VYCK H493 I8£4 ■*#• ^ ,T*m ■ •;•:•...•.% # ... .. j &;*>:* *. '.: *$&*& S • SH&iiX'.*•"■• -: • • w[3 ' ■ '^Vi mi ■ __ ^n ': r-'^WOTSN DOC FEV1 WASHINGTON'S ESSAY ON V U)W >«" *i A\ Cy cry ion* = SPEEDY BINDER ^ ^^E Syrocme, N. Y. -,»' ■ Stockton, Calif. NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF 3NI3IQ3W JO AlV»ail 1VNOUVN 3NI3K13W JO UKI1I1 IVNOIIVN 3NI3IQ3W JO A 8 V » 9 II > i NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF 3NI3IQ3W JO All V 118 II TVNOUVN JNIDIfliW JO UV1SI1 IVNOIIVN ] N I 3 I d 3 W JO AIVI9I1 \Ms i NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF 3NI3IQ3W JO HVIII1 IVNOIIVN 3NI3I03W JO A S V II S I 1 TVNOUVN 3NI3IQ3W JO A « V « 9 I 1 NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF E pr^^/ S ARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF \ CRITICISM DOCTOR WASHINGTON'S YELLOW FEVER. s .vrifett,. r' j CRITICISM DOCTOR WASHINGTON'S YELLOW FEVER. 1/ BY TH: HENDERSON, Fellow of the Medical Society of the Diitrict of Columbia. GEORGETOWN, D. C. JAMES 0. DUNN, PRINTER. 1824. \NCK hL> vvo IfH^ 'ut>>^->f PREFATORY REMARKS. In the summer of 1823, an Essay on Yellow Fe- ver was read before the Medical Society of the Dis- trict of Columbia, by B. Washington, M. D.; and was presented to the profession through the medium of the Philadelphia Journal of Medical and Physi- cal Sciences, in August of the same year. At the same time, it was circulated more or less generally, in a pamphlet form in Washington. In this way, falling into the hands of the Editors of the Intelli- genccr, it received a newspaper puff, and attracted popular attention. Certain opinions contained in the Essay, were commented on as honourable to the candour of the author, although they were consider- ed as presenting the state of the Medical profession in an unfavourable aspect. As the author of the Essay did not remove the impressions which were created, a respectful attempt was made on my part, to stop the progress of errour, by inviting proof or disavowal, and by giving some facts which were authentic. It was then intimated that notice would IV at a proper place, be taken of those parts of the Essay which were strictly professional. The fol- lowing Criticism was read; not, however, without previously submitting it to the judgment of many able and candid medical gentlemen, who all united in the assurance that the letter and spirit were strict- ly within the boundaries of fair criticism. It was shewn to these gentlemen with a request that any improprieties might be pointed out and removed. The author of the Essay has taken a different view of it: and has, it is thought, misrepresented its character. It is therefore published. Any want of judgment which the Essay displays, certainly the author has not carried into his course since it was made public. Wrapt in the mantle of errour, he is content with silently observing the pro- pagation of his views, which are unsupported by fact or philosophy. Some time before his Essay was published, he was invited in the Medical Soci- ety to display his experience; or, in other words, his cases. For as his views were at first represented, he was informed that could they be supported, an era would be proclaimed in our profession, such as the discovery of vaccination only had equalled: and such as weeping humanity despaired of realizing.— V With regard to his experience,—his cases, his facts, —the author was mysterious, as in his Essay he is unsatisfactory. If there be any new considerations presented in his Essay on Yellow Fever, it is hoped they will be valued for something else than their novelty. If any objections which this Criticism has raised, be found not to bear the test of experiment; it will give to the writer all that pleasure in acknowledgment of his errour, which can exist in the mind of a candid man, whose desire is to see the practice of physic resting on the immoveable basis of philosophical induction. TH. HENDERSON. Georgetown, May 1824. ousvsQaask "If a man in any science, make an assertion, it behoves him to bring some proof of such assertion. Tliis has unfortunately been very rarely the case; in medicine, a man has very often taken his own -whim as the truth, without bringing any proof."—[Fobdice on Fever. A regard for truth has led to this notice of the Essay on Yellow Fever. A conviction of the essential nature of the considerations presented, and the practice recommended, lead to the inquiry, how far the first are to govern an esti- mate of the healing art, in its general aspect in this country; and the latter, to influence our practice when called on to grapple with this monster, the Yellow Fever. These sub- jects should be prosecuted in the true spirit of criticism. The attempt is made with the impression that we are labouring in the field of philanthrophy; where to spare errour would be a cultivation of personal feelings, at a sacrifice too costly for the consistency of the medical man. Is the spirit or letter of the Essay, foreign from truth? We think it is in direct opposition to experience and reason. Is it important to exhibit this? It is; because the errour is au- thoritative in its origin; ingeniously speculated on; and direct- ed to the younger members of the profession, who may not be guarded against the specious garb, under which it appears. Not that it is to mislead, where maturity of mind and extend- ed observation have formed the practitioner's judgment;—to such, the errours are palpable. Even to such, an inquiry may not prove altogether uninteresting. The motives of the author are not questioned. What can they be other than those of the most exalted spirit of bene- 8 volence? But the fallibility, in some, or the impotence of human essays under other circumstances, teaches the truth that an essay to be useful, calls for something beyond the quo animo; and that evil has often resulted from the best feelings of the heart, not being under the happy direction of an overruling judgment. The observations which follow lose no weight on account of their not being the fruit of experimental acquaintance with Yellow Fever. Practice ever has been, and ever will be mainly directed by authority—because authority is, or ought to be founded on experience. The Essay does not justify us in believing it to be the result of experience, for it gives us none. Not informing us when or where this or that remedy was used, it leaves on the mind the impression of fine spun theory, woven by the midnight lamp. The reader is not permitted to follow the author by judgment on his cases— only one is given in which the emetico-cathartic was exhi- bited; and that case is recognized, as one of oppressed func- tions of the stomach and brain from a large mass of undi- gested aliment. As an Essayist would be estimated, who should write, that, certain indications met with boldness, tetanus and hydropho- bia would be classed with the ephemera, and like them cut short in their career; without giving a case to enforce his suggestions, or even a plausible reason for receiving them, so will the author of the Essay be respected, till some better reasons be offered for the admission, that in his hands the treatment of Yellow Fever has been less fatal, than in other circumstances. In an ordinary disease, no such circumstan- tial detail would be required. Yellow Fever is not an ordi- nary disease. The efforts of genius displayed in speculations on this disease are entitled to regard—yet it is of importance that theory should rest on its proper level, and be appreci- ated duly. In the introduction of a remedy, opposed to all experience and at variance with every principle that reason 9 ran suggest, as we suppose; theory alone cannot afford grounds for exultation, in the prospect of blotting out an opprobrium to our profession. Are we, on the authority of the Essay, to use emetics in Yellow Fever? We are told "that emetics can be confidently recommended as by far the most salutary means that can be adopted in Yellow Fever." By a concurrence of testimony neither to be questioned nor controverted; by symptoms and post mortem appearances, we are irresistibly led to the conclusion, that the stomach is "the scat and throne" of this disease. Justified in the apprehen- sion that this key to the system being lost, and destroyed by the violence of the disease, one of the greatest impediments arises to its successful treatment.—Paralyzed in its functions, and disorganized in structure, the means of introducing re- medies into the system are lost. Other lesions are to be con- sidered as secondary agents in leading to fatality; the chief one being the irritability—the inflammation, the death of the stomach. In authors of the highest practical character, no- thing is so frequently set forth as the "vomiting with strain- ing, mucus and common drink alone being ejected";* "the sense of burning heat at the stomach";t "sickness at the sto- mach from the first, which increases with the disease, and immediately after any "thing is taken to quench the thirst, retchings succeed, with anxiety, stricture, soreness, with in- tense heat about the praecordia";* "the worst symptom, a retching or vomiting, which is greatly aggravated by erne- tics";|| "the irritability emetics give rise to, can never be com- pensated by the imperfect evacuation they may produce";§ "vomiting and violent straining to vomit, commenced very * Johnson on Tropical Climate9. ■j- Blane on Seamen. \ Moselt on Tropical Climates. || Hcnter on Diseases of Jamaica. § Chisholm on Fever. B 10 early, and could with difficulty be controled: most generally in the commencement, nothing but the drink and other liquids which had been swallowed, or a glaring mucus, were thrown up";* and Dr. Rush speaks of the efficacy of bleeding in checking the vomiting in the early stage of the disease, and thereby enabling the stomach to retain medicine. "Among other symptoms, an affection of the stomach peculiarly disa- greeable—it is impossible to give a clear idea of it in words— anxiety and nausea, and certain unusual feelings, strangely combined."t "The stomach, which seems truly to be the throne of the disease, was generally irritable from the first, easily excited to vomiting, which when it came on spontane- ously or from any thing taken, was uncontrolable, or re- strained with difficulty; soreness at the pit of the stomach, which was much increased by straining to vomit."J A few extracts have thus been made from some of the ablest and most experienced authors, affording their views of the symp- toms indicative of the state of the stomach, and its connexion with the pathology. A brief view of the post mortem appearances in relation to the stomach, will now be taken. Some stress is laid on this part of the subject in the Essay, in which it is said, on the locality of diseased action in Yellow Fever, that "post mor- tem examinations, though ardently prosecuted, have hitherto cast so little light on Yellow Fever—which like the gout, flies about the system, seizing as a vulture, and yet when death ensues we seek in vain with the knife for the traces of its violence." If the author means to say that dissections have not yet thrown any light on the cure of Yellow Fever, it may not • Samcei Jackson, Philadelphia Journal of Medical and Physical Science. f Robert Jackson on Fever. * Dr. Dickson of Charleston, Philadelphia Medical Journal, T -■ 11 afford a material ground for difference with him: but if, which seems evidently his meaning, that the knife has thrown no light on the seat of the disease, or its locality, there is pointed issue joined. Whatever may be the difference among medical men as to the treatment of, or any other circumstance connected with, the disease, they all concur in the post mor- tem appearances—the brain slightly affected—the contents of the thorax nearly natural—the abdominal viscera being the obnoxious regions—the stomach inflamed, gangrenous, mor- tified, abraded—the intestines more or less so—the liver fre- quently although not always diseased—sometimes the spleen and kidneys—but the stomach, "the seat and throne of the disease." There is amongst the host of authorities not a dis- senting voice as to the locality of diseased action. How ab- surd, then, the analogy attempted to be shewn with "gout, and the seeking in vain for the traces of the disease." That case is not to our knowledge recorded, where the appearan- ces were not palpably located; or if there be a case of the kind, it is an exception to a most general rule. We are com- pelled to refer the author of the Essay for information, to Un- reports of Professor Physic, of Dr. Parish, and Sam. Jackson, on the subject of post mortem appearances.—Nay, he is re- quested to read the paper of Dr. Daniel, on the diseased state of the stomach, &c. in the same number of the Journal with his own; that of Dr. Dick of Charleston; and that of Dr. Ran- dolph of New Orleans. We must quote one more author on the post morten appearances in this disease: Professor Chap- man, in his Therapeut, ii. 298, "the stomach was universally met with in a state resembling that which is produced by the action,of the corrosive poisons; or in other words, presenting the phenomena of malignant gastritis." Under these views, most clearly established by authority, let the subject be prosecuted to its most interesting conclu- sion. Are vomits safe in Yellow Fever? To the proof of the negative #f this question. 12 Dr. Burnett observes, that "his experience should prove a lesson against the use of emetics in fevers of hot climates, Where gastric irritability is one of the most formidable symp- toms." The treatment pursued on board two British fri- gates, was by emetics, calomel and antimony, 8cc. and fatal to a most remarkable extent. We find Blane assiduously engag- ed from first to last, in allaying the irritability of the stomach, which occurs so early and proves so fatal. Mosely says, "the vomiting is from irritation, and not from filenitudr; therefore v mits are never to be given: no, not even warm water, as recommended by Hillary, for fear of exciting and stirring up that terrible commotion which nothing can allay. "How often (says he) have I seen and lamented the effects of emetic tartar given to remove the supposed cause of the treacherous symptom of vomiting. Instead of removing the irritating sickness in this fever, or exciting a diaphoresis, a spasm has been produced in the stomach, incessant vomiting, inflamma- tion, and the patient has vomited away his life." Hunter's testimony is to a similar effect. Chisholm says, "except in very slight cases of this disease, vomits should never be giv- en; for the irritability they give rise to can never be compen- sated by the partial and imperfect evacuation they may pro- duce." Robert Jackson tells us he cautiously avoided eme- tics. Dr. Rush's experience of bloodletting in allaying irri- tability and enabling the stomach to retain medicine, is allud- ed to above. Dr. Archer, an able and accomplished practi- tioner of Norfolk, states—that when the stomach would ad- mit of it, which was rarely the case, an emetic of Tart. An- tim. had a good effect: but as a general remedy, it could not be used; as when nausea prevailed, it was apt to increase it, even after its operations had ceased. The prominent feature of an almost uniform and uncon- querable irritability of the stomach, is laid down as an esta- blished truth in Yellow Fever—occur when and where the disease may. The danger of increasing this irritability, is 13 awfully apprehended by every author whose works have fall- en under our observation: and the fact that this takes place from emetics, is admitted by the author of the Essay, (page* t 312). He therefore modifies the treatment, and gives the emetico-cathartic or dry vomit. Does ipecacuanha or tartar emetic lose the emetic property by being combined with ca- lomel. It is well known that they do not; so far from it, this combination is, while it frequently operates as much as an emetic alone, much more, nauceating and debilitating to the stomach, than an active emetic at once prescribed and done with. It may be asserted as a fact not susceptible of denial, that the operation of an emetico-cathartic is never under ab- solute control; and experience teaches us that nausea, heav- ing, and effectual vomiting, are very frequently the result of its administration. Here, then, this prescription in no wise differs from an emetic; or to us, the secret is unknown of so exhibiting it as to produce this exact effect: and it remains to account for its peculiar adaptation to Yellow Fever. This is done by its operation as a dry vomit. To the dry vomit, then, belongs this efficacy: it is by this that the Yellow Fever is to be made to "terminate happily, like the ephemera, and to be cut short in its career". In the author's Essay there is no peculiarity but this; for let it be here remembered distinct- ly, that he reprobates above all things, emetics or wet vomits. There are two authorities on the subject of emetics in Yellow Fever, most properly to be introduced here. The first is the venerable Robert Jackson, whose experience in early life in this disease, has already been alluded to. In 1817, this experience is rather more favourable to the use of emetics in Fever generally; and his words are given relative to the subject matter of review.—''Emetics do no good, they even do harm contingently when the habit is full, the arterial action high, the pulse hard, tense, or small deep, and con- tracted—the skin thick and torpid; or where the functions of important internal organs, \ iz: head, lungs or liver, are op- u pressed by sanguineous congestions:" again, "a prejudice exists with many against the use of emetics in the Fevers of the West Indies; and emetics I am free to say do no good— they even do harm contingently in the ardent and concentrated forms that present themselves in that country, if given with- out preparation by abstraction of blood; but even when so given they do less harm than I was at one time disposed to believe." But even if this author were an unqualified friend to the use of emetics in Yellow Fever, it is worthv of remark, how diametrically opposed he is to the mode of exhibition, and the accompanying circumstances in their use, recom- mended by our author; who says, "we lay it down as a maxim, that blood cannot be taken away before the evacua- tion of the alimentary canal:" and "the reason why so much mischief has followed the use of emetics, is the ordinary mode of their exhibition, followed by large draughts of fluids, alternately distending and emptying the stomach," Sec. Dr. Jackson, who, by common consent, is admitted to be autho- rity as high as is to be met with, and who has recently com- municated the fruits of a ividely extended exfierience of almost half a century, lays down no maxim such as has been quoted, but gives as his experience, "that in some cases abstraction of blood to a very large extent is indispensably necessary to assure a safe and effective operation from emetics; in others, the preparation of the stomach by tea, whey, warm water or other beverage in which alkali has been dissolved: besides, during the operation the stomach is to be washed out at in- tervals, with alkalized infusion of camomile tea or warm water. As it is seen that an emetic of severe operation arrests or sensibly mitigates the force of the disease, while a mild one has no beneficial effect; it is proper to administer emetics of severe operation in the stronger forms of fever, and to en- courage the vomiting, &c." These last remarks are general. Let it be borne in mind here, the horrour with which the au- thor of the Essay deprecates even a single glass of water 15 with his dry vomit. Another author on this subject, is Dr. Yates, in No. 1, Vol. viii. New-York Med. Repos.—He says, out of seventeen decided caaea of Malignant Fever sixteen were cured, by giving more than a grain of tartar emetic after each fit of retching; and this from day to day, till the vomit- ing ceased. After the stomach had in this way become quite calm, he gave a full dose of the emetic with the view more fully to empty the biliary ducts. A motive most de- precated by our author. There can, then, be no difficulty in curing Yellow Fever, or very great difficulty in deciding be- tween the author of the Essay under review, and Dr. Yates: for the former tells us the indications pointed out by him being met with boldness, Yellow Fever will be cut short like the ephemera—the latter with a remedy hitherto considered as almost fatal, cures sixteen out of seventeen decided cases; the mode of exhibition and the modus operandi of his emetic being the very reverse of that of the emetico-cathartic pro- posed by our author. We will now refer to the Essay for the modus operandi of the emetico-cathartic, which is, "to cut short Yellow Fever in its career, and make it terminate happily, like the ephe- mera." It is said that this emetico-cathartic or dry vomit, "will, after ejecting the immediate contents of the stomach, cease further to excite that viscus, and will exert its purgative pro- perty; "when the emetico-cathartic is properly given, all which is above the fiylorus is thrown ufi, and that which is below passes down. Now that this appears on paper in the Essay, is true enough; this is not satisfactory. The author may be admitted to be a good judge of the extent to which vomiting should be carried in diseases;—but we recur to the question, who shall say to this dry vomit, so far shalt thou go and no farther? Are we to expect a revival of a sect of practitioners called mechanical physicians, who attempted to adjust the doses of medicine, by a mathematical rule—such as "the 16 doses are as the squares of the constitution?" Or is this prescription to be used as possessing an eclectic intelli- gence, and a regulated power? We have been a long time employed in the practice of physic; and have resorted to this dry vomit in many cases, speaking with precision; and we say with disinterested candour that very little, we cannot say that any difference has appeared in the nausea, vomiting, or muscular violence in the emesis produced by it. Dr. Fordyce in his second dissertation on fever, makes the following observations on emetics—the reader will apply them to the subject of this review. "When the stomach is empty, and drink is not administered during the action of an emetic, the vain attempt at evacuation after the contents of the stomach are evacuated, or the retching always proves. stimulating, and deranges the system very considerably." Again he tells us, "If an emetic of almost any kind, which takes up a very small volume, be exhibited, if there should be nothing in the stomach to be evacuated, there arises an effort to evacution, or in other words a reaching which is attended with a great deal more pain, than if there was a quantity of some substance in the stomach to be evacuated. This has induced practitioners, to give, after an emetic has been exhibited, watery fluids to drink, 8cc." And, that there is very frequently nothing in the stomach to be evacuated, except muCus, in the first stage of the disease, is true.—It is an absurdity, to use the least appropriate strength of expression, to say that the contents of the stomach alone are thrown up: and then the calomel intimates to the ipecacuanha, you have done your office; vomit any more, and you involve all the horrible consequences of an irritable stomach in Yel- low Fever: I will pursue my journey downwards and finish this business; before I go, however, I deprecate again your exciting this stomach any more—we must " cut short this Yellow Fever and make it terminate like the ephemera."— This may be considered a light way of treating the reason- 17 ing of the author on the intelligent modus operandi of this firm of adventurers; but take from page 314 to near the end of page 315, and say if a serious reply can be well made to it. But suppose for a moment, that all this theory—for it is nothing more, and we shall presently give reasons for so thinking it,—should not be realized; suppose that this dry vomit should not in the generality of cases operate with this eclectic, intelligent, mathematical effect; what consequences are involved in the supervention of undue emesis, and who shall say, how much of the emetic power shall be sufficient to "excite that disordered state, momentarily increasing until fatal symptoms, either arising from, or evidently hastened on by the remedy, take place?" The author of the Essay has trium- phantly answered this objection in theory: and while ingenuity has been exercised on gratuitous premises and erroneous in- ferences, we with all due respect require of him facts, on which our judgments are to rest. Has he given them? One case is given us; and he observes, "under simitar circumstances we would venture to give this, at a much later period, as we have subsequently practised with the best success." If the one case is to be received as a case of Yellow Fever, it cannot be so done without inquiring into it. A man of tern- perate habit and good constitution, vomiting, lethargic, fever- ish, pulse somewhat oppressed, eyes dull, suffused, respiration hurried—an emetico-cathartic, is given him, and he throws up two large fragments of undigested food, perhaps salt pork or beef-the man recovers forthwith-and Yellow Fever ts cured. Now, who has not found all these symptoms from the same causes? Who has not seen a man or woman reliev- ed from apoplexy by throwing up undigested food from an over-distended stomach? It is very questionable whether this was a case of Yellow Fever: and we think, without risking the charge of skepticism, that more and very different cases are requisite to make out the author's conclusions. It is not an unreasonable view to take, that the circumstances in C 18 which the subject of the case was placed, were such, as to de- ceive not only himself, but even his surgeon into the appre- hension of Yellow Fever; and we all know the effects of appre- hension, and the force of circumstances in such cases. The equivocal character of this case, then, leaves the right and reason to ask for more facts, before we can agree to face all authority, experience, and—place it last—reason: something more must be adduced before we are at liberty to admit that Blane, Hunter, Jackson, Mosely, Robertson, Burnett and Johnson, with a host of others, have been deceived on a point, which observation made as clear as noon day;—before we can allow, that it was owing to their treatment that Yel- low Fever has become more mortal; before we can say, that the author has borne himself out in the assertion, that this course pointed out by him will place Yellow Fever on a foot- ing with the ephemera: we would think him more reasona- ble in inferring that salt pork or beef undigested, was the cause of Yellow Fever. We think and hope that the author of the Essay and our- selves will agree on one point—that vomiting is vomiting; nay, go farther together—that an emetic and an emetico- cathartic, a wet and dry vomit, both produce puking.—We are utterly at a loss for authority, other than the author of the Essay, for the fact, that a dry vomit can be made to produce so much and no more puking, and that with an ex- act degree of violence.—-Now if these be admitted, and who will deny them, why should not the violent exertions pro- duced by the act of vomiting, as much affect "the seat and throne of the disease" in the one case as the other? Melan- choly experience proves that emetics are most fatal. The author of the Essay has utterly failed to satisfy any person but himself, that an emetic with a cathartic mixed with it, possesses such a different influence.—On this point in his Essay, it may be truly observed, that "generalities are bar- ren" and accumulation of facts indispensable. 19 An objection which may be made by prejudiced minds, or by those uninformed on the subject, that no experience is offered by us, is abundantly admitted. But, is the mul- titude of men whose names adorn our science, and whose works are standard, and who have enjoyed the most abun- dant and extensive field for observation, in the fleets and armies of unaclimated Europeans, to be disregarded? If so, by parity of reasoning, how is the author of the Essay to be admitted, whose observation has been comparatively circum- scribed, and whose detailed experience, has been weighed in the balance, and found utterly wanting? We will not ques- tion the private principles of our author; but truth is more to be regarded than a friend—and no subject to be safely ap- proached, requires more philosophical observation, founded on practical unerring facts, than Yellow Fever. It is time that those who write should write to some purpose; it is time when innovation is attempted, that solid ground should be occupied; it is a duty for those who make this innovation a ground for sweeping charges against our profession, to use precision in terms—lest peradventure a deeper lecture on death be read, instead of an improvement suggested. In the Essay before us, there is a prevailing passion for theory; all which, in its place, is well. But when the specu- lations are illustrated for practical purposes, the exemplifica- tion is singularly unfortunate. Take the case given as a proof of the sedative operation of mercury. A man during a sickly autumn, was seized with Bilious Fever; he takes at night ten grains of calomel; this commenced in the morning a gentle operation, which going on steadily, ten grains more were given, which instantly checked the purging: then comes on constipation of the bowels—and the inference of the author is, that mercury possesses a remarkable property of destroying or suspending, the susceptibility of the intestines to the action of purgatives. We should say this case was treated without energy; and that obstruction of the bowels 20 was the result, as frequently happens when early active pur- gatives are not exhibited in like cases. The last conclusion to form from such a case, would be, that ten grains of calo- mel had checked the purgative operation of a preceding ten grain dose, which seems to have done well. At least, more cases are necessary to this point, in order to enlist in its fa- vour such unreasonable skeptics as we are. We will not quarrel with the author about the modus operandi of mercu- ry—only observing, that before it is admitted to be a sedative, as he lays it down, some stubborn practical facts are to be gotten round or over. Abundant experience teaches that in autumnal fever, calomel, in doses of three or four grains, giv- en once in four or five hours, produces purging, and often very free purging. It is not sanctioned by experience, that it is so sedative as to bring about constipation. This effect has been observed after absorption—not before it;—nay, it has been a great source of delay and difficulty with practi- tioners, to control the purgative effect of calomel, even in grain doses; so prone is it to produce a loose, rather than an opposite condition of the bowels. Ample experience esta- blishes the fact, that calomel given in doses of five, eight, or ten grains, occasions very frequently, vomiting—and this, for- sooth, by its sedative powers; for according to the author, it is stimulant only when absorbed. It is indeed almost always necessary to combine opium with calomel, when the object is to introduce it into the system; the opium to prevent purging and irritation which calomel by itself, so frequently occa- sions. In the case of this combination; which is the seda- tive, the calomel or the opium? If the former be given alone, griping, purging and intestinal irritation,—palpable sedative effects!!—prevail to a great degree; give them combined, and all is calm and ease. An ingenious attempt has been made to give mercury a counter stimulant character. To be such, is one thing—to be a sedative and antispasmodic, is another. Let us state a few cases which will place the rela- 21 tive action of antispasmodics and mercury, in a true light.— Cholera morbus should, if mercury in its primary operation be a sedative or antispasmodic, be met by this remedy instead of opium. It is suggested to the unprejudiced observer, to form some estimate of the probable result of the sedative in- - fluence of mercury in this case. In colic, if mercury be a sedative or antispasmodic, this remedy should be directly soothing and sedative, and preferable to opium. Is this the fact? In bilious colic, we give calomel, not because by any sedative operations it allays the irritability of the stomach, but because of its specific gravity it is retained when bulky and unpalatable doses are rejected. In dysentery, when we give calomel, it is proverbially true that no relief is obtained until free and copious evacuations are brought off by it. In short, when an immediate and primary sedative and antispas- modic is required, we resort to any other medicine rather than mercury. The modus operandi of mercury, we have considered*in two aspects; one locally stimulant on the sto- mach and bowels and liver—the other alterative and gene- rally stimulant, when affecting the system after absorption. This simple view is, in our opinion, the whole truth as to the operation of mercury. From a work, the character of which is admitted in Europe and America to be unrivalled, we quote this expression: "Whenever we wish a strong and perma- nent impression to be made on the alimentary canal, and through it on the neighbouring viscera and the system gene- rally, calomel, by universal consent, is adopted for such a purpose.—IParis Pharmacologia, Art. Mercury.'] If a medi- cine which almost invariably purges powerfully, and most frequently occasions vomiting, be a sedative; then is calomel a sedative. It is not desired to disturb the author in his mercurial theory; as it leads to no practical result or material errour. So many able writers are to be found differing from each other on the modus operandi of mercury, that we utterly despair of saying any thing worth penning. We are content 22 to take their practical instruction, where it is to be found, and thank them for it. It shall be our endeavour to find some in the Essay: and will brighten our intellects, and blame them, too, for not being able to do so sooner. How exceedingly discrepant medical men are in their expe- rience. How strangely their lots are cast in the sphere of professional observation. These remarks are elicited by the deplorable picture the author gives of what he has observed from the use of mercury. For example he tells us "that we meet with innumerable instances of these with shattered con- stitutions, whose atrophic limbs and sallow complexions are hurried to the grave with all the marks of early decay and premature old age, "a melancholy group"—the victims of mercury." Messrs. Miner and Tully, have lately made a book, in which they prove to their own satisfaction, that no- body can use the lancet with safety but themselves, and give this singular notion: "It has been calculated, t^at within an hundred years from Sydenham, the indiscriminate use of the lancet and the antiphlogistic regimen, so highly recom- mended by him, was the cause of more premature deaths, than the wars that ravaged Europe, during that period." A reviewer quaintly asks, who ever did or could make such a calculation? Now we ask the author of the Essay how he knows that the instances of mercurial destruction were innu- merable? Did he, when he met with them, attempt to count them? What with Tully and Miner's bleeding and antiphlo- gistic regimen, and the author's mercury, it is only to be wondered, that these reporters themselves are left "rari nantes in gurgite vasto" to tell the mournful story. We have been engaged for more than fifteen years in the practice of medicine, and have enjoyed extensive opportuni- ties of observing the effects of mercury in disease. Having always entertained opinions of this article opposite to those which are here held forth, we have used it as the sheet an- chor of safety in autumnal disease; and can say, and do affirm 23 with confidence, that no subject of observation has been more rare, than the poisonous effects of mercury;—on this point the declaration from us is entitled to perfect respect, for uninfluenced by love of system, we have endeavoured to seek with unbiassed minds for the truth. We have in the whole course of our experience seen but two cases of danger- ous mercurial disease. Again: to what a region the author must have been trans- ported where "the opinion prevails that mercury, unrestrict- ed in quantity, may be taken at all times, under all circum- stances, regardless of contra-indications, with the most perfect safety." We must believe that this opinion prevails some- where, because the author says so; but where it can be, ex- cept in the quicksilver mines of Peru, we cannot conceive. Such an opinion does not prevail in this country even with regard to beef-steak or mutton chop—not to say mercury. We congratulate the author on his escape from such a region;—let him content himself, and "falter thanks to Hea- ven for life" redeemed from such dangerous associations, and from the sphere of such heterodox notions: and that he has escaped from the pestilential atmosphere of such prevalent errour. Still more wonderful is the ascription of powers to mercury__"the fraction of a grain will sometimes manifest as much and as immediate febrifuge power, as could be found in all the extended catalogue of the materia medica beside"! "An equally minute portion is, at times, sufficient to create as great a state of constitutional excitement as any larger quantity"'.! "Whilst a half-ounce dose may operate as mild- ly as an equal weight of castor oil"!!! The author then grave- ly tells us, "that enough has been said to guard the inexpe- rienced against falling into the fashion of the day, which degrades medicine from the rank of a liberal science, to the mere trade of vending mercury."—Here we again are carried irresistibly to the mines of Peru, where vast quantities of mercury are vended. 2* % Believing that more is meant in these paragraphs, than is precisely expressed, we take the liberty of inquiring of our author, by whom it is that medicine is thus degraded ? Is it by a popular abuse of this article? Then nothing has been said to do avray the evil; for old women, or domestic prescri- bes, cannot understand abstract notions about sedatives and counter-stimulants. If he means that our science is degrad- ed by its professors, quo ad hoc; enough has not been said to give colour to the "grievous unlikelihood" of the assertion. More precision in terms than the word innumerable and the expression half-ounce doses of calomel convey; happier exem- plification is requisite, than is to be found in the prevalence of opinions with regard to the exhibition of mercury, such as have been adduced; or the wonder-working fractions of grains; something more distinct and authoritative is necessary to bear out the author. Most unfortunate indeed must have been his associations, if his experience tells him such woeful tales. Supported as this charge is against our profession, medical men have nothing to fear from it.—It is only to be regretted that a member of the medical profession should have assumed the responsibility of publishing to the world, that the diseases of our country are becoming daily more mortal—and this owing to their treatment: and exhausted himself in his attempt at reform, in unsupported practical in- novations; in speculations exemplified by looseness of expres- sion, such as will neither bear investigation, nor command respect. Peculiarly unsupported by evidence, is the assertion, that the diseases of our country are becoming daily more mortal. What diseases the author alludes to, he has not been pleased to inform us.—Whether they be in Cullen's Nosology, or in Milton's Paradise Lost, or in Thompson's Castle of Indo- lence,—for these poets were nosologists—is yet to be made known. Whether it be asthma or apoplexy, fever or fluxes, gout or goitre, madness or measles, pleurisies or palsies—or 25 what; no intimation is afforded. Be this as it may, the fata- lity is increasing, and that not moderately, but daily: and this not in Maine or Georgia, Maryland or Missouri; but throughout the country. The assertion is a bold one, and not easily established; it would therefore have been wis- dom to be silent, rather than axiomatic. But when the cause is regarded on which this crude suggestion is found- ed, surely charity should have interposed, until evidence and data infallible and incontrovertible, were adduced, both as to the fact and its cause. A diligent and extensive inqui- ry into the history of the diseases of our country since 1600, affords not a shadow of foundation for the assertion—so far as we have been able to ascertain, having diligently sought after the truth. If, however, the fault be with us, we ask for information; for reference to those authorities and statistics, which justify the author's ground;—and it will be our duty to bow before authority, such as the nature of the case justi- fies us in requiring; such as has not yet fallen into our hands. Before truth, however humiliating to what we consider an honest professional pride, we must give way, if it lead to the unlearning what we have learned: to the breaking up of our most favourite principles and systems—even to the acknow- ledgment, that the diseases of our country are becoming daily more mortal, and this owing to our treatment. Till these requisitions are complied with by Truth, in her clearest as- pect, we conclude, nullius addictus jurare in verba magistri. *M i ') I r i ✓X 3N13 10 3W dO .1 IVNOIIVN 3N.3KMW dO A.V.,1, IVNOIIVN dN.3,a3W dO A 1 V . a , 1 , V N O 11 V N ^ o- .•.,c... H.I...AI .,.,«., „,........= ..no... u..."., o. ...,c,.. ^ „.,,£., u. i /V F MED. CINE NATIONAL I.BRARy'oF MEDICINE N A T I O N A L I I B R A R Y O F M E^D I C I N E N A T I O N^A I I I ■ I I IVNOIIVN 3NI3IQ3W dO AIIV * a I 1 IVNOIIVN 1NOIQ3W dO AVVBaiT IVNOIIVN IN I 3 I03W dO A MEDICINE NATIONAL LIBRARY OF MEDICINE N A T I O N A I I I B R A R Y O F M E D I C I N E N ATI ONAL II II, iCS" I ./ViXn f ./x\ v\ ! /vi ■a NLM032888036