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$' Surgeon  General's Office     •






  Auras
No.
'<?
£<-,----^o 2^.000 ooao3^^tP ;j^g*g] 
DUE
LAST DATE
DEC 3019^ 
 
A  TREATISE
ON THE DISEASE  CALLED
THE  MILK   SICKNESS,
OR,
TREMBLES
%%(J^°
Vl\  DR,  J. .1. Mt'lLHLNNt
        ■'I'lllNUFIELU.




0 M.I. \<;HK1!  \ND HAI.SEV. I'KINTEH-





           IS 13. 
TO  THE PUBLIC.
  Nothing but  a  desire to  contribute something,  be it ever so
little, to the advancement of a  true  knowledge respecting  the
disease termed  Trembles, Milk-Sickness, or Sick-Stomach,
could induce me to lay before an intelligent and discerning People,
a production upon that subject, when so many articles have been
written, and so many pamphlets have been published, by men who
stand deservedly high in the Profession.  But, when I come to
look at the  result, and contemplate the  amount of good they have
done—particularly in the curative means which they  have held
out—I am stimulated to  an exertion in this cause, in consequence
of what I must consider an ill-judged and an injudicious mode of
treating the disease.
  I have, as I think, set forth my means of treating the disease
termed Sick-Stomach, in a fair and candid  manner ;  and, if they
are good, and such  as have generally been successful, I know that
a liberal-minded community,  will reward me, by their approbation
—if they are not such as will meet  the exigency of the disease, I
am also willing that their disapprobation shall rest upon the effort.
                                     J.  J. McILHENNY. 
MILK-SICKNESS;  ALIAS, SICK-STOMACH.
  There  are times,  in the course of our professional lives, when  it
becomes  necessary and important,  that we should pause  and take
a view, not only of our conduct as Physicians, but reflect well on the
future course of our professional duty, as men who are called upon to
treat the infirmities of mankind, and thwart the direful  and dreadful
effects of human maladies.
  Among the vast number of disorders to which the human  frame  is
liable, there is none, perhaps,  that holds a more conspicuous name
among Medical men—there is  none that fills  the  minds of persons
residing within the bounds of infected districts, with more horror, with
more  dread, with more forebodings  of death—than does the disease
which heads this article.
  If this is a true picture of the disease, is  it to be wondered at,  that
the subject has been so much hackneyed—so much written and spoken
about?  It is a disease  that calls loudy for aid; it is a  disease, the
very sight of which,  demands our best efforts.   If there is any philan-
thropy in  the profession—if there are any means by which Physicians
can arrive at any more certain curative effect than such as  has generally
been adopted, they are conjured, not only by the duty they owe their
fellow-men, but by the duty they owe their profession, to remove, at
least, one more of  our maladies, that long since has been truly styled
an Opprobrium Medicorum.
  It is not my present intention to go into a long and elaborate discussion
as to what may or may not be the cause of Sick Stomach.  That is
a subject that has too  often  engaged  the attention of our  professional
brethren, to the neglect of a proper  inquiry into the pathological and
therapeutical condition of their patients.   Searching into  the  cause of
the disease, has engaged  the attention, not  only of medical men, but
intelligent and scientific individuals, for years past, without arriving at
any definite or satisfactory conclusion, as to what particular thing may
have produced it.
  Residing, for many years, within the  bounds of a highly infected
district of°country, and being  called upon  to treat  quite a number of 
                                 I

persons laboring  under the disease,  I  may be allowed, at least, the
privilege of suggesting a few facts, which came under my own  imme-
diate and  personal observation.   My present intention is not  to lay
claim to  the  discovery  of any  thing  connected with  the cause of
Trembles; it is more particularly  directed  to  the consideration of the
best curative means.  Suffice it to say,  that I consider it, without
doubt,  a disease of vegetable origin: that  it ia  produced by animals
eating the vegetable, and,  through them, communicated to the person
or animal  that  partakes either of the meat, butter, or milk.
  I am fully satisfied of its vegetable origin, from the fact, (of  which
all our farmers are fully apprised,) that until vegetation comes forth in
the Spring—until our woods are covered with herbage, and the whole
face of  the country  abounds with plants—the disease does not show
itself.   Neither does it appear after the heavy  Fall  frosts: after the
frosts have been severe enough  to freeze  the ground,  and  entirely kill
all vegetation.   I  well  know, that there  are some who contend that it
is water—others,  that it is an exhalation from certain spots, of ground,  v
containing some kind of mineral, from which exudes or emanates a delete-
rious and destructive poison; and that we frequently meet with it in winter.
But such ideas will not receive a moment's credence in a neighborhood
where the disease is prevalent.   I have no doubt but that an occasional
case does  occur in winter, by animals eating of the dried stock, coming
across some  defended spot,  where the plant might still contain sufficient
acridness to produce  the disease.   I have known cases to occur in lh,e
middle of  winter; but, upon examination and inquiry, I have, univer-
sally, found them to be generated by  persons eating salted meat—meat
that was killed off pasture  and  put away for family use.   Many cases
are, no doubt, produced in our cities, by the use of dried meat and butter,
which are there taken and sold.   I lately noticed, in a paper published
in New-York city, thata number of persons had there  died from eating
meat, which, upon examination, was found to  have been transported
from Ohio.  I have no doubt but that many of those strange diseases,
as termed  by  Physicians, which occur  in  our cities, and which are
dubbed "Bilious  Congestive Fever,"  for  want of abetter name, are
the true and genuine Sick-Stomach.
                           LOCALITY.

  I believe that Professor Drake, in his pamphlet entitled " Drake on
Milk-Sickness" has given a clear and correct description of the character
of the country in which this disease abounds.  The soil, locality,  place, 
 timber, undergrowth, and every appearance, is as fully delineated, in my
 opinion, as could be.   His conclusions and  remarks were drawn from
 examinations of  sections of country ranging from fifteen to thirty miles
 from where I now write.   It might be well  to add, that we find the
 disease prevailing on high dry ridges, as well as in low,  flat, marshy,
 timber land.  I know of some high,  dry spots of country, where cattle
 have been enclosed, and were not permitted to run in any other situation,
 that produce the  disease, and those purely limestone in their character.
   While writing  this  article,  I received  a communication from an
 intelligent Medical friend,  Dr. T. B. Johnston, whose  residence  is
 now in Southern Indiana, which says :
   "I entered the State at its south-eastern corner, in the county of
 Dearborn.  I passed  next into  Switzerland and Jefferson—in which
 last county, there is said to be two .small sections, one near and a little
 below Madison, supposed not to comprise more  than one square mile
 in  extent.  Next I passed, into  Clark,  where  it has not  been noticed
 until the last two years-—since  which time  it has appeared in  that
 portion of the county situated between that range of hills called knobs,
 and the Ohio, where I know there is much of that oak land, somewhat
 similar to the land in other regions where it prevails.   From this county
 I passed into Washington, which is exempt.   In coming into Harrison,
 I  found  the  disease  prevailing  on a small stream called  " Whisky
 Run"—the timber, soil, stone,  &c,  similar to  the  other adjoining
 counties.
   "It was not, however, until I reached Paoli, the county seat of Orange,
 that I was in the midst of the disease.  In the mean  time,  I  had passed
 from the purely limestone region, and in its stead, the sandstone form-
 ation had taken its place.  I had then entered the great Coal Basin.
 Near Paoli, the country becomes more uneven.   Persons with whom
 I conversed, generally thought it originated on the hills; but, on inquiry,
 I found that there were streams with small flats in the immediate vicinity ;
 yet, in some places, it must have originated on the hilly land.  The country
 from Paoli to the French Licks, is very broken—the hills  are covered,
 principally,  with  oak,  beech, and sugar-tree: the  two latter are often
absent.  On leaving the French Lick, the country became, gradually, le ss
rough and uneven. Some seven or eight miles towards Portersrille, there
was a farm described to me, which was situated on  an elevated plateau,
similar to those in Ohio.  On this farm, the disease was said to prevail
to agreat extent—the timber, soil, &c, similar to the above described. At
Portersville, once the Seat of Justice of Dubois county, I found a small
collection  of wretched  looking houses, situated on the east fork  of
White  River.  The inhabitants  there  almost universally  located  the 
I)
disease in the flat land, which  has almost depopulated the country.   It
prevails throughout much of the rich land of Cib?on county, where
there is a dense growth of ash, elm, and walnut.   I might as well here
add, that I never knew the Trembles to prevail where there was a dense
growth of beech,  or where there was  not a free growth of weeds.   I
well know that it  is circumscribed—that a small section  will produce
the disease—then an exemption for some distance, when it will again
recur.  So of some farms—a portion will produce it, and the other will
not.  In fact, there is not a  county  from Floyd  to the mouth  of the
Wabash, and as far north as  White  River, that is exempt from Milk-
Sickness ; and it often occurs in  both Southern Illinois and Kentucky.
I have  never heard of  it above the forty-fiist degree of north latitude,
and it seldom reaches that line.
  •'The sum total of my observations as to  the aspect of the country
in which it i? found, is, that  it prevails  most in  the  level rich  lands ;
but is often found in the hills, and even in the barrens."
                             CAUSE.
  While I so fully concur with Professor  Drake as  to the locality of
the disease, I cannot agree with him respecting  its true cause.   Our
difference,  however,  consists merely in  a name:  in distinguishing
between a different species of plants of the same  genus.   He appears
to be pretty well satisfied, that the Rhus Toxicodendron, (Poison Oak,)
or Rhus Radicans, (Poison Vine,) is the plant that produces the disease.
Now, it is a well-known  fact,  as the  Dr.  states,  that the sections of
country in which the disease is prevalent, abounds with both species of
Rhus.   It is also found there in much  greater abundance,  than it is in
regions where the Trembles do not prevail.
  My  firm convictions are, that the disease termed Sick-Stomach, is
produced by the Rhus Toxicodendron, or Poison Oak ; and that it  is a
separate and distinct species  from the Radicans  or  Poison Vine.  I
believe there are none, who have examined  these plants, but will readily
admit, that the Poison  Oak, notwithstanding they contend that it is
nothing more than sprouts or  scions from the roots of the Poison Vine,
is much more acrid in its character than the Poison  Vine.  This  is a
fact universally  admitted among all our farmers.  Now,  if this is  the
case, would it not be entirely contrary to the general order of vegetation ?
For, it is a well-known fact, that in proportion to the age  and size of a
plant ©r tree, in  that proportion it contains  more active, efficient matter.
  All along Mad River-bottom, (for the disease does not occur nearor
than from  one  to four miles of the  river,  on the east  side,) grows 
7
abundance of Rhus, particularly on the west bide.   The  bottom land
abounds in  elm and walnut  timber—and  a tree is scarcely to be seen,
which has not on it more or less of the Rhus.  In examining it,  I find
it almost universally to accord with the Rhus Radicans or Poison Viue.
You can discover no shoots springing  from it,  notwithstanding it may
be in a loose and defended spot of ground ;  and I am not apprized of
a single case of Milk  Sickness ever occurring  west of Mad River and
east of the Big Miami.
  A writer  in  the Springfield (Ohio)  Republic, animadverting upon
Professor  Drake's pamphlet, speaks  positively upon the subject, and
says, that the Poison  Oak never vines—that  it is never seen to take
hold on trees, but that it grows from one to three feet in height—that it
is much more wgwfr in its character; and finally attributes the Trembles ''
in animals,  to the action of that plant.
  There is  another distinguishing mark between them, and that is, the
Toxicodendron having three leaves, and the Radicans five.   We are
not alone  in this matter—we have some botanists who think that the
Radicans and Toxicodendron are distinct  species.   I well know, that
the weight of botanic authority  is on the  other side of  the question;
but, it appears to me, from the  fact of the Toxicodendron possessing
more acridness of character,  and it being distinguished by a different
number of  leaves—also,  that we have the testimony,  to sustain our
side of the question, of farmers and woodmen,  who have resided, many
of them,  the  whole  period of their  lives, in the very  midst of the
disease; and who, by the by, are pretty good judges of every thing
connected with the location, soil, timber, etc.,  of a country, especially
when the same intense interest and  anxiety are felt, as have always
been manifested in discovering the true cause of Sick-Stomach.
  Inasmuch as the controversy,  in our region of country, is assuming
quite an important character, will someone who is "skilled in plants,"
give us  the  true result of their botanic investigations 1
  Another reason I  might urge, why the Rhus Radicans, or common
Poison Vine, is not the cause of Trembles, is in consequence of finding
it in  sections of country where  never a  single case of  what is here
termed Milk-Sickness occurred.   You will find the Radicans abundant
all along the River counties in this State—commencing  at Hamilton,
Clermont, Brown, Adams, Scioto, and so up the river;  and I do not,
after a residence of 20 years in that section of the State, ever remembar
hearing of a single individual being affected with what is termed Sick-
Stomach.   And, furthermore, I do not remember ever seeing there any
jf what is here termed  Poison Oak.   I am  not aware of their beinp 
 ;nany shoots from the vnii;—but if there  were, I think they were not
 distinguished from the  Radicans,  like the Toxicodendron,  with three
 leaves.   From these, and other considerations of equal weight, I am
 constrained to  believe, that the Toxicodendron is a distinct species—
 native of a different soil.
   In confirmation of our views, we will again recur to the letter of Dr.
 Johnston,  who spent much lime in making di.scoveries concerning the
 disease:
   " The plants growing over the hills from Paoli to French  Licks, did
 not differ much from  the country previously passed through, and I was
 assured, by those that could have no interest in deceiving me, that the
 disease did not there prevail—the road  running generally along the
 ridges—indeed, in no place  did I see  but little,  if any,  of the small
 Rhus.  Here there were many persons engaged in fencing up the seeps
 or weak springs, which ooze out of the hills, the waters of  which are
 often impregnated with iron, and traces of this mineral  may be seen
 throughout  this  region.  On  approaching  many of the  streams, a
 sulphurous odor can be discerned half a mile distant.   The  streams in
 this region are very  inconstant—rising from  small sources  that issue
 from  the hills,  which have a light covering of earth to retain moisture
 —dry up early in the season, and the fact  that stock are  frequently
 found dead near those springs, on the  slope  of the  hills, has strength-
 ened  the opinion, that the water has caused  the disease.  But, it may
 be accounted for otherwise.   The great thirst that always attends the
 disease, would cause animals to seek water, and those springs constitute
 the principal water that is to be found there, and after drinking they
 are both  unable and unwilling to go away.  The opinion that the
 disease is caused by water, is strengthened by Dr. Seaton's  pamphlet,
 which is now considered, by the discerning, to be a real humbug.
  "I travelled on through a  section of country in which the disease did
 not prevail,  and I  could  not discover  any appearance  of  Rhus,
 particularly of the Toxicodendron, until I came  within five miles of
 Portersville.  I there  found  the Rhus in  considerable abundance, and
 on inquiry, found the  disease prevailed.    From this place to Porters-
 ville,  the Rhus became more  abundant—the features of the country
changing as I approached  White  River—the  bottoms  becoming more
extensive.   Half a mile beyond Portersville, I stopped at a farm which
I learned had been often depopulated by the disease—upon examining
around the adjoining land, the  greatest abundance of the little  Rhus
could be discovered.   From  this  place to  Peterborough,  the Rhus is
quite  abundant—indeed,  on  some of the  fhh-  adjoining  the  small 
y
 hireams, the ground  is entirely covered  with a lux  -iant growth of
 Rhus—so much so, that it excludes all other vegetation.  There is no
 place,  that I ever have seen,  where the disease prevails to such an
 extent,  as it does here ; many improvements, in this county,  have been
 abandoned, and much fine land vacated, on account of the great preva-
 lence of Milk-Sickness.
   " On  the flats of Patoka the disease prevails.  There is  one small
 portion of land, some seven or eight miles from Petersborough, which
 is grown up with small oak and hazle,  much  resembling the Barrens
 in Ohio—and  contrary to what I have ever seen there,  the Rhus is
 growing in great abundance.   In  conclusion, upon this part-of the
 subject, I would  merely say,  that I have, invariably, found the Rhus
 to abound in all the Milk-Sick regions that I have ever seen;  and, in
 proportion to its abundance, so is the disease ; and I have never known
 the disease where it did not abound ; and, further, that it is distinct and
 separate from the large Rhus which grows in such abundance through-
 out the  west and south-west.   I have often seen the  latter  ascending
 nearly  every tree, where the former  was not  to  be found, and vice
 versa;  frequently, however, we find both growing in the same woods.
   " That the disease does not depend upon the water, is  evident from
 the  fact, that many of the fine farms  in Gibson county, and some of
 the adjoining counties, have been  cleared from the very spots where
 the disease was  known to have previously existed to an alarming extent,
 and  now large numbers of stock are  there fed with perfect impunity—
 drinking the same water that they formerly drank.   Dr. Owen, of New
 Harmony, has analyzed the water from many of the Springs  supposed
 to cause the disease, and in no case did he find any agent contained in
 it deleterious to health—and declares his willingness to drink the water
of any spring in the State."
  To sum up our conclusions on the cause of Milk-Sickness, we must
be allowed to express  our decided conviction, that it 13 produced by the
 Rhus Toxicodendron, or Poison Oak, for the following reasons:
  I. Sick-Stomaeh does not prevail  where there is no Rhus—that in
every section of country where none of the small Rhus can  be found,
there can be none of the Trembles  found.
  II. It  does universally  exist where  there  is  an abundance of the
smaller  Rhus.
  III. It never occurs until vegetation comes forth in the Spring.
  IV. Where it prevails most, the  Rhus is in its greatest luxuriance.
  V. After the heavy frosts kill all  vegetation,  the disease subsides.
  VI. It is a well-known fact; that cultivation kills the  Poison Oak—
entirely  destroys it
          2 
10
   VII. It  is equally as well established,  that animals kept within a
 well-cultivated enclosure, are perfectly exempt from the disease.
   VIII.  Almost every observant and intelligent individual who has been
 raised amidst the disease, has come to the  conclusion, that  the Rhus
 Toxicodendron is the cause of Milk-Sickness.
   IX. That it is distinguished  from the Radicans, or common Poison
 Vine, by  its  different  number of leaves—also,  by  its acridness of
 character.
   X.  A certain locality produces the  disease, find it where you may,
such  as flat, heavy  timber land,  interspersed with  hazle and other
underbrush, which is quite productive  of the Rhus.
   XI. The seldom appearance of the  disease  on hilly, dry ground, is
in consequence of such a place not being congenial to the production
of that plant, so that  what little  does exist, is not so apt to produce the
disease, in consequence of its unhealthy growth.
                              TIME.

  The disease termed Trembles occurs at all periods from May till
December.  Cases, however, occur but seldom in May;  but we have
frequent attacks during the month of June.   It is altogether owing to
the  forwardness of the season—if we have  an early  Spring, and the
face of the country is covered with herbage, we may look for the disease
in proportion to  the season.  In the Summer of 1841, I had quite a
number of cases early in July;  indeed, the majority  which occurred
that summer, was in that month.  But cases, perhaps, have occurred
more  frequently in the months  of September and October, than any
other.
                           ANALOGY.

  I wish to call the attention  of Physicians,  to  a  disease of cattle,
analogous, in ray opinion, to that of Trembles, produced by eating the
Buckeye.   Reared, as I was, in the midst of Buckeye, I had frequent
opportunities of seeing  cattle,  as we termed  it,  Buckcyed.  As the
Buckeye is among the first trees that put forth in the Spring, it was no
uncommon  thing to see cattle down with a disease that  we then termed
Trembles.   From  the best recollection I have of animals thus affected,
I am at  a loss,  upon comparing that disease, with what we here call
Trembles, to distinguish them apart:  The same nervous excitement__
the same inability  to walk—the  same  train of symptoms  developed
upon exercise—as much constipation of the  bowels—persons resort to 
11
the same curative treatment.   In short, a greater similarity of symptoms
I never beheld in any disease;  yet, I never knew of a calf becoming
affected from sucking—neither did I ever know of a person becoming
sick from the use of the milk.  I merely mention these things for the
purpose of calling the attention of Physicians to the subject.
   It appears to me, the circumstance of cattle becoming affected in a
similar manner to Trembles,  by eating Buckeye, is proof conclusive
and undeniable, of the vegetable origin of the disease.   The disease
brought on by eating the Buckeye, appears to be as powerful on animals,
as what is here denominated Trembles.   I am well satisfied, that there
are as  many cattle that die from the effects of the Buckeye, as do from
the effects of the other poison.   It is no uncommon thing, in a neighbor-
hood where the Buckeye timber largely  predominates, to find, in the
Spring season, dozens of cattle  down—some dying, some dead,  and
others  completely unable to walk.  There is the same muscular inability
—the same trembling—the same want of power to stand erect—as we
see in  animals similarly affected, with what is generally understood by
Milk-Sickness.
   I am well aware, that the meat, butter, or milk, of a Buckeyed animal,
does not produce the same general effect upon persons or animals, as
does the poison  which generates what we call Trembles.   Indeed, I
never have  seen but Utile effect from  it, excepting once in the case of
two dogs, which had eaten freely of the dead carcase of an animal that
had died from this cause.  Tlaey both manifested the same symptoms
as did  the animal—such as, trembling, muscular debility, &c.;  but they
both finally recovered.   Whether this was an anomalous case or not, I
am at a loss to determine, it having been some considerable time since I
had an opportunity of knowing much concerning the particular effects
of the  Buckeye.
                           SYMPTOMS.

  There is  but little  diversity  of opinion concerning the leading
symptoms of Sick-Stomach.  At first a weariness—a general lassitude of
the whole system—muscular prostration and inaction—a dull, drowsy,
rather  melancholic,  disposition—but little  inclined  to talk.  These
symptoms continue for a longer or shorter period; and if the disease
is not gradually thrown off, it generally increases in severity; perhaps,
by some sudden muscular exertion, or some considerable excitement,
it will often set in with a burning sensation at the pit of the stomach—
accompanied, occasionally, by an acute, lancinating pain.  Directly after
which, nausea generally takes place, which,  at first, is often attended 
12
 with free vomiting, but soon  terminates in  continued and distressing
 retching.   At first,  there  is  discoverable  quite  an anxiety  in  the
 countenance—a  sharpness of features, something  resembling  those
 noticed in Cholera.  Indeed, all the distinguishing symptoms of acute
 inflammation of the stomach exist,  but with  increased aggravation.
 There is a deathlike coldness  of  the hands and arms—scarcely ever
 much febrile  excitement—a peculiar fetor of the  breath—not merely
 of the breath  alone, but of all the secretions, and particularly that of
 perspiration.   Here  is  a  distinguishing mark,  sufficient of itself to
 identify the disease, and class it at once.  An experienced person can
 detect  the  disease  the  very  moment  he enters  the  sick  chamber,
 particularly if retching and vomiting  are  going  on.   Perhaps the
 greatest distinguishing  symptom,  is in perspiration.  In some cases,
there will be, at times, rather a profuse sweat, which will be of a cold,
clammy nature—it is then*that we have that peculiar odor, which is truly
Pathognomonic of  the disease.   These  symptoms, added to obstinate
constipation of the bowels, are sufficient to  determine  the disease at
once, and lay aside all idea of confounding it with Fever, or any  other
of the Phlegmasia.
                           PATHOLOGY.
   As to the Pathology of this disease, I know but little.   I have treated
 quite a number of cases,  but  have never been favored with a post
 mortem  examination; consequently, I have  had no other means of
 ascertaining morbid appearances, than that of judging from symptoms:
 the mere external developments of the internal condition.   We arc
 told,  however, that in animals which die of this disease, the many
folds, or Mesentery, is in a hard, dry  condition, and, in many cases,
 perfectly black—and that all the folds which lie enclosed in the bowels,
 and are in close  contact with  them, are frequently in  such a brittle
 condition,  that they  can be readily  broken, particularly  those that
 envelope the stomach—and that traces of inflammatory action can be
 frequently  discovered the whole length of the intestinal canal; but the
 greater amount,  those that have left the  deepest marks, are to be seen
 in and around the stomach and duodenum.
   If this should be a true condition of the morbid  appearances of the
 animal, which we are satisfied it is, we may reasonably expect, that the
 same  results are to be seen in the human  subject.   So far, however, as
 my opinion goes, I believe that  the poison, when taken  into the
 stomach, produces inflammation of that organ, particularly confined to
 the mucous coat—that inflammation  continuing, thickens the mucous 
13
lining to such an extent, that it closes, in proportion to its severity, tht
passage from the stomach to the bowels.  I am  satisfied that there is
inflammation down to the upper part of the bowels, but, generally,  in
a slight degree.  I do not believe that there is any general inflammatory
condition of any of the ehylopoetic viscera, but that the  entire force
of the  disease, is spent upon the stomach, and, perhaps, duodenum.
  From what observation I have been able to  make upon  the subject,
I am inclined to the  opinion, that the  lower  portions  of the bowels
remain, measurably, if not entirely, exempt from  inflammation—that
it is entirely a disease of the stomach—that in proportion to the severity
with which that organ is  attacked,  in that proportion  will the ehylopo-
etic viscera become deranged.
  Another proof that the disease  is inflammatory, is the constipated
condition of the bowels.   There could not be such a  dry and hardened
condition of the  fecal matter  produced by any other derangement,
excepting that of inflammatory action.
  I  have  been  led to make these remarks, in consequence of an
opinion that is prevalent with some of our practitioners, that the disease
is nervous—that the great gastric irritability is, or  might be, attributed to
nervous  excitement.   This,  to  me, appears  impossible;  for,  if  the
nerves  of the stomach were in such a morbid condition, acting under
such a powerful excitement, as to produce such distressing symptoms,
would  not the brain  become  sympathetically affected ?  Would we
not have an apparent  case of  Phrenitis?  Whereas,  the mind, gener-
ally, remains quiet—we sometimes see  mental depression, but rarely
ever mental aberration.
                          TREATMENT.
  We are now called upon to try the realities of all our investigations;
and test the truth of our conjectures, as to what may, or may not, be
the cause of Trembles—and  what is  our Pathology of the disease.
We  now  stand  as an  interposer between the disease and death.  As
much interest as there may be in our former investigations,  there is
none  that so importantly demands onr attention, as does the curative
plan  which we  may adopt.   It is the touch-stone that tries—the key
that  unlocks—the  balance  that  weighs—the mirror, in  which  are
to be seen, reflected,  and  tried, the  permanency and  efficiency  of
whatever  superstructure we  may have reared.   The success  of our
treatment  is either to establish it, or demolish  it—it  is  the  criterion
by which a  discerning and impartial community are to  judge of its
mechanism—its durability—its power—its force—and its certainty. 
LI
   We find but little diversity among physicians, in the plan of treating
Sick-Stomach.   Some depend, considerably,  upon  bleeding—others,
upon emetics—some spend most of their time in trying to stop vomit-
ing;  but there appears  to be, in general, but one Therapeutic agent,
which is implicitly relied on, and that  is calomel.   It is given in the
forming, middle, and advanced stages  of the disease—given, too, not
merely in grain doses, but in drachm doses, repeated at short intervals.
   In examining the different theories set forth in the treatment of Milk-
Siekness, I must, to a considerable  extent,  dissent from the generality
of practitioners; yet, in so doing, I will not merely condemn, but will
give such  reasons  as  I consider plausible and  worthy of attention.
There is no way of arriving at any certain Therapeutic means, without
resorting to some  different practice from the one  that is  commonly
adhered to ; for, it is a well-known  fact, that a great number of individ-
uals perish annually from the disease;  and, in no other way, but  by a
comparison of remedies, can we arrive at any  definite or satisfactory
conclusions.
   Bleeding.—As to  bleeding  in Sick-Stomach, I,  perhaps, have not
tried  it sufficiently to  give a correct  decision;  but, in several cases
where I have resorted  to venesection, I  am satisfied that the result was
not what I had anticipated.   I  had  expected to  have found some
diminution of the  gastric disturbance—some abatement of  the general
uneasiness  and inquietude; but I was disappointed.   Instead of bring-
ing these results about, it only had a tendency to prostrate—to produce
a feeling of languor and faintness, which was too apt to continue.   I see
no good  reason why we should bleed.  The  pulse  is soft and slow—
there  is but little heat of the skin—in fact, there is a general shrinking
of the flesh—and it is but very seldom that they complain of pain  in
the head.
   Emetics.—As to the  use of emetics, there is,  in  my  opinion, but
one objection.   If, after the emetic has operated freely, you can succeed
in throwing its effect upon  the  bowels, you accomplish all that could
be desired, overcoming their constipated condition;  and you frequently
have but little trouble afterwards, in keeping up a soluble state of the
bowels.  But if you do  not thus succeed, which you scarcely ever can,
you increase the inflammatory action of the stomach, and caus,e much
more  distressing nausea.
  Stopping Vomiting.—This is a curative plan about which, I think,
there  should not be much diversity of opinion.   It is a matter of plain
observation and remark, that such cases as are treated with a view to
prevent emesis, are, in general, much more difficult  in managing, and
too often end in death.   The reason is  obvious.   Vomiting is nature's 
15
cure.   She  resorts to it when the stomach is loaded with any foreign
substance—when  there is  contained  in  that  organ a principle that is
deleterious or destructive to  the best interest of the animal  economy;
and you might almost  as  well stop the breath itself,  as to put a stop
to this outlet of the virus.
   Laudanum, essence of meutha, and the other paraphernalia of reme-
dies that are too often resorted to for the purpose of allaying the gastric
irritability,  are so many engines  of destruction.   Besides  preventing
the stomach from rejecting the morbid matter  that there accumulates,
they increase the  constipation of  the bowels, and assist in bringing
about that state of the stomach, from which there is but little chance
of recovery.
   The next  Therapeutic agent that claims our attention, is calomel—
the lion, as it is generally termed,  of Sick-Stomach.  I must beg leave,
with all due  deference to the opinions of  many eminent medical men,
to discard its use,  at least in the onset of the disease.
   Viewing the disease in the light which I do, I mast reject the use of
all powerful and drastic agents.   I  have  tried  calomel, scammony,
aloes,  &c, to my entire satisfaction.  I find, immediately after their
administration, that they complain of increased distress—a general
restlessness seizes them—perhaps greater nausea  succeeds, with aug-
mented thirst.  You will find practitioners, whose only prescription is
from  twenty to forty grains of calomel, given every two or three hours,
trying to effect a passage in this way.  I have witnessed this exhibition
with horror; 1 have stood by and  seen such doses administered  until
you would see a fair maniac made of the  patient—until yeu would see
the last, fair, bright hope of life, merged into that dark and hopeless
state, from which  you would, but seldom, witness a recovery.
   And why should not this be the case ?  How could it be possible, that
calomel, with its slight purgative power, could overcome the powerfully
constipated condition of the bowels ?  How could it break through that
barrier of hardened, dry, and compact fecal matter, which is always
an  attendant  on that  disease ? Response  answers,   how?  Indeed,
without other aid,  the administration of any  medicine  per orem, will
often effect but little.   If it should  succeed,  as in many cases it does,
in producing the desired purgation, all will be well; but if it does not—
if it remains in the stomach, adding poison to poison—inflammation to
inflammation—the result cannot help but be disastrous to the patient.
   Mr. B., a carpenter  of our  place,  told  me, that the first season he
was here,  which  was  in the  year  1817, he made fifty-one coffins,
all for persons who died of sick-stomach; and I  am informed,  by the
very best of testimony,  that the almost universal practice, at that time; 
16
was  the free  administration  ot calomel  and other drastic diug*, and
solely and entirely depended upon—that it was no uncommon thing for
families to keep calomel in the house, and at the very first onset of the
disease, to lake it in thirty, fifty, and one hundred grain doses, washed
down with a little cold water.   This is  mentioned for the purpose  ol
showing the manner of treatment and the result.
  I do not, by any means, wish it to be  understood, that I am opposed
to the administration of calomel in all diseases ;  I am perfectly friendly
to its use, and in a great number of disorders to which the human
constitution  is liable,  I  consider it indispensable; but I do wish it
distinctly understood,  that I  object to the continued use of any article,
no difference what, that has been often and  repeatedly proven  to be
deleterious and destructive to the best interests of the thing to which it
has been applied.  I furthermore protest against that dogmatism, which
blindly leads a man to adopt a practice,  because of its being sanctioned
by some high authority, which has proven itself almost as destructive
as the Bohon Upas, to every individual that would fully come  within
its entire embrace.
  That such has been the case, to a very great extent,  in the treatment
of Milk-Sickness, is  utterly undeniable.  In proof of  this,  let us sum
up a little history.  Take the case just  above cited, where such  a vast
number died in one season.  Go to the  verge of the furthermost boun-
dary of the disease, and there  inquire, what has been the result.   The
answer will be, mortality, mortality!   Summon from the commence-
ment of the disease up to the present time, any individual who has been
at all conversant with the prevalence of the disease,  and he will tell
you, that it has been death general, and very frequently death universal.
  Let us come a little  nearer home, and see what we will there find.  In
looking over Dr. Drake's pamphlet on Sick-Stomach,  we find it stated,
that in ten families, numbering thirty-five persons, who were afflicted
with this disease, the mortality was so  great, that nearly two-thirds ol
the whole number died; also, that in another family, six died between
the  1st of July and the  18th of August of the same year.  Indeed,
throughout the whole history  of the disease, it has been characterized
by great mortality.   And what has been the  treatment?   An  almost
universal sameness—the  administratration of drastic medicines, to the
exclusion of all others.
   I claim no infallibility in the treatment  of this disease—1 claim not
to be the discoverer of any thing new in this matter—I  do not pretend to
 be  possessed of any  specific which I  can apply, and proclaim  entire
 :afety to the patient; but one  thing I do claim, and that is, the right ol
 rejecting the old and  long-established  routine  of practice, which has: 
17
failed in performing that degree of curative effect, which we would like
to have produced; and  to  substitute, in its place, a method  which I
consider much more effectual,  and much less injurious to the system.
  The means Which I generally use, and, as yet, they have been favored
with entire success, are few  and simple.   When  called  to  a patient
laboring under the disease, I give but little medicine of any kind.  If
the stomach is not too irritable, perhaps  a little oil or senna and cream
of tartar,  with the addition  of a  little ginger, and that in but  small
doses, repeated as often as the stomach will bear it, without producing
vomiting.   At  the same  time, I make use of the stomach  pump  to
administer injections ; I introduce one of the tubes up the bowels as far
as I deem necessary—perhaps a foot, eighteen inches,  or more—at all
events, sufficiently high  to  pass above the sigmoid flexure  of the
colon, and thereby stimulate the upper  bowels.  The first injections
which I employ,  are but small—afterwards, if the torpor of the bowels
is great, use them more freely.  I have, in some cases, thrown into the
bowels as much as a gallon of warm  water, in  the course of three or
four hours, and let it pass off, before the fecal matter would become
sufficiently softened to allow it to  come  away.   This, of all means I
ever  used, or ever saw  used, I consider the most effectual.   The
common syringe  is most generally used;  but that merely empties the
rectum, and does  not reach sufficiently high up to stimulate the bowels,
or moisten the scybalous matter, so that a passage can be effected.
  I once attended an  intemperate  man,  who  was  attacked with this
disease.   The inflammatory action of the stomach ran  so  high, that it
was almost impossible  for any thing to  be retained, so that a passage
could be effected.  I used more than fifty injections, of ordinary size,
administered with the  common syringe,  without any  apparent effect.
I then had recourse to the stomach pump, which I introduced high up
into the bowels, and throwing  up a large quantity of water, salt, and oil,
a passage was finally effected ; and  in the first and second operations,
there was a large quantity of  scybala passed, as large as the  end of a
person's thumb,  softened on  the  outside, and  so completely dry and
hard, or rather tough, that you could scarcely break it to pieces  with a
hammer.   Now,  I would ask, if the administration of any purgative
whatever,   not excepting  Croton oil, could  possibly have effected an
opening of the bowels in a case of this kind ?
  I  am well aware, that this course  of  procedure is  attended with a
great deal  more trouble than that of any other.   I well know  that it is
much easier to administer a few doses of some convenient drug, than it is
to perform a more complicated and laborious task;  consequently, some
of the most powerful drugs that we have,  are given with a view to meet
               :i 
IS
the exigency of the case—thinking  that it will be all-sufficient;  and
often, in this way, a case is allowed to go on  until all remedial means
are useless.
  It appears to me, that an epispastic is another valuable agent in the
successful treatment of Sick-Stomach.  It seems to  allay, frequently,
to a considerable extent, the extreme sickness of the stomach, and to
allow a freer and fuller respiration.
  Another simple thing I universally  use, and that is yeast.   Pro-
cure it from the distillery—make it  sufficiently thin, with  water, to
drink, and use it freely.   It is well known to be a powerful anti-septic,
and that it is possessed of no inconsiderable share of purgative quality.
I have seen it, from the first, allay the nausea and vomiting, and assist
the stomach, not only to receive other medicines, but aid in its opera-
tion.   I also advise its free and frequent  use in clysters.   As simple as
this may appear, it has  often been attended with the greatest benefit.
  I have,  more than once, seen the free exhibition of cream of tartar
and flour  of sulphur, produce the happiest effect.  This may  be in
consequence of their laxative quality, combined with the  perspiratory
effect of the sulphur.  At all events, their mildness and blandness, added
to their anti-septic properties, are not, in  the least* injurious, arid may be
productive of good.
  The reason why I object to  the use of calomel, scammony, aloes,
Croton oil, and all those drastic drugs, particularly at the  onset of the
disease, is because of the  uncertainty of producing an operation upon
the bowels.  We  frequently see cases,  where  the constipation of the
bowels, will continue, in despite of  every attempt  to overcome them,
from five to fifteen  days and upwards,  and still they would recover;
therefore,  in consequence  of this uncertainty,  we object to the use of
powerful means;  for, if we fail  in opening  the bowels,  which, wilh
such means, we are very apt to do, we hurry on a gangrenous state of
the stomach and bowels;  whereas, the  mode of procedure  which we
adopt, I am convinced, will be much more certain in its effects, and will
not assist  in bringing about that morbid  condition  of  the parts  from
which there is no recovery.  I firmly  believe, that many cases Of Sick-
Stomach are thrown off by spontaneous vomiting, and others  would be,
if the energy of the stomach was not retarded and prostrated, by the
exhibition of such articles as either have too  much specific gravity, or
are otherwise of such a nature, that it cannot  reject them.
  Furthermore, we object to the  use  of calomel, in consequence of its
slight purgative power.  Is  not  the opening  of the bowels considered
by all as  a sine qua non,  in this disease?  Every person is ready to
respond,  it  is.   Then, I would, in  sincerity, as a person who wishes 
19
to treat this matter in a true spirit of rational inquiry and investigation,
ask, why it is that so many persons contend for the use of calomel in
this  disease,  and continue its administration from  case to case, when
they know, that but slight purgative property belongs to it, and certainly
must admit, that  if it does not produce catharsis, the stomach has but
little power to throw it off.
   These are  some of the  many reasons which we might adduce against
the use of calomel, and every other powerfully irritating medicine.   I
am well satisfied, that in many cases, inflammation of the mucous mem-
brane of the  stomach is so great, that it thickens to such an extent, that
the  passage from the stomach to  the bowels become entirely  closed.
Now,  I would ask, which  would be the more likely to  allay that
inflammatory action, which  is  there going on,  and conduce  to  a
healthy return of those  organs,  that mode of treating the disease by
drastic medicines, (such as have but little tendency to open the bowels,
and are constantly exciting and keeping up that state of irritability, by
their drastic  effect,)  or a soothing course  of procedure?  such as rest—
giving but little medicine, and that of a very mild nature—using, freely,
bland and cooling enemata, administered  by the stomach tube, or some
other apparatus  that will reach sufficiently high into  the  bowels to
stimulate their upper portion, cleansing it of all vitiated secretion, and
thereby conduce, largely, to the  allaying of the inflammation of the
pylorus.  I merely ask a consideration of these facts, and I am willing
to leave the response to every candid and reflecting individual.
   I well know that many physicians will tell you, that they must use calo-
mel; that the liver is locked up, and by no other means can they stimulate
it to action.   Well, better would it be, if the key, for a time, was lost
and it should remain locked, than  to let the bowels continue  closed,
and give such powerful, drastic drugs, which increase the inflammation,
open not the bowels, and finally produce  a  gangrenous  state of the
stomach,  with death to close the  treatment.
   I say nothing  against the  use  of calomel, after  you have produced
free purgation ;  then it will pass  off in due season, without producing
any of its ill-effects.  I  must confess,  however,  that I have seen but
few cases that showed much biliary  derangement.  I have noticed some
cases,  where consecutive  fever followed  the disease, that they would
become slightly jaundiced.   In such cases, calomel becomes a proper
agent; but when the bowels are once moved, and kept open, the disease
most generally, yields, and a cure speedily follows.
   There is  an opinion  prevalent,  that  a  person once affected  with
Trembles,  never entirely recovers.  Now, this may  be true, to some
extent; but,  I believe that many of those who  thin',  they labor under 
:>(j
ihe effects of the disease, actually are suffering from the elfect3 of ihc
medicine.  Such powerful remedies are employed, and frequently lie in
the system so long before they are carried off, that they produce lasting
effects.   Out of twelve or fifteen cases  treated in the summer of 1841,
they  tell me that they feel  but little, if  any,  of the effects of the
disease.
   These  suggestions  are  all  the  sincere  convictions of my mind,
produced by a careful and candid consideration  of facts,  which  have
been brought to light, both by observation in my own practice, and in
that of others;  and they are not formed for the  purpose  of opposing
any man's theory, further than I deem  truth: and, as  such, they are
offered for consideration.
   In conclusion, in order to strengthen  our testimony in this matter, \\e
will  give the following extract from a recent letter from Dr. Johnson,
who has had some experience in the treatment of Milk-Sickness, and
quite an  extensive observation upon  the subject.   He  says :
   "Nowhere is the disease treated with more success  than in southern
Indiana.   Formerly, most persons died  who were treated by mercurials.
This agent is now never used, by those who are successful in the treat-
ment of the disease.   Much of the  success in the treatment,  is  to be
attributed to the skill of Dr. Trafton, the oldest physician in Evans-
ville.  For several years he treated it, as many physicians still continue
to do, with mercurials, and was unsuccessful.  At length, a particular
friend of the Doctor's died, and on a post  mortem examination,  there
was found  all the evidences  of violent  inflammation of the stomach,
particularly in the region of the pyloric orifice.   This occurrence led to
a more enlightened  view  of the disease, and an entire change in the
treatment.  Instead of calomel, and active purgatives, the milder articles
of cathartics, and  gentle laxatives, were used—such as sulphur andbi.
lart. pot., senna, soda, seidlitz, &c,  with  a  free use of enemata.   With
this treatment, the mortality of the  disease,  which had hitherto been
great, was measurably arrested.  Instead of being considered  the most
fatal disease of the southern portion of the  Stale, it is now, if taken early,
 and treated as gastritis, thought to be completely under the control of the
 proper medicines.  I may venture the assertion,  that calomel has never
 done good in the early stage of  the disease, and seldom, if ever, at any
 period,  and by far the majority of cases  thus  treated,  prove  fatal;
 whilst under the opposite treatment, with the milder articles of Materia
 Medica, a case seldom proves fatal.   I am sustained, in this assertion,
 by all the physicians in this portion of the State,  who treat the disease
 successfully ; and so thoroughly are the people convinced of these  facts,
 that  they will not employ a practitioner,  in a case of Milk-Sickness, 
21
who is  known to use this article  in  the  treatment of  that disease.
  "The question naturally arises, why is calomel so deleterious in this
disease?  Is it from its specific action  on  the system,  or its chemical
action on the coats  of  the stomach ?  I think  neither will account for
it satisfactorily.   Admitting that the disease is one sui generis, caused
by specific poison taken into the stomach, causing inflammation of that
organ,  and  consequent derangement of the whole  system ;  yet,  why
calomel  should  be  much  more injurious  in  the  inflammation  thus
produced,  than  when produced by  other  causes,  can  hardly  be an-
swered  satisfactorily.  It may  be said, that it enters into combination,
or is chemically  changed by the virus which causes the disease—or,
that it is long retained in the stomach, and is acted on  by the vitiated
gastric  juice,  forming a corrosive compound, capable of producing much
mischief.  These I think rather unsatisfactory.  I believe that it is not
so much that  calomel has any of the above  pernicious  effects, that the
treatment of the disease with it has  been  so  unsuccessful.   Calomel,
moderately used, may, in some cases, be advantageous, as  where the
disease is complicated with bilious fever;  and I have no doubt but that
one of  the reasons  why it has  been  considered an article so certainly
producing evil  consequences,  is, that those  who have used it, have
nearly  always  neglected  the  most important part of the  treatment,
depending upon it alone, or in combination with other heroic  medicines,
to  perform a cure.   From what has been  said of the pathological
condition of the stomach, this  treatment would generally prove disas-
trous to the patient.   This shows the fallacy of treating a disease merely
by its name.  Should the disease, because it is produced by some agent
contained  in  the meat,  butter, milk,  &c,  be treated different from a
similar  disease,  produced  by  a different cause?   I should think not.
The  same  symptoms should be met by the same treatment, and that
treatment should be rational.   What medical man would, in a case of
pure gastritis, give powerful and  drastic purgatives ?  Then, if we have
the  same  evidences of a  similar condition  of the same  organ, (as
tenderness  of the  epigastrium,  vomiting,  extreme thirst,  anxiety of
countenance,  and  great muscular  debility,)  why  not  adopt a similar
treatment?   It  is  not the name that gives the symptoms, but the
symptoms the name  of the disease;  and these symptoms  are the
 evidences of the departure of some organ  from a healthy condition—
 and in  Milk-Sickness, the organ  most  seriously affected is the stomach.
Then the remedies  used should be such as would act as gentle laxatives,
given often,  and  in  small quantities—but  the  proper treatment is
better known to you than me.   But  it does  appear to me, that those
 who treat  the  disease  with  mercurials,   and are unsuccessful, do 
22
 not fail so much from the evil effects of calomel, *s from a  mistaken
 notion of  the disease,  and  the consequent  neglect  of the  proper
 treatment.   They try to  overcome  the obstinate constipation of the
 bowels, by powerful cathartics.   These are generally rejected by the
 stomach;  and I doubt not, but that in many cases, the passage from the
 stomach to the bowels is nearly or entirely closed;  and  this condition
 is aggravated by the articles used.
   " Whilst  volumes  have been written by  different medical men,  in
 different portions of the West affected with this disease, by  men  who
 stand higfrin the estimation of the citizens of the country, as practition-
 ers of medicine,  nothing, as  yet,  worthy  of the profession, on the
 treatment  of the  disease,  has  appeared.  If the labor  and  research
 twhich have  been  directed  to an investigation of the cause of the disease,
 had been bestowed on efforts to ascertain its Pathology, many valuable
 lives might have  been saved, and it would long since have been stripped
 of its terrors.
   " The man who can dissipate  the prejudices, and  correct the errors
 in the  treatment  of Milk-Sickness,  which  now  prevail  to such  a
 lamentable  extent,  will be  entitled  to  the  highest honors of  the
 profession, and the eternal gratitude of his country."

                     NOTE  BY THE AUTHOR.
  Owing to the hurry of business, some few errors have escaped detection.  None,
 however, that alter the actual meaning of a sentence, excepting one on page 7, line
 13, for "rigid," read acrid. The others which occur are merely typographical and
orthographical errors, which will  be readily seen by the reader. 
 
 
DR. MelLHENNY
ON
MILK SICKNESS 
 
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