CHITICAli AKB TATROROCICAL, BY PiETUS,__ REMOTE DESCENDANT OF THRASEA TJETUS. Baltimore •• PUBLISHED BY CUSHING & JEWETT. .T. ROBINSON, PRINTEn. Nov. 1817. LETTER I. Vutd qui latuit, tuto vixit. CHARLES CALDWELL, M. D. Sir, With that ingeniousness of sentiment, and civility of style, to which, from a candid and careful appraise- ment of your talents and learning, I conceive you to be entitled, I approach you. That we do not enjoy the reciprocal advantage and pleasure of a personal acquaint- ance, may be by each regretted; but in matters of sci- ence individual intercourse can be of secondary moment only. As a gentleman and writer, in your profession, you are known; and if you are at all conversant with Roman story, a literary advantage readily conceded to you, it will not require much display of eloquence to satisfy you that to appear on the theatre of scientifick discussion, with even a remote descendant of Thrasea Paetus, is not to ask your genius to bend, nor your pride to blush. For I must have fallen off, a great deal indeed, from the rank and claims of my great ances- tor, if I am by the world, denied all consideration. Of my skill in argument; my generosity in conquest; or my candour in defeat, a little exercise will afford to yourself and the publick an ample opportunity of forming a decision; if triumphant 1 will not boast; if defeated I will not complain. 4 A day or two ago, your late work, the “ Prelimi- nary Discourse” to Dr. Cullen’s Practice, to serve as a key to Profr.* Chapman’s Lectures, was put into my hands, and for the first time an opportunity was, thereby, afforded to me of perusing it. A month or two since, it is true, it was announced to me that you had come out before the publick against the doctrine, of unit in disease, advocated by the late Doctr. Rush. And it was also added, that you had taken with a hand large, if not a temper generous, from a source opened in this city without a becoming-recognition. To sus- tain before the reader what is alleged I have only to re- fer his intelligence and candour to an attentive perusal and examination of your late work. He will discover, so far as the battery reared by you against the doctrine advocated by the late Doctr. Rush, of unit in disease, is constructed of materials solid and not subject to decay, that so far you have had access to quarries opened by a gentleman of this city ; and that you have not made due acknowledgements. The more perishable are strictly your own, and taken from sources over which I admit you hold exclusive dominion. My present address is to represent to you that an injudicious mind has been employed to select, and an unartful hand to arrange your materials. The skill of the artist has not been sufficiently dexterous to give even a new shape to, or obliterate the original form. With much awkward- ness he has interlaced the borrowed with a domestick fabrick not of the same texture or durability. I am frank, because I wish to be understood; and ingenuous both from a feeling of liberality to you and a desire to see justice done to my neighbours. 5 To appropriate to private advantage and individual credit what has been the result of efforts not our own, is an act so uncivil and sinistrous, that to it I would not give a name or assign a rank lest I use a term more familiar than courteous ; such a term as may, for its in- terpretation, call rather on the impatience of sensibility than the manliness of understanding, I therefore refer you to your honour as a gentleman, and to your dig- nity as an author. That plagiarism, committed on a work already approved and complimented by some of the first authorities of Britain* and France, f and in the hands of almost every reading professional man in the United States, your sagacity would suggest to you, could not long remain without a publick reprehen- sion. In a future letter I shall call your attention more particularly to this part of the “ Preliminary Discourse,” while in the mean time I invite the attention of the rea- der to the two new sources of argument thrown open by your late efforts, to our contemplation ; one, that diseases must be in their nature, corresponding to the organization of the subdivision of the body attacked ; the other, corresponding to the natural stimuli. But before I bring under formal consideration the main to- picks of the “ Discourse,” it may not be viewed as improper to say a word or two on the motive, avowed by yourself, as impelling you to your late undertaking. “Were it not,” you remark “for the measures of unre- lenting hostility prosecuted for years by a late distin- guished teacher in the university of Pennsylvania, for the overthrow of systematick and classical medicine, we could have no plea for wishing to occupy any por- * A letter from Cambridge, England. A letterfrom the faculty of Paris. 6 I tion of the time of your readers in attempting its de- fence.” * From this quotation, presented in fairness and honest feeling, the reader would infer that during the interval in which the measures of unrelenting hosti- lity were prosecuted, you were under some disability from geographical distance ; from the relation of a pu- pil to this distinguished teacher ; from the obligation to him as a patron ; or that you had not assumed the mas- culine rights.—Let this be as it may, I have never un- derstood that you as a publick antagonist, ever looked this distinguished teacher in the face while he lived. Indeed as you now offer the production of your pen to our notice, we may fairly conclude that neither the ener- gy of your talents nor weight of your knowledge, as a mound, has even been antecedently laid across the tide of this teacher’s hostility which precipitated itself with such lamentable force and ruinous effect, against the foundations of systematick and classical medicine. But the battle is fought; the field is won, and the author of the “ Discourse” has proclaimed to the world that the medical doctrines of Rush “ will not long sur- vive their illustrious author. We might almost have said that they descended with him to the grave. ”f The doctrines have ceased to influence the professional mind, or offend the eye of science, and yet the Doctr. comes out to contend with what? the shadow of a shade. By whose hand were the laurels taken from the hero’s brow ? When dangers threatened and blows were giv- en, the voice of fact, says the author of the “ Prelimina- * See Delaplaine’s life of Rush.—Dr. Caldwell is the putative author of the biographies published under the authority of Dela- plaine. t See Prelim. Disc. p. 27. 7 ry Discourse,” was not on the ground. Now, over the dead hero, to wave the banner, carefully furled dur- ing the martial strife, is neither brave, nor generous ; to spurn the urn of the fallen great, whom the hand of des- tiny has laid to rest, is without decorum ; and wants pie- ty. Walk lightly on the ashes, the fire of which death has extinguished : disturb not, Sir ; disturb not, his repose whose sun before it set, shed a beam of glory on his race. “ For more than a century preceding the commence- ment (the scholar should have written precedent to) of this war of examination, thus openly and formally de- clared against it, methodical nosology had been consi- dered as resting on the immovable basis of reason, ex- perience and the unqualified approbation of every en- lightened physician of the time.” It appears, then, that the hostility, or war of extermi- nation, was carried on openly and formally before the broad eye of the world, thus affording a most eligible opportunity for the friend who had never abandoned the good cause that has now invited the author of the Pre- liminary Discourse, to put on his armour, and manifest his zeal, and display his. dexterity : But in the face of a determined resolution, possibly, he concluded that the better part of valour was discretion. We also presume from the above excerption that the idea of the unit of disease, is original with the Late great teacher of the University of Pennsylvania. That, how- ever, is not wholly the fact. Doctr. Clarke, I think of New Castle in England, about thirty years since, la- boured very assiduously to establish the opinion that fe- ver is an unit, borrowing, in all probability the first ru- diments of his notion from Themison, the celebrated greek physician, who so strenuously, and indeed sue- 8 cessfully, opposed the shield of his ability to the humo- ral pathology of Hippocrates. Themison viewed fever as bearing nearly the same relation to idiopathick feverous diseases, that extension is* considered by the natural philosopher to have to mat- ter itself; That it was not essentially the disease, but merely an accident or condition ; yet inseparably associated; that through it, as a sensible sign, we re- cognise the presence of this assortment of disease, not very dissimilar to the manner in which the philosopher ascertains the existence of matter through the quality of extension. Without doing injury to either party we may admit Clarke, who wrote expressly on the identity of fever, if not Themison, to have opened the way for Doctr. Rush to exercise his ingenuity and industry on a soil as waste as unfertile ; without a flower to cheer or a fruit to nourish. The interval between the unity of fe- ver and the more expanded idea of unity of disease is so limited, that a moderate genius might step over it, with but a slender call on mind or body. Doctr. Rush, as to his Unitarian system, is always wrong; Doct. Caldwell, as to principle and argument, seldom right, except when this principle and this argu- ment derive both strength and solidity, by his approach- ing with more familiarity than civility, a source, which had been deemed inaccessible and sacred, otherwise than under due recognition of prior and paramount claim. I now advance to an examination of the ground, untenable as it is in fact, on which the learn- ed author of the “ Discourse,” has found it advisable to take his first stand in defence of the plurality of radi- cal disease ; that of organick dissimilitude. 9 “ The human body is known to be a compound ma- chine, consisting of various subordinate parts, which differ not a little from each other in their structure, functions, and uses. Of these parts it will be sufficient for our present purpose, to enumerate the skin, the muscles, the brain and nerves, the heart and bloodves- sels, the absorbents, the glands, the stomach, and ali- mentary canal, and the bones.” “ It is further known that these subdivisions of the body are susceptible of disease either severally, in par- cels, or all at once. The latter, however, is a pheno- menon, which does not, perhaps, very olten occur. An universal disease, in which no part of the system escapes, we have rarely witnessed.” That a wart, a wen, the itch, the gravel, may be circumscribed to particular subdivisions of the body, is that to which every professional man gives his assent. But that any enlightened pathologist should assert that “ an universal disease, in which no part of the system escapes, is rarely witnessed,” excites that astonishment to express which I have not language. You have cer- tainly, Sir, witnessed the small pox under the inoculat- ed form, and in the artificial way; and you have seen that a few days subsequent to the artificial insertion of the poison, a circumscribed inflammation takes place, and gradually maturates. Is this an affection of skin ? While the pustule enlarges, a tumefaction arises in the axilla. Is this an affection of the axillary gland? Can the gland be diseased from the skin without the inter- mediate absorbent being involved ? presently a fever manifests itself; are the heart and blood-vessels concern- ed in a fever ? Among the various phenomena of fe- ver there is head-ache, pain of the back, perhaps vomit- 2 ing. Are the brain and nerves the seat of sensation ? Is the stomach affected in vomiting ? The patient, if the fever be severe, with difficulty can traverse the room or rise from his bed ; are the muscles the instruments of motion and progression ? And when a patient cannot sustain his body in an erect position, and trans- port himself from place to place, is it at all probable that the muscles are in fault ? If after a patient has laboured constitutionally under the variolous action, the small pox poison were applied, to the fresh end of one of his bones exposed in conse- quence of amputation, would the part be susceptible ? Your answer I know, must be in the negative. Then the bone, in its living powers, has been operated on by the constitutional variolous action. In the course of a few minutes, I have presented to your judgment a disease in which, so universal is it, no one part of the system escapes. And I am perfectly confident, if you will permit your understanding to run through the chain of your recollection, that you will have many others brought in review before your mind; What would you think of the measles; the chicken pox ; the vaccine disease; the mumps; the hooping-cough ? In short, every disease that is univer - sal or constitutional, must, by necessity, affect every individual part. A constitutional disease, is, a disease, of the whole living system. Hence, every feverous disease is a morbid action, diffused throughout the liv- ing whole. And not only diseases, strictly febrile, but every universal or constitutional disease ; the Scrofula, the Hydrophobia, the Tetanus, the Gout, the Epilep- sy. But why this enumeration ? I am writing to a physician.—Were the venereal poison applied to the skin, or the muscles, or the glands, or the absorbents, 10 11 or the nerves, or the blood-vessels, would it not pro- duce a disease of qualities, similar to its own ? When a patient dies, he ceases to live throughout every part. But if a morbid action did not take place in every subdivision, life would continue in some ; and we should see here, one with a dead skin; there, ano- ther with a dead heart and blood vessels ; and a third with the muscles extinct, the other parts retaining their integrity and their life. This, as absurd as it is in fact, is inevitably consequential on your doctrine. Extricate yourself, if you can. Really we have here much inno- vation, but little improvement. “ Who will be so -weak as to assert that the same kind of disease can prevail in the intestines and in the bones ? in an absorbaet and in the optick nerve ? in a gland and in the nerve of hearing.”* That any enlightened and experienced physician could be found, who would be so weak as to assert that the same kind of disease can prevail in the intestines, the bones, the absorbents, the glands, or a nerve of the eye or ear, is not s® much a matter of dQubt and ques- tion, as whether any physician of sense, reading, and experience can possibly have so far abandoned himself to the guidance of an erratick imagination as to bring into controversy a fact which forever must receive the tribute arising from temperate observation and sober conviction. Upon re-consideration and a discreet at- tention to the dictates of his understanding and judg- ment, I am thoroughly persuaded that Dr. Caldwell, will not only assert it, but, under the fullest conviction of its importance, believe it to be necessarily true, that the disease affecting those various enumerated parts is * See Prelim. Disc. p. 35. 12 in kind) the same. Does not the scrophula, the lues venerea, &c. affect those specified subdivisions ; the in- testines, the bones, the absorbent, the gland, the nerve ? with equal reason we are to admit and “ maintain the identity of a man and an elephant, or a lion and a whale,’* as the sameness or identity, in kind, of the scrophula of a bone and a gland, the intestines and an absorbent! This really is to trifle on a grand scale, the magnitude of which may have been suggested by the unhappy analogy drawn from comparative nature.* Speaking of several parts of the body, our author says “ that the organization and healthy action of these parts are utterly dissimilar; so also are their uses; it would be contrary therefore, to every principle of rea- son, and every established rule of philosophizing, to allege that their diseases can be alike. They must be different, or nature is palpably inconsistent with herself. ”f Nature, in all her parts and all her operations, is con- sistent with herself; but most unfortunately for the sci- ence of the Doctor, disease is not consistent with nature; they cannot operate in unison. Fqf instance, two eyes, ortwd ears, in healthful condition, are alike in condition and function ; their organization and action are healthy and similar. But to the one or ear, apply the poi- son of small pox, where the constitution is susceptible of this disease ; or the poison of the lues venerea ; im- mediately the function or action is disturbed, and its or- ganization becomes dissimilar to that of the other. “ Ar- guments would be wasted in an attempt to elucidate” this obvious position, and observation. And it requires something like a miracle, wrought by the philosophy of the Preliminary Discourse, to induce a pathologist to * See Prelim. Disc. p. 35. t See Prelim. Disc. p. 34. 13 believe otherwise. Nature is upon terms with herself, but disease will not be upon terms with nature. “ Carbonick acid gas, which is to the stomach a grate- ful and salutary stimulus, proves immediately fatal, when applied to the lungs. This can be attributed to no other source than a difference in the excitability of the two organs I cannot accede to this last conclu- sion, from a well known fact. It is probable, perhaps wholly defensible, that the carbonick acid gas, has no positive effect on the excitability of the lungs. Suppose we were to consider the carbonick acid gas, as acting negatively : that is, the animal dies from being immers- ed in the gas, simply in consequence of the gas, by its weight and tenuety, descending into the branchiae and occupying the air cells to the total exclusion of that por- tion of the atmospherick air which is necessary to life. The carbonick acid gas, acts a little like the rope or water, by cutting off from the lungs a necessary materi- cal for life. When immersed in water, or a rope is pas- sed round the neck, the animal will for a longer period manifest signs of life, because a portion of the vital air is detained in the bronchial cells. But under the expe- riment with the gas, the animal almost instantly ex- pires ; I presume because the gas from its gravity, com- pletely occupies, in a moment of time, the whole bron- chial structure. I have considered, with some attention, the various experiments on this subject. “ They are not organized alike ; they act, and whe- ther sound or unsound, must act in a manner corresj- ponding to their organization ; disease is the morbid ac- tion of organized parts; their diseases, therefore, can- not be alike.”f * See Prelim. Disc. p. 51. t See Prelim. Disc. p. 33. 14 That disease is a morbid action of organized parts, is very true. For, if parts were not organized, they would afford but little susceptibility for the impression of morbid causes, and manifest but few phenomena. But if organized parts act, “ in a manner corresponding to their organization : that is corresponding to the laws of their life and their economy, I deny the action can ever be morbid. That which is corresponding to their organization, is in observance of the laws of life, and the result must be soundness and health. What is ac- cording to organization, is agreeable to the natural eco- nomy, for the natural economy is dependent on the na- tural organization, and what is of the natural economy cannot be disease. Nothing is more clear than that the organization of parts, is the result of fixed, healthy laws. And it is equally clear, that the laws of life, the economy and the organization, must be altered, sub- verted, or more or less changed, before morbid pheno- mena can become apparent. Without sensible pheno - mena, we know nothing of disease. But you assert that “ although we do not believe that excitability derives its existence from the mere organization of matter—-for it is a quality of mat- ter not organized—we feel, notwithstanding, confident, that it is greatly modified by it.”* We understand organization to be that construction, in which the parts, whether animal or vegetable, are so disposed as to be subservient to each other. To or- ganize is to construct, so that one part co-operates, by fixed and steady laws with another, as to answer a given purpose in the ceconomy of nature. And where there is not this mutual relation and co-operation of parts— * See Prelim. Disc. p. 50. 15 there is neither regular function nor organization. Nor can we conceive matter not organized: that is, where the parts are not held together in mutual relation, by- laws of animalty, can possibly be possessed of excita- bility. In what matter, not organized, are we to find the evidences of excitability? All living matter is orga- nized. Is there excitability where there is no life ? Although the parts may differ in their organization as much as parts of the same body can differ, yet their diseases are radically and essentially the same in a mul- titude of instances. What would you determine as to the understanding of that physician, who would say, that an inflammation of the brain, is not in nature the same as that of the eye, of the lungs, of the liver, of the stomach ? What- ever variety might occur, would be incidental, and af- fect in no essential manner, the nature of the disease. Would not a cancer of the rectum, of the womb, of the stomach, be of the same nature, with a cancer of the female mamma, of the wing of the nose, or of the skin of the face ? The organization of these parts is very dissimilar, the one to the other. Permit your attention for a moment, to be directed to the disease termed scrophula. Imagine it to occu- py the. lungs, the mensenterick glands, the eye, the joint of the knee, or hip. Plow would its nature be in those different organs ? A little further permit your understanding to range. The virus of lues venerea, is applied to the skin of the thigh, the inside of the lip, to the eye, to the ear. What is the result? It is anomalous; corresponding to the organization : similar in nature to the functions performed by those various parts ? or, would the pro- 16 duction be a venereal poison, and adequate to the pro- pagation of the lues venerea ? let your judgment un- der the responsibility of your professional reputation answer. Again, for a step or two, attend me. A rabid ani- mal inflicts a wound, at the same time infusing the ve- nom of the saliva, on the hand, the female mamma, the eye, the ear. Would the sympathies of the sys- tem be so associated with those parts, as for a hydro- phobia to be produced ? or would the parts be equal- ly liable to take on the morbid action? I could not determine, whether one part would be more susceptible than another, all circumstances of the application of the poison, being equal. These parts of the body are as dissimilar in organization, as may be necessary to try the doctrine. And, I have endeavoured, by simplicity of style, to place my questions completely within the field of the most limited understanding. Wherever disease is, nerves, blood-vessels and ab- sorbents, are its chief seat, and primary subjects. Wherever there is organization, there are nerves, blood- vessels, and absorbents. All structure depends on those instruments immediately. On them originally act all morbid agents. The few exceptions in favour of a peculiarity of organization, are too unimportant to require consideration. We may have from friction, a corn ; from a contusion or wound, an aneurism or varix, &c. &c. But you are engaged, in the main ge- neral principle, of the plurality of disease. Yet in the face of all that has been urged ; in disre- gard of the gentler voice of persuasive philosophy ; or the harsher injunctions of common sense, the author of the Discourse,-’ pertinaciously contends, “ that 17 an unsound state of the functions of the lungs, produ- ces a disease, widely diffe rent, from that which arises from an unsound state of the functions of the stomach.” You mean, perhaps, that the disease produces the un- sound state of the functions. The unsound state of the functions, does not precede the disease, I imagine either in the lungs or stomach. Inflammation, and hemorrhage, and scrophula, pro- duce unsound states of the lungs. Is the inflammation, the hemorrhage, the scrophula of the stomach, radical- ly and generically different, from those of the lungs ? If so, in what does this radical difference consist ? It is very obvious, that we do not breathe with the sto- mach, or digest our food by the function of the lungs. But it is very certain, let the inflammation be where it might, the distinctive signs wou’d express it: there would be increase of heat, and of redness, tumefac- tion, and pain, whatever should be superadded, would be from the nature of the function, of the organ involved, and would be casual and incidental, as regards the dis- ease itself. The disease must follow its cause. A zoologist, indicates to me, four animals which he asserts to be cows : One is white, another is black, a •third is with horns, a fourth, is without horns. I re- ply, that these animals are not radically cows : the one, is white, the other is black, a third is horned, a fourth is not provided with the same weapons of the heads. And I add, that this difference of colour, and local fi- gure, must be deducible, from a particular dissimilarity in the ceconomy of the skin, and the heads of the ani- mals. The zoologist would insist, that this discre- pance of colour, and local figure, is wholly contingent, 18 derivable in all probability, from the immediate pa- rents; but that the distinctive characters, which discri- minate the cow genus, from every other family of ani- mals, are present, and determine the question. A nosologist asserts, that the inflammation of the brain, of the stomach, of the lungs, and of the liver, is the same in nature. But the author of the “ Pre- liminary Discourse,” would reply, that the fact is otherwise ; that the disease, is radically corresponding to the organization of the subdivisions of the body af- fected ; that in the inflammation of the brain, there is pain of the head, and intolerance of light; in that of the stomach, the pain is in the upper region of the bel- ly, accompanied, probably, by vomiting; in that of the lungs, there is pain in some region of the thorax, with coughing; and in that of the liver, there is pain in the hypochondrium with yellowness of the skin and eyes. Are we to pity, or laugh, at such philosophy as this ? I hope when I adopt the language, however peculiar, indulged in by Dr. Caldwell to the venerable Rush, my style will not be affronting. “ Dr. Caldwell does not in reality believe the inflammation in the organs, the objects of the above allusion, to be generically dis- tinct and essentially different. His belief is inwards not in fact” * He only plays off a little rhetorical flourish at the expense of his sounder logick and better sense. But to conclude the present letter. 1. Disease is not as to its nature, in a manner, corresponding to the orga- nization of the subdivision of the body, casually affect- * See Prelim. Disc. p. 4S. 19 ed. 2 Every universal disease,* does and must affect each individual subdivision of the body, otherwise the brain and nerves might be dead, and the skin and mus- cles living. 3. The local diseases, the vitia, have nev- er been considered, as affecting every subdivision of the system. How much has the author of the “ Discourse,” in his effort under consideration, added to the former stock of medical philosophy ? * Although every disease must be local in its commencement; in its operation and consequences each constitutional affection is, by necessity, universal. Probably no general disease, such as is termed an idiopathick fever, has its origin in the stomach. Animal secretions, with the attributes of poisons, seldom, per- haps never, act primarily on the stomach, producing a regular fe- ver. Conducted by a better and more luminous philosophy, than that which refers the origin of diseases to a local affection of the stomach, the reader, and also the author of the “ would fix his attention on the lungs, as the organs first affected in all operations of effluvia, whether animal or vegetable. With the air, necessary to respiration, poisonous and hurtful effluvia, must be inhaled, and brought into immediate contact with the susceptible surfaces of the bronchial cells. The stomach, in gene- ral is guarantied by its own juice.