t-4 \ -t -J* I MEDICAL THESES, SELECTED FROM AMONG THE INAUGURAL DISSERTATIONS, PUBLISHED AND DEFENDED BY THE GRADUATES IN MEDICINE, OF THE UNIVERSITY OF PENNSYLVANIA, AND OF OTHER MEDICAL SCHOOLS IN THE UNITED STATES : WITH AN INTRODUCTION, APPENDIX, AND OCCASIONAL NOTES. /—' BY CHARLES CALDWELL, M. D. EDITOR OF THE WORK. Tp_^firjj^TINUED ANNUALLY, V /_ ' pr, \'-^ S "*/.... ^<^L,; PHILADELPHIA: PUBLISHED BY THOMAS AND WILLIAM ERADFORD, PRINTERS AND BOOK-SELLERS, NO. 8, SOUTH FRONT-STREET. 1806. District of Pennsylvania, to wit: c ru^, y BE IT REMEMEBERED, That on the tenth day < seal > of January, in the twenty -ninth year of the Inde- lb"Y^' pendence of the United States of America, a. d. one thousand eight hundred and five, Thomas and William Bradford, of the said district, have deposited in this office, the title of a book, the right Avhereof they claim as proprie- tors, in the Avords following, to wit: ' Medical Theses, selected from among the Inaugural ' Dissertations, published and defended by the Graduates in ' Medicine, of the University of Pennsylvania, and of other ' Medical Schools in the United States: with an Introduction, a ' Appendix, and Occasional Notes. By Charles Caldwell, ' M. D. Editor of the Work. To be continued annually.' In conformity to the act of the Congress of the United States, intituled,' An act for the encouragement of learning, by securing the copies of maps, charts, and books, to the authors andpropiietors of such copies during the times therein mentioned:' And also to the act, entitled, ' An act supple- mentary to an act, entitled,' an act for the encouragement of learning, by securing the copies of maps, charts, and books, to the authors and proprietors of such copies during the times therein mentioned,' and extending the benefits thereof to the arts of designing, engraving, and etching historical and other prints.' D. CALDWELL, Cierk of the District of Pennsylvania. CONTENTS. k k I. PAGE. Johnson on the Influenza................. 1 y. Stuart on the Salutary effects of Mercury, in Malignant (] Fevers ......................... 37 V * Glover on Digestion .................. 63 k IV* { ^~\D v Hodges' Experiments and Observations on the Absorption of "Active Medicines into the Circulation, ...... 103 V. V\^ 4) - Quackenbos on Dysentery, by an induction of facts from which the Mitchillian Doctrine of Pestilential Fluids is il- lustrated, ....................... 138 VI. Jackson on External Applications........... 159 r> r VII. 4- T V J* Massie on the Properties of the Polygala Senega, ... 186 y\\ Darlington on the mutual influence of Habits and . 205 Disease, ........................ 205 A VIIL. fa* Cocke on the cause of the Extensive Inflammation, which -' attacks Wounded Cavities and their Contents, .... 235 IX. W, Bryarly on the Lupulus Communis or Common Hop, 265 <\ x j % Smith on Wounds of the Intestines, .......... 286 XL \ v Klapp's Chemico Physiological Essay disproving the ex- (J istence of an Aeriform Function in the Skin, and pointing- out, by experiment, the impropriety of ascribing Absorp- tion to the External Surface of the Human Body, . . . 299 CONTENTS. XII. Dangerfield on Cutaneous Absorption, ....... 333 XIII. Tongue on the three folloAving subjects. I. An attempt to prove, that the Lues Venerea, was not introduced in- to Europe from America. II. An Experimental Inqui- ry into the Modus Operandi of Mercury, in curing the Lues Venerea. III. Experimental proofs that the Lues Venerea, and Gonorrhoea, are two distinct forms of dis ease...........................334 PREFACE, BY THE EDITOR. The favourable reception given to the first A-olume of ' Medical Theses,' published at the commencement of the year 1805, and the very flattering terms in Avhich it has been noticed in several periodical publications, have encouraged the proprietors to proceed with the Avork. Feeling confident, as they do, that this second volume, is, in no respect, inferior to the first, they can scarcely admit even a doubt, much less can they entertain any serious apprehensions, respecting the estimation in which it will be held, and the fate Avhich ultimately awaits it. Composed, as it is, of various articles, each of them confessedly valuable in itself, it will be easy to form an estimate of its.general merit, by vieAving it as arising out of the combined excellencencies of the whole. The several dissertations which it comprises, are founded on obser- vation—.most of them, on experiment, and they are all perfect- ly accommodated to the present state of medicine in the United States. They do not consist of dry details and recitals of Avhat has been done, said, or conjectured, by medical charact- ers in distant countries, under circumstances materially different from those to which Ave are subjected. The mere opinions even of celebrated characters, in our own country, are admitted into them with great caution. They exhibit a faithful record of Avhat their authors have themselves Avitness- ed, or of Avhat they have otherwise learnt from sources of the highest authority. Considered as separate specimens of intel- lect and investigation, they do great credit to the individual Avriters; and taken together, they constitute a monument peculiarly honourable to th? Medical School of Philadelphia. PREFACE. From this view of the subject, it is difficult to conceive, Iioav any sincere friend of that school, or any fosterer of medical science in our country, can continue hostile to such a Avork. If then, any spark of such hostility, does exist, it is hoped that an attentive perusal of the first and second \-olumes of 'Medi- cal Theses,' will contribute much towards its extinction. The field of mecUcal science, in the United States, earnesly invites, and affords ample scope, for the united labours of all her votaries. It Is certainly, therefore, no less the interest, than the duty, of these fellow-labourers, if they even do not deal in acts of mutual assistance, at least to suffer each other to persevere in the great work, without jealousy or molesta- tion. The editor avill only add, that there arc already on hand, materials sufficient for a third a olume, which will appear early in the year 1807, should the public think proper to continue their patronage, PHILADELPHIA, FEBRUARY. 1st. 1806. « # AN INAUGURAL DISSERTATION: ON THE INFLUENZA: SUBMITTED TO THE EXAMINATION OF THE REVEREND JOHN EWING, S. T. P. PROVOST; THE TRUSTEES AND MEDICAL PROFESSORS OF THE UNIVERSITY OF PENNSYLVANIA, FOR THE DEGREE OF DOCTOR OF MEDECINE; *N THE EIGHTH DAY OF MAY, A. D. ONE THOUSAND SEVEN HUNDRED AND NINETY THREE. BY ROBERT JOHNSON, OF PHILADELPHIA; MEMBER OF THE AMERICAN MEDICAL SOCIETY. "The explaining, correcting and confirming the observations of our predecessors ts more useful, and as honourable as hunting after new discoveries, of which the truly learned will find but vert Jew, whatever the ignorant may imagine."_____Grant DEFINITION. THIS is a disease capable of being propagated by conta- gion,* and consists in a preternatural and encreased secretion ' of mucus from the membrane lining the nose, fauces, and bronchia:, accompanied with a cough, dyspnsca, and a great tendency to sweat. * In this opinion the editor is obliged to differ from the author. He believes influenza to be a disease exclusively of atmospherical origin. Its remote cause is probably a delete- rious gas, Avith the nature of which Ave are wholly unacquainted. This gas, whatever be its composition or origin, is capable of diffusing itself through a greater extent of atmosphere, and with greater celerity than any other. Hence the wide and ra- pid spread of Influenza, which sometimes overruns a whole country in a few Aveeks. For the production of this disease, an exciting cause is for the most part necessary, which cause, hoAAre\er, never need be very poAverful, and at times so strong is the epidemic con- stitution of the atmosphere, that hundreds are attacked by the disease without having been exposed to any discoverable exciting cause. All the facts which our author has advanced in proof of the contagion of influenza can be more simply and satisfactorily explained on other principles. Indeed there is no more ground to consider influenza contagious, than there is to annex that quality to intermitting fever or common catarrh. INTRODUCTION, THE Influenza seems to have been knoAvn to the earliest medical writers whose works we have an opportunity of con- sulting ; yet, from a variety in some of its most prominent symptoms, it has received a great many different names, and sometimes, been considered as a new disease. Among the writers from Hippocrates, to Sydenham, it is generally called Febris catarrhalis epidemica* ; but in 1673, the latter supposes it to be a new fever, and names it accordingly. It is curious to remark the regular, and constant pace which the science of health and philosophy haA'e kept with each other. As long as philosophers imagined the elements of natural bodies to be four, physicians supposed human bodies to consist of as many humours : but as soon as the corpuscular philosophy became pretty generally received, medicine discovered her 'acrimony, spicule, and salts of Ara- rious sizesf.' In like manner, when astrology took the lead of true science, and people began to fancy all terrestrial things were governed by the heavens, some Italian doctors found out that this distemper proceeded from the infiuence of the stars, and therefore gave it the name of INFLUENZA. Some assert that the disease now known by the name of influenza cannot be the same with that described by Syden- ham, as the influenza is manifestly contagious, and the great Sydenham, a strict observer of nature, makes no mention of * Motherby's Med. Diet, under the word Influenza. tBlack's History of Medicine. 6 JOHNSON ON INFLUENZA. any such property belonging to that which he describes. Hippocrates was certainly as attentive, and as sagacious as Sydenham, yet he discovered not (what AAas much more easily discoA^erable) the circulation of the blood ; a circum- stance at which we justly, wonder, that it possibly could have escaped the observation of a person much less attentive and enlightened than he who is Avith propriety styled the father of the healing art. The sameness of the symptoms, however, indubitably proves the identity of the Tussis Epi- dzrnica and the modern influenza. Dr. Grant in a letter to doctor de la Cour, says that he has carefully attended to the beginning, progress, and termination of the influenza, and finds upon comparison that the same has been discussed by the English Hippocrates long before, ' in as masterly a manner an the subject docs admit of HISTORY OF THE DISEASE. As a description of this distemper may be found in vari- ous publications, I shall content myself with a short account of it, as it appeared in the city of Philadelphia, in the year 1789. The influenza made its appearance in the month of Octo- ber, previous to which, and for some weeks after, the weather Was dry, cool, and pleasant. It commonly set in Avith uni- verse! lassitude, with chills, and fever ; an acute pain in the head, and eye-balls ; not unfrequently a considerable itching in the eye-lids ; and some had a sAvelling and inflammation f f the eyes. There were some also who had abscesses formed in the frontal sinuses'. A sore throat, hoarseness, and a pain in one or both ears, in some cases ushered in the disease ; whilst in others it came on with a violent sneezing, followed by a discharge of acrid matter from the nose, which often excoriated and inflamed the upper lip. In some cases the nose dropped blood, nay, in some it ran in streams ; and in one case related by Dr. ♦Rush's M-r.utcrint Lectures. JOHNSON ON INFLUENZA, 7 Rush in his Lectures on the Theory and Practice of Physic* the discharge in this way amounted to twenty ounces. Most persons had a bad taste in the mouth, attended with a want of appetite, though some few had their appetite preternaturally encreased. A sore mouth was no uncommon attendant on this disease, and some had a severe tooth-ach, SAyeiled jaws, See nor did the tongue entirely escape ; for in some it Avas so SAvelled as to occasion a considerable defect of speech. The breast was often affected Avith acute darting or Hying p.ins; these sometimes became fixed, and suddenly brought on, or were accompanied with a painful and laborious respira- tion. A cough universally attended this disease, which Avasi sometimes convulsive, and extremely painful; in some it brought on a spitting of blood, and two persons died in the act of coughing |f. The stomach was sometimes affected with nausea, and vomiting, and in some the disease seemed to fall upon the boAvels and was carried off with a diarrhcea-^-though in general the patients were either costive or regular. The violent pains which in many persons affected the limbs, very much resembled the rheumatism ; but those which v.ere felt in the loins and thighs, were remarkably severe. Profuse SAveats over the whole body very generally appeared at some time or other during the course of the dis- order, and sometimes Avith obvious advantage. The pulse AAras various ; sometimes tense arftl quick, but seldom full. The fever remitted about the fourth or fifth day, but the cough often continued several Aveeks after every other symptom had disappeared §. * "Which commenced in NoArember 1790, at the college of Philadelphia. It is with pleasure I embrace the present opportunity of acknoAvledging my great obligation to his valua- ble lecture on the influenza, for several of the particulars of its history of symptoms here related, || Rush's Manuscript Lectures. . § Hippocrates in his Book of Epidemics has this passage, in which there is a striking rc^emblace of circumstances, and symptoms : " those who have coughs in the winter, and espe- 8 JOHNSON ON INFLUENZA. The most remarkable circumstances respocting this dis temper were the miliary and erysipelatous eruptions which in some instances accompanied it, and the great tendency Avhich the fever manifested to degenerate into typhus. Although it affected persons of both sc:;ei, and of all ages, it was observed that it seized few children below five years of age -, and a physician of this city, Avhose practice is very ex- tensive, assures me that he remarked old people as well as children, were less subject to the influenza than persons in middle life. DIAGNOSIS. The influenza is not likely to be confounded with any disease except the common catarrh, which, [though it appears Avith nearly the same symptoms, and like it, often seems to come on in consequence of the application of cold] may be dis- criminated from it, by coming on with more cold shivering, by the febrile symptoms appearing earlier, and being more con- siderable in decree. It moreover gives a more sudden and violent shock to the strength, and in many instances produces a perpetual Avatching, followed by a disorderly and uneasy state of the mind, mateiiuily different from the phrenetic delirium of the febris ardens incident to patients labouring under catarrhs from cold, or such like inflammatory diseases. It is likewise distinguished by its affecting more persons at once, spreading over a greater extent of country in a given time, and in being [more] contagious. The influenza is sometimes accompanied with miliary and erysipelatous eruptions, but the catarrh from cold is not. The latter is sIoav in its advances, seldom giving alarm until, perhaps, long after the existence of danger, whilst the former, for the most part Irss dangerous, excites immediate terror, as well by the r. umber of functions which it affects at the same instant, as by the rapidity of its progress ; for in the influenza the transitions ci.dly Avith the southerly winds, are subject to fevers during t ■ .eir hawking up much thick mattter ; but then they common- ly cease in five days. But coughs will extend to forty.'1 Clif- ton's Hippocrates. Page 2 14. JOHNSON ON INFLUENZA. 9 from apparently high health to sickness are often, as it were, instantaneous. Blood-letting, and other suddenly debilitating remedies were seldom so necessary in this disorder as in the common catarrh, and fewer consumptions were the consequence of it, than might have been expected from a common cold among an equal number of persons. There is no disease to which the hunv.Ji body is liable, so extensive in range, so sudden in attack, so furicus at the begin- ning, so rapid in its course, and at the same time attended with so little danger. OF THE REMOTE CAUSE. In a tract of this kind it will probably be expected that the author should inquire into the original cause of the disease on which he writes, as such ■ r. essay is commonly supposed to exhibit the candidate's medical researches, as avcII as his me- dical reading. With regard to this subject, it may not be im proper to observe, that it is one which has been considered as very abstruse in every age and coimtry where medical science has been cultivated ; and on v/hich it is not only diffi- cult what to say, but what to leave unsaid. Here I must confess my ' knowledge dwells upon the surface of things *.' The present received opinion is, that this species of catarrh arises from contagion, Avhich possibly may be true ; yet to my mind it appears no easy matter to conceive how the disease can spread so far and A\4de in so short a space of time as Ave perceive it does, or how it can affect persons many miles apart, at the same time, where there had been no previous di- rect or indirect intercourse—ifpropagated only by 'a matter arising from the body of a man labouring under it.' Hippocrates when speaking of epidemic diseases in gen- eral, says, ' Avhen many are seized with the same disease at onetime, the cause is chiefly to be attributed to what is most common and made use of by all. This is certainly Avhat Ave inhale in inspiration.' Galen is of the same opinion: 'for we all neither are exposed at the same time to other causes, * Woolaston. B 10 JOHNSON ON INFLUENZA. nor are subject to them at all times ; but the air alona surrounds us all abroad, and is taken in by all in respiration.' That the remote cause of the influenza is chiefly to be sought for in the air, is rendered highly probable by the folloAving facts. Van Swieten in his comment on the 1407th aphorism of the justly admired Boerhaave, tells us upon the authority of Forestus, that a distemper, which he calls a malignant catarrh, ' arose as it were from a certain vapour, since thick clouds of an ill smell preceded it for some days, breaking out so suddenly, that it seized almost instantly a thousand persons.' About the latter end of the year 1732, and the beginning of 1733, when epidemic catarrhs raged throughout all Europe, wc are informed to at the like distemper prevailed in Africa, and even persons at sea, though at an immense distance from land, were affected in the same manner f, The like has been observed much later : for in the year 1780, when the ship Atlas left Malacca, there was no epi- demic disease in that place ; yet upon her arrival at Canton, it was found that at the very same time, that the creAV on board the Atlas in the China Seas had the influenza, the same dis- order raged at Canton. ' On the second of May 1782, the late admiral Kempenfelt sailed from Spithead with a squadron under his eommand, of which the Goliah Avas one, whose crew was attacked Avith the influenza, on the 29th of that month; the rest were affected at different times; and so many of the men were rendered incapable of duty by this prevailing sickness, that the whole squadron was obliged to return into port about the second week in June, not having had communication with any shore, and having cruized solely between Brest and the Lizard.5 About the sixth of May, Lord Howe sailed for the Dutch coast, with a large fleet under his command; all were in perfect health ; towards the end of May the disorder first appeared in the Rippon, and in tAvo days after in the Princess Amelia. Other ships of the same fleet were affected with it t Memoires pour servir a l'histoire des Insectes, par Reau- mur, page 435. JOHNSON ON INFLUENZA- II at different periods; some indeed not until their return to Portsmouth about the second week in June . This fleet also had no communication with the shore until their return to the Downs, on their way back to Portsmouth, towards the third or fourth of June \. To these facts the following passage froni the late celebra- ted doctor Cullen, seems someAvhat opposed : this disease ' has seldom appeared in one country of Europe, without appearing successively in every other part of it; and, in some instances has been even* transferred to America, and has been spread over that continent, as far as Ave have had opportuni- ties of being informed ||. From whence the doctor obtained his information I know hot; but, as he has not mentioned a single circumstance whereby a person might be enabled to judge of the accuracy of it, and as there are objections to the probability of his infor- mation being so accurate as to satisfy us that the disease was transferred in the manner he supposes, I am obliged to consi- der this passage as an assertion not fully supported, either by concomitant circumstances, or subsequent observations; though, at the same time, I acknowledge it to be the assertion of a very respectable, of a very eminent physician. But from the nature of things, his information in its full extent, could not have amounted to more than—that the disease Avas later in appearing in some parts of Europe than in others ; and that it Avas not only later in appearing in Ame- rica, than in some parts of Europe, but that the inhabitants of that amazingly extensive Continent were not affected with it all at once. Now what Can this prove ? That the disease is propa- gated only by contagion ?—.Surely not. But granting all that the doctor has asserted to be matter of fact, that the disease has i Lond. Med. Trans, vol. 3, page 61. * In the year 1782, the influenza appeared at London be- tween the 12th and 18th, at Oxford in the third week, and at Edinburgh on the 20th day of May. Could the disease have been transferred to these three cides in such quick succession, by things imbued with the contagion, or by persons labouring under the complaint ? But more of this hereafter. ||Cullen*s first lines, vol. 3, page 104. 12 JOHNSON ON INFLUENZA. pppearc J in every part of Europe successively, and has been transferred to America ; aa'uI this enable us to account for the appearing of it in the island of Bourbon, situate in Africa, at the identical time that it raged in Europe ; or explain in Avhat manner it •broke out at the same time among persons at sea and on J.and, where those at sea had not even the smallest communication either with those on land, or Avith any other person AvhateA-er ? We must either deny the truth of these facts § ,or admit that the disease is not always induced by conta- gi'j'i, according to the common acceptation of that word; that §The author had not an opportunity of consulting the first volume of the Medical Communications on the subject of the influenza until several months after this essay had been pre- pared for the press ; and his surprise Avas not a little upon reading it, as he there found an anticipation of several obser- vations which he supposed had first occurred to himself. But" notv,ithst.Jiding he conceives that much gratitude is due the society for their generous exertions in favour of the healing art, that the design of the Avork is laudable, and that the pub- lication contains a vast collection of valuable information res- pecting this wonderful epidemic ;—.yet cannot help observing that the folloAving part of the ' Account of the Epidemic Catarrh, of the year 1782,' appears exceptionable, in as much as it opposes opinion to matter of fact, and substitutes asser- tion in the room of argument: ' It is cred.r.ly affirmed, that the creAvs of several ships were seized with the influenza many miles distant from land, and came into various ports of England labouring under it; the same thing is said to have happened to ships in the East- Indies* and other parts. A want of precision, or of authenti- cation respecting the circumstances above alluded to, makes it improper to draw any inferences from them.' Ibid. Page 65, That the facts ?re precise a.ill immediately appear upon- referring to them, and if credibly affirmed, Avherefore is it im- proper to draw any inferences from them 1 This may be a convenient way of getting over objections which militate against pie-conceived and Lvorite opinions; but fortunately for science, this mode of barely denying/acts, is very unsuc- cessful in producing conviction or of establishing doctrines, in the pit-sent stale of medic ^'philosophy. Before Ave were darned the privilege of inferring from them, it would have been proper to have shewn that they were not fired.,e, or auth.niic, or that they did not itpfl-j. But v.ithout even at- tempting to do tins, the compiler endeavours to elude their JOHNSON ON INFLUENZA. 13 is, the disease cannot in these instances, be supposed to have been propagated by personal communication^. The foregoing fact respecting the co-incident appearance of the epidemic catarrh in Africa and Europe, first mention- ed by Reaumer [who derived his information from the letters of Cassini] is quoted by Van Swieten, in his chapter on epi- demic diseases, and must have been knoAvn to Doctor Cullen, force by suggesting distrust; not by argument, but by telling us that' Avithout pretending to deny the truth of them, the folloAving anecdote will serve to sheAV that great caution is requisite before they are admitted.' * Mr. Henry of Manchester, informed the society, from Avhat he thought good authority, that a ship from the West- Indies to Liverpool, Avas by stress of Aveather driven cut of her proper course, into a higher north latitude, where her whole crew Avere seized Avith the influenza ; but wishing after- wards for more accurate information on the subject, he Avrote to Dr. Currie of Liverpool, desiring him to make every neces- sary inquiry into the matter ; that gentleman, Avho took great pains to investigate the affair, at last met with the surgeon of the vessel, from whom he learnt that before the crew were seized with the disorder, they had been off the north of Ireland, and had some communication Avith the inhabitants pf those parts.' May Ave not ask if this anecdote proves any thing in point ? Is it precise ? At what time did this communication take place; in the Avinter, spring, summer, or autumn, and in what year? Were the persons Avith whom the communication Avas had, then labouring under the disease ; or was it then prevalent in that part of Ireland ? This anecdote, which was intended to excite in us a distrust of the truth of the facts before alluded to, proves nothing except its oaati want of precision, and deficient authentication of circumstances. For unless it had been shewn that the disease prevailed among the inhabitants Avjth whom the creAV had this communication prior to, or at that time, the fact only goes to shew that such a communication took place, and subsequent to that, the influenza appeared on board the vessel. But supposing that Mr. Henry Avasat first mistaken, and that the crew Avere infected by the inhabitants as the anecdote ^indirectly suggests, this supposi- tion can in no wise affect the authenticity either of the facts before mentioned, or of any other facts Avhatever. V But the greatest number concurred in opinion, that the influenza was contagious, in the common acceptation of that Avord, that is to say, that it Avas conveyed and propagated by the contact, or at least by the sufficiently near approach of an affected person.' Med. Commen. vol. I. page 46. u JOHNSON ON INFLUENZA. who was unquestionably, well acquainted with the writings of that great man. My oAvn observations, as far as they have gone, are perfectly consonant Avith this fact; nor can 1 con- ceive why the influenza might not arise as spontaneously in America, as in Europe, and there as readily as in the island of Bourbon: The morbific matter exciting the disease must have originated at sometime, and somewhere ; and a cause li''.e to that which gave rise to it in any one country, at any one point oftime, might produce it in another country at the same time, under similar circumstances. It may be objected, that the disease could not have ari- sen from the air, because the countries here mentioned must experience at any particular time, very different states of that element. This argument may be allowed to have some Weight against the supposition of its arising entirely from the sensible qualities of the air, but extremely little against the pro- bability of its taking birth ' from some inexplicable variety of exhalations contained in it, which mixing with our fluids, or by their stimulus disorder our bodies *.' This Was tie opi- nion of th6 deservedly celebrated Herman Boerhaave respect- ing epidemics in general, and, as far as I have been able to discover, it has not been overturned by fair argument, or sub- sequent observation, at least as far it applies to the epidemic catarrh. This; indeed was not the opinion of Boerhaave alone ? but also of most of those physicians who were famous for their asriduous attention to the true source of medical knowledge, the operations of nature. The antients 'tis true, were some- times mistaken, although they studied nature; and the mo- derns are not, perhaps, less frequently wrong in their opinions, notwithstanding the immensity of their discoveries; not be- taUse they do not study nature at ail, and study books alone ; but chiefly because they study her either too much through the medium of bocks and pre conceived hypotheses, or with a ♦lew to propagate something new~, And this E one great reason vhy we should seldom read the modern systems of phytic, unless Avell armed with' a great * Aphorism 1408. JOHNSON ON INFLUENZA. M deal of scepticism on the subject.' We may, and indeed Ave ought to esteem some few of the writings, ard opinions of the modern authors, and, with no impropriety, entertain a mo. dest confidence in our own talents for observation ; yet it would be well not to overlook or despise the medical records of nature as' handed down to us by the antients ; for in these there are certainly many useful remarks which appear to be at present foryoi^n. Doctor Cullen made war upon the antients, and, unfortunately for our art, with too much success ; for he not only delivered his pur.ils from the undue influence of great names, and scrutinized the writings of his predecessors Avith great freedom, but contributed much to render the reading as well as quoting the antient authors unfashionable. He expo- sed some of the errors of the humoral pathology, but was not always equally happy in substituting truth in the room of them. The desire of being the discoverer of something new, and of being thought wiser than our forefathers, has perhaps, in some instances led to the advancement of useful knowledge ; but it has often proved the very hot-bed of error, and warped the judgment of persons the most ingenuous and enlightened. Many diseases evidently owe their birth to the sensible qualities of the air, « for with the seasons, the constitutions of men likewise change,'* and though some of these do not be, come epidemic, yet many of those which do, only become so * Clifton's Hippocrates. Page 3^-Sydenham says epide- mics are admitted or excluded as the sensible qualities of the air favour or oppose teem. On the same subject consult ir or, dyce on Fevers, page 19, &c. Moisture with heat, and sudden changes from hot to cold, by raising much putrid vapour at, fects the elasticity of the fibres, destroys the fire and vivid cu> eulation of the blood, and dissolves the humours beyond what a healthy' state admjts. At the very time the surface pt tlie body requires the freest p. aspiration, the heat of Lx air makes the proper quantity of cioathlag irksome to inconsiderate pec- ple; from whence it happens, that the most putrid e.uuvia, which should pass through the ...ores of jhe skin, are checked, grow caustic, ana mix wit', the blood, while due carets not taken to preserve the juices from corruption by an anti&ep^ regimen ; and, when they are corrupted, sufficient regulations are not observed for carrying off the disorder, with ehheacy or dispatch, by either proper cloathing, detergent me.decines, Qi a suitable diet, &c, 16 JOHNSON ON INFLUENZA. in consequence of such sensible qualities. Russel in his learn- ed treatise on the plague, says, that without the concurrence of a pestilential state of air, the contagion of that disease when imported, even in Turkey, does not spread. Did the influenza depend upon a specific contagion it must always exist, or Ave cannot possibly ascribe it to such a cause. Tie smallpox, the A'enereal disease, &c. never intermit; but the influenza has become extinct, and again broke forth upon the Avorld after a period of more than four-score years.$ I do not assert, nor do I vvish to be understood to mean, that the influenza is not at all contagious: on the contrary, I am possessed of facts* which prove in the most incontestible manner, that it may be, and often is propagated from one per- son to another by means of contagion. Hut I mean, and the arguments whicu I have adduced, I trust, will warrant the conclusion, that the disease often does arise from ' some vicious quality of the azr't or exhalation in it, as well as from a mat-? tpr aiEiag from the body of a man laoouring under disease.^ i It is recorded that a similar disease appeared in 1510, 1557, 1580, 1587, 1591, 1675, 1709, in the latter end of 1732 and in the beginning of 1733, in 1743, 1762, 1767, 1775, 1782, andin 1789. See Lond. Med. Trans. Vol. 3. Page 77. * The folloAving communication I received of Doctor Leib my preceptor in medecine : ' In the year 1782, when the in- fluenza ravaged the sea coasts of Europe; the ship I was on board of captured a Spanish brig which had been taken by a privateer belonging to the British with whom we were then at Avar. All the crew on board the brig had the influenza, and we had scarcely cast anchor in the harbour of L'Orient, which was in a few days after the capture, before the greater part of the ship's creAv were seized with the disease, and myself among the number.' t Hiidanus supposed the cause of the Plague at Lausanne and the neighbouring districts was not only contagion, but also some vicious quality of the air. For, says he, ' the huts of the peasants and poor people were not exempt from the plague, though situated on the highest mountains, and at a distance from each other, and the peasants kept not the least inter- Course with one another.' i ' In some instances it was observed that the influenza did not shew itself in certain places until some one or more ar- rived at those places either actually labouring under the disease, or coming immediately from other places, whose inhabitants had been affected by it for some days: while in other instaa- #." JOHNSON ON INFLUENZA. 17 Considering the subject in this light, we shall be enabled to account for the progressive virulence* sometimes observa- ble in this epidemic, without any manifest alteration in the sensible qualities of the air. The ' vicious quality' of it con- spires with, and greatly assists the effluvia issuing from the sick, to encrease the malignancy of this distemper. OF THE PREDISPOSING CAUSE. The venerable Galen judiciously remarks, that no cause can affect without a predisposition of the body^, otherwise all who are exposed to the rays of a summer sun would be seized with fevers, as well as those who use too much exercise, are passi- onate, or grieved. Moreover, all would fall sick during the dog-days, or die of the plague.' This is a circumstance which requires very little proof to be admitted as true, the observation of every body supplying innumerable facts in its support. I shall therefore adduce but a few, nor should these be mentioned, but to combat the only argument of any im- portance which has been advanced against the idea of the remote cause of the influenza residing in the air. Baron De Tott, in his memors, informs us, thatl the plague, which that year carried off a hundred and fifty thou- sand persons, in Constantinople, was then at its height. Ob- liged (says he) to direct the workmen myself, many of whom were attacked by the distemper, I had nothing to preserve me from it, but the salubrious smell of the forges, and the precaution of giving directions with the end of my cane. But ces, very attentive and intelligent observers could not trace any communication between the families first attacked in the towns in Avhich they resided, and other places, where the dis ease had previously appeared.' Lond. Med. Trans. Vol. 3. Page 60. * ' It was also remarked that those who were attacked la- ter from the time of the appearance of the disorder com- monly had it more severely, and were longer ill, &c. Med. Commun. Vol. I. Page 24. If See a note by doctor Rotheram in Cullen's first lines, vol. I. page 52. ' The predisposing is that which renders the body liable or capable of being affected by disease when the exciting cause is applied.' c id JOHNSON ON INFLUENZA. perhaps, Avhatmost preserved me from the infection Avas my ncA'er giving myself up to fear, and the melancholy ideas of its ravages present *.' I have chosen this fact from amongst the multitude Avhich might be brought forward, first, because the plague is the monarch of all diseases, the most highly contagious of any Avhich afflict the human species; and, secondly, because the baron here relates a matter of fact, without regard to any par- ticular theory in medicine. He Avas not preserved from the disease, as he supposes, by the salubrious smell of the forges, for that Avas as common to the workmen who were seized Avith the plague as it was to him ; nor was he preserved by the precautions which he observed in giving directions ; so short a distance as the length of his cane \ was certainly within the sphere of the activity of the infection. 'Tis true, doctor N Cullen is of opinion, that persons may be preserved from the contagion of the plague, by avoiding all near communi- cation with the sick, or their goods, and ' that it is probable, a small distance will answer the purpose, if, at the same time, there be no stream of air to carry the effluvia of persons, or their goods to some distance.' It cannot, however, be ima- gined but that during the baron's continuance at this place [Avhich was a very considerable time] the Avind blew perhaps, in every direction; that, therefore, he must many times have been exposed to a ' stream of air' passing over the bodies and goods of persons tainted with the pestilence, and that he was notpreservedfromthe infectious miasmata either by the smell of the forges, or by giving directions with the end of his cane; but by, Avhat is more probable, his active life in which body and mind avcre vigorously employed, by his strict observance || Volume the second, page 83. \ The effluvia arising from the diseased, received into the ambient air, form a pestiferous atmosphere, more or less impregnated Avith these effluvia, as it recedes from their source. That contagion is thus communicated in the cham- bers of the sick, appears from persons being infected without touching the diseased body, or any thing in the room that may be supposed to harbour the infection.' Russel on the plague, page 298. JOHNSON ON INFLUENZA. 19 of temperance, and, by his never giving himself up to the debilitating influence of fear. In the fall of 1789, the influenza was very prevalent in the city of Philadelphia and its vicinity, and perhaps in many other parts of America. At that time I Avas seized with it myself, and was so ill as to be confined to bed for two days, nevertheless, the remainder of the family, which consisted of six persons of different ages, and of both sexes, entirely esca- ped every symptom of the disease*. Patrick Russel, who resided many years at Aleppo, and Avho consequently had the best opportunity o£ seeing, and know- ing what he relates, says, that' some exposed every way to the infection of the plague as if invulnerable, remain sound the whole season.||' I am therefore decidedly of opinion Avith doctor Cullen, that even' the mos%-powerful contagions do not operate, but Avhen the bodies of men exposed to the contagion are in certain circumstances, which render them more liable to be affected by it, or when certain causes concur to excite the power of it §.' * May we not, then, safely conclude that there is required a certain state of the system favourable to the action of the remote cause, to render it capable of receiving the infection ; and that this remote cause of the influenza may exist in the air, and yet every person shall not be affected with this epidemic at the same time, as the predisposed state of the system may not be present in every person at this particu- lar time. 'IF *' To others, and those numerous, it was so favourable as only to attack very few in each family.' Lond. Med. Trans. vol. 3,page 59. || Page 305. § First Lines, volume the second, page 246. J, ' If the cause lay in the air all must have been seized at once,'—but as thisAvas not found to be the case, and as the disease appeared at different periods in different towns and villages, doctor Hamilton infers that the cause was contagion. But this is inferring too much ; for even from his oavii account of Harpenden, Luton, and St. Albans, it appears that at the first of these places, though it is half Avay between the two latter, and several miles nearer London than St. Albans, the influenza shewed itself later than in either of the other two places. The manner in which he accounts for this difference 20 JOHNSON ON INFLUENZA. The state of the system whichis necessary to the formatioh of the disease may be inferred from the symptoms with which it is accompanied, particularly that' prostration of strength, and impaired vigour in all the functions of the body, t' Avhich almost always attend it. The predisponent causes of catarrhs in general tend likewise to designate it as a state of more or less debility. These causes, according to Cullen, are weakness of the system, and particularly the lessened vigour of the circu- lation, occasioned by fasting, by evacuations, by fatigue, by a last night's debauch, by excess in venery, by long watching, by much study, Sec. &c* The influenza being contagious furnishes additional proof. ' The bodies of men, says the last mentioned author, are es- pecially liable to be affected by contagions, when they are any ways considerably weakened by want of food, and even by a scanty diet, or one of little nourishment; by intemperance in drinking, which, when the stupor of intoxication is over, leaves the body in a weak state, &c. &c.i But the following cases related by Doctor Hamilton, clearly develope this matter, and very satisfactorily prove that previous debility is absolutely necessary to the admission and formation of the disease. * A boy of about twelve years of age, of a stir- ring disposition, suffered severely ; yet escaped the disease, though the rest of the family had been ill some time, till after bathing with other boys in a river, and remaining there longer than prudent, when he was seized the next day with the influ- enza. We may add to this, that he was a valetudinarian for a long time before, but had lately ovecome in a great measure all his complaints/ bf attack in point of time in these villages, forcibly applies in support of the doctrine which he wishes to explode. He informs us that Harpenden is on an eminence, the soil of a light dry nature, when compared to the others; and from hence, with. great propriety concludes that the difference arises from * its situation favouring less its exciting and predisposing cause.' t Currie's account of the diseases of America, page 102. * First Lines, Aolume the first, page 134. And, \ At page 246, of the second volume. JOHNSON ON INFLUENZA. 21 ' A young gentleman at Luton [continues the same author] about twenty-three, of a volatile turn, and lately a valetudi- rinn, but who, for eight or ten Aveeks had se far recovered, as to be able to follow his amusements, and who, for this purpose, generally Avalked or rode, whether the weather was favourable or not, several hours a day, often at the same time indulging himself freely in the glass, was at last seized with the epidemic* and suffered severely *.' OF THE EXCITING CAUSE. As truth is the object of which I am in search, and not the pursuit of fame for new discoveries, permit me once more to quote, a passage from the great commentator of Hippocrates : ' In our bodies, as it were prepared for disease, some external adventitious circumstance kindles a fever, Avhich of itself would not generate a violent disease, yet from the disposition of the body, every one of these is rendered, not the cause of the dis ease but the occasion §.' The exciting or occasional cause of the influenza must therefore be that external circumstance which kindles the fever, to wit, the morbid miasma, or contagion which has been considered under the general head of the remote cause; though strictly speaking, the remote cause includes both the exciting and predisposing causes 11. || Doctor Hamilton after mentioning that soldiers suffered much from the influenza, owing to their irregular living lio-ht cloathing, &c. Sec. adds—' the delicate also, and the val- etudinarian, in all my observations were great sufferers, and still greater in proportion as they Avere exposed to the vicissi- tudes of the weather.' See Lond. Med. Memoirs, from, page 432 to 438. §See a note by doctor Rotherham quoted at page 17 < no disease can exist without an occasional cause ; yet it is neces- sary, that at the same time, the state of the body be such as to admit that cause to take effect, or act.' ^ < Remote causes arc of two kinds, viz. the predisposing and exciting, or as it is sometimes called the occasional.' ibid. £2 JOHNSON ON INFLCENRA. THE PROXIMATE CAUSE Of every disease is that Avhich immediately produces it, and whose removal effectuates the cure *. The proximate cause of the influenza is nearly the same as that of a common catarrh from cold, as appears by the similarity of their symptoms, which differ only in degree. According to doctor Cu'Icn, * the proximate cause of catarrh (whether from cold or contagion) seems to be an increased afflux of fluids to the mucous membrane of the nose, fauces, and bronchia, along with some degree of inflammation affecting these parts. The latter circumstance, says he, is confirmed by the appearance of the blood ;' and it is this latter circumstance, viz. the degree of inflammation affecting these parts, which appears to me to be the proximate cause itself, and the increased afflux of fluids, a consequence of that imflammation i. It is unphilosophic to admit more causes than are abso- lutely necessary to explain the phenomenon ; and equally so to assign that as a cause which is only an effect. Is it not also unphilosophic to combine a cause and its effect, and assign the combination as a cause ? How is a secreting or exhaling surface induced to discharge a preternatural quantity of a fluid ? Is it not, either by some j-o-.ver which determines to that surface, or by some affection of the surface itself? What shall we then suppose to be the proximate cause of this preternatural secretion or exhalation ? Without doubt the power which determines to that surface, or * See the note above quoted—and Van SAvieten's Com- mentaries, vol. 1, page 21—,'• a disease as an adequate effect is the same with its complete or proximate cause, the presence of which supposes the disease, and the absence its removal.' \ At our meals the membrana pituitaria is frequently irr i- ta-ed by sharp mustard, so as to cause the nose to run water; yet, who, in this case, would assert that the proximate cause of this, temporary compl lint Avas an increased afflux of fluids to this membrane ? Is not the irritation of this membrane the fi-oximate cuuse t This is what we first attempt to remove, and which we never fail to effect, by inhaling through the nostrils the grateful effluvia of a piece of wheaten bread. Is not this u cacc perfectly in point ? JOHNSON ON INFLUENZA. 23 some affection of it, whereby it is compelled to secrete, or pour out in unusual quantity, and not the afflux of fluids to it. Remove the cause, and the effect ceases, is an axiom as old as philosophy itself, and happily applies to the present case. If we remove the extra-power Avhich determines an unusual flux to the secreting or exhaling surface, it will perform its office in the ordinary manner; nor will the same effect fail to take place upon removing the affection of this surface where- by it is constrained to secrete or exhale preternaturally. In the influenza, the poAver which constrains or compels preter- natural secretion or exhalation (for it matters not which) is nothing else than an inflammatory affection of such a surface*. In that kind of gonorrhaea, which is brought on by Arene» real infection, doctor Cullen observes, that the chief thing to be attended to is the inflamed state of the urethra, a circum- stance Avhich is not only inseparable from the disease, but * occasions all the troublesome symptoms that ever attend it. SAviediaur, in his excellent treatise on the venereal disease, calls the gonorhaca virulenta a local inflammation of the urethra in men, and of the vagina in women, the discharge being only the mucus usually secreted in preternatural quantity, some- what changed in colour and consistence, by the stimulus applied to these parts; and in express terms, says, it is like the discharge from the nose and lungs, on taking cold, where the mucus assumes nearly the same appearance. It has already been remarked, that the proximate cause and symptoms in general of a catarrh from cold, and those of the influenza, were very nearly, if not altogether the same, [except in degree] Avhich may lead us to conclude, that as an inflammation of the lining of the urethra brings on a preter- natural discharge of mucus from thence, altered in colour and consistence ; so, in the influenza, alike affection of the mem- brane lining the nose, fauces, and bronchi© [being a similar secreting surface] will be productive of a resembling dis- charge. *' More fluid circulates through, and is secreted, in a part that is inflamed, than when it is in a natural state.' Mother, by's Medical Dictionary, under the word inflammatio. 24 JOHNSON ON INFLUENZA. A certain degree of inflammation favours a copious flow of mucus from the urethra, and yet a higher inflammation will suppress the running entirely, bringing on severe pains in different parts of the body, Avith an increased action of the heart and arteries. The like is observable in catarrhs, where a certain degree of inflammation excites a free discharge from the nose, fauces, and bronchia ; whilst an increased inflamma- tion of the internal surface of these parts not only suppresses secretion there, but is followed by a sense of fullness in one or both nostrils, dyspnoea sicca, and a quickened pulse*. This last, viz. the febrile action of the arterial system, is a natural consequence of inflammation in these parts; for, as F. Hoffman obsenres, and after him doctor Fordyce, ' any such impediment to the freer circulation of the blood, as destroys its equilibrium, is the essential character of a fever §.' That increased inflammation produces such effects, is confirmed by uniform experience, as may frequently be seen in the patients affected with gonorrhoea, who use too astringent injections; for in this case they have the running checked, with an aggravation of every inflammatory symp- tom, seldom failing to bring on inflammatio testium, cystitis, or both, and an immense accumulation of misery. Sydenham remarks, Avhen treating of the epidemic fever and cough of 1675, that it' frequently proved very fatal to abundance of the common people, Avho, whilst they unadvised- ly endeavoured to check the cough by taking burnt brandy, and other hot liquors, occasioned pleuritic or peripneumonic disorders ; and by this irrational procedure rendered this dis- ease dangerous, and often mortal, which of its own nature is slight, and easily curable.' But it sometimes happened, (con- tinues he) not only when the disease had been unskilfully treated, in the manner above described, but also spontaneous- ly, at the beginning of the illness, or in a day or two after- wards, especially in tender and weakly persons, that the coup-h Avas succeeded by alternate intervals of heat and cold, a pain in the head, back and limbs, and sometimes a tendency to * ' A feA-er accompanies every inflammation.' Van Swie- ten's Comment. Arol. 5, page 81. § Fordyce on fevers, page 14. JOHNSON ON INFLUENZA. 25 sweat, especially in the night; all which symptoms generally folloAved the fever of this constitution, as it were of the lungs, which occasioned a difficulty af breathing, stopped the cough, and increased the fever.' The obvious tendency of'burnt brandy and other hot liquors,' taken down in such cases, would be to increase an inflammation already begun; to stop the cough, or at least the execretion of mucus from the lining of the bronchia; to pro- duce difficult respiration from the swelling of the inflamed membrane; and, an uWvoidable effect, the foregoing increa- sed fever. '\ The manner in which the disease must necessarily origi- nate, will likewise shew that these symptoms arise from the proximate cause here laid down ; and that the degree of this, accounts for every variety observable in the influenza. For, whether the morbid miasmata which constitute the exciting cause, be emittwi from the body of one who has the disease, or be engendered in the atmosphere, or exhaled into it from putrefying substances, animal or vegetable, or in short, in whatever manner they may get there—it cannot be questioned, Dutthat they float in that element *, and enter with it in inspira- tion and deglutition; and being retained by the tenacious mu- cus of the nose, fauces, lungs, stomach and intestines, irri- *' We have many examples to prove, that the air cannot hold, nor yet conA'ey contagion to any distance. If it be mixed with atmospheric air, it is soon dissipated, perhaps chemically decomposed, if it be a compound body [possibly he would have been nearer the truth had he said re-compounded, or neutralized], and its nature altogether changed.' Lond. Med. Mem. vol. 2, page 439. Upon first readingthispassage, I doubted whether the author meant seriously, as it appeared to me to be trifling, if not with common sense, at least Avith common experience, and with the testimony of some of the greatest authorities in medicine. See the quotations from Hildanus, Russel, &c. atpages 16 and 18—' It is well knoAvn the stench of putrid carcases, gangrened limbs, the polluted stinking air of jails, &c. bring on malignant pestilential fevers, just as the putrid sanies of a gangrened limb, absorbed into the the blood, brings on a fever of the same kind.' Huxham on fevers, page 243. See likeAvise on the same subject, Ferriar's Med. Essays, p. 236. 26 JOHNSON ON INFLUENZA. tate and inflame these parts, thereby producing, in the first instance, or secondarily, the train of symptoms Avhich take place in this disease. Doctor Houlston of Liverpool, goes so far as to assure us, ' that in sitting near an infected person, an irritation of the mucus membrane of the nose was sensible, such as is produced by the dust of pepper, and which sneezing tended to remove. * Now, though it seems almost certain that the a irus of every disease Avhich is contagious, affects the part on Avhich it has first fastened, before it disturbs the rest of the body, and assi- milates to itself more or less of the humours which it there meets Avith ; yet it Avould seem possible that some of it might be absorbed, and immediately taken into the circulation [in persons of lax habits,], and there excite or increase a fever by itsoAvn stimulus, or by the stimulus of such part of the blood as it assimilates to its own nature tv But for my oavii part, I should suppose it a rare occurrence in the influenza, * Med. Commun. Vol. I. Pa:;e 57. See also James' Med. Dictionary under the Avord Catarrh. ' But it is not to be doubted, that there is sometimes in the air such a subtile caus- tic matter Avhich, being received in inspiration, insinuates it- self into the glandulous parts, through which it passes, ex- cites pain, tumor, and redness, and brings on a catarrhous fever.' What this subtile caustic matter is essentially, may no doubt be very difficult to explain ; but from analogy it Avould seem probable that it is the .same Avith that which produces the plague, the jail orhospital fever, and, peradventure, an intermittent: and that the various appearances of these (seem- ingly different) diseases arise from the greater or less concen- tration of this matter, together with the accidental, though greatly cbversifv ing circumstances of season, soil, cultivation, climate, Sec. and also the manner of living, food, raiment, Sec. &c. According to Doctor William Fordyce, ' if animal bodies a>e In a decaying state, and the air be filled with their steams, they sometimes produce pestilential fevers; the steams of EOTre decayed vegetables have the same effect. The effluvia of human bodies are likewise very hurtful to the air. Three thousand men living within the comj^ss of an acre of ground would make an atmosphere of their own steams seventy-one feet h'gh, which would soon become pestilential, without the winds to dispel it. The air of prisons for this reason produces mortal fevers.' See his Inquiry into the causes, 8tc. of fevers, page 16. t See Ferriar's Med. Essays, page 235. JOHNSON ON INFLUENZA. 27 that the, materies morbi,' in the first instance, enters the mass of blood without exciting a local affection ; but as there are said to be some cases where the patients are instantaneously seized with, and exhibit all the other symptoms of the disease, Ave may, perhaps admit that in those cases, the local affection may not be present. HoAvever, such cases have never fallen under my observation. * Upon the whole, therefore, the proximate cause of the influenza appears to be a local Inflammation of one, or more of the parts before mentioned, viz. of the mucous membrane lining the nose, fauces, aspera arteria, ssophagus, Ec. ^e. t OF THE CURE. So moderate is the influenza in many instances, as to re- quire but a few days refraining from the use of animal food, to lay in bed or keep within doors, taking at the same time some warm di&ent drink, and to return gradually to the usual manner of living ; whilst in others, again, great attention is absolutely necessary, and the cure difficult. The treatment of this disorder must be either local, or ge- neral, or both; as will appear by attending to its history of symptoms, and its remote and proximate causes: but as most local remedies produce general effects, and general ones often relieve particular parts, it may be most proper to omit distinc- tions of this kind, and premise one universal ride by Avhich the indications of cure arc to be governed, viz. the season of the year, the state 'f the system, and the symptoms present. * ' I believe contagious miasmata seldom, if ever, produce their effects by enteruig the vasa inhalantia on the surface of of the body where the cuticle is not removed. I apprehend they more commonly make their way by the prima; via;, the lungs, or other external passages, &c. kc. Dr. Kirkland. t'Some inflamation* I will allow, says Doctor Hamilton, the state of the mucous membrane proved that there was a degree of it present' Lond. Med. Mem. Vol. 2, page 45 o. After enumerating certain remedies which he used, adds—' with a linctus to mitigate the burning heat and pui:i 1 felt in my throat;' from which one would think the degree of inflamma- tion in his oav:i case was not very inconsiderable. 28 JOHNSON ON INFLUENZA. 1. BLOOD-LETTING is a proper and speedy remedy to take down the phlogistic diathesis, and may be either par- tial or general, according as the symptoms indicate. The pulse, though it may assist in determining the quantity of blood which should be drawn, and the frequency of the ope- ration, it can by no means be allowed to direct us altogether in the use of this valuable remedy. * From the great disposi- tion Avhich this fever discovered to degenerate into typhus t we should be cautious in the use of the lancet, and all things else being equal, bleed less freely in the spring than in the fall of the year. 2. CATHARTICS, or purging medicines, are no doubt necessary, particularly if the patient be afflicted with a violent head-ach, a throbbing of the temporal arteries, much cough, constipation of the boAvels, accompanied with a tense pulse: but as medicines of this kind debilitate the system considerably by a single operation, if given in full dose, it would seem safer [for the reason suggested under the preceding head] to administer them so as to keep the body regular, or gently lax \; or to supply their place either by clysters |J, or emetics in the manner next to be mentioned. * * Where there is just reason to fear a contagious malig- nity in a fever, Ave should proceed with the utmost caution as to repeated bleeding.' Huxham on fevers, page 238. See the 1st ato1. of the Med. Commun. p. 75. Notwithstanding this epidemic [the influenza of 1789] was visibly of an inflamma- tory kind, it would not with us, admit of Avhat is called the an- tiphlogistic plan.' Currie on the diseases of America, page 323 : and at page 103. ' Several Avere benefited by bleeding; bu in general the patients recovered sooner when it was omit- ted, except when pneumonic symptoms ; such as acute pain, and a full or hard pulse indicated it.' t' In the course of the disease there frequently appeared unequivocal signs of a putrid tendency.' Med. Commun. Vol. I. page 80. \L Gentle laxatives were frequently used with adAantage in the beginning of the complaint, especially where there Avas a dispose ion to costiveness, strong purges do not appear to have been often given; and from general observation respecting the effects of bleeding, there is reason to think, they would in mc-t caseshaA'e been prejudicial.' Med. Commun. vol. I. page 38. UWallis's Sydenham, vol. II. page 337. JOHNSON ON INFLUENZA. 29 3. VOMITS. Whenever there appears to.be an inflam- mation of the lungs, which may be known by stitches or acute pains about the chest, these would be improper, as tending to give exquisite and unnecessary pain ; and Avould endanger the rupture of a blood vessel in the lungs, -with all its bad conse- quences, without any probability of their proving seviceable. An early exhibition of full vomiting is very proper, in order to bring on a determination of the fluids to the surface of the body *, which not only contributes to the expulsion of the exci- ting cause,\\ and thereby preventive of an inflammation of the lungs, Sec. but often brings on a salutary perspiration over the whole body ; a copious secretion of mucus in the bronchiae, fauces and nose ; and in this, anticipating or assisting nature in her oAvn way in bringing on a mild solution of the disease. It will therefore be best to \\mit full vomiting to the first stage of the complaintj and aftenvard to supply its place by emetic medecines in small doses, frequently repeated, so as to keep up a pretty constant nausea; for which purpose the gum ammoniac, antimonial wine, or emetic tartar is usu- ally prescribed; and, though any one of them will answer tolerably well) the latter being copiously diluted, and fre- quently given in small quantity, seems to have been attended with the happiest effects, by rendering the bowels * Emetics exhibited upon the first attack [of the influenza] Avere evidently of use in relieving the head and breast. Lond. Med. Trans. vol. 3, page 73. ' They do not appear to have been very generally used, [in the epidemical catarrh of 1782] but all who did employ them, concur in opinion, that they were of great service, not only where there was reason to suspect an accumulation of mucus in the bronchial ramifi- cations, but also where they were given chiefly with a view to assist in producing a speedy and copious perspiration.' Med. Communications, vol. I. page 35. ||' Before the miasma was fixed and propagated in the body, it was wholly carried off in several patients who kept in bed immediately after feeling the first attack, by a large perspiration. Other spontaneous evacuations, by vomiting, looseness or urine were less frequent, and did not seem to procure such immediate, and great relief, unless they Avere followed by a sweat.' Dr. Reimarus, Hamburgh. See Med. Commun. vol. I. page 30. 30 JOHNSON ON INFLUENZA. moderately open, and keeping up a gentle diaphoresis §. ' This medicine administered in this manner, [in the opinion of doctor James Carmichael Smyth] had also a very remarka- ble effect in bringing on a remission of the febrile symptoms, and in accelerating the termination of the disease.' However, the long continued use of antimonials f, or of nauseating medicines of any kind, is apt at length, to debilitate the stomach so much as to render it, in a good measure, inca- pable of retaining food, drink, or medicine; and this, perhaps, at a time Avhen they are most needful. These medicines likewise soon loose their sudorific power over the system, and, as Dr. Donald Monro assures us, even James' celebrated febrifuge powders have occasioned such a purging as to hasten the patients to their graves. The MISTURA MUCILAGINOSA t, which is very frequently used in the Philadelphia Dispensary, is an agreeable and efficacious medicine in most catarrhal complaints^ parti- cularly Avlieic the cough is very distressing, and the necessary evacuations have been previously made. A table spoonful every two or three hours, according as the cough, anxiety, morLid watchfulness, 8cc. are urgent, is the manner in Avhich this excellent remedy is usually prescribed. This mixture possesses severd advantage?, as avcII from the medicines which it contains, as the due proportion in which they enter into its composition, and the facility A\ith Avhich its powers may be increased without becoming much [if at all] less agreeable to the patient. The tincture of opium will render it mere anodyne in a given quantity, a few grains of tartar emetic will correct the constipating qualities of this, and the whole mixture is thereby more or less laxative ; whilst their jcint eicacy renders it more powerfully diaphoretic, with' §' All attempts to force sweat appear to have done more J.an.' than good.' Loud. Med. Trans, vol. 3, page 72. f Large doses of antimonials, or even smaller ones too frequently repeated, have sometimes brought on evacuations, a. Inch entirely sunk the patient/ Lir.d on hot climates, pugei61. And, ' On the same subject, see Dr. D. Monro's Observ. vol. 2, p^ge 13 and 15—idso Dickinson en fevers, page 115. \ R. r lixir: Paregoric : | j Vini Antimo-ial: gss Mucilag: Cum Ara.ic :—fuc- : Clycii rh : aa gis—aqua; Pontis gviij M. JOHNSON ON INFLUENZA, *! scarcely any alteration in its taste, or diminution ofitsdimv.U cent quality. But I have seldom seen it necessary either to vary the form of the prescription, or give any other opiate*, and I have observed at least a thousand instances since I attended the practice of the above institution—where the use of it was attended not only with evident relief, but [as the patients sometimes emphatically expressed it] with * blessed effects' 4. LOW DIET. Animal food seems to be very hurtful, especially in the beginning of the disease ; it ought therefore to be immediately laid aside, and a light vegetable or milk diet substituted in its stead .f Doctor Rotherham is of .opinion that' an abstinence from all food Avould accelerates the cure ;' and possibly, in some cases, it might have this effect; yet as the prescription seems a harsh one, and might in many persons induce an irritation from hunger much more danr gerous than the stimulus of a small quantity of bland aliment in the stomach, it would be preferable to allow as much as Avould allay this sensation. Low diet has its limits; nor should it be much longer persisted in than whilst the inflam- matory diathesis is present in the system. A gentleman of the faculty in this city, who had the influ.- enza in the fall of '89, strictly adhered to the antiphlogistic regimen, and to his astonishment perceiA-ed the disease, instead of abating, to grow Avorse : he reversed the plan, lived generously, and got Avell §. *l Opiates Avere a.common remedy Avith most physician:,, and they all agree in testifying their great use ; particularly in mitigating the cough, which Avas in many cases the most troublesome and tedious symptom of the disease. A led. Commun. vol. I, page 38. t What doctor Sydenham has beautifully said, when pointing out the cure of the quinzy, is strictly applicable here, viz. ' Meatsof every kind, and likeAvise broths prepared from diem, arc sacred, andmustnot be touched.' §' A generous diet [in some instances] was highly con- ducive to a more speedy recovery, and many boie a more liberal use of Avine than is generally given in catarrhs frcnu cold.' Lond. Med. Mem. v. 2, p. 468. J2 JOHNSON ON INFLUENZA. 5. DILUENT DRINKS. OfAvhatever kin' th«» fever may be, these seem to be indicated. There is a great variety of them, and but little preference ; as any of them will answer sufficiently well, if a due attention be paid to their temperature and quantity. As a general rule, tepid drinks -f, would seem to be safest, as cold ones sometimes do injury in inflammations of the lungs, and in some instances, might check or prevent a salutary perspiration: but as there are certainly some exceptions to this rule, much must be left to the sagacity of the physi- cian \. Pure water, whey, barley-water, water acidulated vrith currant jelly, vinegar, lime juice, 8cc. with or without sweet- ening, are all very proper drinks in this disease. Whilst an inflammatory diathesis prevails in the system, a little nitre or some such neutral salt may be dissolved in one or other of these drinks, and given with safety and advantage. Typhus and typhoid cases require diluents also ; but occasionally, the patients may be alloAVed Avine-whey, wine and water, veal- broth, chicken broth, and pure unmixed wine, according to circumstances *. 6. BLISTERS are frequently necessary in this complaint, and peculiarly so when pleuritic or peripneumonic symptoms become violent; in which case, they are to be placed as t' The drinking frequently of tepid, emollient liquors, is a kind of internal relaxing fotus to the prima? via;, prxcordia, 8cc j which is of no small consequence, especially in inflammations ! of the lungs, pleura, &c. This was the practice of the antients, j who gave little else in fevers, besides their Avatery diluents, ptisan, or barley-water, hydromel, oxymel, &c.' Huxham on fevers, page 245—.See Doctor William Fordyce's inquiry into the causes, &c. of fevers, pages 90, and 180. \ Brydone says the Italians use ice and ice-water with great advantage in inflammations of the lungs ; but I have not | learnt that this practice has been imitated in America, and un- , til experience shall have demonstrated more generally its safe- I ty, Ave should venture on it with some hesitation* *' Proper dilution is unquestionably useful in all fevers, but certainly some require more than barley-water, and lemon- ade.' Huxham on fevers, page 245. See also Lond. Med. Mem. vol. 2, page 459. JOHNSON ON INFLUENZA. 33 rectly over the part affected as possible *. When the influenza is attended with ophthalmies, head-ach, or acute pains in the eye-balls, blisters applied oA-er the temporal arteries, to the nape of the neck, or behind the ears, are of eminent service §. 7. THE PEDILUVIUM should never-e omitted in the incipient stage of this, or of any other catarrhous affection. The patient may sit in water of a temperature somewhat higher than that of his own body t> from five to thirty or forty minutes ; taking, at the same time, or very shortly after, a few drops of antimonial wine in a little Aveak tea. The ease Avith which this remedy may be procured, being Avithin the reach of every body, the suddenness of its effects, and the little danger attendant on its application, are no small recommendation in its favor. According to Doctor Hamilton, ' it determines to the surface, encourages a larger share of blood from the head and superior parts, to the lower; is generally followed by sleep, relieves delirium, moderates the cough, and removes sickness at the stomach, from the great sympathy between this organ, and all the parts of the body ; but especially Avith the surface \.' 8. WARM AQUEOUS VAPOURS frequently received / into the lungs by the breath, constitute a remedy of immense consequence in this disease. Many persons fancy that a little vinegar added to the warm water, improves its virtues consi- *' Blisters seldom failed to relieve the head, and to prevent too great a defluxion on the lungs.' Lond. Med. Transact, vol. 3, page 73. § There has been much contrariety of opinion Avith regard to blisters : some exclaim against frequent, and, as they term, it, indiscriminate use, others forbid the application of them where there is a putrid tendency only ; others admit them but object to certain kinds in certain kinds of fevers,—-as for instance cantharides in the jail fever, where they would prefer blistering with the steams of hot Avater, or sinapisms of vine- gar, leaven, Sec. Whilst others again, the most celebrated of whom is the late doctor BroAvn, condemn their use in all cases whatever. t See Huxham on fevers, at page 12. \ See his remarks on the influenza of 1782, in the second volume of the Lond. Med. Memoirs. E 34 JOHNSON ON INFLUENZA. derably, the truth of which hoAvever has been questioned ; nevertheless as the vapour, in consequence of this addition, foe's more grateful to ihe lungs and fauces of some people, as it can do no injury, and as it may coincide with the wishes of the patients, it will sometimes become a duty to prescribe in this Avay. The method of using or of applying the vapour, is of very little importance ; a bason filled with hot water, and the foc.e placed over it, or the steam received through an inverted funnel, will ansAver as Avell as, and perhaps better than Mudge's inhaler. DIRECTIONS TO NURSES, AND ATTENDANTS OF THE £ICK. As the influenza is a febrile disease, and a contagious one also, it will be proper to pay attention to the air of the patient's chamber ; as the salubrity of this, Avhich depends no less on frequent ventilation, than upon universal cleanliness, accele- rates the cure, and is preventive of relapses. Nor is the temperature of it to be neglected; for although cool air is undoubtedly useful in fevers, yet it is not less so in many cases, .to support that degree of warmth which may promote a proper quantity of perspiration. A fire-place is of great use in purifying the air, and in some measure regulating the temperature of it, and Avhere a choice can be had, the sick ought never to be put in a room in which there is not such a ventilator. Let me repeat it, every thing about the patient should be kept clean, and his linen frequently changed; his bed placed some feet from the Avail, and no curtains suffered to envelope it; all unnecessary furniture should he removed, and no wearing apparel permitted to hang round the room. If at any tine it should be found unadvisable tochange the air of his apartment by opening the windows, doors, &c. it will be right to impregnate it with thesteams of vinegar*, or with the fumes which arise from brown sugar when thrown on a few coals. The present state of philosophy will not enable us to explain satisfactorily how the healthy change is produced ;—whether the steams of the vinegar, or the fumes of the sugar neutra- *< Steams of vinegar resist putrefaction by impregnating the air with its powers.' Fordyce on fevers, page 18. JOHNSON ON INFLUENZA. 25 lizc, or decompose the morbid impurities issuing from the sick,—or in short how it is effectuated : but it is well we are certain of the fact, though Ave should forever be ignorant how it obtains. OF PROPHYLACTICS, in the influenza little can be saidAvith certainty, as we are yet so totally ignorant of the true nature of the materies morbi; but it may perhaps be proper to observe that equanimity and temperance in eating and drinking, are amongst the best pre- ventatives of all disorders. Temperance is too indefinite a term, however, as that Avhich is no more than strictly neces- sary to one person, might It) another be a very dangerous ex- cess ; for Avhich reason more ought to be left to the feelings of the person than to the judgment of the physician. When an epidemic rages, and indeed at all times, changes in the manner of living are dangerous ; but especially so, if they be not gradually made, 'Jest by the change some innovation should happen in the body,' as saith the great Hippocrates. OF THE PROGNOSIS. The influenza has brought on death in persons previously very much debilitated, and paved the Avay for it in some instan- ces by disposing to dropsy, consumption of the lungs, &c Yet the united testimony of all the writers upon this subject proves that it is seldom either obstinate or fatal: * and as death or recovery in this disease is marked by no peculiar symptom (that I know of) it has appeared to be useless to enter into a detail of doubtful circumstances. There is no part of our medical researches accompanied Avith so much uncertainty as is the prognosis of disease ; for, in the language of the poet, ' shadows, clouds, and darkness rest upon it.' I shall conclude this essay with remarking that, although the influenza is, as mentioned above, for the most part a mild disease, still it is not always without danger; that if there be a risk in leaving our constitutions to struggle with the com- * See Med. Commun. vol. 1. page 40. The termination or consequences of this disorder were like every other part of it, extremely various.' 5 JOHNSON ON INFLUENZA. plaint, thcvc isa6n.'.rh—.-ir.y, more to be apprehended from injudicious treatment; that while in some eases we fancy we are assisting nature, avc should be careful lest we be found contending with her to the great hazard of the patient; that although medecines become the props of sinking life when judiciously administered, yet if dealt out by the rash and the unskilful itis justly to be feared they will be used improperly, in which case they are as dreadful as the sword of the destroy- in "■ angel. By this I mean not to insinuate, that the faculty alone are to dispense medicines;—.far from it; hut would wish to suggest, in the cause of humanity, the necessity of caution, as ' bold practice' borders upon cruelty. A DISSERTATION, ON THE SALUTARY EFFECTS OF MERCURY, IN MALIGNANT FEVERS: SUBMITTED TO THE EXAMINATION OF THE REVEREND JOHN EWING, S. T. P. PROVOST; THE TRUSTEES AXD MEDICAL FACULTY OF THE UNIVERSITY OF PENNSYLVANIA, FOR THE DEGREE OF DOCTOR OF MEDICINE; ON THE TWENTY SECOND DAY OF MAY, A. D. ONE THOUSAND SEVEN HUNDRED AND NINETY EIGHT. BY JAMES STUART, OF VIRGINIA: AND RESIDENT MEMBER OF THE ACADEMY OF MEDECINE OF PHILADELPHIA. Prapetibus pennis ausus se credere calo : Insuetum per iter gelidas enavit ad arctos. Virg.. /Enid VI. Ke mea dona tibi studio dispostafideli, Intellecta priusquam sint contempta relinquas. Lucret. Lib. I. INTRODUCTION, IF any medicine from general utility and acknowledge^ virtues in relieving the miseries of humanity, demand the exclusive attention of the physician, that surely is the one Which is the subject of the following essay. Mercury has not only eliminated the venereal virus, humbled the obstinacy of dropsy, broke the enchantment of epilepsy, and subdued an innumerable host of diseases, equally inimical to life, but now compels malignant fever to own its sway. To do justice to the merits of this hero of the materia medica, and to point out its many excellencies in the cure of every disease in which it has been successfully employed^, would require more time than I can at present, employ, and extend this treatise to a length beyond the limits generally assigned to an inaugural dissertation. I shall therefore confine myself to treat only of its salutary effects, in what have been termed putrid, or malignant fevers. In executing this, I shall divide the subject into four heads. J. I shall define the term Malignant, and offer a few remarks to prove that all diseases are equally malignant in pro- portion to the prevailing Inflammatory Diathesis. II. I shall consider the Modus Operandi of mercury, when applied to the system. III. The different modes of applying it and the several means of assisting the operation. IV. And last. The treatment of the mouth during a salivation, Avith the remedies for checking it, and the objec- tions from injury to the teeth and constitution. If in treating of some of these particulars, the benevolent reader should perceive me stepping aside from the beaten track 40 INTRODUCTION. of his preceptor, and be inclined to associate his censure Avith my name, I earnestly solicit his indulgence, and beg him for a moment to suspend his conclusions until he reflects that when the animal economy is under a morbid stimulus, it is in proportion to the force of that stimulus, insensible to all others. Hence the almost astonishing doses of opium, daily exhibited in tetanus, would prove fatal to the same person while under the influence of only the ordinary stimuli of health; he Avill then, I trust, feel no more offence at the exhibition of twenty grains of calomel every three or four hours in the most violent stages of malignant fever, than that the peruvian bark, which Avas once dealt out by physicians in doses of tAventy grains, with a farcical solemnity and all the mystery of magic or necro- mancy, should noAv be administered by nurses in doses of half an ounce. A DISSERTATION ON MERCURY. I. DEFINITION OF THE TERM MALIGNANT. PHYSICIANS from the time of Hippocrates to the pre- sent day have agreed in affixing to a certain assemblage of symptoms occurring in febrile diseases, such as a grim ca- daverous countenance, great prostration of strength, a dis- position to faint on be ng raised up, petchiae, vibices, dissol- ved blood, hemorrhagy from different parts of the body, 8cc. the term putrid or malignant. The term putrid, originated from a supposition that these symptoms depend on a putres- cent state of the fluids, but since modern experiments have proved, that such a state in the living body can never take place, * the term has given place to the less exceptionable one of malignant, and lately to the gangrenous state of fever, t The term malignant probably arose from the ferocious, or, malignant countenance of the patient, observable in this state of fever. A case is said to be more or less malignant in proportion to the violence of these symptoms, and as a greater or less number occur in the same time and patient; but, unfortu- nately neither writers or practitioners have been so unanimous in their opinions or practice, of the proximate cause, or in their methods of cure in this state of fever. Hence Sydenham complains of the practice of his cotemporaries, ' Cum in ezefe- bres presertim Maligns dicantur, in quibus intensioris prae ceteris inflammationis gradus conspiciatur, hinc medici se ad usum cardiacorum, et alexipharmacorum nescio quorum con" * Vid. Cullen's first lines Sect. 72. t Dr. Rush's proximate causes of fever. 42 STUART ON MERCURY. tulerunt, quo scilicet per cutis poros expellant, quod somne- ant venenum (hoc enim estdicendum, nisi malint verbis hide- re, quam illud quod potest intelligi, serio pioponere) ex quo factum est ut regimen calidissimum, methodumque huic p.i- rem, iis morbis adaptaverunt, qu$ fiigicissima turn, remedia, turn regimen, pra ceteris sibi postulobant.' That malignant symptoms depend upon an inflammatory diathesis, or great excess of stimulus, I infer, 1. From the same remote and excuing causes Avhich pro- duce inflammatory fevers, when applied in higher degree, pro- ducing the malignant state of fever. Hippocrates in, lis epidemics mentions a case of putrid billious fever being, brought on from the stimuius of a caustic, and Dr. Boerhaave in his tlefinition of a synochus says' k has been customary to call that disease a putrid synochus, (i.e. a malignant fever) which arises from the mi;r violent causes of inflammation.' And his commentator B*aro» Van Swieten, under the same aphorism considers, ' a /ugh degree of stimulus; the exciting cause of ail malignant fevers.' 2. From tiaje effects of blood-letting in this state of fever, for an account of which as I have nothing to add> I beg leave to refer to Dr. Rush's defence of blood-letting. 3. From the facility with which the inflammatory and ma- lignant states of fever are clmnged into each otlier. Dr. Huck» in his remarks o» the fevers of Jamaica says, ' It often depends upon the manner in which the patient is treated in the beginning, whether he shall have a yellow^ or only a reuniting, or intermitting fever.' A case is recorded in the Medical Essays to this purpose, a girl who was afflicted with a tertian, took a draught of spirit of wine, hot ate and ground pepper, and in consequence was seized with a violent continual fever; but, when the con- tinual fever went off, the tertian returned with great irregu- larities, attended with the most obstinate and malignant symp- toms. In further proof of this, I will relate a case that occur- red in my own practice. In August, 1797, a young man was afflicted with a quotidian, attended with dysenteric symp- toms, and was cured by small bleedings, calomel and opium ; a few days afterwards, the quotidian returned without any STUART ON MERCURY. 43 dysenteric symptoms ; on which he unadvisedly took large doses of laudanum, and drank hot spiced brandy (with a view, as he said, of sweating off his fever) by which means it Avas accended to a high degree of malignity, the dysenteric symp- toms returned, and he died yellow with symptoms of a morti- fication of the intestines, on the fifth day from the commence- ment of the continual form. Whilst on the other hand, it is equally certain that the most malignant state of fever may be changed to that state where sizy blood occurs, and finally, that may be reduced to the diathesis Avhich constitutes health by no other means than a perseverance in the antiphlogistic remedies. In confirma- tion of Avhich I refer to authors who have employed blood- letting as a remedy in these fevers. * 4. From all fevers, under certain circumstances assuming symptoms of the highest malignity. The small-pox, for example, in a good constitution and under proper treatment, is acknoAvledged to be uniformly a mild inflammatory fever; but, by a hot regimen and the abuse of stimulating medicines it may be accended to a grade of malignity equal to the plague. Hence m Minorca, before the nature of this disease Avas well understood, the most of those Avho survived an attack, remained blind, consumptive, or lame, with carries of the bones, sordid ulcers, &c. so that Mr. Cleg- horn justly considered it to approach in violence the plague f. The same remarks are applicable, only in a less degree, to the putrid sore throat, the pleurisy, rheumatism, gout, meas- les, influenza, dysentery, scarlet fever, pucrperile fev^er, jail fever, &c f. for a particular account of Avhich, I refer to authors who have professedly treated on each of these diseases. * Cotalus, Sydenham and Rush. t Cleghorn's account of the diseases of Minorca, page 277. \ In Mrs. Jeil'ery's case, near the NeAV Market, last au- tumn, symptoms of malignity attended a difficult and exces- sive discharge of the menses. She was relieved by several bleedings at the arm and the use of calomel joined with frictions of mercurial ointment on the region of the uterus, which excited a gentle allection of the mouth ; the blood Avas at first florid without a disposition to separate, but at the second bleeding became sizy. 44 STUART ON MERCURY. Galen Avas long since acquainted with this relation between the inflammatory and malignant state of fever, as is evidenced bv the following observation, ' that symptoms of malignity or putrefaction only vary as nature overpowers the disease, or is herself overpowered, and that in inflammations she over- poAvers the disease *.' This opinion, although not in the language of the present day, is very emphatically expressed, as in cases of malignity the excitability of the blood-vessels is prostrated from excess of force, nature may be said to be over- powered f; while in what are called inflammatory fevers, attended Avith sizy blood, &c stimuli have been applied only adequate to excite the highest convulsive action in the blood- vessels, and less than sufficient to induce paralysis, rupture, effusion, &c. nature may properly enough be said to over- power, as she is still capable of reflecting the force of stimuli. After what has been said, I shall define a malignant fever to be that state of fever, in which there is overaction in the blood- vessels, or a defect of action and a disposition to paralysis or gangrene, from great excess of stimulus. Thus, Regulus, after loosing both his eye-lids and his long confinement in a Cartha- genian dungeon, upon sudden exposure to the rays of a meri- dian sun, must have been in the midst of darkness from the excess of surrounding light. * De februm differentia, lib. i. cap. vii. chart, torn. 8. p. 115. t Omnia hsec exinde tantum procedere, quod natura a primo morbi impetu quasi oppressa, devinctaq : non satis va- lida est ut symptomata regularia et magnitudini morbi consona exarserat; omnia vero phenomena prorsus sunt anomala. Etenim perturbata ceconomia animali, et quasi disjecta, febris exinde deprimatur, quae obtinente genuino naturae ductu vi- gere solet. Syden. Schedul. Monit, de nova febris ingressu, p. 541 et passim. STUART ON MERCURY. 45 II. THE MODUS OPERANDI OF MERCURY, WHEN APPLIED TO THE SYSTEM. I. As an evacuant of fxces, bile, mucus, and lymph. To any one who considers the great degeneracy of some, and the increased quantity and vitiated quality of others of these substances in malignant fevers, the necessity of imme- diately discharging them will be sufficiently obvious; and accordingly, most prudent physicians have been anxious to excite stools as soon as the circumstances of each particular case would admit of, but generally with an intention of pre- venting an accumulation of putrid matter, and thereby obviating any farther accession to the putrid ferment, on Avhich this state of fever is supposed to depend. In effecting this, from an apprehension of inducing a fatal debility, they have mostly confined themselves to the use of purges of the mildest nature, such as the neutral salts, senna, manna, cream of tartar, &c But, since this supposed putrid state of fever has been proved to depend upon excess of stimulus, and since the application of a caustic § eating of a particular kind of fish f, and large doses of opium f have each been knoAvn to produce the same alarming symptoms as are occasioned by what are generally called putrid contagions, this intention of cureproA'es to be badly founded, and is to be changed for the more rational one of abstracting from the sum total of stimuli. These matters are often so acrid as to excoriate the rectum and the skin of the external parts. When long retained they prove a nidus to infection, and concentrate it when already present. By mechanical pressure, from an accumulation offices in the large intestines, the capacity of the veins are diminished, the passage of the fluids through the smaller arteries is straitened, and a larger quantity of blood thrown on vital parts. Both evacuations and dissections shew the encreased quantity and vitiated quality of the bile, which takes place in someof these fevers. Mr. Cleghorn mentions vast quantities of this fluid discharged in the malignant tertian of Minorca ; and I have seen nearly tAvo quarts eA'acuated in the short § Hippocrates' Epidemics, book iv. t Desportes, t Rush. 46 STUART ON MERCURY. space of tAvcnty-four hours. My OAvn case in the bili- ous yelloAV fever of 1793, exhibited fully an equal quantity. It was so acrid as to excoriate the fauces, tongue, lips, and anus with the external skin AvhereA'er it touched. Doctor Phys4ck's hand was inflamed by the acrid matter found in the gall, bladder, and prima) via in dissections made in this cky, in the yelloAV fever of the same year. The Doctor supposed this matter fbund in the intestines to be an altered secretion from ike liver. Mr. Cleghorn dissected nearly one hundred bodies that perished by the malignant tertian at Minorca, and says he always found the vessica fellea full and turgid and the stomach and intestines overflowing with bilious matter. But, notwithstanding the large secretion of this fluid that takes place in some of these fevers, cases occasionally occur, In Avhich it is entirely absent; in which the faces first dis- charged are white and float on the surface of water like light wood, and in all other respects are similar to those accompa- nying the jaundice. Dr. Chishoim takes notice of their appearance in, the fever of Grenada in 1792, and they frequent- ly occur in the yellow fever, accompanied with great anxiety t>nd soreness in the region of the liver; it is a symptom of dangerous prognosis, as it shews such an engorgement of the vessels of that organ as threatens an immediate paralysis or ';*angrene. This opinion is confirmed from the large quanti- ties of bile and the relief afforded from the exhibition'of purges which have a specific operation on the liver. From the preceding observations and the dissections cited* it would seem that the matter found in the intestines was al- ways merely a vitiated secretion from the liver ; but from some experiments made on the black vomit discharged in the yel- leAV fever of this city, in 1797, lam satisfied that this is not always the case, and that its sources are frequently various. In four instances I touched the tip of my tongue Avith some of this matter ; in three of these cases there was some difference of appearance. The first, at a small distance, very exactly exhibited the colour and consistence of coffee grounds; but, Avhcn more closely inspected, the fluid part Avas of a dark greenish colour, and the lumps brownish and soft. It imparted upon its hrst STUART ON MERCURY- 47 application to the tongue, an intensely bitter and a very nau- seous taste ; in about half a minute a pricking sensation was perceived, which I can compare tonotlung but that excited by the fine prickles of the prickly pear. The patient Avho dis- charged this matter, had vomited and purged bile early in the disease, and died on the fifth day from the attack, soon after I first saw her. / In the second case the discharge came on the seventh day of the disease, and at a small distance was similar to th« former; it was found to be brownish, or rather .of a chocolate colour, and extremely nauseous in scent and taste, but it did not impart the last sensation to the tongue. This patient had a hemorrhage from the gums, and the stools were similar to what was vomited up; she recovered after lying three days under this discharge without any perceptible pulse. In the tlurd case, the matter was discharged by a child about four years old, on the fifth day of the disease, She had white stools throughout the whole course of the disorder, and on the two first days nothing was discharged by vomit, but mucus and the liquids drank. She was early comatose, and discoA'ered great anxiety on being roused. On the third day, the mucus became streaked, with a greyish colour, as if a small portion of ashes had been stirred in it, but on the fourth and fifth days it became very dark; although upon a nicer examination, it Avas still streaked with phlegm. This disco- vered, on its first application to the tongue, neither taste nor smell; but, in a short time excited the same pricking sensa* tion as the first. In both the first and third of these experiments, small pimples came out on my tongue, in a short time, and dis-- appeared in about ten or twelve hours *. From these facts it appears, * At the time of Avriting these observations on black vomit, I supposed this pricking sensation, and the pimples on my tongue, to have been occasioned by some peculiar proper* ties of this fluid; but since, on repeating the same e'tperi* ment, I have always found the fatal black matter insipid, and generally inodorous; except where it was acid, or occasionally mixed with putrid blood, (which last rarely happens) I con- clude these effects must have originated in some cause which escaped observation. 48 STUART ON MERCURY. I. That the black matter discharged from the stomach and intestines, in some of these fevers is often of different properties, and is to be referred to different sources. 2. That it is not always necessarily a fatal symptom ; and that when it takes place, the probable issue of the disease may be presaged from the knowledge of its source. The first matter which I have noticed, from its greenish colour and bitterness of taste, may be considered as an altered secretion from the liver, with a mixture of blood from the ruptured vessels of that organ ; I refer its source to disorgani- zation, and from this cause it must be necessarily a fatal symptom *. The subject of the second experiment from its late occur- rence, from the hemorrhage from the gums which attended, from its intolerable stench, from its want of acrimony, and more especially, from the frequent recoveries which take place after its occurrence, must have been grumous blood, issuing by diapedesin or rupture immediately into the stomach and intestines or sAvallowed from the mouth. The last, from the gradual changes it went through in acquiring a dark colour, from its mixt heterogenous appear- ance, from the absence of a bitterness of taste, from its want of smell, and lastly from the discharge of white stools through the whole course of the disease, I refer to an altered secretion from the arteries of the stomach, which, in a healthy state, were wont to secrete the mucus and the gastric fluid f. * Doctor Rush mentions two patients, which recovered from the yellow fever of 1793, after discharging black matter, on the first day of the disease, but as no mention is made of tne lumps which give it what has been called the coffee ground aspect, and from his own remarks, I conclude it must have been nothing more than a dark bile, without any disorga- nization of the part from whence it was derived. f ' The blood is here so much resolved, that before death it enters the smallest serous vessels, tinges the saliva and the seru n discharged by a blister, and by oozing into the stomach gi ea that blackish cast to what is then thrown up.' Pringle's Diseases of the army, p. 1^7. Sir John discovers much penetration in this remark, but, that he was entirely unacquainted with the means, by which this last discharge acquires 4 that blackish cast,' I shall take occasion to prove in another place. STUART ON MERCURY. 49 Possibly cases may and do occur, in Avhich all these fluids are present in the prima via, at the same time ; but, from a determination of the fluids to any particular part, being known in some degree to exempt other parts from injury, such an occurrence must be rare. It maybe said in contradiction to this remark, that in cases where the discharge indisputably proceded from the liver, dissections have shewn the stomach and intestines in an inflamed or even in a gangrenous state ; but, this might be the effect of matter externally applied, which is knoAvn to destroy secretion, and from the immediate disorganization of the vessels, no discharge afterwards takes place until sloughs are cast off, which as coming from liv- ing and healthy vessels, must be ahvays bland and inoffen- sive. This is illustrated from the effects of a caustic; the part to which it" is applied, first contracts and squeezes out the lymph before contained in its vessels ; a slough is then form ed upon Avhich all further discharge ceases, until that is cast off. The yelloAvness of the serum in these fevers has been supposed to depend upon bile in its compound state, but, experiment has convinced me that this supposition is also erroneous. In a case of yellow fever last autumn, I tasted the serum taken Avhen the patient was very yelloAv; it was unusually saline, but without the least bitterness of taste. A few days after- wards, I made the same experiment on the serum, from the blisters of an icteritious patient, which was the yellowest I ever saAv, but not in the least bitter, nor unusually saline. The acrimony of the humours therefore, although the colouring matter of the bile is so eminently conspicuous, does not depend on the presence of that fluid in a compound state, but upon the acquisition of an encreased proportion of salts. I have been the more particular in this digression, not on- ly with a view of elucidating the operation of mercury, in the cure of this state of fever, but, because the discharge of the black vomit, is so strongly associated with the death of the patient, as the inevitable consequence, that he is commonly deserted both by physicians and attendants upon its first ap- & 50 STUART ON MERCURY. pcarancc ; and often, when by a perseverance in proper reme- dies, life may be preserved. * I now come to mention, in a summary view, the several good effects of mercury in evacuating the dilferent humours, which have been noticed to be present in the first passages, in this state of fever. 1. By evacuating them early in the disease, any farther encrease of acrimony is prevented. 2. The generation or concentration of infection is prevented by the same means. 3. The stimulous from the mechanichal pressure of har- dened faces is removed, the capacity of the veins of the larger intestines is encreascd, and a revulsion from vital parts effect- ed. 4. An accumulation of bile is prevented and its regurgita- tion into the stomach. 5. The Avhite colour of the faces is changed, the anxiety and oppression attending are relieved, and the yellowness of the skin prevented. 6. From its specific action on the hepatic system t the sti- mulus of contagion is superceded, congestion is removed, and hemorrhagy from that organ prevented. 7. In depleting the extremities of the vessels and afford- ing an opportunity to them of contracting, it prevents he- morrhagy from the stomach and intestines. * This took place in a case which I have mentioned in ano- ther part of this essay. A gentleman of respectability in his profession was called at the first appearance of this discharge, in consultation with me. Upon seeing the matter vomitted, he pronounced her irrecoverable, I told him, I supposed it con- sisted of blood, and was not the result of disorganization. He answered, that if I thought so, he should leave her in my care, as he did not think it worth while to take her case into conside- ration. He then went away without any other proposals. As the patient recovered, the truth of my suspicions was con- firmed. t For these effects of purging I refer to Sydenham; Hillary on the diseases of Barbadoes ; Clark on diseases in voyages to hot climates; And Doctor Rush's account of the effects of purging in the bilious yellow fever of 1793. STUART ON MERCURY. 51 8. By creating an artificial weak part in the intestines, the effusion of lymph, serum, &c. in vital parts is prevented. 9. By removing acrid matter immediately from affected parts, it takes off indirect debility and strengthens the patient $ II. It induces a counter stimulus in every of the vascular system, and by a determination to the throat and mouth saves vital parts. The cure of all fevers, consists in exciting a new action in the vessels, or one different from that which consti- tutes the proximate cause of the disease ; * and accordingly no sooner do signs of the mercurial action appear than all untoward symptoms begin to decline. On its effects in dysentery, Dr. Clark has made the following remarks : * For several years past,, says he ' when the dysentary has resisted the common modes of practice, I have administered mercury with the greatest success, and am thoroughly persuaded, that it is pos- sessed of powers to remove inflammation and ulceration of the intestines in this distemper, f Dr. Gilchrist, at a much earli- er period, has noticed this salutary property of mercury in curing inflammations. ' Nothing embarrasses more' says the Doctor, than inflammation in a low state ; but, quicksilver is a powerful antiphlogistic, and' removes inflammation without accelerating the motion of the fluids, which it rather dimi- nishes by subduing their inflammatory disposition, when there is little or no fever, it as powerfully removes obstruction with- out deminishing the impetus of the blood; on a proper degree of which resolution depends.' I apprehend these effects in relieving intestinal inflamma- tion may be referred to a threefold operation. I. To its action immediately on the topical affection. 2. To its general operation on the blood-vessels. 3. To its operation in removing acrid matter from the parts affected by purging. 1. In releiving topical affection. This may be understood from its effects when topically applied to external ulcers, by Avhich a sanious discharge is, in a short time, changed for 1 In proof of this specific action, I refer to its effects, in what has been improperly termed Idiopathic hepatitis. * Hence the action of Peruvian Bark, and other compara- tive low stimuli in curing slight cases of fevers, may be ac- counted for. t Clark on diseases of voyages to hot climate*. S3 STUART ON MERCURY. a laudable pus. Before dismissing this subject, I must re- mark, that mercury appears to me, to possess exclusively the property of superseding the action of all animal poisons, whether generated in the body by altered secretions from its own organs, or derived from other animal matters externally applied. * This supposition derives support from its known effects, in the venereal disease, hydrophobia and small pox, which are all acknoAvledged to depend upon the specific sti- mulous of a'imal poison. Perhaps, upon this principle, it may be found a specific against the bites and stings of all ve- nomous animals and insects. 2. Its general operation on the blood-vessels. For this purpose it must be introduced into the circulation. This may be done bv the seve-.-d modes to be hereafter described. Its action in this way is peeved both from the change in the pulse and in the secretions succeeding its use, for an account of wiich I refer to authors who have employed it in the cure of febrile complaints. 3. By removing acrimony immediately from the parts affected. This effect has been before noticed in this treatise, when treating of its effects as a purge, to which I now refer. The salutary effects of a spontaneous salivation, arising in the malignant state of fever, have been noticed by many Avriters on pestilential diseases, t But these effects are much more conspicuous from a mercurial salivation. I will here enumerate the most important. 1. When copious, by abstracting stimulous from the blood- vessels it gradually reduces the pulse and obviates the further necessity of purging and bleeding. 2. By producing a neAv excitement, and a different deter- mination to the fluids, it relieves the burning of the stomach * Dr. Rush in his account of the yellow fever of 1793, has remaked that sAvellings of the Lymphatic Glands did in no instance suppurate, where a mercurial salivation took place. Perhaps, this may be referred to this property of Mercury in counteracting or superceding the operation of the poison thrown on these glands. t Sydenham's account of the continual fever of 1667 68 and 69. Also, Huxham's Essay on Fevers. STUART ON MERCURY. 53 and the distressing vomiting in these fevers. Large dosesTv are more generally attended with this effect than small ones.' This appeared in a very striking manner in the case published by me in October, 1797. The patient had been bled and pur- ged freely, and Avas under the use of mercury, in nearly all the forms hereafter to be recommended, while the vomiting was still distressing, with little or no mitigation of the other symptoms, until by_ a mistake the nurse gave at one dose, a drachm of calomel Avhich had been left to be rubbed on the lips and gums, after which, her vomiting suddenly ceased, and the other bad symptoms declined until the sixth day, when a discharge from the salivary glands appeared, which was suc- ceded by convalescence. Dr. Rush, in his account of thetyellow fever, of this city in 1793, says the ' effects of mercury in every case where salivation was induced were salutary.' Dr. Wade, in bis account of the same disease in Bengal, gives the same favora- ble account of a mercurial salivation. Dr. Chisholm says * that if salivation (in the Boullam fever) was speedily raised, the danger was removed, and the patient recovered,' and Mr. White, who practised in the same disease, declared, he did not loose a single patient, where a quantity of mercury had been given sufficient to excite salivation. I can also here add my own experience as testimony in favor of this evacuation. As in all the cases I knew or heard of, where salivation took place in the yellow fever of 1797,1 know of but one where the disease proved fatal. This patient perished by a hamorrhagy from the gums on the tenth day of the disorder, and after all other bad symptoms had ceased. I impute this unfortunate event to his not losing a sufficient quantity of Blood early in the disease, aS I did not see him before the fifth day of his illness. The advantages of salivation in malignant fevers are further established from its good effects in the plague at Algiers. One of the American captives, who was ransomed at the time when a peace Avas concluded between the United States and the Dey, and noAv in this city, asserts that mercury was in general use in the cure of that disorder, that he had it himself, and was cured by a salivation, with the assistance of sixteen bleedings. ' 54 STUART ON MERCURY, There is also another advantage resulting from this action in the blood-vessels ; as relapses never take place Avhere the discharge is sufficiently established *. III. THE DIFFERENT MODES OF APPLYING IT, AND THE SEVERAL MEANS OF ASSISTING THE OPERATION. And 1. By the mouth. 2. By the gtims. 3. By frictions. 4. By shoes or socks impregnated with the ointment. 5. By ointment in the form of clysters. 6. By fumigation. I. BY THE MOUTH. Salivation may be induced by all the various and almost innumerable preparations of this mineral which chemistry presents; but as it is necessary to keep up some purging during the whole course of these fevers, for the reasons before mentioned, and as calomel or the hydrargyrus muria- tus mitis possesses a purging property in an eminent degree over most others, and since it is one which has been most employed, and more especially since, from general use its virtues are better established, I shall prefer it to every other preparation for internal use, in this state of fever. In the first days of these fevers, from the observations before made, strong purges are indispensable, and from their rapid progress and dangerous tendency these are to be so employed, as to produce as speedy an operation as possible. For this purpose, ten or fifteen grains of jalap are to be combined Avith ten grains of calomel, and given every three hours until a discharge is procured. As pills are known, sometimes to pass through the whole tract of the intestines in an undissolved state, and from the obstinate obstruction which here attends, a large quantity of these purges may, probably, if given in the form of pills, be accumulated in a portion of the intestines and become produc- tive of inflammation and its consequences ; they are alwavs to be given in the form of powders. I know to those who are * Vid. Chisholmon the Malignant Pestilential Fever, Sec. STUART ON MERCURY, 55 regulated more by the names of diseases than their symptoms, that such doses may seem inadmissible; but experience has established their safety, and we are here ' to attend more to the effects produced than to the dose *. In many cases five or six of these doses are necessary be- fore the desired effect is produced. Mr. Wm. Bunting's ap- prentice boy, who was but eleven years old, in the yellow fever last season, took two doses of five grains of jalap, with the same quantity of calomel, each at the interval of two hours, and afterwards, four doses of ten grains each, at the interval of three hours between, before any evacuation took place. To induce salivation, from three to five grains may be given every three hours, and cases occur, where ten or even twenty grains may be given at the same intervals of time, not only with safety, but Avith advantage. Doctor Chisholm gave nineteen grains three times a day, and the patient became convalescent after the tenth day, when he had taken two hundred and fifty-four grains. I have even gone farther in its internal use Avith the greatest success. In one case, which I haA'e before cited, the patient took three hundred and fifty-si\ grains internally, in six days, during which time, every other method of intro- ducing mercury into the system was employed. At seeing this account let not the rip. id dogmatist contract his brow into a frown of disapprobation ; but, rather let him learn, that where Ave would meet with success < Ave must always accommodate the curative force to the morbific, or to the cause of the disease*.' The form of powders is here also recommended in preference to pills or bolusses; both for reasons before mentioned, and because, in SAvallowing them* part of the calomel adheres to the fauces and throat, by which means, the absorbing surface is increased. If the calo- mel be triturated with twice its quantity of loaf sugar, the patient, before an advanced stage of the disease, can take it Avithout any other addition; but, in this case, from the dryness of the mouth, fauces and oesophagus, and from the debility of * Pringle's Diseases of the Army. * Brown's Elements. 56 STUART ON MERCURY. the organr- of deglutition, a small portion of some liquid must be added to facilitate its passage into the stomach. In this way a salivation is often excited in slight cases, in the space of thirty-six hours ; but, in cases of more violence, a perseverance for five and eAen ten days is oftener necessa- ry ; and sometimes the irritability of the intestines is so great as to render it impossible to excite this discharge by any inter- nal preparation whatever. When this happens, they are to be laid aside, and recourse is to be had to some, or all of the means hereafter described. 2. By the internal surface of the cheeks and lips and by the gums. Mr. Clare particularly recommends this mode of introdu- cing mercury into the constitution *, and Doctor Woodhouse found it speedy and effectual in the yellow fever of 1793. I suspect it Avas effectual only when received into the circula- tion ; and as it is probable salivation may be induced merely from the local and partial operation of mercury on the salivary glands, without its producing any change of action in the general system of blood-vessels, its use is not to be relied on, without employing other means at the same time f. To introduce mercury in this way, calomel is rubbed in on the gums, and the inside of the lips and cheeks, or the mouth is. washed with a solution of corrosive sublimate in water several times in the day. 3. By mercurial frictions. The great number of absorbents, spread over almost the whole surface of the body, and the effects speedily produced by mercurial frictions, eminently prove the facility with which * A NeAv Method of introducing Mercury into the circula- tion, by P. Clare, Surgeon. t The late Doctor William Annan, in his last illness in the Yellow Fever of this city in 1797, exhibited a melancholy proof of the local effects from this mode of applying mercury. He had often during his illness, Avashed his mouth Avith a solu- tion of corrosive sublimate, and when I saAv him, two days before his death, and insisted on his using more mercury internally, he urged as an objection, that his mouth was already sufficiently affected by the use of this gargle. STUART ON MERCURY. 57N in this way enters the constitution; and the determination Avhich it discovers to pass off by the salivary gland.;, when thus introduced, renders it adA'isablc to make an early trial of its efficacy in all cases of great danger. To produce as speedy an effect as possible, the Avhole body and extremities are rub- bed twice or thrice a day, Avith large quantities of the strong- est mercurial ointment. In more ordinary cases, rubbing the upper and lower extremities, particularly in the course of the absorbents, Avith half an ounce of the same ointment twice a day, until it nearly disappears will be generally sufficient. Before each inunction, it is necessary to Avash the parts to Avhich it is applied Avith soap and Avarm Avater: as by that means the mouths of the absorbents, freed from the oily mat- ter left from the former applications, come more immediately in contact Avith the fresh ointment. In these frictions, the nurse or person who performs should take the precaution of inclosing her hands in bladders, otherAvise, from the great fa- cility Avith which it enters healthy vessels, to that Avith which it enters those under morbid excitement, she will be salivated before any effect is produced on the patient. 4. By impregnating shoes or socks with mercurial oint- ment. This method, as far as I knoAV, was first introduced into practice by me in the. last fever that infested this city: and not with standing it has been supposed, that mercury en- ters the absorbents Avith great difficulty when applied to the skin without friction, experience has proved, that it is easily taken up when applied in this way to the feet. At the time when I first began to use this mode, the necessity of employ- ing other means in the same cases, Avhere these socks or shoes Avere worn, rendered it impossible to ascertain the time required to affect the mouth by this Avay, but since I have sa- livated a venerial patient in four days time, by their use alone. In this mode shoes or socks prepared of bladders are to be well lined with strong mercurial ointment, and confined on the patients feet. 5. Mercury has also been employed, with supposed ad- vantage,, in this state of fever, by clysters, prepared by adding H STUART ON MERCURY. the common ointment to starch, or oatmeal gruel. These are to be frequently injected from time to time. Probably Plcnk's solution would here answer abetter pur- pose ; as the mercury in this preparation is less clogged, and from the absence of oily matter, would be less likely to be immediately returned. 6. By fumugatiohs. This mode of affecting the system, is remarkably speedy, in so much that the mouth is sometimes affected in the short space of ten or twelve hours ; but much danger has been ap- prehended from the application of these vapours to the lungs. This may be prevented by confining them to particular parts and in dangerous cases, Ave are by no means to loose the pro- bable advantages to be derived from so powerful a remedy, on account of such futile objections. Itis applied by sprink- ling cinnabar of mercury, on coals contained in some conve- nient vessel for the purpose, and holding it under the hams of the patient, Avhile he lays on his back, with the knees in an inflected posture. The bed cloaths are to be well confined to prevent the escape of fumes, and their affecting his lungs. From the aptitude of these fumes to affect the bowels with gripes and to pass off by stool, they ought always to be appli- ed in a small quantity at a time, and frequently repeated ; but they are immediately to be laid aside, as soon as the least af- fection of the bowels is threatened. In whatever Avay mercury is employed in the beginning of these fevers, and more especially, where much febrile heat prevails, its operation is particularly assisted by blood-letting and the application of cold water, cool air, and even ice to the skin. 'i is practice has unfortunately been the subject of much obloquy amongst those physicians Avho are riveted to the dog- mas of the former theory of the action of mercury ; but as this theory is proved to be erroneous, and is now on the eve of everlasting oblivion, the fabric will ere long share the same fate with its tottering foundation. So far are cold applications from injuring the constitution, thci effects prove them always salutary ; as they become an evacuant by abstracting heat; they relieve that intolerable STUART ON MERCURY. -59 burning of the skin, which is so distressing in this stage of fe- ver ; and so far are they from militating against the action of mercury, that by lesssoning the prevailing febrile action* they powerfully assist it. Nor is this city the only place, Avhere the salutary effects of these applications have proved so con- spicuous, as to warrant their propriety and general safety. A Dr. Armstrong in the West Indies, Avitli a view of assisting the operation of mercury in the cure of malignant fevers, is said to wash his patients frequently in cold Avater, with the greatest success. But in more advanced stages of the disease, where the skin is cold, and the pulse feeble or imperceptible, every stimu- lating application to the surface favours our views. For this purpose are to be applied sinapisms and blisters to the extre- mities ; and cloths wrung out of hot brandy, saturated with sea salt, are to be successively laid over every part of the body, and renewed as often as they become cool. * Hot bricks or jugs filled with hot water are also here applied with advan- tage. When we have produced the desired effect, from the use of one or all these modes combined, it sometimes happens, that the profuse discharge from the salivary glands, and the intolerable pains in the jaws and teeth, become objects of attention. When this occurs three indications present. 1. It is necessary to mitigate pain. 2. To moderate the discharge. 3. And heal the local injury. The first intention, as we are, from the nature of the dis- ease which preceded, and from apprehensions of relapse, debarred from the internal use of opium, is answered by topi- cal applications. For this purpose opium is dissolved in water and the mouth washed frequently therewith, but I have lately found from experience that milk answers the intention much better than simple water. My first inducement to use it, was * Fomentations of these substances Avere first employed by me in the endemic of this city in the year 1797. I know of no external application more powerful in exciting the heat of the skin; even epispastics not excepted. 60 STUART ON MERCURY. from its known properties of obtunding acrimony. My method is to triturate h. !i a drachm of opium, in an ounce of pump Avater, and, when sulTiticntly dissolved, to add lour ounces of new milk ; the unsure u then to be used as a gar- gle as often as t!ic pains, Sec. i-cndcr it necessary '*. The second indication is aiiSAvcred, by determining the fluids to other parts. The fluids arc called off by purges or laxathes, and blisters. Sulphur has been particularly recommended by some, not only as a laxative, but as it is known, Avhen combined with mercury, to render it inert, it has been supposed to form such a combination in the system, and thereby to possess ad- vantages peculiar to itself; while others have denied it to possess that property. Which of these opinions is most correct, I will not venture here to decide ; but as the flowers of sulphur prove an efficacious and convenient laxative, and as they are possessed of equal virtues (if we do not allow them any superiority) they are still preferred. As we are here to keep up a gentle and regular discharge from the intestines, small and frequent doses are recommenced. When the swelling of the salivary glands is great, blisters are to be applied, either immediately to the swellings, or on the back of the neck. 3. The local injury is healed by increasing the tone of the parts affected. The tone of the parts is increased by astringent gargles', composed of red rose leaves, red oak bark, or galls, with a small portion of allum and honey. Mr. Bell recommends a strong solution of borax, as possessed of peculiar virtues in answering this intention; but, from what trials I have made of this, I am inclined to think it inferior in efficacy to several of the astringents before mentioned. The introduction of mercury into more general practice, has been retarded from a supposition of its injuring the teeth and constitution ; but these effects are imaginary and without * Since writing this di -s<■•■ tution, I have found a very strong infusion of the finer teas (thea viridis linn.) to answer the purpose still better. STUART ON MERCURY. ' 61 foundation ; as, Avhere the teeth have been sound before its use, and the patient has been diligent in cleansing the mouth, while under salivation, they have never been known in a single instance, to sustain any injury f- To refute the supposition of injury done the constitution, we need only refer to the constitutions of those, Avho have recovered from malignant fevers by its use. Many have been cured of obstinate ulcers, swellings of the joints, rheumatic pains and chronic obstruc- tions of the viscera, and most enjoy better health than they ever had before its use. But, grant for a moment that the constitution be injured, and the teeth destroyed from the use of this remedy. Can the loss of a tooth or a trifling injury to the constitution be put in competition with almost certain death ? I say almost certain, as the chance of recovery in malignant fevers, Avithout its use, is, at most, as one is to two. And I am firmly persuaded that, by its free and proper use, with the attention of nurses, and a strict adherence to the anti- phlogistic regimen in the beginning of the disease, ninety-nine cases of an hundred will terminate faAe-rably. The belief, therefore,' that the yellow fever, plague, or other malignant diseases are necessarily mortal, will be proved to be as much the effect of a superstitious torpor in the understanding, as the ancient belief that the epilepsy was a supernatural disease, and that it Avas an offence against heaven to attempt to cure it f.' t Yid. Rush's works. J Dr. Rush on the Bilious Yellow Fever. t v I *J AN INAUGURAL EXPERIMENTAL ENQUIRY, BEING AN ATTEMPT TO PROVE, THAT DIGESTION IN MAN, DEPENDS ON THE UNITED CAUSES OF SOLUTION AND FERMENTATION: SUBMITTED TO THE EXAMINATION OF THE REVEREND JOHN EWING, S. T. P. PROVOST; THE TRUSTEES AND MEDICAL FACULTY OF THE UNIVERSITY OF PENNSYLVANIA, FOR THE DEGREE OF DOCTOR OF MEDICINE; ON THE THIRTY-FIRST DAY OF MAY, A. D. ONE THOUSAND EIGHT HUNDRED. I/" BY JOSEPH GLOVER, OF CHARLESTON, S. C, MEMBER OF THE PHILADELPHIA MEDICAL AND CHEMICAL SOCIETIES. ■—Tentanda via est, qua me quoq' possim Tollere humo.~---------, J'/v PREFACE. THE difficulty of experimenting, appears to be the reason why physiology has not kept pace with other branches of me- dical science. In most of these we may travel on a smooth and delightful road; but the most trivial circumstances influ- ence the result of experiments ; thus assertion is opposed to assertion, and on the reputation of the author rests the posi- tion. In the following pages it is contemplated to investigate the process of digestion; a subject by no means perfectly understood. In doing this, I have endeavoured to arrange such ideas on the subject, as I have collected from the opi- nions of others, or from such facts and experiments as I have myself ascertained. These" have taught me the difficulty of explaining the phenomena of digestion on most of the theo- ries which have been advanced ; nor do I expect that the one Avhich I have adopted, is void of imperfections. Too fond of reducing eAery operation of the animal economy to a single principle, many physiologists have explained the process of digestion on some favorite theory, and thus, by setting a limit to the hand of nature, have left unaccounted for some of the most important phenomena. The result of my investigations, such as it is, circumstan- ces have induced me to cast as my portion into the scale of science. Should it suggest an idea Avorthy the attention of the philosopher, I shall feel highly gratified ; but, on the contra- ry, should my experiments prove inconclusive, and error stamp the reputation of my essay, still I shall be pleased Avith the reflection, that the most feeble attempt to elucidate this i 66 PREFACE. important branch of physiology, can be by no means injurious to science. The haste, so unavoidably annexed to the short time allot- ted for this publication, will no doubt induce the reader to overlook the many inaccuracies of language, which I am fully aAvare are contained in the following pages. They may per- haps bring to his recollection, that sentence of Doctor Bcddoes so expressive of the liberality of the philosopher, when he says, ' we should set a due value on our present knowledge, though it be imperfect; and restrain those rude hands, that are ever ready to pluck up the tender plants of science, because they do not bear ripe fruit at a season when they can be only putting forth their blossoms.' Impressed with the generosity of these ideas, I submit my observations and experiments to the candid inA-estigationof the philosopher, whose patronage alone stamps the merit of every youthful performance, gives actiA'ity to the mind, and sanctions future investigations, EXPERIMENTAL INQUIRY. SECTION I. OBSERVATIONS ON DIGESTION. MAN, like every other being in nature, requires a con- tinual and regular supply of food, for the several purposes of supporting life, of promoting the growth of his system un- til he arrives at maturity, and of forming new parts Avhen such become necessary. Indeed, on contemplating the compli- cated structure of his frame, it is evident, that a continual loss of the solid and fluid parts, of which he is composed, must be the inevitable effect of every action or function of life which he performs. Nature, always Avise, to obviate this general waste of his system and continual tendency to decay, made it necessary that he should have some inducements to repair it, and thus be reminded of the connection which exists between aliment and life. Accordingly we find he is indued with the stimulus of hunger and thirst, which, together with the pleasure he receives from gratifying those appetites, induce him to take into his stomach a certain quantity of matter to allay those dis- agreeable sensations. This matter includes not only the seve- ral kinds of animal and vegetable substances which we denomi- nate food, but also comprehends the fluids taken in with which they are diluted. These having arrived at the stomach which is the great receptacle of his aliment, a greater or less length of time is requisite, according, to circumstsnces, for them to undergo 63 GLOVER ON DIGESTION. those processes Avhich are essential to their assimilation being completed. In fact, I conceive it an impossibility to deter- mine with any certainty, the exact time necessary for the digestive organs to perform their respective functions as tha,t will depend in a great measure on the strength of those organs, on the quality, quantity and manner in which the food is prepared, its previous mastication, and various other causes of Avhich Ave are not always aAvare. The most preva- lent opinion on this subject, is, that from about the third to the sixth hour after food is taken, it is discharged, through the pylorus, of a pultaceous consistence. There are however some extraordinary deviations from this allotted time, which cannot but comince us of the great uncertainty of calculations of this nature. Wc have on record instances related of sub- stances remaining in the stomach indigested for months ; and on the contrary, that in two hours after food was taken into the stomach, that organ Avas found empty. * These I con- ceive to be rare occurrences, neither do I believe it by any means common, even in the space of three hours, for the sto- mach to discharge its contents ; as in a majority of mankind, I pr: sumc, a much longer time is requisite for food to under- go mose changes, Avhich are usually effected on it during its stay in that organ. To our several kinds of aliment, different condiments are added by various nations, many of which merely gratify the palate, while others asssist in promoting digestion. Among us at present sea salt is most universally used for this purpose.t Professor Chaptall tells us, that the acidulous tartrite of pot- ash is greatly consumed in the north of Europe, where it is used as a table seasoner ; and Professor Barton has informed me, that the Creek Indians make use of hickory ashes, and that in some of the southern states, the ashes of a particular kind of marsh-grass Avere formerly preferred for the same pur- pose. * Yid Hatter's Element. Physiol. Tom. VI. page 281. t According to the experiments of the celebrated Prin»lc, a small quantity of sea salt hastens putrefaction, while a lar- ger quantity retards that process.----Diseases of the armv, Appendix; paper 3. Exper. 25. GLOVER ON DIGESTION. 69 Besides this difference in nations with respect to condiment there is one of still more consequence, Avhich is, their stri- king peculiarities in the choice of food. We find, that in Lapland, Iceland, Greenland, Nonvay, and other cold coun- tries, the inhabitants live chiefly on hsh and flesh ;* while an the contrary, avc are informed of certain sects in India, who live almost, if not solely, on a vegetable diet. Both the Lap- lander and the Indian enjoy their health in these extremes ; their habits, together with their climates, being better adapt- ed to their respective modes of living ; as the southern latitude in which the latter resides, appears to prevent his subsisting for any length of time, on fish or flesh ; while its stimulus is absolutely necessary to support the general waste of the sys- tem, to which the former is exposed from cold. A majority of mankind live in the medium of these extremes ; experience having taught them, that a due proportion of animal and vege- table food, is the better adapted for their nourishment, the one counteracting the ill effects arising from the other. Of all animals, man appears to be the most omnivorous. Destined to range through every the most distant part of our globe, he is capable of accommodating himself to the food of every country. Certain other animals are likewise capable not only of changing their accustomed diet, but sometimes acquire so vitiated a taste, as to refuse their former food. This was particularly the case with the wood pigeon of Spal- lanzani. This acute physiologist tells us, that by dint of hun- ger he brought this bird to relish flesh so well, that it refused every other kind of sustenance, even grain, of which, it is naturally so greedy. Various other facts of a similar nature, arc found on record. Von Troil informs us, that the Iceland- ers, when there is a scarcity of fodder, feed their cattle with steenbitr, (a kind offish) which, together with the heads and bones of cod, is beaten small, and mixed Avith one quarter of * This is sometimes though more rarely, the case in sou- thern latitudes. At Orange river, in Africa, Fordyce tells us that the inhabitants live upon limpets, dead and putrid seals and whales, not tasting a particle of vegetable food of any kind excepting aromatics. ' Treatise on food. p. 175. 76 GLOVER ON DIGESTION. chopped hay. He further adds, that the cattle are fond of this food, and yield a good deal of milk after having used it. * Professor Barton, in his course on natural history, has likewise related a fact no less interesting. He has told us, that deer have been frequently observed to feed on dead fish, which had been washed up on the banks of the Susquehanna and other rivers. These are instances sufficient for my pur- pose, but many others of equal importance might be collected. From the several kinds of aliment taken into the stomach, man is plentifully supplied with fluids, and from the compo- nent parts of these fluids, is the growth of his system and the solids of his body produced. This growth of his system and production of solids is induced, although he may subsist on very different kinds of food, as by the peculiar operation of his digestive organs, he is capable of assimilating, by certain processes, matto**s taken from either the animal or vegetable kingdoms into a fluid sui generis. These processes of assimi- lation are comprehended in the term digestion; by it we arc to understand, those processes which take place in the"diges- tivc organs of man, and by which his food is converted into laudable chyle. The modus operandi of nature in this conversion of our food into chyle, has attracted the attention of philosophers in every age, and various theories have been advanced to explain the phenomena which occur. With this view we find, that, the theories of the heat of the stomach, oimechanical action, offer- mentation, of solution and others, have all been advocated by men, whose fame has added reputation to their opinions) But, as no one of these can exclusively account for all the pheno- mena of digestion, and as in the choice of a theory, the prefer- ence should always be given to such a one, as will explain to us the most of them ; I am induced to adopt another, and attempt to prove the dependency of this important function, on the united causes of solution and fermentation. * Vid. Letters on Iceland, p. 133. GLOVER ON DIGESTION. 71 OF THE HEAT OF THE STOMACH. The theory of the heat of the stomach, was at one time so fashionable, that Professor Blumenbach tells us, instead of the term digestion, that of coction, was formerly used by the greater part of physiologists *. This opinion, however, I believe at present has but few advocates, as I presume no person will now contend that heat is the sole cause of diges- tion. This would be equally as incorrect as to say, that it does not assist in promoting that process. While we refuse to admit that heat is the sole efficient cause of digestion, we cannot but acknowledge its effect in expediting that process, as it has been long since made evident by experiment. It therefore only remains that we should shew from the situation of the stomach, that it is advantageously seated to be supplied with heat from its neighbouring parts, as Ave may easily con- ceive from contemplating their relative situations with respect to it. We find that its right side is covered by the thin edge of the fiver; its left touches the spleen ; that behind it is the seat of the pancreas, and immediately above it is the dia- phragm ; that the peritoneum lies before it, which, by the action of the abdominal muscles, gives it a motion diametri- cally opposite to that which it receives from the diaphragm in respiration ; and that the aorta, the largest artery in the body, lies just behind it. All of these circumstances must tend to give it additional heat. Hence we may with propriety ac- knowledge the accuracy of Doctor Barry, Avhen he tells us, that' the heat of the stomach in a healthy man, is greater than the common heat of sun in a summer's day f.' OF MECHANICAL ACTION. TodisproAre that the nr--hanical action of the stomach has any effect in promoting dig, tion, I need say but little. Facts speak for themselves. That accurate experimenter, the Ab- be Spallanzani, has decidedly proven the very wonderful mus- cularaction exerted in the stomachs of some animals; but his * Institut. Physiol, vol. II. p. 23. f Yid. Treat, on Digest, p. 8, 73 GLOVER ON DIGESTION • experiments likewise tend to shew, that no such action takc3 place in the human stomach. Having frequently swallowed wooden tubes during his experiments, Avhich were made so thin as to be incapable of bearing the slightest pressure, he neA'er, in a single instance, discovered one of them to be broken. In addition to this, he mentions the fact of cherries and grapes being voided entire, as I have myself frequently ob- served. He likewise relates an experiment with ripe grapes, Avhich avc all knoAV to be incapable of bearing the least mecha- nical action, which appears to be directly in point. ' Of twenty-five,' says he, * which I swallowed, eighteen Avere voided entire, of the other seven, the ski'ns only appeared \.' These experiments alone, I deem sufficient to prove, that no triturating power is possessed by the human stomach, particu- larly as the fact of grapes being voided entire, must be noto- rious to every person who has attended to the subject. In short, I do believe, that the muscular fibres of the stomach, have no other effect on our food, than merely that of propel- ling it through the pylorus. OF FERMENTATION. While some physiologists of considerable reputation, have considered fermentation as quite sufficient to explain all the various phenomena of digestion, others of equal celebrity have contended, that no such process takes place in a healthy stomach. This diATersity of opinion, I cannot attribute to motives of prepossession in favor of any particular theory, but would rather presume, it was the consequence of a supposition that to admit the one to be a fact, Avould be a tacit acknow- ledgment that the other could not be true. This too I suppose is the reason why even at the present time, those Avho have ascertained the solvent poAvcr of the gastric juice, Avill not admit that fermentation ever takes place in a healthy diges- tion. But this perhaps though too common an error, is still one by no means the less prominent. Does not chemistry teach us, that nature frequently requires in her operations a multiplicity of causes to induce a single effect? Why then, t Natural History, vol. I. p. '222. GLOVER ON DIGESTION. 73 if one of the causes, which have been advanced, is not suffici- ent to explain the phenomena which occur, should we attempt the establishment of another, equally inadequate to account for the wonderful effect of the conversion of our food into chyle ? The operations of nature are uniform, and frequently too deep for the shallow limits of human wisdom to demonstrate ; but I think, when we shall have been more successful in our experiments, it will be found, that digestion depends on the combination of several cause >, and that fermentation does cer- tainly take place, as I shall endeavour to prove in a subsequent part of this essay, OF SOLUTION. That solution docs likewise tJae place in digestion, I de- believe, as the experiments of many physiologists of conside- rable reputation tend to prove the position, and my own have induced me to embrace it. The opinion, however, is by no means novel. Barry informs us, that' Basil Valentine was the first among the chemists who supposed that animal diges- tion was owing to an acid dissolving menstruum.' That' Para- clesus received this opinion from him.' And that < Van Hel- mont carried it farther; and asserted, that the spleen prepared this menstruum, which was from thence conveyed into the stomach, by the vasa brevia.' Hence it appears, that the the- ory of solution has been long since favoured. Since when, very accurate experimenters have written, in hopes complete- ly to decide the question in its favor. But, although they have most demonstratively proven the solvent power of the gastric juice, they have by no means shewn that fermentation does not likewise take place. For my own part, I do not hesi- tate in believing, that both solution and fermentation do take place in a healthy digestion; indeed I think, with cor- rectness I may venture to assert, that in the human stomach, fermentation does as necessarily follow solution in the conver- sion of food into chyle, as thought succeeds impression in the formation of ideas. 74 GLOVER ON DIGESTION. Food, in the first instance, is considerably attenuated, by the mastication Avhich the rotatory motion of our jaAvs and pressure between our molares are so capable of giving it. Its particles being thus divided, are intimately mixed with the mucus of the mouth and saliA-a, after which it passes down in- to the stomach. This we may term a process preparatory to digestion. It is certainly one of much more consequence to the perfect digestion of our aliment, than is generally suppo- sed ; as it is evident those persons, who half chew or bolt their victuals, as it is called, are generally subject to all the nume- rous diseases arising from indigestion. Hence appears the ne- cessity of persons being particular in the mastication of their food, as nothing scarcely can be of more injury to the con- stitution, than continually to supply the stomach with indi- gestible half-masticated food. Something, in its effect very similar to mastication, is observable in domestic fowls They by a peculiar instinct, take into their gizzards, pebbles and gravel, which.certainly serves in them every purpose, Avhich teeth do in some other ani- mals. I haA e made use of the word instinct through choice, because I cannot believe with Spallanzani that they are picked up by mere accident, or through their ignorance in mistak- ing them for food. One fact appears to oppose his theory, Avhich is, that those fowls which are kept on a gravelly soil are rarely if ever found to have a greater number of stones in their gizzards, than those raised where less gravel is present. Again, if they Avere gicked up by accident, Ave should expect that they are not at all necessary to their health; Avhereasy the very reverse of this is the fact. A very respectable au- thor, who investigated^this subject with considerable success, by experimenting on chickens hatched with artificial heat, has given us the very best information I have perused. He says, < I have hatched vast numbers, and frequently have given the chickens small seeds Avhole, taking care that they should have no stones. In this case the seed was hardly di- gested, and many of the chickens died. With the same treat- ment in every respect, others who had their seeds ground, or have been allowed to pick up stones, have none of them been GLOVER ON DIGESTION. 75 lost.' * This Avould appear to shew, that pebbles are essen- tially requisite to the healthy digestion of these animals. In- deed, the experience of many persons tends to prove this to be the case, as Ave often hear of their sending for gravel for their poultry, and when interrogated why they do this, they tell us that without it their fowls grow poor, dwindle away, and sometimes die. Mr. John Hunter, commenting on this asser- tion of Spallanzani, that pebbles are picked up by birds through chance or ignorance, says with much humour that < it appears singular, that only those which have gizzards should be so stupid.' The more freely food is masticated, and the more minute- ly it is divided; the less heavy does it lay on the stomach, and the more easy it is of digestion. The experiments of Spal- lanzani, * made on himself, prove the latter position; the for- mer is obvious to common observation. Mastication not only promotes digestion, by minutely dividing the matters to be carried into the stomach ; but likewise, by mixing them with saliva to form a pulpy mass, it involves a very considerable portion of atmospherical air, which, being rarefied by the heat of that organ, tends considerably to burst the several particles of food from each other. Here then Ave see that it indirectly promotes solution, for, as the several particles of food arc separated from each other, in that proportion will so- lution be expedited; because, a greater number of surfaces will thereby be exposed to theaction of the gastric juice, and of consequence the food -will be the more speedily dissolved. In the investigation of a subject like the present, it is ne- cessary that we attend particularly to the causes Avhich influ- ence digestion, and judge of their effects, by comparing them to the effects of similar causes out of the body. And again, by accurately examining the products of digestion, and by comparing them to similar products out of the body, thereby investigate its causes. Thus, as all vegetable substances, ca- pable of undergoing the vinous fermentation, contain the con- stituent principles of carbonic acid and of alcohol, and as these * Fordyce on food, p. 24. t Natural History, Vol. 1. p. 224. 75 GLOVER ON DIGESTION. p'lbstancesare obtained from such vegetables, the former dur- ing the fermentative process, and the latter after that process has ceased; it is evident, if such products are obtained from the digestion of food in the stomach, it must be the effect of a similar process. The same observations will apply to the other stages of fermentation. In the following pages, I shall endeaA-our to relate in brief detail, such facts and experiments as have induced me to adopt the present theory. This will be done in three several sections. In the first I shall proceed to deliver a few observations on the matters Avhich influence digestion. The second will contain an attempt to shew, how far solution is admissible in digestion. And in the third and last, I shall endeavour to relate, why it is presumable that fermentation does likewise take place. SECTION II. OF THE MATTERS WHICH INFLUENCE DI- GESTION. THE chief of these are, saliva, the gastric juice, the mu- cus of the prims vise, the bile, and the pancreatic juice. And, 1st. OF THE SALIVA. By saliva Ave mean that colourless, glutinous, and resolvent fluid, Avhich is secreted by the parotid, submaxillary, and sublingual glands. It is perfectly tasteless and inodorous in health, and consists of water holding a mucilage and certain salts in solution. On being placed on the fire, its watery part speedily eva- porates, .leaving its saits in a state of crystallization, resem- bling two or three different kinds of salt. These are, accord- ing to Fordyce, sea-salt and sal ammoniac, together with vari- ous other crystallizations of irregular forms; and agreeable to Plenck, sal ammoniac and animal earth ; the former he inferred from triturating quicklime with saliva; the latter from salival calculus and the products of fire. Saliva from its sapid nature, jives an increased flavour to food. It tend;; to relieve thirst, by supplying the mouth and GLOVER ON DIGESTION. 77 fauces Avith a sufficient quantity of moisture ; and has a certain and evident effect in digestion. It does not however, possess a solvent power, as has been asserted by some, at least it do<-s not possess this property in a greater degree than simple water. I put an ounce of pure saliva, and as much of simple water, into two separate phials; to each of these I added two drachms of roasted veal. These phials Avere placed uncorked in a sand bath, which was kept as near as possible to the heat of the human body. After suffering them to remain at rest for eight and forty hours, I decanted the water and saliA-a from each of the phials. The veal which had been immersed in water, and that which had been in saliva, were now placed separately on bibulous paper, and as much of their moisture removed as possible. The one which had been in water, was now weighed ; it had lost twenty-three grains of its weight. On weighing the other, it had lost no more. This would certainly seem to shew, that saliva has no solvent power, at least not out of the body. Again, it has been asserted, that saliva corrodes copper and iron more speedily than simple water *. To ascertain this point, I made the following experiment: Having placed tweh'e grains of sheet copper in a phial containing saliva, and the same quantity in another of equal size, containing Avater only ; I put them both in a sand bath, which was generally about the temperature of one hundred of Fahrenheit. They Avere both kept in this situation for one week, at the expiration of which time, they were taken out, wiped dry, and weighed. I could not discover, that either one of them had lost more of its weight than the other. From this I presume Ave may conclude, that saliva has not a much greater effect, if any, in the corrosion of copper, than simple Avater. Desirous of knoAving Avhat effect saliva has in digestion, and with a view of ascertaining whether it possessed aft rinen- tative property or not, I exposed equal portions of leaA'ened * Vid. Haller's Element. Physiol. Tom. VI. p. 54. and Plenck on Hum. fluids, p. 72. 78 GLOVER ON DIGESTION. bread and roasted A-eal, in tAvo separate flasks, to the heat of a sand bath, which I Avas careful to keep as near as possible to the temperature of the human body, or from ninety-six to ninety-eight of Fahrenheit. To one of these flasks, I had previously added eight ounces of water ; to the other, seven ounces of water and one of saliva. The veal, to which saliva was added, I took the precaution of masticating, in order that it might be the more accurately blended with that fluid. In the space of six hours, the one containing saliva smelled a little sour, emitted air bubbles, and shewed evident marks of fer- mentation. Whereas that process did not commence in the other, which contained water alone, until four hours after. Professor Rush has long since made a similar and very de- cided experiment. ' To elucidate the properties of saliva,' says our author, ' I placed mutton and bread, of each two drachms, in two glass vessels. To one I added an ounce and a half of saliva, to the other the same quantity of water, and placed both of them in a sand bath. Five hours having elap- sed, the mixture Avith saliva began to ferment. In seven hours it discovered evident marks of acidity; whilst, in that, to which water Avas added, scarcely any motion was perceptible. After twelve hours had elapsed, the mixture with saliva emit- ted a putrid smell; Avhilst the mixture with water remained mild and inodorous to the twentieth hour *.' An experiment somewhat similar, has likewise been made by Pringle, but not with exactly the same success. He exposed two drachms of fresh meat and the same quantity of bread, together with water and saliva, to the heat of a furnace, kept at the temperature of 100 of Fahrenheit. The mixture remained about two days, he says, with scarce any visible fermentation; but on the third day that process became manifest f. This investigation, however, does not appear to have been made sufficiently fair, for he tells us, that his experiment was made in a closed phial. Now we know that the presence of vital air, is a circumstance essential to fermentation, and hence its exclusion must have been the cause of that process being retarded. In every com- * Inaug. Disser. de Coctio. Cib. in Vent. Exper. V. t Vid. Diseases of the Army, Appendix, paper 4, Ex- per. 30. < CLOVER ON DIGESTION. 79 parative experiment like this, every circumstance should surely be made as similiar as possible, to those which occur in the living stomach, and of consequence, there should be an admission of vital air, as this fluid is always involved in sali- va, which is several times in the course of a single minute conveyed into the stomach. We are informed, that some uncivilized nations, are so well aware of the fermentative property of saliva, that they prepare an intoxicating drink, by mixing saliva with certain Aegetable substances. Plenck relates that they prepare it from the cheAved roots of the jatropha manihot or cassada and Jufier methisticum. Whether saliva possesses a septic or antiseptic quality, has likewise been a subject of some controversy. To satisfy myself on this head, I placed equal quantities of roasted vreal, in two separate phials of the same size. To one, I added an ounce of pure saliva, to the other, as much of simple water; these I placed, uncorked, in a sand bath, which I endeavour- ed to keep as near as possible to ninety-six of Fahrenheit. The heat of the bath, however, was sometimes as high as one hundred and ten, but never below fifty. In twenty-two hours, the one containing saliva emitted a putrid smell; the other only smelled sour. In eighteen hours after, I exami- ned the phials again; they both smelled putrid; the one with saliva was the most so, and likewise had changed its co- lour a little, which was not the case with the other. From these experiments, I presume it appears, that sali- va possesses the property of promoting both fermentation and putrefaction; and not that it promotes fermentation, and at the same time retards putrefaction, as has been supposed. The quantity of tAvelve ounces of saliva, is generally sup- posed to be secreted by an healthy adult, in the space of tAven- ty-four hours. At least this is according to the experiment of Nuck, Avhose assertion I believe continues to be considered as the most correct. The quantity however, is capable of being Avonderfully increased by certain medicines and other stimulants. Indeed Haller speaks of fifteen ounces being effused in the space of thirty minutes *. * Vid. Element. Phisiolog. Tom. VI. p. 59. 80 GLOVER ON DIGESTION. 2d. OF THE GASTRIC JUICE. The gastric juice in health, is a colourless and turbid fluid, void of both taste and smell; and I must add, bearing considerable resemblance to saliva. I do not believe, as some authors have supposed, that it is secreted from the small glands of the stomach, as it is inconceivable tome, how such minute glands could be the source of such large quantities of this fluid, as are at times secreted. I therefore shall prefer embracing the theory of those, who suppose the immediate source of the gastric juice to be the extremities of the arteries of the stomach ; for 1 can as easily conceive, in the wisdom of nature, that arte lies may be expanded on the coats of the sto- mach in such manner as to perform secretions, as that they should be united together by cellular membrane, in the form of glands for the same purpose. Many persons are at present of opinion, that the gastric juice contains an acid. From the experiments of the Abbe SpLdlanzani, from those of lis colleague Professor Scopoli, and indeed from those of many others, I think we have good reason to doubt of the presence of a sensible acid in the gas-* trie juice. Having obtained some pure gastric juice from my own stomach, I found it capable of coagulating milk very rea- dily. This however I conceive as no proof of acidity being present, as I have coagulated it with a solution of fresh runnet, in which I could not detect the smallest particle of acid. Nothing can be more erroneous than the opinion which prevails among some persons, that acids alone have the power of curdling milk. The truth is the very reverse of this ; for it is now known, that the heart, lungs, and even liver of a turkey have been discovered to possess this property *. It will surely not be said that they are likewise acid. Again, ceruiii vegetables, as the galiumluteum, or ladies bed-straw, vJidantidcruLUtaor cross Avort, rubia tinctorum or madder, carduus or thi&tie, cynara scolymus or artichoke, as avc 11 as many others, have been observed to have this effect. Indeed * Vid. Spalianzani, NV.. Hist. vol. I. p. 271. GLOVER ON DIGESTION/ 81 living fish have been observed to have this property; and Jacquin tells us *, that even lime-water produces an imperfect coagulation of milk. Another fact, of no trivial import in the decision of this question, is related by Mr. John Hunter. This gentleman tells us, that' in the slink calf, near the full time, there is no acid found in the stomach ; although the contents have the same coagulating powers with those of animals who have' sucked, t Now, as this coagulating property is evidently communicated to the stomach by the gastric juice, and as an acid could not be detected in the stomachs of these young ani- mals, although they possessed this coagulating property, I think it appears sufficiently clear, that an acid does not exist naturally in the gastric juice. This fact I consider as conclu- sive, at least in as far as it prevents our being deceived hif acids which are evolved in digestion. Haller likewise appeal's to have been fully persuaded, that pure gastric juice does not contain an acid, and-has quoted the authority of at least a dozen persons to prove his assertion. J: To determine this point however more satisfactorily, as it is of such importance in the adoption of a theory of digestion, I made the following experiment. Deeming it necessary to obtain the gastric juice perfectly free fronrany extraneous matter, and likewise from any acidity of a former digestion. I kept a cat fasting eight and forty hours, after which it Avas killed. I found no food in its stomach, and but a small quantity of gastric juice. This I submitted to the usual tests for detecting the presence of an acid, but could not discover any. Hence I have been induced to conclude, that the gastric juice does not contain a sensible acid, and that whenever an acid is present in that fluid, it must either be the effect of disease or proceed from the remains of some former food. Barry says, ' that the humours which are contained in the stomachs of the most rapacious birds, fishes, and beasts of * Vid Element. Chem. Treat, de lacte. fVid. observations on the animal oeconomy. p. 163. } Vid. Element, physiol. Tom. VI. p. 143. L 82 GLOVER ON DIGESTION. prey, have never an acid, but a saline taste' \ And from the chemical analysis of the gastric juice of the crow, by Profes- sor Scopoli, Ave find he could not detect the presence of an acid in that fluid, but discovered it to be composed of, first, pure water; secondly, a saponaceous and gelatinous animal substance; thirdly, sal-ammoniac: and fourthly, an earthly matter similar, he says, to that which exists in all animal flu- ids. We come next to consider the solvent power of the gastric juice, which is the great basis on which the whole of the pre- sent favourite theory of digestion depends. Spallanzani tells us, that this fluid in a dog, not only acts on bone, but even corroded the dense enamel of two dentes incisores taken from the upper jaw of a sheep. * And from experimenting on himself, he found tie could digest not only ' muscular fibres and membrane, but tendon, cartilage, and even bone itself, when not too hard.' From the excellent in- augural thesis of Dr. Stevens, Ave likewise learn, that various animal and vegetable substances, were dissolved by the gas- tric juice of the human stomach when inclosed in spheres. In like manner bone, and even ivory spheres were dissolved, Avhich he had introduced into the stomach of a dog. Since the publications of these two ingenious gentlemen, and particularly since the paper of Mr. John Hunter has ap- peared, further investigation of the solvent power, of the gas- tric juice seemed unnecessary. This gentleman discovered, that in those persons who had died of violent deaths, the sto- mach itself Avas corroded and dissolved at its great extremity, and accounts for the stomach not being acted upon during life, on the theory of a living principle. Several facts tend to shew, that there is something innate in living matter, which resists the action of the gastric fluid. It is welt known, for instance, that worms exist in the human stomach unaffected by digestion while living, but are speedily acted upon by the gastric juice as soon as they are deprived of iife. To account for this feet, we must consider the gastric juice as a mere chemical solvent, \ Treat, on Digestion, p. 22. * Vid. Natural History, page 211. GLOVER ON DIGESTION. 83 then by reflecting that all chemical solvents act by attraction, Are may say, that the action of the vessels in living matter, is too great to be overcome by the attractive force of the gastric juice, and consequently their combination cannot take place. Another fact which shews, that the solvent poAver of the gas- tric juice is decidedly inert, as it respects some kinds of liv- ing matter, is, that there are several species of serpents, and particularly the rattle snake, who receive their young, on the least alarm, down their throats into their stomachs, where they have been known to remain for three and four hours. Fifteen or twenty of these young rattle snakes, have been found in the stomach of an old one, and not in the least in- jured by the gastric juice. * ' A polype,' too ' inserted into the stomach of another polype, continues to live as before.'f Although convinced from these facts, ofthe inertness of the gastric juice on these animals, still I was not satisfied of its action on other living animals. I therefore determined on an experiment with the gastric juice of a dog. For this pur- pose I kept a dog fasting twenty-four hours, at the expira- tion of which time I obliged him to swalloAv a number of small spunges. As his stomach retained these very readily and without any apparent inconvenience, I suffered him to re- main at rest for tliree hours, immediately after which he was killed. From these spunges I obtained about half an ounce of very pure gastric juice. In it I im mersed a common earth- worm. The animal AVrithed about, and shewed symptoms of great distress. I corked the phial, and being at some dis- tance from home, walked with it in my pocket to my resi- dence. At this time I examined it -again; exactly half an hour had elapsed from the time of my placing it in the phial. The animal shewed no symptom of life, and on taking it out of the phkl, I found on its body evident marks of violent in- flammation. Suspecting this, however, to be the consequence of the heat of my pocket, which ( as it was in the month of April) I believe to have been about 80 of Fahrenheit, I re- peated the experiment. The animal after being immersed * Professor Barton's Lectures on Natural History. t Spallanzani's Natural History, Vol. I. p. 111. fi* GLOVER ON DIGESTION. in the gastric juice, at the temperature of 70 of Fahrenheit, for fifty minutes, shewed no signs of life ; but there Avas no inflammation evident, as in the former. Knowing, however, that these animals live in a temperature still lower than this, I determined again to repeat the experiment. To effect this I placed an earth-worm in the phial of gastric juice as before, and covered it over with the same sod and in the same spot from Avhich the animal was taken. Fahrenheit's thermometer stood in the turf at 60. Iu an hour I examined the phial, took out the Avorm, and found it lively and not in the least in- jured ; but on increasing the temperature to 70, it died as the last. Hence we may infer, that this animal also resists the action of the gastric juice while living and at its own tempera- ture. How far this will be found to be the case Avith other ani- mals, I am at present unprepared to decide. I am aware that according to the experiments of Dr. Stephens, a living leech which some persons have supposed to be an animal destitute pf pores and capable of sustaining a degree of heat, equal to the human temperature, is digested by the human stomach. * But that they are capable of sustaining this degree of heat, I am not satisfied; at least, of this we may be certain, that the temperature, at which they usually live, is not by any means as high. I had rather presume, that as in my experiments, the animal in this instance, had died previous to its being acted on by the gastric juice. Plo^ does indeed tell us, that he has seen the eyes of a carp and the nose of a roach, which were taken out of a jack-fish, digested, while they Avere yet alive, t And Cornelius is likewise said to have found a snake half di- gested in a bird's stomach, while life in that animal was still perceptible. In all experiments with a view to ascertain the action of the gastric, juice on different kinds of* living animals, to proceed fairly I think Ave should keep this fluid exactly at the natural temperature of the animal immersed in it, otherwise it may be destroyed, either by an excess, or too great abstraction of i heat. The gastric juice of different animals too, requires a* * Vid. his Inaug. Disser. pub. at Edin. in 1777. tVid. Plot's Staffordshire. Chap. 7. Sect. 37. GLOVER ON DIGESTION. 85 different temperatures to promote their action. Thus we learn that this fluid in amphibious animals and in fishes, acts on aliment at the common temperature of the atmosphere ; but in most animals of the class mammalia, a higher tempe- rature is requisite. The gastric juice'of different animals varies in another respect still more considerably. Thus, in some animals, we see that it appears destined to act on animal food only ; in others, on vegetables alone ; and in others again, on both. The gastric juice of man acts on antimony and copper; the former I relate on the authority of Professor Chaptall *, the latter on that of Professor Barton. This last gentleman mentions, in his lectures, the case of a child, Avho Avas much indisposed and salivated, inconsequence of swallowing a cent; flie cent when voided, was examined and found to be sensibly diminished. According to Jacquin, Spallanzani and others, the gastric juice of itself has little tendency to either fermentation or pu- trefaction ; but when mixed with other substances, its effect is rather to retard those processes. From the numberless small arteries of the stomach, Ave may presume the quantity of gastric juice secreted to be very great; but like other secretions it is increased in quantity by stimuli, and particularly by the stimulus of food. 3rd. OF THE MUCUS OF THE PRIMAE VIAE. This mucus is found on the internal surface of the stomach and intestines, and covers it very completely. It has the ap- pearance, consistence, and properties of mucus in other parts of the body. It is secreted from small glands, which are situ- ated under the villous coat of the prims vix. The quantity secreted appears to be very great. Its use seems to be that of lubricating the surface of the primx vix, in order to facilitate the passage of their contents. It must likewise defend the internal surface of the stomach and intestines, from the action of the gastric juice, and from the acritude of the bile when regurgitated. * Vid. Elemen. Chem. Vol. II. p. 260. 86 GLOVER ON DIGESTION. To ascertain whether this mucus has any effect, either in promoting or protracting the process of fermentation out of the body, I placed equal portions of leavened bread in tAvo flasks, each containing eight ounces of water. Reserving one of these as a criterion, I added to the other about four drachms of this mucus, which I had procured from the stomach of a subject, avIio had died of a fall. Both flasks Avere placed in a sand bath, which was kept as nearly as possible at the tempe- rature of the human body. In seven hours, the one contain- ing mucus emitted air bubbles and smelled sour, whereas the one Avithout mucus had no appearance of fermentation for seA-eral hours after. 4th. OF THE BILE. The name of bile, has been uniformly given to a peculiar fluid, exclusively found in animal bodies, and which is secre- ted from a gland of a singular structure, called the liver. It is more or less of a yellowish-green colour, of a disagreeable bitter taste, of a thicker consistence and more plastic than saliva, of a singular aromatic smell when evaporated, which has been compared to that of musk, and which is by some thought agreeable. Bile differs from all other secreted fluids in the body, in this, that it is not like them, separated from florid arterial blood, but is secreted from the dark coloured blood of the vena portaruiu, which is nothing more than a large vessel, made up, by the concurrence of all the veins of the viscera of the abdomen, (except those of the liver) which empty their blood into.it for tha purpose of secretion. Now a plentiful supply of btood to agland, being essential to the secretion of a fluid, and this blood being conveyed to the liver by the vena porta- rum, it has, and I think Avith propriety, been said, to perform the office of an artery. It ramifies every where throughout the substance of the liver, and terminates in tAvo very differ- ent kinds of vessels. The one returns the blood, which is no longer fit for secretion, again into the general circulation; GLOVER ON DIGESTION. 87 the others are the secretory vessels^ In the former case, the extremities of the vena portarum inosculate with those of the hepatic veins, and thus the blood is returned to the inferior or ascending cava. In the latter, the secreting vessels soon ter- minate in the pari biliarfi, by the union of which, in their passage out of the liver, trunks of a larger size are gradually formed, till at length they terminate in one of considerable magnitude, known by the name of the hepatic duct. This duct in its turn, soon terminates in another, which has gotten the name 6f the ductus communis choledochus, in conse- quence of its being the common duct of the liver and gall- bladder, through which bile is continually distilling into the duodenum, in which intestine this duct ends. Just however where the hepatic duct ends, and where the ductus communis choledochus begins, another duct arises, which extends to the gall-bladder, from whence it has received the name of ductus cysticus. The secretion of bile, is a subject as yet involved in consi- derable obscurity. While some physiologists have considered it as the effect of a peculiar secretion in the liver, others of equal reputation, have asserted, that it is found formally in the blood. The correctness of these assertions are only to be determined by experiment, as therefore I cannot do thi3 at present, I shall not venture a conjecture on the subject. The bile being once secreted, it is received by the small branches of the hepatic duct called pori biliarii, from whence it passes into larger branches, till at length it gradually arriA'es at the great trunk of the hepatic duct; from thence it passes through the ductus communis choledochus, and is finally dis- charged into the duodenum. This is the most common course of the bile, but if from any spasmodic affection or morbid distention of the duodenum, or from any obstructtion in the ductus communis choledochus its passage should be prevent- ed, a retrogade motion of this fluid is the consequence. In this case it regurgitates through the cystic duct and finds its way into the gall-bladder, which is a very convenient recep- tacle, destined to prevent the hepatic duct from being surchar- ged with bile, in cases either of obstruction or of too great secretion. $8? GLOVER ON DIGESTION'. Cystic bile differs, it appears, from hepatic, in this, that* its consistence is more grumous, it is of a darker hue, and has a more pungent bitter taste. They do not differ in their constituent parts, but only in the proportion of those parts. In fact I do belieAe, that the only material difference Avhich exists between them, depends on the more aqueous part of the cystic bile being absorbed, from its confinement and stag- nation in the gall-bladder. Two causes concur to promote the .discharge of cystic bile. The one is, the pressure which the gall bladder receives from the neighbouring parts, and particularly from the stomach when distended with food ; the other, that either from the acrimony which bile acquires by stagnation, or from the mere stimulus of distention, a contrac- tion of the muscular coat of the gall-bladder will be induced, and its contents will thus be readily propelled into the duo- denum. From the experiments of the most accurate chemists, the constituent parts of the bile appear to be, 1. A coagulable • lymph: 2. A resinous matter:1 3. Animal gluten: 4. Soda, and 5. A colouring matter, which is believed to be iron. Nei- ther of these component parts of the bile is present in a per- fectly free and disengaged state ; they are all so combined as form an apparently homogeneous fluid. Bile, Avithout the assistance of an intermedium, is not miscible, as far as I know, Avith any volatile or fixed oil, Avith animal fat, nor yet Avith butter or any other oleaginous substance. Neither does it appear to render these substances miscible with Avater, al- though perfectly so itself, I have seen some of the bile of an ox, Avhich had been mixed in a phial Avith an equal quantity of olive oil, and which after having been kept for more thatV twelve months and frequently agitated", had not the least dis- position to unite with it. The idea of its rendering oils misci- ble with water, appears to have arisen from its being long since used in the cleaning of stuffs, and hence it has been sup- posed to act chemically and in the same mannerin which soap does. It does I believe act chemically, but still not in exactly the same manner in which soap docs. Soap is said to have an attraction for both oil and water, and thus renders them GLOVER ON DIGESTION. 85 miscible ; whereas, bile by having a greater attraction for the stuff to be cleaned, than oil has, only tends to displace it, and it is in this way that I believe it always acts, when used to remove spots of oil, or other greasy matter, from substances to Avhich they are adherent. ^ The use of the bile in the animal economy is evidently material, and I may add, it is singularly important in the pro- cess of digestion. I do not however believe, that it has any effect in this process while going on in the stomach, as itsv presence in this organ is the consequence of regurgitation, and is without doubt morbid. This I infer, first, from the sickness of stomach, vomiting, vertigo and other symp- toms of great morbid action, which attend its presence in that organ. And secondly, from these symptoms being speed- ily relieved, by such medicines as effect its discharge. Doctor Monro ca ught having several frogs, at different times killed three of them, and as speedily as possible emptied the contents of their gall-bladders into the stomach of another. The consequence of this was, that the animal died shortly after. * I do not attempt to prove any thing more from this, than that there is someAvhat deleterious in the bile of these animals, particularly as Ave are aware that the bile of other ani- mals have been taken not only Avith impunity, but even Avith advantage. I have poured the recent cystic bile of a cat doAvn the throat of a puppy, Avithout his suffering the least incon- venience from it; and I have seen a black servant whose taste had become so vitiated, after haAing accustomed himself to take the bile of an ox frequently as a stomachic, that he became fond of it, and so far from its proving injurious to him, he al- ways thought himself much better after using it. Bile neutralizes both the vegetable and mineral acids and is itself decomposed by them. In the duodenum, by mixing Avith the chymous mass discharged from the stomach, it first begins to separate the chyle from it, and being itself decompo- sed, its more aqueous part unites with the chyle, Avhile its resinous adheres to the fxces giving them their natural yellow colour; thus the former is prepared to undergo the * Dr. Wistar's Lectures. M 90 GLOVER ON DIGESTION. round of the circulation, the latter to be discharged from the body. ' A further use of the bile,' says an admired author, 'is, to evolve and exterminate from the alimentary canal, the fixed air, which had been hitherto confined among the chymous mass.' * Again it prevents the too great accumulation of mu- cus in the intestines, and by its stimulus increases their pe- ristaltic motion. Hence it is that biliary obstructions are ge- nerally accompanied with costiv eness, and sometimes with a discharge of mucus. The property of being both poAverfuIly antiseptic and an- tizeumic, is likewise said to be possessed in an especial man- ner by the bile. Maclurg tells us, that' this fluid after.having remained to his knowledge, for three days in a dead body, and although Avhen the gah-iladder was taken out, there was a very offensive smell in all the abdominal viscera; yet this fluid, being poured into a phial, and closely stopped, acquired a SAveet smell, Avhich continued some days before the putrid fetor began,'f This property of bile has been supposed to be intimately connected with its bitterness. Knowing howe- ver, that bile is secreted from the dark coloured blood of the vena portarum, (which is entirely free from any changes affected by air, through the medium of the lungs, and in fact, possessing all the characters of common venous blood) does it not appear probable, that its antiseptic quality depends on its attraction for, and consequent iLu.i prion cf, cxygene. The opinion that the blood, by its circulation through the ab- dominal viscera, receives a putrescent tendency, appears to be erroneous, as it is deprived of its oxygene and consequent- ly becomes antlputrescent; for bocies can only become putrid by the absorpion of this gas. The difiereiice wiiich exists between the blood of a fcetus, which is appreciated to the secretion of bile, and that of an adult, appears to be avoiti.y of some attention. The differ- - ence is brieny this, the blood, from which the bile of a fcetus, is secreted, partakes more of the quality of arterial blood than that of a-n adult; this likewise makes a proportionate variation in the properties of the Life and consequently that of a fcetus * Biumenbach. t Vid.Treat. on the Human Bile. p. 76. GLOVER ON DIGESTION. 91 is of a more putrescent nature, or in other Avords, has less tendency to resist putrefaction. The quantity of this fluid secreted seems evidently to be great, particularly Avhen we consider the vast apparatus of its secretory organ, and the quantity of blood conveyed to it for this purpose. Indeed Dr. Monro tells us, that four ounces of cystic bile have flowed through an ulcer of the side daily. * 5th. OF THE PANCREATIC JUICE. The juice denominated pancreatic, is a limpid fluid, Avhich bears a greater resemblance to saliva than to any other fluid in the human body. It is secreted from a long and flat gland of the conglomerate kind, which lies under the stomach, and between the iiver „na the spleen, and which is known to anato- mists by the name of the pancreas. The situation of this gland in the abdomen is transverse, being in the dupicature of the posterior portion of the mesocolon. It is found not only in man, but in most other animals, in quadrupeds, in birds, and in many fishes. The external appearance of the pancreas, is that of one uniform substance, with its surface somewhat uneven from a considerable number of small convexities, and resembling very much in its structure the salivary glands. In the centre of the breadth of this gland, we find its great duct running in a longitudinal direction, and into which several smaller ones empty themselves on each side, like so many minute branches inosculating Avith one parent stalk. It has very properly gotten the name of the pancreatic duct, and opens generally in common with the ductus communis choledochus into the duodenum, for the purpose of emulging its contents. This however is not always found to be the case, as it sometimes opens by a separate duct into that intestine. An exact analysis of the pancreatic juice, as far as I know, has never yet been made ; but, like most of the fluids of the hu- man body itis found to contain common salt and sal-ammoniac. The difficulty of procuring a sufficient quantity of this fluid, I believe is the reason, why its analysis has not hitherto been •Vid. System of Anatomy. Vol. II. p. 389. 92 GLOVER ON DIGESTION. much attended to. We arc directed to obtain it by inserting a small tube, to which a phial is appended, into the pancreatic duct of a living animal ; but this cannot be so readily accom- plished, as we may at first sight imagine. The use of this fluid is not perfectly understood. It is generally believed to have the effect of diluting the chymous mass, after its having passed into the duodenum from the sto- mach, and to assimilate it to animal nature. Likewise to di- lute and attenuate the bile, which is sometimes too viscid and acrid. From analogy the quantity of this fluid secreted appears to be very great; as the pancreas is no less than three times as large as the salivary glands, and has every circumstance as faA-ourablc for the secretion of its fluid. Like other glands in the body, its secretion is increased by stimulants, which no doubt makes a very considerable variation in the quantity se- creted at different times. The pressure which this gland receives from the stomach when distended with food; the irritation of the chime in its passage into the duodenum ; and pven that of the bile itself, tends to promote the discharge of its juice. Like the bife, Haller says, * it is capable of being regurgitated into the stomach. SECTION III. HOW FAR SOLUTION IS ADMISSIBLE IN DIGESTlOK. To assert that solution does not take place in digestion, would be to deny every thing like testimony in medicine. My attempt will only be to sheAv, Avhy it is not probable that it can be the sole efficient cause of that process, and how it should be considered as tending to promote it. By solution Ave can comprehend nothing more, than so minute a division of the panicles of any matter, as to render that matter capable of being dissolved in a fluid; and this too, vii out effecting any change of its component parts; for no possible division be it ever so minute can have this effect. 'Element. Physiol. Tom. VI. page 309. GLOVER ON DIGESTION. 93 Thus, the component parts of water are the same, whether it be in the state of ice or of vapour. If this be a correct defini- nitionof what we understand by the term solution, a solvent ih the stomach can have no other effect on our food, than merely that of separating it into very minute parts or particles ; but this is very far from being all which takes place in digestion. Such a change must be effected on our aliment, for the due nourishment and support of our systems, as to convert it into that mild and bland fluid which we denominate chyle. This fluid differs in both its appearance and properties from the matters taken into the stomach, from which it was prepared, and consequently cannot be the effect of mere solution, by which operation matter may be divided, but I presume can never be changed in its component parts. Again, chemistry has not yet taught us that any difference exists between the chyle of carnivorous and that of herbivorous animals, and from the most direct experiment we learn, that two animals of the same species being fed, the one on the matter of muscular fibre, and the other on farinaceous matter, both afforded chyle in no respect different from each other *. Whereas, could chyle be produced by mere solution, it should surely differ in its properties, in proportion to the variety of matter from which it is prepared. From these facts it appears, that the aid of some other operation is requisite to explain the formation of chyle. Per- haps several may be found necessary. In addition to solution, I do believe, that fermentation has likeAvise a very considera- ble effect. By it we know, bodies not only become decompo- sed and reduced to their elementary principles; but, by a recombination of those principles another substance is formed, differing materially from that from which it was obtained. It is by a similar decomposition ^nd recombination of the ele- mentary principles of food, together with its subsequent mix- ture with certain fluids of the primx vix, that I believe it becomes so far animalized and changed in its properties as to form chyle. That by the combination of bodies another is formed, differing in its properties from either of those of Avhich itis composed, is too true to he denied. Thus, if we * Fordyce on food, p. 143. 94 GLOVER ON DIGESTION. Combine with a proper prbportion of hydrogene and carbonc, a cert; ;n proportion of oxygene, wc obtain sugar, a substance differing very essentiaily from either of the other three. I he effect of solution not being that of a change of the component parts of food, it is clear that its only operation in digestion must be, that of expediting fermentation. This opinion, if we judge from analogy, I presume will be found correct. In similar circumstances out of the body, the more minutely any matter is divided which is oapable of fermentation, the more speedily will that matter go through its several stages. To return to our simile of sugar. If we dissolve this substance in Avater, its particles may be so minutely divided as not to be perceptible in that fluid, yet by evaporation the same sugar may be obtained, not at all changed in its properties. But if avs suffer sugar to ferment, the result will be very different. It will be resolved into its elementary principles, carbonic acid will be disengaged, and we will likewise obtain alcohol. Here then is a decomposition and recombination of its elementary principles. Sugar being composed of oxygene, hydrogene, and carbone, and these elements being separated by ferment- ation, are re-united to form these two substances, to Avit, the oxygene unites with a part of the carbone and is disengaged in the form of carbonic acid, while the remainder of the car- bone is dissolved by the hydrogene and forms the alcohol. Thus we see the material difference in the effects of solution and fermentation. SECTION IV. v-.-IY IT IS PRESUMABLE THAT FERMENTATION TAKES PLACE IN DIGESTION. We have already ' ordered digestion a priori; that is, we have investigate 1 the causes which influence digestion. We have tJten notice of the several properties of the matters which havv- the most material effect in this process. And avc have likewise seen, that all the circumstances essential to fer- ir.ei.taion, are possessed in an especial manner by food in tie stomach. We have seen, for instance, that it is plenti- fully supplied with moisture, not only from our drinks, but GLOVER ON DIGESTION. 95 even from our saliva and the fluids of the stomach itself; that it receives a sufficient quantity of air from our saliva, by wmch fluid it is enveloped and conti mally conveyed into the stomach j and lastly, that its situation is admirably adapted to be supplied with the necessary quantity of heat; on all of which circum- stances fermentation in a particular manner depends. We have also shewn, that saliva and the mucus of the primx vix, have a considerable tendency to promote this process. Having preceded thus far on our subject, it next becomes necessary, that we consider digestion a posteriori; or, in other words, that we attend to the effects produced by the digestion of food in the stomach. But in the first place, we shall say a few words on fermentation. Fermentation is that great agent in nature, by which bodies are rendered totally different in their chemical proper- ties, and which, from the variety of its products, has been long since divided into three several stages ; to wit, the vinous, the acetous, and the putrefactive. From the first of these processes we obtain, alcohol; from the second vinegar; and from the third, ammoniac ; by which means we are able always to ascertain, the nature of whatever fermentation has taken place- It will be recollected, that these several stages of ferment,, ation are capable of taking place, entirely independent of each other. Whenever the saccharine principle of any matter predominates, the vinous fermentation will take place; when the mucilaginous is most abundant, it will undergo the ace^ tous ; and when a greater proportion of gluten is present, it will run immediately into the putrefactive stage of fermenta?- tion. From this it appears, that on the several proportions of saccharine matter, of mucilage and of gluten, which any sub^ stance contains, depends the priority of the fermentation which will commence. Thus it is, that the vinous fermenta* tion is capable of preceding the acetous, and vice vei'sa. But they do not necessarily follow each other. Hence it is, that old and generous v\ ines, in which the mucilaginous principle had been destroyed, are no longer capable of becoming acid, without the addition of a certain proportion of gummy mats 96 GLOVER ON DIGESTION. ter *. Neither does milk afford a vinous spirit by its oAvn spontaneous change, as in this case it loses its saccharine principle. Different gases are disengaged, during the progress of these several stages of fermentation. The nature of these de- pend on the matter fermented. Thus, in the vinous ami acetous stages of fermentation, carbonic acid is disengaged; while in the putrefactive, azote, carbonated hydrogene gas, sulphurated hydrogene gas, and phosphorated hydrogene gas, are all occasionally evolved. We will now consider how far these gases, as well as the other products of fermentation, can be considered as being evolved in the primx vix. In support of the first of these positions, we haAre that - common fact, of our perceiving considerable eructations of air in affections of the stomach. Here it may be said, that the disengagement of air is the consequence of disease. To this I answer, that the eructation I consider as such, but not the formation of air. In affections of the stomach from gout, the quantity of air disengaged is sometimes very great, yet we cannot suppose that it is formed by this affection. I regret that I cannot from my own experiments, say any thing rela- tive to the nature of the air, which is involved in the stomach during digestion. To place this matter, hoAvever, in as clear a light as I am able, I shall take the liberty of making a quo- tation from Plenck f. This gentleman informs us, that,' in a very healthy man, frozen to death by cold on a winter's night, there was found a mixture of four kinds of air in the primx vis. ' Fixed air was found in the greatest quantity in the sto- mach, and but little in the small intestines. Vital air was contained chiefly in the stomach, and small intestines, and, 'Azote, and carbonated inflammable air, in the iarge intestines.' Tothese I may add, that sulphurared hydrogene gas, and phosphorated hydrogene gas, have been proven to be disenga- ged in crepitu. *Chaptal's Chem. Vol. Ill,page 268. t Treat, on the human fluids, page 141. GLOVER ON DIGESTION. 97 It appears from the works of Van Helmont, that he was the first person who suggested the idea of the presence of an acid in the stomach. His opinion has been assented to by Haller who relates, that the acetous fermentation is very pre- valent in the stomach; that an acid is spontaneously eA'olved before putrefaction, and even sometimes resists that process. He indeed mentions an acid being detected in the stomachs of ruminating and of omnivorous animals, in those of birds and even of carnivorous animals. * Most persons have witnessed the presence of an acid in their stomachs. But here an objection arises. It has been said, that whenever an acid is present in the stomach it is morbid, and indicates the diseased state of that organ. When accompanied with eructations, I believe this to be the case ; as the quantity then appears to be preternatural, and is attend- ed with an inverted peristaltic motion of the stomach, which is certainly the effect of morbid action. But we must not infer from hence, that the presence of an acid in the stomach is the effect of disease, as I hope to shew that it is detected in that organ, in the most sound and natural health. This has been proven by Dr. Rush t many years ago. He has shewn us by several Avell directed experiments, that he always detected the presence of an acid in the contents of the stomach, when thrown up by an emetic, three hours after food was taken ; but as it has been objected to his experiments that the acidity preceded from the emetic tartar, which had been decomposed in the stomach, I shall endeavour to super- sede this difficulty. A gentleman in perfect health and capable of ruminating, dined on roasted beef, Irish potatoes and leavened bread. His drink was nothing but water. In four hours after, he brought up a portion of his dinner. It had acid taste, and turned a blue vegetable substance of a red colour. The same gentleman having dined on boiled mutton, cab- bage and leavened bread, and having drank water alone, as before, in four hours after, ruminated again. The portion of *Elemen. Physiol. Tom. VI. p. 140, and 141. tlnaug. Disser. de Coctio-Cib. in Vent. N 98 GLOVER ON DIGESTION. food brought up had an acid taste, and, as the last, turned a blue vegetable substance of a red colour. These experiments were frequently repeated after having dined on different substances, and with uniform success. It was observed, that the acidity was not as perceptible to the taste in an hour or two after having dined, as it was in several hours after, These experiments may be readily repeated, as I do believe, that almost any person with a little trouble, may learn to ruminate. ^ Again, to determine Avhether an acid is evolved in the'di- gestion of a cat, one was fed on boiled beef and Irish potatoes. In five hours after, it was strangled. Its abdomen was open- ed and its stomach taken out, having previously placed liga- tures on its two orifices. The food had become soft and pulpy, and there was very little of any kind of fluid in the stomach. Some of this pulpy mass being placed in a glass vessel and' mixed with a little Avater, shewed evident marks of acidity. It very speedily restored the yellow colour of paper stained with rhubarb, after its having been turned brown by an alkali. I am not ignorant of the assertion of Dr. Fordyce, that in his experiments on dogs, cows, and sheep, he could not find the least trace of acidity in the duodenum ; * neither could it have been expected otherwise, since, as has been already re- lated, the bile has the effect of neutralizing acids, and of con- sequence as that fluid is almost always flowing into the duode- num, the quantity of acid must be unusually great to be defect- ed in that intestine. It is a prevalent opinion, that the acid which is present in the stomach is the phosporic, and consequently that it is not the effect of fermentation. But, as it is our duty not to admit either one position or another, unless it is supported by facts or experiments, I shall relate such of these as have in- duced me to presume, that it is not the phosphoric acid which is usually found in the stomach. And, 1st. The acid found in the stomach, does not precipitate sugar of lead from its solution in water. * Vid. Treat, on Food. p. 150 and 151. GLOVER ON DIGESTION. 99 2nd. ' Being saturated with kali, that is, what was former- ly called fixed vegetable alkali, it produces kali acetatum, formerly called regenerated tartar, or sal-diureticum.'* Desirous of knowing whether an acid is evolved in the digestion of animal substances, as well as in the former ex- periments, the gentleman, capable of ruminating, dined on roasted veal alone and drank water as usual. In four hours after, a portion of the contents of his stomach was brought up. It turned a blue vegetable substance of a red colour, and had an acid smell and taste. I confess my being at a loss in this case to determine, whether the acid was the effect of the di- gestion of the veal, or whether it preceded from the remains of some former food. It was my intention to have ascertained this point, by repeating the experiment on the same person, after his having subsisted on animal food for eight or ten days, but, as I have not now as many days previous to the deliver- ing in of my piece, I shall be obliged of consequence to decline the idea. The following experiment however, will at least adduce probability, in favour of the acid having been evolved by digestion. Having placed two drachms of roasted veal in a glass ves- sel, and covered it completely with saliva, it spontaneously became acid, long previous to there being any signs of putre- faction taking place. This fact is corroborated by the experi- ments of many authors of reputation. Haller takes notice of it-t Dr. Rush found that beef acquired an acid taste and smell, when exposed for two days to the heat of summer; $ and Maclurg relates, that a mixture of mutton and water, passes through the acetous stage of fermentation before it putrefies. § All animal matters when mixed with fermentable vegeta- ble substances, have a tendency to promote fermentation, as appears from a number of experiments instituted by Pringle, and who likewise adds, that' after such mixtures become sour they never return to a putrid state, but, on the contrary, * Fordyce on Food. p. 148. tVid. Element. PhysioL Tom. VI. p. 316. \ Vid. Inaug. Dis. p. 21. § Treat, on the bile. p. 75. 100 GLOVER ON DIGESTION. grow more and more acid *. And yet, so far from our find- ing this ferment to be injurious to digestion, on the contrary, animal food seems to be the best adapted for the aliment of dyspeptic patients. The publication of Dr. Wilson's ingenious inaugural dis- sertation on digestion, has induced many persons to suppose, that every idea of fermentation taking place in digestion is un- founded. The Doctor submitted to distillation, the contents of his stomach, brought up by an emetic four hours after food was taken, Avith a view of ascertaining, whether he could detect the presence of spirit of wine. This he could not, and from hence concludes, that fermentation does not take place in digestion. It will be seen that I have repeated the Doctor's experiment, and I am happy to add, with the same success; but I shall not draw the same conclusions. Being in perfect health, I dined on corned beef, potatoes and leavened bread. My drink was water alone. In four hours after, I took twenty grains of ipecacuanha and brought up the contents of my stomach. It shewed evident marks of acidity. On submitting it to distillation, a transparent and limpid fluid came over into the receiver, which had a taste somewhat sweet, and an agreeahle flavour ; it had not the least appearance of spirit of Avine, neither could I detect in it the presence of an acid. On examining however the residuum, which had not been evaporated to dryness, I was not a little surprised to find it still acid. A dog was kept fasting for twenty-four hours. He Avas then fed for two days successively on animal food. Four hours and a half after taking his last meal, he was killed. The food in his stomach shewed evident marks of acidity. On submitting it to distillation, I obtained, as in the last experi- ment, a transparent and limpid fluid, somewhat sweet, with an agreeable flavor and in no respect different from that which I had obtained from the contents of my OAvn stomach From the above experiments we learn, first, that an acid was produced in digestion as in the former experiments, and that it was even found in the residuum after distillation ; and * Diseases of the Army, Appendix, paper 4, Eper. 28. GLOVER ON DIGESTION. 101 tecondly, that spirit of wine could not be obtained from the food by distillation; but by no means that fermentation did not take place. I do not suppose that the vinous fermentation in a healthy stomach, is ever so complete that spirit of wine is formed, this would be equally as incorrect as to say, that putrefaction takes place in that organ. Neither can we sup- pose, that spirit of wine can ever be obtained from any matter, in which the acetous stage of fermentation has been completed and is then present. We have already seen that the acetous fermentation is capable of preceding the vinous; it is probable this may be the case in digestion; nor would it be by any means singular. In the preparation of koumiss from the milk of mares, a drink much in use among the Tartars, the acetous fermentation always precedes the vinous. But admitting that the vinous fermentation does have the priority, every circumstance, to which our food is exposed in the stomach, must tend to hurry it on so speedily to the acetous stage, as to prevent the former from being at all perceptible. The heat to Avhich it is exposed in the stomach, is greater than that which is requisite for the vinous fermentation; and this excess of heat favours the ace- tous stage. When speaking of the acid formed during digestion in the stomach, the word evolve has been used by many persons; Avhenever I have followed them in this respect, it will be recollected that I have always meant, that it was evolved by ,# fermentation. I do not suppose, that the acid in the stomach ' is simply disengaged from our food, as it is from the common sumach when mixed with water, or any other substance in which it is very abundant. The quantity of acid contained in the food, on which we have experimented, is not so great that this could have been the case ; neither can it be obtained from it out of the body by any other means, than by the assistance of fermentation. It now remains with the reader to determine, whether or not my-position is correct, that this acid is the effect of fer- mentation. Fermentation out of the body, differs from that which takes place in a living stomach, in this, that the former is 102 GLOVER ON DIGESTION. Spontaneous ; whereas, the latter is induced by all the nume* rous circumstances in the stomach, which tend to promote that process, and of consequence must be more speedy. Does not the fact of digestion being more speedy Avhile we are at rest, than during exercise, favour the theory of fermen- tation ? How shall we account for that warmth about the region of the stomach, so perceptible in some persons for several hours after death, unless we admit of fermentation ? Whether Ave shall ever be so successful as to imitate nature in digestion, as in many of her other operations, I am unable to decide; but, I flatter myself, time, that correct discerner of truth and error, will direct the attention of some more for- tunate experimenter to this subject, and dissipate every doubt Avhich may still involve it. Having thus delivered my observations and experiments on digestion, in as concise a manner as my time would admit of, I shall now close this essay; but to do this without an acknowledgment to the several medical professors of this uni- versity, would be a breach of that duty which my feelings claim. To you, gentlemen, at least this small tribute of my esteem is due. Permit me then to present you with the sincere acknowledgments of a pupil, for the many opportunities of improvement which your lectures have afforded him. With the assurance of my wishes, that you may continue to enjoy all the pleasure of success in the science of medicine, I now bid you adieu. EXPERIMENTS AND OBSERVATIONS ON THE ABSORPTION OF ACTIVE MEDICINES INTO THE CIRCULATION; SUBMITTED, AS AN INAUGURAL THESIS, TO THE EXAMINATION OF THE REVEREND JOHN EWING, S. T. P. PROVOST j THE TRUSTEES AND MEDICAL FACULTY OF THE UNIVERSITY OF PENNSYLVANIA, FOR THE DEGREE OF DOCTOR OF MEDICINE; ON THE EIGHTH DAY OF JUNE, A, D. ONE THOUSAND EIGHT HUNDRED AND ONE, V BY BENJAMIN G. HODGE, OF THE WESTJNDIES, HONORARY MEMBER OF THE PHILADELPHIA MEDICAL ANfl CHEMICAL SOCIETIES. Ore trahit quodcunque potest atque addit acervo, Hqr< INTRODUCTION. WHEN I first conceived the idea of writing on the absorp- tion of medicines, I determined to take up the subject purely in an experimental point of view, without any reference or regard to the arguments that have been adduced, to prove either this or that thing. I observed the difficulty of drawing a conclusion upon many points involved in the subject, from such facts as are in our possession: so much are these facts opposed to one another, and so great the plausibility attach- ed to each. This being the case, I was anxious to make some attempts of my own, to arrive at truth; and I was certain, it was only, (if at all) to be found, by making a direct and impar- tial appeal to the only true authority, to Nature herself. It soon appeared, tiowever, that the subject I had chosen, was much more than I could possibly do justice to; was more co- pious than I at first imagined, and would lead to a much more numerous train of experiments, than the term allotted would permit me to make. The difficulty, likewise, of procuring subjects for experi- ments, was. a matter of no inconsiderable obstruction to our progress. The reader, therefore, will perceive, that we have advanced but a little way, and that too, in a field which has already been trod by others. The ground they have passed over, however, well deserves a more accurate examination. We can flatter ourselves only with having attempted this, by repeating a few of their experiments, and by shewing the pro- per degree of credit that ought, in our opinion, to be attached toothers; and if, after all, the reader should be cUssatisfied, let the trouble and inconvenience of experimenting, answer for our deficiencies. As it will be impossible, and even unne- o 106 INTRODUCTION. cessary, in the following dissertation, to notice every thing that has been said and done upon the subject, we shall relate only those particulars that appear to be the most important; and in the course of such relation, we shall introduce the expe- riments we ourselves have made, together with such observa- tions as may occur to us upon the subject. The man, who would attempt to teach, or write, on sub- jects connected with physiology, without the aid of facts and experiments, had better relinquish the matter altogether. Here it is, by these guides, and not conjecture, that we must be conducted to truth. ' Of all the discoveries that haAre been ' made concerning the inward structure of the human body,' says an elegant writer, ' never one was made by conjecture. Accurate observations of anatomists have brought to light innumerable artifices in the contrivance of this Avonderful machine, which we cannot but admire, as excellently well adapted to their several purposes. But the most sagacious physiologist never dreamed of them till they were discovered. It is to these guides, therefore, that I mean to commit myself, in the following inquiry. But, alas! what dependence can be placed upon the greater number of facts that are to be found in the records of medicine ? Who can draw the difficult line, that separates truth from error, in most of those particulars, that have been dignified with the name of facts ? We shall, perhaps, in the following dissertation, have occasion to ob- serve, that the term has been much abused, and that it has but too often been employed to designate the dreams and errors of the imagination. It would be unnecessary to offer any preliminary observa- tions on the nature of the question, that is to be agitated. The importance of the subject, in a practical, and its beauty in a physiological point of view, will be too obvious to the physi- cian and philosopher, to need the aid of eulogy to recommend it. Its utility will at once be made apparent, by referring the attention of the reader to the treatment of a common intermit- tent fever. In this disease, for' example, if it could be cor- rectly ascertained, whether the Peruvian bark exerts all its influence in the alimentary canal without going any farther; or, whether it is absorbed into the circulation, and is there INTRODUCTION. l07 enabled to produce in part its salutary effects, the practice, resulting from this knowledge, would be materially different. In the former case, the practitioner would throw in the medi- cine, only on the approach of a paroxism ; but, if the latter position were true, the patient would be obliged to take the medicine with no, or but little variation in quantity, during the whole of the intermission. A similar remark would apply to many other cases ; and his certainly owing much more to an ignorance in the where, than it is in the how medicines operate, that so much difference has prevailed concerning the time and mode of exhibiting them. One thing I must request the reader to observe, Avhich is, that the folloAving experiments were not made, as is sometimes the case, to bend to the theory of the experimenter. On the contrary, Avhen we entered upon the investigation of the sub- ject, and had nearly advanced to the conclusion of it, Ave still believed in the absorption of active medicines: but, from the results of our experiments, and for other reasons Avhich shall be given in the sequel, we have been necessitated to relinquish our former opinion. Whether the reasons assigned for so doing are sufficient, will be determined with more propriety by the reader. We are conscious to what danger we expose ourselves, in attempting to oppose a doctrine that is become venerable by time, by talents, and by industry. But, from you, illustrious professors! (to Avhom I now address myself) from you we have little to apprehend ; for, from a long acquaintance with you, both in a public and private Avay, we have much reason to believe, that prejudice forms no part of your characters; and that you are always Avilling to listen, with candour, and indulgence, to any attempt, the ultimate object of which is truth, that' jewel, which all good and wise men,' together with yourselves, ' are in pursuit of.' EXPERIMENTS AND OBSERVATIONS ON THE ABSORPTION OF MEDICINES, Vc THE notion, that medicines, in order to be effectual, must be absorbed into the circulation, in their active states, took its rise at an early period. It was the very soul of the humoral pathology. As this doctrine referred all the pheno- mena of disease, to particular dispositions of the fluids, so it was imagined, that medicines could do no essential service, unless they Avere applied to the seat of the disease. These theories have been, in a great measure, corrected; the for- mer, by a more improved pathology; the latter, by a nicer attention to the effects of medicines on the body. In conse- quence of this accurate attention, physicians soon discovered the insufficiency of the above explanation; and found them- selves obliged to seek for some mode of accounting for several particulars 'respecting the operation of medicines, more ra- tional and satisfactory, than the one by absorption. That ex- quisite, though mysterious law of the animal economy, by which one organ is rendered sensibly alive to the feelings of another; by Avhich impressions on one part, are immediately propagated to others, the most distant in the body, presented itself to their consideration; and this principle, under the va- rious names of vis medicatrix, consent, sympathy, &c. has long been considered as a chief agent of the business in ques- tion. 110 HODGE ON ABSORPTION. But, although the influence of this sympathetic connec- tion has been acknowledged, physicians have never departed entirely from the old doctrine. They have ahvays continued to believe, that medicines, in general, are absorbed into the circulation ; and that this, in many cases, is even necessary to their proper action. Thus Dr. Cullen, who Avas a great ad- vocate for the notion of sympathy, nevertheless observes, * In many cases of increased evacuations, it is indeed pretty evi- dent, that the medicines, exciting the evacuations, are actually conveyed and applied to the secretories or excretories of the parts concerned:' and, the absorption of mercury into the constitution is, with many, deemed absolutely necessary in the cure of lues venera; not to mention many other in- stances. This opinion, however, is at present totally denied by some physicians, Avho attribute the effects of all medicines to sympathy alone. The supporters of this heresy, among Avhom I may in- clude myself, declare, that no active medicine is ever taken up into the circulation. That opium, camphire, &c. cannot, nor have they ever been pnn'en, to circulate, as camphire and opium, in the blood vessels of a living animal. They think it would be incompatible-with the life of the animal, that such active substances should be absorbed into the circu- lation ; since milk, and other bland fluids, are knoAvn, Avhen injected into the vessels, to occasion immediate death. They argue further, that, as the poAvers of sympathy are acknoAV- Iedged, it would be useless and unphilosophical to admit of more causes than are sufficient to explain the phenomena; and that it would, moreover, be contrary to the general sim- plicity of nature, Avho never employs tAvo instruments to ac- complish a single purpose. This new theory, therefore, re- sclves itself into the following form, and supposes, that every medicine, « When received into the stomach, after the first impression on the very sensible coats of that organ, the nature of it is gradually changed by the solvent poAvers of the gastric juices ; or, if incapable of being digested into a mild and nu- HODGE ON ABSORPTION. *H tritious chyle, it is carried through the intestinal canal, and ejected as useless and noxious to the body.'* These objections are founded, not on hypothesis, but in matter of fact; and if the inutility of a thing, be a proof offa falsity, we should have little trouble in establishing our point by shewing from many circumstances, that absorption is not only insufficient, but that it is perfectly unnecessary, in ex- plaining the action of medicines. The following facts would. suffice for this purpose: When the body is in a state of langour and debility, one glass of wine, will immediately restore to the muscles then' accustomed tone; will revive the drooping spirits, and will add new force and vigour to the whole arterial system. A tremor of the hands in drunkards is often lessened, or re- moved, by a dram, or some strong wine; and that, in so short a time, as entirely to prelude the possibility of absorption. Some medicines, as camphire and opium, have been found in the stomach, without any diminution in quantity, long aftep they have produced their peculiar effects. * Frogs,' says Girtan- ner, ' which live a long time after the heart is cut QUt, and, which are consequently deprived entirely of blood, are killed as quickly by the poison of the viper, as if their blood had not been let out.' And the celebrated professor Whytt has ascer- tained, by experiment, that if the heart of a frog be taken out, and a solution of opium injected into the abdomen, the animal will be convulsed in a very short time. Dr. Barton, in his valuable lectures on the materia medica, says, he once stopped an hemorrhage in a distant part by the exhibition of only two grains of sac-saturni. Medicines not only can be shcAvn to produce their effects on distant parts of the bodyi by a mere impulse upon the part to which they may be ap- plied, but there are many, whose operations are alone ex- plicable upon this principle ; many that can act in no other way ; a striking instance of which is to be found in the cure of buboes, hernia humoralis, &c. by emetics, We might thus go on to multiply proofs of the same nature, and to shew, that the effects of every class of medicines, as sialagogues. * Percival, Operation of Medicines, 112 HODGE ON ABSORPTION. diuretics, diaphoretics, Sec. are all referable to a sympathy betAveen the different parts of the system. But, perhaps, Ave have already insisted too much upon the establishment of a principle, Avhich fcAV people, in the present improved state of medicine, will be hardy enough to deny. Some gentlemen, more partial to their own theory than to the facts of others, have endeavoured to raise objections to the experiments, concerning the injection of milk and other mat- ters into the circulation, and to destroy the true deductions, that ought to be formed from them. This they do, by obser- ving * that what passes along the lymphatics or lacteals, is carried into the thoracic duct, and there mixed with a large portion of chyle or lymph, by which its acrimony is sheathed and diluted, or its chemical properties changed, before it enters the blood *. Such objections, hoAvever, do not, by any means, appear to be sufficiently founded. For, in the first place, simple dilution does not alter the nature or proper- ties of any substance whatever. A given quantity of wine will produce similar effects, whether it be taken into the sto- mach in a diluted, or undiluted state. And, in the second place, as it is well knoAvn that the chyle mixes with, and becomes blood itself, very shortly after it is poured into the blood vessels, the milk, and other foreign matters united Avith it, Avould then be deserted, and would be left in that same undiluted state, in which they have been injected into the vessels, and in which they kill. As to the chemical change, which these foreign matters are supposed to undergo, in the lacteal and lymphatic vessels, that will be readily admit- ted. It is just one of the propositions we wish to maintain. We Avish to establish, that all matters, capable of forming chyle, must be reduced to that state previous to their entrance into the circulation; and if they will only grant this, they shall have our free consent to call the change, a chemical one. If therefore, any substance causes death, 8cc. when inject- ed immediately into the blood vessels, it follows, of necessity, that that substance, proAided it be in the same form, will ahvays produce the same effect, let the mode of introducing * Percival. HODGE ON ABSORPTION. 113 it into the circulation be ever so much varied. We Avill avail ourselves of this reasoning on a subsequent occasion, to extri- cate us from a difficulty. We do not mean, however, to insi- nuate from this, that some other substances may not be thrown into the blood-vessels, and may not exist there without much danger. This inference Avould be opposed by facts, and one of a very remarkable nature is related by the celebrated Fontana * ; but such experiments only prove the possibility of the absorption of those substances, and Avith possibilities we have nothing to do. The supposition, that active medicines are taken into the circulation, appears to owe much of the credit it possesses, to the very mechanical manner in which the lymphatics are sup- posed to absorb and transmit different articles into the blood. Not being acquainted with any other modes of explaining the rise of fluids in tubes, but by capillary attraction, and the formation of a vacuqm, philosophers availed themselves of these principles, to account for the same phenomenon in the absorbents. The explanation was a very natural one. Unfor- tunately, hoAvever, they forgot, in this, as in many other cases, that they were reasoning, not on dead, but living mat- ter ; and that analogies, drawn from the one, Avould not always be applicable to the other. Thus it is not only difficult to imagine hoAv the soft, delicate, and yielding extremities of these vessels can form themselves into capillaries, &c. but from many circumstances, it is rendered pretty clear, that they evince something like design in their operations. They shew a greater aptitude to receive some substances, than others, that are reduced to the same form. They absorb the nutritious, in preference to the other contents of the alimenta- ry canal, which Avould not be the case, if they acted purely on those mechanical principles. Neither will these principles explain the manner in which they carry away the hardest parts of the body, such as bone, cartilage, muscle, &c. unless, indeed, we Avere to assume what is not proved, viz. that these parts undergo a solution previous to their absorption. But * Fontana on Poisons. 114 HODGE ON ABSORPTION. the amazing poAver of the chylo-poietic viscera, among which the lymphatic system must be included, appears to be the most material objection to the absorption of medicines, in their active forms. From that almost nameless variety of substan- ces, which the caprice or necessity of man has induced him to take as aliment, only one combination results, viz. chyle. The absorbents are capable of selecting, amidst so great a variety, such principles alone, as they can afterAvards convert into chyle. The chyle of different species of animals, differs in no respects, although their aliment is, apparently, the most opposite in its nature. The absorbents appear, further, to be the most pre-eminent of the chyliform organs, for they not only produce chyle, from such matters as have suffered the action of the stomach, (for chyle is not formed in the stomach or intestines) but they possess the power of absorbing, and ope- rating the same change upon milk and other nutritious articles, that may be injected into the different cavities of the body, as the rectum, the abdomen, 8cc. In these cases, the absorbents appear to have the whole business of digestion in their own hands. This chyliform poAver in the lymphatics, may be sheAvn, by an analogy derived from the animal and vegetable kingdoms. The Avhole tribe of vegetables are intirely destitute of a stomach. Some animals, of an inferior order, are like- wise formed without this organ. Now, in both these living productions, there can be nothing to digest their food but the absorbents ; and yet, the alimentary matters, they take in, are most certainly digested. The only proofs, then, upon which the absorption of medi- cines rests, are the appearances of those substances, in the secretions, and in different parts of the body, after they have been taken into the stomach, 8cc. Facts of this nature are plentifully scattered over every work that relates to medicine. Indeed, I recollect but very few substances, not only in the materia medica, but even in Nature herself, that have not, at one time or other, been discovered to pass through the circu- lation. But it must not be supposed, that whenever an author relates facts of this kind, that he always does it upon the evi- dence of his oAvn senses. As the absorption of medicines was universally believed, and looked upon as a medical axiom till HODGE ON ABSORPTION. H* lately, physicians copied from one another with as much confi- dence, as if the circumstances they related were actually before their eyes. Thus, although few men in modern times, have had the happiness of witnessing, as Etmuller did, the pre- sence of' simple water wine, and wine with sugar, and emul- sions,' in the identical unchanged state, in the urine, in which they Avere taken by the patient; yet, we find his facts fre- quently mentioned, and that too, by some of the most res- pectable modern physicians. As some of these facts, hoAV- ever, are handed doAvn under the protection of names, that Avill always command our respect and veneration, we must now proceed to consider them. There was no subject wherein a greater unanimity prevail- ed among physicians, than that iron and its various prepara- tions, were absorbed into the circulation. The opinion was grounded upon many plausible circumstances. Iron, it was well known, existed as a component part of the blood, and was supposed, likewise, to be the cause of its red colour. It was, and, I believe, continues to be, a general observation among practitioners, that this colour is increased by the use of martial medicines. Mr. Menghini even found, by experi- ment, that the blood of persons, who take martial prepara- tions, contains more iron than it does in an ordinary state; and Mr. Lorry observed, that the urine of a sick person, to whom he administered iron in a state of extreme division, Avas coloured with the nut-gall.* Many modern physicians have altered their creed upon this point, chiefly in conse- quence of an experiment made by the ingenious Dr. Wright, wherein this gentleman was unable to detect any iron in the thoracic duct of a dog, to whom he had given an ounce, and an half of sal martis.f Such contradictory experiments produced much doubt in my mind, especially as I was induced to believe, that, if any foreign matter could gain admittance into the blood, except in the form of chyle, it would certainly be iron. In order, therefore, to make up an opinion on the subject, I had recourse to the following experiments. * Chaptal. t Philpsophical Trans, Abridged. 116 HODGE ON ABSORPTION EXPERIMENT. One drachm of green vitriol, finely powdered, was Avrapt up in some meat and given to a dog. In about an hour and a half after this, he vomited a little ; but whether he threw up the whole quantity, I cannot decide. I suspect he did not, since so considerable a time elapsed, before the vomiting commenced. However, as soon as I perceived this, I dis- solved four drachms of the same medicine in a quantity of milk, and injected it into his rectum. In the course of half an hour afterwards, I had the misfortune of seeing this voided likewise. I then dissolved near an ounce more of the medi- cine, in some more milk, Avhich I again injected into the rectum, taking, at the same time, effectual precautions of preventing a return of it. In an hour and an half after this, the dog Avas killed, and several drachms of chyle were obtain- ed from the thoracic duct. To one portion of this Avas added some of the prussiate of potash; to another, the alcohol of galls. No change of colour, however, ensued in either case. But Avhen I dissolved the sixth of a grain of the vitriol, in a portion of the same chyle, my tests discovered the presence of it immediately. Quantities of the serum and urine were tried in the same manner, but Avithout discovering the pre- sence of iron. Mr. Jacobs assisted at this experiment, whq agreed to every thing I have related. EXPERIMENT. Having procured a dog, and kept him starving for several days, I poured down his throat two scruples of a solution of sal-martis; at the same time, half an ounce of the same me- dicine, dissolved in a sufficient quantity of milk, was injected into his rectum. In the space of fifteen minutes, the dog vomited a little, and Avas affected with a violent tenesmus, without being able, however, to discharge the contents of the rectum. In about an hour and a half the dog Avas killed, and the thoracic duct secured by a ligature. After the duct became distended, I punctured it, and collected a quantity of ai.yie sufrfci: r.t for the purposes of experiment. This being HODGE ON ABSORPTION. H7 divided into separate portions, suffered no change of colour, upon the application of the different tests formerly mentioned. A white coagulum always took place in the chyle when tested by the alcohol of galls. After the experiment Avas finished, and we were about to leave the room, the propriety of exami- ning the mesenteric glands, was suggested by an ingenious friend. For this purpose, I detached a number of these glands, which being cut through, in order to expose their internal surface, were immersed, in separate portions, in clean water. To these glands, thus circumstanced, were added sufficient quantities of the alcohol of galls, and the prussiate of pot-ash. Soon after, a black colour in the one, and a blue in the other, took place, evincing thereby, the presence of iron, At first, I supposed this circumstance might have been owing, either to the knife made use of in dividing the substance of the gland, or to some particles of green vitriol accidentally insinuating themselves into the water. That it did not depend, however, upon this latter cause, must appear evident from this, that the colours produced, Avere confined wholly to the substance and interior structure of the glands. But to be thoroughly satisfied upon the subject, I repeated the experiment above half a dozen times, taking care to avoid the knife, and every circumstance that could influence, or could be adduced as an objection to the experiment. But the results were the same in every instance. Did I perform the experiment too soon for the iron, thus absorbed, to pass through the gland, and to arrive at the thoracic duct ? Would it not have discovered itself in the duct, if sufficient time had been allowed ? This looked extremely probable, and a wish to see how far it was true, brought about the following expert ment. EXPERIMENT. Having kept a dog starving two days, I offered him half a drachm of green vitriol, dissolved in a portion of milk, a part of which only he took: half an ounce of the same medicine, dissolved in another portion of milk, was injected into his rectum. After remaining three hours and a half, he was 118 HODGE ON ABSORPTION. killed, and a quantity of chyle collected from the ductlft tho- racicus, which did not produce by the addition of the usual tests, any colour, that was in the least indicative of the pre- sence of iron. Our next object, was to examine the mesente- ric glands: and here the same phenomenon occurred, as in the last experiment, only the colours were more intense in the interior structure of that part of the mesentery which inter- A'enes between the glands and intestines. The liquor of the thoracic duct exhibited a very different appearance in this, from Avhat it did in the preceding experiments; instead of a Avhite milky colour, it resembled serum that is slightly tinged with the red part of the blood. To ascertain whether this iron in the glands Avas really owing to absorption, or whether it was the mere effect of transudation taking place after death, I had recourse to another experiment. EXPERIMENT. Half an ounce of green vitriol Avas injected into the rectum of a dog. Tavo hours afterwards he was killed, and immedi- ately, before transudation could take place, several of the me- senteric glands were taken out. Separate portions of these were tried by the different tests, while another portion Avas put into simple water to serve as a comparison. A black colour was produced in that gland to which the alcohol of galls was applied. It was not quite so evident as in the former experiments. No change of colour took place in that portion tested by the prussiate, except in a small part of the mesen- tery, which adhered to it. That portion of gland placed in water suffered no change. Some chyle was taken from the thoracic duct, but it was not found to contain any iron. I then wished to see if the black colour produced in this experiment, were the effect of the alcohol of galls, independent of any iron. EXPERIMENT. Some glands were taken from the mesentery of a dog, which had served for an experiment of a different kind, but which had taken no iron. These, however, suffered ne HODGE ON ABSORPTION. 119 change of colour, by the application of the alcohol of galls to the in. With regard to the absorption of the iron, as far as the glands, it does not appear that any weight can be attached to the circumstance. For it must be recollected, that in every instance an immense derangement was brought on the intes- tines ; the colon and rectum always looked as if they Avere fast tending to gangrene, and in some cases they Avere actually in that state, being as black as my hat. These experiments, then, not only prove the absence of iron in the chyle, but likewise, that of the acid with which it was combined; for, if the sulphuric acid had been present, it would have formed a blue colour Avith the prussiated alkali. But it may be objected, that they are inconclusive, inasmuch as they l only evince, that iron did not subsist in the chyle as a vitriol, qualified to strike a black colojir with galls,' he. This objection may be an ingenious one, but it certainly is not founded in a knowledge of chemistry. For, contrary to the assertion of Dr. Percival, if iron had existed there, either as iron, or as an oxyde, or in any other form, it would certainly have been discovered by the above means. But hoAv are we to reconcile the experiments of Menghini and Lorry, formerly mentioned, and likewise, the more intense colour of the blood, observable in patients under the use of iron ? In answer to this, I must take leave to observe, that these facts, even when admitted in the fullest extent, will not, by any means, establish that opinion, which, on superfi- cial examination, they are so eminently calculated to do. The subject respecting the existence of iron in the blood, is well known to be involved in much obscurity. How its presence there, is to be explained ; what purpose it ansAvers; hoAv far it is subject to variation, in point of quantity ; and, if subject to variation, Avith what particular states of the system, an increase or diminution, in its quantity, may be connected ? are queries, which cannot be ansAvered in our present imperfect knowledp-e of the business; and until they arc, these experiments will be of little value. It is not our business to account for the pre- sence of iron in the blood, but if is most probable, that it is a compound substance, formed by a peculiar process of organic \?6 HODGE ON ABSORPTION. ; ion. '-.c} is intirely independent of absorption. In this vrhy, i. ..pp^a-:.-. r . be for ned in vegetation ; for experiments shew, thai ;t exists in vegetables, that have fed entirely on air or distilled waterf. It is pretty evident, however, that this iron may exist in very different quantities at different times. In- deed, why cannot this take place with the iron, as it does with regard to the other component parts of the blood ? The rela- tive proportions of these are well known to be constantly changing. The serum is at one time abundant; at another, it exists in small quantity. The redk globules are now more, now less; and the same thing is true of the coagulating lymph. Iron may, therefore, be found in thebldod in larger proportions at particular times, and that too, Avhen the pati- ent is under the use of iron: yet it docs not follow, that this increase in its quantity is necessarily owing to the absorption of the medicine. The use of martial medicines may only be the indirect cause, by producing that state of the system on which an increase of iron in the blood depends. As to the colour of the blood becoming redder by the use of iron; I think this is more liable to objection than the question we have just been considering. If the colour of the blood really depended on iron, the circumstance, I acknowledge, would go a great length to prove the absorption of this metal. But sufficient evidence is still wanting to sheAv the truth of the posi- tion. The greatest physiologists, 'tis true, have agreed in attributing the redness of the blood to the iron it contains ; • but when we reflect hoAv many various colours iron gives in its various states; when we reflect, that the unknown cause, Which gives colour to the iron, may give colour to the blood; when we reflect, that of this crocus of iron, Ave can hardly procure one poor grain from four hundred grains of these red particles of the blood ; Ave cannot but be conscious, that this peculiarity is not yet explained.* Besides these objections, it maybe presumed, that the improvement, both of the appe- tite and of digestion, and a more vigorous circulation, all Avhich result from the exhibition of Iron, are circumstances as *Chapthal, Abernethy. t John Bcil. HODGE ON ABSORPTION. 121 satisfactory in explaining the phenomenon, as any unknown cause that could be alledged. It is unfortunate for medicine, that theory is so often mis- taken for truth, instead of being considered as the mere crea- ture of uncertainty. Despairing of the possibility of ever introducing iron into the circulation, I determined to make the attempt with some other substances. The power of stopping hemorrhages in distant parts of the body, and some other particulars, respecting the operation of astringents, have entitled this class of medicines, in the esti- mation of many, to the privilege of being absorbed into the circulation. To arrive at some degree of certainty on the sub- ject, the following experiment was instituted. EXPERIMENT. Half a drachm of the powdered nut-gall, concealed in a quantity of meat, and three ounces and a half of a saturated aqueous solution of the same medicine, mixed with some milk, Avere taken by a dog, that had been starved for several days. It may be necessary to observe, that the dog did not vomit, nor did he appear to be affected in any respect whatever. About two hours afterwards he was killed, and a large portion of chyle collected from the thoracic duct. But this did not exhibit the least appearance of astringency, by adding to it a solution of the sulphate of iron. The chyle, in this instance, could have been formed only from the aliment which I had just given the dog, and with Avhich I had combined the galls. Notwith- standing this, however, it did not contain a particle of the medicine. Among the many substances, concerning the absorption of which, physicians have been generally agreed, lead must be mentioned. The insidious manner in which this metal undermines the constitution, favours much of absorption. The change of colour Avhich it causes in the muscles of paraly- tic limbs, has likewise been supposed to depend upon the same principle. And professor Thunburg, who was salivated by Q 122 HODGE ON ABSORPTION. accidentally taking a large quantity of ceruse, mentions, that the lead Avas perceptible in his saliva *. ' It were to be wished that the professor had been a little more particular, and had ascertained the presence of the lead by some better criterion than that of taste. But although these circumstances are not at all conclusive, yet they were sufficient to create a strong sus- picion in my mind that I should fipd them realized by experi- ment. EXPERIMENT. I kept a dog confined, and whenever I fed him, I mixed a portion (generally about fifteen grains) of sac. saturni Avith his food. The dog bore this regimen very well at first; but after some time he grew sick of the medicine, and commonly threAv it up, so that I Avas obliged to desist. By this prac- tice, I forced him to take, altogether, «iot less' than sixty grains, exclusive of that which he vomited up. Half an ounce of the same medicine was immediately injected into his rectum, and proper precautions taken to prevent its expulsion. After tAvo hours had elapsed, he was killed, and a quantity of the liquor of the thoracic duct collected, which did not shew the presence of lead, when tested by the phosphoric acid, and the sulphurated hydrogene gas. Neither did the serum of the blood evince the existence of lead in it by the same tests. Here lead did not exist in the chyle or blood, either as sugar of lead, or as an oxyde, for if it had been present in those states, it Avould have been rendered sensible. The glands of the mesentery did not contain any of the medicine. My next object was, to ascertain whether mercury could be found to enter the circulation, since it is upon this subject particularly, that the doctrine of absorption has rested its greatest support. The authorities in favor of the absorption of this metal) are numerous and nearly as respectable. Our credulity, indeed, is often startled, especiallv when we are informed, that upon opening a vein some dn.chms of it have flowed out * Voyage to the Cape of Good Hope. HODGE ON ABSORPTION. 123 with the blood**, Sec. But, after 'all, it must not be denied, that cases of a similar nature have been handed doAvn to us by men of great eminence in the science. Boerhaave, Haller, Mead, Brodbelt, and a long catalogue of others, have seen globules of mercury in the bones. Added to this, is a case, related by Dr. Cooper, of a Avoman Avho Avas salivated, produ- cing the same affection in her sucking child. This last fact, ■ however, deserves very little consideration; for, if mercury was used externally in any form, that circumstance alone would be sufficient to explain the mystery. But in opposition to the above facts, we have the experiments of Dr. Slare, Avhich were made on the saliva of a lady in a state of saliva- tion without discovering the smallest quantity of mercury t- Dr. Saunders,' by various and accurate tests, could not disco- ver, in the secretions, any mercury in persons under a saliva- tion, either from the internal or external use of it$.' Some experiments of a similar kind, which I have made, were marked with similar results ; but as they may answer some useful purposes, and may probably tend to guard others from a deception which I was near falling into myself, I shall relate them. • EXPERIMENT. Several ounces of saliva were procured from a patient in a high state of salivation. In this were immersed several pieces of gold, silver and copper, Avhich were alloAved to remain two days. At the end of that time, no amalgam was formed on them. Supposing that if there Avere any mercury, it Avould more readily unite Avith other metals, Avhen it was in a state of vapour. * Mead's Works. t History of the Royal Society. \ Saunders on the Liver. 124 HODGE ON ABSORPTION. EXPERIMENT. I took the same saliva, and after suspending a bit of gold just above the surface of it, it was subjected to heat and en- tirely evaporated; but no amalgam appeared on the gold. I Avas apprehensive that these experiments were made on too small a scale. To obviate this objection : EXPERIMENT. A quart of the same saliva, being slowly evaporated to a thick consistence, produced no change of colour in a bit of gold that was immersed in it a whole night. EXPERIMENT. By the favour of............I obtained several ounces of blood from a patient, in a high state of salivation. After it had se- parated into serum and crassanfentum, I placed in the bottom of the bowl containing it, a piece of the purest gold, and al- lowed it to remain there a whole night. But no amalgam Avas formed on it. EXPERIMENT. A part of this blood, being placed in an oil flask, Avith pieces of gold and copper suspended on the surface of it, was exposed to heat. The gold did not suffer any change, but in a short time, the copper became as white as silver, and some persons, very capable of judging, declared it to be the effect of amalgamation. As the gold, hoAveA'er, was not affected, some doubts still remained, which I thought, could only b© cleared up by a comparative experiment. EXPERIMENT. I, therefore, obtained some blood from a person, Avho was not under the use of mercury, and by treating it as in the last experiment, the same appearance precisely took place. Tlv copper Avas whitened. Had not faith in the experiments of others, and some degree of scepticism, induced me to mal.e HODGE ON ABSORPTION. W> this trial upon the blood of a healthy person, I should have been most miserably deceived. The deduction, then, that must be formed from these and other experiments, is, that mercury does not exist in the circulation or secretions in a pure metallic state. But they go no further; for, if mercury had been present, either as an oxyde, or in combination with an acid, it is evident, it would not have been detected by the means made use of; and pro- per experiments, Avith a view to find it in those states, have not, as far as I know, been made. But do not the depositions of fluid mercury (supposing for a moment that such was ever the case) in the bones, 6cc. shew that it must have existed in that form in the circulation ? I answer, no. For, that it does not, is evinced by what has been said; and that it cannot is proven by a fact, related by Saunders, who injected two drachms of mercury into a vein ; and thereby killed the dog, that was the subject of the expe- riment.* If such depositions can be accounted for at all, it must be by supposing, either that the mercury is reduced from its combinations in passing through the extremities of the arteries, or, that this takes place after these combinations have been deposited. The only thing that remained, was to ascertain, Avhether mercury existed in the states just men- tioned ; for Avhich purpose the following experiment was made. EXPERIMENT. I procured a glass tube, hermetically sealed at one end and open at the other. Into this Avas introduced several drachms of the dried blood and saliva of the same patient. A bit of gold was placed over a small hole, left in the open end of the tube, to prevent any mercury from passing off undetected. The tube was then exposed to a red heat, and after remaining there a sufficient time, we could not discover that any mercury had either passed off in vapour or was present in the tube. The contents of the tube exhibited much the appearance of globules of mercury. This appearance occurred likewise in a former experiment on the blood, and, in both instances. * Saunders on the Liver. 126 HODCE ON ABSORPTION. was near leading me into an error; but when attentively ex- amined, they Ave re found to be globules of air instead of mer- cury. So great was the resemblance, that these globules were, at first sight considered by many, eAen the professor of che- mistry himself as mercury. Will not this serve to explain those appearances, which, on dissection, have been attributed to mercury ? ' Heaven knoAvs hoAv seldom things are what they seem!' one thing I am certain of, that if any person, prepossessed with the belief that mercury is absorbed, had seen these experiments, he would, without doubt, have pro- nounced them to be globules of mercury. I shall conclude this subject with a quotation from Mr. Hunter. • It may be supposed unnecessary to mention, in the present state of our knowledge,' says this great man, { that mercury never gets into the bones in the form of a metal, although this has been asserted by men of eminence and authority in the profession; and even the dissections of dead bodies have been brought in proof of it; but my experience in anatomy has convinced me that such appearances never occur.' * Another circumstance, that has been urged by the sup- porters of absorption, is, that animals, which are at one time innocent and wholesome, will become poisonous, in conse- quence of eating certain poisonous matters. The fact, I believe, is strictly true. We ourselves have witnessed it in the fish called the sprat, in the West-Indies, and in confir- mation of the same thing, may be found, in the memoirs of the London Medical Society, an excellent paper on the sub- ject, by Dr. Thomas. This author, in speaking of the poison- ous quality of the sprat, and some other fish in the West- Indies, observes,' that it arises, hoAvever, from their food, is strongly corroborated by several circumstances; but what that food is, remains yet to be discovered. It is a well known fact, that the land-crab, (cancer-terrestris) when taken near manchineel trees, is found, particularly in dry seasons, atone time safe, at another, poisonous, from feeding on the bark or leaves of that tree in lieu of other nourishment.' Pheasants ?.:-e said to acquire a poisonous quality, by eating, from neces- * Hunter on the Venereal. HODGE ON ABSORPTION. 127 shy, the fruit of a certain plant. A fact, of the same kind, is related in Foster's Observations, during a Voyage round the World; where part of the crew, and some domestic animals, were poisoned by a particular species of fish. ' Sometime after- Avards,' says the writer,« I was told, that a fish of the same species Avas caught at Tanna by some of the sailors, who salted it and eat it, without any ill effects; whence it is to be suppo- sed, that this species is not poisonous in itself, but only from the food, which it accidentally meets with,' &c. These authorities, without mentioning others, are suffici- ent to establish the truth of the matter. Taking the fact, therefore, for granted, let us see what can be made of it. At first, we were inclined to look upon this as one of the strongest proofs that could be brought forward in support of the absorp- tion of medicines; but, upon reflection, it appears to us, that it ought to be taken with considerable limitation, and that for the following reasons: When fluids, or other matters in a state of solution, are enclosed in different cavities, they cannot, in a living state, be removed from those cavities, but by natural or artificial passa- ges, or by absorption. The gall-bladder may be distended to a great size ; the urinary bladder may be enlarged to an almost incredible extent, so as to be mistaken for dropsy ; the liver may be filled Avith pus; yet, they never suffer any part of their contents to,pass through into the abdomen. Indeed, if it were otherwise, it would not only endanger the life of the animal, but would altogether supercede the necessity of having reservoirs in the body for particular fluids. As soon however as death takes place, the case is altered. These reservoirs immediately loose the power of retaining their contents, and transudation is the consequence. This fact is very familiar to anatomists, who find the bile, the urine, &c. transuded, in almost all their dissections. Agreeable to this, it is easy to conceive, that poisonous matters, existing in the alimentary canal, may, after death, transude through and affect the muscles and other parts with their deleterious qua- lities; and might thus impose upon us the belief that they were absorbed during life. This is not speculation; but is rendered more than probable by the folioAving words of Dr. 128 HODGE ON ABSORPTION. Thomas, the same sensible Avriter. whom avc have quoted above. Speaking of the poisonous fish in the West-Indies, he remarks, ' when taken off the hook, if the precaution is used to gut and salt them immediately, they seldom or never create any disorder. The following facts evidently prove this. Mr. Henry Buckley, treasurer of the island of St. Kitts, is extremely partial to the barracuta (perca major of Brown) and never refuses to purchase them from fishermen whom he knows, provided they gut and salt them as soon as they arc taken out of the water. He has never met with an accident since he adopted this practice, which is now upwards of thirty years.' Again: ' A fisherman caught some yellow-bill sprats in Halfmoon-bay, and, after using the above precautions of gutting, &c. threAV the entrails into the sea, for fear of poi- soning his favorite dog, which accompanied him in all his excursions: this happened in the morning. He carried the sprats home, and, together with his family, dined on them; in the afternoon he returned to his usual occupation of catch- ing sprats, and observing his dog busily eating something, which it had picked up in the surf, he had the curiosity to ex- amine what it was, and found it to be the guts of the fish thrown ashore by the waves. He immediately aftenvards observed his dog in great agonies, and soon after he carried him home he died.' The above is related from unquestion- able authority, and can be confirmed by the testimony of several of the most respectable inhabitants of St. Kitts. Ano- ther fact, equally important, happened to a Mr. Duport at Palmetto-point. This man has been a fisherman more than forty years, and employs a number of negroes in drawing seins in different parts of the island. They one day caught a great quantity of yellow-bill sprats, which, as usual, he forbade his negroes to make use of, to avoid accidents ; but, contrary io his orders, they gutted a number of them, and threw the guts on a dung-heap in an enclosed yard, where he kept his poultry. To his astonishment next morning he found a great number of them dead, but, on inquiry, none of his people Avere affected *.' Other instances of the same nature are rela- ted, which I omit. * Memoirs of the Medical Society of London. HODGE ON ABSORPTION. 129 These facts are very important, and very much to our purpose. They prove, that the poisonous property of these fish is owing, as has been supposed, to their food; likewise, that they can be rendered innocent by taking out the stomach and intestines, as soon as they are caught. This circumstance, I apprehend is only to be explained'upon the principle of transudation; for, if these poisonous matters, found in the sto- mach, 8cc. could be absorbed into the circulation, and after- Avards diffused through every part of the body, it would be im- possible, that the above, and improbable, that any other, pre- cautions whatever, Avould be sufficient preventives against the effects of the poison. Whenever, therefore, any animal, othenvise wholesome, is found to poison, in consequence of a particular kind of food, I would attribute it to the cause al- ready assigned ; or else to carelessness or mismanagement on the part of the cook. This coincides with the intention of na- ture, who ordains, that the aliment of every animal should be decomposed; should be formed into chyle ; in short, should become a part of the animal itself. Does sulphur ever enter into the circulation? this has been answered in the affirmative by some, and their assertion is grounded on the following reasons. They say, that as ' sul- phur, whether externally or internally used, produces a cure in the itch ;' so, in either way, they presume, its operation to be similar. * In other words ; when sulphur is taken in- ternally, they suppose, it is absorbed, and, by means of the circulation, is applied, in its active state, to the seat of the disease on the surface of the body. Secondly, they assert, that ' sulphur tinges the silver, that may be Avorn by the pa- tient of a black colour; and that it communicates its odour to the perspiration.' These circumstances, if true, would no doubt, carry much weight; but, at present, we suspect that they carry more inac- curacy and deception with them than any thing else. For, that the internal use of sulphur will produce a cure in the itch, is a position not altogether so completely established as these gentlemen would make us believe. Many physicians deny it * Percival, Operations of Medicines, B I'O HODGE ON ABSORPTION. and in particular we have the authority of Dr. Bonomo, who has paid much attention to the disease, and has thrown more light on the nature of it, than any other person. His words are, ' Neither do inward,jnedicines perform any real service in this case, it being always necessary, after a tedious use of these, to have recourse to other external ones, already men- tioned*.' But granting, Avhat is not probable, that sulphur, taken internally, is a cure for the complaint in question; even then the fact would not be a sufficient proof of its absorp- tion. For sympathy, which is so active an agent in all the concerns of health and disease, Avould deservedly claim a large part of the credit, (In cutaneous diseases avc should remem- ber, that the stomach may only be sympathetically affected; and that such disorders may be cured by the operation of me- dicines on the stomachf.' That sulphur will tinge the silver, Avhich may be about the patient, will not be denied; but the fact will be of no use to us in the present controversy, unless Ave could be certain (which is not the case) that the patients, in all such instances, were strictly confined to the internal use of the medicine. It is well known, that sulphur, in a state of vapour, is one of the most penetrating substances ; so much so, that a small quantity, rubbed on any part of the body, will, by the application of heat, traverse every other. A per- son, merely by handling some of the sulphur-ointment, and t, afterwards going near a fire, had his sleeve-buttons rendered completely black. But independent of the foregoing object tions, the absorption of sulphur is rendered very improbable by experiment. A gentleman in this city, whose talent for chemical research is very great, could not discover any sul- phur in the blood of a patient whose system, to use a com* mon phrase, was completely saturated with the medicine. I gave a man, a large quantity of the hepatic water, which, like other mineral Avaters, is said to pass off, by the urinary passages; but was not able, by means of the acetite of lead, to detect the presence of any sulphur in the urine. * Philosophical Transactions Abridged} vol, 5, t Jacksons's Medical Sympathy. HOBGE ON ABSORPTION. 131 Among others, the presence of carbonic acid in the urine has been urged as a further proof of the absorption of medi- cines, and when this fact comes to us from so great an au- thority as Dr. Priestley, it is no wonder that so much stress has been laid upon it. It is, however, by far the Areakest ar- gument, that could be selected. When carbonic acid is united with other substances, it must exist either in a state of chemi- cal combination, or in that of simple mixture. In the former case, the attraction is stronger, but in the latter, the acid is retained by a very slight force, and can be driven off by a low degree of heat; much lower, indeed, than the natural tem- perature of the human body. It is owing to this circum- stance, that, when porter, cyder, &c. is taken into the sto- mach, the natural heat of the part produces a disengagement of the carbonic acid, and this is either belched up immedi- ately, or else, is carried forward, and discharged per annum. This consideration renders it impossible that carbonic acid should ever exist in the blood, in a state of mixture; for, not only the heat, but the very agitation of that fluid, would be sufficient to expel it, and occasion death. Whenever fixed air exists in the urine, the same consideration makes it neces- sary, likewise, that it should be in a state of chemical com- bination with the earthly and alkaline bases, present in that excretion, otherwise, it would produce a flatulency, and con- sequently, a disease of the bladder. If the reader will only look at Dr. Priestley's experiment, he will find that this is perfectly correct; and that what the doctor took for carbonic acid was actually in a state of combination; for, ' it must be observed,' says he, ' that it required several hours to expel this air by heat; and after the process, there was a conside- rable sediment at the bottom of the vessel. This Avas, pro- bably, some calcareous matter, Avith which the fixed air was united*,' &c. The urine of a person, who was constantly kept on the use of two or three bottles of porter a day, did not afford me any carbonic acid, when exposed to a heat sufficient to expel it, if it had existed there in the state of simple mix- ture. Let us then, for a moment, suppose, that Dr. Priestley, * Priestley on Air. 132 HODGE ON ABSORPTION. to use his own words, has, ' more than once expelled, from a quantity of fresh made urine, by means of heat, about one fifth of its bulk of pure fixed air, as appeared, by its precipi- tating lime in lime-water, and being almost wholly absorbed by water*.' I ask, if this can be a sufficient proof of the mat- ter in dispute, when avc know, that an alkaline carbonate ex- ists, naturally, in all urine ? carbonic acid is secreted from almost every part of the body, and its presence in the urine is no more a proof of its absorption than the presence of the lythic, the phosphoric acids and ammoniac, Sec. is an cvi- derce,. that these matters were absorbed. The following experiment proves, that all urine will ex- hibit the same phenomena that occurred in the above men- tioned experiment of Dr. Priestley. EXPERIMENT. A quantity of common urine was placed in an oil-flask and exposed to a boiling heat. The air that escaped Avas made to pass, by means of a syphon, through lime water. The first air that came over Avas nothing but the common atmospheric air of the vessel; but the next portion produced a large preci- pitation in the lime-water, and was greedily absorbed by water. Upon pushing the experiment a little further, the precipitate appeared to us to be in part re-dissolved, and there was, likewise, a very abundant white sediment, formed in the flask. At first, I had not the smallest doubt that it was the carbonic acid, which was given over, both in this, and in Dr. Priestley's experiment; but it struck me, that if it had been this acid, it never could have been driven from its combina- tions with lime and the fixed alkalines, by the boiling heat; nor did it appear to be united with ammoniac. I, therefore began to suspect that it was not the carbonic acid; and I found my suspicion most handsomely confirmed by the next experiment. * Priestley on Air. HODGE ON ABSORPTION. 133 EXPERIMENT. A fresh quantity of the same urine Avith that used in the above experiment, was treated exactly as in the former case ; but as soon as I perceived, by the precipitation in the lime- water, that the proper air Avas coming over; I removed the lime-water, and placed, in its stead, a clear solution of the acetite of lead. Here a copious white precipitate, immediate- ly took place. This convinced me, that it was not carbonic acid; for if it had been such, no precipitation or change would have been made in the lead-water. As the muriatic, the phospho- ric, and the lythic, acids arc knoAvn to exist in urine, it must have been one of those salts. We learn, then, that Dr. Priestley's experiment is correct, but that his deduction from it is wrong. The air, which came over in his experiment, certainly resembled fixed air, in precipitating lime-Avater, and in being absorbed by water; and no person, without further experiments, could have pos- sibly avoided the error into which this illustrious character has fallen. These experiments, though few, will, I flatter my- self, be satisfactory to every person, and Avill be sufficient to set aside every thing that has been said concerning the absorp- tion of carbonic acid. Lastly, it may be useful to mention, that the precipitate, produced in urine, by lime-Avater, is not, as has been advanced, any proof of the absorption of carbonic acid; for all urine, that I have examined, will exhibit the same phenomenon. We are told, by Mr. C. Darwin, that he discovered the presence of nitre in the urine of a friend, who had taken about tAvo drachms of that salt *. As this experiment has excited a good deal of curiosity, and has contributed to confirm the belief of many in the absorption of active substances, to pass it by unnoticed, Avould, perhaps, be a mark of neglect; I there- fore, determined to repeat the experiment. But, before doing this, I found what I thought a satisfactory refutation of his pretended fact, in the following experiment. * Zoonomia. 134 IfODGfc ON ABSORPTION. EXPERIMENT. To a pint of urine Avas added a drachm of nitre, and after it had completely dissolved, I soaked a bit of paper in the so- lution, and aftenvards allowed it to dry. Upon placing it in the flame of a candle, it did not shew the least appearance of hitre. I then mixed two drachms of nitre Avith the same quan- tity of urine, but was unable to discover this by similar means. I gradually increased the quantity of nitre, until I carried it as fin' as three drachms and a half to the pint of urine, and with this quantity I was but just able to detect it; perhaps, I should not have done it, even then, had I not been aware of its pre- sence. The truth is, that Mr. Darwin's experiment Avas as hypothetical as the theory it Avas intended to support, and he fleserves as little credit for the one as he does for the other. 1 Fingere qui non visa potest;............. hunc tu,' medice,' caveto.' So far, then, as our experiments go, we have seen no rea- son for admitting the absorption of medicines. We proceed, in the last place, to ansAver, in a general way, some facts, which have been deemed very important, and no less deci- sive, against our opinion; One Avould be almost tempted, in- deed, to belicA-e in the absorption of active medicines, not only from a great body of plausible facts on the subject, but from the rage, that has ahvays existed among physicians, for finding out another and a shorter passage to the bladder, than that of the general circulation. Their object was, to ex- plain, by such a passage, the sudden appearance of the pro- perties of those matters in the urine, that had been taken into the stomach ; and it is, at least, reasonable to suppose, that these menAvere, In some measure, convinced of the reality of the fact, before they Avould set themselves to theorize about the probable cause of it. This circumstance, I may observe, Would seem to be nearly as much in favor of absorption, as it is opposed to the notion of a new passage ; for it is certain, on the one hand, that the properties of many substances do occa sionaliy evince themselves in the urine; but althoup-h this new passage has existed so long in the inuicinations of physi- HODGE ON ABSORPTION. 155 cians, yet it has, very unfortunately, never been found to exist in the body. Without wishing to avail ourselves of the ad- vantage of this imaginary passage, I have mentioned it, merely to shew, that the qualities of bodies do exhibit them- selves in the urine, and other secretions of the body ; and as the fact is established by so much testimony, it must be admits ted. Neither am I going to assert, that this fact has no wei ght at all. On the contrary, our senses, the only instru- ments of knowledge, are extremely limited in their opera* tions, and, although itis a reflection humbling to our pride, it is nevertheless true, that they convey into the mind, not the essence, but only the qualities of matter. The qualities of substances are the only criteria by which we can judge of the presence of those substances. Indeed, itis perfectly impossi- ble to disconnect the ideas of substance and quality, or to imar gine that they can exist, the one without the other. Some of the properties of medicines, as smell, colour, &c. cannot, therefore, be supposed to exist in the secretions, without some material agent to produce them ; and so far, the case is pretty clear. But, while we maintain this kind of language, w^ must not imagine, that the presence of one or two qualities, peculiar to any medicine, is an evidence of the presence of that medicine in its intire form. By a natural, though unfortur nate, association of ideas, however, the matter has been other* Avise considered. The whole has been judged of, from a part only; and opium, rhubarb, he. are said to enter the circula* tion, because the odour of the one, and the colour of the other, are found in the secretions. Thus, Avhile I am looking at a picture before me, containing the head of a great and good man, all his virtuous qualities are seen on, and are insepara* ble from, the picture ; and I almost fancy myself in company with the great original. But it is Avell knoAvn, that all medi- cines, with Avhich Ave are acquainted, are compound substan? ces, possessing various sensible qualities, some of which reside in the one, some in the other, of their component parts, It is equally well knoAvn, that many, and for aught Ave know, the greatest number of these articles, are fitted to administer nourishment to the body. Thus opium contains a gum that Js nourishing ; stramonium is eaten by the goats and other do? 1^6 HODGE ON ABSORPTION. mcstic animals ; and the willow forms the bread of mankind, in some parts of the world; together with many other instan- ces that might be mentioned. Nature knoAvs no characteris- tic distinction between medicinal and esculent vegetables. They all appear to be composed of the same elementary prin- ciples, and the whole difference lies in the name. Medicines, therefore, like other aliment, Avhen taken into the body, ac- cording to the poAver of the digestive organs, are decompo- sed. Some parts of them will be rejected as useless, others Avill go to the formation of chyle. These nutritive parts, ii is presumed, will, even in the form of chyle, retain some of the sensible qualities which they possessed in the state of combination, and will thus be carried into the circulation. So that, whenever the qualities of medicines appear in the secre- tions, the only thing they prove is, that the nutritious parts of those medicines were absorbed. This may be illustrated by many facts and examples. Thus sea-birds have their flesh sedgy, from living intirely on fish; yet, no one will believe, that the fish is taken up and swims, as fish, in the blood vessels. A circumstance, much in point, is related by Dr. Percival. * Extract of log- wood, taken internally,' says this ingenious physician, * some- times gives a bloody hue to the urine. But the astringency of it does not, according to my trials, accompany its colour- ing matter *.' In like manner, certain articles of food, as the different species of the siliquosa, the asparagus, the garlic, the indian fig, See. all communicate their smell or colour to the urine ; yet, do we not know that these vegetables nourish the body, and, to answer that purpose, do Ave not knoAV that they must be formed into chyle ? Madder communicates its colour to the bones, &c. yet, do Ave not know, that madder contains principles that are nutritious ? The turkey-buzzard feeds on putrid animal matter, and it is said, that this is absorbed as putrid matter, because, forsooth, the feathers of these birds have a stinking odour! Now, when we reflect, that these birds are ahvays up to their eyes in putrid matter, and ahvays surrounded by a putrid atmosphere ; when Ave reflect, that * Manchester Memoirs. HODGE ON ABSORPTION. 137 putrid matter, according to Spallanzani's experiment, will be rendered sweet by the action of the gastric jorir ft upon h% and when Ave reflect, that this putrid flesh is not o*ry nourishing, but that an animal will be killed, if only one drachm of putrid serum be injected into its vessels, Ave cannot but be surprised, that a fact of this nature should be looked upon as a proof of absorption. Let the reader extend this principle, and he will be able to explain many other facts. We have thus considered the most interesting particulars in favor of the absorption of medicines, and shall conclude, with this observation to the reader: siquidnovisti rectius istis; which I do not doubt, candidus imperii: sinon, hisutere tnecum. s AN INAUGURAL DISSERTATION, IN WHICH, BY AN INDUCTION OF FACTS FROM DYSENTERY, THE MITCHILLIAN DOCTRINE OF PESTILENTIAL FLUIDS IS ILLUSTRATED. SUBMITTED, TO THE PUBLIC EXAMINATION OF THE FACULTY OF PHYSIC, UNDER THE AUTHORITY OF THE TRUSTEES OF COLUMBIA COLLEGE, IN THE STATE OF NEW-YORK, The Right Revd. BENJAMIN MOORE, D. D. President; FOR THE DEGREE OF DOCTOR OF PHYSIC, ON THE NINTH DAY OF NOVEMBER, ONE THOUSAND EIGHT HUNDRED AND TWO. //■*■" BY NICHOLAS I. QUACKENBOS, A. B. OF THE STATE OF NEW-YORK. AN INAUGURAL DISSERTATION ON DYSENTERY. CHAP. I. LITERARY AND PHILOLOGICAL REMARKS. A great controversy exists among Physicians concern- ing the true meaning of the words contagion and infection. Some have considered them as synonymous, and others have contended that they signify things of a very different nature. It does not, perhaps, become one just entering into the pro- fession to decide on this point, upon which men of high cha- racter and eminence have differed so widely; yet I cannot suppress a belief that the two words did originally denote ideas very unlike each other, and that at this time they ought not to be confounded. There is scarcely an instance of two Avords in the English, Latin, or any other language, possessing the same critical meaning. Though in common speech, they may be employed as convertible tcrnu; yet they are always found, on nice ex- amination, to have a plain and sensible difference. The books of rhetoric and belles lettres inform us Avherin' pride' differs from * vanity ;' how' fatigue' is distinguished from < uneasi- ness ;' and by what means ' delight' varies from ' pleasure ;' w ith hundreds of other examples of the kind. These, though in common acceptation, reputed to be synonymous words, are in reality very far from each other in true signification. What happens in the language of common life occurs al- so in the dialect of medicine. Words reputed by many to be U2 QUACKENBOS ON DYSENTERY. quite alike, are knoAvn by the correct and learned to intend things widely remote in their meaning. Thus * Lues,' ' Pes- tis,' ' Contagium,' and ' Infectio,' have been supposed by ma- ny as words of signification so nearly alike, that in glossaries and lexicons they have been employed familiarly one instead of the other. But I shall endeavour to shew that this is a mis- take. 1. 'Lues' seems to be derived from luo, to pay the cost, make atonement, or suffer punishment for a crime or fault. Hence luere pcenas signifies to suffer the penalty for an omis- sion or breach of duty. And, for the same reason, ' lues' is employed to mean any distemper brought on through or by a violation of moral obligation: particularly it applies to the disease consequent upon scortatory love, which has been term- ed emphatically < Lues Veneria,' the malady incident to pros- tituted embraces. Such is the literal and original meaning of the word ; but like other words, it acquired afterwards a great- er latitude of signification. Thus Claudian the poet Avrites. c Ilinc hominum, pecudumque lues, hbnc pestifer aer ;' alluding to the sufferings of men and cattle ; and Virgil goes a step further, and extends the idea to trees and corn: c Arboribusque salisque lues, et lethifer annus.' 2. Whether ' Pestis is derived from ' pereo,' to perish or to die; or comes from the Hebrew ' paschat,' importing to spoil or pillage, seems not necessary now to be disputed. It is sufficient for the present purpose to show that whether the former or latter etymology be adopted, pestis means some- thing ruinous and destructive ; generally applying to such cala- mities as cannot be prevented by human foresight. Pestilence is therefore coupled by Virgil with the anger of the Gods: ' Pestis et ira Deorum stygiis sese extulit undis. And again there is classical authority for the following: ' Me eruciat sxvopestis violenta veneno ;' showing that the word originally signified almost any unavoi- dable distress ; and, in a limited sense, applied particularly to disastrous sickness, and endemic distempers. QUACKENBOS ON DYSENTERY. H? 3. No person doubts that contages, contagiwn, andcontagio, are fair derivatives from contingo, to touch or be in contact, Their primitive sense doubtless AVas,' Diseases communica- ble by approximation of skin to skin.' Hence these forms of expression apply peculiarly to gregarious animals, as sheep, cattle, and the human species. Creatures of these kinds, her- ding and mingling together, associating Avhile they feed, and when they lie down to rest, are remarkably prone to catch dis* eases by contact. In this strain Melibteus assures Tetyrus that (Virgil, Eel. i. v. 51.) the noxious contagion of the neighbour's flock shall do no injury to his : ' Nee mala vicini pecoris contagia laedent.' The forms of expression, when either of these words is used, are adapted to give an idea of something creeping, or passing off from one person to another—thus: .* Dira per in incautum serfiunt contagia vulgus.' And again j .....----' Dira per omnes Manabant populos foedi contagia morbi.' And also : ' Invadunt totum contagia morbida regnum.' From these authorities it would seem plain, that the popu- lar and obvious meaning of contagion could scarcely be misun- derstood, since it respected merely that class of disorders among men and brutes, which were imparted from one to ano- ther by contact, as they fed, slept, played, and associated toge* ther. Contagion therefore is that peculiar, morbid poison, which is prepared in the bodies of living animals, especially of those which flock and huddle in crowds, and is wiped off, or is com- municated by touch from those that are contaminated, to those which too nearly approach them. Such was the com- mon sense of mankind, while it remained unvvarped by preju- dice and forced meanings. It is a pity that such unlettered, though strong common sense was ever departed from. 4. ' Infection' was certainly derh-ed from inflcio. This word Avas of very various and questionable meaning among the Romans. It is compounded of zn, ncgatiA-e, and facio, to dp, 144 QUACKENBOS ON DYSENTERY. signifying to undo, or rather to violate, to corrupt, to taint, or to tincture any thing. To be a little more particular—the verb inHcio, expressed that property of an agent, by which it emhued the substance upon which it acted, manifestly and gla- ringly changed its qualities, and altered it materially from Avhat it originally vras. The substance or thing so altered was said to be infected. One of the most frequent and distinguishable cases of infec- tion was the change Avhich white cloths underwent by dying. The colouring material, or the dye-stuff, Avas the agent, and the changing or v itiating the Avhite colour by its tinging pro- perty, was said to infect or stain the fabric ; its Avhiteness wa9 alleged to be overcast, polluted, spoiled or undone. So Avhen the clear and fine atmosphere was vitiated by mix- tures obnoxious vapours, and poisonous gases extricated from corrupting bodies, it was declared to be infected. The pure air, like the Avhite cloth, had acquired a foreign tincture; and this effect, Avrought upon the respirable and healthy atmos- phere by the adventitious material with which it was charged, Avas, in a figurative sense, denominated infection. The air so vitiated or corrrupted, so different in its constitution, and so altered from what it was, literally speaking, had become infec- ted, or ' infectus,' that is, undone, or spoiled for the purpose of its primitive and ordinary destination. Air thus vitiated was infected air. In like manner, a healthy animal might be infected by co- ming into an atmosphere of such a tincture, or so corrupted. An external agent of this kind could infect or undo the healthy frame. When this act of undoing, or, in other Avords, of unfit- ting it for the performance of its accustomed and useful functions, was accomplished, the constitution was affirmed to be infected: as was observed in a preceding paragraph, infection was, in one of its senses,, but another term for dying or imparting co- lours. In many forms of distempers excited by pestilential air, there was observed, in addition to the other symptoms of debility, Sec. a remarkable change of complexion. In many cases the patients looked almost as if they had been dyed, or coloured with some tinging material. This confirmed the no- tion of infection having penetrated the body, and wrought a QUACKENBOS ON DYSENTERY. 145 change, as evident to the eyes of others as uncomfortable to the feelings of the individual himself. And by this process of the human mind, it seems to have been accepted and under- stood, that a white garment put into dye-stuff, pure air expo- sed to septic exhalations, and a healthy animal acted upon by a pestilential atmosphere, were all examples of'■infection.' The term was applied to another case. When any thing noxious was added to wholesome drink, it was declared to be infected, that is, to be undone or spoiled for the natural and intended purpose of slaking thirst healthily. The beverage was infected ; i. e. the pure liquor has had something infused into it, by which it has been vitiated or poisoned. Hence the verse can be interpreted : ' Pocula si quando sxvae infecere novercs.' Having thus discussed the history of these words, I shall observe that they all refer to popular and not to scientific dis- tinctions in things. They may perhaps answer well enough for the purposes of ordinary conversation, but possess not suf- ficient distinctness for those of medical and philosophical lan- guage. Considering the matter with the best information I have had, there appear to be but two great operations in nature, for preparing or engendering noxious fluids. The former of these is accomplished by the instrumentality of the living vascular action of animals, and it may be, of vegetables. The latter is produced by a putrefactive process taking place in certain organized bodies after death. To signify these two grand na- tural processes, there ought to be invented tAvo suitable and appropriate terms. But as such an innovation in the technolo- gy of the profession might not be right, I shall employ the two words contagion and infection, to denote them. When noxious fluids are produced by living vascular ac- tion, 1 call them contagion : when they are the offspring of putrefaction, I term infection. But as this subject has been stated with great perspicuity in that valuable periodical work, the Medical Repository ; a work which is an ornament and an honour to our nation, as well as our city ; I shall quote the passage (vol. v. p. ICQ.) T 146 QU U'KFNBOS ON DYSENTERY. ' That vitiated product of living vascular action, which can excite in a well person a disease like that by which itself was produced, and continue indefinitely to do so after being trans- ferred from one body to another, will be denominated conta- gion; and lues, vaccinia, measles, and small-pox, will be con- sidered examples of it. On the other hand, that venomous offspring of putrefaction going on in some of the kinds of orga- nic matter after death, or separation from the living frame, which disorders the healthy functions without being specifi- cally communicable, and Avithout the power of communicating itself, will be called infection ; and typhus, dysentery, plague, and yellow-fever will be given as instances.' CHAP. II. MEDICAL AND PHYSIOLOGICAL CONSIDE- RATIONS. WE now proceed to the medical history of our subject. In describing this, Ave shall depart from the common mode of mentioning the symptoms, diagnosis, £cc. and offer such reflections as have occurred. It appears evident that the combination of elementary sub- stances, which, Avhen applied externally, would occasion the disorders commonly called ' fevers,' would do the same, if they came in contact with the internal parts. This is well shewn in a piece published first in the New-York Magazine, in 1797, and afterwards in the Medical Repository for that year. The principal points which appeared at that time, Avere, that septic acid frequently existed in the alimentary ca- nai as an exciting cause of fevers, and that neutral salts were more useful than other cathartics in such cases, because a great proportion of them could neutralize that acid by means of the superior attraction existing betAveen it and their alka- line bases. Doctor William Bay, who graduated in physic, in May, 1797, in this college, chose Dysentery as the subject of his Inaugural Dissertation ; and having adopted the above princi- QUACKENBOS ON DYSENTEBY. 147 pie, endeavoured to shoAv that if septic acid was the exciting cause, neutral salts, in which pot-ash and soda are united to the weaker acids, were very efficacious remedies. This disserta- tion fell into the hands of the monthly reviewers in London, and the Aviiter of the criticism upon it rejected the doctrines contained in it both practical and theoretical. And more re- cently, in one of the numbers of the Monthly RevieAv, for 1801, the writer of the criticism upon Dr. Chisholm's Essay on Malignant and Pestilential Fever, speaks disrespectfully of that excellent work, because the author has advanced doctrines derived from the same source.* Anatomists have agreed that the cuticle reflected or con- tinued over the lips at the mouth, passes down the pharynx and oesophagus, and after lining the stomach and intestines, both small and great, is connected again with the true skin at the verge of the anus. The inside of the body then, or what is called the alimentary canal, in all its turnings and windings, is a surface coated with an epedermis in connec- tion Avith the muscular, vascular and nervous parts beneath, without the intervention of a true skin. It resembles, in this res- pect, cicatrization on the limbs, or other external parts of the body where spots that had been ulcerated, are skinned over af- * Vide the note, page 14 of Chisholm's 2d volume. ' See the case of the manufacturers of soap and candles in the city of New-York, stated and examined, &c. published by the association of tallow-chandlers and soap-makers.' The advocate employed on this occasion was Dr. Mitciiill, the in- genious and learned professors of Chemistry in Columbia College ; and the scientific knowledge, the general erudition, the good sense, and the elegant language displayed in the course of his argument, in support of his clients, must secure the admiration and applause of those who read his Remarks on the Proceedings of the Legislature of the state of Ncw-'iork;' ane his ' application of the Mitchillian Doctrine of septic fluids, to the processes carried on in several branches of handicraft business, particularly the making of soap and candles,' 8cc. Without a hyperbole, he may ' be considered,' touschisoAvn language, ' as having caught nature in her work-shop, exa- mined her collection of raw materials, and discovered which of them she employed in this fearful manufacture (the acid of putrefaction or infection,) which, like the poisoned shirt of Hercules, enwraps the wearer too closely to be shaken off.' p. 33. 148 QUACKENBOS ON DYSENTERY. ter a destruction of a portion of the cutis vera. Such places are tender, and more liable than others to accidents. We call the stomach and intestines a part of the internal structure of an animal. There is one sense, in which this is hardly correct, oris apt to mi dead. Their internal structure is as much an inside as the barrel or bore of a frump is the in- side of that machine. They are open at both extremities, the substances they transmit are forced in at one end, and expelled at the other, or at some intervening outlet. Air and water move easily through, and are applied freely to their insides as well as to their outsidcs : and besides those two fluids, a vari- ety of substances mingled Avith them, even to the thickest con- sistence that can pass the valves, are pushed along their Cavi- ties. The bore of a pump is thus, strictly speaking, an out- side surface, or at least as commonly and indeed more expo- sed than that which is ordinarily termed the outside. The perforation through the body of an animal, extending from the mouth to the anus, ought to be deemed an external surface, Or, at least, a surface as much or more exposed to harm and accident, than any part of the external or cuticular surface. It Is the thoroughfare of every thing put into it for the purposes of hunger, thirst, gluttony, intemperance, and medicine. The alimentary canal being thus, like the pump, in almost constant action, and besides the perpetual conduct of foul and noxious matters, will often get out of order, and of course stand in need of frequent repairs. One of the accidents to which this internal apparatus is fre- quently subjected, is called l Dysentery,' and has been known by a synonymous Avord from a remote antiquity. Such persons as subsist chiefly on oily, gelatinous, farinace- ous, and saccharine food, are very little incommoded by this disease. On the other hand, the A-ictims of its violence are commonly such as eat animal food heartily, particularly that which is lean. In the American and British service, both by sea and land, dysentery is nearly connected with the beef-ration, which is dealt out to the seamen and soldiers. Our experi- ence in Xav.--York has convinced us of the readiness of beef to corrupt, and of the offensiveness and virulence of the gases which exhale from it during that process. We know these QUACKENBOS ON DYSENTERY. 149 vapours have very often produced dysentery in the repackers and salters of beef, who were exposed to it. And from a vari- ety of testimony it may be concluded, that this deleterious elfluAium from beef is septic acid (the acid of azote) in a vola- tile form. Of a number of persons exposed to this septic effluvium, some were seized with dysentery and others with fever. Such a disposition and quality we knoAV to reside in beef, which I have given as an example, and doubtless inhere in all other lean animal substances. Beef, in a corrupting condition, called tainted or semi-pu- trid, is not an uncommon article of diet in armies and navies. Whether this vitiation arises from the small quantity of mu- riate of soda (sea salt) or from an adulteration of the muriate of soda applied, or from an inherent predisposition in the beef to spoil, the ultimate effect is nearly the same. It becomes charged with that acid, which is capable of producing those mischievous effects in the alimentary canal, the aggregate of which is denominated Dysentery. Or, as the septic poison in the meat acts upon a secreting surface, it may cause a. flux in some constitutions, as well as a dysentery in others, and act as a cause of some species of diarrhoea. If absorbed, it stimu- lates the sanguiferous system to morbid action, and induces that condition thereof called ' Fever.' Being of an acid quality, it irritates the orifice of the common bile-duct, and provokes a more free secretion and supply of the gall. This alkaline fluid from the liver, in moderate forms of disease, is general- ly excreted copiously, and thus neutralizes the exciting cause. As the bile is plentifully prepared and discharged, the diseases in which it abounds arc commonly called ' Bilious ;' and the ordinary opinion is, that the bile itself is the peccant matter or cause of the malady. But this notion is very erroneous. The bile is but the effect and not the cause. And the reason where- fore it runs so readily and plentifully, is to correct the mis- chievous quality of the offending cause in the stomach and intestines, whether engendered there or taken in from Avithout: accordingly, some of the Avorst forms of dysentery, and other malignant distempers, are those in which the bile is excreted from its viscous in scanty proportion, or not at all. Though the alimentary canal may receive, the septic acid 150 QUACKENBOS ON DYSENTERY. or exciting cause of dysentery from the atmosphere, or in tain- ted beef or other lean animal substance, these are not the only ways by Which it may come in contact with the stomach and intestines. Lean animal matter, as beef, mutton or fish, may be eaten in its entire and uncorrupted state ; but it may be so long retained in the body, especially in the large intestines, that it may corrupt, and septic acid be formed from it there; and this accident is very liable to befal those persons who are subject to indigestion and costiveness, or, in other words, who are not regular in respect to alvine evacuations. In such cases scybala may be formed in consequence of too great absorption of the fluids of the intestines, and from the residuary lumps of hardened fxces, containing some septic acid, and engender- ing more, is the spasmodic,condition of the colon induced. A cause of dysentery may thus be received into the body from Avithout, or it may be produced within it from the decom- position of such articles of food as contain septon or azote. The former is the distemper deemed* infectious or endemic ; the latter, the sporadic. But it may so happen on board a ship or in a camp, that many persons of a crew, or a detachment fed on similar rations, may fall sick together from the unwhol- some quality of their food, Avithout any vitiation in the air at all; and the disease, though strictly sporadic, may thus assume the guise of an endemic. The like may happen in neighbour- hoods and districts in the country, Avhere the inhabitants live very much alike, or subsist on nearly similar articles of of diet, and feed on meat cured with muriate of soda (gene- rally adulterated, and rarely or never purified in America,) bought at the same store, and part of the same parcel. If there should happen a condition of the digestive organs, wherein the gall should cease to flow at a time when oxygenat- ed septon from any of the sources already mentioned, abound- in the alimentary canal, disease might be expected to ensue. But such a disorder would not be a mere jaundice, from a re- tention of bilious matter tinging the skin with an icteritious or y< iiow hue, but would be a disease from poison, causing the stomach and upper intestines to invert their motions and ex- pel their contents ; creating pain, flatulency, heat, and inward distress ; and stirring up more or less of' fever' by an imbibi- QUACKENBOS ON DYSENTERY. 151 tion of some of the septic venom: to all Avhich there might be superadded the peculiar and characteristic symptoms of dysen- tery. For violent fits of the American yellow fever have oc- curred in Cases where the stomach and intestines had been much disordered, terminating favourably after tormina, te- nesmus, and slimy stools mixed with blood. Whence the connection between yellow fever and dysentery can be discern- ed ; both arising from the same general cause, and chiefly dif- fering in the part of the body particularly invaded by that cause. Dysentery may exist without being accompanied with yellow fever, and yellow fever may arise unattended by bloody-flux, Yet though it may be easy to distinguish the extremes, there is nothing more difficult than the establishmant of the limits between the two, in cases where they are blended and incor- porated with each other. In short, though JVosology may dis- tinguish, and sever and place them far asunder, science, Avith better information, traces their genealogy from one original, and finds them intimate kindred, descended from the same parent. This is by no means a new opinion. If Ave look back into history, we will find that the ancients were also well acquaint- ed with this fact. Diodorus Siculus, who has always been considered a correct and faithful historian, (lib. xii. cap. 2.) gives an account of the expedition of the Athenians under Eu- rymedon and Demosthenes against Syracuse. This was about the 410th year before the Christian xra. A plague broke out in their camp adjoining the city, OAving to an offensive marsh in the neighbourhood, and raged and increased to such a de- gree, that a great part of the army perished. Diodorus (lib. xiv. cap. P.) describes, with some detail, the distemper which invaded the Carthagenians in the year before Christ 394, when encamped on the same ground, near Syra- cuse, that had been formerly occupied by the Athenians. He calls it a ' plague;' says it was first ascribed to the vengeance of the gods, for the rifling and plundering of the Temples of Ceres and Proserpine. But he considers the place itself as the great occasion of the disorder. The ground was marshy and spungy—great multitudes of men were thronged together «—it was summer-—the nights were chilly and the days intolera- 153 QLACKENBOS ON DYSENTERY. bly hot—the pestilential air av as blown upon them by a south* crly Avind—there Avas no idea of importation from foreign pla- ces—the symptoms avc re catarrhs and swellings of the throat, which were caused by the stench of the bodies that lay unburi- eti, and the fiutrcfaction of the soil. Then followed fevers; pains in the back, heaviness of the loins, dysenteries, blotches and boils over the Avhole body. Some ran mad, beating every one they met.' The exciting cause of dysentery being knoAvn, there is no difficulty in administering remedies which, in most cases, Avill destroy or expel it. From the known efficacy of alkaline salts to correct putrid taints and tendencies in beef, and in all animal substances, pot-ash and soda present themselves first on the list of anti-dysenteric remedies. We know they can correct offensive and virulent qualities of the faeces out of the body, or in beef after it has been eaten, and naturally enough can believe they will act in a similar way in the intestines, pro- vided they can by any means be conveyed there. Notwithstanding the prejudices of some against the em- ployment of alkalies, and the belief of others in their being un- wholesome and improper in the extreme ; that acids are the great and useful antiseptics, and of course, by the rule of op- posites, that alkalies are endowed with qualities directly the reverse : notwithstanding all this, I am one of those who haA-e an entire confidence in the superior excellency of alkaline medicines. It is knoAvn that in some parts of our country the persons who practise the veterinary art, give to horses, and other crea- tures, weak alkaline ley, made by boiling wood ashes in water, for the colic and scowers. And occasionally the country peo- ple will, in similar diseases, take some of the like medicine internally for their own relief. Besides, it is said that during a severe dysentery Avhich prevailed among the Indians near De- troit, soue years ago, the prescribers of medicine among the savages administered weak ley of pot-ash to the sick, and with admirable success. A strong solution of muriate of soda, diluted with a third of sharp acetic acid, has been often administered to dysenteric QUACKENBOS ON DYSENTERY. 153 patients, as is credibly reported, Avith excellent effect. After recommending this remedy, and witnessing the operation of the brine, swallowed as hot as the patient coul I bear, in doses of two or three table spoons full, repeated frequently, I have had reason to think favourably of it, as an antydysentcric pre- scription. And Avhat seems more capable of being deduced in favour of alkalies in the intestinal canal, is the knoAvn constitu- tion of the gall; a secreted fluid abounding with the very al- kali which is the basis of common salt, and in times of health perpetually mingling with the alimentary mass, for the pur- pose apparently of preventing its degeneracy to something noxious. It seems therefore clear, that a solution of carbo- nate of soda in water might be employed at anytime in aid of the bile, or in some measure as a substitute for it if deficient, and thus allay the uneasiness and pain frequently caused by it. We knoAV that gall has been long employed by dyers and scourers to cleanse silks and delicate stuffs, and to free them from spots and stains; it is therefore not improbable that this saponaceous liquid acts in a like manner in the alimentary ca- nal, deterging and cleansing the whole passage, as far as its strength and virtues extend. Alkalies promise to be useful on another account. The discharge per anum in some of our pestilential and dysenteric diseases, arc so sharp and corrosive as to excoriate the skin around the anus, and to excite inflammation almost Avherever they touch an external part. * When shirts, sheets, or draAv- ers are besmeared with these or any other kinds of faecal mat- * In Lowthorp's Abridgment (Phil. Trans, vol. iii. p. 232.) may be seen an account of Mr. Baylc's Experiment related to the Royal Society in 1664, of the antiseptic poAver of fine uri- nous spirit, or spirit of sal ammoniac, in preserving blood yet warm from the veins, from coagulation and from putrefaction a long time. This experiment, he says, he devised to show the ' amicablcncss of volatile spirits Avith the blood.' In the same volume (page 115) in a paper on dysentery, may be seen the writer's opinion that the sharp corrosive hu- mours in that disease, ' are of the nature of aqua foriis and spirit of nitre, and which eataw.iy the tunicles of the intestines and mou'iis of the vessels.' For'correcting this he adds ' the absorbent earth crabs-eyes to his prescription.' u 14 QUACKENBOS ON DYSENTERY. matter, alkaline leys are ahvays competent to destroy their their activity, to carry them off, and to leave the garment clean and uninfected in the hands of the washer. If alkalies can accomplish these desirable objects in alimen- tary egesta immediately after their evacuation, there remains no doubt of their capability to accomplish as good a purpose, jf injectedinto the intestinum rectum, and made to penetrate the colon itself. In addition to all this, it seems to be established as a truth, that in those parts of the United States where carbonate of lime constitutes the great strata of the earth, and where of course the water contains a considerable quantity of lime in so- solution, dysenteric complaints are comparatively rare aud mild. The lime-water Avlich the inhabitants of these situa- tions constantly drink, acting always as a preventive of the disease, or as a corrector of its exciting cause within the body. We shall next consider which of the alkalies will be pre- ferable, and also Avhat form or combination of either will an- SAver best the purpose of prescription. To give the alkalies in their simple or caustic condition would be injurious: the disease would be aggravated, not cured by such harsh medicines. I begin with pot-ash (salt of tartar) and Avould give the car- bonate in dysentery, making a solution of it of such a strength as, on being tasted, should not affect unpleasantly the mouth. To this, sugar may sometimes be added to help the taste. A table spoonful may be given every quarter or half hour, accor- ding to circumstances, until the patient experience relief. And in order to render its effects more speedy and certain, encmataof the same Aveak alkaline solution should be given from time to time, either alone or with broth or starch ; occa- sionally with the addition of a small quantity of thebaic tinc- ture to the mixture taken by the mouth, as well as to that ad- ministered per anura. Much benefit will, I presume, be derived from this mode of treatment. On trials with carbonate of magnesia, it appears to be not sufficiently strong and efficacious. Its powers are greatly in- ferior to carbonate of pot-ash. Though its qualities are good QUACKENBOS ON DYSENTFRY. 15j as far as they go, yet they are, however, too feeble to be relied on in cases where decisive and energetic practise is required. The disagreeable taste of pot-ash is sometimes objected to by patients. When this happens, carbonate of soda may be employed. This is much less unpleasant, and may be tasted and swallowed with ease : indeed, on reflecting that soda is the basis of the bile, and of the culinary salt, which we con- stantly and by instinct as it were, swallow with our food, it appears to be more natural and friendly to the constitution than either pot-ash or magnesia ; and forthis reason it is that neutral salts, with a basis of soda, are preferable to all others, for their efficacious, safe and kind operation. The bringing them more generally into use would be a great improvement in the practice ofphysic. The formula of giving carbonate of soda in dysenteric cases is, a solution in water strong enough to be taken into the mouth and stomach without smarting, or any other inconvenience. The dose is from a tea spoonful to two or three table spoons- ful ; and the times of administration are every quarter or half hour, or every second and third hour, as the symptoms seem to require. Portions of the same solution are applied in the form of glister, to be retained ; and they are very useful and efficacious in allaying tenesmus, and diminishing the frequen- cy of evacuations. ' I havre seen several cases of dysentery cu- red with this plain prescription in the two modes just menti- oned. Sometimes, however, the carbonate of soda may be dissol- ved in mint-Avater, instead of common Avater: and occasionally the addition of some laudanum, where the patient suffers much pain, has had a happy effect. I think Avhere alkalies are prescribed there need be less hesitation to administer opi- ates than in conjunction with any other remedy. Doses of el. ricini, or of ol. olivarum, may be occasionally interposed with advantage, as mild oils have a tendency to obtundthe acid ex- citing cause of the malady. The same quality probably belongs to all fat and greasy substances that are not rancid. On the contrary, lean meats are found universally bad for dy- senteric patients, who ought always to be interdicted their use. I have known a convalescent, relapse into dysentery after eat- H6 QUACKENBOS ON DYSENTERY. ing a dinner of beef, lor food we would recommend rz'rr, tapioca, sago, panado, and generally farinaceous and saccharine substances; and likeAvise soups and jellies, if the sick have an inclination for them. In all these kinds of food an advantage Avould be derived from sprinkling in as much muriate of soda as can be conveni- ently and agreeably done. By these means the alimentary canal can in general lie sufficiently alkalized. We alkalize our clothes and the outer surface of our bodies with solutions of soap and weak leys, to keep ourselves clean and healthy. The intestines arc alkali- zed by the bile, and their internal surface is protected by the mediation of that admirable liquid, which is prepared and applied Avithout our knowledge or concurrence, by the most excellent provision in the animal economy. W hen the gall is insufficient, it becomes the physician to alkalize the intestines and their contents, by something as nearly allied to the bile as he can find. Soda is such a substance. Perhaps camomile, gentian, or some other bitter, Avould improve it, by making it resemble the natural secretion more nearly. The carbonates of pot-ash and soda seem to be better in dy- sentery than the combination of those simple salts with stronger acids. They are more easily decompounded, and while the septic acid of the intestines joins the alkalies, to form septies of pot-ash and soda, the carbonic acid is extri- cated to produce the agreeable effect of Avhich it is supposed capable, and for which it has been long celebrated. But it ought to be remembered that the tartritcs of pot-ash (soluble tartar) and of soda, (Rochclle salt) and phosphate of soda, by Avhich is meant the compound formed by mere muriatic acid and soda, and not the adulterated and heterogeneous compo- sition forming the sea-salt commonly in use. No objection ought to arise against the use of these alkaline remedies, in ordinary cases, as being too fiery and pungent; nor even in cases of inflammation and ulceration of the intestines: for it is shoAvn, in a memoir in the Medical Repository, by Dr. Mitchiil, that carbonates of pot-ash and soda are very substan- tial helps to the surgeon, when applied to the surface of foul and eroding ulcers. And from their internal use, another QUACKENBOS ON DYSENTERY. 157 good effect will ensue : the fxces will possess very little fator, and no infection. Nurses and attendants may perform their services commodiously, and Avithout hazard of catching the distemper. Under the use of these remedies it can never spread. Alkaline remedies, excellent as they aro, may be abused; and for want of proper care in their administration and conti- nuance the customary good effects may not be produced by them: but they can do a great deal; for they can overcome the acid exciting cause of the dysentery, and prevent its further mischievous operation upon the intestines, andzV* absorption into the system. They may do all this, and yet not be capable of curing every case that presents. Inveterate dysenteries and fluxes will often baffle medical skill, and end fatally, in opposition to alkaline and all other remedies. After the stomach has lost, in a considerable de- gree, its power to digest, the liver to furnish bile, the lacteals to imbibe their appropriate fluid, and the intestines to perform their peristaltic movements, there is no great prospect of re- covery, even though the exciting cause of the malady should have been entirely expelled from the body. Still it appears, from repeated trials and careful observation, that the alkaline plan of treatment Avhich we have described, is preferable to every other. Rhubarb, ipecacuanha, cerated glass of antimo- ny, calomel, and Peruvian bark, seem to be very inferior re- medies. None of them promise to do much good, further than as they operate as cathartics. And for a purgative pur- pose, the neutral salts which we have enumerated possess a decided superiority. b *.N INAUGURAL DISSERTATION, ON THE EFFICACY OF CERTAIN EXTERNAL APPLICATIONS, SUBMITTED TO THE EXAMINATION OF THE REVEREND JOHN EWING, S. T. P. PROVOST; THE TRUSTEES AND MEDICAL FACULTY OF THE UNIVERSITY OF PENNSYLVANIA, FOR THE DEGREE OF DOCTOR OF MEDICINE; ON THE TWENTY-SEVENTH DAY OF MAY, A. D. ONE THOUSAND EIGHT HUNDRED AND TWO. BY HENRY JACKSON, OF SAVANNAH, GEORGIA, HONORARY MEMBER OF THE PHILADELPHIA MEDICAL AND CHEMICAL SOCIETIES. i J\lon recito cuiquam, nisi amicis, idque coactus* Hor. INAUGURAL DISSERTATION. THE period of the first application of medicines, to the external surface of the body, must have been very remote. The practice is, probably, to be ranked among the first attempts that were made, in the early infancy of our science, towards the removal of disease. At a time when chemistry had not yet discovered the different metallic preparations, or experience ascertained the nature and dose of the active vege- tables, medical prescriptions were necessarily confined to external formulae. Accident may have first suggested their utility. The common incidents of life must have afterwards established it. The relief afforded in febrile head-ach, by the application of cold water, or of a cool green leaf; the allevi- ation of pain in other parts of the body by means of warm fo- mentations, the gentle friction of the hand, emollients, sina- pisms, and blisters, must all haA'e tended to the confirmation andcontinuanceofthepracti.ee. Accordingly, if we consult the materia medica of those people who have made but little improvement in the medical art, we shall find it to be compo- sed chiefly of such articles, as relate to external application'; such are the hot and cold bath, frictions, the potential caustic, and fomentations of different herbs. The majority ofthese items arc, at present, among the principal remedies of the Indians of North-America. 161 JACKSON ON EXTERNAL APPLICATIONS. In proportion, however, as the number of our medicines has increased, by the assistance of chemistry,, natural history, and repeated experience, the manner of administering them has undergone a material change ; and, at the present day, external application;., by being limited to local affections, to certain parts of the body, or to certain stages of a particular disease, may be said to be almost deserted. Whether or not this change has been justified by their deficiency of effect, o? a Avant of success in their use, the folloAving observations and experiments, may, perhaps, tend to show. THE practice of applying medicines externally, is founded on the intimate connection of the skin, or external surface of the body, with every part of the system. This connection, oh whatever it may depend, is illustrated by many familiar phe- nomena of life, both in health and disease. The langour and debility experienced on a hot summer day, the hilarity of mind, and activity of body occasioned by the coolness of a sub- sequent evening, are instances of it; as well as the very sen- sible effects produced on the system, in regard to appetite, activity, gaiety, or the exercise of .body or mind, by the sudden changes of our variable climate, in every season of the. year. On this connection depends, also, that pleasing, though inde. | scribable sensation, Avhich eAery one must have experienced | from a change of linen and fresh garments—a species of self- j feeling, the gratification of which, forms, perhaps, the only | justifiable luxury, as its indulgence, however far carried, can .tend only to the preservation of health. In some persons we find the effects of this change to be very remarkable : an in- stance of which is mentioned by Dr. Rush, in a gentleman to the soutfiAvard, who has always recourse to it with effect, in order to remove an approaching fit of hypochondriacism, A fLnnel shirt will excite, in a person unused to its irritation, a slight degree of fever; and, on the contrary, a departure from the usual quantity of dress, or of bed-cove; inc, au;i jAckson on External applications. 162 occasion a catarrh, or a pleurisy. So intimate, yi fact, is this connection, thatan unusual, though apparently a very inno- cent impression, will produce sometimes a very alarming dis- ease ; in proof of which, there are instances of persons, du- ring the late Avar, who Avere_seized Avith convulsions, the first night they exchanged, the earthen floor for the feather bed. In disease, we find this connection to be equally, if not more strongly manifested. The powerful effects of cold appli- cations to the skin, in hamorrhagy, the varying state of the skin itself, according to the state of the disease; and its affection as a premonitory symptom of disease, all evi- dence it. Hence the reason of its having been considered by physicians, as early as the first annals of medicine, as of the first importance in forming a prognostic of the favorable or ' unfavorable issue of any general affection. Do not all these circumstances, whilst they demonstrate the connection of the skin with the system, point out the pro- priety and utility of external applications ? Anotherobsen'ation cannot but tend to strengthen this inference—-it is, the ex- tension of this connection in a state of health, to the mental part of our frame, by the common observation of mankind, which has long since made the colour of the countenance an index of the disposition ; and Avhilst the blooming lively front has been considered as the attendant of a generous and open temper, the pale lived complexion has been received as the mark of one that is cold, selfish and contracted. We find this connection, hoAvever, to exist in a much more sensible dep;ree, between the surface and particuLvr parts of the system than others. The sympathy, as it is termed, be- tween the skin and stomach is the most important, and appears* to have given rise to the application of the generic term to connections of this nature. On it depend many physiological and pathological phenomena. The increase of the digestive poAvers by the external application of cold, the flushing of the face after a meal, the cure of sickness by a blister, of a diarr- hoea by aflunnel shirt, and many others, are to be referred to this important connection. This consent between the skin and the stomach, has been exemplified by two facts, so very decisive, it would be unpardonable not to mention them par- \ Jw ;;s JACKSON ON EXTERNAL APPLICATIONS. ticularljj. The first is the well-known cxpeiiment of Doctor Hartley on a dog, to which he gave the nux vomica, and then beat him severely. The action excited on the surface, pre- \ vented the operation of the drug on the alimentary canal, and / no sickness ensued. The other is mentioned by the celebrated DarAvin, and is still more to our purpose. ' Two dysenteric patients,' says he,' in the same ward of the Infirmary at Edin- burgh, quarrelled, and whipped each other severely^for along time with horsewhips; both of them were much better after it.' The success that attended Dr. Seaman's remedy, in NcAv-York, in a case wherein a quantity of opium had been ,-*.. v taken, Avhilst it is a proof of this connection, is a further con- firmation of the utility of external applications. A second particular connection of importance, appears to exist between the skin and the mind, but, whether this is effected through the medium of the stomach, oris independent of it, may, perhaps, be doubtful. The remarkable connection V /v — k between the stomach and the mind, so great as to influence y\«A the views, the desires, and the passions of man, and to have ^ i^ led, formerly, to the supposition that it was the seat of the \ *'" soul, may account for the sympathy that exists between the skin and the mental part of our frame. That there is a connec- tion, is proved by the effects of a fresh change of garment*, mentioned before, and by the common observation of mankiad. The effects of a cold Avet day on our tempers as well as on our ability of mental exercise, must have been often experienced by all, and the influence of the passions on the skin, particu- 1 larly of fear, is almost too obvious to need a remark. Let it suffice to say, that the melancholic temperament will still con- tinue to be known by the hardness and dryness of the surface, and the choleric, on the contrary, by its softness and moisture. 11 "Lj VkM- 0*4'}•* AmonSthe external applications in use at the present day, ^ .'. nJuM-the PrinciPal are rinapisms, blisters, frictions, and various oint- vif^ fV^ menls' the manner of administering which, seems to have been left chiefly to the judgment or caprice of the practitioner. In a department of medicine, however, which, from the fore- JACKSON ON EXTERNAL APPLICATIONS. 164 going observations, would no doubt be of the grcatestjitihty if duly attended to, some care ought to be exerted in selecting ^ft/Y- those parts of the surface, which appear to possess a more ultimate connection with the whole or with parts of the sys- tem. Are there any, that on this account deserve particular regard? Yes—the connection between the fjee£ and the gene- 1 i_^A ral system is so great, that they have been considered as the J second greatest avenue of disease. To be convinced of this, we have only to reflect on the catalogue of morbid affections, induced by their imprudent exposure to cold or wet; and on the advantages resulting both in health and disease, from a careful preservation of their warmth, by the habitual use of flannel socks. Illustrative, and in proof of this connection is (y f : the practice of the .untutored Indian, who, when obliged to '*>.,}\ \ pass a night in the Avoods, is careful to place his feet as near \ as possible to the fire, neglectful of the position of the rest of his body ; and by a provident attention to this apparently tri- ; fling circumstance the lives of two persons Avere preserved, whose progress in an open boat, across the DelaAvare Bay, was impeded by the ice, and who Avere obliged to pass the \ whole of a severe Avinter night in this situation, without any other covering than Avhat a single great coat could afford them *. This intimate connection has not escaped the dis- cernment of physicians, and the feet accordingly have been the subjects of external application, whenever any powerful im- pression has been intended to be made on the system. Itis not, however, sufficient to vieAV them, merely as the parts to Avhich a cataplasm or blister may be occasionally applied. * As a more extensive knoAvledge of this circumstance may a (\ be the means of saving the lives of others, Avho are so unfortu- Jr<\t ( ^ nate as to be placed in a similar situation, I shall take the | ^Aa liberty of relating it as delivered from the chair of the practice farJ**^ of physic. The gentleman who Avas present, finding that l/ their efforts to reach the shore AArou!dbe unsuccessful, ordered his companion to seat himself in the bottom of the boat, to pull off his shoes and stockings, and open his bosom. Having done the same, and seated himself opposite to him, each pla- ced his bare feet against the breast of the other. Thus inter- locked, Avith the great coat thrown over them, they passed a very comfortable night. The ice the next morning was suffi- tntly strong to enable them to reach the shore Avith safety. 165 JACKSON ON EXTERNAL APPLICATIONS Their connection Avith the system, entitles them to a more di- h (>■ versified regard. This is evident from the happy effects of S\J\ Dr. Cullen's prescription in a case of obstinate costiveness ; W j s after eA-ery remedy had been tried Avithout success, he ordered (jj * his patient, the duke of Argyle, to walk bare footed over a cold slab of marble—The consequence was an effectual catharsis. Next to the feet, the wrists and ankles appear to be the o-.ost eligible parts for external appplication, as possessing the \ , vA-A* * most intimate connection with the system, a pre-eminence i h *"> that depends, probably, on the superficial situation of the t.yjV* bloodvessels. Isthespjne, in this respect, entitled to any par- ^ i . ticular regard, as the country practice of curing intermittents, ^ 1 by anointing it Avith turpentine, Avould seem to indicate ? Of the importance of the epigastric region, so near the capitolof the system, I shall say notl ing; to enumerate its points of superiorty Avould be to relate the principal features of the ani- mal physiology. ^ i.f^ vA Before I enter on the consideration of the folloAving parti- cular external applications, it is necessary to remark, that the experiments relative to them, were all performed on a subject pO1 in a state of perfect health, and that consequently there I should be some allowance for the greater difficulty of making I an impression on the healthy, than on the morbid system. That this is the case, Avas evident from the greater length of time requisite for the sinapisms of mustard, garlic, horse- radish, &.c. to produce their effects. Fully aware, moreover, of the fallacy of experiment, pi 'icularly as it relates to the mere frequency of the pulse, I underwent, what may be term- ed, a preparatory test, and found that by sitting still, with nothing on me but a flannel morning gown, the state in which I the greater part of my experiments AVere performed, the fre- quency of my pulse was diminished tAvclve beats in a minute. It must however, at the same time be observed, that this dimi- nution in feequency Avas not attended by a diminution in any other respect. The fulness of the pulse appeared to inciease JACKSON ON EXTERNAL APPLICATIONS. 160 in proportion as its frequency was lessened. These consider- ations will be applied by the candid reader to the individual experiments. SWEET OIL. In Italy there has existed, for many years, the practice of (\j[^ (y^v/V anointing the body Avith olive oil in fevers—a practice that has been strenuously recommended by the physicians of that country. This remedy has been used, not only in inflamma- tory, but a}so in bilious, and what have been improperly term- ed putrid fevers. Professor Murray, hoAvever, from theory I fancy, and not from observation, objects to it, and adds, as the reason, ' that it cannot fail to debilitate the stomach, to pro^ duce nausea and vomiting, and from the strong smell which heat soon gives it, to corrupt the bile and increase the fever.' Suspicious that a practice so ancient, and so strongly recommended, could not be perfectly inert, and to see tho effects of olive oil when applied to the surface of the body, I underwent the folloAving experiment: Having breakfasted at eight o'clock—at ten, my pulse beating seventy-six strokes in a minute, its natural standard, I undressed entirely and thrcAV QArcr myself a flannel morning- gown, in which situation my pulse descended to seventy-tAvo. About a quarter after ten, my Avhole body Avas rubbed over with oil, in tAvcnty minutes after Avhich there was a very per- j ceptible diminution in the force of the pulse, though its fie- j quency Avas little affected, varying betAvecn sixty-eight and seventy-two. At twelve o'clock the application was repeated, Avhen a still further diminution in the force of the pulse took place—in tAventy minutes after it AVas Aveak, greatly contracted in its volume, and its frequency lessened to sixty-two. This diminution in force and frequency continued till two o'clock, Avhen a third application Avas made, Avith a further diminution of frequency to fifty-eight. Every stroke of the pulse Avas now perfectly insulated and distinct. At four o'clock, six hours after the first application of the oil, the diminuion in force still the same, the frequency at sixty, eai impatience 167 JACKSON ON EXTERNAL APPLICATIONS. resulting from the irksomeness of the situation, made mc put an end to the experiment. IknoAV not Avhether the increase ordecrcasc of the irrita- tive motions has any effect on our sensations, but about half after tAvo, Avhilst the pulse Avas at fifty-eight, I never in my jlife experienced a stronger sense of the lingering lapse of Yurie—.the space of a minute seemed to be immeasurably ex- , tended. To impatience I cannot ascribe it, for the satis- f faction arising from the issue of the experiment, as far as it had been tried, made me anxious for its continuance. From this experiment, the rationality of the Italian prac- tice is evident, and Professor Murray's apprehensions, of de- bilitating the stomach and corrupting the bile, turn out to be perfectly visionary. A quarter of an hour after the oil was Avashed off, I dined, and felt no difference in the strength and ability of the digestive organs. Twice Avas this experiment performed with the same result. Had time permitted me, I should have made a third trial Avith it, in order to have watch- ed its influence on the different secretions. Can Ave, from the result of this experiment, account for the practice of anointing the body with oil, so common among the ancients, and at this day, among the inhabitants of warm climates? It is used in this manner by the people of Africa, and in some parts of Asia; and Captain Cook informs us, it is a particular custom among the inhabitants of the islands of the Pacific Ocean. Mr.Nicbuhr, in his travels through Asia, mentions it in terms that are very pertinent: ' The Arabs,' says he, ' pretend that this unction stengthens the body, and wards off the heat of the sun, to which, by going almost naked, they are very much exposed.' The ancients considered the x\j\ external use of oil as essential to the preservation of their Hf health and vigour, as is shewn by an anecdote related by Pliny, ,, J\ > Wherein Pollio Romulus, Avho Avas above an hundred years old, \>%! in answer to the question of Augustus, hoAv he had so effectu- ■ ally preserved the vigour of his body and the poAvers of his mind, replies^ By the internal use of mulsum and the ex- ternal use of oil.' Does it promote longevity, as Lord Veru- 1am supposed, by preventing the too great perspiration and JACKSON ON EXTERNAL APPLICATIONS. 168 SAveat, or by diminishing arterial action, does it prevent the too great exhaustion of the excitability ? The external use of oil in fevers, has not been confined to fyj& >■ Italy. It has been used, at Grand Cairo and at Smyrna, in the ,~ plague; and, also, according to Piso, in the fevers of South- ; America. Would it be serviceable in every state of fever? Its sedative influence evidently appears from the foregoing .. , experiment, and there can hence be no doubt of its utility in fevers of great morbid action—but, would it not be of equal, nay, of greater utility in those states of fever, Avherein there is a high degree of cutaneous excitement, and wherein the application can come in contact Avith the very seat of morbid action ? It is a remedy so innocent, and the prospect of service from it so favourable, that a few trials with it should not be neglected. Oil has been used externally in other diseases, as Avell as (j\J*. XA-- fevers, strictly so called, particularly in dropsy; and its sue- ^ "■, cess, in a number of cases, has been announced to the world, by Dr. Oliver, in the forty-ninth volume of the Philosophical Transactions. The same success seems to have been experi- enced both in Germany and France, though, with respect to it, as with all other remedies, there are exceptions, and cases in which it appeared to be entirely inert. Friction was, in H ^ j ^ ^ every instance, conjoined with it, and it is difficult to say, ( from the known efficacy of friction in dropsy, how much is to \ be justly ascribed to the oil itself. Since, however, from a \more just pathology of this disease, dropsy has been consider- ed, not only as a consequence of fever, but a febrile affection itself, may not the oil by its sedative effects on the sanguife- rous system, equalize the excitability and restore to the torpid lymphatics their natural proportion ? In every case the quan- tity of urine was increased, a fact not to be accounted for by its merely moderating the action of the cutaneous absorbents. The cases related by Dr. Oliver are very remarkable. One of them was the consequence of hard drinking, at the age of fifty-seven, and another occurred in a woman at the age of seventy-two. Both of them were relieved. These cases should certainly lead to the more general use of a remedy so v 169 JACKSON ON EXTERNAL^ APPLICATIONS. mild and safe as sweet oil is, Avhich cannot injure, should it, not do any good, and especially when so little dependence is to be placed on Avhat are termed diuretic medicines. Tissot supposed the efficacy of the external application of oil, iq dropsy, to depend on its preventing the absorption of the hu- midity of the air, but Professor Murray, on this point, very justly remarks, that merely anointing the abdomen only, would, in this case, be of no avail, and that the application Avould be necessary over the whole surface of the body. Whilst the doctrine of absorption still remains doubtful, let us not have recourse to it, unnecessarily, to explain the action of a remedy whose results are so evident and so Avell tested by experiment and observation. A great deal has been said on the efficacy of oil applied V^^-^- ^""externally in that dreadful state of the system which is the ' (fir consequence of the bite of a viper, and there is no doubt, from ^"' * the foregoing experiment, of its utility in the fever that is *■ f"V;v formed ; but that it alone should be sufficient, a\ ithout the aid '* .... of more efficacious remedies, may justly be liable to doubt. On a subject, in regard to which there are so many different opinions, and to which there is no doubt attached a great dcaj of fallacy, I can do nothing better than give a place to the fol» loAving very just observations of Professor Murray. ' Vera venenatos fuisse plures, dubitare non sinunt peritia virorum qui experimentis adstiterunt, et effectus mali qui morsum ex- ceperunt: quis vero veneno infestos fuisse omnes qui sanati* onem admiserunt, nos convincet ? et quis, ejusdem maligni- tatis omnes et singulos venenatos esse, serio affirmabit ? Ut igitur oleum quod unius speciei virus enervat, contra alius ve» ncnum nihil valere probabile sit! Variat prxterea in una eademque specie morsus effectus pro profunditate vulneris di versa, pro parte vel magis vel minus nervosa, pro irae, qua serpens succenditur gradu, pro copia salivx venenata, et per aduncos dentes effusx, qua post morsum unum et alterum infiic- turn fiarcior et debilior est, pro numero vulnerum illatorum, pro majore vel minore sanguinis ex plaga effluxu, pro diversi- tate insuper temperiei animalium, vel caloris aeris. In tanto experimentorum numero horum momentorum aliquid facile potest neglectum esse.' After these observations, it may be JACKSON ON EXTERNAL APPLICATIONS. 170 Avell to remark, that Messrs. Geoffroi and Hanauld, a\ hen com- missioned by the Academy of Sciences, in consequence of the respectable testimony by which this subject Avas supported, to examine into the efficacy of olive oil in the bite of vipprs, con- cluded, after a variety of experiments, that nothing could be affirmed of its specific virtue. Some recovered without oil, and others, on whom the oil Avas applied, died. A letter of a Mr. Miller, of Carolina, has lately appeared in the Medical Repository, in confirmation of the utility of Shis remedy. It stands, I believe, an insulated case in this country, and the credit attached to it should be regulated by this consideration. In respect to a disease, however, so fatal, and the issue of which is so rapid as to baffle our greatest exertions, every praise is due to a citizen, whose humanity led him to give such early publicity to a remedy, the effects of which, were appa- rently so beneficial. Another disease, in which the external application of sweet , , oil has been of service is, diabetes. In the explanation of its * | effects here, also, recourse has been had to the absorbents; I but diabetes, as well as dropsy, is a febrile affection, and in the cure of it, those remedies have succeeded best, which have directly diminished the action of the blood-vessels. Its utility, in this disease, has been established by the common practice of cure in Scotland, and has also been sanctioned by the authority of the late writers avJio have treated on it. From the experiment, Ave may deduce the propriety of the domestic practice in applying oil to burns, Avounds, and to parts inflamed by the bite of venomous insects. This obser- vation Avill extend also to the use of the various mucilaginous herbs, gums, &c. Avhich as nearly allied to oil, prove service able in the very same cases. How does sAveet-oiLact ?_ Does it prevent the action of the external air on the surface, Avhich is to be ranked among those constant stimuli, the consciousness of which Aye lose through habit, or, * as all parts of the skin,' says Abcrnethy, ' may be considered as the extremities of the body,' does it, by dimi- nishing the action of the capillaries, lessen, also, that of the large vessels associated Avith them ? Let the medical virtuoso decide. 171 JACKSON ON EXTERNAL APPLICATIONS. ESSENTIAL OILS. The external application of the essential oils has been much more common in the hands of the empyric, than in those of the real physician, by whom it would seem their effir cacy has not been sufficiently estimated. However much the nostrums of the day deserve to be decried, as appli- cable to every state of the system and to every stage of a disease, yet there are hundreds of well attested cases of their utility, when properly administered. The British pil and the essence of mustard, amidst the numerous in- juries that have , no doubt, resulted from a promiscuous application, it cannot be denied, have proved very often successful,.......a truth that should lead to the more frequent use, in similar cases, of those simple essential oils, which possess an equal, if not a superior virtue. That they are not inert, I conclude from the following experiments. At eleven o'clock in the morning, my pulse at seventy-six, the neck, thorax, and abdomen, as low as the hips, were rub- bed over with the rectified oil of amber. The effect on the pulse was as follows: In 5 minutes, pulse beat 77 10 ... 78 15 ... 78 20 ... 78 25 ... 79 30 ... 80 40 ... 82 50 - - - 82 60 82 80 82 100 ... 83 130 ... 82 160 ... 82 In fifteen minutes after the application, there Avas an evi- dent increase in the fulness and force of the pulse, and Avhich continued to augment during the first hour. From this to the JACKSON ON EXTERNAL APPLICATIONS. 172 end of the experiment, there was no perceptible variation, An increase in the heat of the body, and some fulness of head, accompanied the course of this experiment. At half after nine o'clock........my pulse at 74.....The neck, thorax, abdomen, and upper extremities were rubbed over with the spirits of turpentine.....within a few minutes after which, a sensation of pricking was felt over the Avhole surface to which it had been applied.....and an infinitude of macule, very similar to the first eruption of the measles, appeared, particularly on the back. In 5 minutes, - Pulse beat 74 10 - 78 15 - 80 20 - 8o 30 - 76 It was now re-applied, when in 5 - - - - 74 10 - - - - 76 20 - - - - 78 30 - - (• .- 78 40 - - - - 76 50 - - - - 76 60 - - - - 74 80 - - - - 70 100 - - - - 66 The spirits of turpentine evaporated in about ten minutes after its application, which may account for its temporary ef- fect on the frequency of the pulse, and for its not occasioning that increase in its fulness and force, which was produced by the oil of amber. It is apparent, from these two experiments, that the essen- | tial oils, when externally applied, exert a stimulating effect I on the system ; and it has been the shortness of the time only, allotted for the preparation of an Inaugural Thesis, that has prevented my varying the experiments, so as to ascertain their proportionate influence. Their virtue in paralysis, conjoined with friction, is acknowledged......What would be their effects 175 JACKSON ON EXTERNAL APPLICATIONS. in epilepsy ? Would not the oil of amber, if applied to the Avhole surface of the body, sometime before the expected fit, prevent, by the permanency of its stimulus, its recurrence,? The spirits of turpentine, by exciting a cutaneous inflamma- "' [tion, would no doubt prove serviceable in many of those local K ' 'pains, av herein the morbid action is not so great as to indicate i .... ^depletion. It has often given relief in chronic rheumatism, | and in those modifications of ittermed Sciatica and Lumbago. PERUVIAN BARK. j|_ The external application of this celebrated article of the fL/^v. \~ Materia Medica, if effectual, cannot but be considered as of the highest importance. Taken internally, it is by no means an agreeable remedy, and in some cases, there appears an al- nost insuperable antipathy to it. In children, moreover, itis frequently impossible to ;;ct a sufficient quantity taken, to pro- duce any advantage. This, however, is not all. Of late years particularly in the most severe of our epidemics, the stomach has shewn a morbid irratibility, that, by their premature eva- cuation, has prevented the due operation of medecines, ta- ken internally. From this, therefore, and the additional con- sideration, that in the state of convalescence, the grand object of the physician is te exchange, as soon as possible, medical for culinary stimuli, the external application of this article if attended Avith success, Avill appear of infinite impor- tance. The Peruvian Bark has been applied to the surface in the form of cataplasm, fomentation, and the bark-jacket, the last of which is made by quilting two or three ounces of finely poAvdered bark in a silken or muslin handkerchief, which is to ibe AVorn round the waist. My experiments with it, in this phape, which were numerous and greatly varied as to the time ication, have convinced me, that it exerts a constant and durable stimulus on the system. It always raised my pulse three, four, or five beats in frequency, increased it in fulness and force, and augmented the heat of the body, - pnape, ~4— pfappl JACKSON ON EXTERNAL APPLICATIONS, 174 Thcitf.uc ofthese experiments, has been justified by the tests of repeated experience. In the second volume of the London Medical Observations and Inquiries, there are related a number of cures effected by it in this manner. Dr. Barton informs me, that the venerable Rittenbouse prevented the re* ourrence of the intermittent fever, to which he was subject, by the constant use of the bark-jacket; and that in children, he has lumself found it of essential service. So great in fact was its influence, that when, through oversight it was suffered to remain on till the complete formation of the paroxysm, it ne* never failed to augment its violence. Cataplasms of bark, have also been used. In myself, when applied to the. feet, they increased the fulness and force of the pulse, and pre- vented that diminution in frequency, which rest always pro- duced. At the same time a disagreeable sensation of heat and dryness, was evident in the palms of the hands. It is scarcely necessary to say any thing further on the utility of this article, as an external application. One thought hoAvevcr, suggests itself. In that stage of Typhus, or low state of fever, wherein the life of the patient depends on th# hourly administration of the cordial draught, more necessary during the night than the day, and which is too often trusted to the presumed accuracy of an uninterrested nurse, how often might a valuable life be preserved by the constant stimulus of the bark-jacket, exclusively of its good effects, as a continual application ? OPIUM. The external use of opium, is supported by the venerable names of a H>i sius and a Cullen—.The former has ascribed to it considerable effects, and has even gone so far as to assert that it will vesicate. Dr. Cullen says, he has often found the external application of it relieve the pains and spasms of the stomach and intestines. To this might be opposed the autho- rity of Wedelius, Alston, and Crump, whose experiments with this article, do not justify the assertion of these re spec- 175 JACKSON ON EXTERNAL APPLICATIONS. table characters. By the kindness of my intimate friend Mr. Jenkins, tAvo opiate plasters Avere applied to the soles of thti feet, and permitted to remain on for eighteen hours, Avithout producing the least perceptible effect. Not satisfied Avith this, I applied, about four o'clock in the afternoon, an opiate plaster of four inches by five to the epigastric region, Avith an inten- tion of suffering it to remain till the next day. I did not enter my bed in the evening, Avithout some disagreeable appre- hensions of the probable effects of the plaster before morning; my sleep however Avas not affected, and on removing the plaster about twelve o'clock the next day, it had not caused the slightest affection of the cuticle. What then are we to think of their frequent use ; and shall we boldly declare, that both Berghius and Cullen laboured under a gross deception ? In the annals of medicine, for 1798, there is an account of a letter from an Italian physician at Florence, on the external use of opium, in which he asserts that,' an opiate ointment made by incorporating a drachm of finely powdered opium, Avith a pound of axunge, so that an ounce contained six grains, Was effectual in a number of instances, and although the sleep produced, was not ahvays proportioned, either in intensity or duration to the dose of opium, yet a state of calmness always succeeded. Certain of the efficacy of the opiate ointment, he also tried frictions of laudanum diluted with alcohol, and found them equally successful. I have not tried the efficacy of the opiate ointment; but my experiments with laudanum, have been many. In one instance, more than an ounce of laudanum was, at different intervals rubbed on the abdomen, Avitnout its producing the least change in the pulse ; and in another the neck, thorax, abdomen, and upper extremities were rubbed Avith it, till an ounce and a half Avas expended. In this last experiment, the pulse Avas increased both in fre- quency and fulness, but this effect was very temporary, and the consequent depression Avas not such as indicated any pre- vious considerably stimulant effect. Some fulness of head, and nausea also attended; but this was to be ascribed to the smell of the opium, Avhich always induced these effects, in the person Avho Avas the subject of the experiment. Is lau- danum then, externally applied, entirely inert ? or are not the JACKSON ON EXTERNAL APPLICATIONS. 176 experiments on the healthy subject conclusive and not to be admitted in contradiction to those made on the system, in the morbid state ?—!I shreds, and steeped in sonic warm Avater, were applied to the epigastric region. In the course of half an hour it raised the pulse from 74 to 80 be.o.s in a minute, though it varied as to fulness and force. A slight nausea now and then occurred, ?nd continued to occur after the appli- cation Avas removed. It was suffered to remain on for two hours, at the end of which time the pulse Avas doAvn at 70. The nausea Avas so slight as not to prevent my dining. I sus- pected indeed some defect in the tobacco, and had resoh-ed to repeat the experiment the ensuing day. About four o'clock in the afternoon, however, the nausea returned in a much greater degree, and in the course of half an hour a vio- lent vomiting ensued, continuing at intervals till ten o'clock at night. The quantity of bile discharged was immense. So great was the association formed betAvecn the smell of the to- bacco and the retroj^ade action of the stomach, that I found it impossible to repeat the experiment with any degree of accuracy. The utility of this plant as an external application in the cases above mentioned, is confirmed by the experience of Dr. Barton, Avho also thinks that its external use as an anthel- mintic is too much neglected. A variety of other remedies applied to the surface have proved serviceable, and surely one, Avhose operation is particularly directed to the alimentary canal, is deserving of attention and rial. A fomentation of the leaves is said to be useful when applied to indurated tumours. i Wc noAv come to the consideration of the vesicating appli- cations—A class of medicines which by their importance, so often the dernier resort of the physician, merit the greatest attention. Though of old date, they imply a greater advance- ment in the medical art than other remedies ; for before man could be brought to suffer Avith indifference, the force done lis feelings by their application, or reconcile the idea of cu- ring one pain by exciting another, not only repeated expe- rience of their efficacy, but some abstract reasoning would JACKSON ON EXTERNAL APPLICATIONS. 178 seem to have been necessary. Whatever ,may have been their origin, or by whatever people they were first employed, their utility, sanctioned by the practice of ages, is not less con- firmed by the test of daily experience. The common articles used for this purpose are the mustard, the horse-radish, the garlic,_and ti\e onion, to vshich are to be added from the ani mal kingdom, the American and the Spanish cantharides. To see their effects on the system, the folloAving experiment was instituted. At ten o'clock in the morning, my pulse beating 80 strokes in a minute, accompanied with some degree of head ach, two large sinapisms of strong mustard completely covering the feet, Were applied to the lower extremities. They were suf- fered to remain on for four hours, more than one of which had elapsed before they occasioned any considerable pain. Very little variation in the frequency of the pulse occurred, if any, it was a diminution, but the increase of force, and particularly of hardness, Avas very considerable. About twelve o'clock the pain in my head and the disagreeable febrile heat I had expe- rienced the preceding part of the morning, left me entirely. In the feet the increased glow of heat was very great, and tOAvards the end of the experiment, resembled the sensation experienced by holding a part that had been scalded, near the fire. • On removing the sinapisms and washing the feet, the pain ceased, but returned in about half an hour as violent as before, and I found it, during the remaining part of the even- ing, till twelve o'clock at night, disposed to remit and increase at an interval of from half an hour to an hour. The pain and redness were evident during the two succeeding days. The influence of this experiment on my temper was A'ery manifest. During its continuance I felt irritable, and peevish, and not much inclined to ansAver any questions that were ask- ed me. I found it impossible to attend to the subject of the work I Avas perusing, and in counting the frequency of my pulse, Avas obliged to commence again and again, before 1 could perform it accurately. The exertion it now required being much greaterthan Avhat Avas before necessary. The effects of horse-radish and of garlic Avere the same, though in a less degree ; how far this was affected by some 179 JACKSON ON EXTERNAL APPLICATIONS. variation in the size of the applications, I will not venture to decide. In addition to the above, I undenvent the following. Two blisters of the size of two inches by three, Avere ap- plied to the inside of the legs, a little above the inner malleoli: They were suffered to remain on for twelve hours, at the end of which time they had produced an extensive separation of the cuticle, and a sore which required the delicate attention of the tAvo succeding weeks to heal. Their effects on the sys- tem were not by any means so powerful as those of the sina- pisms ; the pain arising from them Avas not so great, nor were the fulness, force or frequency of the pulse sensibly af- fected by them. We may hence draw the practical con- clusion that blisters are chiefly suited for local affections, and that, when we wish to make a more powerful impression on the system, sinapisms should be resorted to. This con- clusion I believe accords with the experience of every medi- eal practitioner. The importance of this class of medicine, is such, that they cannot be too particularly mentioned. The surprising effects of sinapisms in those states of the system Avhereinthe most powerful internal remedies have failed, and that have drawn from the suffering patient an enquiry by what charm he had been relieved, will stamp them as a remedy of the first magnitude in the mind of every candid physician. Their utility has been particularly experienced in the convulsions of children from teething and from small-pox, in affections of the breast and stomach, and in Avhat has been termed irregu- lar gout. In the vertigo and strangury that are the conse- quences of a retrocession of the gout from the feet, they have afforded almost immediate relief—and Avho will not assent to their usefulness in those low states of fever wherein a power- ful stimulus is indicated ? What Avould not the application of two large sinapisms effect in preventing the recurrence of the intermittent fever? Blisters have been used for this purpose, and surely the more powerful influence of sinapisms would be proportionably more efficacious in destroying that associ- ation on which the return of those diseases appears'to depend. In fact exclusively of local considerations, should not sina- JACKSON ON EXTERNAL APPLICATIONS. 180 pisms more frequently supplant the use of blisters, as their effects are more powerful, their immediate consequences to the parts do not preAent a second application, and they are not followed by that disagreeable affection, which is so often the result of a blister. Of the efficacy of the last, in diseases especially where there is a local affection, I shall say nothing—This subject has been fully treated of, by an antecedent graduate. I shall only observe in regard to the experiment, that the sore which was the consequence of their application, acted as a conside- rable irritation on the system. CAMPHIRE. If domestic practice can sanction the efficacy of any re medy, Ave must consider this as one of the most valuable ar- ticles of the whole Materia Medica, for external application. It is in fact, in this country, the family Panacea, and the bot- tle containing the camphorated rum, is resorted to v.ith more faith and confidence in its utility, than the ancients used to attach to the influence'of their domestic deities. As an external application, hoAvever, camphire has not been confined altoge- ther to the private shelf, it is still held in considerable esti- mation, and frequently employed by the physician. Its poAver of occasioning the translation of gouty and rheumatic pains has been established, by a fact related by doctor Cullen, and has been further confirmed by the experience of doctor Barton. Its use therefore, should be attended with caution, especially where there is a disposition to irregular gout, or to effections of the more important viscera. My experiments Avith this article, Avere made Avith the spirits of camphire, and with it in substance. The abdomen in one casef, and the whole upper part of the body in another, a\ ere rubbed over with the former, and an agreeable sensa- tion of heat and warmth was immediately perceptible over the Avhole surface to which it had been applied. The same sensation was excited in a greater degree, when it Avas ap- plied in substance, in the form of cataplasm, to the feet. 181 JACKSON ON EXTERNAL APPLICATIONS. In none of my experiments Avith it, hoAvcvcr, though various, could I discover, that it exerted any effect on the pulse. By this it appears that the principal utility of this article, as an external application, has been pointed out by domestic practice. What its effects may be in those states of the sys- tem whereiit the excitability is accumulated, I must leave to a future more successful experimenter. FRICTION. The efficacy of this as an external application in many diseases is universally acknowledged. It is a remedy of an old date, and like sAveet oil, lias been Used not only in the re- storation, but also in the preservation of health. In some nations, particularly in China, it has become as necessary a part of their daily habits as the use of the bath or the razor; and an old gentleman is Avaited on by his latralyptes as regu- i larly as he is with us by his barber. The effects of this pro- 1 cess are said to be astonishing ; that he avIio before its com- j mencement was languid,, dull, and inactive is rendered by it ' sprightly, animated, and nimble. The ancients considered friction as highly important, and A\ith them also it Avas the separate duty of a particular set of people. Hippocrates himself is said to have Avritttn a treatise on the subject. The effects of friction on the human frame may be in some measure estimated by those of currying on the horse, which a farmer will declare is worth half his feeding ; and that it is essentially necessary to the preservation of his health and vi- gour. Contrary to this, however it must be remarked that the celebrated Darwin Avill not suffer his horses to be cur- ried. The reasons of a singularity so opposed to the com- mon practice of the whole civilized world, are, I believe un- known. Friction produces different effects according to the sub* st'.nct! Avith which it is performed. In some cases the hand on- ly is used, and proves often of great relief. Whether there ia any difference between the hands of the two sexes, orhowiai JACKSON ON EXTERNAL APPLICATIONS. in the soft delicate hand of the female may be more effectual, agreeably to Corporal Trim's experience, I am at present not able tp determine. Next to the hands soft flannel, linen, and the flesh brush are to be successively U6ed, and the inten- sity of the application gradually increased. From an inat» , /( tention to this last circumstance it arises that in palsy this re» . ' >^ T-' medy so often fails in restoring the lost excitability. In rheumatism friction has proved a very useful remedy. ;, I > 1+' MM-,. Captain Cook is said to have been relieved by it, of a violent ..... attack of this disease, by the natives of Otaheite ; and I am informed that a person noiv resides in Philadelphia, who has gained great credit in the cure of rheumatism, by the same remedy. He begins by gently stroking the inflamed part, and proceeds gradually to squeezing, pinching, and finally changing the inside for the back of his hand, makes some ve- ry severe impressions on it. His success it is said has been very great. In taking a view of the effects of this remedy, do not the virtues of the Metallic Points resolve, themselves into tnosc of simple friction. Dropsy, however, is the disease in which friction has dis» *»*», /) -■31 • . Kj*b~t' //l-«-4 covered the greatest utility, and in Avhich it particularly me* I * \ rits our attention. On this point Dr. Rush has mentioned i three important cautions, the observance of Avhich is absolute- —- '" -- " . i\ ly necessary to obtain the. good effects of this remedy—1. That -T\ ,, u,. j the friction should always be upwards—Q. Performed in a re- I cumbent posture, and—.3. In the morning only. A neglect of these rules av ill render its application of no effect, though continued for months. In palsy and a variety of obstinate affections, such as the ,p* : stiff joint and club foot, friction has been found of great ser- 7 vice. In fact it is surprising what alterations a patient use of this rcmedv for a feAV months will effect. The external application of vinegar, in Avlich nitre has \r : been dissolved, has been recommended in feAerby Dr. Thorn- ' J^^ ton, who is in the habit of ordering the bodies of hi.; patients '^•^*3A.X to lie Avashcd, and their arms to be plunged in a solution of it. Dr. Gregory often directs his patients, iu what has been tcnu- ^->-* 183 JACKSON ON EXTERNAL APPLICATIONS. ed the putrid fever, to be washed Avith a spunge dipped in sim- ple a inegar and water ; and says he has known it to reduce the pulse, from 110 to 90 strokes in a minute, whilst the de-« lirium and other threatening symptoms have soon after dis- appeared. The external application of cold water alone, has been found very serviceable in yellow fever, agreeably to the expe- rience of Professor Rush—' Cold water,' says he, * was a most agreeable and powerful remedy in this disorder ; I directed it to be applied by means of napkins, to the head ; I also ordered the Avashing of the face and hands, and sometimes the feet Avith cold water; when applied in this way, it gradually abstracts the heat from the body, and thereby lessens the action of the system.' How far does the application of cold Avater to the head, act as a preventive to disease ?—On this subject, I hope I shall be pardoned for inserting the following. Standing one rainy afternoon at the door of my lodgings, I was struck by the con- duct of an aged country friend, Avho, in walking down the street, took off his hat, and exposed his bead to the rain. My curiosity was excited by an act, which I could not help instant- ly condemning, as the offspring of a foolish prejudice. On inquiry, however, I find it is a common practice in the coun« try, particularly during the time of harvest, when covered with sAveat, they are overtaken by a shower. An intelligent farmer assures me, that it has often secured him from colds and fevers, with which others who were present with him at the time, and who neglected this precaution, were afterwards seized. I have thus brought to a close this imperfect sketch, of a few only of the many external applications noAv in use. I re- gret exceedingly, that an opportunity did not offer, of seeing their effects on the system in the morbid state. A variety of experiments, which I underwent, have not been mentioned, either from suspecting some fallacy in their issue, or from a JACKSON ON EXTERNAL APPLICATIONS. 184 want of time to enable me to repeat them. If by this Aveak but honest attempt, I have removed one single impediment, from the path of a succeeding graduate, who may wish to en- ter on this fertile subject, I shall feel contented, and think the end of my dissertation answered. With my best wishes for the prosperity of the university, and a respectful tender of my thanks to its worthy professors, I conclude this first qssay of a truly medical Tyro. Nee semper feriet quodcunque minabitur arcus. Hor. Aa AN EXPERIMENTAL ENQUIRY INTO THE PROPERTIES OF THE POLYGALA SENEGA; SUBMITTED AS AN INAUGURAL THESIS, TO THE EXAMINATION OF THE REVEREND JOHN ANDREWS, D. D. PROVOST PRO TEMPORE, THE TRUSTEES AND MEDICAL PROFESSORS OF THE UNIVERSITY OF PENNSYLVANIA, ON THE EIGHTH DAY OF JUNE, A. D. ONE THOUSAND EIGHT HUNDRED AND THREE. FOR THE DEGREE OF DOCTOR OF MEDICINE; BY THOMAS MASSIE, OF VIRGINIA, MEMBER OF THE PHILADELPHIA MEDICAL, AND OF THE AMERICAN LINNEAN SOCIETIES. * Et sentire quae velit, et quae sentiat dicere. Hor. INTRODUCTION. AMERICA may be compared to a mine of treasures as yet imperfectly explored. To the ingenuity and talents of a few individuals the scientific world is much indebted ; but in a field so spacious much remains to be done, and a great va- riety of objects present themselves to arrest the attention of the Botanist, Naturalist, and Physician. To the latter our country has furnished some of the most valuable articles of the Materia Medica, which are employed in opposing the ravages of disease. With the qualities of all of them Ave are by no means perfectly acquainted. The following essay is an at- tempt to explain more fully the properties of one of them, viz. ofthe Polygala Senega, Avhich, from its abundance in the United States, and its efficacy in the treatment of Cynanche Trachealis, (a veryTrequent and often fatal disease) is entitled to our attention, even had it no other good qualities. How far this attempt may succeed is submitted to the de- cision ofthe candid. The essay Avould have been much more complete, had not the season of the year prevented me from procuring any ofthe fresh plant, or of the varieties ofthe spe- cies, many of which possess properties very nearly allied to those of the senega. Should what 1 haA'e written, however produce the effect of bringing this medicine into more exten- sive notice, and thus prove in any measure beneficial to man- kind, the trouble and labour of preparing this essay will be con- sidered as amply repaid. The numerous imperfections with which it abounds, no doubt, furnishes ample room for the censure of the critic : But he should be silent Avhen he reflects, it is the work of a youthful hand, actuated by necessity, not choice. I AN EXPERIMENTAL INQUIRY. Among those vegetables, which Nature, in the luxuriancy of her gifts, has bestowed on America alone, is to be classed the Polygala Senega, or Milkwort. This valuable plant grows abundantly in various parts of the United States, as in Jersey, Pennsylvania, Maryland, Virginia, and in the country bordering on the Ohio and Mississippi, where it obtains the name of Rattle-Snake Root, from its supposed efficacy in cu-. ring the bite of that animal. Agreeable to the sexual system of Linnaeus, it is arranged under the class Diadelphia, order octandria, genus poly- gala. The character of the genus, as marked in the systema ve. getabilium, is, , Cal. 5. Phyllus; foliolis duobus alaeformibus coloratis; legumen obcordatum, biloculare. Ofthe genus he enumerates twenty-six species, the six- teenth of which is the senega, and which is described thus : -------------floribus imberbibus spicatis; caule erecto herbaceo simplicissimo, foliis lato lanceolatis. The Polygala Senega Avas first introduced to notice by Mr, Tennent, who learned its use from the Indians, and recom- mended by him as an excellent medicine for curing the bite ofthe Rattle-Snake, and for the treatment of pneumonia. After him Kiernander Avrote a dissertation on it, which was published at Upsal in 1749 *. Since that period it has become more extensively knoAvn and used by physicians, of which * See Medical Essays of Edinburgh, vol.5. Amoenitates Acad. yoI. 2. 191 MASSIE ON THE POLYGALA SENEGA. further notice shall be taken in the subsequent pages. As yet the root only has been employed in practice. In order to ascertain the effects ofthe poAvdered root on the arterial system, I instituted the following experiment: EXPERIMENT I. To my friend Mr. Lawrence, his pulse beating 65 strokes in a minute, I gave 20 grains of the powdered root of seneca in molasses, at 9 o'clock in the morning.—-In five minutes his pulse beat 65. Min. 5 [ 10 j 15 | 20 | 30 | 40 | 50 |j50 |_70 | 80 | 90 Puis. 65 j 70 j 72 | 72 [70 j /6 J~69~|"~66_| 64~|~6Tj 65 In ten minutes after the exhibition of the medicine his pulse increased in fulness ; and a sensation was felt in the oesophagus, which he compared to burning, with a consider- able discharge of mucus from the trachea. In an hour and an half from the commencement of the experiment, all the effects of the medicine had subsided except the irritation in the throat, before mentioned, which still continued in a slight degree, and soon after quite left him. EXPERIMENT II. To my friend Mr. Liggett, with his pulse beating 65 in a minute, at 10 o'clock, v. m. I gave 20 grains of the powdered root suspended in water. Min. _5 J 10 J 15 J 20 { 25 | 30 { 40 | 50 | 60 J 75 j 90 Puis. 65 J 76 | 80 j 82 j 84 j 90 |~90"| ~82"| 80 j 80 J 86 105 86 Immediately after taking the medicine, the sensation in the (Esophagus, mentioned in the preceding experiment, was very considerably felt, accompanied Avith a large discharge of mucus by hawking. In tAventy minutes he compLined of much heat in his stomach. In thirty minutes of nausea. In forty miautes the nausea was increased. In an hour and an half his skin became very hot. In one hour and three quar- ters a profuse perspiration commenced, and the disagreeable symptoms were quite removed. MASSIE ON THE POLYGALA SENEGA.- 192 EXPERIMENT III. To my friend and fellow graduate^ Mr. Wilson, his pulse beating 68 in a minute, at 11 o'clock, a. m. I gave 20 grains of the powdered root. Min. 5 | 10 | 15 1 20 | 30 | 40 j 60 f 75 f_90 | 105 { 120 { 150 Puls72 j 72 j 76 J 78 | 80 j 80 j 78 |~78~j[~78j 72 j 72 j 68 Nothing peculiar occurred in this experiment, except the long continued influence ofthe medicine on the pulse, which was increased in force as Avell as frequency. The same irri- tation in the oesophagus, hitherto mentioned, was also very permanent. Considering the power of the root of Polygala Senega in exciting the arterial system, is sufficiently proved by those ex- periments. I was next anxious to learn, in what principle the power principally resided. In order to accomplish this, it was first necessary to resolve the root into its constituent parts, which I supposed the following experiments would enable me to do accurately enough: EXPERIMENT IV. I submitted one ounce of the root in powder, with six oun- ces of pure water to distillation, and obtained in the receiver a clear transparent fluid, destitute of oil, and of pungency, but which had a peculiar taste and smell, compared by my friend Mr. Walker and myself to that of musty flour. EXPERIMENT V. I digested one ounce of the root in powder, with three ounces of very pure vitriolic ether, for eight hours in the sun. On separating and evaporating the ether, forty grains of » yelloAv resin remained in the vessel. EXPERIMENT VI. I put the remainder of the root, after it had undergone the operation of the ether, into an oil flask, with six ounces of distilled water, and exposed them to a boiling heat for half B b 193 MASSIE ON THE POLYGALA SENEGA. an hour. The liquor, Avhen filtered and evaporated, afforded me thirty grains of a dark Aitrious friable matter, which I supposed to be gum. EXPERIMENT VII. To be certain that the matter obtained in the last experi- ment was gum, I dissolved twenty grains of it in water, then added gradually a drachm of sulphuric acid, diluted Avith an equal quantity of water, and no precipitate ensued, Avhich, agreeable to Hxrmstadt, proves the presence of pure gum. EXPERIMENT VIII. A solution of resin, and a solution of gum, tested by the oxysulphate of iron, underwent no change of color ; neither did the resin, gum, or decoction, when tested by the alcohol of galls, shew any presence of iron. EXPERIMENT IX. In order to ascertain how long the root would furnish wa- ter with active principles, when boiled on it, I put one ounce Avith seven of water, in an oil flask, and exposed it for half an hour to a boiling heat; I then strained the decoction and added fresh water, which I continued in the same heat for the same length of time. It was much less colored than the first water, (which was very dark,) and possessed much less pungency. The water of the third boiling was nearly color- less and insipid. Cold water takes up very little of the active properties of the root. EXPERIMENT X. I accidently mixed a portion of the decoction of the root with soap and water, a dirty green color was produced; but evaporation furnished me nothing more than revived soap. I regret that I cannot say any thing of the other parts of the plant, the season of the year preventing my obtaining any of the fresh vegetable. To examine the effects of the resin on the pulse, I per- formed the following experiment: MASSIE ON THE POLYGALA SENEGA. 194 EXPERIMENT XI. To my friend Mr. Towless, his pulse beating 72 strokes in a minute, I gave ten grains of the resin dissolved in spirit, at 9 o'clock in the evening. Min. 5 { 10 | 15 | 20 | 30 { 35 | 45 \ 60 | 80 Puis. 80 | 88 { 80 | 72 | 70 j 65 j 65 | 65 | 65 Immediately after taking the resin, he felt a great deal of irritation and roughness in the oesophagus, with a good deal of nausea. In ten minutes his pulse was much increased in fulness, with some irregularity. In forty minutes some irritation in the oesophagus still remained, with slight nausea. In eighty minutes all the effects had subsided, except, the depression in the pulse. EXPERIMENT XII. An amiable lady obligingly took a spirituous solution of twenty grains of resin at 9 o'clock, p. m. Her pulse beating 76 in a minute. Min. 5 | 10 | 15 J 20 ] 25 | 30 | 35 { 40 | 50 j 60 { 75 J 90 Puis. 88 j 88 { 92 j 92 | 88 J 80 [W\ 80 | 78 j 72 J 72 j 76 In ten minutes she complained of a very disagreeable sen- sation in the oesophagus, and of a considerable degree of nau- sea. In fifteen minutes her pulse was much increased in ful- ness. In forty minutes the nausea subsided ; but the irrita- tion in the oesophagus still remained. In an hour and an half her pulse returned to the natural standard, and every disagree- able sensation disappeared. EXPERIMENT XIII. In order to try the activity of the gum, I took ten grains dissolved in Avater, at 7 o'clock in the evening, my pulse beat- ing 84 in a minute. Min. 10 | 15 | 20 { 30 [ 35 j 40 | 50 j 60 ) 70 j 80 Puis. 84 j 76 J 73 [ 70 j 68 j 73 j 76 j 76 } 76 { 76 195 MASSIE ON THE POLYGALA SENEGA. In fiA-e minutes afier taking the medecirc I felt a sensation in the oesophagus, as if the membrane had been abraided. This continued upwards of an hour; and to the extremely nauseous taste ofthe mcdecine I attribute the sinking of my pulse. EXPERIMENT XIV. To Mr. Thomas Redmond, a healthy boy, fourteen years Old, I gave twenty grains ofthe gum dissolved in Avater, Avith the effect of vomiting him in five minutes in a copious man- ner ; soon after vomiting he became quite well, and resumed his amusements. EXPERIMENT XV. At half past 11 o'clock in the morning, after a light break- fast, I took tAventy grains of the gum, dissolved in water, my pulse beating 74 in a minute. Min. c [ 10 | 15 1 20 | 30 | 65 | 65 Puis. 74 | 74 J 74 | 74 j 74 j 74 J 74 The only operation of this medicine, Avas to produce the irritation in the oesophagus, so often mentioned; and to ope- rate slightly as a purgative Avith some nausea. EXPERIMENT XVI, To my friend and felloAv graduate Mr. Pendergrast, I gaA'e at 11 o'clock, a. m. thirty-two grains ofthe gum in pills, his pulse beating 72 in a minute. Min. 5 [ 10 ) 20 j 30 | 40 | 50 | 60 | 70 Puis. 78 j 80 | 82 J 76 | 74 | 74 J 76 j 76 In ten minutes he complained of much nausea; in twen- ty minutes the nausea Avas so much increased as to be quite distressing, and the medicine was with considerable difficulty retained on the stomach. In thirty minutes the nausea was somewhat diminished ; in forty minutes still more so ; in six- ty minutes it was quite gone, and the gentleman in every res- spect in as good health as before the experi ment. MASSIE OX THE POLYGALA SENEGA. 196 EXPERIMENT XVII. To a dog I gaA-e half a pint of a very strong decoction of the seneca, made by boiling, three ounces ofthe poAvdeied root in a quart of Avater to a pint. It produced excessive ef- forts to vomit, with the rejection of a large quantity of frctl.y matter. His stomach Avas quite free from aliment, as no- thing was throAvnup but this frothy matter. In about half an hour after taking the decoction, a small quantity of blood distilled/rom the annus. During the expe- riment he Avas affected with a convulsive swalloA'ring, and sheAved a great deal of uneasiness about the larynx. From these experiments it appears that the resin is more stimulating than the gum. They both have a strong tenden- cy to produce vomiting, which I conceive arises in a great measure from the irritation they produce in the pharynx. Tickling with a feather or any other mechanical friction, will produce vomiting, and much in a similar A\ay, I conceiAre those preparations act, in consequence of a peculiar and spe- cific action, they exert on the oesophagus. That the opera- tion of this medecine in the stomach, has an emetic tendency, I am far from denying ; but I believe itAvould not so frequent- ly occasion vomiting, unless assisted by the irritation before mentioned. The best menstruum for the root of seneca is common spirit, which always contains a large proportion of AArater. The .spirit will dissolve the resin, whilst the Avaterit contains takes up the gum, and thus the combined powers of both gum and resin Avill be obtained. Perhaps a strong dose of the gum or resin of seneca might be substituted with excellent effects for other emetics, in those patients Avhose stomachs are inirritable from having taken opium, stramonium, or any other narcotic poison. The prac- tice of tickling the throat with a feather, in these cases, is often attended with success, when other means fail. The same irritation would be produced in a much higher degree by the seneca. 197 MASSIE ON THE POLYGALA SENEGA. OF THE MEDICAL PROPERTIES OK THE POLYGALA SENEGA. We have already shewn it is a stimulant to the arterial system, an emetic, cathartic, and expectorant; it often proves powerfully diaphoretic, diuretic, and sometimes salivates. Dr. Rush, in his lectures on Clinical Practice, recom- mends the seneca as a diaphoretic, and Dr. Barton, in his Col- lections, says,' this medicine sometimes operates so power- fully as a sudorific, that I have been assured it has been known to remove portions of the mucous body, or rete mucosum, from the skin of blacks who have used it.' He also speaks of its diuretic properties; and the ingenious Professor, in his Lectures on Materia Medica, relates a case in which the sene- ca produced a copious salivation, with a foetor resembling that of putrid flour. With a view to produce this effect, I gave a young man the powdered root in pills, ten grains night and morning. During the time he took it, it proved considerably diuretic, but soon after having begun the use of the medicine he became very much indisposed from another cause, and was obliged to discontinue it, much to my regret, as I had not another opportunity of prosecuting this experiment. We may here remark, how often salivating medicines act as diuretics. And as a reverse sympathy obtains between the skin and kidnics, so a direct sympathy prevails between the skin and the salivary system. This sympathy is particularly obvious in the small pox. Dr. Cullen observes, * that in the distinct kind, salivation does not so often occur; but in the con- fluent it is an uniform attendant,' which seems to be in pro- portion to the morbid action on the surface of the body. In scarlatina anginosa, the inflammation in the throat, is coinci- dent with the efflorescence on the skin, and the use of blisters in this disease, Avhich is forbidden by Dr. Withering, is per- haps injurious, by the application of stimulus immediately to the part affected, which increases the associated morbid action, already too violent. This coincidence of action, is very apparent in the operation of those medicines which salivate as mercury, tarter emetic, opium, camphor, conium maculatum, squills, polygala senega, digitalis, and the nitric acid, all of MASSIE ON THE POLYGALA SENEGA. 198 which exert decided poAvers on the skin ; digitalis perhaps less so than any ofthe others ; but even that agreeable to Dr, Darwin, whilst it depresses the pulse, produces much heat on the surface of the body. The poAver of mercury is increased by a combination with most of those medicines, and I doubt not but experience will prove, that all possess the same property. The seneca has been already used by our Indians for the cure of syphilis *. This disease when it will not yield to mercury alone, is sub- dued by a combination of it with opium or conium maculatum, which probably arises from their tendency to act on the same system. And the celebrated power of the antimonial powder ofthe Pennsylvania Hospital is perhaps owing to the combi- nation of nitre and tartar emetic with the mercury, they having a tendency to produce the same kind of action. The reader will pardon this digression since it furnishes me a clue to explain the operation of seneca in scarlatina anginosa. OF THE USE OF THE SENECA IN SCARLATINA ANGlNOSA. Dr. Withering has recommended the use of the seneca in this disease: ' among other remedies, says the doctor, I gave the seneca root, and frequently with advantage. But I soon had occasion to remark, that it procured relief only when it occasioned a copious flow of urine t-' If my obser- vations are just with respect to the salivating medicines, Aiz. that Avhen they increase the action ofthe vessels in the mouth and throat, they also increase the action of the vessels on the surface of the body. It is evident, that Avhen the seneca acts in this manner, it can be of no service. On the contrary, I rather suspect it Avould do harm. But when it proves a diu* retic, since a reverse sympathy obtains between the skin, and throat and kidnies, morbid action is invited from those parts to the kidnies, depletion takes place there, and the equilibri- um of the system is restored. This opinion is further con- * See Barton's Collections, p. 34. t See Withering's Account of the Scarlet Fever and Sore Throat, p. 84. 199 MASSIE ON THE POLYGALA SENEGA. firmed by the ill consequences arisiiig from the application of blisters, before mentioned. Itis worthy of remark, that the Indians also use the seneca in the malignant sore throat *. OF THE BITE OF THE RATTLE-SX AKE. As a remedy for the bite tof he Rattle-Snake the seneca has been strongly recommended by Mr. Tennent and Kfernander, to be giv-en internally, and applied externally to the wound. But more accurate investigation into its use has shcAvn, that the seneca has no more claim to the title of antidote, than any other of the numerous class of medicines, that have been ranked under that head. Fortunate, however, would it have been for mankind, if all the medicines which have been re- commended for virtues, that did not reside in them, had pos- sessed as many valuable properties as the seneca does. This subject has been so fully treated by Dr. Barton, that for complete satisfaction on the vegetable remedies, that have been employed in America for curing the bite of this danger- ous animal, I refer the reader to his paper, published in the third volume ofthe Philosophical Transactions, and shall only make a few quotations, which are directly to my purpose. After having touched on the characters of some of the most reputed specifics, he observes, ' I was not ignorant that in the seasons of supervening langour and torpidity, the rat- tle-snake, in particular, bites Avith seeming reluctance, and without any, or with but little ill consequences arising from the wound. I likewise well knew, that even in those seasons, when the sun powerfully exerts its influence, at which times these animals are best qualified to strike and to injure, indivi- duals ofthe species must often be found, the cavities of whose venomous fangs are entirely, or nearly destitute of their active poison, from the introduction of which into the system, those alarming symptoms which characterise the successful bite of this animal arise.' * See Barton's Collections, p. 34. MASSIE ON THE POLYGALA SENEGA. 199 These observations enable us to explain the manner in Avhich the seneca has obtained the name of a specific. Per- sons have been bitten by those animals Avhen they Avere near- ly harmless, and their recovery after the administration of the seneca, has been attributed to its salutary operation; Avhen, if it had not been used, no ill consequences would have ensued. This interesting paper has also sheAvn, that after the evacua- tion ofthe poison from the fangs ofthe rattle-snake, it requires some days to accumulate again, and that animals bitten in this interval suffer little injury. Moreover, that among the western settlers, where those accidents most frequently oc- cur, and where the seneca first obtained this reputation, in- ternal medicines are by no means the only remedies used, but that recourse is always had to external applications, such as ligatures, scarifications, and blisters. And even supposing the poison had been introduced into the body, doubtless much more confidence is to be placed in the latter remedies, than in the internal administration of any. IN DROPSY. From the diuretic and diaphoretic properties ofthe seneca, it would seem a priori, a medecine extremely well adapted to many cases of dropsy, and experience has proved it such. Milman in his treatise on Dropsy, speaks in a very favourable manner of this medicine. Enumerating some of the most active diuretics, he adds, * And here I cannot pass over in si- lence the seneca root, of which prepared according to the Edinburgh Pharmacopaeia, I have given three ounces twice a day ; but in this form it has generally excited vomiting, and discomposed the body very much ; but when I have made usp of only half an ounce ofthe root, in the same quantity of wa- ter, the medecine has proved a very good one ; and although it sometimes produced vomiting, and often occasioned nausea, yet it generally purged nine or ten times in the day, and some- times proved extremely diuretic' He aftenvards relates four cases in which he used the seneca. The first a case of both C c :oo MASSIE OX HIE POLYGALA SENEGA. anasarca and ascites, in a young man, twenty years ol ngc, was perfectly relieved. The second Avas mitigated by no re- medy. On dissection the A-isccra Avcrc found in a diseased state, and polypi in the aorta, and vena cava. The third case Avas of a hard drinker, Avho had been long afflicted with astma, and had then both ascites and anasarca. By the use ofthe seneca in conjunction Avith saline draughts, and the acetum scilliticum, he received some relief; but even- tually perished. The fourth I shall relate in the Doctor's oAvn words: ' His thighs and legs were much distended, his hands and face were much SAvelled, the eye-lids were greatly enlarged, there Avas little or no water in the abdomen, the complaint had come on sIoavIv, and encreased gradually; but he was cured by a de- coction of the seneca root, in such a dose, as to procure four or five stools a day, and Avith the drink of cream of tartar. *, My friend Mr. Hartshorn, apothecary to the Pennsylva- nia Hospital, politely furnished me with the following inter- esting case, in which the seneca appears to have been of infi- nite service. Elisabeth Becher Avas admitted into the Pennsylvania Hos- pital on the 30th of October, 1802. She was affected with drop- sy in its Avorst forms : hydrothorax, ascites, and anasarca. As I did not understand the language in which she spoke (Ger- man) I could not obtain an accurate history of her case ; all I could learn was, that the dropsical effusion had succeeded a puerperal fever. She Avas bled 3 x on the day of her admission, and began the use of the saturated tincture of digitalis, which was continued till the 4th of November, Avhen, as it produced no change Avhatever, it was omitted. The anthnonial powders (composed of nitre, calomel, and tartar emetic) were now prescribed, with blisters to the Avrists and ancles. These poAvders Avere exhibited every two hours for eight days, Avithout affording any relief. Her mouth was very slightly affected. Her pulse, which had been so feeble, except on the day she came in, as to forbid the use of the lancet, Avas now scarcely perceptible. She was ordered de- * Medical Tracts, vol. v. p. 92, 99, 105, 111. MASSIE ON THE POLYGALA SENEGA. 201 coct. rad. senecx, ^3S. every two hours, calomel continued. After taking the decoction three days she hud a return of her catamenia; a profuse salivation came on, and the dropsy was very soon entirely removed. It Avas observed, that the salivation in this case was attended Avith a foetor, very different from that Avhich generally accompanies mercurial ptyalism. Although mercury, in this case, may have been a very active agent, in producing salivation, yet from the peculiar foetor which attended it, I am inclined to think, the seneca must have co-operated Avith it. And believing they act much in a similar manner, I can readily conceive, that their united poAver may have induced the ptyalism. To these commendations of the seneca, the respectable authority of Dr. Percival* may be added; who says in hy- drops pectoris, the seneca root, in liberal doses, sometimes answers every intention, and operates powerfully by the skin, the kidnies, and the bronchial glands, to the great relief of the patient. From the very considerable stimulant power which the seneca possesses, I do not deem it proper in those cases of dropsy, where there is great activity of the arterial system, until the inflammatory action is subdued by the lancet, un- less administered in such doses as to produce plentiful pur- ging. But as soon as the pulse will admit it, I am persuaded it may be administered Avith the most sanguine hopes of suc- cess. Where the pulse is Aveak and languid, as in the case of Elizabeth Becher, it seems extremely well adapted. IN TETANUS. A case is mentioned by Dr. Barton, in his lectures, of Tetanus, brought on by the bite of the rattle-snake, Avhich was perfectly relieved by very large doses of the decoction of polygala senega. The poison of the rattle-snake, I conceive acted here, as some of the vegetable poisons do, merely by its strong stimulant poAver. And that the seneca relieved the disc.se, by producing a iicav action, Avhich from the great dift'usibility of its stimulus, it seems avcII adapted to do. * Percival's Essays, vol. ii. 202 MASSIE ON THE POLYGALA SENEGA. My friend Mr. ToavIcs, also informed me of a case, which he saAV in Virginia of tetanus, cured by very large doses of the decoction. The cutaneous perspiration, he says, Avas so co- pious, as to run off the patient in streams. I exceedingly re- gret, that he had not the materials to furnish me with a cor- rect and minute statement ofthe case. IN PNEUMONIA. In the first stage of pneumonia, in which a good deal of inflammatory action always prevails, I am convinced the se- neca can be of no service, notwithstanding what has been said to the contrary. But in an advanced stage of the disease, Avhen after plentiful evacuations, a difficulty of breathing, difficult expectoration, and pain, still continues, the seneca may be administered with much advantage. In this state of pneumonia Dr. Welford, a physician of Fredericksburgh in Virginia, informed me he used it with very favourable re- sults ; and that he learned its use from Mr. Tennent, the first introducer of the medicine into practice, who in these cases found from it the happiest effects, In the pleurisy, as it is called, which prevails in many of the low and marshy countries of the United States, 'I do not doubt,' says Dr. Barton, speaking ofthe seneca, ' that it has been of real use.' This pleurisy or pneumonia,, is a true inter- mittent, attended Avith local pain either in the side or in the head. Bleeding in this disease is often necessary ; but Ave must resort to stimulant medicines, after sufficient evacuations, for a radical cure; and the seneca may then be used with advantage. Perhaps a combination of the powder of seneca root with Peruvian bark, may compose a medicine, superior to either singly, in the treatment of intermittents, by uniting the last- ing and powferul stimulus of the seneca, to the tonic power of the Peruvian bark. MASSIE ON THE POLYGALA SENEGA. 203 IN CYNANCHE TRACHEALIS. Much praise is due to Dr. Archer, for the interesting dis- covery he has made, of the efficacy' of the seneca in this disease. The formula he recommends, is the following: &. Rad. Senek. in pulv. crass. §ss. coque in aq. fontan. fviii. ad §iv. Of this a tea-spoonful is to be given every half hour, or hour, as the urgency of the symptoms may require ; and at inter- vals a few drops to keep up the stimulus until it either acts as an emetic or cathartic. The cynanche trachealis is a disease confined very much to the trachea, and removed considerably from the seat ofthe circulation, it often obstinately resists general remedies. The seneca, by the peculiar power it has of exciting the throat, as well as the general system, seems particularly adapted ; first, to invite morbid action from the trachea to a neighbouring part, and then to diffuse it through the system. In the same way, I suppose, mercury acts, when it produces salivation, and thereby relieves the disease. OF THE ACTION OF THE SENECA ON THE UTERUS. In a letter from my friend Mr. James Archer, son of the celebrated Dr. Archer, from Harford county, Maryland, I received the following interesting communication: ' I can add one solitary fact of no trifling moment, respecting the ef- fects of seneca on the female constitution ; which is, thatitwil. iproduce abortion or miscarriage. This was communicated to me last summer, by an illiterate man in this neighbourhood, well known for his strict adherence to truth.' Of one case in ' Avhich it operated in this manner, in a very few hours too; he informed me, l he had ocular demonstration.' He says, in- deed, ' he has known and heard of many other like instances, in I believe all of which, it was taken by women who had indulged in illegitimate love, intentionally to destroy the fcetus in utero.' The form of preparing it for this purpose, is that of de- coction, made very strong, and given to the quantity of a very 204 MASSIE ON THE POLYGALA SENEGA. large tea-spoonful, or more, but not less, at once. One dose, he says, has generally succeeded, unless they were very flu- advanced in pregnancy. Taught by this relation, Ave should administer the seneca in a sparing "manner to pregnant Avomen, or omit it altogether. To those labouring under obstructed catamenia, it may per- haps be given Avith great advantage. And the case of Eliza- beth Bechcr, before mentioned, whose menstrual discharge returned, after using it three days, tends much to confirm the opinion. Thata medicine should act superficially on the ute- rus it> not a solitary fact, in medical science. This quality has long since been attributed to madder, and the Adelia Ricinclla, or Ram Goat ofthe West-Indies, possesses this power in an eminent degree. But Avhilst sincerely reprobating the use of medicines for the unnatural purpose of producing abortion, it is also to be lamented, that t,o little indulgence is sheAvnto an excusable frailty, that the unfortunate victim of passion is compelled to hu.ve recourse to so horrid an expedient, to shield herself from the obliquy of an unrelenting A/orld. The philosopher, Avho is acquainted with the force of human passions, and the weak- ness ofthe human heart, can pity and forgive the unfortunate girl, whom, too often the child of unsuspecting sensibility, is led astray by the seductive povA'er of love. But, alas! there are few philosophers! The mass of mankind, governed by prejudice, have affixed irretrievable shame to a deviation from Avhatthey have termed virtue. And the child of nature who has wandered, to conceal her disgrace, has recourse to those remedies which too ol anbury herself and her infant, under the same ruin! IK A DISSERTATION ON THE MUTUAL INFLUENCE OF HABITS AND DISEASE; SUBMITTED AS AN INAUGURAL THESIS, *0 THE EXAMINATION OF THE REVEREND JOHN ANDREWS, D. D. PROVOST PRO TEMPORE, THE TRUSTEES AND MEDICAL FACULTY OF THE UNIVERSITY OF PENNSYLVANIA, ON THE FIFTH DAY OF JUNE, A. D. ONE THOUSAND EIGHT HUNDRED AND FOUR. FOR THE DEGREE OF DOCTOR OF MEDICINE BY WILLIAM DARLINGTON, OF PENNSYLVANIA, MEMBER OF THE AMERICAN LINNEAN, AND PHILADELPHIA MEDICAL, SOCIETIES. ...........Custom moulds to every clime the soft promethean clay. Armstrong, INAUGURAL DISSERTATION. ' Man is a bundle of Habits.' THE great and universal influence of custom, or repeti- tion of action, upon the operations ofthe living body, has long been known and acknowledged by the observant part of man- kind ; but the application of this important principle to the pre- vention and cure of diseases has been too much neglected by physicians. The justly celebrated Doctor Darwin has, in- deed throvm great light on the subject of associate motions, and the diseases of association ; but much remains yet to be known respecting the power of disease in destroying the ha- bits of the system, and also of the influence which the intro- duction of new habits, or a recurrence to old ones, where they have been violated, may have in removing diseases. It is with a view of turning the attention of the accurate observers in medicine to this interesting subject, that I have selected it as the object of my inquiries in this inaugural essay. I am fully sensible of the difficulties attending a thorough in- vestigation of it, and the necessity of much more experience than it was possible for me to possess, to do justice to it:— But a desire of seeing the subject prosecuted by extensive and ingenious practitioners, and of having the degree of its influ- ence ascertained, induced me to adopt it. The nature ofthe living body is such, that it can accom- modate itself to a great variety of impressions which were at first disagreeable, and even prejudicial to it: A repetition of D d 203 DARLINGTON ON HABITS AND DISEASE. them, agreeably to one of the Lavs of sensation, renders them less and less detrimental, until they finally not only cease to be disagreeable, but become nccessaary to the support of health and life.—.When any habit has become thus established, the continuance of it may be considered as a proof of health, and a violation as one of the premonitory signs of disease. Many peculiarities, and unnatural operations often become habitual by subjecting ourselves to the influence of custom, or repetition of impression and action,—as is finely illustrated by the ingenious author of Zoonomia. Doctor Cullen in his Lectures on the Materia Medica, observes, that' both temperament and idiosyncrasy may be variously affected byjrustun, insomuch that by this any tem- perament may be corrected, confirmed, obliterated, or even a neAV one induced.'—Custom, he defines to be^ ' the frequent repetition of impressions on the system. Custom is often confounded Avith habit. Habit is only the effect of custom, as Avhen frequent repetition of impressions has given laws tt the system.' By this distinction avc may understand Avhy, in many in- stances, customs appear to be easily prevented from taking effect,.—and also why many attempts to introduce new habits, fail. The repetition of impression is not continued long enough to give laws to the system .'—Hence we may perceive the pro- ' priety and necessity of long perseverance in difficult cases, Avhcre avc wish to induce a hcav action that shall be perma- nent. The explanation of the phenomena of habits is founded principally upon the theory ofthe celebrated John Hunter: iiz.—That tAvo different actions cannot exist at the same time in the same part, or system ofthe body ;—-and that the most poAverfu! exciting cause will always produce an action of its own kind, to thecxi'.nction, or removal ofthe one previously existing. The correctness of this theory is so evident that it is nov/ generally adrr.uu-d, and taught in the schools of medi- cine. The livinghcrly is endowed with a certain susceptibility, or aptitude for action, upon the application of stimuli, which is denominated e^cuabLity. This excitability may be defined a DARLINGTON ON HABITS AND DISEASE. 209 condition ofthe systr.n which oAves its ex! unee to a particu- lar organization of matter. With this organization it is capa- ble of being excited into action ay hen stimuli are applied ; but it is entirely passive as it respects the kind of action into Avhich it may be excited. Every different stimulus has the power of producing an excitement peculiar to itself *. The ever-vary- ing state of the system is owing to the great variety in kind and force, of the exciting powers applied—HoAvever, when any particular impression is continued for a considerable length of time, or repeated to a certain degree, and is of suffi- cient force to produce its specific excitement, the previously existing action is destroyed, and a new one takes place Avhich Avill often become permanent, even if the cause should be removed. Some curious facts are related of the influence of custom in giving laAvs to the operations ofthe system,—as ofthe Ideot /) i. of Stafford, England, Avho, being accustomed to tell the hours ^ ofthe church clock, as it struck, told them as exactly when it did not strike, by its being out of order. There is also a story told by Montaigne, of some oxen that Avere employed in a ma- chine for drawing Avater, Avho, after making three hundred turns, which was the usual number, could not be stimulated by any whip nor goad to proceed farther. * To avoid circumlocution I shall employ the Avord excita- bility as expressive of the system in a certain condition. When I say a stimulus acts upon the excitability and converts it into an excitement, I mean, that organized matter, possess- ed of this property, is throAvn into action when an impression is made. This condition of matter is common to all bodies duly organized, and the various phenomena of life are owing to the variety in organization, and of stimulus applied. Hence I infer that in the same system, the variety of excitement is owing to the various nature ofthe exciting powers. Although the system be passive in the abovementioned relation, yet it cannot remain dormant, or inert. If the more poAverful of the usual stimuli be abstracted, the aptitude in- creases so as to be acted upon by the weaker; Avhich cannot be all abstracted. This being the case, it behoves all Avho prize a healthy excitement to apply such poAvers, and such only (as far as practicable) as are calculated to produce this effect. AM* ■£i 210 DARLINGTON ON HABITS AND DISEASE. By the light of this principle, I apprehend, arc the habitual operations ofthe body to be traced to their source. By it we may learn how the frequent and regular application of the du- rable stimulus of aliment is capable of preserving the-habit of healthy excitement, in opposition to those causes which have a contrary tendency ; and to which we are unavoidably more or less exposed. The stimulus of aliment, however, like many others, is of such a nature that it cannot establish a habit which will continue after the removal of the cause:—-A con- stant and regular application is necessary to the permanence ofthe effect: hence any considerable interruption ofthe pro- cess leaves the excitability unemployed,—other less favorable agents take effect, and convert it into an excitement of inju- rious tendency. The influence of any habit with respect to diet on the sys- tem, is very great, and should never be overlooked in the treatment of diseases ; more especially in those of long stan- ding, or of weak morbid action, such as chronic dyspepsia. L. Cornaro, who dietcd himself very strictly, was possessed of good health whilst he observed his regulations, but when he de- viated from his rules he found his health and temper much affected:—Many other facts evince a similar effect of custom in this respect; wherefore Professor Rush, among the pro- phylactics of apoplexy, and some other forms of disease, re- commends to avoid becoming habituated to any one kind of diet, —for a change would then be dangerous ; and few people can avoid changing it in the course of a life-time. This theory is equally applicable to the operations of the mind,—-or more properly speaking, of the brain ; for the mind is as much an effect of the operation of external agents upon the brain, as vision is of the impression ofthe rays of light upon the retina. The knowledge of this unfolds to us the immense importance of my subject in relation to morals; and points out the necessity of an education that will give permanence to such habits of thought (and consequently of action) as are calculated to promote the happiness of man, and the welfare of society. The susceptibility of acquiring habits of thought and action is much greater in youth than in adult age ; because the exci- tability at that period of life has not been acted upon by any DARLINGTON ON HABITS AND DISEASE. 211 stimulus long enough to establish its particular excitement, or to give a lasting and definite mode of action to the system ; and therefore, the new impression has no old established ha- bit to overcome. It is similar to the taking of a new country, or one inhabited only by a feAV defenceless savages, by a com- pany of adventurers,—they meet with no obstacle in obtaining possession, nor in establishing what form of government they choose ;—but if that country had been long occupied by a brave and well-disciplined people, the conquest would be extremely difficult, if not impossible. Hence it becomes an object of great interest, both in a national and social point of view, that the rising generation should be subjected, as far as possible, to such impressions as are adapted to produce an habitual excitement of patriotic and moral ideas. The influence of habit upon the mind Avas long since known, and expressed in the following just and interesting ad- monition : ' train up a child in the way that he should walk, and when he is old he will not depart from it.' A healthy, or rational state of mind, depends upon correct perception, association, comparison, and induction, or infer- ence from propositions:—But our perceptions may be correct, and yet from a too great frequency of heterogeneous impres- sions, the habitual trains of thought, or operations ofthe brain will be interrupted; and hence Ave may understand why Book- sellers, revieAvers, and all those whose occupations subject them to great variety and dissimilarity of mental exertion, are so apt to become meniacal upon the least predispositon*. From their distracted and unconnected state of mind, they might be said (if the expression were allowable) to be habitu- ally destitute of Mbit in their operations. The probable means of restoring a regular train of thought will be hinted at hereafter. There is also a derangement in mental operation which is induced by too exclusive an application of any particular im- pression which is calculated to excite wrong ideas. This is most frequently occasioned by great distress, or mistaken no- tions of religion.—In these cases, such a despotic habit of ac- * Professor Rush's M. S. Lectures. 112 DARLINGTON OX HABITS AND DISEASE. lion is established in the brain, that most others are excluded ; and therefore the patients are forever dAvelling upon one theme. Absence of mind, as it is called, is to be explained upon the same principle. It is a cotinucd and exclusive excite- ment of the brain which cannot be overcome by the usual impressions upon the senses ; hence some ofthe greatest per- ?.*~.nages, those who have prosecuted abstruse inquiries Avith the greatest success, have been most subject to it. Having premised thus much concerning the nature of ha- bits, and the principles by Avhich I conceive they are to be ex- plained, I shall next proceed to consider the influence which disease exerts over the more remarkable habitual operations of the system, and to notice the practical inferences which are to be made from an attention to it. INFLUENCE OF DISEASE UPON HABITS. The approach of disease may very generally be discerned by its causing a suspension, or sudden violation ofthe accustom- ed operations of the body ; and more especially in those Avho are subject to conspicuous or remarkable habits :—For exam- ple, in those who are affected with habitual discharges from the system; as the hemorrhoids, issues, chronic diarrhea, and others :—-Or in those who are accustomed to the use of tobacco, or other poAverful stimuli. Under the head of habi- tual discharges may be considered the periodical evacuation of the catamenia ; the state of which is at all times an impor- tant index to the condition of the system, in females. The suppression of those established evacuations, is gene- rally considered as the cause ofthe diseases which folloAv ; but it is only a symptom, ovneccssary consequence of the operation of a more powerful incitant than that by Avhich they were sus- tained, producing a different kind of action. Thus, when conception takes place, the menses are suppressed, because DARLINGTON ON HABITS AND DISEASE. 213 there is a new excitement induced by the application of a more powerful stimulus; and the previous, excitement, or habit, must necessarily cease *. This principle likeAvise applies to the suspension of those habits Avhichare acquired by the frequent application of stimu- lants ;—.the remote and exciting causes of disease produce a new action in the system, and thereby obliterate the former one,—.doing aAvay the necessity, or appetite for the accustomed stimulus: These effects so uniformly appear as harbingers of disease, that they ought always to give the alarm when ob- served. There is also an inaptitude to the usual actions: the excretions are affected, &c. Sec.—-A long list of premonitory signs of this nature, is given by authors, which indeed are ge- nerally so well understood, that all we have to do is to endea- vor to make a proper use of them. By a due attention to them we may often be able to remove diseases whilst in theiv forming stage, which Avould otherwise baffle the skill of the ablest prac- titioners. ...................'For Avant of timely care, Millions have died of medicable wounds.' Armstrong. When Ave have been exposed to the remote causes of disease, and perceive their effects upon the habitual operations of the body, we may consider them as the premonition of impend- ing evil, and should take measures accordingly. * As disease is only a different excitement from that which constitutes health, or that by which all the functions of the body are performed Avith ease and regularity, pregnancy may very properly be considered as a diseased state. (V ide Med, Repository, Hexade I. vol. vi. pages 51 and 150 ; Avhere Doc- tor Vaughan has ingeniously and ably proved that pregnancy is a form of disease.) The violation of the menstrual habit i, one of the first symptoms of the disease,—.and health cannot be said to be completely restored until this habit re-appoars, as it is essential to a perfect state ofthe female system. This does not take place upon delivery,—but the disease may, at this period, be said to have come to a aids; and k.cta' t seems to be the most eligible method of bringing the system gradually back to the healthy state of excitement; Avhen it again assumes that important habit. 2M DARLINGTON ON HABITS AND DISEASE. There are two stages, says Professor Rush, in which dis- eases may be prevented, viz. in the predisposition and in the forming stage. Where the system is predisposed to great morbid actions, such remedies as lessen the action should be used; as fasting, rest, gentle cathartics, or small bleedings ; and particular care should be taken to avoid irritating or ex- citing causes. Where the predisposition is too weak morbid action, the use of gentle stimulants, as the pediluvium, and warm teas, Avill generally remove it. Doctor Lockette, in his Inaugural Dissertation on the Warm Bath, speak s highly of it as a prophylactic; and it certainly has great efficacy in restoring an equable and healthy excitement, when used during the predisposition to, or even in the forming stage of many diseases. The value of warm diluting drinks, and gently stimulating vegetable infu- sions, was frequently experienced by my respected Precep- tor during the prevalence of the yellow feA-er in Wilmington, Delaware, in the autumn of 1802. By the timely and judi- cious use of those simple remedies, he evidently avoided the fatal epidemic, by removing the predisposing debility, and preventing the formation of disease, after the fatigue of pro- fessional duties had favoured it. , There is an account ef a comedian who lived to near the 'age of 100 years, and Avas never sick during that long period, \ in consequence of always going to bed as soon as he found | himself under the action of the predisposing cause, or in the (forming stage of disease. By inducing a gentle diaphoresis (in this state, he restored that equilibrium, which a few days, or perhaps a feAv hours neglect, might have rendered a co- pious depletion, and a tedious confinement necessary to ac- complish. The approach ofthe dysentery is almost always announced to the patient by a violation of the habitual operations of the boAvels; and, in this state, a gentle cathartic will generally prevent the formation of the disease. It was prevented in a company of soldiers during the revolutionary war, by causing them to drink sea water freely, which operated as a purge.* * Rush's M. S. Lectures. DARLINGTON ON HABITS AND DISEASE. 215 In the forming stage of catarrh, the free use of diluting drinks, and an abstinence from, or sparing use of cordial and stimulating diet, -will almost uniAersally remove the disease. It is said the celebrated David Garrick was in the practice j,.'* of removing catarrhal affections, in this stage, by eating a salt herring; the object, and good effect of which was the thirst it produced, thereby inducing him to drink largely of diluting liquids, which gave the disease a centrifugal direc- tion, and restored an equable excitement. This disease be- ing one cause (and a very frequent cause) of consumption, should never be neglected.* The accession of mania is generally to be foreseen by an obvious interruption of the habitual trains of thought. A diseased perception, or a derangement of any of the other operations of the mind, is very quickly manifested, either in conversation or in actions ;—and Avhen once observed, should be immediately attended to. In this early state, a proper ap- plication of physical and metaphysical remedies will often haAre the happy effect of checking the progress, and pre\-ent- ing the formation of this deplorable disease. It is much easi- er to repair the mind when but one pillar is deranged, than af- ter the whole fabric is demolished. As mental derangement, particularly that kind or grade called melancholy, or hypochondriasis, very.frequently ori- ginates from erroneous perception, we need not, avc cannot in such cases, expect a return of rationality until the perception be corrected: ex. gr. If a man admit the idea that he is composed of glass, it will be impossible to convince him by any argument that there is no danger of accident from blows or falls.—.The idea of fragility will inevitably be associated with that of vitreous structure : therefore, to produce a radical cure or to prevent such cases from degenerating into confirmed ha- bits of wrong action in the brain, we should aim at restoring a correct perception as soon as it is observed to be diseased. * Rush's M. S. Lectures. E e 216 DARLINGTON ON HABITS AND DISEASE. Erroneous perceptions very often require, and arc relieved by the application of such remedies as alter the state of the system and organs of sense ;—but there are also wrong per- ceptions from the partial subjection of objects to the inspection ofthe senses. Sometimes it is necessary that several of the senses should unite in their report of objects to the sensorium, in order to produce a correct perception ; hence, it would bo proper in all cases Avhere we suspect this has not been the fact, to call in the aid of the other senses. Many diseases ofthe mind are rendered incurable, and many errors propagated in society by a neglect of this valuable, this essential rule. Vice is a morbid excitement, or operation ofthe mind, or brain, which tends to injurious consequences in society. The will, or perhaps more properly, the capacity of volition, is acted upon by morbid motiA-es, and anew excitement of per- nicious tendency is the result. If those motives be repeated in their application to a certain degree, a vicious habit of thought and action becomes established, and the moral facul- ties are impaired. Here we see the necessity of a preponde- rance of such motives as excite to virtuous actions. It has been said that education is not sufficient to establish habits of probity and rectitude which will endure through life, because there are many instances of parents of exemplary morals having children of dissolute, or exceptionable charac- ter :—-But this assertion originated in an ignorance of the laws of the mental economy. It is true, such cases are often ob- servable,—.but the persons are constrained to moral acts by parental authority, and not suffered to exercise their reason on the subject. No motives are held out calculated to volunteer 0 them into good actions. The will is rather suppressed; and therefore, agreeably to the laws of excitement, is more rea- dily excitable into Avrong action, upon subsequent exposure to morbid motives. ' For Virtue is the Child of Liberty, 1 And Happiness of Virtue ; nor can they ' Be free to keep the- path, who are not free to stray. Beattie. DARLINGTON ON HABITS AND DISEASE. 217 Itis a mistaken notion, both in domestic and national go- vernments, to make the dread of punishment the inducement to upright conduct;—.There ought to be motives of such na- ture and force applied, as would ensure a virtuous volition; and this is just as practicable as it is to ensure a healthy ex- citement of body by a proper use of alimentary, and other suitable stimuli. When a person of virtuous habits has been exposed to inv / moral causes until they begin to take effect, their influence may soon be perceived. His old habits will be violated by the | formation of a new excitement; or a different direction be- : ing given to the will. In the predisposition to, or in this, ' forming stage of vice, many persons by a proper management, might be arrested in their mischievous, and often fatal career. How many, in this stage ofthe disease, have been converted to permanent rectitude, by presenting motives to them of a more poAverful and salutary nature ! The pathology of the mind presents a vast and important field for observation; in which it is the peculiar province of physicians to display the true principles by which the various phenomena are to be explained. Volumes would be requisite to detail and apply every circumstance illustrative of this j beautiful theory of the mind, as taught by the ingenuous pro- fessor ofthe practice of physic in this university; but the limits of this essay render it necessary that I should dismiss the fur- ther consideration ofthe subject under this head, and pro- ceed to consider the influence which a repetition of impres- sions may have in producing new habits of action, and thereby removing previous actions of morbid nature. INFLUENCE OF HABITS UPON DISEASE. Proceeding upon the principle ofthe unity of action in the particular systems of the body, and of removing one kind of action by exciting another, we may understand hoAv a conti- nuance, or repetition of those impresssions which are suffici- ently powerful to induce a new excitement, can eradicate the original morbid action; or, in other words, how habits of 218 DARLINGTON ON HABITS AND DISEASE. wrong action may be removed by producing those Avhich arc more favorable to a return of healthy excitement. In cases of wrong action induced by subjection to new im- pressions, the first object in the treatment is the removal of the cause; andif the excitability be not too completely con- verted into the peculiar excitement of the new stimulus, the effect Avill soon cease.—.But if it have been so long applied that its particular action is confirmed in the system, that action will continue, even though the cause be removed. The sys- tem appears to acquire an independence from repetition, by which it can of itself continue those actions that could only be produced originally by the presence of the exciting poAvers. When this is the case, morbid excitement must be destroyed by such agents as will produce a new action. If the. morbid action be violent, it must be diminished be- fore a new exciting poAver can be safely applied :—if it be more moderate, but of long continuance, and deeply rooted in the system, it will often be necessary to take an intermediate step, and eradicate it by inducing another disease ; but one which will be afterwards much more easily remoA'ed. We have an instance of this in the treatment of old cases of syphilis,—we destroy it by bringing on a mercurial disease ; and when we / have completely removed the syphilitic habit by introducing this new one, such applications are used as are calculated to displace the latter, by producing the excitement of health. And lastly, Avhen morbid action is feeble, and not of long stan- ding, the diseased habit may often be destroyed by such exci- ting powers as are suitable to induce, directly, the action of health. When any acute or recent disease is occasioned by an ex- cess of those agents Avhich are adapted to the support of health and life, it may be removed merely by restoring an equilibrium of excitement in the different systems of the body ;—but where causes are applied Avhich produce a pernicious excite- ment in every degree of force (provided they take effect at all) the case is widely different. No man ever cured syphilis by simply equalizing the excitement:—.It must be destroyed by such remedies as have the poAver of producing a new and different action. DARLINGTON ON HABITS AND DISEASE. 219 It is upon those principles, which Avere first systematized by the ingenious Hunter, that avc propose to explain the action of habits upon disease ; or rather, the influence of one kind of action upon another;—for an acquired habit is nothing but a different action rendered permanent by repetition. To remove an established excitement of evil tendency, of- ten requires the aid of extensiAe observation, and acute rea- soning. There is a certain grade in the force of every particu- lar excitement, aboAre Avhich it is not safe to attempt a change by the immediate application of different exciting powers; hence it is generally necessary in the beginning of diseases to diminish the excitement of the system by depletion, before Ave can administer such remedies as are suited to restore heal- thy action, Avith advantage. The neglect of a due degree of this has been the cause of much mischief in the practice of physic. It is a truly impor- tant part of the treatment; and to the illustrious Professor Rush are we indebted for much light and information on this subject. By attending to the circumstance, Ave may be ena- bled to introduce new habits of action upon rational principles, instead of groping in empirical darkness. In our regard of the effects of custom, in the manage- ment of diseases, we should never lose sight of those habits which are induced by the revolutions of the celestial bodies, by the return of the seasons, and our connections with man- kind ; more especially the connections of friends and rela- tions,* neither should we overlook those laAvs of the system which have been occasioned by any particular mode of liv- ing; Ayhether of dress, diot, drinks, &c.—nor of those esta- blished by any particular medicine, whether it have disagree- able or salutary effects. They all have their influence, which by attention may be converted into use, but by neglect are always liable to counteract our endeavours. We see somewhat to this purpose in intermittent fever; the disease appears to be sustained by the united influence of the remote cause, and the diurnal reArolution ofthe earth. It has been supposed that medicines given just before the ex- * Doctor Cullen. 220 DARLINGTON ON HABITS AND DISEASE. pected paroxysm would have most effect in preventing it by exciting a different action ; but Professor Barton informs us,* that he has often found the paroxysm aggravated by this practice ; and that he has had most success in the treatment by applying the remedies immediately after the paroxysm, or for a considerable time previous to the expected period of the next one ; unless there were danger of the succeeding one pro\ing fatal; Avhich is sometimes the case. This Avould certainly seem the most rational practice; for in this case, there is but the influence of the remote cause to counteract, and therefore a new action would be much easier cexited by the stimulus applied, than when it had to combat the above mentioned additional force. To prevent re- lapse, the application should be continued until the new ac- tion be established. The unmanagable disease of epilepsy appears to be often rendered habitual in the system by the influence of the peri- odical revolutions of the globe. The scientific Professor of Materia Medica relates a case in his lectures, which was ori- ginally brought on by fright, but which became periodical; recurring daily about the same hour. He removed the disease by exciting an action, previous to the expected pa- roxysm, which was superior to the accustomed epileptic action. The cure of intermittent diseases, or those which'occur at Stated times, is most commonly affected by some of the more poAverful incitant, or tonic medicines;—but to show that there is nothing specific or exclusive in their operation upon the diseased action, Ave need only mention the fact, that they have all been occasionally removed by exciting a superior action of a different kind, Avithout the exhibition of any thing internally. Intermitting fever has frequently been cured by violent emotions of 5nind, or great bodily exertion ; or, which is per- haps more effectual, by the united exertions of body and jiA-lu. Doctor Cullen prevented several paroxysms of epi- * M. S. Lectures. DARLINGTON ON HABITS AND DISEASE. 221 lepsy in a girl by threatening her with punishment if she had any more. It is certainly our duty to remove diseases by those powers Avhich will produce a healthy excitement, or one the most favorable to health :—Yet the above, and many other facts evidently show, that it is not any particular remedy alone, Avhich will destroy an existing morbid action; but that any cause Avill dm it which is sufficiently poAverful to produce a neAV excitement.—Therefore, the best medicine is that which will produce the best new action. The influence of custom in rendering mot' .s or ope- rations periodical, was avcII understood by Doct >r Cullen :— 4 An instance of this,' observes that great man, l we have in Bleep, which is commonly said to be owing to the nervous poAver being exhausted, the necessary consequence of which is sleep, i. e. a rest of the voluntary motions to favour the re- cruit of that power: But if this were the case, the return of sleep should be at different times, according as the causes which diminish the nervous influence operate more or less powerfully; whereas the case is quite otherwise, these returns of sleep being quite regular.' This law of habit might be applied with great advantage, in conjunction with other means, in cases of morbid or preter- natural wakefulness ; by favoring a regular periodical return of sleep, this distressing affection would probably be often re- lieved, where it now resists the operation of the most valuable soporific medicines, promiscuously given. Any habits of patients respecting sleep, should at the same time be always attended to ; for instance, if they have been accustomed to sleep in the neighbourhood of a great noise, the continuance of that noise will be necessary to the production of sleep in them, however it might prevent it in Others. The same principle has been applied by Doctor Danvin and others, to the regulation of the alvine excretions. A re- gular stated time of evacuation, or even an attempt at evacu- ation, has been found effectual in obviating and removing a constipation ofthe boAvels. ' Custom, or repetition, gives strength to motion.' 4 This,' ■says Doctor Cullen, ' is of considerable importance in th© 222 DARLINGTON ON IIAlilTS AND DISEASE. practice of physic, though but too little regarded: for the re- covery of weak people, in a great measure depends upon the use of exercise suited to their strength, or rather within it, frequently repeated and gradually increased.' Doctor Rush has amply illustrated this principle by his own practice in the Pennsylvania Hospital, in the treatment of rheumatalgia and paralytic cases. Many ofthe patients affect- ed with those disorders, have recovered their Avonted strength, by beginning to lift small weights, and repeating the exercise every day, gradually increasing them. As disease is a habit of Avrong action, so I would reverse it, and say that all habits of injurious tendency are diseases'; and ofk course require medical treatment. The management of them all requires a knowledge of the Uiavs ofthe animal economy; otherwise the practice will be empirical, and the success fortuitous. The habit, or disease of drunkenness is a truly pernicious one ; and the treatment ©fit proportionally difficult and critical. The cure is becoming daily an object of more solicitude and importance, and to accomplish this radically, is the province of the observing physician. It has been treated successfully.—< And were those principles, before laiddoAvn, properly enfor- ced in practice, I have no doubt but Ave should frequently ar- rive at this grand desideratum. When the use of an active or diffusible stimulus has be- come so habitual as to render it a necessary support of animal life, it is in vain to attempt the disuse of it, without at the same time substituting an equivalent. If this be neglected, the system languishes from defect of its accustomed support', and a train of symptoms ensue which are generally disagree- able in proportion to the power, or previous continuance, of the stimulus omitted. It is from this cause that we see so many fruitless efforts at reformation among the unhappy vo- taries of Bacchus. How often have the unfortunate subjects ofthe habit of intoxication, upon seeing its fatality, resolved, and pledged themselves to abjure it forever! But, alas! from an ignorance ofthe laws of organic life, they have ' Resohed, and re-resolved—yet died the same.' The abstraction of so poAverful a stimulus leaves the svsten* DARLINGTON ON HABITS AND DISEASE. 225 in a state of distressing Iangour and debility, in which it is not calculated to re-act under the pressure of business and domes- tic wants. In this situation they again have recourse to the insidious poison, in order to restore the pleasurable excite- ment they have lost. But it is an error pregnant with every evil. They restore an excitement Avhich hurries the body to dissolution.—They follow a pleasure AA'hich allures but to destroy. The disease of drunkenness is often kept up by customsy which might, with a little resolution, be easily broken. Many persons addicted to it, only get intoxicated at certain times in the day, or among certain companions,—others only at certain places of resort, or at certain festivals, &c.—and some only when they can procure their favorite potation *. By observing those circumstances, we may be enabled to dissolve the charm by breaking a link in the chain of associ- ation, and substituting a neAv one which will finally, with pro- per management, establish a new habit. Even when repetition has made the stimulus necessary to health, If the patient be convinced of its evil tendency, and resolved on reformation, we may render his determination effectual by inducing a new action Avith a different stimulus; and thus pave the way for a radical cure. If the habit have been of long standing, it may be proper first to excite a new disease, as Avas formerly mentioned. The patient may begin by only changing the kind of drink ; afterwards he may substi- tute a poAverful stimulus of a different nature ; as opium, some ofthe metallic preparations t, or strong infusions of the vege- table bitters and incitants. By thus gradually effecting a revolution in the habits ofthe system, he may descend by means of tonics, and moderate * Rush's M. S. Lectures. t Hoav Avould a salivation do, Avhere other circumstances do not forbid ? There is no process Avhich has a greater effect in revolutionizing the system. Since writing the above, I have been informed by professor Rush that it was tried Avith success upon a gentleman in Vir- ginia. Blisters, he likewise informs me, have been known to* suspend this destructive habit. Ff 224 DARLINGTON ON HABITS AND DISEASE. stimulants, to a state of healthy excitement.. Or if a continu- ance of some extraordinary stimulus be requisite, he can use such as Aviil prove least detrimental. My friend Doctor Gideon J^ques informed me of a case much to my present purpose, which came under his own care. He removed tnis destructive habit in an elderly man, by exci- ting a ncAv action A^ ith other stimuli; A\hich supported the system at the same time that they produced this effect. The i principal substitutes on which he relied, Avere opium and i seneka snake root, gradually diminishing the dose. It is said that the celebrated Doctor Johnson intirely con- I que red a propensity for chinking ardent spirits, by the free ' use of strong tea. This, and other powerful vegetable infu- sions, might probably be often substituted with advantage for the leathcn draught. 'Drunkenness has frequently been cured by exciting dis- gust, shame, and other neAV actions. Religious impressions have often removed the habit likewise. These facts prove in this case, what was formerly proved by great exertion, or emotion, Avhen considering periodical diseases. There is no- thing peculiar or exclusive in the operation ofthe above men- tioned remedies on the habit of intoxication :—any application sufliciently powerful, will support animal life in the place of the vinous stimulus ; but those ought to be chosen which pro- duce the best excitement: and Avhen the cure is attempted by moral or religious impressions, they ought always to be aided by the proper physical remedies, otherwise the chance of a ra- dical and permanent restoration will be much less. All other pernicious habits, as the excessive use of opium, tobacco, kc. are to be treated upon the same plan. A substi- tute must be used to support animal life ; and if the excitabi- lity be not too much destroyed by the long use of the stimulus, the system may be gradually brought back to the healthy state. But if the hJuit have been of such long standing as to induce a permanent exhaustion of excitability,—or, in other Avoids, if the- impression have been so powerful, and so dura- ble, as ty derange that exquisite organization which renders the body capable of re-action when the usual stimuli are ap- plied, and li* clis derangement be lasting, it will be necessary DARLINGTON ON HABITS AND DISEASE. 225 to continue the use of the substitute *. Therefore, all that Ave can expect in this case, is to remove one evil by submitting to what Avith a healthy person would be another; but Avhich previous circumstances have here rendered necessary, and of course, comparatively salutary. There is an account of some Turk?, w;ho, being at sea, had used all their opium, Avhich from habit had become an essen- tial support of life: In this dilemma they sustained them- selves, at the expense of conscience, by drinking wine which they had on board. As different stimuli produce different actions, and as they possess different powers of acting upon the excitability, it shows the propriety of being provided with a variety of stimu- lating agents, as recommended by professor Barton. They might probably be tried with advantage in cases of great ex- haustion of excitability; for it has been found that medi- cines of apparently less active powers, will sometimes effect a cure, where more potent ones have failed. This circumstance may lead us to understand why a stimu- lus which could remove a tenacious habit of action, may haA'e its action remoAred in turn by a cause seemingly weaker than itself, one which could not destroy the first action; as is seen to be the case in the treatment of syphilis. After continued use has rendered tobacco a necessary sti- mulus, it is not uncommon for those so accustomed to it, to vary the form of using it Avithout any inconvenience. Those Avho cheAv can leave it off, provided they supply the defect by smoking or snuffing. But I have also known persons long habituated to chewing tobacco, to substitute ginseng, and other vegetable stimuli, with complete success ; there- by obviating the disagreeable effects of the former. * The susceptibility of action from the application of any stimulus being destroyed, in a great measure, by the exces- sive use of that particular agent, may we not plausibly infer, that the reason why small-pox and meazles can only be com- municated once to the system, is because the morbid stimu- lus which produces them destroys, permanently, the excita- bility; or that peculiar organization which is essential to the production of such an action ?—.The action of those contagions is so effectual, and of such specific nature, that the system is no longer excitable by them. 226 DARLINGTON ON HABITS AND DISEASE. These facts likewise show the practicability of changing any particular habit, Avhen attention is paid to the state of the system, and a new one at the same time introduced. This must be done; for one habit can only be destroyed by the introduction of another. In the treatment of mania, as of all other forms of disease, it is necessary to attend to the state of the system. If the action of the sanguiferous system be violent in this disease, depletion is just as requisite as it is in a pleurisy; and in mania from physical, or mechanical causes, the cure is al- most as easy. But where there is a morbid excitement of long standing in the brain, induced by causes which acted directly upon the^enses, or where false associations have be- come established, the management of the system generally, can only be considered as a preparatory step towards a cure. Physical remedies, strictly speaking, can only act indirectly on mania from what are called mental causes: and hence, as those remedies are principally trusted to in all cases, Ave may understand why mania from mental causes has been found more difficult to cure. Besides, in this species of mania, the causes very often continue to act while the remedies are using. The senses, like so many great rivers, expose the brain to the invasion of every inimical idea; and therefore while those sources of wrong action are unattended to, physical remedies may often be used in vain. It is frequently in our power to exclude some of the most unfriendly causes; and the channels Avhich admit the enemy, are always open to convey the well-disposed. It is the business of the practitioner to attend to this, and to prevent the operation of morbid causes, as far as possible, by removing those which can be removed, and making such impressions as are suited to introduce rational trains of thought. Where the excitement is not violent or when it has been sufficiently reduced, we may gradually attempt to produce a new action by other causes. If the mind be exclusi\'ely oc- cupied Avith one theme, as is most commonly the case in hy- DARLINGTON ON HABITS AND DISEASE. Z27 pochondriacal affections, the brain should be subjected to the various impressions which are afforded by agreeable so- ciety, and travelling. If it be void of connected operation, a cause should be applied which will produce a regular ex- citement ; and continued, or repeated until this excitement be established. We have many instances of the efficacy of this practice. A lady was maniacal at all times, except when she played at £ards; her friends observing this, played wkh her by turns, .until her brain had recovered its healthy action so completely that she did not relapse afterwards. A judge was perfectly rational whilst on the bench ; bat as soon as he left it he became deranged.* In this case the pressure of business produced a rational excitement which overcame the previous wrong action; but it was not continu- ed long enough to become permanent. Could he have been occupied in this way a sufficient length of time, no doubt he ivould have been perfectly cured, as in the case of the lady. The good effects of business closely followed, or any con- tinued impression of salutary nature, in restoring a regular train of thought, have often been experienced; and it is to be wished that more attention was paid to those remedies which act directly upon the brain. By observing that operation of the deranged mind which is most allied to rationality, and sup- porting it as long as possible by the proper impressions either conversation, objects, or both,—it is more than probable, we might often accelerate the recovery of maniacal patients; ...................' For the attentive mind, By this harmonious action on her powers, Becomes herself harmonious.' Akenside. Vicious habits are to be treated upon the same principle. If the patient have not been so long subject to the impression of morbid motives as to impair the moral faculties, the disease Avill disappear upon symply withdraAving the cause. But if a habit of thought and action, Avhioh' is of injurious tendency to society, be established, the mere abstraction of the cause Avifl * Rush's M. S. Lectures. 228 DARLINGTON ON HABITS AND DISEASE. not be sufficient. The diseased action will continue, indepen- dently of the original cause;—and hence we often see persons in this condition commit vicious acts Avithout any apparent mo- tive ; or at feast, from motives which Avould have no effect on others. In this case a change is only to be effeted by the ap- plication of causes Avhich are sufficiently poAverful to excite aneAv action; and on the nature of that cause depends the na- ture ofthe action produced. If the vicious excitement be violent, it must be reduced be- fore salutary impressions can take effect. This fact has re- ceiA-ed a negatiAre proof from the experience of all ages, by the vain attempts which have been made to induce a healthy action, in such cases, by the violent remedy of ignominious punishments inflicted in public. Such treatment, instead of exciting the desired action, generally renders the case desperate. Like ardent spirit in an inflammatory fever, it hurries the system on to a state of gangrene and death. But the propriety and utility of the above mentioned prac- tice has received positive and ample proof, from the success- ful management of those dangerous cases, in the new jail in the city of Philadelphia. This valuable institution is in reality an hospital for diseased morals. If the action be too great to ad- mit of the immediate application of salutary causes, itis re- duced by putting the patient in the solitary cells ; and no treat- ment has ever been found to produce a state of mind so favor- able for the introduction of a new and healthy excitement. This being premised, motives are then applied which are cal- culated to restore industry and integrity ; and they are conti- nued until it is believed the habit is established. This method of treatment has been found so effectual, that numbers haA-e been discharged completely cured. They have returned to society Avith the character of honesty and sobriety which they haAre ever after retained. It may be said that many have relapsed ; but no more hap- pens here than is often seen to take place in mania, and inter- mittent feA-cr. It Aveighs nothing against the principle. If the remedy had been applied sufficiently long, the cure would have been perfect. DARLINGTON ON HABITS AND DISEASE. 229 That accurate delineator of the human mind, the immor- tal Shakespeare, was well apprized of the great influence ot custom upon our actions ; as is evinced by the folloAving lines: 'Assume a virtue if you have it not. That monster, custom, who all sense doth eat, Of habits devil, is angel still in this ; That to the use of actions fair and good He likewise gives a frock or livery, , That aptly is put on ; Refrain to night; ' And that shall lend a kind of easiness j To the next abstinence ; the next more easy ; j For use can almost change the stamp of nature 1 And either master the devil or throAV him out i With wondrous potency.'...... Religious impressions exert great influence upon the im- moral form of disease. The morbid excitement is subdued, or diminished by the terror of future punishment; and a vir- tuous action produced by the pleasing prospect Avhich is held out, of the enjoyment of everlasting happiness. What has been said will point out the propriety, when a reformation is attempted, of first depicting the evils resulting from a destruc- tive career, and then to pourtray the motives to upright con- duct in all their alluring beauties, RECURRENCE TO OLD HABITS. Where the confirmed habits ofthe system are not attended with much inconvenience, it Avould be better to endure them than attempt a reformation ; and indeed under all circumstan- ces they should be borne Avith, unless pains be taken to pro- ceed upon the same principles as above directed : for an omis- sion of the accustomed stimulus has been known to produce disagreeable, and oven fatal consequences. A patient of Doctor Hope was affected with vertigo, coma, he. to an alarming degree, in consequence of leaving off thi use of snuff, through complaisance to his wife. The doctor, upon inquiry was informed of the circumstance ; he ad\Lcd the person to return to his former habit, which entirely re- lieved him. The same remark applies to hJiu acquired by 230 DARLINGTON ON HABITS AND DISEASE. the repeated use of any other stimulus, or to any habitual discharge from the system ; and Avhen guided by this principle, the treatment -will be easy to understand in all cases. The application of preternatural stimuli to the healthy bo- dy is at all times prejudicial, and often dangerous. They in- terrupt the usual operations; and until the system accomo- dates itself to the force ofthe impression, its condition is more or less precarious. Resorting to the use of snuff has been known to cause fatuity;—-and by leaving it off, health Avas again restored. This should teach us to be cautious how we attempt innovations of this kind ; and also to make inquiry in pvery case where such a circumstance may be suspected, The re-appearance of those habits which were attendant on the health of the patient, after they have been suspended by diseased action, is likewise a matter of great importance, and should never be neglected, nor overlooked by the practitioner Avho is ambitious to make an early and correct prognosis. In all dangerous, or critical cases, the friends ofthe pati-' cnt demand and expect the opinion of the physician respect- ing the event; and much of his reputation depends upon the correctness with which it is given. By a nice observance of the healthy habits as they'return, he may be enabled to pre-' diet a favorable issue, before the negligent attendant can per-' ceive any alteration. Sometimes, indeed, where the disease has been violent, and of considerable duration, some of the more remarkable habits have been permanently destroyed, as I have myself witnessed. But otherwise they are not; and in all cases, Upon a favorable crisis, it is the light of returning healthy operations which produces the dawn of convalescence. I might here give a long list of the symptoms which indi- cate a termination of diseases in health ; but they are so amply detailed by authors, and so judiciously commented upon by Professor Rush in his lectures, that in me it would be a work of supererogation. Besides, any person who directs his attention that Avay cannot fail to observe them ; and observing them, he will soon learn to make the proper inference. There is an additional consideration attending an obser- vance of the first symptoms of convalescence, which is of still DARLINGTON ON HABITS AND DISEASE. 231 greater importance ; and that is, the more early use of resto- rative, or tonic remedies than is frequently thought advisable by the generality of practitioners. It is a point Avhich re- quires great judgment, it is true, and mischief may often be done by commencing the stimulating plan too soon; but I be- lieve a propef attention to the above mentioned circumstances would obviate this evil in a great measure. That a neglect of them has produced evils on the other hand, I have no doubt. How many instances are related of patients breaking over the rules of regimen prescribed by their physicians, and indulging their appetites in what was strictly forbidden, not only Avith impunity, but Avith great ad- vantage ! Almost every experienced nurse can relate an in- stance of such transgression, whereby the patient has evident- ly accelerated his recovery. In those cases, the habits of health have returned unat- tended to by the physician, and the patient, by obeying the early indications of convalescence, has rendered his recovery more speedy than it would have been by observing the formal regulations of system, under its present imperfections. By disregarding, or counteracting those indications, in the infancy of their return, we may often retard the cure, if not prevent it altogether. The recovery of convalescent patients may be much pro- moted by attending to the recommendation of Professor Rush, of having every object removed from their vieAv which can tend to prolong the disease by association. The sight of old pkisters, pill-boxes, remnants of juleps, he. exert a very unfa- vorable influence upon patients of delicate constitution, where the recovery is tedious. They should be taken away as soon as they can be dispensed with ; or if practicable, the patient should be removed to another room, where objects will be presented to him which are calculated to make him forget his disease. The same observations may be extended to the treatment of mental and moral diseases. When the maniac discovers the least sign of returning reason, it should be encouraged and 2.32 DARLINGTON ON HABITS AND DISEASE. assisted by every humane endeavour * :—And Avhen the pro- digal retraces with penitent steps the destructive path in Avhich he has strayed, he should be received with open arms, and kindly directed in the A\ay that leads to peace, prosperity and happiness. I haAre mentioned very feAV of the instances in which the influence of custom is evinced; but, if the explanation be correct, they can all be understood from what has been said ; and may be turned to our advantage in the practice of physic. I shall now conclude these desultory observations, which I fear Avill suffer in the eye of the critic from the uncouth form in which they make their appearance :—But to close without a tribute of respect to the illustrious professors in this univer- sity, would be to suppress the Avarmest emotion of my heart. To all of them I am much indebted for their persona) kindness and attention. They have individually honored mc Avith that regard for my improvement which at once evinces the patronizing hand of liberal science, and is calculated to ensure a grateful and permanent remembrance. The enlightened professor of materia medica, in particu- lar, has conferred obligations which it will ever be my duty and pride to acknowledge. To his polite and friendly in- struction I oAve that taste for the study of nature, from which I anticipate the most rational and lasting pleasures of my life. It is his happy attribute to fascinate his pupils with the science* he so ably teaches. It is high time for the haughty bigots ofthe old world to acknoAvlcdge and revere the scientific talents of America. No longer can it be said, to the reproach of our country, that all her productions are of an inferior order. As she has produced a Washington, a Franklin and a Jefferson, to wrest and pre- * This is of importance to attend to. Maniacal patients should be released from chains and cells as soon as the case will admit of it. ?L nia which Avould otherwise have admitted of a cure, has, I believe, become habitual from a continued im- pression of those objects which were applied during the vio- lence of derangement. DARLINGTON ON HABITS AND DISEASE: 233 serve our rights and liberties from the grasp of trans-atlantic tyrants,—so has she given us a Rittenhouse, a Rush, and a Barton, to maintain our dignity and independence in the va- rious branches of philosophy, medicine, and natural history. AN INAUGURAL ESSAY, BEING AN ATTEMPT TO ASCERTAIN THE CAUSE OF THE EXTENSIVE INFLAMMATION, WHICH ATTACKS WOUNDED CAVITIES AND THEIR CONTENTS, SUBMITTED TO THE EXAMINATION OF THE REVEREND JOHN ANDREWS, D. D. PROVOST PRO TEMPORE, THE TRUSTEES AND MEDICAL PROFESSORS OF THE UNIVERSITY OF PENNSYLVANIA, ON THE FIFTH DAY OF JUNE, A. D. ONE THOUSAND EIGHT HUNDRED AND FOUR. FOR THE DEGREE OF DOCTOR OF MEDICINE BY JAMES COCKE, OF VIRGINIA. INAUGURAL ESSAY, In deciding on a subject for a dissertation, much difficulty presented. The great variety of diseases, which are interest* ing to physicians, have already attracted the attention, and exhausted the ingenuity, of other candidates for medical de- grees. Independently of their productions, all diseases have been treated of, by medical Avriters of the greatest note, on whose descriptions and modes of practice, I could not have flattered myself, Avith the hope of making any improvement, I have been induced to institute this enquiry, into the cause ofthe extensive inflammation which takes place on Avounded cavities, not only from a consideration of the contra- riety of opinions, which prevails among surgeons, on this subject, but by a hope, that I might bring into vieAv, a source of this inflammation, which I think the true one, although it has heretofore escaped notice. In the progress of this essay, I have been obliged to take a short review of the doctrines of the principal Avriters, who have touched on this subject. 1 hope I have succeeded in quoting their opinions fairly ; and that I have in no instance, forgotten the respect, which is due to those, who have labour* ed to enlighten, and alleviate the miseries of mankind, The greater danger of wounds penetrating into the cavi# tics ofthe body, than of wounds of equal extent in other mus- cular or membranous parts, must have been noticed by the earliest practitioners of surgery. But, although the fact has been so long knoAvn, and admitted, by all Avriters who have mentioned the subject, no satisfactory explanation of it has yet, been given, 238 COCKE ON THE \n occurrence so frequent, so obvious, and so interesting, as the violent inflammation, which takes place on Avounded cavities and on parts contained in them, could not fail to at- tract the attention of pathologists, and it has been attributed, by those of the highest credit, to diflercnt causes. None of their theories have, however, been so supported, as to gain general credence, and every surgeon embraces that, toAvhich accident, prejudice or reflection lias inclined him. I shall not attempt to detail, all the hypotheses Avhich have been advanced by authors, with a a ieAV of explaining it. Some of them, from the high authority by Avhich they have been introduced, and from the ability by Avhich they have been ur- ged ; demand particular attention. HoAvcver opposite and contradictory the opinions of writers have been, as to the cause cf the dangerous symptoms Avhich supervene on a wounded cavity, no one has questioned the importance of ascertaining it, as it is evident that a discovery of it, would lead us directly to the most rational way of preventing them. It appears to have been the opinion, generally received, from the most remote period of medical history, that atmos- pheric air has an injurious effect, when admitted into contact with parts, which arc naturally defended from it. The opini- on Avas simply announced, and as inflammation Avas always ex- tensive, when any cavity was opened, and a communication with the atmosphere established; the air being the only fo- reign matter which could possibly insinuate itself, it seemed natural to conclude, that it was the offending cause ; from this circumstance, I presume, the doctrine of the deleterious properties of air took its rise, and this theory the most uni- versally acknowledged, appears for a long time to have been deemed incontestable, although intirely unsupported, except by a slender probability and the respectability of its advocates ; nor do I find that any Avriter had ventured to oppose it, until within a few years. This ancient and common opinion was adopted, extend- ed and inculcated by Dr. Monro, who enters largely into the investigation, ' Ofthe causes ofthe dangerous inflammation INFLAMMATION OF CAVITIES. 2^9 which generally follows the wound of a shut sac, and of the manner of preventing it.'* Influenced, by a consideration of the difference between simple and compound fractures and dislocations, by the re- sults of a number of experiments which this author made, and by the issue of some cases, in Avhich air Avas supposed to have had access to the cavities of joints, he concludes that the inflammation, Avhich takes place on wounded cavities, as well as that folloAving some of the principal operations in sur- gery, is chiefly owing to the admission of air, to which he appears to attribute highly stimulating powers. That this very respectable writer was deceived, by taking only a superficial view of the subject, may, I think, be easi- ly shewn. In the common accident of a fracture of the ribs, with a laceration of the lungs, the caA'ity of the chest is filled with air, from Avhence, it escapes into the cellular substance on the thorax, and is thence diffused through the cellular texture over the whole body; in these cases, unless the in- teguments are wounded and a communication made exter- nally, no great inflammation is the Consequence; although air in abundance is applied to the cavity of a shut sac, to a surface unaccustomed to its action, and on Avhich it is said to produce highly stimulating effects: in Avhat Avay has it here been rendered inert ? and, why is it not uniformly fol- lowed by its supposed ordinary consequence ? Some experiments have been made by Mr. Astlcy Coo- per, to decide, whether air is stimulating to internal surfaces. I do not know the particular manner in Avhich they were performed, but from the known accuracy and ability of that gentleman, I have no doubt, of their having been conducted fairly, and of their having borne strongly and directly on the point, which he wished to ascertain : the result was, a con- viction that air does not stimulate. I am unable to determine, whether the pressure on the contents of the abdomen, by the diaphragm and abdominal * Monro's Description of all the Bursse Muscosse, of the human body^page 39. II h 240 COCKE ON THE muscles, is so uniform, as to exclude the air entirely from that cavity when Avoundcd, as has"been asserted by Mr. John Bell, but as that cavity contains the intestines, filled frequent- ly with flatus only, and composed of thin and yielding coats, it seems equally probable that air should get access to this cavity, as to that of the chest, filled with the lungs; which arc avcII known, to be sometimes oppressed by air, entering through Avounds ofthe breast. As a proof, that the cavity of the abdomen is replete with its contents, Mr. Bell observes, that hernia is frequently produced, by a Woav upon the holly or by any sudden exertion.* That either of these, may be the cause of hernia, I am Aveil aAvare, as a blow on the abdo- men, may be jiven in such a way, as to make the boAvels press violently on all sides; and if there is a Aveak part, it will yield, and some ofthe contents aviII be forced out ofthe cavity. On the same principle a bladder nearly filled with water, will burst, when forcibly stricken. That the abdominal muscles are capable of contracting so violently, as strongly to compress the boAvels and to produce a rupture, cannot be disputed ; but it is not more correct, to suppose the muscles of that part to be in their common state, thus contracted ; than it would bo to calculate that the gastrocnemii muscles are always acting with great force on the Tendo-Achillis, because they some- times act so powerfully, as to rupture it. If this pressure were so extreme and unremitting, the boAvels Avould not be able to perform their functions; and the large and undefended vessels, especially the veins, Avould have their circulation arrested. One great source of alarm to Mr. Bell, is certainly ideal; he apprehends that the blood- vessels of the abdomeM Avould burst, if not supported, by pres- sure on the surrounding boAvels. That these vessels can bear unaided, the weight and momentum ofthe blood, is fully pro- ven by their sustaining no damage, after child-birth or the discharge of large collections of water in abdominal dropsies. In neither of Avhich cases can the flaccid parieties of the ab- domen be supposed to have any influence on them. * Bell's Discourses on wounds, part II. page 71, INFLAMMATION OF CAVITIES. 34 1 The doctrine of air stimmlating internal surfaces, during so long a period almost universally acknowledged, has been sub- jected to a close-aud severe examination by some late writers. As just and weighty objections could be adduced against it, it has been rejected, and attempts made by Mr. Hunter, Mr. Abernethy and Mr. John Bell each to substitute his own in the place of it. The genius and celebrity of Mr. Hunter, as might have been expected, have engaged many of the most respectable surgeons of the present time, in favour of his opinion. The high respect which I entertain for the talents of these gentle- men, some of Avhom I have been accustomed to view, with that partial regard, which results from a sense of benefits con- ferred, of which I hold instruction to be the greatest; and the veneration which I feel for the character of Mr. Hunter, in- duce me to hesitate when I think of attempting an exami- nation of his theory, and of pointing out any mistake, into Avhich, from the multiplicity of subjects engaging his attention, and the vast extent and importance of his discoveries and im- provements in physiology and surgery, he may have fallen, in some points of inferior moment. Nor should I undertake it, if I were not compelled to Avrite, and at the same time fully persuaded of the inaccuracy of his doctrine on the subject of this paper. ' In many cases ofthe emphysema, Avhere the air is diffu- sed over the whole body,' says Mr. Hunter,' we have no such effect, (as inflammation) and this air not the purest, excepting there is produced an exposure or imperfection of some inter- nal surface for this air to make its escape by, and then this part inflames. Nay, as a stronger proof, and of the same kind with the former, that it is not the admission of air, which makes parts fall into inflammation, we find that the cells in the soft parts of birds, and many of the cells and canals of the bones of the same tribe of animals, which communicate with the lungs, and at all times have more or less air in them, never inflame; but if these cells are exposed in an unnatural 242 COCKE ON THE Avay, by being Avounded, Sec. then the stimvhn of imperfection is given, and the cells inflame, and unite if allowed ; but if prevented, they then suppurate, granulate,' Sec. * These are the chief grounds on Avhich Mr. Hunter has introduced the neAV, and to me, incomprehensible doctrine o the * stimulus of imperfection ;' Avhich appears to have been assumed, without the semblance of proof, or any arguments sheAvingeven the probability ofthe existence of any capacity in the animal economy to give it. It is, indeed, very certain that all Avounded cavities are imperfect, and this being a neces- sary and unavoidable circumstance and uniformly attending ; as it applies to every case, is, with perhaps something more of the appearance of truth, charged with the consequent in- flammation, than air, Avhich had before been suspected. Mr. Hunter is not explicit as to the source of the stimulus of imperfection ; nor am I certain, whether he intended to con- vey the idea, that it is given by an intelligent agent, but from the manner in which he speaks, he must have viewed it, as arising from some power capable of deciding when such a stimulus is necessary, directing its efforts to the benefit of the system and instituting such actions as are necessary to restore parts that are injured. If this doctrine were in every other respect satisfactory, the introduction of this single term, which I am unable to fa- miliarize to myself, by the substitution of any simple expres- sions, would be sufficient cause with me, for its total rejection; as avcII might we admit, the volition of nonentity in metaphy: sicks. Bui, I am still more unwilling to admit Mr. Hunter's terms, from a recollection ofthe extensive injury, Avhich sci- ence has heretofore sustained from theories, requiring the aid of imaginary intelligencies, to explain the operations of the human body, both in health and disease. They paralizcd in- vestigation, and appeared to render superfluous the researches of the physiologist, and pathologist farther, than to trace causes to that point at which these agents might be supposed to com- mence their action. Whether the cells in the soft part of birds, and the cells and canals of their bones are liable to become inflamed, from * Hunter on Blood, vol. II. p. 98. INFLAMMATION OF CAVITIES. 243 the alternation of heat and cold, I am not certain. But, as other animals beside man, particularly the horse, are subject to catarrhal affections, by passing suddenly from a Ioav to a high temperature of air, I think it entirely probable that these cells and canals, which are parts of the respiratory apparatus of birds, may also under similar circumstances be inflamed. Other considerations however, have Aveight with me, as they shew the inadequacy of this theory. Emphy- sema, the very affection, on Avhich Mr. Hunter has in a consi- derable degree, rested his conclusions, against the supposed effect of air in inducing inflammation, is intircly apposite to my purpose and contributes largely to disprove his doctrine. It shews that inflammation does not always occur to any con- siderable degree, from a cavity being rendered imperfect, and remaining so for some time ; Avhich frequently happens Avhen, from a fracture of the ribs, one lung and both sides of the pleura are torn, and a communication with the external air remains for several days ; and in such cases it cannot be de- nied that the cavity is imperfect; both by a communication through the lung, trachea and mouth; and also, by a lace- ration of the pleura costalis and intercostal muscles, giving passage to the air, into the cellular membrane on the trunk. Whence it is diffused over the Avhole body, which latter cir- cumstance alone, seems sufficient to warrant the cavity being called imperfect. When a wound is made into any of the cavities of the body, the abdomen for instance, every part of that cavity, as the integrity of the Avhole has been affected, should, according to the doctrine of Mr. Hunter, feel the stimulus of imper- fection, and take on that action, Avhich this stimulus is suited to excite. But generally, a portion of intestine, is protruded through the wound, and in a short time we perceive the peri- toneum, which covers this piece of intestine, becoming more vascular, and incipient inflammation taking place on it; Avhile. every other part of that cavity is entirely free from inflam- mation. Surely no good reason has been assigned, Avhy a ge- neral cause should produce an effect so partial, nor does any explanation by the author of this doctrine occur to me, unless the stimulus of necessity is brought into action, which maybe 244 COCKE ON THE said, to induce the inflammation, Avith the intention of render- ing the cavity perfect, by producing an adhesion between the lips ofthe Avound and the surface of the protruded bowel. Hut as the admission of this extraordinary agency, Avould be gra- tuitous ; I think it proper, to adopt a mode of accounting for these occurrences, which seems to be founded on a firmer basis. The utility ofthe inflammation Avhich takes place on the surfaces of wounded cavities, will not 1 believe be questioned nor will it be affected if sheAvn to arise from a law Avhich per- vades all animated nature, and not to be under the guidance ©fan intelligent principle or anima medica. Theinuammation, Avhich generally folloAvs the evacuation of matter from an abscess, and which, uniformly occurs in ca- vities that are laid open, could not escape the observation of Mr. Abernethy, who, ever close in his investigations and cautious in his conclusions, found it necessary, to abandon the theories Avhich had been advanced by others, and to pro- pose a more plausible one, which, attributes the inflamma- tion to the frequent renewal and the long continued application of air, to a surface unaccustomed to it. To this opinion of Mr. Abernethy, ho\Arever, an objection presents itself. Although under ordinary circumstances his explanation may, and I believe will, be found to be literally true, yet I am certain that his intention was to inculcate the doctrine, that air, when frequently renewed and long conti- nued, acts on internal surfaces as a stimulus ; Avhich meaning may be fairly deduced from his words; ' a constant renewal of air is permitted, and the application of a matter so unusual to these surfaces, I am inclined to believe does harm.'* Which doctrine, I think aviII not prove to be correct, as I am led to believe from a consideration of the mildness and pleasantness * Abernethy's Essay on Lumbar abscess, p. 55. INFLAMMATION OF CAVITIES. 245 of air, Avhen applied under certain circumstances, either to the internal or external surfaces for any length of/time, and from an assurance, on high authority, that it is not stimula- ting to the animalfibrc. Of the various theories which have been proposed on this subject none has been more confidently advanced, than that of Mr. John Bell of Edinburgh. He assures us, that the ' in flammation running so quickly round all the surfaces of shut sacs, Avherever they happen to be wounded, proceeds altoge- ther from another cause, (than air) simple and plain to the last degree. For, in the wound of any shut cavity where the parts do not adhere, the inflammation spreads and runs its course, by a law of the animal economy, which we explain very ill, Avhen we call adhesion the adhesive stage of inflam mation, representing, as the first stage of a most dangerous disease, that adhesion which is a natural and healthy action, the most natural in all the system and the farthest from dis- ease.' t Simple and plain, as the cause ofthe rapid progress of in- flammation in cavities, appeared to this ingenious surgeon, it is certainly to be regretted that he has not dispelled the darkness which to the aicav of most others* still rests upon this point. The ideas of Mr. Bell, as to the cause ofthe inflammation, are more clear and accessible. ' It is plain,' he says, ' that inflammation, or the absence of it, arises not from the pre- sence or absence of air, but from the length of the incision, there is no inflammation Avhere the wound is small, though it is made on account of confined air; there is inflammation where the incisions are large, though they are made with the intention and also with the effect of letting loose the con- fined air *. I am entitled by a variety of circumstances to deny, that the membranes lining cavities, are liable to become inflamed t Bell's discourses on Avounds, Part. II. p. 93, * Bell's Discourses, part II. p. 90. 246 COCKE ON THE from slight mechanical injuries. . In a number of experi- ments performed by Dr. Monro, he found that the inflam- mation AvasneArer in proportion to the size ofthe wounds made into the cavities of animals, but that it corresponded with the time and manner of the exposure of the boAvels to the air.* The capability of membranes lining the cavities of joints to bear violence Avithout great inflammation, is shewn in all cases of dislocations, where the capsular ligament and conse- quently the lining membranes are lacerated. Similar hardi- ness is evinced by the pleura, Avhich must frequently be consi- derably torn, by the rough ends of fractured ribs, and yet we see persons in Avhom it has happened, recovering Avithout any of the symptoms of thoracic inflammation. Inflammation from local irritation is generally proportion- ed to the extent of the injury, which is certainly not the case in Avounds of cavities, the lining membranes of which, are sometimes extensively lacerated and no inflammation follows, while in other cases, the most alarming inflammation super- venes on a cavity, wounded only by a small puncture. Irri- tation from wounds, on Avhich Mr. Bell lays so much stress in that discourse, in which he treats of inflammation of cavi- ties, will not explain, Avhy inflammation immediately takes place, on any portion of intestines, protruded through a Avound of the abdomen. It surely will not be said, that the irritation or inflammation cf the wound, has been communicated to the bowels by Mr. Bell's sort of contagion, and thus propagated over the Avhole ofthe peritoneum covering them. If the inflammation of cavities Avere caused by the irrita- tion of wounds, it Avould be expected to spread gradually from the wounds to the nearest portion of tho lining mem- brane, and in a regular way to travel OA'er the whole surface, Avhich does not take place. But if any of the contents of a cavity are exposed, t.iey immediately inflame over their Whole surface, leaving in a sound state all that extent of lin- ing membrane Avhich intervenes, from the wound to the part protruded. In some cases, the inflammation of the intes- tines cannot be supposed to have the slightest dependence ore, * Description of the Eursre Mucosae, p. 45. INFLAMMATION OF CAVATIES. 247 or the most remote connection with, the irritation of the wound. Of which, tAvo experiments, made by Mr. Hunter Avith other views, furnish striking proofs. In one of these experiments, the surface of the testicle of a young ram, be- ing exposed, became almost immediately more vascular, and in an hour or two discharged matter, different from that Avhich is generally found on its surface. In the other, the cavity of the abdomen of a dog was laid open by an incision of seA'eral inches long ; in five minutes, the increased action ofthe vessels of the cavity, had altered, and augmented tie quantity of the lubricating matter; in fifteen minutes the surface Avas apparently more vascular, and the appearance of the secretion still more changed. ' The spleen' (and I sup- pose the other viscera) ' had its surface excessively red, from the increased number of small vessels carrying red blood. From these appearances' says Mr. Hunter, ' the fluid Avhich lubricates the peritoneum seems to undergo changes, in consequence of exposure, and at last, when in- flammation takes place, to have coagulating lymph substitu- ted for it.'* Before avc can suppose this instantaneous effect to be produced by the irritation of the wound, it Avill be necessary to conceive, that its velocity is nearly equal to that of the electrick fluid, and to attribute to it a power more extraordi- narv, that of inducing inflammation on one flart of a surface, passing over that which from its continuity should next be affected, and seizing on another, and more distant part. The irritation, from the puncture of a lancet, or even an incision, cannot be compared Avith that which is given to the tunica viginalis testis, when a caustic has been applied to it, for the cure of hydrocele; by which application, that mem- brane, suffers all that it can do, from irritation, yet the in- flammation is inconsiderable until the tunic has ruptured.! If irritation from a wound or puncture were alone, suffi- cient to produce fatal inflammation; the violence done, by * Hunter on the Blood, Vol. II. pages 144. and seq. t Abernethy's Essay on Lumbar Abscess, page 56. I i J48 COCKE ON THE an incision made into the abdomen and uterus with the frag- ment of a butcher's knife, in the case related by Dr. Mos- ley and noticed in another part of this paper could not have been survive n. It is not my design to deny that irritation is the conse- quence of wounds, for I believe there is no wound, however slight, which docs not produce some degree of irritation, but, I think avc have ample grounds for deciding, that local irrita- tion from a Avound is incompetent to the production of inflam- mation so extensive as that Avhich folloAvs a wound into a ca- vity. At a time, when cold Avas supposed to be actual matter, and thought to be a stimulant; there could have been no diffi- culty in giving a plausible solution to the question, ofthe cause of the inflammation which attacks internal parts, when expo- sed to the open air ; as the air is generally below the tempe- rature of the body. Cold had stimulating powers attributed to it, from pain, redness and inflammation of the skin having been observed to follow exposure to it, and by the system ha- ving been observed to be strengthened by the application of it, in a certain degree. That the privation of an accustomed stimulus will produce pain is well known, and the violence of the pain will be in pro- portion to the extent and continuance of the diminution, within certain limits. This pain when caused by cold, arises From the actions ofthe exposed parts being lessened and per- formed irregularly, but pain from exposure to cold, is not very violent, until a higher temperature is applied. The manner in Avhich it is then produced, will be noticed in another place. That cold is not a stimulus is shewn by the weakness, tor- por and death which are produced by its long continued, appli- cation, by the effect which it has on the puke and by its use in diseases of too great excitement. The increase of strength, said to be produced by cold, as in the cold bath, does not appear during the application of cold, INFLAMMATION OF CAVITIES. 249 and is entirely OAving to the disposition of living matter, to become more sensible to its common stimuli, after they haAre been Avithheld for a short time. Which disposition does not shcAv itself in those cases only, in which heathasbeen applied, after its abstraction for some time ; but its effects are almost as striking in cases where persons have fasted for a long time. Some of the company of captain Bligh felt the symptoms of intoxication from eating oysters, and some berries of an inno- cent nature, after they had for several days eaten a very small portion of food. Dr. Percival mentions a young physician of Geneva, Avho, when a student at Montpelier, fasted three days, after which, the first nourishment he tookAvas veal broth, and that had an intoxicating effect on him. As all the above mentioned theories, appear in some part either defective or inapplicable. I shall make an attempt to account for the inflammation which occurs on wounded cavi- ties and their contents, in a manner which has received the sanction of no surgical writer. But I hazard it, at present, with extreme diffidence, both on account ofthe hasty^manner in which I am compelled to advance it, and flie slight support which a very limited time allows me to derive from experi- ments, or from medical and surgical writers. Before I proceed to suggest my ideas of the cause of in- flammation supervening on wounded cavities, it must be obser- ved that inflammation maybe produced, 1st. By preternatural stimuli acting on a part possessing only its due proportion of excitability, in which consists its health ; instances of this are afforded by cantharides, some chemical preparations, heat of 212 degrees, £vC. applied to the sound skin. 2ndly. It may be produced by ordinary stimuli acting on a part, the excitabi- lity of Avhich has been accumulated by a temporary sus- pension of their action, which may be noticed in parts of the body Avhich have been exposed, to a great degree of cold ; it is also observable in catarrhs and some species of cynanche. The effect of cold in rendering animal bodies more sensi- ble to heat, or incapable of bearing so high a degree of it. 250 COCKE ON THE must soon haA-e been learned from experience, by the inhabi- tants of cold countries ; and although they probably possessed no correct theory, as to its mode of action, they did not neglect to avail themselves of their knoAvledge in practice, as is shcAvn by the mode which they adopt, to recover persons who have suffered from exposure to violent cold. That cold has the effect of making parts more sensible to heat subsequently applied, has been noticed and illustrated by Mr. Hunter, whose phraseology, when treating on this point, is new. He supposes the quantity of life to be lessened by cold, and says, stimulus must be proportioned to the quantity Of life. He says farther, ' cold, according to its degrees, produ- ces tAvo A-ery different effects, one is the exciting of action without lessening the powers, the other is absolutely debilita- ting, while at the same time it excites action, if carried too far; in the first, it becomes like suitable exercise to the vas- cular system, as bodily exercise is to the muscles, increasing strength ; but when carried or continued beyond this point, it lessens the powers and becomes a Aveakener, calling up the action of resistance after the powers are lessened.'.......... Again, ' Cold produces the action of contraction in the vessels, which is an action of weakness. A degree of cold suddenly applied, which hardly produces more than the sense of cold, excites action after the immediate effect is over, Avhich is the action of dilatation, and Avhich is the effect of the cold bath when it agrees ; and as cold produces weakness in proportion to its degree, its application should not be carried too far, for then it produces a much worse disease, irritability, or over action to the strength of the parts, and then indolence too often commences,' * Between the doctrine advanced in this extract from Mr Hunter, and the opinion of Dr. BroAvn on the same subject, I perceive no particular difference, except in terms. They both allow that the effect of cold applied for a short time is the exciting pf action, after it is withdrawn, or a higher tempe- rature is given to it, Avhich takes place on leaving the cold •Hunter on the Blood, vol. ii. p. 74. INFLAMMATION OF CAVITIES. 251 bath. When a part lias been exposed for a long time to a greater degree of cold, the disposition to action is increased so greatly as to have inflammation or gangrene brought on by ordinary stimuli subsequently applied, examples of which arc frequently seen in frosted limbs. It Avas, I believe, first taught by Dr. Brown, that all se- dative powers, weaken the tone of the fibre, Avhich by accu- mulating irritability predispose to inordinate action on the ap- plication of a slight stimulus. Cold, I think, is eminently in- titled to be considered a sedative power. That it produces debility is sheAvn by the effect which it has on the pulse and on the skin, also by the general reduction of strength Avhich is observable in those Avho are exposed to it for any length of time. Of this debility, I presume, an accumulation of exci- tability or by Avhatever name it may be called, an increased aptitude to be acted on, to be the uniform consequence. An instance of this debility from cold and consequent sensibility to heat, is shcAvn in the common cold days of winter on our hands and faces.—When we first leave a room, the tempera- ture of which is pleasant, and go into the cold air, the expo- sed parts immediately become pale and remain so for a short time, after which, from an accumulation of excitability, lessened tone, or weakness of the vessels of the parts, the ac- tion existing in the system will be sufficient to tliroAv blood enough into these parts to render them quite florid ; and if Ave return to the same temperature, Avhich had before been grate- ful to our feelings, or to one a little higher, the action AAill be so much increased, as to give considerable pain, and even to go on to inflammation and mortification. It has been conjectured that when any part ofthe body has been weakened by cold, the adjacent parts sympathise Avith it, and, as soon as the cold is removed, the action of the neighbouring parts spread to it, giving to it a greater degree of action than its weakened state can bear, of which, inflam- mation is the consequence, frequently terminating in gan- >'-ivne. * * Burns on Inflammation. Vol. I. p. 267. 252 COCKE ON THE It is not material to my present inquiry to ascertain, whe- ther inflammation is induced by the sympathy just mentioned, or is the consequence of cold being applied beyond the poAvers of resistance of the parts, or is produced by stimuli acting on the accumulated excitability, Avhich supervenes on debility. I incline, for various reasons, to the latter mode of explaining the phenomena, and one of the greatest weight, is, that it re- ceives the support of all the arguments used by my preceptor Dr. Rush, in favour of his theory of fever; in either case, predisposing debility occurs, on this, an accumulation of ex- citability follows, on which any accidental additional stimuli, or eVen the ordinary stimuli will act with sufficient force to induce inflammation. I think it strongly in-favour of the truth ofthe explanation which I propose, of some cases of local inflammation, that it accords so fully with the theory of fever of Doctor Rush, which has thrown light on various diseases, and led to innume- rable improvements in medical practice. As the temperature of the internal parts of our bodies, is always considerably above that ofthe surrounding atmosphere, whenever a direct communication is made between the cavi* ties ofthe body and the external air; it-is obvious, that by a known law of heat, a reduction ofthe temperature of the ca- vities must be the consequence. These cavities, being unlr foranly accustomed to a heat of ninety-eight degrees, a re- duction of that temperature by a number of degrees, which would have but little influence on the external surface, ever exposed to varying temperatures, may induce debility on the membranes lining the cavities ; on which I suppose inflam- mation to folloAv on the principles which have been mentioned. I belieAre the redness, Avhich is observable on the skins of in- fants a few hours after birth, to be a slight degree of inflam- mation, and think the sudden change of temperature, to which they have been subjected, is obviously the cause of it. It is rendered more probable, that this is the true cause of the inflammation of cavities, when exposed to a temperature much lower than is natural to them, Avhen the extent in Avhich INFLAMMATION OF CAVITIES. 253 the same principle may be observed to act, in the inferior or- ders of the animal creation and also in the vegetable king- dom, is taken into consideration. All that vast number of animals which go into the state of torpor, strongly evince the extensive prevalence of a princi- ple which is beginning to be generally understood and admit- ted, Avhich is, that animal matter becomes more sensible to its or- dinary stimuli after they liave been diminished or withheld for a short time. We learn on the authority of Fontana, that vipers which, during the winter had been kept at the temperature of 59 degrees, were destroyed in tAvo minutes by exposing them suddenly to a temperature of 67 degrees ; which is very far below that, which they easily bear and in Avhich they are in full vigour during the summer. This fact is clearly in favour of the opinion, that cold has had the effect, on these animals, of rendering them infinitely more sensible to the stimulus of heat, than they were before they had been exposed to cold. The Abbe Spalanzani observed, that newts conceal them- selves in the earth and become torpid in the month of Octo- ber, when the thermometer generally stands at 54 degrees ; after remaining several months in this state, they re-appear in February, when the degree of heat is much less than at the time of their becoming torpid. No one, I believe, contends that there is any physical necessity, from the constitution of these animals, that they should go into the state of torpor; indeed it is known to be otherwise, as the same species of ani- mal Avill be subject to become torpid in one climate and not in another *. They require a certain quantity of heat to keep them active, and this must be larger at the close of summer, than they can bear at the commencement of spring, furnishing one of innumerable instances, in which it is obvious that living matter becomes less sensible to stimuli Avhich are frequently repeated. We here find the newts retiring on account ofthe defect of heat, when it is generally equal to 54 degrees; they * Professor Barton's Lectures. 254 COCKE ON THE continue in their state of torpor, exposed to feeble stimuli, for several months ; Avhen, by some change which has taken place in them during the time that they have spent in their winter quarters, they are prepared to come forth in February when the temperature is frequently below that of freezing. That it is defect of heat Avhich causes them to become torpid is shcAvn by their remaining active, when kept in warm places; and the change which takes place in the time of torpor, ap- pears to consist in their acquiring a capacity, of having perfect life supported by a less quantity of heat. By which, 1 mean, the excitability of their syskms has been accumulated and great action is produced in them by a slight stimulus. This principle, so general and so frequently manifesting its influence, could not elude the accuracy and penetration of Mr. Hunter, to Avhom it appeared in a variety of familiar instances. He avails himself of it, to explain some phenome- na which had not before been plausibly accounted for. He notices the disposition in eels to be so violently affected by a moderate heat applied to them Avhen torpid, as to be destroyed by it in a few minutes, lie reports the same effect having been produced on some other animals, as snakes and lizards. On the same principle, he explains the speedy death of birds caught during the Avinter, and brought suddenly into a Avarm room. The immediate destruction of animals passing from a low to a moderate temperature, may, I think, be fairly attributed to the violent action which arises from the heat suddenly appli- ed to their very excitable systems, because they become capa- ble of bearing a degree of heat, when applied by the steady and unerring hand of nature, equal and often superior to that which kills them, when afforded by art, without a due regard to their particular states. The effect of cold in disposing to increased action on the sub- sequent application of heat, is not confined to animals, but vege- tables may be observed to have a similar effect produced in them, of which a variety of facts present themselves as inte- resting examples. It is particularly pleasing to notice the existence and influence of a laAv common to these tAvo great orders of anin.atcd creation, forming another chain, by which INFLAMMATION OF THE CAVITIES. 255 nature seems to have connected her works. This agrees with the many cogent arguments which have lately been ad\Tanced to support the opinion, that a gradation has been observed so regular and insensible, as to preclude the possibility of draAv- ing a line of separation, and even to force us to admit, that there is no point at Avhich animal life can be said to cease, and vegetable life to commence. Which doctrine is rendered almost certain, by the learned investigation, and the able and beautiful vindication which it has received from Professor Barton *. In the vegetable statics of Dr. Hales, there are some very interesting experiments, by which the effect of cold in predisposing to action is clearly shewn. In the spring, when the temperature is still very little above the freezing point, the sap begins to rise in vines, and the force and rapidity of its motion are observed to be considerably increased by a cold night having preceded a warm day. If the sun rises clear, the sap continues to rise no longer than nine or ten o'clock, after which time, it Avas observed gradually to subside until even- ing ; which, I think, shews, unequivocally that it is not the heat alone independently of circumstances which causes the sap to rise, as that is greatest after twelve o'clock. It must, therefore, depend on the irritability or excitability which is ex- hausted by the heat acting on it from sunrise until nine or ten o'clock; and the absence of the sun every night suffers the plant to accumulate a stock of excitability for the succeeding day. The irritability of the hedysarum gyrans is said to be exhausted by the noon day sunt- And the experiments of Fontana shew that the irritability of the sensitive plant is most abundant in the morning, less at mid-day, and almost imper- ceptible in the evening. It has also been remarked, that corn ripens in countries alternately cold and warm in a much shorter time than in such as are uniformly warm, * Lectures on the affinities between animals and vegetables. t I have here, as well as in several other places used the facts which have been collected in the third volume of Medical Extracts. Kk 256 COCKE ON" THE These, arc only instances, in Avhich the health antJ growth of vegetables arc promoted by the alternation of heat and cold; but there are not Avanting others in which, to con- tinue the analogy, mortification and death are the conse- quences of a transition, too rapid, from the temperature of freezing even to that of a clear morning of spring. All deli- cate vegetables aiid the young leaves and fruits of trees, are liable to be blighted after a frosty night. That this arises i' om the stimulus of the heat of the next day, being dispro- portioncd to the remaining quantity of life, or to the excita- ble state of the vegetable, and is not the necessary conse- quence ofthe frost, is proven, by the mode which has been successfully practised to prevent it; that is, by the simple precaution of moderating the heat by the evaporation which Avill arise from Avatering the plants before the rising ofthe sun. Independently of the arguments which are afforded by analogy, draAvn from the lower orders of animals and from vegetables; I am countenanced, in the opinion which I have advocated, by the facility with which it applies to a number of cases, which have not been explained on any other prin- ciple. One of these cases on which, I repose with great confidence, is that of the lungs, pleura and intercostal mus- cled being Jacerated, by a fracture of the ribs. In this case the air escapes into the cavity of the thorax and into the eel- lular membrane ; here no inflammation of consequence takes place, although air gets access to the cavity of a shut sac and should, according to Dr. Monro, produce inflammation: this air, is frequently renewed, that first taken in, finding its AVuy into the cellular texture, it is also long continued in its application, and these according to the opinion of Mr. Abernethy are the two requisite circumstances, for the pro- duction of inflammation. I have in another part of this essay endeavoured to shew that imperfection of the cavity, suppos- ed by Mr. Hunter to be the cause of inflammation, could not be denied to exist in this case; and certainly where a lacera- INFLAMMATION OF CAVITIES. 257 tion of the soft parts has taken place to so great extent, there must be as much irritation as could be desired by Mr. John Bell. , Why inflammation does not occur here, is not satisfac- torily explained by either of the writers, Avho have been men- tioned. The reason is immediately obvious, Avhen the the- ory which I have embraced is attended to, the air in passing through the lungs, the central point of animal heat, must acquire a temperature equal to that of the body ; and is there- by rendered unfit, -to induce the debility on the cavities, Avhich is necessary to predispose these parts, to take on in- ordinate action, on the application of so feeble a stimulus as that of their natural heat.* But if, along with this fracture and laceration, a Avound is made through the integuments of the thorax, then the sur- rounding air gets access to the cavity, without having had its temperature increased, and inflammation arises in the manner which I have already stated. Nor is this effect of temperature by any means confined to a few cases of unfrequent occurrence; but it may be seen almost daily in the practice of physicians ; all catarrhal af- fections are produced in this Avay ; and the range of this prin- ciple, includes all grades of action, from the transitory glow, which we feel in our nostrils, in passing from the cold air, to a warm room ; up to the fatal inflammation and gangrene, which take place on the application of heat after long ex- posure to intense cold. * It might be contended here, that the air in passing through the lungs is deprived of its oxygen, and thereby rendered incapable of stimulating the cavity of the thorax. A considerable portion -of the oxygen which is taken in, in healthy respiration, is well known to be expired in the same state, and this, when the lungs are Avounded, must pass un- altered into the cavity of the chest; but we have no grounds on which to found the opinion that oxygen, after getting in- to the chest, would unite Avith any thing there, and stimulate that cavity by the heat which would thus be produced: and I am acquainted with no fact, which favors the idea ofoxygen possessing more irritating powers than any other gas. 258 COCKE ON THE There can be no doubt, as to the sensibility to the stimu- lus of heat being increased by a previous exposure to cold. The pain which is felt on holding the hand near a fire, after having been in the open air on a cold day of winter, or after handling ice, is familiar to every body. Which circumstance demands the admission of this principle for its explanation ; as the same degree of heat Avould have produced no unplea- sant sensation in the hand, if it had not before been in a redu- ced temperature. I tlink it probable, that I have the authority of Mr. Ciinc to support me in the doctrine Avhich has been contended for in this essay ; but of this I am not certain. I recollect, that he attributes the inflammation of wounded cavities to adiiference of temperature ; but whether he belieA'es the doctrine of cold being a stimulus, or in what Avay he explains its action, I have not learned. 1 am encouraged to adhere to the theory Avhich has been proposed to account for inflammation arising in Avounded ca- vities, by a consideration of the great advantage in practice which may be obtained from its being ascertained to be true. If the fewness of temperature should be proven to be the prin- cipal cause of inflammation on internal parts of the body v»hen exposed to it, a number of operations will be performed with- out hesitation and Avith safety, which are noAv declined by sur- geons, or undertaken Avith the most painful dread of the dan- gerous inflammation wl.ic.i they knoAV must supervene. The manner in which I should guard against inflammation, con- sistently with my ideas of its cause, is plain, and immedi- ately presents itself to view ; and I flatter myself that the pro- position of Dr. Beddoec, to have rooms filied Avith air, modi- fied in such a Avay as to suit the diseases of his different pati- ents, will be considered a sort of precedent, and will shield me from ridicule, for suggesting the advantage that would probably result from performing some eperations in rooms of a temperature equal to that of the human body. The operations which Avouid thus become less dangerous, are all those in which it is necessary to make an opening into INFLAMMATION OF CAVITIES. 269 any of the large cavities of the body, for the discharge of substances contained in them, as in operations for empiema and those for the discharge of extravasated blood, and any viscid or solid matter from the abdomen ; also, all the cases in which the cavities of joints are opened for the removal of fluids or cartilaginous bodies; and the operations for hernia when it is necessary to lay open the sac. A mode of preven- ting inflammation on the exposed boAvels in operations for hernia, which is pointed out by Professor Wistar, gives a ta- cit acknoAvledgement of the truth ofthe doctrine Avhich has been advanced in this enquiry. He recommends .bladders ol warm water to be put on the intestines, which are unavoida- bly exposed in the operation : He has found this practice use- ful ; its use could not be that of preventing air from touching the bowels, because no care could obviate it, besides it has been sheAvn, that air is not injurious to parts naturally defended from it. In these cases, I suppose, the heat of the Avater prevents the peritoneum frpm falling into that state of debility which would be followed by inflammation on the princi- ples which have been advanced. To these, may perhaps be added, the operations for the discharge of large collections of pus. The success of Mr. Abernethy's mode of discharging the matter of lumbar abscesses, may, I believe be attributed to the smallness of the punctures and their immediate closure, which prevent the temperature of their cavities from being redu- ced, and thereby obviate inflammation; the simple operation of paracentesis is successful for the same reason. The cause of hectic fever consequent on opening lumbar abscesses and other collections of purulent matter, being en- tirely unknown; I may be alloAved to venture a conjecture, that hectic fever is in no other respect different from the or- dinary constitutional derangements arising from local inflam- mation except that Avhich depends on the health of its sub- jects being injured by previous suppuration. It is, I believe on the same principle that the causes which produce inflam- matory fevers in well-fed and healthy men, giA'e rise to ty- phus fevers in sailors, soldiers, and poor persons who are .260 COCKE ON THE ■debilitated by having been badly fed and croAvdcd together in confined situations, U3 on board ships, in jails, and in the miserable habitations of the indigent. In one case, debility is brought on by a tedious and distressing suppuration; in the other, by an habitual destitution of the necessary supply of food, &c. debility is also induced ; Avhich debility is of a chro- nic nature; and this, according to Professor Rush, expends the excitability of the system, leaving it in a state, in which stimuli generally act with too little force upon it to excite in it the commotions of (inflammatory) fever.* Two other operations, which are so formidaole as to in- timidate the most intrepid operators, deserve the greatest at- tention from surgeons, and any .proposition Avhich affords the slenderest hope of their terrors being diminished, claims a candid con si deration from those, Avhose standing in the pro- fession entitles them to discountenance or to admit and en- courage any inno\ration, proposed as an improvement. One ofthe operations to AA'hich I allude, is the extirpation of schirrous and dropsical ovaries. I do not know that this operation has ever been performed, and as I had no authority to support me, I had scarcely dared to whisper my opinion of its feasibility, until I found it had been proposed a long time since by the venerable Dr. Shippen, Professor of Anatomy in this University. There is certainly nothing in the anatomy ofthe parts, v. inch should deter surgeons from remoA-ing them Avhen from disease they have become incapable of per- forming their oaice, and endanger life, or at least render it uncomfortable. We do not hesitate to take out cancerous eyes and schirrous testes Avhen such sacrafices are necessary to pre- serve the lives of our patients. And, however strongly pre- judice might oppose this practice in its commencement, I be- lieve it would be submitted to, when the nature ofthe case, and the slight permanent inconvenience Avhich avoi !dft>e the consequence ofthe loss of one ovarium, was fully comprehend- ed. All surgeons sometimes witness the pain, anxiety, and despondency which are concomitants ofthese affections. The unhappy subjects of them despairing of a recovery, calculate • Medical Enquiry and Observations, vol. IV. p. 127. INFLAMMATION OF CAVITIES. 361 on spending their lives in a state of wretchedness and disease. Under these circumstances, no alternative however painful, xrhich gives a prospect of health, would be rejected. The urgency of the cases, and the rapid manner in Avhich they hasten to a fatal termination ; have compelled surgeons to turn their attention to the distresses of parturient women ; who from mafeonformation, cannot be delivered in the natu-* ral way. For their relief, an operation has been occasionally performed, called the Caesarian section which is perhaps tho most dangerous one in surgery. A larger proportion of the persons who have been the subjects of it, have died, than of those who have borne any other accreditted operation. The danger of this practice being considered, it is doubtless much to be desired that it could be dispensed with, this, however, seems impossible, and all that can be done, is to deprive it, of every portion of danger, which is not inseparable from it, and intimately connected with the parts which are the subjects of ope ration. I know not, in Avhat manner, the irritability of the uterus is to be estimated ; and am therefore, unable to decide, what degree of inflammation would arise from an incision made into it; I presume, that a wound made in this part, would be equally liable to become inflamed frpm irritation, as one made in any other muscular part of the body. But as the influ* ence of temperature, is so obvious, in causing increased action and inducing inflammation, mortification and death in -Jiving matter, it is at least probable, that the fatality Avhich has almost uniformly folloAved this operation, may in some degree, depend on the exposure of the cavity of the abdomen, and it-i contents, during th« operation. This operation therefore, which has heretofore been almost ahvays only a prelude to derih, has an indisputable claim to be performed in rooms ofthe temperature of 98 degrees. The danger cannot be aug- mented by it, but may possibly be diminished. Among the very few instances of this operation being suc- cessfully performed, there is one reported by Dr. Moselcy as occurring in the West-Indies; a young negjro Avoman, v/ho Avas in labour, becoming impatient of the pain which she suffered, conceived the idea of relieving herself in a sum- 262 COCKE ON THE man* Avay, and Avith a common knife made an incision into the abdomen and uterus, through which the chUd was deli- vered. The intestines which had protruded through the Avound, Avere replaced along with the placental portion of the funis, by some person at hand, and a stitch or two Avere put into the wound. The medical attendant, Avho soon after arri- ved, suspecting that some dirt or other matter had been thrust into the abdomen along with the intestines, took them out, examined and returned them, and at the same time extracted the placenta through the wound. This patient recovered, although almost every circumstance conspired to make the case peculiarly violent; the incision was made with a rough instrument, and the boAvels handled and exposed much more than would have been necessary in a regular operation. As this case terminated favourably, under so untoAvard circum- stances, it is fair to conclude that it ought to be attributed to something else than chance, and I can conceive no circum- stance to Avhich it may with so great probability be ascribed, as to the heat ofthe weather in that climate, increased proba- bly by a still more heated cabin, Mr. John Bell mentions a curious case of a soldier being Avounded in the side by a halbert, afterwards walking a milo Avith his intestines hanging out, wrapt in the skirts of his shirt, and deposited in his hat: the roads were dusty, and the intestines dry as parchment and blackened \\ ith dust, Avhen he obtained the assistance of a charitable old lady, who bathed his intestines with warm milk, and replaced them. It must be observed, that' the weather, it being mid-summer, was intensely hot.' Here it appears that neither the dust nor other irritation was capable of exciting a fatal inflammation, which, I think, would certainly have been the consequence of' exposure, so long continued, to a low temperature. When I resolved to write on this subject, I flattered my- self Avith the idea, that I should be able to prove the truth of my opinions, but was obliged to relinquish a series of experi- ments which I had conceived for that purpose, by the unfa- INFLAMMATION OF CAVITIES. 26 vourablcness of the season of the year, in Avhich only, I had an opportunity of attending to the subject, and for the Avant of several conveniences Avhich are indispensable to accuracy and success in experimenting. It is, however, pleasing to me, to reflect that the truth or fallacy of my explanation, is capable of being ascertained with absolute certainty; and I hope it will be deemed Avorthy of examination, by some abler hand and more experienced experimentalist. LI AN INAUGURAL ESSAY LUPULUS COMMUNIS, OF GARTNER; OR THE COMMON HOP. SUBMITTED TO THE EXAMINATION OF THE REVEREND JOHN ANDREWS, D. D. PROVOST PRO TEMPORE: THE TRUSTEES AND MEDICAL PROFESSORS OF THE UNIVERSITY OF PENNSYLVANIA, ON THE FIFTH DAY OF JUNE, A. D. ONE THOUSAND EIGHT HUNDRED AND FIVE. FOR THE DEGREE OF DOCTOR OF MEDICINE, BY WAKEMAN BRYARLY, OF MARYLAND: HONORARY MEMBER OF THE PHILADELPHIA MEDICAL SOCIETY. PREFACE. I HAVE chosen for the subject of my Inaugural Disserta- tation, the Humulus Lupulus of Linnaeus, the Lupulus Com- munis of Gxrtner, or the Common Hop. I have thought it unnecessary to say any thing respecting its natural history, as it is diffused through every part of the United States, and is a native of both the old and new Avorlds. The cones are the only portion ofthe vegetable, which is used in medicine. It would be much more congenial to my inclinations to glide through the process of graduation, in obscurity, than thus publicly to subject myself to the criticisms of the world : but as the laws of the University require a dissertation from every candidate for medical honors, I am compelled to submit this, to the inspection of the public : and hope that its being the production of a juvenile mind, impelled by necessity, and not led by choice, -will apologise in some measure, for its im- perfections. CHEMICAL AND PHARMACEUTICAL TREATMENT. EXPERIMENT I. Four drachms ofthe lupulus were put into a glass vessel, into which tAvelve ounces of pure Avater Avere infused, and the precaution taken of keeping it Avell closed. After macera-^ ting twenty-four hours, it was put into a glass retort, to Avhich a receiver was adapted, the retort was then exposed to a moderate heat in Blake's furnace. In five hours, the contents of the retort were reduced to a dry cake, and a Avhite transparent fluid had passed over into the receiver." The distilled fluid had an empyreumatic smell, and pos- sessed, in an eminent degree, the bitter property ofthe vege- table. It was then tested by the tincture of litmus, by Avhich it was converted to a red colour, but underwent no change ol colour by the oxy-sulphate of iron ; a variety of tests Avere then unsuccessfully tried, in order to ascertain what acid it was. EXPERIMENT II. One pint of Avater was poured upon four drachms of th- lupulus, in an open vessel, and subjected to a gentle heat, till reduced to half the quantity ; it Avas then passed through a filter ; the fluid after percolation was yelloAv, very bitter, an J emitted, in some degree, the odor ofthe plant. 270 BRYARLY ON THE COMMON HOP. EXPERIMENT III. Six drachms ofthe lupulus Avere put into a glass bottle, to which twelve ounces of water AA-ere added; after macerating five days, Avith frequent agitation, the liquor was poured off and strained. It Avas neither so bitter, nor so yellow as the decoction, but Avas endoAved with more of the odor peculiar to the vege- table. EXPERIMENT IV. Four drachms of the lupulus were put into a glass bottle, intoAvhich ten ounces of highly rectified spirits of wine were infused. After the lapse of five days, in which time it Ava;: frequently agitated, itAvas decanted and filtrated. The tincture a\ as very green, and extremely bitter, and formed a white precipitate by the addition of Avater. EXPERIMENT V. Eight ounces of proof spirit Avere put into a bottle, to which two drachms of the lupulus were added. After ma- cerating six days, the liquor Avas poured off and passed through a filter. It Avas slightly yellow, and not so bitter as the alchoholic tincture, but more so than either the decoction or the infu- sion. EXPERIMENT VI, A decoction obtained by means of experiment II. AA'as exposed to heat in an open vessel: it afforded me, after eva- poration, a dark coloured bitter substance, which weighed one drachm and an half. EXPERIMENT VII. Four drachms of the lupulus were put into a bottle, to which a quantity of water, sufficient to cover them, was ad- ded. Alter macerating twenty-four hours, it was poured off, and another- portion of Avater added; after repeating the affu- sion four times, it war -*-:-- -' - - ' BRYARLY ON THE COMMON HOP. 271 vessel, to heat: when evaporated to dryness, it afforded a residue of one drachm, of a dark, gummy, and somewhat bitter substance. EXPERIMENT VIII. Four drachms of the lupulus were put into a bottle, to which several portions of highly rectified spirits of wine were alternately added and poured off. It Avas then passed through a filter, and exposed in an open vessel, to the sun, for evaporation : it left one drachm and ten grains, of a dark, resinous substance, at the bottom of the vessel: it was much more bitter than either the extract or the gum, EXPERIMENT IX. To two drachms of the lupulus, in a bottle, six ounces of proof spirit Avere added. After macerating three days, it was poured off, and exposed, in an open vessel, to a gentle heat. There remained, after evaporation, thirty grains of a gummy, resinous substance. It was more bitter than either the gum or the extract, but not so much so, as the resin. It appears, from the preceding experiments, that a mo- derate degree of heat is sufficient to volatilize the bitter prin- cinle in a large proportion ; and that there exists in the lupu- lus an acid, in a free state, which it Avould seem is sui generis. But I had not a sufficiency of time and opportunity to prose- cute the investigation as far as I could have Avished. The odor of the hop is easily dissipated by heat, Avhich appears from every experiment in which it was used. The bitter resides much more in the resin, than in the gum. Mm 272 BRYARLY ON THE COMMON HOP. EXPERIMENTS ON THE HUMAN SYSTEM. EXPERIMENT I. At ten o'clock in the morning, two hours after a light breakfast, I took tAvcnty grains of the powder, suspended in water; my friend and felloAV graduate, Mr. Mitchell, attend- ing to the pulse, beating 80 strokes in a minute. Minutes. 5 10 15 20 25 30 S5 40 45 50 $5 60 70 80 "Pulsed 83 85 82~8Q_78 80 77 75 76 78 78 80 79 80 The powder Avas very bitter, and excited much nausea and burning in the fauces, which continued for a considerable length of time. In fiA'e minutes the pulse was fuller and stron- ger. In tAvcnty minutes the pulse became languid, and the nausea increased very much. In 70, the nausea Avent off, and the pulse became natural. The flow of urine was very sensibly increased. EXPERIMENT II. At 11 o'clock, a. m. Mr. Mitchell took twenty-five grains of the poAvder, in a very small quantity of Avater; his puis* beating 62 in a minute. Minutes. 5 10 15 20 25 30 35 40 45 50 55 60 Pulse. 6S 60 58 60 60 59 51 56 52 53 58 60 In five minutes the pulse was increased in fulness. In fifteen there was much nausea with an inclination to puke. In 30 minutes the nausea and sickness became very consider- able : in less than an hour it operated powerfully, as a ca- thartic. EXPERIMENT III. At five o'clock p. m, tAvo hours after my usual dinner, 1 took one ounce of the decoction, Avith my pulse beating 80 strokes in a minute, my ingenuous and worthy friend Mr. Merry attending to it. BRYARLY ON THE COMMON HOP. 273 Minutes. 5 10 15 20 25 30 35 40 45 50 55 60 Pulsed 80 82 8 1 80 80 80 80 80 80 80 80 80 The decoction was very disagreeable, and occasioned much nausea. At ten minutes, the pulse was somewhat fuller than natural, but suffered very little alteration. EXPERIMENT IV. i At ten o'clock, a. m. I took forty drops ofthe alcoholic tincture, my pulse beating 74 in a minute; Mr. Merry at- tending to it. Minutes. 5 10 15 20 25 30 35 40 45 50 55 60______ Pulsed 76 80 83 81 81 79 77 74 75 74 74 74 In fifteen minutes, the pulse became fuller and stronger. At twenty there was a sensation of fulness and tension in the head, with evident narcotic effects. At tAventy-five, the drow- siness increased and the pulse became very languid. At thir- ty-five, the drowsiness diminished, and at forty-five went off almost entirely. At sixty, the pulse resumed its natural ful- ness. The secretion by the kidneys was very sensibly aug- mented. EXPERIMENT V. At 11 o'clock, a. m. Mr. Merry took 80 drops of the alcoholic tincture, his pulse beating 58 strokes in a minute. Minutes. 5 10 15 20 25 30 35 40 45 50 55_________ Pulse. 63 61 60 61 59 58 58 58 58 58 58 At fifty-five he took thirty drops more. Minutes. 60 65 70 75 80 Pulse. 61~60 58 58 58 In five minutes the pulse Avas increased in fulness and strength : at fifteen the pulse became small and much drow- siness supervened: at twenty the system became languid, at- tended with profuse diaphoresis. At 30 the narcotic effects 274 brYarly on the common hop. Avere much less, and at 40 they Avcnt off' almost entirely: at 60 the pulse was fuller than natural: at 70 it became depres- sed and languid. It operated on the urinary organs. EXPERIMENT VI. At five o'clock, P. M. I took one ounce ofthe aqueous in- fusion ; it was extremely' disagreeable and excited much nausea, but had no sensible effect on the pulse. EXPERIMENT MI. At eight o'clock in the morning, Mr. Mitchell took six grains ofthe resin, dissolved in a very small portion of alcho- hol; his pulse beating 70 in a minute. Minutes. 5 10 15 20 25 30 35 40 45 50 55 60 rulse. 7 J 70 /6 78 /4 '/ J <2 7V 71 70 ?0 70 In ten minutes the pulse was increased in fulness and strength ; at 20 he felt much elated ; at 40 he became lan- guid ; at 70 the pulse resumed its natural force. EXPERIMENT VIII. At 9 o'clock in the morning, I took eight grains ofthe extract, dissolved in water; my pulse beating 74 in a minute ; Mr. Merry attending to it. Minutes. 5 10 15 20 25 30 35 40 45 50 55 60 Pulse. 76 76 75 74 74 72 73 74 74 74 74 74 It produced much nausea and sickness, with a great dis- position to vomit: at ten minutes the pulse was fuller than natural; the nausea continued for a considerable length of time. EXPERIMENT IX. At half after ten in the morning, I took 70 drops of the tincture with proof spirit, Mr. Merry attending to the pulse, beating 76 in a minute. Minutes. 5 10 15 20 25 30 "5 40 45 50 55 60 Pulsed 78 79 *78 78 79 78 78 77 76 76 75 76 BRYARLY ON THE COMMON HOP. 275 In ten minutes the pulse was fuller than natural; it ex- erted very sensible effects on the head, and caused some drowsiness. EXPERIMENT X. At 8 o'clock, a. m. Mr. Merry took 8 grains ofthe gum- mi-resinous extract, dissolved in proof spirit, his pulse beating 58 in a minute. Minutes. 5 10 15 20 25 30 35 40 45 50 55 60 Pulse. 60 61 63 63 60 58 58 59 58 58 58 58* In five minutes the pulse became much fuller and stronger, and continued so till the 25th minute, after which it resumed its natural fulness and force. At 15 there was some pain and tension in the head. At tAventy-five there was an increased perspiration. It acted very evidently as a diuretic. EXPERIMENT XL At 9 o'clock in the evening I took ten grains of the gum dissolved in water; Mr. Mitchell attending to the pulse, beat- ing 76 in a minute. Minutes. 5 10 15 20 25 30 35 40 45 50 55 60 Pulse. 77 78 78 77 76 76 76 76 76 76 76 76 The pulse was very little altered in fulness and force. It txcited some nausea, Avhich soon went off. EXPERIMENT XII. In order to ascertain the effect of the lupulus on the bow- els, Avhen taken for some time, I took sixty drops of the tinc- ture, every eA-ening, for one Aveek, and found that it had very little effect on them ; but if any thing, it rendered them more laxative. Two of my friends Avere so polite as to become the sub- jects of the same experiment, and with nearly a similar result. 276 BRYARLY ON THE COMMON HOP, From these experiments, it appears, that the powder acts very considerably as a cathartic, but exerts very little influ- ence on the pulse ; this I attributed to the distressing nausea which it induced. The tincture made Avith the highly rectified spirits of Avine, is the most agreeable preparation, and acts more power- fully as an anodyne than any other, and should always be pre- ferred when this effect is desired. The infusion and decoction are both very disagreeable, and are much less active than the tinctures. The resin is more active than the gum, which explains the greater activity ofthe tincture, than either the infusion or the decoction. From the preceding experiments with the tincture, and many more Avhich I have thought it unnecessary to relate, it appears, that it acts decidedly as a powerful narcotic, and has this very great advantage, that it either renders the bowels laxative, or leaves them in the same state, in which they Avere when the medicine Avas exhibited. ON THE MEDICAL PROPERTIES OF THE LUPULUS COMMUNIS. The Hop was introduced into the materia medica, at an early period, and received, like many other medicinal arti- cles, all those extravagant encomiums, which the enthusias- tic physician is so much disposed to heap on a medicine that he has employed Avith advantage. The advocates of different theories ascribed to this A-ege- table, different virtues, in order to explain its modus operandi, agreeably to the principles they had respectively espoused, as ' a sweetner of the blood,' as an ' antiseptic,' as an ' at- tenuant,' Sec. But these erroneous epithets are now justly discarded ; and the fanciful theories which gave them birth, have Aranished before the rays of a better light, and will soon be consigned to oblivion. The hop lias cither been mentioned very superficially, or passed over entirely, by a majority of modern writers on the BRYARLY ON THE COMMON HOP. 277 materia medica. But this should excite no prejudice against it; for many of the most celebrated and useful medicines of the present day, have, in their turn, experienced the same fate. Dr. Darwin and Professor Barton,* haAre, placed the hop in that extensive and important series of medicines, called Sorbentia by the former, and Bitter Tonics by the latter. From the preceding experiments, I am inclined to think it intitled to a respectable station on the list. I will first speak of its utility in CALCULUS. The opinions relative to the exibition of the hop, as a remedy in, and as a preventive against the formation of, cal- culous, are directly opposite ; some asserting that the num- ber of calculous cases has augmented: while others contend that they have diminished since the introduction of that artU cle into malt-liquors. Mr. Ray, who is entitled to much attention, says that calculous cases have become much less frequent in the city of London, since the use of malt-liquors has become more general; and it appears, from the London bills of mortality, that the disease of calculous has by no means encreased, and that it is not a frequent one in that city, Avhere the use of malt-liquors is so general. Dr. Sydenham complains of the frequency of calculous symptoms in his time; and observes, that they occurred among his gouty patients, in the decline of life. Here this il- lustrious physician takes notice ofthe great analogy that sub- sists betAveen the tAAro diseases, and that gouty patients Avere very apt to become calculous in the decline of life. But to speak more properly, gout and calculous are the same disease, differing only in situation. They are both the effect of mor- bid excitement, or wrong action; and both consist in a cal- culous effusion; the one in the joints, the other in the uri- nary organs. The mere difference of situation cannot be said to constitute a difference in the nature of them. * M. S. Lectures on Materia Medica. 278 BRYARLY ON THE COMMON HOP. From the circumstance of gout being so frequently the ef- fect ofthe immoderate use of ardent spirits, and from calculus being so often the consequence or concomitant of gout; avc are induced to ascribe Dr. Sydenham's increased number of * calculous cases, to the alcohol, and not to the hop. A Cyprianus, a writer of high authority, asserts, that he performed the operation of lithotomy, on 1400 patients, and that not one of them was a drinker of malt-liquors ; but that many of them Avure Avine-drinkers. This fact related by a man of such extensive observation, is entitled to peculiar at- tention ; for it seems to prove, in a very impressive manner, that the drinking of malt-liquors, seldom, if ever, contributes to the productien of calculus. Dr. Lobb makes the folloAving extravagant assertion res- pecting the vii'tues ofthe lupulus, viz. That the decoction of the phut had, in less than three days dissolved a very hard calculus ; and that itis one ofthe more powerful lithontriptics. This assertion I have not thought of sufficient consequence to induce me to put to the test of actual experiment; but ad- mitting that the decoction hadthepower of dissolving a calcu- lus out of the body, it would by no means folloAv that it could ef- fect the same in the body, after having undergone the course ofthe circulation. I Avish I could, with safety, bestow upon the lupulus, or any other medicine, the appellation of a lithon- triptic, but I fear that many years must elapse before man- kind v, ill be blessed Avith so precious and invaluable a discovery. Although I cannot ascribe to any medicine the poAver of dissolving a calculus, I will readily admit, that certain medi- cines may prevent the peculiar secretion on which the forma- tion of calculus depends. This secretion is frequently the ef- fect of debility ; and the hop, by acting as a tonic, may re- move this state of the system, and, of course the further for- mation will cease. Experience has taught us, that many of the most effica- cious medicines, in procuring relief from calculus, are deri- ved from the class of bitters ; and I should suppose the hop possessed of that power in a very eminent degree; for, be- sides its tonic poAvers, it has the advantage of operating on BRYARLY ON THE COMMON HOP. 273 the urinary organs, in increasing the Aoav of urine: and per- haps, all medicines Avhich have that effect, are of more or less utility in this disease. It Avould be as tedious as useless, for me to go through the long catalogue of diseases in which the hop might be used with advantage, as a tonic. The actual state of the system, which is so strongly inculcated, in his lectures, by our pro- fessor of the materia medica, should ever direct us in all our prescriptions; and all diseases arising from a defect of action, in Avhich the union of an agreeable bitter and tonic is indicated, cannot fail of being benefited by it. Having finished the consideration of the hop as a tonic, I proceed, in the next place, to speak of its virtues as a narcor tic. This I deem its.most valuable property. I cannot admit, with our illustrious Professor ofthe Insti- tutes, Sec. that the induction of sleep consists merely in eleva.- ting or depressing the system, to Avhat he calls the ' sleeping point;' for facts compel us to admit, that some substances are endoAved Avith a soporific quality, and that some possess the power of inducing sleep much sooner than others ; howeA'er inadequate our present knoAvledge may be to the explar nation. The narcotic effects of the odor of the hop, are generally known ; and it is very common to send to the breAvers to get hops to use in this way. I have heard of several instances, in which the ' hop-pillow' has succeeded in procuring placid and refreshing sleep ; and it is said, that this kind of pillow produ- ced sleep, during the illness of the present king of England, after his physicians had prescribed every thing else in vain. From the odoriferous quality of the hop, I should readily conceive that sleep might be induced by means of the pillow, particularly Avhen Ave consider, that the patient, from the aici- nity ofthe hop to the respiratory prgans, must necessarily be constantly inhaling the odors. Wfe have also seen, that its properties are easily Aolatilized by a moderate degree of heat, and that its narcotic effects could not be perceived, in any of the preceding experiments, when heat had been applied. N n 280 BRYARLY ON THE COMMON HOP. From these facts, Ave must conclude, that the principium narcoticum, Avhatever its precise nature may be, is volatile ; and that the odor of the hop, a\ ill produce the effects of the plant, when used in this Avay. The narcotic effects of porter, and other potations, in Avhich the hop is an ingredient, are so evident to all who use them, that they have universally obtained the epithet of ' heavy drinks.' That the anodyne effects of these liquors are derived from the hop, is proven by their being propor- tionate to the quantity ofthe hop, Avhich enters into the com- position : for instance, beer exerts its anodyne effects more decidedly in the summer, than in the Avinter; because the brewers find it necessary to use more of the hop for its pre- servation, in the former season, than in the latter. Dr. Barton informs me, that he has himself repeatedly taken the tincture of the hop, made Avith the highly rectified spirits of wine, and that he has frequently prescribed it to his patients. He says it has generally, if not always, seemed to induce evident narcotic effects, similar to those of opium. In himself, in twice the dose of laudanum, it induced sleep as decidedly as laudanum. The Doctor also observes, that it agrees Avith patients in whom laudanum, or opium in any shape, produces sickness at stomach, head-ach, and other dis- agreeable effects. He docs not assert that it never induces head-ach ; on the contrary, he is persuaded that it sometimes does: but he has not known a single case of its producing the disagreeable pruritus, or itching, which is so frequently •the effect of opium. I will relate the case of a lady, which Dr. Barton has com- municated to me. Her situation often rendered it necessary for the doctor to prescribe laudanum for her; but the disagreeable effects, such as head-ache and sickness at stomach, which it produ- ced, even in very moderate doses, obliged him to have re- course to some other medicine. The tincture of the hop, in the dose of forty drops, induced profound and placid sleep, and none of the above disagreeable effects. This was the case on more than one occasion. Dr. A. Fothergill, in a, BRYARLY ON THE COMMON HOP. 231 paper published in the Philadelphia Medical and Physical Journal, says he has found the iiop possessed of an anodyne poWer, Avithout the disagreeable effects of opium, and that it can be given for any length of time Avith impunity, whereas the Portland powder, and other bitters, if long continued, seldom fail of producing the most alarming consequences. I will mention in this respectable physician's own words, the cases in which he has found it of most advantage. ' The cases in which I have found it to succeed best, have been such as demanded a light, agreeable bitter, com- bined with an anodyne quality : as, First—in various cases of dyspepsia, attended with pain and flatulency in the stomach and bowels; entire loss of appetite, and restless nights. Secondly>—in catarrhs and asthmas, and other cases attended with a troublesome tickling cough, and great inquietude. Thirdly—in painful cases of gravel and stone, or biliary con- cretions, or severe pains of child-bed Avomen. Lastly—in the above and other painful cases, where an opiate was great- ly Avanted, but could not be exhibited in any of the usual forms, without producing violent retching, severe head-ache, or other very untoward symptoms. Here a strong infusion of the hop, pursued freely, both internally and externally, has seldom failed to soothe the pains and finally, to procure a calm, tranquil sleep.' Dr. De Roches relates, several cases in which the hop had succeeded in procuring sleep, after opium had failed. From the recommendations of Professor Barton, in his lectures, the following gentlemen Avere induced to prescribe it, and they have been so polite as to communicate to me the result. Mr. Parish related to me the case of a patient, in Avhich it Avas necessary to exhibit something to procure rest, and opium ahvays produced very disagreeable effects; he then had recourse to the tincture of the hop, which induced all the good, Avithout any of the disagreeable effects of the opium. Mr. Mitchell informed me, that he has frequently, during the last summer, prescribed the tincture of the hep, as a 882 BRYARLY ON THE COMMON 1ICF. Substitute for laudanum, and that it induced the anodyne- ef- fects of the laudanum Avithout any of its di ,;■; ;n table consc-« quinces, such as sickness at stomach, costiveness, Sec. In order to make the trial fairer, he gave them other medl* cines for laudanum, but a\ as unable to procure rest by any of them except the hop. I gave to a child, that could not rest without laudanum, some ofthe tincture ofthe hop, and it induced sleep, equally well Avith the laudanum. I was informed, that a gentleman who had been in the habit of using laudanum, Avished to discontinue it, but avus Unable to sleep Avithout it; he had recourse to the tincture of hop as a substitute, with the effect of inducing sleep. The utility of a medicine, endowed with the divine poAver of inducing sleep, must be as obvious to the humane physici- an, who tenderly feels for the distresses of his patient, as ad- vantageous to the unfortunate sufferer, labouring under dis- ease. Nothing, indeed, can give the physician, a more ex- alted idea of his profession, than the knoAvledge of being pos- sessed of a medicine, capable of allaying the pains of his pati- ent, and inducing a calm and tranquil sleep. Opium, the medicine generally resorted to for this pur- pose, was thought of so much importance, that it attained the appellation of the magnum Dei donum. But however justly entitled this celebrated medicine may be to the highest com- mendations, many cases must occur to every practitioner^ in Avhich its exhibition is either useless, or totally impracti- cable. 1. Opium, administered in every shape, often fails of indu- cing narcotic effect. We have seen, in the preceding cases, that the hop has here succeeded. It must be highly consola- tary to the physician, to know that he can have recourse to the latter, after the failure ofthe former. 2. Opium frequently disagrees so much with the consti- tution, that it cannot be exhibited with advantage. In such cases, the Hop has not disagreed with the patient, and h.vt induced the desired effects. BRYARLY ON THE COMMON HOP. 283 3. Opium is often rendered inadmissible, from its consti- pating effects. In this case, the hop must be an excellent substitute; for, from the preceding experiments, it evidently appears, that it rather augments, than diminishes the alvine excretions. I • 10 AN INAUGURAL ESSAY ON WOUNDS OF THE INTESTINES. SUBMITTED TO THE EXAMINATION OF THE REVEREND JOHN ANDREWS, D. D. PROVOST PRO TEMPORE; THE TRUSTEES AND MEDICAL PROFESSORS OF THE UNIVERSITY OF PENNSYLVANIA, ON THE FIFTH DAT OF JUNE, A. D. ONE THOUSAND EIGHT HUNDRED AND FIVE. FOR THE DEGREE OF DOCTOR OF MEDICINE, BY THOMAS SMITH, OF THE ISLAND OF ST. CROIX: HONORARY MEMBER OF THE PHILADELPHIA MEDICAL SOCIETY. .....................................Utsi Cuccus iter monstrare velit..........Hor INTRODUCTION. IT is proposed in the following pages to take a brief view of the different methods Avhich have been recommended for treating wounds of the intestines, to describe certain experi- ments, on brute animals which Avere made to ascertain the method most likely to prove successful, and to offer some doubts relative to the common opinions on this subject. ■ I do not intend to enter minutely into the general mode of treating Avoundsof the intestines, but to confine myself entirely to the best manner of stitching them. Perhaps there are few acci- dents, to which surgeons are called, where they find them- selves more at a loss how to proceed, than in wounds of the intestines. These circumstances, as Avell as the frequent fatali- ty of such injuries, evince the great importance of the sub- ject. It is Avell known to surgeons, that the most trilling punc- ture, made into the cavity ofthe abdomen, is apt to induce very serious consequences, from the tendency which the peritone- um has to inflame, when slightly injured; how much must the danger be increased when an intestine is wounded, and an opening produced, through which its contents may pass into the cavity of the abdomen. We are, hoAvever, told by a celebrated author, * that there is very little to be appre- hended from this circumstance, on account of the equable pressure Avhich is always kept up in the abdomen by the vis- * Mr. John Bell. O o 288 INTRODUCTION. cera. But I hope to prove from experiment, that his ideas Avere not altogether correct on that subject. The invaluable work on hernia, of Mr. Astley Cooper, gave rise to this es- say, and the ingenuous observations of Messrs. Cooper and Thompson, respecting the difference between the conse- quences of longitudinal and transverse wounds of the intes- tines, induced me to attend particularly to that part of the subject. « INAUGURAL ESSAY. WOUNDS of the intestines may be known by a passage of blood from the mouth and annus, as well as by the discharge of fceces and foetid air from the external wound, and they ought to be suspected, when nausea, vomiting, violent griping, pains through the abdomen, cold sweats or faintings occur after, penetrating Avounds of that cavity. The intestines are some- times wounded without protruding through the external wound: in such cases it would be of very little advantage to know, Avhether the wound was transverse or oblique; for the method to be pursued must be similar to that in simple pene- trating wounds of the abdomen, viz. blood-letting and a low diet. Some authors recommend dilating the external wound, and searching for the injured bowel; but the danger arising from penetrating wounds in the abdomen, of all sizes, is so great, that in no instance ought it to be attempted, as there are cases on record of persons recovering from a Avounded bowel, without having been under surgical treatment. It is therefore, only in cases, Avhere the wounded intestine is pro- truded that the suture can be properly applied. The differ- ent kinds of sutures which have been recommended, have all had their advocates ; the most ancient, and that Avhich appears to have been most generally used is termed the glover's su- ture, Avhich I shall now take the liberty of describing. In making this suture, a fine small round needle should be used armed Avith a silk thread, which has been previously waxed. The surgeon bringing the lips of the wound in contact, perfo- rates both edges at the same time, and carrying the needle to the same side at which it entered, he must make a second 890 SMITH ON WOUNDS stitch, at a small distance from the first, perhaps the eighth v of an inch, and in the same manner by a proper number of stitches, must close the. wound throughout its Avhole extent. This being done, a sufficient length of thread is left out at the externa' wound for the purpose of duruingit away, when avc suppose 'he wound ofthe intestine to be united, which is gene- rally c npleted in six or seA-en days : in Avithdrawing the liga- ture, pare should be taken to dr it very gently, feast Ave should < destroy the adhesions which have taken pLcc, This mode of stitching a Avounded intestine, is certainly a Aery complica- ted process, and should be dispensed with in every instance for a more simple one. A more modern method has been spoken of by Mr. Lc- dran, which is termed the looped suture. To make this su- ture, an assistant takes hold of one end of the Avound whilst the surgeon does the same Avith the other, and the needles, which should be round, straight and small, carrying each of them a thread a foot long, and not waxed, must be equal in number to the stitches intended to be made : as many threads arc noAv to be passed through both lips of the wound as are thought necessary, taking care that they are a quarter of an inch distant from each other. All the threads being passed, the needles are to be Avithdrawn, and the ends of the threads pn each side are tied, after which, joining them together they are tAvistcd into a sort of cord: by this means, the divided portions of intestines are drawn into pleats, so that the stitches which were distant about a quarter of an inch are now brought together, and thus the lips of the wound are prevented from seperating. The ligatures are to be fastened to the external dressing, afterwards they remain until the wound in the intes- tines is healed ; they are then to be untAvisted, and all the ends cut off on one side ; after Avhichthey must be withdrawn sioAviy and separately. The same objection may be applied here as in the gioAers suture, this is certainly a more compli- cated process, and it increases the danger of the operation, by lessening the diameter of-the intestine, thereby occasioning dangerous obstructions. Mr. Join; Beli has recommended in Avounds of the intes- tines, that we should only use one single stitch, which should OF THE INTESTINES. 291 be passed through the Avounded bowel, and then drawn through the integuments of the abdomen at the external wound. But notAvithstanding Avhat Mr. Bell has said, of the equable pres- sure which is kept up among the viscera, preventing the faces from being shed,into the cavity of the abdomen; I must, however, beg leave to differ from him, for in the expe- riments which I performed, I found that treating the intestine in this manner was not sufficiently secure for preventing the fxces from escaping into the abdominal cavity. The folloAA'ing suture has also been proposed in a complete division ofthe intestine *. It Avas first recommended by Mr. Ramdhor in cases of hernia, where a portion of the intestine had been destroyed by mortification. In these cases, he has advised to extirpate the diseased part, and to introduce the up- per portion ofthe sound intestine within the loAver, for about an inch, and to confine it there by sewing it once or twice round with a fine needle and thread; but besides the difliculty of knoAving which is the upper or loAver portion in wounds of the intestines. I find that it never can be performed on the living subject, as Aviil appear by the ninth experiment; for immedi- ately upon making the section of the intestine, the divided parts became so much inverted, as to render the introduction of one within the other, utterly impossible. The method which appears to promise most success, is that recommended by Mr. Astley Cooper, in his Avork on hernia, in that part wherein he treats particularly of mortification of the intestine. He directs, that the injured part should be removed, and the divided portions brought into contact, and secured by four stitches, one being at, or near the mesentery, and the others at equal distances from each other. This method is certainly the most safe and simple of any that has yet been spoken of, and will no doubt in time.be ge- nerally adopted. Perhaps four or five stitches a\ ill be found sufficient in most instances of a complete division of the intes- tine. But Ave should be careful not to use more than are real- ly necessary, for it has been observed, that puncturing the * Mr. Benjamin Bell speaks highly of it in his System of Surgery. 29S SMITH ON WOUNDS intestine frequently, increases the danger of the operation very much. In order to decide bctAveen these different methods, I de- termined to institute a scries of experiments upon dogs by wounding their intestines, and uniting them Avith the various sutures above stated. I am aAvare that it is not easy to deter- mine AAith precision the treatment proper for the human spe- cies, by inferences derived from the dog ; but the analogy in the present instance appears to me very strong. I shall in the next place commence, by relating my experiments. EXPERIMENT I. APRIL 7. Assisted by my friend Mr. Klapp, an incision Avas made into the abdomen of a dog, and one of the small intestines; having been brought into view, a transverse section was made into it, and the Avound secured by four stitches, one at the mesentery, and the other three at equal distances from each other, the threads Avere then cut off at the knots, and the external Avound closed by the interrupted suture.* The animal did not appear to have suffered materially from the operation, for in tAventy four hours he took food, and after the first day exhibited no symptoms of indisposition. On the 30th, he was killed, the wound of the intestine was found1 completely healed-; the place at which the intestine had been divided, appeared someAvhat thickened, considerable adhe- sions Avere observed among the small intestines. Three of the ligatures had disappeared, the other Avas still remaining loosely attached to the internal coat, and probably would have been discharged in the same manner as the others, had the dog been permitted to live a feAV days longer. * The interrupted suture Avas used in every instance, for eccuring the external Avound, unless particularly mentioned. OF THE INTESTINES. 29S EXPERIMENT II. APRIL 7. On another dog, I repeated the same operation, Avith this difference, that the ligatures Avhich had been cut off in the preceding experiment at the intestine, Ave re now left out at the external Avound, in case it should be necessary to Avith- draw them. In consequence of the restlessness of the ani- mal during the operation, considerable violence was done to the parts, before they could be reduced. On the second day after the operation, the dog appeared so ill as to make his recovery doubtful: On the 4th day, it was thought proper to remove the ligatures; after this he appeared better and took nourishment. On the 19th, he was killed: upon lay- ing open the abdomen, the effects of inflammation were still obvious. The omentum was found adhering to the parietes of the abdomen, and very much indurated. Preternatural ad- hesions had taken place among all the viscera, but more par- ticularly in the small intestines, which Avere knotted and tAvisted together in an astonishing manner. The intestine at the place where the wound had been made Avas not quite united. EXPERIMENT III. APRIL 9. Several of my friends honored me with their attendance, whilst the folloAving experiments were performed; the abdo- men of a dog having been opened, and the small intestines brought into vieAV, a longitudinal incision of about an inch and a half was made parallel Avith the mesentery, which was secured by four stitches, and the intermediate spaces sewn with a fine thread to prevent the fxces from escaping into the cavity of the abdomen :* the threads were cut off at the intestine. The animal died in about thirty six hours. On dissection the marks of inflammation Avere found much less than might have been expected. * According to the proposal of Thompson of Edinburgh, 294 SMITH ON WOUNDS The wound in the intestine Avas completely torn open, excepting at one stitch. EXPERIMENT IV. APRIL ft. A full groAvn dog was submitted to the same experiment as the former, Avith this difference, that the intermediate spaces betAvcen each stitch Avere left unseAvn. Six hours after the operation, the animal vomited stercoraceous matter appeared dull and drowsy. On the 10th, in consequence of food heing offered, of which he took a small quantity, Aomit- ing AA'as again excited. On the 12th, he took food, and from that time appeared to be doing Avell. Seven days after he was killed; on opening the abdomen the omentum was found adhering to the site of the external wound, being con- siderably indurated. The mesenteric glands were enlarged. The Avound in the intestine was not completely united, two of tho ligatures had disappeared. The other two still re- mained ; the wounded gut had adhered to tho mesentery and adjoining portion of intestine. EXPERIMENT V. APRIL 10. On a full grown tarrier, I repeated the former experi- ment, wishing to see, whether a longitudinal incision could not by great care and attention, be so managed, as to do away the opinion of its being universally fatal. To effect which, a very small opening was made through the parietes of the abdomen, and a portion of intestine, being brought into view, it Avas di- vided longitudinally for about two inches, and afterwards secured by six stitches which were cut off at the knots The parts having been returned, the lips of the external wound were brought together and secured by adhxsivre plaister*. The animal did not appear to have suffered in the least from * For it Avas observed, that the ligature used for securing the external Avound increased the inflammation very much. OF THE INTESTINES. 295 the operation, for in less than tAventy-four hours he took food and has continued doing avc 11 ever since. EXPERIMENT VI. APRIL 16. Pleased Avith my success in the preceding experiment, I obtained another dog and opened his abdomen. In one ofthe small intestines. I made a longitudinal wound for about three inches, and treated it in every respect"similar to that related above. This animal appeared to have suffered very' little more than the other, considering the extent ofthe wound, for in about twenty-eight hours he eat and continued doing so until the tenth day after the operation, Avhen he refused nourish- ment. Tavo days after he died, on examination, it Avas found that the wound had healed completely, but directly above the wound a bone half an inch long, and nearly as broad, was dis- covered to have perforated the intestine*. EXPERIMENT VII. APRIL 16. Wishing to knoAV hoAv much of the intestine might be re- moved, without much endangering the life of the animal, I performed the following experiment: having obtained a full grown dog, an incision Avas made into the cavity of the abdo- men, two inches of one ofthe small intestines were removed, the divided portions were then brought together, and the wound was treated as the transA-erse incisions had been. In dis- secting ofthe divided portion of intestine, some of the branch- es ofthe mesenteric arteries Avere wounded, but did not bleed during the operation. On visiting him in the afternoon, I found there had been a considerable hemorrhage which still conti- nued. I did not open the Avound, but applied a piece of wet- ted linen to the parts, Avhich had the desired effect. On the * This must have been oAving to a diminution of the intes- tinal canal Avhichis always produced by longitudinal Avounds of the intestines. PP 296 SMITH ON WOUNDS 18th, the belly being somewhat tense, two of the external li- gatures were cut away, that the blood, should any have collect- ed, might be discharged ; but the Avound did not open, and the dog scon resumed the appearance of perfect health, Avhich continued Avithout interruption until May 6, Avhen he Avas kill- ed. The divided portions of intestine were found united, and the ligatures had been all discharged*. EXPERIMENT VIII. APRIL 16. Having opened the abdomen of a pointer pup, three inches1 of intestine were excised, the arteries being secured, the intes- tine in other respects, Avas treated as the last had been. In twenty minutes after the operation, he vomited the food Avhich he had taken in the morning, and appeared dull the remain- ing part of the day. Three days after the operation, he took food, and continued doing well. May 6th, he was killed, and the abdomen being opened, it was with difficulty I could ascertain where the division had been ; the coats of the intes- tine appeared somewhat thickened; one of the ligatures re- mained attached internally. EXPERIMENT IX. APRIL 18. Having divided the intestine of a dog transversly, I at- tempted to treat it in the manner spoken of by Mr. Ramdohr, viz. by introducing the upper extremity ofthe divided intestine within the loAver; after having procured a piece of candle, as directed by him, it was inserted into that portion of intestine, Avhich Avas supposed to be the uppermost. I then endeavour- ed to introduce the superior within the inferior, but the ex- tremities of each became so inverted, that it was found utterly impossible to succeed, it Avas therefore given up and treated in the Avay recommended by Mr. John Bell, using only one * The viscera in this experiment appeared much more naturaL than in any other, probably from the hemorrhage that took place, Avhich sheAvs the propriety of bleeding largely in such cases. OF THE INTESTINES. 297 stitch, and fastening it to the parietes of the abdomen. The dog took food the day after. On the 20th, it was observed that the feces were discharging at the external Avound, when the animal appeared very weak, but still continued to take food. On the 21st, he Avas much Avorse, and the abdomen being tense, the ligatures at the external Avound were remo- ved to facilitate the discharge of the fxces Avhich gave a tem- porary relief. On the 22nd, he died. On examination there was found a considerable quantity of fxces and Avater in the abdominal cavity. One portion ofthe intestine had united to the external Avound through Avhich part of the fxces Avere discharged. EXPERIMENT X. Sc XI. APRIL 28. Wishing to give Mr. John Bell's method of stitching an intestine a fair trial, I made the following experiments : ha- ving obtained two full groAvn dogs, a transverse incision was made into the intestines of each of them, which was secured by one stitch and fastened to the wound. No. 10, died in about twenty-four hours. The marks of inflammation were very great, and the fxces had been discharged into the abdomen. No. U, died on the 2nd of May. The intestines appeared very much inflamed, fxces as in the other instances were found in the abdomen, also Avater which the animal had drank. The large intestines appeared gangrenous and tore very easily. EXPERIMENT XII. A pointer pup of about two months old Avas submitted to the following experiment: a triangular piece was cut out of one of the small intestines, and the Avounded intestine sewn to the parietes of the abdomen. The animal very soon show- ed symptoms of indiposition and died in thirty hours. On examination, the peritonxum and all the viscera of the abdo- men were found considerably inflamed, a quantity of water >vas also in the cavity. • S98 SMITH ON WOUNDS It appears then from the result of my experiments on dogs, that not only the intestine may be returned, into the Cavity ofthe abrfemcn, but that the ligatures may be cut off and returned Avith the intestine,* and that Ave need not be under any apprehension of their being discharged into the cavity, for by some process of the animal economy of Avhich avc are ignorant, the ligatures have in every instance either been discharged Avith the faces or been found loosely attached to the internal coat of the intestine. It has been said by Messrs. Cooper and Thompson, that there is a curious dif- ference in the facility Avith which a longitudinal and transverse wound of the intestine unites. But in all the experiments Avhich I have made, it was found that with care the longitu- dinal united as kindly as the transverse, only requiring a little more attention to the diet ofthe animal, which should be very sparing and liquid until the wound has had time to heal. It certainly requires more pains to close a longitudinal wound of the intestine completely, than one which is trans- verse. The longitudinal incision always occasions a dimi- nution in the diameter of the intestinal canal, thereby pro- ducing dangerous obstructions. If it should be of any consi- derable extent, probably the surgeon would be justified in cutting out the wounded portion and treating it as a transverse division. This may be done without much endangering the life of the animal, as appears by two experiments where three inches of the intestine were removed. * As Avas observed by Mr. Thompson of Edinburgh. i / A CHEMICO-PHYSIOLOGICAL ESSAY, DISPROVING THE EXISTENCE OF AN TRIFORM FUNCTION IN THE SKIN, AND POINTING OUT, BY EXPERIMENT, THE IMPROPRIETY OF ASCRIBING ABSORPTION TO THE EXTERNAL SURFACE OF THE HUMAN BODY. SUBMITTED TO THE EXAMINATION OF THE REVEREND JOHN ANDREWS, D. D. PROVOST PRO TEMPORE: THE TRUSTEES AND MEDICAL PROFESSORS OF THE UNIVERSITY OF PENNSYLVANIA, ON THE THIRD DAT OF JUNE, A. D. ONE THOUSAND EIGHT HUNDRED AND FIVE. FOR THE DEGREE OF DOCTOR OF MEDICINE, BY JOSEPH KLAPP, OF ALBANY, NEW-YORK: HONORARY MEMBER OF THE PHILADELPHIA MEDICAL SOCIETY. 1 Fiat Experimentum.' To Mr. JOSEPH KLAPP. Dear Sir, IT afforded me great satisfaction to Avitness the zeal and industry with Avhich you conducted the enquiry which has led to the important deductions contained in your Inaugural Dis- sertation, disproving the existence of an xriform function in the skin. With pleasure I bear testimony to the neatness and accu- racy with Avhich your experiments were performed, and con- sider them as completely satisfactory on this interesting sub- ject. That the light Avhich you have throAvn on this question may stimulate you to extend your enquiries to other branches of the science of medicine, and that you may enjoy health and happiness in life, and meet Avith success in the exercise of your profession, is the ardent wish of Dear Sir, Your sincere and affectionate friend, JAMES WOODHOUSE, May 3d, 1805, INTRODUCTION. A favourite author, not less distinguished for literary ac- complishments, than correctness of observation, says, a com- position that enters the world Avith a vieAV of improving it, has a claim to the utmost indulgence, though it fail of the effect intended. If such encouraging lenity await the voluntary writer, whose object to instruct is often alloyed by an indig- nant thirst for public adulation, my claims on the score of in- dulgence cannot but meet with liberal success, as nothing less urgent than a law of the University could have induced me, at this juvenile period of my life, to appear in the character of an author. The subject which has been selected for this essay is one which has been much canvassed by men of acknow- ledged talents; many of the difficulties, however, attend- ing its satisfactory investigation, Avere either left neglect- ed, or imperfectly surmounted, though it for a while attract- ed the experimental attention of a Cruikshank, a Priestley, and an Abernethey. The present enlightened state of medical science excepts none frpm the privilege of laboring in her enchanting domi- nion ; and as invaluable truth is alike appreciated, Avhether de- tected by the searching penetration of irresistible genious, or discovered by the good fortune of a mere novice in medicine, I have been induced to venture on the subject under considera- tion, Avithout pausing to offer an apology for interfering with the labours and opinions of such eminent characters. ...........................................and truf/i alone, Shall be our chosen theme, our glory to the last. Coavper. Q urs, during which time, no oxygen air was disengaged fro11 "ie Avater. In this experiment, we may Avith safety conduct mat carbonic acid Avas not contained in the water, and c-lseQuentiy none was emitted by the skin; for it has been p^ved to a certainty, that healthy leaves of plants will readilyiecomPose carbonic 514 KLAPP ON CtJTICULAR ABSORPTION. acid, if contained in the Avater in Avhich they are immersed, while in the light of the sun ; its coal will be devoured for food, and its oxygen escape in the form of pure air. Lest a few of those who may honor this dissertation Avith a perusal, should hesitate in admitting experiment 1, as satis- factory, on account ofthe pressure ofthe quicksilver, the fol- loAving one Avas made, which proves, beyond a doubt, that car- bonic acid gas is not emitted in the perspiration of animals. EXPERIMENT 4. Thermometer 56°. Having procured some pure hydrogen air, from diluted sul- phuric acid, and the filings of malleable iron, four ounce mea- sures of it, were thrown up into a glass vessel, preAiously filled and inverted in quicksilver: my hand and wrist, after all loose air was separated from their surface, as in experiment 1, avci-c introduced into the inverted vessel, and kept in this situation, for three hours. My hand and wrist being surrounded by the hydrogen gas, in this experiment, suffered nothing from either the pressure or coldness of the quicksilver. Professor Wood- house observed this, as Avell as the chief experiments detailed in tins essay; and in his presence, the air in the vessel from which my hand and wrist had just been removed, Avas examin- ed. Having ascertained that the volume of air had not been in any degree, diminished, we passed up one ounce measure of it, over lime Avater, in an eudiometer ; no milky appearance was observed by either of us: about three ounce measures of lime Avater were then passed up into the vessel containing the remainder ofthe air in which the experiment was conducted; ^mt no carbonic acid could be discerned, in either case. Dr. Rush relates, i:i his lectures, an experiment Avhich in- duces him to believe in an xriform function of the skin: a lighted candle, he says, in the morning, was extinguished by the air of ih e bed in which he had slept, the preceding eA-ening. I do not he&tate to admit the experiment, as correct, but can- not subscribe Co the inference of our ingenious Professor. The readine. ;s with Avhich respiration renders air impure, from the consumption of its oxygenous portion, is well known to every physiologic N and in my humble opinion, the conta- KLAPP ON CUTICULAR" ABSORPTION. 315 mination of the air in the bed, Avas oAving to this process. This explanation will appear more probable, when we consi- der how often we lay, in the course of an evening's sleep, with our heads under the bed clothes. Having discovered, by all the above experiments, that the skin, with its membranes entire, has no connection with the office of transpiring elastic fluids, I will next relate those ex- periments, Avhich, in my own mind, undeniably prove, that gar ses are not absorbed from the external surface of the human body. EXPERIMENT 5. Thermometer 60°. Five ounce measures of atmospheric air Avere thrown up into a glass vessel, previously filled and inverted in quicksil- ver ; my hand and wrist, Avith the necessary precautions used in experiments 1 and 4, were introduced into it, and retained in this situation, with little or no inconvenience from the mer- cury, for three hours, and then withdrawn. We immediately examined the air in the vessel; its volume was not diminish- ed, and, when passed through lime water, no milky colour en- sued ; which Avas an additional proof that the skin did not throAv out carbonic acid ; we next proceeded to ascertain whether or not any of the oxygenous portion of the air had been removed during the experiment; for this purpose, one measure of it was passed up, over Avater, in an eudiometer charged with phosphorus, and in less than tAventy-four hours, the absorption of -flfr Avas complete. In this experiment, no addition or alteration occurred in the atmospheric air to which my hand and wrist had been exposed for three hours ; but with the vieAV of giving complete satisfaction on the subject, the following experiment Avas performed. EXPERIMENT. 6. Thermometer 54°. Five ounce measures of oxygen air, of 4 per cent purity, being transmitted into an inverted vessel, previously filled with quicksilver, my hand and Avrist, freed from all adhering air under the surface of the mercury, were introduced into it, and held 1 n this situation three hours. Upon examination, the 316 KLAPP ON CUTICULAR ABSORPTION quantity of air had suffered no diminution ; it was then pas- sed through lime water, and as turpidness did not occur, we in- fered that carbonic acid had not been given out by the skin ; the air was next tested, as in the former experiment, in the eudiometer of Berthollet, and Avas found not in the least adul- terated. The experiments just related, prove, in the first place, that Carbonic acid is not transpired; in the second place, that azotic air is neither emitted nor absorbed ; and in the third place, that oxygen air is not inhaled by the skin ofthe human body. The care with which they were conducted, and the Completeness of their plan, exclude all the deception which experimental enquiries, in the hands of inattentive observers, are often liable to. In order to discover whether, or not, fixed air be remo- ved from the external surface, by cutaneous obsorbents, the following experiment was made. EXPERIMENT 7. Thermometer 61°. Five ounce measures of carbonic acid obtained from car- bonat of lime, by diluted sulphuric acid, were transmitted in- to a glass vessel, preA'iously filled and inverted in quicksilver; my hand and wrist were then introduced into it, and kept in this situation for three hours. The volume of air was next attended to, in order to accomplish the object of the experi- ment; it was found diminished in quantity only about half a drachm. The removal of which, I do not hesitate to ascribe to the combination of the carbonic acid with the perspirable fluid; as my hand, Avhen removed from the inverted vessel was considerably moistened by this discharge. When we call to mind the affinity that naturally subsists between aque- ous substances and this acid gas, the effect which we have mentioned is what ought to be expected: besides, it is highly improbable that the skin, even if it were endowed Avith the poAver of absorption, would inhale carbonic acid which is thrown out by the lungs, as, excrementitious from the system, and refuse to absorb oxygen air, confessedly the pabulum vita, as was the case in experiments 5th and 6th. KLAPP ON CUTICULAR ABSORPTION, 317 The experiments are now related, which have created, in my oAvn mind, a firm belief, that a few physiologists for Avhose talents in the science of medicine, I shall still cherish the high- est sentiments of respect, have, from the illusion of unfore- seen circumstances, Avhich often render of no avail the best di- rected enquiries, erroneously imputed an xriform function to the skin. It is to Mr. Abernethy, Avhose pre-eminent abilities and industry have long entitled him to the first rank in his profesr sion, that we are indebted for the best mode heretofore used in the investigation of our subject. But while I am recording the merit which so justly belongs to this distinguished charactf er, perhaps the zealous friends, and cultivators of Physiology will regret, that his ingenuous researches had not terminated in the acquisition of truth. Their motives on this interesting occasion would, I am conscious, have sufficient grounds of support ; for one great source of ignorance and uncertainty in medicine is the accumulation of experiments and plausible theories, which are directly opposed to each other. In taking leave of this part of my essay, it will not be amiss to observe, that the preceding, as well as the folloAving pages, are respectfully submitted to the examination of the public, not with the expectation of dislodging, immediately, opinions heretofore credited, but solely with the hope of cal- ling the attention of others, who may ingenuously decide on the subject of the controversy; as I shall be satisfied, either in being supported or refuted, by such an interference. 318 KLAPP ON CUTICULAR ABSORPTION EXPERIMENTS, AND OBSERVATIONS ON THE IMPROPRIETY Ol' ASCRIBING ABSORPTION TO THE EXTERNAL SURFACE OF THE HUMAN BODY. PART SECOND. When first the duty devolved on me to write an Inaugu- ral Dissertation, I intended to have confined myself to the con- sideration of those subjects Avhich are above treated of, but as time was not Avanting, and the usual limits allotted to a pub- lication of this kind, were not exceded, I resolved to extend my enquiries still further into the functions ofthe skin. Physicians, both in ancient and in modern times, have been at a loss to account for the manner in which many medicines produce their respective effects upon remote parts ofthe ani- mJ body, when only applied to the external surface. Some have supposed that this phenomenon in medicine, could not be satisfactorily explained, without admitting, that a portion ofthe articles were taken up by the absorbing vessels, ofthe skin, and conveyed into the general circulation, to be directed to their appropriate parts, and there give rise to ef- fects corresponding with the nature of the medicines em- ployed. In behalf of this theory, we have on record the works of many respectable physicians, among which none are sb emi- nently entitled to our consideration as the experiments and observations of Dr. Alexander Monro.* The doctor made a great variety of experiments on frogs, in different conditions, all of which tend to prove that, in them, opium, ardent spirits, and essential oils are absorbed from the external surface. He found that after the crural nerves of one frog Avere cut, and * Physical Essays, Vol. 3. KLAPP ON CUTICULAR ABSORPTION- the hind half of the spinal marrow of two others completely de- stroyed ; camphor applied to the hind legs of all, produced the same effects, in nearly tho same time, as when appli- ed to a sound animal. ' But to prove this absorption in fact/ says our learned author, ' I divided two frogs at the pelvis two hours after the camphor had been applied to them in the above Avay ; I then pulled the skin off the fore part of their bo- dy ; and found, that the flesh and boAvels had a smell ofthe cam- phor. To discoA-er this more certainly, I cut them in pieces, and poured on one, rectified spirit of Avine and on Q e other, water: and Was sensible of the taste of the camphor, both in the spirit of wine, and in the water.' As all the experiments made by the Edinburgh Professor, Avere con- ducted without any regard to the lungs, Avhich I shall soon prove to be an extensive apparatus of absorption, I do not he- sitate to pronounce them incomplete, as the articles which he used might have passed into the system through this quarter, and not absorbed from the external surface, as he inferred. But even if I was disposed to allow that his experiments com- pletely prove that absorption does take place from the surfa- ces of frogs, they cannot, with any certainty be used in the in- vestigation of our subject. An amphibious animal is widely different, in its anatomical structure, Avay of life and its econo- my, from man. If then, it should hereafter be satisfactorily ascertained, by a series of neAv experiments, or by a repeti- tion of those of the Professor, Avith a proper variation, that the frog is endoAved with the function of cutaneous absorption, the discovery would not, in my mind, excite surprise, even if I should establish, by the experiments shortly to be detailed, that this office is unconnected with the economy ofthe human body. Dr. Barton, who perhaps is better acquainted Avith the functions of the lymphatick system, than any other man in America, is inclined to give some credit to cutaneous absorp- tion in frogs. He informed me in private conversation that he had frequently observed, that if this animal was confined in a dry glass vessel, it became enfeebled, diminished in its natural size, and scarcely able to leap ; but if a small quantity af Avater was poured into the vessel, or the air in it only loaded S s 320 KLAPP ON CUTICULAR ABSORPTION. Avith moisture, it soon acquired its wonted vigour, its body became plump, and its motions Avere usually lively. In the first part ofthe sixth volume ofthe Philosophical Transactions an account is given ofthe Lacerta Subviolacea, * in which it is mentioned, that this animal Avas weighed at different times. On the 24th of March it Aveighed 342 grains, but in some- what less than an hour, it Aveighed only 324 grains, having lost 18 grains, ' It is a Avell ascertained fact, however,' says the ingenuous naturalist, Dr. Barton, ' that the weight of ma- ny ofthe Amphibia, particularly the frogs and lizards, is very various'at different times, even in the course of the same day or hour. This difference of Aveight is often entirely indepen- dent on any aliment, whether solid or fluid, being taken into the stomach, and must be ascribed to the absorbtion of water.' Dr. Darwin, the ingenuous author ofthe Zoonomia, says, * that those who have remained half an hour in a warm bath, Avhen they have previously been exhausted by exercise, or ab- stinence from food or fluids, have absorbed so much as to in- crease theirweight considerably. Dr. Jurin found an increase of weight to 18 ounces, by sleeping in a cool room, after a day's exercise and abstinence ; so much, in that situation, was absorbed from the atmosphere.'f After having read the fair and conclusive experiments of Dr. Currie, the assertion of Dr. Darwin will appear highly erroneous; for in one instance, where death was caused by inanition, no cutaneous absorption occurred, though the pa- tient was immersed in a Avarm bath for an hour. In Dr. Jurin's experiment, the absorption doubtless took place from the lungs, and not from the external surface. It is argued in favor of absorption, that animals live in hot, moist climates, without drink, and yet discharge a consider- able quantity of humors, both by perspiration and urine ; and that in some diseases of the human body, a much greater quantity of urine is discharged, than the quantity of drink taken in. That animals do live in hot, moist climates, with- out drink, we Mill readily admit, but that their thirst is allay - * A species of Lizard first described by Dr. Barton, and called by him Lacerta'Subviolacta. t Zoonomia, page 4 40. KLAPP ON CUTICULAR ABSORPTION. 521 ed, their cutaneous and urinary discharges carried on, in con- sequence of absorption by the skin, is an induction which modern discoveries will not counlenance; for doubtless, in them, as in cases of hydropic and other diseases, Avhere a much greater quantity of urine is often discharged than the quantity of drink taken in,, the lungs supply the exigencies of the system. And what more pai ticulaiiy renders my rea- soning at least plausible, on this subject, is the experience of a number of respectable physicians. Dr. Rollo* published an account of an interesting case of diabetes, in which he mentions that the Aveight of the patient Avas not encreased by a continuance of ten minutes, in a bath of 110 degrees of heat. ' In the year 1788, Dr. Currie hap- pening to be at Buxton, made an experiment on the effects of bathing, on the weight of the body. After half an hour's immersion in the bath, he found his Aveight rather diminished than encreased. In the year 1790, he had a patient in dia- betes, Avhose cuticle, as is usual in that disease, was in a mor- bid stale. Being desirous of trying hoAv far the inordinate action of the kidneys might be affected by a gentle stimulus applied to the skin, he immersed him in a bath of the tempe- rature of 96 degrees, Aveighing him before and after the im- mersion. ' In this case, no variation in the Aveight could be detected. Dr. Currie afterwards made five different experi- ments of the same kind, upon himself, varying the heat of the bath, from 87 to 95 degrees ; but he could never, in any one instance, find his Aveight augmented. It may hoAvever be said, that though in diabetes, where the epidermis is dis- eased, no liquid is inhaled ; and though in health, when the vessels are full, no absorption may take place ; yet, when the body is Avasted, from a want of proper food through the sto- mach, the plastic powers of nature may be employed to sup- ply the defect, and to excite an inhalation through those pores on the surface, by which an exhalation is usually performed. To prove that this does not happen, Dr. Currie relates, very minutely, a remarkable case of dysphagia, where death was the consequence of inanition, notwithstanding every, attempt * Zoonomia, page 255. 322 KLAPP ON CLT1CULAR ABSORPTION. to support the system, both by the rectum, and by the sur- face. This patient, on different occasions, stepped perfectly naked, upon Merlin's balance, immediately before immersion; and again immediately after it, his body being previously dried. The Aveights Avere never moved. The result was sur- prising ; for Dr. Currie couid not distinguish the slightest variation in the weight of the body, though the beam Avould have detected a single drachm, though the immersion had been continued for an hour, and though a constant friction had been kept up, nearly the Avhole time, on the inner sur- face of the thighs, with the view of encreasing the action of the absorbents. If the non-absorption by the surface of the body be established, it will, Dr. Currie observes, ascertain, that, in the ordinary course of things, contagion is received into the system, by the lungs only, and will, he thinks, jus- tify a practice, which he has been informed, is common among our more experienced seamen, on the coast of Guinea, and other warm climates, who when exposed, during the night, to a breeze from the marshes wrapt their heads in a sea-cloak, or other covering, and sleep fearless on the deck, with the rest of their bodies nearly exposed.' Since the celebrated French Philosopher, Bichat, suggest- ed that absorption took place from the lungs, and published the experiments corroborative of his opinion, we have not been at a loss to account for the manner in which certain vola- tile articles applied to the skin, have, in a short time passed into the system, and manifested their presence by the effects Avhich they produce on the excretions ofthe body. The fol- lowing quotation from this author, will afibrd the reader an epitome of his theory. Extract from a work entitled ' Recherches Physiologique* surla Fleet la Mart: par Xav. Bichat, Professeur d'Anato- mie et de Physiologie. A Paris, an. 8.' Page JJ2. l La respiration d'un air charge des exhalaisons qui s'elevent de 1'huile de thcrebentine, donne aux urines une odeur particu- liere. C'est ainsi que le sejour dans une chambre nouvelle- ment vernissefe intnie d'une maniere si remaiquable sur ce fluide. Dans ce cas, c'est bien evidemment par le poumon, au moins en partie, que le principe odorant passe dans le KLAPP ON CUTICULAR ABSORPTION. 323 tang, pour se porter de la sur le rein; en effet, je me suis plusieurs fois assure", qu'en respirant dans un grand bocal, et au moyen d'un tube, Pair charge de ce principe qui ne sauroit alors agir sur la surface cutance ; l'odeur de Purine esttoujours notablement changee.' 'The respiration of an atmosphere charged with the vapours of spirit of turpentine, gives the urine a peculiar odour. Thus, after remaining some time in a chamber neAvly painted, we find that a remar- kable change is produced in this fluid. In this case, it is ex- tremely evident, that, through the lungs, at feast in part, the odorous principle passes into the blood, and from thence to the kidneys. In fact, I have frequently cominced myself of it, by breathing air charged with this principle, through a tube adapted to a large glass vessel, (by which means the cutane- ous surface of the body could not be acted on) and always found the odour ofthe urine remarkably changed.' In this experiment, as the vapour was not applied to the surface, it could only act upon the lungs. The experiments and observations ofthe Parisian Profes- sor, are fully established in an inaugural essay by Doctor Rosseau, an ingenious French physician, of this city *. As many articles, however, occasionally applied to the skin, for medicinal, and other purposes, are not endowed with an odour sufficiently volatile to gain access to the lungs, so as to effect any remarkable change in the system, the operation which they produce, must, therefore, be referred to the reci- procal harmony which subsists between the various parts in the organized body. Tartrite of antimony, rubbed upon the skin, excites nausea and vomiting ; which are the usual symp- toms produced when it is taken into the stomach t- A poultice of tobacco leaves applied to the region of the stomach, excites an emetic operation, after large doses of sul- phat of zinc have been given without producing this effect. { * Dr. Rosseau made his experiments in this city, about the same time that professor Bichat published his Physiolo- gical work, in Paris. t Dr. Barton. j SherAvin's Experiments have since been repeat, u by ^ graduate of this university, and found correct. 324 KLAPP ON CUTICULAR ABSORPTION. Opium produces sleep, when externally applied ; and in certain affections of the stomach, many physicians, and par- ticularly Dr. Whytt, have availed themselves of the knoAv- ledge of this circumstance with manifest advantage to their patients. Dr. Barton informed me that he had cured several cases of intermittent fever, by applying poultices of the Cinchona bark, to the skin. These, and other active articles, in my humble opinion, produce their respective effects on the animal body, through the medium of sympathy ; as the theory which sup- poses their absorption, is involved in too many difficulties to be generally received. I am avcII aAvare that Professor Monro has made experi- ments Avhich may induce some to believe that opium acts chiefly upon the system, after being applied to the skin, in consequence of its absorption. But I have before observed that the results of experiments made upon frogs, cannot, Avith any propriety be contrasted Avith those of experiments made on the human body. Having now premised the facts and observations which are necessarily connected with the investigation of my subject, I will next proceed to lay before the reader the experiments which demonstrate, in the first place, that the lungs furnish an extensive surface for absorption ; and in the second place, that the skin of the human body has no claim to that function. The important experiments of Bichat, and those made in this city by Dr. Rosseau, have certainly given an extensive range to our views of the Physiology ofthe animal body ; but as the emanations from spirits of turpentine which they breath- ed, might have been conveyed either in part, or wholly, into the system, by the absorbing Aressels of the mouth, fauces and trachea, over Avhich parts this active article passed before it could have come in contact Avith the lungs, their experiments, in my opinion, do but incompletely prove what they have ad- duced. With the intention, however, of ascertaining this subject more ceAalnly, I made the two following experiments: for KLAPP ON CUTICULAR ABSORPTION. 325 assistance in their performance, I am indebted to my worthy friends and fellow graduates, Messrs. Smith and Legare\ EXPERIMENT I. A dog was secured upon a table, by passing leather straps. in different directions, around his body and extremities. An incision Avas made through the skin and muscles, just above the upper end of the sternum; and the trachea was laid bare ; a strong ligature was passed around it so as to intercept all communication between the lungs and the mouth of the ani- mal. A longitudinal opening was then made, immediately be- low the ligature, into the trachea, to which was adapted one end of a long tube, the other end being passed out of a AvindoAV, In this situation the dog breathed the air of the atmosphere, through the tube, for more than two hours, during which tim-e his mouth, fauces and trachea above the ligature, were fre- quently inflated with the vapours of spirit of turpentine. Now it is evident, that if absorption exclusively belongs to the lungs, under the circumstances of this experiment, the va# pours of spirit of turpentine cannot be conveyed into the sys» tem. At the expiration of the time mentioned, the dog was carried into another room, the tube was removed, and the li- gature which had been around the trachea was divided by the scalpel, and withdrawn; the animal after I had stitched up the aperture from which the tube had just been removed, breathed in the natural way. In this condition he was left from 11 o'clock in the morning, until 6 in the evening, Avhen his existence was instantly terminated, by thrusting a knife be- tAveen the superior cervical vertebrx into the spinal marroAV, with the vieAv of procuring from his bladder the urine which had been secreted in the course of the day, it being retained by a ligature which I had passed around the penis, in the be- ginning ofthe experiment. After the urine was collected in a cup, Mr. Legare and myself examined it Avith great atten- tion, but neither of us Avere able to detect in it the least smell of violets. The result of this experiment convinced me, that though the enquiries of Bichat and Rousseau had been incompletely 326 KLAPP ON CUTICUL VR ABSORPTION. conducted, yet the inference which others deduced from them was an important truth. But what establishes, beyond a doubt, the absorption from the lungs, is the folloAving expe- riment. EXPERIMENT II. A strong dog being fastened dovm upon a table, an incision as in the former experiment, Avas made, just above the supe- rior extremity of the sternum, and at this place, a ligature was passed around the trachea, which completely prevented the animal from respiring through his mouth ; a small aper- ture was then made, below the ligature, into the wind-pipe, to which was adapted one end of a long tube, while the other end communicated Avith the mouth of a bottle containing spi- rits of turpentine. In this situation, the dog continued to in- hale, by his lungs, emanations of turpentine, for two hours, the operation was then discontinued, the tube was removed together with the ligature about the trachea, and the incisions Which had been made were closed. The mouth, fauces and trachea, of course, resumed their former functions. The dog was noAv left, from 11 o'clock, A. M. to half after six in the evening, when he was killed: the urine collected gave a strong smell of violets. My obliging friend Mr. Thomas Smith, and myself, made ourselves acquainted Avith this cir- cumstance from repeated examinations. The above tAvo experiments, Avill, if I am not mistaken, convince the candid reader that the lungs afford an extensive surface for absorption, and at the same time prepare him to expect the manner in which I shall prove that certain arti- cles applied to the skin, gain admission into the system. As most of the experiments made by different physiolo- gists, in proof of absorption from the external surface, are ex- ceptionable on account of their not having been conducted in such a manner as to exclude the lungs from an agency in the case; it occurred to me, that experiments made over quick- silver, in inverted vessels, would be void of such, or any other objection. As spirit of turpentine readily insinuates itself into KLAPP ON CUTICULAR ABSORPTION. 327 the system, and gives the urine a peculiar odour, which is a good criterion of its presence, I determined to make use of it, as the principle article in my experiments; accordingly in EXPERIMENT III, My foot Avas placed in a Avash-bowl, containing spirit of turpentine ; friction was occasionally used, and at the expira- tion of one hour, as I experienced some pain from the irrita- tion of the turpentine, my foot was withdrawn. In a short time I retired from my room, and did not return until the ex- piration of one hour, when the urine was found to be impregr nated with the smell of violets ; the odour, hoAvever, was much more powerful at subsequent examinations. In the course of half an hour, from the beginning of my exposure to the ema- nations of turpentine, a slight head-ache, with an evident acce- leration of the pulse, Avere excited, which continued for seve- ral hours : but the urine continued to emit the smell of violets until the next day. In this experiment, it is very clear that the spirit of tur- pentine was conveyed into the system ; but to ascertain Avhe ■ thcr the absorption took place from the skin or the lungs, the Iavo following experiments Avere made. EXPERIMENT IV, Three days after performing the above experiment, a quantity of good spirit of turpentine was passed up into a glass vessel, previously filled and inverted in quicksilver. The cork in the mouth of the phial containing the turpentine, was drawn, under the surface of the quicksilver, so that the va- pours of this volatile liquid, could not mix with the air ofthe room. My hand and Avrist were next introduced into the in- verted vessel, and in this situation, surrounded by spirit of turpentine, Avere retained for an hour and a half. My hand being immediately well washed, I left the laboratory and Avalk- cd to a considerable distance ; in the course of an hour, the urine Avas attended to; but the smell of violets was not in the least observable: the same reference Avas made repeatedly T t 328 KLA'T ON CUTICULAR ABSORPTION. during the remainder of the day, without being able to de- tect any change in the natural smell of the urine. The sys- tematic affection Avhich Avas experienced in the former experi- ment, did not occur in this. I continued to inspect the urine, occasionally discharged, until the next day, but nothing cha- racteristic ofthe presence of spirits of turpentine was detect- ed. Phis experiment Avas conducted under circumstances Avhich alloAved every opportunity for absorption to take place ; friction Avas repeatedly used by rubbing my hand and wrist against the sides of the vessel which confined the turpentine over mercury ; and what I deem of great importance is the complete manner in which the lungs were excluded from an interference which they would otherwise make in the experi- ment. Having iioav ascertained that in my first experiment the turpentine which was evidently carried into the system, did not gain access through the agency of cutaneous absor- bents, it was natural for me to discover whether the lungs, Avhich with the skin were the only parts exposed to its ema- nations, had not been the organs which accomplished the ab- sorption. EXPERIMENT V. A glass vessel, containing a quantity of atmospheric air, Avas inverted in quicksilver; three or four ounces of spirits of turpentine were introduced into it, and agitated with the air contained in the vessel, in such a manner as to intimately mix the odour with every part of it. A convenient glass tube was then used, one end of which communicated with the air in the vessel, and the other end was taken into my mouth, and in this manner I inhaled the air highly charged with turpentine, Avithout suffering any of it to come in contact with the skin. Having effected this part of my experiment, I left the room and took a moderate walk ; I had not retired long, before a slight head-ach and quickness of the pulse were experienced ; the urine voided, after an hour and a half had elapsed, was found imbued with the smell of violets; but in the course of the afternoon, the impregnation was much greater, and which KLAPP ON CUTICULAR ABSORPTION. 329 continued to be observed until 11 o'clock, P. M. when I Avent to bed; the next morning the urine emitted only its usual smell. The above experiments fully establish, in the first place, that spirit of turpentine is not absorbed from the external sur- face ; and in the second place, when it manifests itself in the system by the effect Avhich I have mentioned it produces in the urine, consequent to its application to the skin, or diffusion through the air, it has been absorbed by the lungs and not from the skin, as some physiologists have erroneously ima- gined. It appears somewhat remarkable to me, that men most re- fined in their researches in medicine, and who have otherwise greatly enlarged our knowledge of the animal body, should at- tribute absorption to the skin, Avithout extending their inqui- ries to collateral circumstances, which must infallibly end, ei- ther in refuting or establishing their doctrine. If spirit of turpentine, garlic, camphor, asparagus, &c. and the gases, are taken up from the external surface, why have they not been found in some part or other, of the lymphatic system ? In the most successful investigations that have been made, into the functions ofthe lacteal lymphatics, the nature of their contents has ahvays been attended to, as affording a test of their having absorbed certain articles, previously presented to them. In answer to this, it may be said, that absorbents have not yet been discovered, opening on the skin of the human body, while lacteals have long since been traced by the anatomist. But this temporary evasion involves a more glaring error; for why contend, Avith so much assu- rance, for functions of parts avIiosc existence is not yet proved? If the skin was endoAved, as the lungs are, with the power of absorption, the extensive surface of these two organs, would be a constant source of disease in the system. With a vieAV to the general subject of absorption, and to ascertain, in particular, whether camphor is taken up by vessels of the skin, as Professor Monro contended for, in his experiments upon frogs, I made the following experiment. 330 KLAPP ON CUTICULAR ABSORPTION. EXPERIMENT VI. Eight ounces of a strong solution of camphor, in spirit of wine, Avere transmitted, with all the necessary cautions of ex- periment 4th, into a glass vessel, previously filled and inverted in quicksilver ; my hand and wrist were then introduced into the vessel, and retained in this situation, surrounded by the camphorated solution, for more than an hour. In the begin- ning of the experiment, 15 grains of nitrat of pot-ash were taken, with the intention of increasing the natural action of the kidneys, and thus affording a better opportunity of accom- plishing the object in view. Friction, as in experiment 4th, was occasionally used, while my hand and wrist were held over mercury, in the solution of camphor. But, with all these measures to excite absorption, not a single circumstance occurred, either in the course of the day, or ensuing evening, Avhich induced me to believe that this effect had taken place. As it is a fact, familiar with the most of observers, that both the flesh and milk of animals which feed on garlic, are affected with the taste and smell of their aliment, I entertained no doubt, but that a strong infusion of this odorous substance, applied to the skin, under the circumstances ofthe following experiment, AVould throw some light upon cutaneous absorption taking the state ofthe urine and breath as a proper criterion. EXPERIMENT VII. A quantity of a strong infusion of garlic was made, a portion of which, with great care, Avas passed up into a glass ves-el, previously filled and inverted in quicksiher: my hand and wrist were then introduced into it, and retained in thE situation for one hour. The infusion was can fed to the labo- ratory in an eight ounce plial, the cork of which was drawn, under the surface of the quicksilver, so that the air which I breathed was not in the least impregnated with it. Friction, as in the former instances, was frequently made use of. Upon withdrawing my innal from the inverted vessel, I instantly left the room, and having washed my hand with so..p and water, 1 exercLcd my self in wulkfeg, for half an hour, KLAPP ON CUTICULAR ABSORPTION. 331 and returned home. The urine and breath Avere then refer- red to ; in neither of Avhich, could the smell of garlic be per- ceived ; my attention to this part of the experiment Avas not here discontinued ; for examinations were repeatedly made, during the remainder of the day ; but the smell of garlic did not in any instance, occur. The facility Avith Avhich absorbing vessels ofthe alimenta- ry canal take up garlic, is a convincing proof, that this sub- stance is not unfriendly to the appetency of the lymphatic system. If then, the skin ofthe human body is endoAved with the power of absorption, is it not probable, nay, I will venture to ask, is it not certain, that this diffusible substance Avould have been conveyed into the system, in the above experi- ment ? As the presence of asparagus, in the system, can ahvays be knoAvn, by attending to the state of the urine, I resolved to ascertain, whether or not, this article could excite absorption from the external surface* EXPERIMENT VIII. A quantity of a strong decoction of asparagus was, with ne- cessary cautions to prevent its odour from passing into the air of the room, transmitted into a glass A-essel, previously filled and inverted in quicksilver. My hand and wrist were next in- troduced into the inverted vessel, and kept in this situation surrounded by the decoction for more than an hour; during the greater part of which time, friction Avas used, with the in- tention of giving every opportunity for an absorbing power on the skin, to exert itself. At the expiration ofthe time men- tioned, my hand and wrist Avere AvithdraAvn, when I directly left the laboratory, and in the course of one hour and a half, the urine Avas examined, but the peculiar odour Avhich aspa- gus gives, could not be perceived. As in the former instances, I continued to attend to the urine occasionally discharged, during the remainder of the day ; but nothing Avas discovered which characterised the presence of asparagus in the body. r 332 KLAPP ON CUTICULAR ABSORPTION I have iaoav completed life detail of the experiments and observations which have given rise to the opposition which I have here offered to the sentiments of many respectable phy- siologists, on the functions ofthe skin of the human body : I am, nevertheless, conscious of having left unrcfuted, many arguments, drawn from analogical data, which, slender as they appear to me, may notAvithstanding, tend to lessen that conviction in the minds of some individuals, which it has been my endeavour to produce. An inquiry into the functions belonging to the external surface of the different orders of animals, will yet, I trust, though much light.has already been shed upon this important subject, afford an interesting page in the annals of medicine. I have for sometime past observed the want of such a work, and if circumstances do not mar my present expec- tations, I intend to devote a share of my future leisure to the collection of materials for its publication. To Dr. Samuel Stringer, of Albany, I am much indebted :'5r useful instruction conferred in the beginning of my studies; imd fe return for Avhich he will please to accept of my thanks and unalterable esteem. Before I close this imperfect essay, it remains for me to proffer my thanks to the Medical Professors of this University, for the permanent advantages Avhich I have derived from their instructing lectures, and for the polite attention Avhich they have individually manifested tOAvards me. That they may long continue to exercise the duties attached to their respec- tive departments, with the same reputation that has heretofore characterised their labours, E the sincere wish of their obliged and grateful pupil. AN EXPERIMENTAL ESSAY ON CUTANEOUS ABSORPTION: SUBMITTED TO THE EXAMINATION OF THE REVEREND JOHN ANDREWS, D. D. PROVOST PRO TEMPORE; THE TRUSTEES AND MEDICAL PROFESSORS OF THE UNIVERSITY OF PENNSYLVANIA, ON THE FIFTH DAY OF JUNE, A. D. ONE THOUSAND EIGHT HUNDRED AND FIVE. FOR THE DEGREE OF DOCTOR OF MEDICINE, u— BY HENRY P. DANGERFIELD, OF FREDERICKS- BURGH, VIRGINIA: MEMBER OF THE PHILADELPHIA MEDICAL SOCIETV. ' We ought, in every instance, to submit our reasoning to the test of experiment, and never to search for truth but by the natural road of experiment and observation.' / INAUGURAL ESSAY*. In selecting the subject of cuticular absorption for an In- augural Dissertation, I have not been misled, either by the hope of offering any thing neAv on so interesting a question, or of rendering that which Ave already know more valuable by the beauties of my style, or the force and perspicuity of my reasoning. Medical science is accused of having hitherto advanced Avith a slow and halting pace; and this too, perhaps, princi- pally because it is an experimental science. Nature, although simple and determinate in her laws, nevertheless requires that he who consults her oracles, if he wishes to obtain cor- rect responses, should undergo the fatigue of minute and labo- rious enquiry. It is this labour and fatigue that frequently determine physicians to remain in ignorance, or to be content Avith imperfect information. Instead of going to the fountain head, to ascertain Avhether the data from Avhich they reason be founded in truth or in error, it is this pain and difficulty of making and of repeating experiments that determine them to receive theories as established, that are founded only on a single series of observations. It is in this way that one au- thor has been induced to rely solely on another, and in this way that we have volumes on volumes that contain little else than a repetition of Avhat had been previously known. In short until within the present enlightened era of philosophy, those that have experimented, have done it with so little attention to the minuti* by which the results of experiments are vari- ed, have been so imperfect in the detail of their modes of U u 536 DAINGERFIEED ON proceeding, that the mind is seldom able to rest srtisficd Avith their conclusions and doubt and uncertainty have thereby been entailed upon us from century to century. On the subject of cutaneous absorption, the medical world has not long been divided. From the times of Hippocrates and Galen down to those of Sabatier, * it has been received as an unquestionable fact, that substances arc taken, by ab- sorption, from the surface of the body into the general circu- lation. The contradiction of this doctrine, at once so novel, and apparently so absurd, could not fail to excite much at- tention. Much, therefore, has been said on both sides of the question, and physicians, once so unanimous in favour of such a power, are now, I believe, very much divided in rela- tion to its existence. Doctor Rousseau, a graduate in this university, Avas the first among us to institute a systematic examination ofthe question; and has, I think, by a set of ingenious and well- devised experiments, succeeded in proving, that there is no such function as cuticular absorption. But for the establishment of so interesting a question, is it enough that Ave haA'e only a single series of experiments ? and those too supported only by the testimony of a single in- dividual ? may not the tests which he employed have been fal- lacious ? may not the want of accuracy on the part of the ex- perimenter have led to deductions widely different from truth ? To decide, therefore, this point Avith accuracy, the only al- ternative left us is to repeat and extend his experiments. Should their results, when thus repeated, be strikingly coin- cident, surely avc shall then have greater reason to rest satis- fied with the truth of his opinions than we noAv have. Mine then, be the humble lot of such repetition; mine the satis- faction of contributing to render truth more certain, by mul- tiplying the evidences on Avhich it rests. Upon superficial examination it might be imagined, that inquiries of this sort were better calculated to amuse than to * A late French author, who, in conjunction with Lavoi- sier, wrote a paper on this subject for the Academy of Arts and Sciences at Paris. / CUTANEOUS ABSORPTION. ooi furnish valuable practical information. But when we advert to the fact, that the assumption of the doctrine of cutaneous absorption has been employed to explain the origin of conta- gious and epidemical diseases ; the similarity of effect produ- ced by the external application and the internal use of the same medicine; and that on it has been predicated the use of numberless ointments and lotions ; Ave at once perceive the futility of such an objection: since a negative conclusion relative thereto would, on the one hand, free us from absurd theories ; and, on the other, save that time Avhich would other- wise be wasted in an inert practice. Although the errors into which physicians have fallen on this subject have been numerous, much may be said in exte- nuation of them. That phenomena should have been ascri- bed to the lymphatic system, in early times, Avhich the better judgment of the present day has referred to a different origin, ceases to be a matter of astonishment, when Ave recollect, that this system of vessels is so minute, as to have eluded the ob- servation of the best anatomists prior to the last fifty or sixty years. How then could it be expected that, Avithin so short a lapse of time, the true character and functions of so large a portion ofthe animal economy, so minute in its parts and infi- nite in its ramifications, could be marked and defined Avithout falling into error ! Men, too, who make discoveries in philo- sophy or the arts, are ever anxious to enhance their value, by ascribing to them eA-ery possible importance. Accordingly, no sooner Avas the existence of this system announced to the world, than it became necessary to assign to it uses commen- surate Avith the ideas entertained of its value by its discoveries. Hence we find it made, not only the vehicle by which every digestible substance taken into the stomach is distributed throughout our bodies, but the medium by which every me- dicine, Avhether of internal or external application, produces its appropriate effects on the animal system. The doctrine of absorption, as now taught, may perhaps be properly divided into lymphatic and lacteal. Of the truth of our opinions relative to the latter, as thus delineated by the elegant and learned author of the Botanic Garden, there can be no question. 358 DAINGERFIELD ON < Thus where the veins their confluent branches bend, And milky eddies with the purple blend ; The chyle's white trunk, diverging from its source, Seeks through the Altai mass its shining course ; O'er each red cell and tissued membrane spreads, In living net-Avork, all its branching threads; Maze within maze its tortuous path pursues, Winds into glands inextricable clues ; Steals through the stomach's velvet sides, and sips The silver surges with a thousand lips.' But when authors, proceeding still further, Avould explain the modus operandi of medicines, by conveying them unaltered into the general circulation, by means of absorption, we are compelled from facts to deny their assertions, and to adduce the experiments of Doctors Hodges and Walmsley * to prove that such is not the case in relation to medicines taken into the stomach ; and that it is not in relation to those applied to the skin, will, 1 hope, be no less satisfactorily demonstrated, in the sequel of this essay. Before we proceed further, it may not be improper to pass in review some of the principal arguments in favour of ab- sorption from the external surface. An attention to the per- spirable matter Avith which our bodies are incessantly bedeAv- ed, appears first to haA'e led modern physiologists to suspect the existence of a set of vessels appropriated to this effect; and the subsequent discovery of the lymphatics, opening to their view the strong analogy between it and the lacteaE, where, perhaps, they had already contemplated the function of absorption, determined them to convert this similitude into a further proof of the existence of cuticular absorption. Those vessels then, no sooner discovered than charged with the im- portant office of absorption, haA'e given birth to the theories already noticed ; and the skin, Avhich Avould appear to have been formed as a covering to the more delicate parts of our system, has been made the ready inlet of a thousand predis- posing and exciting causes of disease. The rapid diminution that succeeds the application of carbonic acid to the skin has * See their Inaugural Dissertations. CUTANEOUS ABSORPTION. 359 been supposed to depend on its transmission through those vessels into the general circulation. The narrative of the un- fortunate sailors, who resisted the dreadful effects of thirst, by wearing wet jackets; the presence of spirits of turpentine and garlic in our breath and urine, when we have been expo- sed to their.emanations ; and, above all, the fact that mercu- rial frictions salivate, have severally been adduced in proof of such transmission. But let us return to the results of a more rigorous exami- nation of facts. In reply to the first proposition, it may be affirmed, that positive experiment has proved the diminution of the carbonic acid to proceed from its absorption by the moi- sture of the hand, for which it has a very great affinity, and, consequently, that this phenomenon has no connection what- ever with organic life. The second position is no less objec- tionable. Thirst doubtlessly depends upon a waste of fluids ; a cold application, therefore, constringing the pores, checks perspiration, and thus mitigates its pains : not to add the in- surmountable objection, that the absorption of a single drachm of water never could be detected by the best balance that ever was invented, although the body Avas subjected to long and repeated immersions in baths of every variety of tempera- ture *. To the third it may be replied, that whenever spirits of turpentine or garlic, have passed into the general circu- lation, they may be decidedly proved to have entered it through the medium of the lungs ; organs Avhose powers of absorption have been sufficiently demonstrated. And to the fourth and final proposition, it is also objected, that although it is difficult to assign a satisfactory theory of the mode in which mercurial frictions operate, yet it may be affirmed, from incontestible evidence, that the one now under conside- ration is perhaps as Avide of the mark as any that could have been suggested. Extending the principle of absorption from the lungs; as contended for by Seguin, Dr. Rousseau has attempted to ex- plain their operation, by supposing the mercury to be volati- lized during its application, and to be inhaled by the lungs. * See Dr. Currie's elegant experiments on this subject, in, his Avork on the hot and cold bath. 340 DAINGERFIELD ON With this vicAv, he has adduced numerous instances of per- sons Avho have been salivated, during their attendance on ve- nereal wards, or after having been exposed to the influence of the more volatile saline preparations of this metal. That the atmosphere of a room, in which a number of per- sons have been daily in the habit of using large quantities of different mercurial preparations, should become sufficiently impregnated Avith this fluid to excite salivation in their attend- ants, I can readily believe ; nor do I find more difficulty in admitting a fact Avhich is thus stated by Chaptal * : ' Oxy- genous gas, obtained from the mercurial oxides, almost ahvays holds a small quantity of mercury in solution. I have been a Avitness to its having produced a speedy salivation, in tAvo persons, who used it for disorders of the lungs. In conse- quence ofthese observations, I filled bottles with this gas, ex- posed them to an intense cold, and the sides became obscured with mercurial oxide, in a state of extreme division.' Here, as in the first instance, avc perceive the means by which mercury may be A-olatilized, and taken into the lungs. But Avhen Ave consider the nature of mercurial frictions, this explanation certainly fails us; since it is neither essential to their operation that the patient should inhale oxygen gas, ob- tained as above described, nor that he should frequent a vene- real A'.ard. 'May it not be supposed,' it is contended, ' that, during tiic frictions, some of the mercury is, by the action of the air, assisted by the heat of the body, oxyded, and that it afterwards parts by degrees with its oxygen, which carries along Avith it to the lungs some parts ofthe mercury, Avhich is with difficulty separated from it,' and thereby produces its specific effects ? In reply to this OATerstrained construction of possibilities, it may be affirmed, that positive experiment has proved, that neither the blue pill nor mercurial ointment are oxyded by iricion. t Hence the doctor is depriA'ed at once of the vehicle by Avhich he conveys this fluid to its place of destination, and * Vide his Elements of Chemistry. t See Mr. J. Donfilai' Inaugural Dissertation. CUTANEOUS ABSORPTION. SM of course of his theory. But even though we gran, for argu- ment's sake, that mercury is oxyded in the case of Avhich we speak : how does it happen that a few drachms of ointment, and the friction of a feAv days, will excite ptyalism, AVhilst those who are engaged for years, and during every variety of temperature, in preparing this article for sale, are never so affected ? and yet in the history of one or tAA'o men, avIiosc employment thisAvas, and of whom I made it my business to enquire particularly, I could never find that they had been af- fected by mercury in the slightest degree. Again, if mercury is not absorbed from the skin (as I hope to prove hereafter,) and if the absorbents which lie on the surface of the body are governed by the same laws with those that are seated in the lungs ; what reason have we to believe that they Avill take up mercury, when those on the cuticle have refused to do so ? should it though, be contended, that those two sets of lymphatics are governed by different laws ; that those seated in the lungs are even as active as the lacte- als ; may it not be inferred, that if the last named set of ves- sels are so fastidious as to refuse to take up foreign matter, that the absorbents of the respiratory organs would also do the same ? at least I can perceive no reason why Ave should deny the one set of vessels the power of absorbing extraneous matter, while Ave so liberally grant it to another. If it be impossible then to explain the modus operandi of mercurial frictions, by calling to our aid the doctrine of cuti- cular absorption, the great question naturally occurs, how do they produce their effects ? On this subject, mysterious as it may appear, we are not 1 conceive more at a loss than we are to explain the mode of operation of any article ofthe materia medica, whether it be taken into the stomach, or applied to the skin. At one time, the absorption of medicines from either of those surfaces into the general circulation afforded an apt and satisfactory expla- nation of every phenomenon. Driven, though, by stubborn fact from this strong hold, Ave were compelled to resort to the doctrine of sympathy to explain, by a natural or acquired consent of parts, whatever that of absorption is inadequate to. .'542 DA1NGERFIELD ON Thus, for example, by long habit, the actions of the stomach and saliA-ary glands arc so connected together by the principal of association, that Avhen a substance is applied to the stomach calculated to produce a specific effect thereon, Ave invariably observe a correspondent effect to take place in the saivary glands. Mercury is a substance so calculated, and thus are the phenomena of salivation at once explained. Why not, then, extend this explanation to medicines applied to the skin ? Why not suppose that habit or nature having established a Certain consent between it and the salivary glands, mercurial frictions act in the same Avay ? Is it not in favour of this supposition, that the bark shirt cures intermittent fever* ? that tobacco nauseates, when exter- nally applied ? and that blisters excite strangury ? when, though, in addition to this,, Ave find that mercury applied to one side of the body has been knoAvn to affect that side only, this explanation will become still more plausible. Mr. Richc- rand, in his excellent treatise on Physiology, states, that a * young man for Avhom' he had ' ordered frictions on the in- ner surface ofthe left leg andthigh, to resolve a large bubo, was seized Avith a salivation the third day, although only half a drachm of ointment had been used each night; the salivary glands on the left side only were swelled, the left half of the tongue Avas covered with apthae, the right side of the body remained perfectly free from mercurial influence:' an evi- dent proof that ptyalism, in this instance, could not have pro- ceeded from absorption, but must have been the result of some secret and unexplained sympathy. I am well aware, however, of the objection, that if the operation of frictions depended on sympathy, any other sialagogue ought to pro- duce the same effects, Avhen similarly applied. Thus stran- gury is often produced by the application of blisters, an effect hitherto ascribed to absorption; for it is contended, that if this effect resulted from sympathy, we ought to experience similar results from any of the siliquosx, and yet no other visicating substance whatever excites this complaint. In reply to this statement, it will be sufficient to observe that the objector has done little more than beg the question. CUTANEOUS ABSORPTION. 34.3 Pursue but for a moment this species of reasoning, and mark the consequences. If bark, for example, when applied to the surface ofthe body, cures intermittent fever by being ab- sorbed, as it must necessarily do, according to this doctrine are we not authorised to expect equally beneficial effects from any article of the class of tonics, that could be as rea- dily taken into the circulation as bark? hence, if this rea- soning proves any thing, it is simply that cantharides is speci- fically different from any of the siliquosa ; that blisters will excite strangury, whilst cataplasms of mustard will not; for the same reason that a purgative does not generally prove an emetic, nor an emetic a purgative. That no absorption of cantharides takes place in the case of strangury, I think sufficiently evident, for the folloAving reasons ? First, If we admit of absorption in the above instance, we must also admit of specific determination to the bladder; and yet specific determination is more difficult of explanation than absorption. Secondly, This effect ought not only invariably to occur, but, to take place in a short space of time, as the absorbents are supposed to be always hi a state of act'iA-ity. Thirdly, If this symptom be referable to the principle of absorption, it ought to be proportioned, in its degrees of vio- tence, to the size of the blister, and to its length of continu- ance, neither of which circumstances are noticed by authors on the subject. Lastly, Because for strangury no remedy, according to the practice of some physicians, is better than the application of a second blister. Here then is an effect produced from the skin on the blad- der, in which the principle of absorption could have had no agency. How then can it be better explained, than by refer- ring it to that great law ofthe animal economy called sympa- thy ? It is vain to object that the doctrine of sympathy explains nothing ; that it is vague and indeterminate in its signification, for when defined to mean no more than that consent of parts X x 344 DAINGERFIELD ON which has invariably been remarked to take place under cer- tain circumstances, it clearly furnishes as full and satisfactory an explanation of many of the phenomena of life, as our pre- sent imperfect knowledge of cause and effect will permit us to obtain, from any source Avhatever. Thus, for example, when I say that a dose ofturpith mineral will speedily excite a flow of saliva, in consequence of a sympathy that subsists betAveen the stomach and salivary glands, is not the explana- tion of antecedent and consequent as complete as when I say this effect depends on absorption. It Avouldbe easy, in this way, to multiply arguments against the doctrine of absorption ; but as my introduction is, per- haps, already swelled beyond its proper limits, and it is impro- per, on a subject so purely experimental as the present, to trust to analogy what can be made the subject of direct experiment, I shall proceed to relate such as I have made, in their proper order, and with the candour and impartiality of one who has no favourite theory to support, but Avhose only object is truth. As the experiments of Dr. Rousseau, as far as I know to the contrary, are those that have excited most attention, or, at least, as they furnish almost all the direct evidence that Ave have against the existence of cutaneous absorption, I thought it my duty, for reasons previously assigned, to repeat some ofthe most important of them, and to communicate their re- sults, before I proceeded to relate those which have been de- vised and executed by myself. EXPERIMENT I. With a vieAv to determine whether spirits of turpentine would discoA-er itself in my urine, by its characteristic proper- ty of imparting to it a violet smell, I took a few drops of it on a lump of sugar, and in the course of three hours, discovered a strong smell of violets in my urine. EXPERIMENT II. Several days after the above experiment, when I could not expect that a particle of turpentine remained in my system I proceeded to the following : At ten o'clock of a fine morning CUTANEOUS ABSORPTION. 345 in April, the temperature of my room being 65 degrees of Fahrenheit, and my pulse 60, its natural standard, after a light breakfast, I exposed myself to the emanations of spirits of turpentine in a closed room, by placing some of this .fluid in a saucer, on a table, at Avhich I Avas busily engaged in Avri- tihg. In about an hour, I referred to my urine, and found the smell of violets as strong as in the foregoing experiment, where the turpentine had been taken in substance. There then remained no doubt but that the emanations from this fluid, entering the body, had been conveyed into the general circulation. The difficulty though, still remained: how had it entered the system ? To ascertain this point, therefore, the following experimeet was repeated. EXPERIMENT III. I provided myself with a long tin tube, by means of which I could, while sitting in my room, draw the air from a dis- tant place without it, where none of the emanations, to which my body was exposed, could have previously existed, or have been conveyed during the experiment. Thus provided, and in a room whose temperature was 75 degrees of Fahrenheit, I took the tube in my mouth, closed my nostrils, and immersed my hand and arm nearly up to the elbow in spirits of turpentine, when I directed the jar to be luted round my arm, in a manner that rendered it impos- sible that I should aftenvards inhale any of the effluvia of this volatile substance. Having previously taken a diuretic draught my assistant was enabled, at the end of an hour, to examine my urine, but could discover no smell of violets, the perspirable matter of my body, and my breath were also examined, and Avere found to have undergone no change. *To render this experiment still more conclusive, another diuretic draught Avas taken, and it was determined to continue the immersion for an hour lon- ger; but when half that period had elapsed, the pain became so intensely severe, that it could no longer be supported. The urine, perspiration, and breath were therefore again examined 346 DAINGERFIELD ON but Avith the same results ; after which the hand and arm were withdrawn, SAvelled to nearly double their natural size, and so excessively painful, that I was unable to use my fingers or wrist for several hours. The pain and burning occasioned by this severe application gradually subsided, leaving behind them a scarlet redness, and great sensibility of the parts, Avhich continuing for four or five clays, terminated in a total destruc- tion of the cuticle. From time to time, throughout the day, I repeated the examination of my urine, breath* and perspi- rable matter, but never could detect in them any thing that authorised the opinion that this substance was or could be ab- sorbed from the external surface. Conclusive, therefore, as tiis experiment Avould appear, it has nevertheless been ob- je :ed to it, that the surface exposed to the influence ofthe spi- ri:; of turpentine was too small, and that the activity of its absorbents might have been less than that of those seated on other parts of the body. To obviate this objection, I pro- ceeded to EXPERIMENT IV. On a fine morning in April, the temperature of the room in Avhich I proposed to make the experiment being between 70 and 80 of Fahrenheit, I adjusted my tube as formerly de- scribed, took eff my clothes, placed the end of the tube in my mouth, stopped my nose, and directed my assistant to be- r - ar my body and superior extremities by means of a spunge with spirits of turpentine. The pleasant sensations produced by the friction ofthe spunge counterbalancing the painful ones created by the turpentine, induced me to direct the attendant to continue it without intermission. The application of this fluid, therefore, so far from having been intermitted, was un- ceasingly continued throughout tbe experiment; so that the absorbents had the additional < d. antra--e of friction, by Avhich to driiisi up the substance with which their mouths were be- smeared. Three quarters of an hour elapsed, Avhen my as- assistant received my urine in a vessel as I sat, but could not discover the least smell of violets. The hour being completed my body was carefully Avashed. I then closed my mouth and CUTANEOUS ABSORPTION. S47 nose, and walking precipitately into the next room, exami- ned my urine, Avithout being able to detect in it the odour by which the absorption of turpentine was to have been proved. My friends also examined my breath, and Avere unanimous in saying that it had undergone no change. The common tests were frequently resorted to during the succcding tAventy-four hours, but with the same results. " EXPERIMENT V. If, then, it is satisfactorily demonstrated by the foregoing fexperiments, that whenever spirits of turpentine manifests itself in the urine, breath, or perspirable matter, it could not have been introduced by means of cuticular absorption, it re- mains to prove by experiment Avhat has already been as- sumed, that it enters the general circulation through the me- dium of the lungs. With this view, having introduced my long tube into the mouth of a large bottle which contained a little spirits of turpentine, I inhaled several successive times the emanations of this fluid. At the end of an hour, referring to my urine as a test, I found it strongly tinctured with a vio- let smell. This experiment, therefore, while it proves the strong powers of absorption possessed by the lungs, amply accounts for the innumerable mistakes that have been made in ascribing the presence of certain substances in the general circulation to absorption from the skin. Doctor Rousseau, after having related experiment No. 4, recommends it to those who may repeat it to be extremely cau- tious how they proceed, as the most trivial inattention might widely vary its results. To me, though, I hope this caution was unnecessary. I candidly confess, that the experiment was undertaken with the firm persuasion that conclusions Avould be drawn from it different from those that had been drawn; but haying no favorite theory to support, I did not care to repeat it with the greatest circumspection. It was made in the presence of a Avorthy friend and ingenious felloAv- graduate, who, believing that absorption from the external surface did actually take place, Avas so well convinced of its accuracy, that his opinions on this subject have thereby un- dergone considerable change. S48 DAINGERFIELD ON Indeed, when I first heard the existence of tills function questioned, I was thunderstruck with what I then believed to be the absurdity of the opposite opinion. I Avas in vain told, that a graduate in this university had experimented largely and Avith great acumen on the subject; that spirits of turpen- tine applied to the skin produced no sensible effect; that the poison ofthe viper, if brought into simple though close con- tact with the cuticle, AAras harmless ; and that many of the phenomena hitherto ascribed to absorption had been distinctly traced to the inhalation by the lungs ofthe substances acknow- ledged to produce them. These were difficulties that my imagination readily surmounted. I admitted the facts, but gave very different explanations of them from those they had received at the hands of my opponents. The fundamental truth, that all medicines act specifically suggested itself as a weapon with which I could parry every objection, and con- found my adversaries. Medicines, said I, when taken into the stomach, produce their several distinct and specific effects. The operations of opium are radically and invariably different from those of mercury, and the influence exerted on the ani- mal economy, by a purgative no less different than that exer- ted by an emetic. Let us then extend this general law of the system. The materia medica abounds with some substances that have, and some that have not, a specific operation on the lacteals and internal lymphatics. Why not then generalize the principle, and say, that it also abounds with some that have and some that have not a specific operation on the external lymphatics. Spirits of turpentine and the peison of the viper, for example, have no knoAvn tendency to promote absorption on the part of the lacteals and internal lymphatics. But the absorbents, seated both on the surface of the body and inter- nally, it may be fairly presumed, are governed by the same laws ; surely, therefore, we have no right to expect that the above substances will stimulate to increased external ab- sorption, when they havt been found to produce no such effect on the self same congeries of vessels, as they exist in the dif- ferent cavities of the body. But even though these two sets of vessels were admitted to be governed by different laws, still it would appear to follow, that the non-absorption ofthe spirits CUTANEOUS ABSORPTION. 348 of turpentine and the poison ofthe viper proved no more than that those substances have not that specific operation calcu- lated to awaken the cutaneous lymphatics into action. Again too, it was further objected, that the highly acrid and stimu- lating substances, made use of in the experiments on this sub- ject, were not such as were most likely to be taken into the general circulation, and of course that no reasoning from them could be received as conclusive. To give, therefore, this question tire certainty Avhich it evidently deserved, it became necessary, not only to repeat the experiments previously related, but to extend them to a variety of articles, some of Avhich at least should be milder and more bland than those heretofore employed. With this view the following series was instituted. SECOND SERIES OF EXPERIMENTS, EXPERIMENT VI. To accomplish these important ends, I selected a sub- stance which, from the uniformity with Avhich it has been supposed to produce its effects through the medium of ab- sorption, promised results highly satisfactory. The substance alluded to is mercurial ointment. To ascertain Avhether it did or did not produce salivation, together with its other ef- fects, in consequence of being taken into the general circu- lation, I applied large plaistersof it to the calves of my legs. But as I Avas apprised of the objection, that the mercury might be volatilized and taken into the lungs, unless means were adopted to prevent it, and that if applied to an abraded cuticle, the experiment Avould be inconclusive, care was taken to avoid both the one and the other ofthese sources of error, by applying them to a perfectly sound cuticle, and by cover- ing them with thick bladders, rollers, and a pair of stockings, which Avere not removed until the end of the experiment. 350 DAINGERFIELD ON Thus circumstanced I waited patiently the arrival of a speedy ptyalism, but at the end of eight days Avas completely disap- pointed, never having observed the slightest alteration in my general health, nor in my pulse, nor in the discharge of saliva. Not content though Avith this, and Avilling to believe that the result of my experiment had failed to correspond Avith my expect .tions only in consequence of want of attention to a re- stricted diet, I accordingly resolved to live exclusively on ve- getables, and to eat even of these with moderation. This determination Avas immediately carried into execution, but with no better success; for, at the end of another week, the plaisters had certainly produced no sensible effect. Umvill- ing, though, to abandon a doctrine so generally acquiesced in, and ardently desiring to knoAV something conclusive on this subject, I reduced my system still farther, by the loss of fif- teen or twenty ounces of blood, continued my vegetable diet, and applied, Avith the former precautions, two large mercurial plaisters to my fore arms, where they were suffered to remain seven or eight days ; at the end of which time, as they had produced no effect whatever, I put an end to the experiment, after its having lasted the greater part of three weeks. EXPERIMENT VII. From the foregoing facts it appeared, that I was fairly au- thorised to conclude that there was no active power of cuta- neous absorption; since, if there Avas, I ought to have been sa- livated, as having lived under every, circumstance essential to that event. Afraid, though, to trust tlis conclusion to con- jecture, Avhen it could be made the subject of direct experi- ment, and apprehending that my experiments might possibly have failed from Avant of activity on the part of the absorbents, to which the plaisters were applied, or from some idiosyncra- cy of constitution, or from some imperfection in my mode of living, or in the quality ofthe ointment used, I resolved to try the effect of frictions. Accordingly, on the same parts, with much less of the same ointment than had ever been applied at any one time in the form of plaisters, I succeeded ih three nights in gently affecting my mouth. CUTANEOUS ABSORPTION. 351 EXPERIMENT VIII. From the foregoing experiment it Avould appear, that the absorbents, stimulated by the friction used in the application of the ointment, were compelled to take it into the circu- lation. To determine, therefore, how far this Avas really the case, it Avas necessary that the ointment should be applied to parts Avhich, at the same time that they possessed the advantages of friction, should leave nothing to apprehend from its being- volatilized and taken into the lungs. Accordingly, I provided a strong pair of oil cloth socks, applied an ounce of unguen- tum hydrargyri fortius to the upper surface of each of my feet, put on the socks, drew a pair of stockings over them, and regularly walked a mile or two every day, that the friction of my boots against my feet might cause the mercury to be absorbed. At the end of ten days, though, I was greatly astonished to find that they had produced no effect. The socks were therefore taken off, and the same quantity of ointment again applied, after which they were renewed, and permitted to remain sixteen or eighteen days longer ; but as in this time no alteration had taken place in the state of my salivary glands, they Avere again removed, and the'experiment considered as concluded. It may not be improper to add, that my diet on this occasion Avas low, and strictly vegetable, EXPERIMENT IX. Apprehensive that there might not have been friction enough in the above experiment, to answer the purposes intended to be answered by this indispensable agent in the production of salivation by means of mercurial ointment, I was anxious to deA'isc some remedy for this probable defici- ency. For this purpose, it was recommeded to apply strongly stimulating substances to my feet, Avhich, at the same time that they excited the absorbents, Avould not impair the cuti- cle. With this view, haAing poured some boiling Avater on a quantity of bruised mustard seed, I immersed my feet in the, Y v. 352 DA1NGER1TELD ON infusion, until the irritation became so great as to be almost unsupportable, Avhen they Avere taken out, and the socks, with the same quantity of unguentum hydrargyri fortius used in the former experiment, were again applied. This done, I immediately set out on a long Avalk, that the mercury might be rubbed into my feet, and the stimulus of the bath be thus co-operated Avith by that of friction. The socks were Avom a Aveek ; but as at the end of that time no appearance of mercu- rial affection Avas to be discoArered, they Avere taken off, and the experiment regarded as complete. I am Avell aware, that this experiment may be conceived by some to militate against my explanation ofthe modus ope- randi of mercurial frictions ; since it may be asked, if they produce their effects in consequence of a sympathy between the skin and salivary glands, Avhy this sympathy was not ex- cited in my experiments with the mercurial socks ? The an- sAver to this question is, I think, extremely obvious : for the feet arc so far remoA'ed from the centre of circulation, and so far from the salivary glands, that it could not be expected they would be readily brought into sympathy with each other. Hence ptyalism Avas not produced: and for the analogical rea- son that' children under a certain age cannot be salivated, be- cause those two sets of vessels' (the stomach and salivary glands) ' have not acted long enough together for their mo- tions to become associated. *' EXPERIMENT X. As I had now made every experiment Avith mercurial ointment that promised any thing conclusive on this subject, I thought it not improper to direct my attention to such other substances as should, by certain characteristic properties, enable Us to detect them in the general circulation, should they be absorbed. Being therefore provided Avith large cata- plasms of bruised garlic, I disposed of my tube as formerly described, took the end of it in my mouth, closed my nose, and directed my assistant to apply the plaister under the exilla of both arms. * See F■■•. Young's Inaugural Dissertation. CUTANEOUS ABSORPTION. 353 In the selection of this place, as the most proper for the application of the garlic, I Avas influenced principally by two reasons; 1st. Because it appeared to me, that if garlic failed to manifest itself in the urine, Avhen ■ applied to the feet, it might have proceeded from the langour of circulation in those parts ; and 2dly, Because having been informed that mercu- rial applications succeeded no where so Avell as under the arms, it appeared clearly the most eligible disposition of my cataplasms that could be made. Thus situated, I suffered them to remain an hour, at the expiration of Avhich time they were removed, and the parts carefully washed, Avhen I quitted the room, with every precaution to avoid inhaling their pene- trating odour. My urine, breath, and perspirable matter Avere noAv examined, but did not, at this or any subsequent period, discover the least smell of garlic. EXPERIMENT XI. Having heard the folloAving fact advanced in favour of the absorption of foreign matters into the general circulation, I determined to repeat the experiment. It is said, if a strong ligature be made round the arm, so as to stop the circulation in the subcutaneous veins, and that if the corresponding hand be then immersed in a strong solution of nitre, while it is occasionally chafed by the other hand, that the nitre will be absorbed. To prove which it is affirmed, that if blood be drawn from a vein in which its circulation had been stopped, and then dried on a piece of paper, it will flash Avhen burned, as if containing nitre. Suffice it to say, that I repeat- ed this experiment, with the precaution of washing my hand- before the blood was drawn, and that I found the assertion to be entirely unfounded. Thus from a careful investigation of facts, have I been obli- ged to relinquish my former opinions, and to acknowledge that the function of cuticular absorption has no other claim to our belief than the sanction of hoary-headed authority, than mental apathy, or inattention to the evidences by Aviichit has been' supported. 351 DAINGERF1ELD ON In thus denying the existence of cutaneous absorption, far be it from my intention to fly so directly in the face of ana- tomical demonstration as to deny that there exists a set of ab- sorbents beneath the skin. All I contend for is, that they have not the poAver cf conveying foreign substances into the general circulation, whether these substances be applied to a sound or abraided cuticle. To prove that such is not the case, in the first instance, nothing more, I presume need be said ; and that it is not in the second- may, I think, be fairly infer- red, from the folloAving statements : First, As the lacteals will not carry extraneous matter into the general circulation, so we have no reason to believe that the lymphatics will. Secondly, Because the spirit of turpentine was not absor- bed in two of my experiments in which the cuticle Avas destroyed. Thirdly, From the analogical fact, that mercurial frictions act by sympathy, and not by absorption *. Fourthly, Because congestions and obstructions have never been detected in the course ofthe lymphatics. And lastly, Because it is easy to find a much wiser and better employment for this system of vessels, than that of converting our blood into one indescribable mass of hetero- geneous matter. The arteries carry to the various parts of our bodies the matter out of which they are formed; the lymphatics mould and give to it its proper shape. One part is redundant, they prune it to its proper standard; another deficient, the arteries furnish the proper materials for its enlargement, the lymphatics manufacture them. It is now time that I should put a period to this essay. Hoav far 1 have succeeded in establishing the points conten- ded for, is not for me to determine. All that I can ask, or flatter myself Avith obtaining, is, that the good sense of every person who dispassionately considers the subject will prevent the attempt from being considered as chimerical. * This argument is conclusive, for the cuticle is often destroyed, Avhere the frictions have been continued for a long time, or huAe been veiy violent. 4 AN INAUGURAL DISSERTATION, UPON THE THREE FOLLOWING SUBJECTS, I. AN ATTEMPT TO PROVE, THAT THE LUES VENEREA, WAS NOT INTRODUCED INTO EUROPE FROM AMERICA. II. AN EXPERIMENTAL INQUIRY INTO THE MODUS OPERANDI OF MERCURY, IN CURING THE LUES VENEREA. III. EXPERIMENTAL PROOFS THAT THE LUES VENEREA, AND GONORRHOEA, ARE TAVO DISTINCT FORMS OF DISEASE. SUBMITTED TO THE EXAMINATION OF THE REVEREND JOHN EWING, S. S. T. P. PROVOST, THE TRUSTEES AND MEDICAL PROFESSORS OF THE UNIVERSITY OF PENNSYLVANIA, ON THE EIGHTH DAY OF JUNE, A. D. "ONE THOUSAND EIGHT HUNDRED AND ONE. FOR THE DEGREE OF DOCTOR OF MEDICINE, 1____. BY JAMES TONGUE, OF MARYLAND: HONORARY MEMBER OF THE PHILADELPHIA MEDICAL AND CHEMICAL SOCIETIES. 1 No man ought to surrender his own judgment to any mere authority, however respectable.' Priestley on Phlogiston. INTRODUCTION. IT will be thought presumptuous that the author, a mere Tyro in the science of medicine should attempt to write upon three subjects, which have, for centuries, agitated the medical s world. If there be no information afforded in the following pages he Avill, at least here, be on a footing with many of his supe^ riors. It would be impossible, in the compass of a discourse like the present, to enter minutely into each of the different sub- jects embraced in this dissertation. It Avould require years instead of the few weeks which are allowed to the candidate, to Avrite a thesis; and a mind pregnant with information, instead of one which can only be in its infancy. The first part of this dissertation ; must necessarily con- sist in a collection of such facts, as he has been able to pro- cure. Most people, have such an aversion from being experi- mented upon, particularly with the venereal virus, that it has prevented the second part of this dissertation from being treat- ed in such an ample as could be wished. I cannot forbear mentioning here, that the experiments contained in the folloAving pages, Avere made Avith the great- est care, and related Avith the strictest fidelity ; yet I am sen- sible, many inaccuracies may have escaped ; which those will most readily excuse, Avho have experienced the difficulties incident to such researches. » INAUGURAL DISSERTATION. AN ATTEMPT TO PROVE, THAT THE LUES VFA'BBF.A WAS XO'l INTRODUCED INTO EUROPE FROM AMERICA. The origin of the disease, now called lues venerea, has been a subject of much debate among most medical writers. The greatest part of these inform us, .that it v s brought by Columbus and his companions from the Wer.t Kuics, between the years 1494, and 1496, merely because it happened to rage with great violence in Europe, shortly after the retufli. of those navigators from their first voyage—iike the yellow fever no person willing to give it birth, fruitlessly seek for us origin in ships and sailors, that have arrived from foreign countries. The proofs of those, who have given this origin to the venereal disease, are all equivocal," and much greater coun- ter demonstration must be adduced, before the scale will preponderate on that side, of the question; though now it appears to be the most prevalent opinion, as scarcely a book on this subject can be opened, but we are informed that this disease was introduced into Europe from America. To find out the precise time of its first appearance, Avould perhaps be as fruitless as the search after the philosopher's stone. The limits of this dissertation will not admit me to enter in so minute an investigation of its origin, as could be,, W1S We will offer here a few remarks upon one of the oldest books we have in existence—namely, the Bible. * * No person will think there is the least impropriety in making the following quotations from the Bible. The fame causes existed then as exist now for the production of this disease ; and in those times other diseases existed which Avete a thousand times Avorse. * Z z 360 TONGUE ON LUES VENEREA. It has been said by some authors, that ' the sore boils' Avherein Satan smote Job by God's permission, ' from the sole of his foot to the croAvn of lis head,' was the venereal disease. In ch. 20. v. 11. he says,—-' his bones are full ofthe sin of his youth, which shall lie down with him in the dust.' It has been said that the following verses lead us to be- lieve that David had the same disease. Psalm 38. v. 3. ' There is no soundness in my flesh, because of thine anger, neither is there any rest in my bones, because of my sin. V. 5. ' My sores are putrified and corrupted, because of my foolishness.' V. 7. ' For my loins are filled Avitha loathsome disease, and there is no soundness in my flesh.' Itis said in Ecclesiasticus, ch. 19. v. 3. as follows,—f And he who joinetli himself to harlots, will be naught, rottenness and Avorms shall inherit him.' The following verses, we find in the 15th chapter of the book entitled LeA nicus, commonly said to be written by Mo- ses. They are part of a law given by him in order to prevent a disease from spreading, which appears to have been a true gonorrhea. ' Leviticus ch. 15. v. 2. ' The man that hath an issue of seed shall be unclean.' V. 3. ' And then shall he be subject to this evil, Avhen a filthy humour, at every moment, clcaveth to his flesh, and gathereth there.' V. 4. < EA'ery bed, on which he sleepcth, shall be un- clean, and every place on which he sitteth.' V. 5. < If any man touch his bed he shall wash his cloathes ; and being washed with water, he shall be unclean until the evening.' V. 6. * If a man tit where the man had sitten, he also shall Avash his cloathes; and being washed with water shall be unclean until the evening.' V. 7. ' He that toucheth his flesh, shall wash his cloathes; and being himself washed in Avater shall be unclean until the u-> citing.' TONGUE ON LUES VENEREA. 361 V. 8. ' If such a man cast his spittle upon him that b clean, he shall Avash his cloathes; and being washed Avith water, he shall be unclean until the evening.' V. 9. ' The saddle on which he sitteth shall be unclean,' V. 10. * And Avhatsoevcr has been under him, that has the issue of seed, shall be unclean until the evening. He that carrieth any of these things shall wash his cloathes; and being washed with Avater he shall be unclean until the even- ing.' V. 11. < Every person whom such a one shall touch, not having washed his hands before, shall Avash his cloathes ; and being washed in Avater, he shall be unclean until the even- ing-' V. 12. ' If he touch a vessel of earth it shall be broken; but if a vessel of Avood, it shall be Avashed Avith water.' V. 13. 'If he Avho suffereth this disease be healed, he shall number seven days after his cleansing; and having washed his cloathes, and all his body in living Avater, he shall be clean' V. 16.' The man from whom the seed of copulation goeth out, shall wash all his body with water; and he shall be un- clean until the evening.' V. 17. ' The garment or the skin that he weareth shall be Avashed with water; and he shall be unclean until the evening.' V. 32. ' This is the laAv of him that hath the issue of seed, and that is defiled by copulation.' We see that the disease of the Jews, called the issue of seed, as described in the preceding verses, was contagious to the greatest degree, and also propagated by copulation. To prove that this was a gonorrhoea, it is only necessary to observe that this disease has till very lately been supposed to consist in a flow of semen*. Hence the word gonorrhoea is derived from the Greek words yon genitura semen and ati * Astriic, a late writer defines this disease to be a dis- charge of semen from the urethra.—*See his description of it, vol. 1. 362 TONGUE ON LUES VENEREA. fluo, i, e. fluxus seminis. And upon looking into this part of the Greek bible a\c find the word y«y»ppo<« i. e. seminis geni- talis profluvium, av hie h is translated in the bible an issue of seed. ♦ It is said by one of the prophets, * fly the person afflicted with the Judham as you would a lion.' Judham being an Arabian Avord which signifies an invete- rate degree of the venereal disease, caused by improper treat- ment*. The iunabitantsof Indostan haA'e, time immemorial,, made use of thj word Khorah to signify the same thingf. The venereal disease has been known to the inhabitants of Indostan time immemorial, by the name ofthe Persian fire. This disease has been attributed by them time out of mind to tic Persians, as the Europeans have attributed it to the Americans, the French to the Neapolitans, the English and Germans to the French, &c. This disease certainly ex- isted among the Greeks and Romans. The disease to which the Scythians were subject accor- ding to Herodotus, and also according to Hippocrates,^ who have both named it morbus faemininus (SAvediaur says) seems to have been a true gonorrhoea||. The last of these authors, (Hippocrates) speaks of defluctions from the private parts, exuicerations, tubercles in the groins, large spreading ul- cers, abcesses and suppurations, mutilations of the bones and nerves §. In his book' de morbis mulierum' he makes mention ofthe suppuration ofthe inguinal glands, and he attributes it to the suppression of the menses, Avhich we iioav know, will not cause a suppuration of those parts. * See Asiatic Researches, vol. 2, and Swediaur's mala- dies syprilitiques derniere edition a Paris, 1798. Tom. 1. t Ibid. \ Hippocrates AvioLe 460 and Herodotus 404 years before the Christian era. f| Voyez Sweiaur, derniere edition, a Paris, 1798. § He speaks of these in his epidemic diseases. TONGUE ON LUES VENEREA. rt c r\ OOO Juvenal, in Satyre XI, who Avrote in 123, and Martial, lib. viii. and ix. Avho wrote in 100, speak of ulcers in. the genital parts, as diseases produced by impure coition. Plutarch,^ in his life of Otho, about the middle ofthe first century, speaking of Tigellinus, says that he Avas afflicted with several diseases, which he had contracted by conversing with lewd Avomen. In Pliny the second, lib. 6, Epis. 34, (whoAvrote in 97) we find a disease of the falling off of the genital parts, which was regarded as incurable, ' Maritus ex diutino morbo circa ve- lenda corporis ulceribus putrescebat.' Diascorides, (who wrote in 50) recommends remedies against rhagades, condylomata, maligna ulcera, vulvae tuber- cula, genitalium et vulva exulcerationes.' Sextus Placitus, papyriensis parabil. medicament, script. antiq. speaks of remedies against' bubones seu tumores ad inguina, carbunculos in A'eretro, ficos in ano, rhagades, phy- mata, callos in veretro.' Qalenus, {opera per 1. Cornar.) who wrote in 200, speaks of phimosis, paraphymosis, rhagades, condylomata, bubones, phymata purulenta, acrochordones, &c Bishop Palladius, who lived in the fifth century, under the reign of Theodosius, junr. relates the following curious, anec- dote of a hermit named Heron, Avho had ahvays led a very virtuous life. From the Greek of Palladius, it has been translated into French, from which I have translated it into English. ' At last, Heron, seized by the influence of evil genius, and transported as if by a devouring fire, could not remain confined to his cell. He sets out all at once for Alexandria: the design of God called him there, and according to the proverb, drove a nail by the other*. 1 Indeed he fell into the forgetfulness of his duties, that were to lead him, in spite of him, to his safety. He frequent- ed theatres, horse races, and spent his life in taverns. From § Vol. 8. p. 303. * That h to say, pride, by the humiliation of his fall. 364 TONGUE ON LUES VENEREA. iV excess of good cheer and Avine, he fell into the abuse of women, and the most dirty libertinage. Having resolved to sin, he had a habitual commerce with a dancer of panto- mimes, and declared to her the evil, (or wound) that torment- ed him. In the mean while there came upon the gland of lis genital parts, a carbuncle or anthrax (probably Avhat Ave -would call a chancre). The disease grew so bad in the space of six months, that his genital parts were mortified and fell off.' This is a sufficiency of the anecdote for our purpose, anil every body will think with me that it was a case of con- firmed syphilis. Celsus, (Avho Avrote in the first century) in his book 4. ch. 31, speaks of' nimia profusio seminis sine venere, et sine noc- turnis imaginibus. That is to say, a true gonorrhoea, Avhich became at last fatal, in causing by degrees a consumption. And in book 6, ch. 18, he speaks of ulcers in the genital parts. G>.:ii' ''Nil V w ' • ■ < ■ > • W :' , . i ,<■;-* ; . a ^.-N #» ■ WM H &&4V?