate and duly acknowledge 
the kindness, if such would, in a familiar epistolary 
style, communicate to him any original thoughts or 
observations on practical facts, observed by accident 
or obtained from irregular sources. 
He would also thankfully receive any communi- 
cations concerning the success, or want of success, 
of his plan of treating the diseases dwelt on in 
this work, or any suggestions of variations of treat- 
ment. FORMULAS. 
421 
FORMULAS. 
Compound Syrup of Valerian, or Fever Syrup. 
Page 100. 
R Syrup of Rhubarb, four ounces. 
Tincture of Valerian, two ounces. 
Oil of Sassafras, twenty drops. 
Piperin, ten grains. 
Supercarbonate of Soda, twenty grains. 
Mix. 
Dose, for an adult, a tablespoonful every two or three hours. 
For large formula, see same page. There is an apparent differ- 
ence between these formulas, but they are medicinally alike. 
Chloroform Liniment.-Page 102. 
R Sweet Spirits of Nitre, four ounces. 
Aqua Ammonia, one ounce. 
Oil of Juniper, half an ounce. 
Oil of Sassafras, half an ounce. 
Gum Camphor, half an ounce. 
Chloroform, one ounce. 
Mix. 
Turpentine Mixture.-Page 239. 
R Emulsion of Gum Arabic, four ounces. 
Sulphate of Morphia, four grains. 
Spirits of Turpentine, one drachm. 
Compound Spirits of Lavender, two drachms. 
Mix. 
Dose, a teaspoonful every two hours. 
The above is Professor Bowling's formula. 422 
FORMULAS. 
Compound Syrup of Peach-Leaf.-Page 284. 
Take as many peach leaves as will fill a ten-gallon kettle, and 
weight them to prevent their rising; add water until they are 
covered ; bring it to a boiling heat, and keep it at a simmer for two 
hours ; take out the leaves, and strain and settle the infusion; then 
evaporate by a moderate heat until it begins to thicken. There will 
now be about one quart. To this add five pounds of good cane 
sugar, and when it is melted, add slowly sup. carb, soda (common 
soda) until it ceases to effervesce; then add one drachm of piperin, 
finely powdered, and one ounce of oil of sassafras; after stirring 
them together effectually, and when the syrup has partially cooled, 
add half a pint of good brandy. 
Usual dose, a tablespoonful every hour. 
Anodyne Carminative.-Page 293. 
R French Brandy, half a pint. 
Pulverised Cinnamon Bark, two drachms. 
Pulverized Nutmeg, two drachms. 
Piperin, ten grains. 
Loaf Sugar, four ounces. 
Mix. 
One to two teaspoonfuls in four times its volume of sweet milk 
three times a day. 
Saline Mixture.-Page 294. 
R Epsom Salts, three drachms. 
Supercarbonate of Soda, one drachm. 
Dover's Powder, twenty grains. 
Dissolve in a pint of water. 
Dose, a tablespoonful every hour. F 0 R M U LAS. 
423 
Anodyne Alterant.-Page 348. 
R Extract of Hyoscyamus, one ounce. 
Extract of Butternut, seven ounces. 
Oil of Sassafras, half an ounce. 
Supercarbonate of Soda, two ounces. 
Simple Syrup, two quarts. 
Usual dose, a tablespoonful three times a day. 
I often add twenty grains of piperin to give the mixture a better 
flavor. 
Alterative Syrup for Scrofula.-Page 382. 
R Fluid Extract of Sarsaparilla, six ounces. 
Tincture of Valerian, two ounces 
Syrup of Rhubarb, two ounces. 
Oil of Sassafras, one drachm. 
Piperin, thirty grains. 
Iodide of Potassium, six drachms. 
Mix. 
Dose, a teaspoonful after each meal for a child, to be taken in 
sweet milk. » 
Another.-Page 383. 
R Wild Cherry Bark, one ounce. 
Elecampane Root, one ounce. 
Burdock Root, one ounce. 
Good Spirits, one quart. 
Let it stand forty-eight hours ; then strain and add one pound of 
coarse-grained cane sugar, and heat until it dissolves. 
Dose, a tablespoonful for a child two or three years old. 
Tonic Syrup for improving the Blood.-Page 384. 
Take of elecampane root, four ounces; water, one quart; simmer 
for two hours, strain, and then simmer down to half a pint; add 
one pound of coarse brown sugar while the infusion is hot; after it 424 
FORMULAS. 
has cooled, add one ounce of burnt copperas, (sulphate of iron,) 
well pulverized and sifted. 
Mix thoroughly, and shake the bottle well before using each 
time. 
Dose, a teaspoonful after each meal. 
This is a most valuable medicine in all cases of debility attended 
with an impoverished state of the blood, as in chlorosis, low stages 
of dropsies, etc. 
Many persons have desired the author to furnish them his 
principal fever remedy, ready prepared, so that they could rely on 
its genuineness; but as its bulk rendered it inconvenient to transmit, 
he has generally declined to comply with such requests. But, 
having succeeded in preparing condensed extracts of valerian and 
rhubarb, containing all the virtues of these articles in substance, he 
will now be prepared to furnish the materials, ready compounded, 
for making the fever syrup, at small expense. One ounce of the 
materials will make a quart of the syrup, and will be sent by mail 
to any part, free of postage, on the reception of one dollar. In this 
form it will be quite convenient to the country practitioner, as he 
can easily carry a supply in his pocket, and make the syrup wherever 
he can find sugar, or can give it in some emulsion, or can form it 
into pills. 
Full directions will accompany each package. Address the Author, 
or Stretch & Forbes, Druggists, Nashville. 
The Slippery-Elm preparations will be sent by mail at the fol- 
lowing prices: 
Medicated Pessaries $9 00 per doz. 
Bougies and Catheters 6 00 " 
Slippery-Elm Cloth 1 00 per yard. INDEX. 
PAGE 
Abdominal Muscles-As aids in expiration 46 
Arterial Action-Proportionately greater in disease than capil- 
lary 31 
Bleeding-As a collateral aid in fever 104 
Boneset-In fever 324 
Broussain Theory 136 
Capillary Action-Instances occurring in health of increased 
capillary, with non-corresponding arterial 
action 30 
Capillary Circulation-Its existence before arterial-Example- 
Carpenter on the subject 32 
Its continuance after arterial ceases 33 
Capillaries-Independent action of 29 
Office of the 72 
Chest-Effect of its expansion and contraction over air and 
blood 46 
Cholera Infantum-Indications to be met in 283 
Treatment of 283 
Circulation of the Blood-Different opinions of physiologists on 
the 27 
Forces concerned in the general 35 
Brief view of the parts concerned in the 36 
Absurdity of opinions advanced by Neil 
Arnott, M. D., on the 56 
Contagious Diseases-How securing immunity from the disease 
thereafter 170 
C.oke's Theory of Fever 121 
Croup............................................................................. 375 
Treatment of. 376 
Debility-In one or more organs, only true cause of disease 66 
(425) 426 
PAQ8 
Disease-When alone manifested 30 
To what due, example 64 
General and local, whence arising, illustration 67 
Dysentery-Organs affected in, different from those in miasmatic 
fevers 275 
Most probable cause of 278 
Not contagious 277 
Not of miasmatic origin 267 
Pernicious effects of Calomel in 275 
Turpentine in 281 
Sulphur in 282 
Diet in 285 
Resume of important points 287 
Formula of comp. syr. peach leaf used in 284 
Success of others with the author's plan in 291 
Exacerbations-Evening, in fever, how accounted for 148 
Excitement-The immediate effect of stimulation on the stomach 145 
Expiration-Act of 45 
Exudations-Mechanical, an example 31 
Eibrils-Office of. 205 
Febrile Diseases-Mortality; paramount importance of 61 
Fever-Nature and phenomena of 61 
Cause of 90 
An incipient inflammation 72 
Essential circumstances connected with, and controlling 
a case of. 88 
Puerperal 75 
Inflammatory, example of 78 
Treatment of, points to be met with in every case 95 
Miasmatic 83 
Malarious, epidemic, and contagious, their cause 91 
Theories of. 112 
Modes of cure in 133 
Mysteries connected with 139 
How terminating in health 151 
Other diseases, how cured by 154 
How cured by inflammation 168 
Continued action of remote cause in>. 174 
INDEX INDEX. 
427 
PAGE 
Fever-Particular............................................................. 199 
Classification, of the different kinds of, by the 
nervous system 201 
Typhoid-Not self-limited 107 
Symptoms of 212 
Present mode of treating 217 
Case of, author's plan of procedure 221 
Cases of, treated by the author and others 228 
How Turpentine acts beneficially in 190 
Why Mercurials act injuriously in 194 
Bilious, or Miasmatic-Leading symptoms of 240 
Nature of the agent producing.... 241 
Case of, illustrating the author's 
mode of treatment 242 
Further illustrated, extracts from 
letters 246 
Yellow.................................................................. 353 
Symptoms of 256 
Cause of 255 
Fever syrup in 257 
Names of fevers, how received 200 
Diagnosis and nosology of 199 
Evening exacerbations in, how accounted for 148 
Mode of action of the poison producing 144 
Delirium in 160 
Critical days in 169 
Gastrites connected with, treatment 238 
Sassafras in 96 
Valerian in 97 
Piperin in 98 
Opium in 129 
Turpentine in 132 
Tartar emetic in, how it aids in, or produces a crisis 158 
Topical remedies in 186 
Minor means used in 98 
Bleeding as a collateral aid in 104 
Obstinate cases of, how met 102 
Concluding remarks on 319 428 
PAGE 
Fever-Continued Bilious 320 
Mode of treatment 320 
Domestic remedies in 324 
Author's former mode of treatment in 324 
Watson in the treatment of 332 
Tanner in the treatment of 338 
Fever Syrup-Formula of 100 
Form of administering 235 
Substitute for, formula of 226 
Pungency of, how remedied 238 
Heart, the-Prime agent in arterial circulation 28 
Suction power of 33 
A motor power in pulmonary circulation-Mrs. Wil- 
lard's theory 50 
Contracting force of, as alleged by Neil Arnott, 
M. D 56 
An instance of the softening of the muscular struc- 
ture of 58 
Hives-Distinctions between croup and 370 
Treatment of 372 
Humoral Theory-Offerer 112 
Human System-A thorough knowledge of, necessary. Summing 
up of important points 62 
Hymen Unruptured-Case of, after twelve years of married 
life 353 
Hyoscyamus, Extract of, and Oil Sassafras-In some of the mis- 
fortunes attendant on pregnancy 337 
Cases in which used 341 
Inflammations-Examples of excessive arterial, over capillary 
action 32 
Inflammation-Essentially a disease of debility 69 
Rationale of curative means in 70 
Inspiration-Act of. 44 
Intermittents-Paroxysms of, why occurring in the day 146 
Paroxysms in, cause of 147 
Quinine in 182 
Liniment-For distress of nervous origin, formula of 102 
Lungs-Manner of action in the pulmonary circulation of the 44 
INDEX 429 
PACK 
Lungs-An instance of the loss of right lung, as illustrative of 
the facility with which a cooperating organ per- 
forms its own and partner's duty 59 
Malarial Poison-Why more potent at night than day 141 
Time of greatest liability of being impressed 
by 142 
Power of water to absorb 175 
Multiplicity of forces employed in the circulation, a benignant 
arrangement 57 
Muscular Contraction-An aid to venous circulation 41 
Mercurials-In Typhoid Fever 194 
Natural Death-What constitutes a case of. 66 
Nerves-Systems of, their divisions and subdivisions 204 
Of animal life, or cerebro-spinal nerves 204 
Of organic life, or ganglionic nerves 204 
Excito-motory, examples of 206 
Excito-secretory, examples of 206 
Of association 205 
Excito-circulatory, system of 210 
Excito-nutrient, system of 210 
Excito-thermal, system of 210 
Excito-sensatory, system of 211 
Nervous impression and lesion 145 
Nervous System-A knowledge of, highly important 208 
Opium-In fever 129 
Ophthalmia ..................................................................... 337 
Treatment of 337 
Piperin-In fever 98 
Phlegmasian Theory of Fever 118 
Pneumonia-Symptoms, treatment, and example of. 247 
Experience of others with the author's plan in 252 
Poultices......................................................................... 71 
Present Theory of Fever 126 
Rubeola-Diagnostic symptoms of 314 
Treatment of 315 
Means of preventing the contagion from taking eifect.. 317 
Respiration 41 
Scarlatina-Grades of 302 
INDEX. 430 
INDEX. 
PAGE 
Scarlatina-Simplex, symptoms of 302 
Treatment of 303 
Anginosa, treatment of 304 
Maligna, treatment of 305 
Case of 307 
Sequoela 312 
Small-Pox-Distinct 298 
Semi-confluent 298 
Different stages of 288 
Treatment of 299 
Cases of, cured without marks 300 
Science and Empiricism-Characteristic difference between 133 
Slippery-Elm-Cloth of. 350 
Bougies of 351 
Pessaries of 357 
Formula of 357 
Cases in which used 358 
Sassafras-Tn fevers 96 
An antiseptic 262 
Spasmodic Theory of Fever 114 
Stimulation-Direct and indirect 130 
Fatal consequences of excessive 310 
Strophulus-Hives 170 
Sympathetic Theory of Fever................................................ 116 
Tartar Emetic in Fever 158 
Thompsonian Theory of Fever 122 
Turpentine in Fever 132 
Vacuum-Philosophy of the effects of a 49 
Valerian-In fevers 97 
Venesection-Why beneficial in fevers 82 
Venous Circulation-Forces concerned in 38 
Variola, or Small-Pox-Not contagious till the eruption takes place 296 
Description of eruption in 297 NOTICES OF FIRST EDITION. 
PROFESSOR BOWLING. 
The work before us is the production of a Ten- 
nessee physician-a fellow-practitioner of our own 
city, an intimate acquaintance, and a warm personal 
friend. Upon many medical topics he entertains 
views and opinions essentially foreign, and often in 
diametrical opposition to those into which we were 
early indoctrinated, which have grown with our 
growth and strengthened with our strength, and we 
have passed that period of life beyond which, it is 
truthfully said, medical men seldom or never 
change. It is written, that no physician over forty 
years of age could be convinced by Harvey concern- 
ing the circulation of the blood; and none of us 
have forgotten that when Jenner forwarded his im- 
mortal paper upon cow-pox to the Royal Society of 
London, that his great discovery might go to the 
world under its high auspices, its learned mem- 
bers, after giving the matter a careful and delibe- 
rate consideration, came unanimously to the con- 
clusion that it ought to be suppressed, upon the 
(431, 432 
ground, that by its publication the author would 
hazard the loss of that reputation which he had 
gained in the scientific world by a paper previously 
published upon the natural history of the cuckoo ! 
Such ludicrous mistakes as these, in the highest 
places of science, should teach all a profitable les- 
son of humility, and to exercise a spirit of forbear- 
ance and inquiry concerning every proposition in 
medicine that makes its way up to the judgment- 
seat through the accredited channels, however 
boldly it may contradict our most cherished opinions. 
The opinions of Dr. Thompson, defended in his 
book, have not been hastily formed and promul- 
gated. Jenner employed thirty years in talking 
upon and investigating an inquiry which seemed 
to be the chief end of his existence to elaborate 
and enforce, before he published the result to the 
world. Dr. Thompson has employed an equal 
length of time in his investigations; and after so 
many years of anxiety and toil, from a firm convic- 
tion of the truth and value of his discoveries, like 
Jenner, has become a publisher from necessity. 
So ardently was he engaged in testing at the bed- 
side the claims of his conclusions upon his profes- 
sional brethren, that he found no time to write any 
thing concerning them, and, until three years ago, 
had never written a line for the public eye. Every 
capable, honest, and unprejudiced mind that faith- 
fully examines this work, will award to its author 
the possession of talents of the highest order, an 
intellect conspicuous for the power to grasp and 
NOTICES. NOTICES. 
433 
analyze the mysteries of man's organism in disease, 
and often to light up, in a peculiar manner, its 
darkest and most inaccessible recesses. This no 
ordinary mind can achieve. Dr. Thompson's mind 
seems to be so constituted as to delight in the very 
effort to solve the most knotty etiological and 
pathological problems. Not content to remain 
within the febrile boundaries, widened, as we had 
supposed, to their utmost limits by the wonderful 
genius of Fordyce, ho delights to take up the ramifi- 
cations of the subject precisely where Fordyce had 
pursued them to exhaustion, where the light of his 
intellect could follow them no farther, and con- 
strained him to acknowledge that their termini were 
lost in impenetrable darkness. Our author delights, 
we repeat, in groping for the lost ends of febrile 
inquiry in the long and tenebrious night during 
which they have reposed in their dark abodes; and 
he has, as he believes, succeeded in grasping and 
emerging with them in the sunlight of truth be- 
yond. We have said that Dr. Thompson makes no 
pretensions to fine writing, yet there is a force and 
compactness in his style, which many older writers 
might study to advantage. 
While Dr. Thompson's love of theory, appa- 
rent upon almost every page of his book, tends to 
the raising of prejudices against it, yet his love of 
truth, on the other hand, should go far to subdue 
any feeling of that kind, and secure for the work a 
candid study. 
Dr. Thompson has displayed extraordinary in- 434 
NOTICES. 
genuity in accounting for many mysteries con- 
nected with fever, selecting, for the most part, such 
as Fordyce believed totally inexplicable, and which, 
perhaps, for that very reason, subsequent writers 
upon fever have avoided. The most difficult of 
these Dr. Thompson brings the analyzing power 
of his mind to bear upon with a force that no one 
can fail to admire, however far he may be from be- 
ing convinced. 
We have made quotations enough to show that 
Dr. Thompson knows what he is talking about, 
and that, if he were fond of controversy, he pos- 
sesses the ability to constitute him a dangerous 
competitor in the highest walks of science. We 
have said that he makes no great pretensions to 
science as ordinarily construed. That is, he has 
not filled his memory with the dogmas of accredited 
authorities, and thus become scientific to the extent 
of the powers of his recollection. He has not 
abandoned the right to think for himself, and when- 
ever the result of his cogitations comes in conflict 
with the dogmas, even of the high-priests in the 
temple consecrated to scientific truth, he modestly 
states his objections, and the reasons upon which 
they are founded. 
Whether the practice suggested by Dr. Thomp- 
son's theory will prove as successful in the hands 
of others as he believes it has in his own, remains 
to be ascertained, and concerning which we hazard 
no opinion whatever. NOTICES. 
435 
BY DR. REESE, OF THE MEDICAL GAZETTE, NEW YORK. 
This is an unpretending little volume, by an un- 
practiced author, who, nevertheless, shows that lie 
belongs to a class of thinking physicians for whom 
we entertain great respect. No one can read this 
■work without perceiving that its author is emi- 
nently a practical man, who refuses to think by 
proxy. What he writes has the rare merit of being 
suggestive, by broaching new ideas, which are cal- 
culated to set other men thinking. We honor such 
a man, and recommend his book. 
FROM DR. S. A. CARTWRIGHT, OF NEW ORLEANS. 
Your book is a small one, and nothing seemed 
easier than to give it a thorough perusal; but I 
found the task a difficult one, and I cannot say that 
I yet have accomplished it. Your book is hard to 
read; not on account of the bones, in the shape of 
theories and speculations into the essential causes 
of things, but on account of the fat, marrow, and 
savory viands you have stewed up with them. 
Hippocrates is hard to read, and so is Sydenham, 
and so is every author abounding in useful and 
practical information-so you need not wonder if 
it has taken me more than three months to read 
your book. Although it abounds -with many objec- 
tionable things, (typographical errors, etc.,) yet I 
regard it as an arrow shot in the right direction. 
It is a safer book to practice by than Watson or 
Wood. It is so far ahead of the age in which we 436 
NOTICES. 
live, that it is not likely that its author will live to 
see the clay when it will be duly appreciated by the 
profession. The day is coming when the folly of 
treating the diseases of negroes by books written 
by authors who have never seen a negro, and know 
nothing of his anatomical and physiological pecu- 
liarities, and who have never been in a cane or 
cotton field, or in a negro-quarter, will be ap- 
parent. That will prepare the way for seeing the 
folly of treating white people, in a Southern cli- 
mate, by the remedies found most appropriate for 
the same people in a Northern climate, laboring 
under diseases peculiar to that climate-a climate 
where arterial reaction, and not venous congestion, 
constitutes the main outlet to human life. 
Your syrup is so strong a capillary stimulant, 
that here it will often cut short pneumonia, by 
sending the blood into the almost bloodless capil- 
laries in cases which would probably die under the 
lancet, gum-water, and antiphlogistics. Your book 
is a look in the right direction, because it leads 
back to the old regular practice of medicine, and 
goes against the reformed system imported into this 
country originally from Edinburgh-a system of 
practice almost certain death in the apoplexies 
of the South, hurtful in most of the fevers met with 
in Southern climates, and very apt to put out chil- 
dren's eyes in ophthalmia. I lately treated a child, 
attacked with purulent ophthalmia a few days after 
birth, with the lotion you advise, applied over the 
eyes, and cured it promptly. This child would NOTICES. 
437 
have lost its eyes under leeching and the methods 
observed in the popular medical books of the day. 
The disease, in addition to the means you advise, 
requires a change in the nurse; good milk nourish- 
ment to cause the bones of the head to fill out-an 
essential indication which calomel, leeching, and 
lunar-caustic can never fulfil. But in apoplexy, 
pneumonia, and the most of our fevers in this cli- 
mate, the pathological condition of the system is 
like the child with purulent ophthalmia, in which 
bleeding and antiphlogistics are as dangerous to 
life as they are to the eyes in the child's case. But 
your kind of practice is not a new thing to me. I 
have tested the merits of a similar practice for a 
third of a century. It was not very long after I 
began the practice before I found that the treatment 
recommended in Northern and European books was 
not adapted to Southern latitudes. 
Your book is most valuable, if for nothing else, 
in setting sassafras, the peppers, and the spikenard 
of the ancients on their as-ain as valuable 
therapeutic agents in the treatment of Southern 
diseases. It is also valuable in being the first thing 
in the shape of a book which has set a face like 
flint against that modern empiricism that doctors 
all the world, not by the remedies adapted to the 
diseases and climate peculiar to each part, but by 
only those adapted to the diseases and climate of a 
very small spot on the earth's surface, as different 
from the fest of the world as any two things can be 
from each other. 438 
notices. 
experience oe others. 
R. D. Hall, M. D., Leiper's Fork, Tenn., says: 
" I have used your remedies for fever and flux, and 
have found them fully equal to what you represent. 
I have treated twelve cases of typhoid fever, and 
have succeeded promptly in all; I therefore heartily 
subscribe to your plan of treatment." 
K. G. Bobo, of Mt. Oliphant, Tenn., says: "I 
have adopted your plan of treating fevers, much 
to my own advantage, as well as that of my 
patients." 
F. W. Cooper, M. D., Clover-Port, says: "I 
have used the prescriptions given by you during 
the lectures of 1853-54, the past summer and fall 
with uniform success. I am satisfied that your 
manner of treatment will do to depend upon." 
Daniel Abbey, M. D., Rock Spring, Ga., says: 
" I have used your remedies for fever with the best 
effect. I hope I will soon receive your book," etc. 
James L. Miles, M. D., Butler, Ala., says: " So 
far as I have tried your plan of treating fever, it has 
succeeded most admirably. I think it worthy the 
attention of the profession," etc. 
Dr. L. S. Tolson, of Wood Lawn, Miss.: "Your 
theory of fever is evidently in advance of the teach- NOTICES. 
439 
ings of the age. I have used your fever syrup 
and chloroform liniment quite extensively, and am 
much pleased with them; have in many cases 
aborted or broken up typhoid fever in its incipient 
stage; but think the syrup contra-indicated when 
the glands of Peyer are ulcerated, but believe that 
if your plan of treatment is pursued in the early 
stage, it will prevent this from taking place. Have 
broken up erysipelatous inflammation many times 
by thre'e applications of the oil of sassafras. I 
have recommended your work to the physicians of 
my acquaintance, because I believe it eminently 
worthy." 
Dr. A. D. Cutter, Dresden, Tenn.: "Ihave used 
your plan of treatment quite extensively this year, 
with complete success; have used over six gallons 
of the fever syrup. I believe your practice the best 
that can be adopted in all fevers having a bilious 
origin. I have not tried it in any other." 
Then follows a report of a number of very inter- 
esting cases. 
Dr. L. II. M. Cooke, Silver Spring, Tenn.: "I 
had used your remedies for fever and dysentery 
before the purchase of your book, from representa- 
tions of young men from my office, who had heard 
your lectures before the medical class, and I think 
your plan equal to your representations." 
Dr. Y. S. Hereford, Whiteville, Tenn.: "I 440 
NOTICES. 
have treated a number of fever cases according to 
the plan laid down by you, and in every instance 
with complete success. I have a beautiful little 
daughter, now in the enjoyment of the most perfect 
health, who was brought down to the verge of the 
grave by that great baby-destroyer, cholera infantum, 
upon whom every means had been employed with- 
out avail, until treated according to the plan you 
recommend. It acted 'like a charm.' I feel that I 
am indebted to you for her life. I believe your 
work is destined at some day to occupy an envia- 
ble position in the eyes of the medical world. If 
you publish a second edition, I want it, and you may 
consider me a subscriber." 
Dr. K. P. Bond, Lake Providence, La.: "I have 
used your plan of treatment in many cases, and all 
grades of fever incident to the region of country 
in which I practice. In intermittent fever, I might 
say it has proved a specific, if such a thing can be. 
I have used it in rubeola scarlatina, and the sequela? 
of these diseases; in pleuritis, pneumonia, etc., 
with the happiest results. But have I aborted 
typhoid fever ? It is a difficult matter to say 
yea or nay; I have been called to see many patients 
■who, if symptoms are to be relied on as indices, I 
would say had typhoid fever, and I have restored 
them to health in from three to seven days. I have 
several times called in other physicians to see such 
cases, who agreed with me that I had typhoid fever 
to treat, and yet in every case the patient was dis- 
charged cured in less than seven days." NOTICES. 
441 
Dr. M. J. Miller, Gas Factory, Tenn.: "I have 
treated upon your plan all the forms of fever com- 
mon in this latitude, with as much success as could 
be desired. If I have not aborted typhoid fever, I 
have never cut short a case of remittent fever. In 
all the cases I have seen, the treatment has been 
uniformly effectual-some of them not lasting over 
four days, and the longest not over seven days." 
Dr. Daniel Abbey, Benton, Mo.: "I thank God 
that your life was spared to give to the medical 
world the benefit of your observation and experi- 
ence. I believe that the doctrines contained in your 
little book are founded upon the true science of 
medicine. Your plan of treatment never deceives 
me; and it leaves the system in such fine condition 
that I have no relapses, nor any dyspepsia follow, as 
formerly was frequently the case." 
Dr. W. Kirk, Buckhorn, Miss.: "I received 
your work on Fever over two years ago, and regard 
it as one of the best works I have ever seen. It 
has been of infinite value to me in my practice. I 
have done a large practice, and have adopted your 
treatment of fevers in full, and have been entirely 
successful." 
Dr. J. G. Boyd, Shady Grove, Tenn.: "Your 
plan of treatment in fever, dysentery, etc., has 
proved entirely successful in my hands. I consider 
it a great achievement in the healing art." 442 
NOTICES. 
Dr. S. L. Walker, Franklin county, Va.: "I 
have tried your plan of treating fever with complete 
success. I will say, in all candor, that I consider 
your work on Fever, etc., a complete practical 
treatise, sufficiently scientific for the most profound 
minds. In fact, your system is beautifully original: 
were your work in the hands of every practitioner 
of medicine, what an incalculable amount of human 
suffering might be avoided ! I hereby endorse your 
work, and cheerfully recommend it." 
Dr. J. E. Fulton, Big Oak, Miss.: "I can say 
that I am well pleased with your work on Fever, 
Dysentery, etc. I have tried your plan of treat- 
ment in typhoid fever, dysentery, etc., and can 
safely say it has not fallen short of any thing men- 
tioned in your work. I loaned your book to a dis- 
tinguished physician, who says that the principles 
inculcated therein are founded on facts, and will 
speak for themselves yet. I hope you will publish 
an enlarged edition." 
Dr. J. N. Croom, Mifflin, Tenn.: "I have been 
in possession of your work on Fever, Dysentery, 
etc., for over two years; and having a large prac- 
tice, I have tried your plan of treatment in full, 
with great advantage to myself and my patients. 
I am well pleased with your little book, and if you 
are preparing another edition, I hope I will soon 
receive it." NOTICES. 
443 
NOTICES OF SECOND EDITION. 
BY PROFESSOR BOWLING. 
This is a beautiful volume, elegantly bound in 
sheep, and got up generally in the highest style of 
the art, at our Southern Methodist Publishing 
House. This is rather a new book than a new 
edition of Dr. Thompson's former work. The 
former edition went off rapidly, and secured for the 
author a high reputation throughout the Southern 
country. We predict a rapid sale of the present 
edition. It is a very great improvement upon the 
last. The typographical blemishes which so dis- 
figured the former edition, have been corrected in 
the present. The whole work has been rearranged 
and reconstructed, and nearly two hundred pages 
of new matter added. For the philanthropist to 
witness genius rewarded-the anxious and arduous 
toils of almost half a century bearing fruit at last 
the most grateful to it-is true happiness. We 
said so much of the former edition of this work, 
that nothing more is necessary to say of this than 444 
NOTICES. 
that we know it to have been urgently demanded 
by the profession, and that the grateful author has 
successfully labored to make it more acceptable to 
the public. 
FROM THE BANNER OF PEACE. 
The popularity of this work by Dr. Thompson, 
its real merit with the profession, lias necessitated 
the issue of a new edition. It comes forth now 
with the emphatic endorsement of some of the 
most intelligent and influential of the medical pro- 
fession, and with, we believe, the respect of all. 
By those who are the best judges, it is set down as 
a lucid and philosophic inquiry into fever, its 
causes, and the means of cure. Advancing views 
at variance with received opinions, offering reme- 
dies unused by the profession, it has, nevertheless, 
broken down much opposition, and won its way to 
favor. Its clearness of style will enable any reader 
to comprehend it, and its logical deductions will 
convince the understanding. 
THOMPSON ON FEVERS. - BY S. P. CRAWFORD, M.D., 
GREENVILLE, TENN. 
The work under consideration, at the 
head of this article, I have read and re-read, and 
have practiced upon its plans with the most satis- 
Froni the Nashville Journal of Medicine and Surgery, Jan., 1.860. NOTICES. 
445 
factory results and the best success of any plan 
heretofore adopted by me. I do not think I am 
saying too much when I say, that all that is known 
in the profession upon fevers, their causes, patho- 
logy, and treatment, and a little more, is rammed, 
crammed, and jammed in that book, in so easy, 
simple, and intelligible a manner, that he that runs 
may read and understand. The author manifests 
astonishing powers of thought, reasoning, and 
genius. The book is a small one, and may seem 
insignificantly little to many voluminous compilers, 
yet it contains more actual thought and labor, 
because of its originality, than many volumes ten 
times as large. Gross's ponderous work is of more 
mechanical labor, but not half the thought; and 
whilst he may have received great eclat for his 
mighty labors in such a production, which only 
answers in my judgment to magnificently set off a 
library, or occasionally serve as a work of refer- 
ence to reproduce an idea that had been forgotten, 
Thompson leads the mind where it never had been, 
develops new ideas and demonstrates new truths, 
sifting all collected material, throwing away the 
dross, and marches up to the very confines of medi- 
cine, and ventures to look beyond it with the 
unassuming independence of the devoted thinker 
-one who manufactures for himself. In short, 
he is one of the occupants of the original field 
where the fewest number have the capacity to 
labor. . . . 446 
NOTICES. 
From the New Orleans Medical Gazette and Hospital Reporter. 
TYPHOID FEVER, AND ITS TREATMENT. BY W. A. 
BROWN, M.D., CUNNINGHAMS, TEXAS. 
.... Within the last decade, a new system of 
treatment has been proposed, as set forth by Dr. 
It. Thompson, of Nashville, Tenn. Thompson's 
theory of typhoid fever could not be considered a 
new one, but is made up of a little of every former 
theory combined. Whether Thompson is correct 
in his views we do not pretend to say, but think 
him as likely to be right as any former writer; but 
as to his treatment, we are sure it is incomparably 
more successful than any other that has been pro- 
posed. Of the modus operandi of his treatment, we 
know nothing; but of its success we can bear 
testimony. If Thompson's treatment is fairly and 
faithfully carried out, it will speedily cure at least 
nine of every ten cases. It may be that there is a 
close analogy between oil of sassafras and turpen- 
tine; or it may be the counter-irritants used do 
something clever; or that something in the com- 
pound is antidotal, and destroys the cause. 
The treatment is no less valuable because we can- 
not explain its modus operandi, for it would be quite 
as difficult to explain the modus operandi of quinine 
in maiarial fevers; yet none can dispute its utility. 
We say that Thompson's system will cure typhoid 
fever, and ask every Southern physician who has 
not tried it, to do so before he sacrifices another NOTICES. 
447 
patient to the uncertainty of former plans. We are 
aware that some will sneer at his prescriptions on 
account of their simplicity. Could any thing be 
more simple than Peruvian bark ? And yet it will 
cure intermittents. We do not agree with Dr. 
Thompson in all his views, and yet he may be 
right. We had read the first edition of Thompson's 
book for more than two years before we tried his 
remedy for uterine contractions ; but at last we did 
try it. We had a case in which we had tried every 
other remedy we had any knowledge of, and failed 
to give more than temporary relief. We had con- 
cluded that abortion must be the final result, and, 
more to amuse the patient than any thing else, pre- 
pared her a bottle of Thompson's anodyne alterant, 
which, to our astonishment, gave prompt relief, and 
she went on to her full term with very little more 
suffering. In the early part of 1859 we were con- 
sulted by a German lady, who said she had mis- 
carried seventeen times successively. She had 
tried the best German physicians to no advantage. 
She said she knew we could not prevent her mis- 
carrying, and only desired a tonic prescription. 
We obtained a reluctant promise to send and get 
Thompson's anodyne, and try it, if she became 
pregnant again. In six weeks she announced the 
fact that she had again conceived, and got the pre- 
scription, which she promised to follow literally. 
At the usual time, four months, she had the usual 
symptoms, but took the medicine freely, and was 
relieved; and a few weeks ago she gave birth to a 448 
NOTICES. 
lino healthy child, to the exceeding joy of herself 
and husband. 
This remedy supplies a desideratum in the list of 
our available means that every physician must have 
felt severely. It would be useless to say more of 
the merits or demerits of Thompson's remedies and 
his book. It is with the view of calling attention 
to a new edition of the work that we produce this 
article. As an act of charity and justice to the 
afflicted, we hope physicians will buy it. It is a 
Southern work, by a Southern man, and should be 
patronized by every physician South, at least. It 
may be had by addressing II. Thompson, Nashville, 
Tenn., enclosing two dollars, by mail, free of 
further expense. The book contains 400 pages, and 
will pay any one well for reading it. 
Verbena Vale, Texas, Feb. 6, 1860.