'YVUcD fe> ' °-^~ ^J/KuSck^t- /: ■tr Jctc2). ANSWER f>i*4 to TO A REVIEW OF MCDOWELL'S TREATISE ON CONSUMPTION. . T T 7b tA« Editors of the Loutsville Journal: Gbntlbmen: The subjoined answer to a review of my Treatise on Consumption, by Dr. Y., which appeared in the September number of the Medi- cal Journal, was designed for publication in the same periodical. The magnanimous editor, Yan- dell, refuses to publish it. < Will vou do me the favor to publish it in your paper, together with a sufficient number <>f extras, in pamphlet lorm, for each of his subscribers? wm. a. Mcdowell. ANSWER TO A REVIEW OF McDOWELL'S TREATISE ON CONSUMPTION,^^,. By Wil A. McDowell. l*^*"^ Ljuisville, Sept. 12, 1844. Messrs. Editors: In a review of my Treatise on Consumption, in the Sep'.ember number of ;.our Journal, I think I have reason to complain of Injustice in several particulars; and consider my- Mvf entitled to room in your next number to an- swer and to define my position. Injustice: l>t. In charging me with claiming , jjare fnljy set forth. They have been readily com- prehended and successfully practiced upon by several physicians of less lofty intellectual pre- tensions than my reviewer; as also by some intel- ligent non-professional gentlemen. The following is a brief summary of these facts: The blood of the consumptive Iras, by various investigators as well as myself, been observed to be too poor; being especially characterised by deficiency of red globules, and excess of albumen. While in those diseases which present opposite indications, and which are generally recognized to pertain to an opposite constitution, we aleo find the character of the blood to be opposite. Being especially characterised by excess of glo- bules, and defic.incy of albumen. And tubercles are recognized by every pathologist, whose obser- vations are worth quoting, to consist of albumin- ous deposits from the blood. Now, / claim the peculiarity of having, in accordance with this pa- thological condition, directed the application in treatment of consumption, of such therapeutical agents as have been ascertained to produce in- crease of the globules, and diminution of albu- originality" in regardingconsumption curable in "?en in. ,l!>e blood- viz: the. opposite character to that of the consumptive blood. The most power- ful of which agents are to the extent of my expe- rience carefully pointed out in my treatise, to- ail its stages, 1 have advanced no such claim. On the con- trary, I have faithfully and even greedily quoted, in support of my position of curability, all the au- thority I had access to, comprising every one of note who had then written upon the subject— S.okes not excepted.* 2d. In animadversions on the following para graph of my treatise: "My only peculiarity consists in tb« application of therapeutical agents, more than usually in ac- cordance with pathological indications that have been ascertained from actual autoptical observa- tion of the fluids, as well as the aolids of the system." , . ,, , ., "If the reader," says the reviewer, "should now come back upon us with the question, where, then, is the peculiarity? we should be obliged to answer, we do not know.'' To this I can only reply: I acknowledge no obh- ation to supply understanding to any gentleman. n the work reviewed the facts in the premises • The reviewer refers to Stokes as having preceded rne in curing the disease in its first stages. t gether with the evidences of their efficacy in pro- ducing the requisite changes. And I believe I am also pecul:ar in considering all such medicines and slim-nta as are productive of stun changes, to be appropriate remedies in cases of tubercular consumption, and none others. And that all those productive of the opposite condition of the blood tend to the production of the disease. Among which, measures ofdepletion stand pre-eminent— the chief mode .which has heretofore, and in- deed is yet, generally practised in treatment of consumption. As to the first charge against me on curability, I have, miserable that I am, been rapped over the knuckles by reviewers; first upon one hand, and then upon the other. One, for the preposterous assertion of curability of consumption, adverse to the high authorities on the subject. Another, for claiming novelty in cures, which were such very commonplace matters. In both cases the learned gentlemen seem to me to have reviewed without having been at the trouble of reading. & AK \v. *> s— \ The fact thatthe general impression of the pro- fession, as well as of the community, is adverse to curability, I believe is unquestionable. In alluding to this general scepticism, I may not, in every instance, have adverted to the exceptions; but the quotations throughout the work, and other manifestations of anxiety to sustain myself by authority against the general scepticism, it seems to me, should exonerate me from charges of inordinate desire to seem original, indepen- dently of my positive disclaimer of such preten- sions in my introduction, wiih the single excep- tion of the above peculiarity. The general impression that consumption is in- curable, is even at the present day, sustained by the highest medical authority in our country; and also the opinion that no improvement has been made in its treatment. "Known from the ear- liest times," says Professor Chapman, "and stu- died, especially of late, with unexampled dili- gence, and under every advantage, it still proves as intractable in the management as at the dawn of medical science. Being fully established, I doubt whether a cure was ever effected of it. Not an instance, at least have I seen, and I be- lieve that those who report to the contrary de- ceive themselves, or the truth is not in them. Efforts directed by talent, and learning, and pa- tient industry, have been rewarded by little suc- cess of any value. They have revealed its mor- bid anatomy, without advancing in any degree our control over it."t The above quotation, I have reason to believe, exhibits a fair exposition of the impression of a vast majority of the medical profession. Aware of this deep-rooted scepticism, in the face of all the light that had been thrown upon the subject, up to the time of writing my treatise; and not on- ly of the incredulity, but of the odium which had got to be attached to pretensions to cure; I thought it best to rest my evidences of curabil- ity of consumption chiefly on the exhibition of the nature of the disease, and of the modus operandi of the remedies used in its cure, rather than on the detail of cases cured. Because in the latter, doubts might arise as to accuracy in di- agnosis. And I confidently believe that the chemical and physiological evidences there ad- duced, will alone suffice to satisfy any intelligent unprejudiced physician. 1st. That the disease, from its very nature, is necessarily curable. 2d. That the modus operandi of the treatment recom- mended, is precisely adapted to accomplish what the nature of the disease developes to be essential to the cure. 3d. That we have many and conclu- sive evidences of spontaneous cures. The best of all evidences of' curability, and conclusive, I think, that if nature's efforts were rationally and appropriately aided, that cures might generally be expected to result. But in our prafession no evi dences, however clear, have heretofore proved sufficient readily to induce general acquiescence in any radical change, however advantageous. A large class, especially comprehending the indo- lent and the conceited—not only in our profession but I believe I may say of every calling]:—are commonly found arrayed in opposition to any ex- tension of the limits of the science which is con- tChapman on Thoracic and Abdominal Diseases, 1814. t Even changes in government, from a despotism to a republic,« e generally see violently resisted, not only by those interested in the stability, but also amongst the mass who can but be benefitted by the revolution! nected with their pursuits. Looking upon all in- novations, not originating with themselves, wheth- er" improvements or not, only as the imposition of additional labors. These violently arrayed them- selves against Jenner for introducing vacination. By these the immortal Harvey was persecuted into penury and misanthropy, in requital for the greatest advance ever achieved in physiology. It then would be folly in me to expect a more mode- rate outpouring of such tender mercies. My ad- vance is neither less revolutionary nor less im- portant to mankind than theirs, and founded in unalterable physiological truths, its ultimate pre- valence is equally inevitable. The revolutionary tendency of my treatment, is not the only revolution which the philosophical labors of the age have achieved, with regard to this much misunderstood and badly managed dis- order. 1st. Until recently the causes of consumption have been so badly understood that temperate climates were esteemed chiefly incident to the disease, and physicians were in the habit of ad- vising a tropical or Southern residence as a chief means of prevention and cure. We now have sta- tistical, matter of fact evidence, that inhabitants of tropical climates are much more consumptive than any others of the world. Those of the tem- perate the least so. 2d. Until recently hereditary predisposition was considered a predominant cause of consumption; by many reckoned a prerequisite, and almost unanimously admitted to be sufficient of itself. This is now by the best evidences attainable on the subject,§ found to be wholly unsupported by facts, a mere delusion of the fancy. 3d. Until recently the tuberculous deposits in the lungs were looked upon with horror, as unnat- ural, malignant, immovable matter. With a great number of physicians such is still the impression. We now have analyses of tubercle by several of the ablest chemists of the world, who are concur- rent in representing it to be composed exclusively of principles that are found as healthy constitu- ents in the body. Being constituted in the propor- tion of not less than 80 per cent, of albumen: identical with the albumen of the blood, and with about one half of the natural solids of the body. The most bland and unirritating and easiest absorbed of any of its solid constituents. 4th. Until recently consumption was considered and treated as a local disease of the lungs. It is now known to be a general disorder of the system. A constitutional disease. 5th. It was until recently considered, essential- ly an inflammatory disease. It is now known, from actual observation, to be wholly independent of inflammatory action, most to pertain indeed to the least inflammatory constitution. With all these radical errors as to the causes and nature of consumption, what reason exists for wonder, that our predecessors should have been radically wrong in their treatment of it? And what better grounds of objection exists against revolu- tionizing their treatment, than of their theories of the nature and causes of the disease. Errors in the treatment of our predecessors mav readily be traced to their erroneous conception of the nature of the disorder. Considering it a loca disease, they endeavored to eject the tubercles from the lungs by expectoration. With this view the exhausted and ulcerated organs were irritated § Louis on Phthisis, 2d edition. Audjl^iiaesed with expectorants. Considering it essentially inflammatory, their ruinous antiphlo- gistic treatment followed as matter of course. To perpetuate this, the frequent occurrence of in- flammatory complications, incident to tuberculous .lungs, like ignes fatui, continued to mislead them. The marked relief afforded by depletion, on occurrence of the painfull catarrhal pleuritic, pneumonic, and other inflammatory complications which were not distinguished by them, from sym- tomsof consumption, misled them to believe they were doing much towards the cure of the disease itself, and that its'farther prosecution might ac- complish it, that these complications were not distinguished from tbe symptoms of consumption, is manifested by examination of their chapters on I svmptoms. Where we find jumbled together in-; discriminately the symptoms proper of consump- tion, and of all its manifold complications. All set forth as symptoms proper of the consumption. Making a comprehensive whole, exhibiting symp- toms of nearly every disease that flesh is heir to. But what excuse, let me ask, have physicians of the present day to offer tor continuing this here- tofore uniformly unsuccessful treatment, with all the light and know ledge which modern researches have thrown upon the subject, staring them in the face? But to return to the "amiable" reviewer of my book. "We have fell most averse," says he, "to disturbing the profound repose which we imagined it was enjoying, and was likely to continue to en- joy, on the shelves of the booksellers. * * * JNot only were we disposed to let his book rest, but we were even amiable enough to admit into our Journal, nearly a year ago, a communication from him in relation to it"!! "From its phraseology, readers have been led to suppose tbat the editors of this Journal had in their possession decisive testimony to the efficacy of Dr. McDowell's mode of treating consump- tion." The readers of the Journal, I think, will not be a little surprised on turning to this publication in the January number, 1844, to find the only "testi- mony" there referred to (which is not published) ft Uncomplicated consumption is a painless disease. T is editorial, and under tlie identical signature of this very reviewer!!|| As to the reposing books, I am happy to b* abit to tickle the benevolence of the amiable {.t-ntle- man in apprising him that they have nearly all been fold—perchance altogether through the aid of that journal publication; and also, by appri- sing him of some good he has actually done in the world, by causing some consumptive patients to consult me, who have been cured, and who may Jive to bless him for it, after he shall have been forgotten by every one else. I must moreover tender him my acknowledg- ments for his unexpectedly manly course in open- ly assailing me in a printed publication, which contrasts most favorably with the insidious chim- ney corner manner in which I have been assailrti by some Other members of the profession, leaving me without chance of reply—protesting utter igno- rance of any cases I had ever cured, but retaining a fertile recollection of those I had lost, &c, to be drank in by the g/eedy ears of their confiding employers, and quoted and promulgated by them as of high medical authority. Such practises, whether proceeding from cupidity or from igno- rance, are not merely annoying to me, but are de- basing to the profession; and, in order that igno- rance may no longer be degraded into an excuse for detraction, I have placed lists of the names of a respectable number of persons who have been cured of consumption under my treatment, all residents of the city of Louisville or itb immedi- ate vicinity, in the hands of Messrs. Pet« r 6i Rob- inson and Schorch & Yenawine, apothecaries; by reference to which, persons interested in the in- vestigation may find out and confer with the re- stored individuals themselves. A large proportion of these cases were in the progress of the disease attended also by other physicians, the concur- rence of whose opinions is corroborative of the consumptive character of the diseases. wm. a. Mcdowell. ||The list of cases alluded to by Y. were deposited hi the Medical Journal office, and remained there ieverj.1 months. t V \ 0 ii': • <«;' '. /