pHl' J ., SING SING, N. T. THIRD EDITION. ■ \ NEW TOEK:^ BAKER & GODWIN, PRINTERS, PRINTINO-HOUSE SQUARE. 1873. /^ Entered, according to Act of Congress, in the year 1873, by BENJAMIN BRANDRETH, M. D„ In the Office of the Librarian of Congress, at "Washington. INTRODUCTION TO AUTHORITIES FOR DOCTRINE OF PURGATION, AND OPINION AS TO CAUSE OF DISEASE AND PREMATURE DEATH. Life maybe considered the union of soul and body. It is one of the most impene- trable secrets of Him who lives in all things, and in whom all live, and move, and have their being ; who, in His goodness, has led man, as by the hand, to the path whereby he may arrive at a knowledge of his bodily infirmities and death ; and how he may reduce the one, and thereby keep the other at bay. All nature is God's work, but man is the only living creature that appears to be endowed with cumulative reason. The Bible tells us he is fallen from his primitive condition of happiness, and in con- sequence of this fall, he receives at his birth a germ or principle of corruptibility, which continues to be propagated throughout all time. For the child receives from his parents the principle of his life, and also that of his death — corruption. From long study and experience, we are convinced that the death principle is corruption, or therein contained. The examination of the dead proves this ; the putrefaction we observe tells us plainly that if that had been removed in time, life would not have been extinguished. The principles of life and death occupy the same body, and one or the other must rule. In order, therefore, that we continue in health, the principle of life must have the balance in its favor. Our method teaches this impor- tant knowledge. Some writers fix old age at between fifty and sixty years. Every five years that a man lives after this period may be set down as a degree added to old age. If there are so few who reach an advanced period of life, it is because the innate principle of corruption becomes active, and disease breaks out with more or less malignity, and the proper means not being employed, death may follow, f- e individual not having reached- that age he should and ought to have attained from the principle of life which he possessed. We look upon this as premature, not nat- ural death. Natural death is a cessation of all the faculties ; the man or woman falls asleep, ceasing to exist without effort or struggle. It is true that all men must die, but no one need die of disease. Even now, hu- man beings have a longer average of life than was their lot in the last century. This may be the consequence of a better knowledge of the laws of life. Let it be com- prehended that we carry within ourselves the cause of disease and death ; let us admit this fact, and not wait until convinced by the terrible manifestations of pain and inflammation. To apply the remedy in time is the knowledge needed. It is worthy of remark, and we see with surprise, that young persons, apparently in the full vigor of health, whose complexions seem to indicate the most robust constitution, are oftener attacked by severe disease than persons always pale and feeble. These persons have more vitality, which occasions a quicker waste or change in the material of their bodies, so that when they are sick, unless the secretions are restored immediately, the death principle gaias the ascendency. Prompt measures in the right direction are all that is needed, and in such cases purgation means life, and the want of it means death. 4 THE DOCTRINE OF PURGATION. Some persons are peculiarly blessed with liealth. In their constitutions no im- purity shows itself, often taking one hundred years or more to wear out the " spark of life." In others, life has ceased before birth, and the child is still-born. All the solid parts of our bodies are made from fluid ; first derived from the blood of the mother, then from the mother's milk. Thus solids and fluids constitute our material being. WASTE AND REPAIR. The body wears. Movement causes waste. The hardest steel wears away when Used. So also the body wears away, but, unlike the steel, it is renewed faster than it wears away in a child, which is the occasion of its growth. It is a great truth, we die daily ; but the food consumed also supplies us with new life daily. These are marvelous facts ; this decay and renewal are among the wonderful mysteries of the Almighty. We know the hair and nails grow. Mark your finger nail near the root. Day by day it advances toward the end ; at length we pare the mark away. The whole nail has been renewed, the growth was supplied, the waste was repaired. The same waste, the same renewal occurs in the nose, and all other parts, though we cannot mark the change as in the finger nail. WHERE THE REPARATIVES ARE. The substance which is to form the nail is in the bl od ; as perfectly mixed as a grain of salt is dissolved in a glass of water. As the blood circulates in the small vessels at the root of the nail, this nail substance deposits and organizes itself, and replaces what is worn away. The hair is also renewed by materials from the blood deposited in the roots of the hair ; so the bones ; and so the flesh ; and so with all other tissues and parts of man's body. Each part receives its needed supply of new material. Thus the eye retains its fire, the tongue its power of utterance, the brain the power of thought. Analogy tells us even the brain, the organ of thought, wears, and is renewed by the blood, which circulates and renews all the parts of the body alike, whether it be brain, spinal cord, the eye, the bones, the flesh, the .^a^r, or the nail. The blood carries new material to repair the waste, and it reloads itself with worn-out parts which it discharges through the appropriate vents. When the new materials are greater than the waste, the child grows ; or the man spreads. When the waste is exactly equal to the new material, the body remains of the same size and weight. These facts indicate that all substance of all the organs and parts of a living body are present in the blood. It is therefore important to our well-being that this life fluid should be free from imperfections. For if the blood does not contain all the needed ingredients, or if it should contain more, it cannot fenew the different parts according to their requirements. Deformed and ill-made people owe their infirmities to the blood of their parents ; pure blood cannot do otherwise than make perfectly organized beings, thus we may estimate the value of certain means to make the blood perfect. Food, by its organ the stomach, supplies all the p rts of which blood is made. We now speak of this conversion. DEFIJSriTION. eUBSTAKCES WHICH CONTAIN AND SUPPLY ^JTRITION AKE FOOD. Healthy food possesses substance, because the stomt) > cannot grind it well with- out it possesses this quality. Too fine food makes tL stomach weak ; it cannot INTRODUCTION. 5 use its muscular power, and debility of the stomach follows. If we do not walk, our legs soon become weak. To be strong, organs need exercise. When food is digested, part makes blood ; the refuse passes off by the bowels, the kidneys, and the skin. Our stomach, if properly supplied, continually prepares new blood, which renews all the organs, carrying vitality to the hair and nail as well as to the head, with its master-organ the brain. Every part is each moment of our lives changing, the worn- out parts carried away, and new parts supplied, whether good or bad. Here we see the necessity of eating and drinking several times a day. We constantly wear and constantly repair. Such is the law of our being. WOBN-OUT PARTS MUST BE EXPELLED. The worn-out parts must be expelled from the body daily, or the blood will be- come impure. We may comprehend this by an inquiry respecting new-born chil- dren^ They have taken no food by the mouth, and yet when born their bowels and bladders are full. Whence did these secretions come ? They came evidently from the blood of the mother, which made their bodies. We also know that sick persons, who eat no food for days, have evacuations by the kidneys and bowels. These parts are also the worn-out parts of the blood. The blood is, in fact, a messenger which takes to every part of the body what it needs for renewal, and also carries back to the bowels, kidneys, and skin, worn-out substance to be expelled from the body. We therefore must admit that every part of a human body is made from blood; and that it wastes and is repaired; that food makes blood, which is distributed with singular intelligence to all the various organs. HOW IMPURE BLOOD IS DEVELOPED. The bowels may be costive ; in this case there is an absorption into the circulation, of gases and gummy substances, which are a great cause of poison to the blood. Should the kidneys fail to do their work, another source of poison to the blood is developed. Again, should the perspiration be checked, matters flow back upon the blood which soon load it with impurities. Suppose only the feet, by cold, cannot perspire, and their fetid exhalations flow back upon the blood. If all these outlets — the skin, the kidneys, and the bowels — do their work even imperfectly only, for a short time, it is evident that the blood will be burdened with noxious matters, which must interfere seriously with the circulation, and soon clog up the smaller vessels, so that only a small amount of blood can pass. Soon the lungs, the intestines, the stomach, and the brain will sound an alarm. You will have pleurisy^ inflammation of the bowels or severe cholic, violent headache, or sick stomach. Because the worn-out parts of the body, instead of being carried out by those avenues nature designed, are shut up, poisoning the blood, thus causing it to become impure. Other causes besides these produce impurity of blood. The food may not be healthy ; digestion may be imperfect ; troubles, grief, anxiety, miasmas from swamps or other exhalations; breathing close air in crowded rooms; staying in too hot rooms ; all these causes tend more or less to vitiate the blood. Grief, fear, and anxiety, Tiurt^ ty making the Mood to circulate slower^ and soon produce a very serious injury to the composition of the blood, occasioning stubborn fevers, and various derangements of the body and mind. The best part of food makes chyle, which is absorbed into the circulation, to repair the waste the blood sustains in rebuilding the body, and in forming bile and 6 THE DOCTRINE OF PURGATION. all the otlier fluids of the body — for all the fluids are made from the blood. The coai-sc portions, and those not needed, are expelled daily by the bowels, the kidneys, and the skin. The fluids, or as some writers call them, the humors, are as natural and necessary as the blood. It is not from humors we are sick, but from the humors becoming unsound ; from infection, or absorption of fungi, or other poisonous vapors or matters. These produce a putrid fermentation, or chills and fever, or fevers continued or in- termittent. It is supposed that in the humors resides the germ of corruptibility, which is aroused into activity by the above causes. To have humors is as natural as to have blood. It is not having humors that causes us to be sick, but because they become corrupted. The humors absorb infection, in consequence of their being the seat of the innate germ of corruption. When this germ or root, from any cause, receives an increase, it may show itself by colds, ca- tarrhs, tumors, or other effects, by which life may be shortened, or a serious attack of some specific disease produced. Corrupted humors always cause sickness ; they cause death. If they are removed in time, the sickness is cured, and death prevented. "We know they can be removed, and should not corruption be quickly removed from a living body ? Their infec- tious smell tells of their hurtful nature to a living body ; cleanse, sweep out from the bowels and blood the unhealthy parts, and your disease will soon be cured. While in health, the humors and the blood are sound ; but so soon as you do not feel well, be sure the humors and blood are getting deranged in their sound quali- ties ; and when painful sensations are felt, we should at once take steps to prevent serious trouble. These steps usually are evacuation, for we cannot recover health until the blood and the humors are freed from all acrid and unhealthy qualities, however acquired. The humors, after becoming corrupted, soon accumulate a degree of acrimony or burning heat, that the burning sensation is often almost insupportable. They often resist great quantities of purgatives, but outward applications are really useless without evacuation of the bowels. Two hundred medical writers, running through a period of over two thousand years, agree as to the means of reducing this death principle — agree as to a general indication — agree as to the perfect innocence of purgation. We hold that this evidence is important in our intelligent age, and hope it may lead to a more uniform and a more humane method of treating patients. Perhaps a wise regard for the im- provement of the human race will make purgation the principal curative reliance ; other means should be only secondary. Physicians may soon be governed by this rule, because purgation may be set down as the magnet, the guide, the star of safety. Purgation corrects errors in the digestive organs ; and Dr. Abemethy observes (in Surgical Observations^ p. 33): "By correcting the obvious errors in the state of the digestive organs, local diseases which had baffled all attempts at cure by local means, have speedily been removed." When local applications are applied, they should be in harmony with purgation, and incapable of doing injury. We can remove disease in two ways : by the upper and by the lower passages — by vomiting and by purging — purging when the patient is weak, vomiting only when he is strong. We will define purgation as " cleansing," and apply to both the upper or lower ways. INTRODUCTION. 7 For forty years I have directed my attention to the cure of disease on this plan, and facts derived from experience have long since confirmed me in the belief that this is calm Nature's own method of cure, because it assists her in removing impuri- ties by the means and outlets she has so wisely provided for herself. Believing that all mineral and chemical agents which can act on foreign or im- pure matters in the blood, invariably injure the organization of the blood itself — destroying its corpuscles, besides injuring the coats of the stomach, and producing serious effects upon the bones — I have therefore discarded minerals and chemicals entirely, and trust to vegetable remedies alone. That which I have principally employed to enforce this theory has been Brand- reth's Pills, whose permanent and wide-spread success is the strongest evidence of their distinguished merit. The question has been asked. If the value of this medicine is so great, is it not a duty to make known its true components, so that physicians and others could pre- pare it ? To this it may be answered, that if Brandreth's Pills certainly would be made the same as they are now, and all their healing, cleansing and innocent quali- ties retained, one of the reasons for their remaining a secret medicine would be removed. But every man knows, who knows anything of the drug and medicine business, that not one box in a hundred would be prepared of such medicines as are incorpo- rated in the Brandreth Pills prepared by me. It is true the pills might be composed of ingredients called ly the same name\ but the name would be all the resemblance they would ]30ssess to the pure extracts and medicinaL preparations which comprise the composition of Brandreth's Pills. • Therefore, for the sake of the lives and health of men — for the sake of the GREAT SANATORY THEORY OF PUR«3A110N— the manner of preparing Brandreth's Pills will never be divulged, until the time arrives when all the drugs of the stores shall be true and uniform preparations. I am not without examples for this decision : Dr. James, the celebrated author of James' Powder, left his prescription to Messrs. Newbery & Sons, of London, more than a hundred years ago, by whom they are yet made. The great Stahl and Hoffman, of Germany, Professors of Physic at Halle, without scruple confined many medicines to their own private practice. And even in our own time, there are few medical men of extensive practice who ha-^ie not rem- edies which they carefully retain in their own families, who are more likely to prepare them with reference to securing their curative effects, without regard to profit, than they would be in the hands of strangers. The quotations from the writings of medical men, embodied in this pamphlet, prove the talent that has been at work upon this Theory of Purgation for over a period of two thousand years —and in vain. Then what has prevented its complete success ? Simply this, in my opinion : Not a single writer has given a medicine which, out of their own hands, would successfully and safely enforce the purgative theory. The public, in Brandreth's Pills, have a medicine which it is intended shall ever be within its reach, always certain to purge only impurities from the blood, and when the upper ways require cleansing, occasion vomiting ; and that is safe for both 8 THE DOCTRINE OF PURGATION. sexes and all ages. Composed of vegetable preparations entirely — indeed, the Pills are guaranteed to contain no mineral in any form — tliey may, if the req^uirement of the constitution need them, be taken daily for any length of time, without a possi- bility of producing any bad effects on the body, and must reduce the sum of disease. WAEEANTEE. 1 , t That Brandreth's Pills, in all future time, are warranted to possess and contain those purgative, those cleansing and innocent qualities, which they have always heretofore possessed in so eminent a degree. The principle of curing disease by the use of purgatives is beginning to be exten- sively recognized as indispensably necessary for the recovery of health by many intelligent families and individual. To prove to them and to the world at large, as well as to physicians of all schools, the broad and deep foundations and authority this principle of cure possesses, I have printed the following extracts which, as in a mirror, is exhibited the views, and experience, and sentiments of medical men, dur- ing a period of over two thousand teabs. They possess a peculiar significance for those who desire to investigate this sub- ject, so important to the lives and health of men, because they throw a flood of light on the application of purgatives as a means of removing disease from the system. The great aim byraany of these writers is, that in the administration of medicine, we should do good possibly, but never lia/rm. Bleeding, Mercury, Tartar Emetic, Antimony, Veratria, Strychnine, Morphine, and a host of similar remedial agents may, nay generally do, a great deal of harm, and often are the occasion of fatal mistakes ; while the great advantage of using Brandreth's Pills in sickness is, that they never male any mistakes^ often prolonging, never shortening life. In pleurisy, in inflammation, in fevers, and where pain is present, their prompt and energetic administration is often life-saving, and it is in evidence they have often effected cures when physicians and friends had given up all hope. Then what risk does any man or woman incur in using a medicine like Brandreth's Pills, which are the adopted remedy of millions of families living in every part of the civilized world ? The facts given in the following pages prove that fevers, inflammations, and severe pain are only, in reality, so many evidences of healthful constitutional power, and that if purgation is enforced according to the necessities of the case, the fever, severe pain, or inflammation will be removed, provided no sedatives or narcotics are employed. B. BRANDRETH. Sma Sing, June 1, 1871. Hippocrates. Purgation the Corner-stone of Curatives. Hippocrates. — Aphorisms, written about 400 b. c. Marhs, M. D., New Yarh, 1818. Edited hy Elias 1. Life is short, art long, Occasion brief, experience fallacious, Thegoiden judgment difficult. It is requisite that the physician exhibit what is essential, and that the patient, attendants, and all which surrounds him, concur therein (1, sect. I). rule. 2. In diarrhea and spontaneous vomiting, if the matter voided be of Diarrhea. a nature that ought to be expelled, let the patient be purged, for in this dSed case the evacuations are benehcial and are easily supported (2. sect. I). Purgation in- nature. 3. The greater the evil the more vigorr as the remedy (6, sect. I). The power of the reme- dy. On Diet. 4. In acute diseases the most violent symptoms supervene; the severest regimen is, therefore, to be observed. But if these symptoms be wanting, a more generous diet is to be permitted, only we are to have recourse to it in proportion to the subsidence of the malady (7, sect. I). In the choice of regimen, more evil results from abstraction than from a small excess. A thin, frugal, and over-exact regimen curl^^^'^ '^^ accords not even with the man in health, who grievously supports the privation. Hence, in general, the superiority of a due refection over that which is deficient (5, sect. I). The nutri- 5. In those diseases which quickly arrive at their climax, a thin regimen should immediately be adopted. In those which attain it at a somewhat later period, we should at or before that period, subtract from their diet ; but, until then, sufficient nourishment should be allowed, that the strength of the patient may be supported (10, sect. I). Diet to be regulated ac- cording to the charac- ter of the disease. 6. That which is excrementitious should be drawn off at the point to which it most tends, by the most convenient outlets (21, sect. I). Purgatives, Diuretics, Sudorifics. 10 THE DOCTRINE OF PURGATION. When to 7. Purgatives should be administered after the food on the stomach tives. ^''^^' i^ concocted, not while it is yet crude (22, sect. I). XoTE BT THE Editor. — Tlicrc IS HO danger in administering a purgative before or after a meal, provided there be pain or dizziness, which symptoms are relieved by purgation . 8. Depletion is not to be estimated by its copiousness but by its How to di- ^^eing judiciously used and easily supported. When it is necessary to recMhe pur- extcud it " ad deliquium animi," let it be done, but previously consult the resom'ces of the patient (23, sect. I). Note by Editor. — Where there is danger of congestion, purgation may be enforced to fainting with Brandreth's Pills (see paragraph 55). 9. If the convalescent acquire not strength from the food he takes, it shows that the body needs a more plentiful supply. But if the same effect arise from an inability to partake of food, it sufficiently evinces the necessity of purgatives (8, sect. II). 10. When it becomes necessary to purge, the evacuations ought to evSatSn°^ bc loosc and free (9, sect. II). How to di- rect the nou- rishment. 11. Impure constitutions, when most nourished, are most injured (10, sect. II). Relapses 12. The (morbid) matter remaining in the body after the crisis is dent ^^^' P^^^ often produces a relapse (12, sect. II). tion. Chan e of ^^- ^^ alviuc fluxcs, a chaugc in the dejections, unless they assume dejections, a vicious appearance, is beneficial (14, sect. II). Tubercles. 14. Whcu the fauccs are affected, and tubercles arise therem, we o?S^o?s^^^°^ ought to examine the excretions ; when they are of a bilious nature, the entire body is affected ; but if they be as in health, we may safely impart nourishment (15, sect. II). Disease 15. Exccss of food produccs discasc, and at the same time points out from intern- ' - . - . — . - . . . . _ _ . perance in food or gation" the tiou. Thus, oppositcs are counteractives of each other (22, sect. II). 16. Evacuation, repletion, frigeration, and calefaction — these, or _ Sudden ac- any Other correspondent modifications of body, when excessive, or too nafurJ^^So- Suddenly accommplished, are dangerous — nature being ever opposed to must '^'"^^e ^^^^^'^'^- That which is gradually done is safely done, whether we gradual pass from ouc extreme to another, or otherwise (51, sect. II). Every- 2^. ^^^' thing which is judicious being done, without success, we are not, there- fore, to recede from our plan, while we still entertain the same views as we did at first (52, ibid). the remedy (lY, sect. II). The sickness which arises from repletion is cured by evacuation ; and that which arises from evacuation, by reple- THE DOCTRINE OF PURGATION. 11 lY. Some diseases accord hetter with some constitutions than others / . Prediapo- and this also obtains with certain ages, as connected with season, climate conrtuutionf and aliment (3, sect. III). In the various seasons, if cold and heat fre- cfimatrS quentlv alternate with each other, we must look forward to autumnal f*^,^^; cia.np,Q ^. - . ' of tempera- d^sea^es (4, ibid). ture. 18. Those suifering from phthisis should avoid vomits (8, sect. lY). emetics inju- 19. The melancholic should be copiously evacuated downwards ; and, Purgatives from the same principle of reasoning, those of a contrary temperament where to be should be differently treated (9 sect. TV). "''^• 20. Sound Doctrine. — In very acute affection, attended with turg- Acute dis- escence, purgatives are immediately to be used ; to procrastinate here wuhouTTl is dangerous (10, sect. lY). ^'^y- 21. Those who are tormented with severe griping s, pains about ^i^^*^*^^ the umbilicus., and in the region of the loins^ and who are neither purgatives relieved by purgatives, or any other means, usually fall into tympanites (11, sect. lY). useful. 22. If there be pain immediately above or below the diaphragm^ plint^yfm- the former demands vomiting, the latter purging (18, sect. lY). iting and 23. Those who, during the operation of purgatives, have no thirst, degree of ought to be purged until thirst be induced (19, sect. lY). purging. 24. JF*ain in the lower region of the abdomen., with griping and ach- paAn in ing of the knees, unattended with fever, indicate the necessity of pur- f^pJr^aS"" gativeS (20, sect. lY). necessary. 25. Darh-Golored dejections., resembling black blood, coming on svacua- spontaneously, either with or without fever, are very unfavorable ; and J^f* ^^^^^' the more so if the color of these dejections become, with their continu- ance, still more depraved ; but if the evacuations assume a more healthy complexion, or, if their darh color be the effect of purgatives, less evil is to be apprehended (21, sect. lY). 26. The expectoration of blood, how small soever in quantity, is Evacuation injurious; but the evac^cation of black blood downwards is (frequently) eJen^Hfcha- advantageous (25, sect. lY). racter. 27. With those who are deaf a coming on of bilious evacuations Dea/ness, generally removes it (28, sect. lY). evacuations 28. If, in those recovering from indisposition, there occur any local p^.^ , pain, it foreshows the formation of an abscess (32, sect. lYV tom of ab- •^ '^ . \ ^ / scesses. 29. From whatsoever part of the body sweat breaks forth, it fore- sv^eatsnnd shows a determination of the disease to that part (38, sect. IY)r ■^«"^> ^y^p- 12 THE DOCTRINE OF PURGATION. tomatic of Tu wliatevci* part of tlie body lieat or cold arises there the disease disease. iiuli- , . ii'/oa n • i\ " cate the ne- SeatS itselt (^o9, ibui). ?«r!/af?o«. W]iere there occur alternate changes of cold and heat, and the com- plexion nnder2;oes various changes of color, we may predict extended illness (40, ibid). Profuse sweats, during sleep, without any manifest local affection, may arise from a too plentiful diet ; but if they take place notwith- standing the observance of a frugal regimen, it shows the necessity of evacuation (41, ibid). Ahscef!sesi>^^ 30. In fcvcr, where abscesses have not been dispersed during the be purged" primarv stages of the disease, they foreshow extended illness (51 sect. It). Fever, in- 31, When, witli cxistiug fever, a thick, gummy, scant urine is fol- the*uiine. ^ lowcd by a thin and copious discharge, it is beneficial ; but it is the more so, when, at the commencement of disease, or a little time after, the urine deposits a sediment (69, sect. lY). pfegnfnir^ ^^' ^ith pregnant women, venesection produces abortion^ especially causes abor- -f ggstatiou bc far advauccd (31, sect. Y). Brandreth's Pills are safe at every period of gestation with the generality of females. Irr&gxilar t-vit !• i -t i • ^ memtrua- 33. Discolorcd and UTe2:ular menses indicate the necessity oi pureja- ^io?? requires . ,^^ -vt-s ^ ./ x o purgation. tlVCS (OO, SCCt. V j. Tiumors,^^ 34. Tumovs which have a soft feel are beneficial ; those which are malignant, hard and callous are unfavorable (6Y, sec. Y). Dropsy, 35, Jn dropsv, if the water pass off" into the intestines, by means of purgation , . r\ a- ^ /^ a ^ tttn the cure. the veius, the disease ceases (14 sec. V I). Purgation brings it to the intestines and so causes the water to be evacuated. Diseases of 36. Diarrhea supervening in ophthalmia is beneficial (lY, sect. YI). ^Fu%a^on. Pai7is of the eyes are relieved by pure urine, bathing, fomentation, venesection, and purging (31, sect. YI). Fever the 37. Paius in the hypochondrium, unattended with inflammation, are naturaicure. relieved by fcvcr (40, sect. YI). Effects of 3S- Long -continued dysentery, supervening in affections of the spleen, 'uf ation induccs either dropsy or lientery, and consequent death (43, sect. YI). Purging in 39. Thosc witli whom purgativcs .agree should have recourse to Spring. i\^Qn^ in the spring (4Y, sect. YI). wheninflam- 40. Thosc attacked with the gout are entirely freed of it in forty purgMaway. days after the subsidence of the inflammation (49, sect. YI). More effects 41. lu atrabilious affections the translation of the humors to various purgauon^ parts has a tendency to produce the following diseases: apoplexy, mania, co'avulsion and hlindness (56, sect. YI). THE DOCTRINE OF PURGATION. 13 42. When a serous collection, attended with pain, takes place be- Accmrmia- tween the abdomen and diaphragm, without its having an issue in either inSines re* cavity, if the fluid be drawn out of the body by means of the veins, the ti'on^^^^^^ disorder ceases (54, sect. YII ; vide Aph. 14, sect. YI). 43. Excessive perspiration, cold or hot, continually going on, is in- -s-M^m^— in- dicative of redundant moisture within ; we ought, therefore, to evacuate aISV^^ccS- it from the system either by vomiting, if the patient be strong, or by c^re^^Pur- purgation if he be weak (61,' sect. YII). games. 44. He should attend to the urinary discharge in order to ascertain whether it be conformable to what takes place in health ; in proportion ,as it departs from the healthy state is the severity of the disease, and {Q6, sect. YII). If, on suffering the urine to remain, without disturbing it, we ob- serve a deposit resembling sawdust, the greater or less quantity of this deposit is indicative of the severity or mildness of the disease ; in either case, it is necessary to have recourse to jpv/rgatives i in proportion as we neglect these, for a nutritive regimen, will be the augmentation of the disease (67, sect. YII). The urine a criterion of health or dis- ease — its tur- bid condition indicative of 46. In continued fever, the expectoration of a livid, bloody, bilious, Conunued or foetid matter, is alike unfavorable ; but, if the expectoration be good, rinS^I^ url- and in due season, it is favorable. The same may be said of the alvine ^ulrJlarly and urinary discharges ; fm^thermore, any excrementitious matter re- and thor- maining in the system, and not coming away with the evacuations, qSeZ ^^ proves injurious (69, sect. YII ; vide Aph. 12, sect. II). HippocEATEs, the genuine works of. Transl. hy Francis Adams, LL.D., and f Tinted for the Sydenham Society. 2 vols. London, 1849. 46. Medicine is, of all arts, the most noble ; but, owing to the igno- Medical ranee of those who practice it, and of those who inconsiderately form a ^s^ora^ce. judgment of them, it is at present far behind all the other arts (The Law, p. 784, vol. I). 47. When nature opposes, everything else is in vain. Nature is the Nature. physician of diseases (p. 102, vol. I). The phy- sician's spe- cial object. 48. The physician must have his special object in view with regard to diseases, namely : to do good or to do no harm. The art consists in three things : the disease, the patient, and the physician. The physician is the servant of nature, and the patient must combat The ser- the disease along with the physician (Epidemics, Book 1, §5, p. 360, IT/ ""^ """^ vol. II). 49. Gentle purging of the bowels agrees with most ulcers, and in uicet-s. wounds of the head, belly, or joints, where there is danger of gangrene, uy.^^* ^^^' in such as require sutures, in phagediac, spreading, and in otherwise inveterate ulcers (On Ulcers, pp. 796-7, vol. II). 14 THE DOCTRINE OF PURGATION. Purge in 50. Disordei's arising from repletion are removed bj evacuation (On d£m^. the jS^ature of Man, p. 262, vol. I ; Aphor, 22, sect. II). jf>r<.r«pass 51. AYhen the discharges become thicker, more concocted, and are STe^^/u^SS ft'^ed from all acrimony, tlien the fevers pass awaj, and the other symp- "r^ed'^^'^' ^^^^^^^ which annoycd the patient (Ancient Medicine, p. 174, vol. I). 52. When there is an overflow of the bitter principle, which we call fui^^fijmp'- yellow bile, what anxiety, burning heat, and loss of strength prevail ! *moted by ^^^^ if relicvcd from it, either by being purged spontaneously, or by artSii ^"^ iiieans of medicine seasmiahly administered^ the patient is decidedly re- purgation, licvcd of the paiu and heat. But while these things float on the stomach t^hejjQiytrue i^^j^concocted and undigested, no contrivance could make the pains and fever cease ; and where there are acidities of an acrid and eruginous character, what varieties of frenzy, gnawing pains in the bowels and chest, and inquietude prevail ! And these do not cease until the acid- ities be purged away (p. 174, vol. I, ibid.) The bad 53. The coction, change, attenuation, and thickening into the form ^TOrious ° of humors, take place through many and various forms (p. 174, ibid.) kinds. ^ 54. We must pur2:e and move such humors as are unconcocted (p. What to ^„^ , -rT\ -t^ & vr pwge. TOd, vol. 11). Purge until evacuations 55. The evacuations are not to be judged of by their quantity, but whether they be such as they should be, and how they are borne. And event?fai2t- whcu propcr to Carry the evacuation to " liquidium animi " (faintness), ^^' this, also, should be done, provided the patient can support it (p. 704, vol. I ; Aph. 23, sect. I). Note by Editor. — To give the patient an opportunity of doing so, have gruel or light broth ready for him to sip a little at a time. Intelligent nursing must go alongside of the purgative method, then success is moderately certain. Purgative ^^' ^^ *^^ matters which are purged be such as should be purged, a^iom. the evacuation is beneflcial (p. 704, vol. II ; Aph. 2, sect. I). Effects of ^'^' Bodies not properly cleansed, the more you nourish, the more What remains in diseases, after the crises is past, is apt to produce relapses (p. 707, vol. II ; Aph. 12, sect. II). Purgative 58. In purging we should bring away such matters from the body as it would be advantageous had they come away spontaneously (p. 723, vol. II). axc/iom 59. Our Doctrine.— h\. very acute disease, purge on the first day, for eanen. Purge it IS a vcry bad thmg to procrastmate m such cases (p. 724, vol. 11 ; Aph. 10, sect. lY). Acfute Die- ',ase only. THE DOCTEINE OF PURGATION. 15 60. In convalescents from diseases, if any parts be pained, there are deposits being formed to the iUness, there the disease fixes (p. Y28, vol. II Deposits But if any part be "in a painful state prevjous }ZT jZrga- Aph. 32, sect. lY). 61. N". B. — The translator says : '' Hippocrates was strictly the phy- ExpeHmee sician of experience and common sense." and comwow 62. JSTature finds out ways for herself without consultation ; nature, Natmr&s untaught and without learning, does what is needful (Epidem., lib. YI, '^S^ *" 5. 5, Edinb. ed.) 63. Ascl&piades^ about 100 years B. C, the earliest hydropathist, con- trived easy methods, and such_ones as any one might nse without the help (and cost) of a physician. This made them very acceptable, and Plinius (Lib. XXYI, Cap. Ill, p. 444) writes about him the follow- ing : " Five things of most common benefit he held to : Occasional ab- stinence from meat, at other times from wine, the use of the flesh-brush, the exercise of walking and of riding ; which, as every one believed he could prescribe for himself such remedies as these, and as it is natural to wish those things true that are most easy, made all people flock unto him as to one sent from heaven." He disapproved of the then popular practice of frequently using violent emetics and purgatives, for which he substituted the clyster as the safest way to obtain — what appeared to him the first measure to be taken in most of diseases — evacuation of the howels. His method of employing siiruple remedies^ for the sake of their safety and innocence, but producing the effect wished for, and his extra- ordinary skill in a quick diagnostic, gained him a fame that almost overthrew the old heroic method of the then practitioners of Rome, as we read of him in Plinius, XXYI, 8 ; Celsus, III, 4, II, 6, Carlius Aurelianns, Morb. acert., I, 15 ; Aquilejus, Florid., lY, 362 ; Plinius, Hist. Nat., YII, 37; and'Saleh Ben Balah, Chap. 12. He recommended clysters of cold water for the aged, and for persons troubled with stone or gravel, for females having falling or other affec- tions of the womb, and in all kidney affections when the bowels require moving. Simple and safe purga- tive remer dies^ THE MEDICINE OF THE PEOPLE, combined with whole- some food^ personal cleanliness, temperance, and exercise of the 'body preserve health and cwre dis- ease. ^ Water clys- ters for the aged. 64. Rhazes or Rasis, on Pestilence^ written about 890 at Corduha- This book of Rhazes' is a curious and valuable record of the Arabian practice in small-pox and measles. The best edition in Arabic and Latin is that by I. Channing, London, 1Y66. The doctor's theory is that of fermentation, and his practice is of the cooling kind, together withyr^^ evacuation of the howels. There is also another translation of this book in English from the Arabic text by Dr. Greenhill (8vo., London, 184Y). Small-pox and measles —powerful purges. 65. AviCENNA, or Abu Ali Al Hosaln Ehn Ahdallah Ehn Sina^ who intestinal was born in the year of the hegira 370 or 987 A. D., t\\Q first writer who ^^l^J'^Zi~ formed a complete system of medicine^ was of opinion that evacuation of evacuation the howels., actively and perseveringly employed, was the main principle in the cure of disease. He was, however, more in favor of clysters than the cure. 16 THE DOCTRINE OF PURGATION. of internal purgative remedies, not considering that that method of pur- gation, often repeated in a proportionately short space of time, bj its mechanical action, must prove injurious, causing ulcerations in the in- coiic. testinal canal. Thus, when subject to a severe attack of colic, he took cigfht clysters in one day, which producing ulcers in the intestines, toge- tJier with an epilepsy, a consequence of intemperance and sensuality, that had weakened his vital forces, thus causing his early death. Of his numerous books, said to be more than one hundred, his " CanonJ^ and some tracts were printed in 1593 in Rome. Parey, Ambrose, M. D., Physician to Henry III., King of France and Poland. Paris, 1579. Transl. TJios. Johnson, M. D. Lon- don, 1634. ExpeHence io^. Although iudccd we cannot deny but that experience has much \hQscience. profited this art, as it has and does many others. For, as men per- ceived that some things were profitable, some unprofitable for this or that disease, they set it down, and so by diligent observation and mark- ing of singularities, they established universal and certain precepts, and so brought it into an art (Pref.) Disease 67. There is no disease which arises not from some one, or the mix- it^ofThe^^' ture of more, humors. Which thing Hippocrates imderstanding, blood. wrote every creature to be either sick or well according to the condition of the humors. And certainly all putrid fevers proceed from the ^putrefaction of humors. N^or do any acknowledge any other original and distinctive of the difi*erences of abscesses or tumors ^ neither do ulcerated, broken, or otherwise wounded members hope for the restora- Purgatwes tiou of Continuity, from other than from the sweet falling down of removemor- humors to the wouudcd part, which is the cause that often in the cure ^vorTtfe^ of these aifects. The physicians are necessarily busied in tempering the blood. blood ; that is, bringing to a mediocrity the humors composing the mass of the blood, if they at any time oifend in quantity or quality. For if anything abound or digress from the wonted temper, none of the accus- tomed functions will be well performed. . . . Purging corrects and draws away the vicious quality of the hlood (pp. 11, 12; cf Hippoc. 29, 30). hmlhTZ^ 68. But with the blood at one and the same time, all the humors the blood in are made, whether alimentary or excrementitious. Therefore the blood, \tate!^^ that it may perform its office, that is, the faculty of nutrition, must necessarily be purged and cleansed from the excrementitious humors. . . . The parts of which the blood is composed ought to be tempered and mixed among themselves in a certain proportion, which remaining, health remains, hut violated^, disease follows (p. 12). Dia/rrhm 69. Evjacuation is no other thing than the expulsion or effusion of ing. Thenat- humors which are troublesome, either in quantity or quality. Of evac- S morbid°" nations some are universal, which expel superfluous humors from the matter must wholc body ; such are purging, vomiting, perspiration, sweats ; some THE DOCTRINE OF PURGATION. 17 particular, which are performed only to evacuate one part, as the be assisted stomach by vomiting and stools, the guts by stools, the liver and spleen by urine and ordure. These evacuations are sometimes j^erformed hy nature ^freeing itself of that which is troublesome to it ; otherwhiles by the art of the physician in imitation of nature (p. 3Y). 70. The causes of congestion are two principally, as the weakness of froS* morbid the concoctive faculty^ which resides in the part, by which the assimila- tfo^nJ^'^'J;^^ tion into the substance of the part of the nourishment flowing to it hyPurga- is frustrated, and the weakness of the expulsive faculty / for while the ^*^^* part cannot expel superfluities, their quantity continually increases (p. 250). Those humors which are rebellious rather offend in quality than in quantity, and undergo the divers forms of things dissenting from nature, which are joined by no similitude or afiinity with things natural (p. 252). A convenient diet aiid purging must be used ; ill humors are amended by diet and purging (p. 253). Yl. Cancer. — The antecedent cause depends upon the default of fr^mlmpur- irregular diet, generating and heaping up gross and feculent blood / by f|^^°J *^® the morbific affection of the liver disposed to the generation of that blood ; by the infirmity or weakness of the spleen in attracting and purging the blood ; by the suppression of the courses or hemorrhoides, or any such accustomed evacuation. The conjunct cause is that gross and melancholic humor sticking and shut up in the affected part, as in a strait (pp. 279-80). 72. The glands at the root of the tongue are very subject to inflam- cmetTpSr- mations and swelling from crude, viscous humors. Swallowing is pain- ffauon and ful to the patient, and commonly he has a fever. Often the neighboring pUcaSons.^^ muscles of the throat and neck are so swollen together with these glan- dules that the passage of air and breath is stopped and the patient strangled. We resist this imminent danger by purging, by applying cupping-glasses to the neck and shoulders, by frictions and ligatures of the extreme parts, and by washing and gargling the mouth and throat with astringent gargarisms (pp. 293, 94). 73. The dropsy is a tumor against nature by the abundance of i>ropsy- waterish humors, of flatulences, or of phlegm, gathered one while in all the habit of the body, otherwhiles in some part, and that especially in tlie capacity of the belly, between the peritoneum and the entrails. From this distinction of places and matters there arise divers hirids of dropsies. . . . Yet they all arise from the same cause ; that is, the weak- ness or defect of the altering or concocting faculties, especially of the liver, which has been caused by a scyrrhus, or any great distemper (pp. 299, 300). 74. The beginning of the cure must be with gentle and mild medi- p^^^gatvo^I cines ; neither must we come to a paracentesis, unless we have for- and diuret- merly used and tried these ; therefore, it shall be the part of the physician to prescribe a drying diet, and such medicines as carry away water, both by stool and unf%ne (p. 301). 18 THE DOCTRINE OF PURGATION. from*^"orV- ^•^- Tetunus — Caiises. — Abundance of humors causes repletion; meutitious dulling tlic bodj by immoderate eating and drinking, and omission of matters. gxercisc or any accustomed evacuation, as suppression of the hemor- rhoides and courses, for hence are such like excrementitious hitmors drawn into the nerves with which they, being replete and filled, are dilated more than is fit, whence, necessarily becoming more short, they pi^^tiv^I siiifer convulsion. ... It is cured by discussing and evacuating remedies, ^'m'ldiciier^ as purging, digestive local medicines, exercise, frictions, and other things &c. ' which may consume the superfluous excrementitious humors that possess the substance of the nerves and habit of the body (pp. 329, 30). Note. — Allcock's Porous Plasters applied along the spine from neck to os sacrum, and Brandreth's Pills two every two hours, is good treatment for lockjaw. from^obftru ^^' ^^^V' — ^hc causc are humors obstructing one of the ventricles tion by mor- of the brain, or one side of the spinal marrow, so that the animal bid matter. £g^(3^^;[|-^ — ^^Q workcr of sense and motion — cannot, by the nerves, come to the part to perform its action (p. 332). Purgation In the curc of the palsy we must not attempt anything, unless we ^'^^^' have first used general remedies, diet and purging, all which care lies upon the learned and prudent physician (p. 333). . 77. Erysipelas. — The cure of such an effect must be performed by Purgef^Sii two mcaus ; that is, evacuation and cooling with humectation. If bile do not bleed. ^\q^q causc this tumor, we must easily be induced to let blood, hut we must purge him with medicine evacuating hile (p. 353). Note. — Bleeding must never be resorted to in Erysipelas ; it is dangerous, never does any good, and is certain to retard the cure. 78. The cure of gangrene, caused by the too plentiful and violent T^lu^rS- defluxion of humors suffocating the native heat, by reason of great mustb^^a- phlegmons, is performed by evacuating and drying up the humors, c%ated. which putrify by delay and collection in the part (p. 456). ... If the body be plethoric, or full of ill humors, you must purge (p. 455). 79. An ulcer has one, and that a simple indication, that is, exsicca- quS?Says ^^^^- • • • before you do anything about the ulcer, you must first use pv/rgation, general means ; for in Galen's opinion, if the whole body require prepa- nai appUca- ratiou, that must be done first, for in some ulcers ^purgation alone will be *^°"^' sufficient (p. 470). . . . Dry ulcers you shall correct by humeating medicines, as fomenting it with warm water, &c., but always you must first purge. . . . Then you must have recourse to refrigerent things (p. 471). Note. — The Gum Elimi Universal Cerate should be procured. We can recommend it. It contains no grease or oil, but is a vegetable production, and very useful in all affections of the skin ; as an application to a felon or otherwise it is superior to bread or liuseed meal as a poultice. ^^^y^OTo- 80. Ophthalmia can proceed from different causes, external and eyes. Pm-ge internal, producing the settling of humors to the eye. The evacuations THE DOCTRINE OF PURGATION. 19 of the matter flowing into the eye, shall be performed hj purging medi- cines, cupping the neck and shoulders with scarification or without \ and lastly by frictions, as the physician shall think it fit (p. 645). Allcock's Porous Plasters are superior, applied to back and shoulders, to cupping, scar- ifications or frictions. 81. The Diabetes is a disease wherein presently, after one has drunk, mabeten. the urine is made in great plenty, by the dissolution of the retentive fac- morMd mat- ulty of the veins, and the deprivation or immoderation of the attractive cluresTn- faculty. The causes are the inflammation of the liver, lungs, spleen, flammation. but especially of the kidneys and bladder. . . . For the cure of so great a disease, the matter must he purged which causes or feeds the inflammation (p. 688). 82. "Whenever the guts, being obstructed or otherwise affected, the coUe. excrements are hindered from passing forth, if the fault be in the small and^physfoi- guts, the effect is termed " Yoloutus, Iteos, or miserere mei ;" but if it ^gy. be in the greater guts, it is called the " colic," from the part affected, which is the colon. Therefore Avicen rightly defines the colic as "a pain in the guts, wherein the excrements are difiicultly evacuated by the fundament." Taulus Eleginata reduces all the causes of colic to four heads, to wit : to the grossness or toughness of the humors impact in the coats of the guts ; flatulencies hindered from passage forth ; inflammation of the guts ; and, lastly, the collection of acrid and bit- ing humors. . . . Over-eating and taking in of nourishments that do net agree with each other, or with the constitution of the body, produce crudity and obstruction, and at length the collection of flatulencies, whereon a tensive pain ensues. . . By the use of crude fruits and too cold drinks the stomach and guts are refrigerated, and the humors and excrements therein contained are congealed, and, as it were, burned up (p. 689). ... 83. There is also another cause of the colic which is not so common, Ente-oceu. to wit, the twininai: of the e:uts, that is, when they are so twined, folded cure by ^-wr- and doubled, that the excrements, as it were, bound m their knots, can- not be expelled.* . . . The colic is cured, the humors heing first atten- uated and diffused, and at length evacuated hy medicines taken hy the mouth and otherwise (pp. 690, 91). * Some sweet oil, followed hy a dose of BrandretNs Fills, is the simple remedy by which to relieve such painful state of the bowels. Also, clysters of water, about summer heat, should be given. 84 Arthritis, or Gout, is a disease occupying and harming the sub- oo^'t. stance of the joints by the falling down and collection of a virulent ^^^^ ^^i^ls^a matter and humors. When there is a great abundance of humors in a general dis- body, and the patient leads a sedentary life, not some one, but all the festingitseif joints of the body are at once troubled with the gout (p. ()9Y). locationr' 20 THE DOCTEINE OF PURGATION. 85. The causes of gont are unprofitable humors which are generated ^emp""^' and heaped up in the body, and in the process of time acquire a virulent wnei^fi'tep iii^lignit.Y- Sucli huuiors arise from an inordinate diet : they offend in tcant of ea^- feediuo: wlio Cat niucli meat, drink strona; wine, sleep presently after duceaVcMMi- their meals, and use little exercise. For hence a fullness and obstruc- morbid" mat- tiou of the vesscls, cruditics, and the increase of excrements, especially ^^^- serous, and, if they flow down into the joints, without doubt they cause this disease. Besides, also, the suppression of excretions accus- tomed to be voided at certain times. . . . Those who recover of great and long diseases, unless they be fully and perfectly purged, these humors falling into the joints, which Imperfect are the relics of the disease, make them become gouty. The humor m"diseaSs iuipact and shut up in the capacities and cavities of the joints, it cannot ^weTa&ut ^^ easily digested and resolved. The humor then causes pain by reason of distention or solution of continuity, distemper, and besides the viru- lency and malignity which it acquires. The concourse of flatulencies and hiiiderance of transpiration increase the morbific painful distention in the membranes, tendons, ligaments and other bodies of which the joints consist (p. 700). Cure: 86. To cure the gout there are two indications : the first is the evacu- Pw^7tion, ation and alteration of the jpeccant humors^ the other the strengthening had1^^sp?in| <^f the weak joints, accompanied by a fit diet. ... A fit time for purg- and autumn, jng is the Spring and autumn, because gouts reign chiefly in these seasons (p. 704 ; cf. Hipp. Aph. 55, S. YI). GOLDEN WOEDS. Purgation 87. ISTow, it is convenient that the purge be stronger than ordinary, for if it should be too weak it will stir up the humors, but not carry musTbe""""" them away, and they thus agitated will fall into the pained and weak ^gradually joiuts, and causc the gout to increase. . . . The fever accompanying B^ures^fso ^^^ S^^^ easily becomes continual, unless the belly being first gently the incident purged, uature be freed by stronger pu|ges of the troublesome burden ^ilTreat- ** of the humors. . . . Seeing that physic is the addition of that which ^^through- "i^cf^ture wants, and the talcing away of those things that are superfluous, c^urse^ofthe ^^^ ^^^ 9^^^ ^^ ^ diseasc that has its essence f7'om the abounding disease. humoT, ccrtaiuly, without the evacuation of them, we cannot hope to cure either it or the pain which accompanies it. Metrius, in his treatise of the gout, writes, that it must be cured by purging, used not only in the declination hut also in the height of the disease, which we have POUND TRUE BY EXPERIENCE (p. 710 ; cf. Hipp. Aph. 23, scct. I, and Aph. 8, sect. II.) Sciatica. 88. Sciatica. — Strorig purgatives are here also useful, such as used in pu^es and phlegmatic causes. Often vomitings do not only evacuate the humors, but also make a revulsion (p. 720). 89. The heat or scalding of the water arises from repletion, inanition or contagion. That from repletion proceeds from too great abundance THE DOCTRINE OF PURGATION. 21 of blood, causing tension and heat in the urinary parts, whence proceeds the inflammation of them and the genital parts. . . . Purgings are cur^y^l convenient, and a diet abstaining from heating articles, together with ff<^f^on. cooling external applications (pp. 738, 740). 90. buboes, or Swellings in the Groins. — The matter of these for the Buboes most part is abundance of cold, tough cmd viscous humors, as you may Evacuate the gather from the hardness and whiteness of the tumor, the poverty of the pm^ation. pain and contumacy of cure ; which also is a reason why the virulency of this disease may be thought to fasten itself in a phlegmatic humor. The cure shall be performed by detergent medicines, and the humor evac- uated hy a jpurging medicine (p. 746). 91. Tetters, Bing-worms or Chops. — For general remedies, the distem- per of the liver and habit of the body must be corrected. This may be T^**^'>^ done by diet conveniently appointed, by purging and alterative medi- kT.^'pur^' cines, as they acquire their matter from salt phlegm or adust bile (p. 754). 92. N"ow, the Small-Pox is pustules, and the Measles spots, which arise in the top of the shin, by reason of the impurity of the corrupt blood «ent there by the force of nature (p. 757). You must neither purge nor draw blood, the disease increasing or being at its height, unless perad- venture there be a great plentitude, or else the disease complicate with others, as with a pleurisy, inflammation of the eyes, or a squinancy* which require it, lest the motion of nature should be disturbed, but you shall think it sufficient to loose the belly with a gentle clyster ; but when the height of the disease is over, you may with cassia, or some stronger medicine, evacuate part of the humors and the relics of the disease (p. 759). * Quinsy. Parey was plainly unacquainted with the good effect of purgation in the early stao-e of Small-Pox, .when the purgative employed was efficient yet innocent. In many thousand cases the Brandreth Pills have been administered, more or less dur- ing the course of Small-Pox, and with evident advantage in every case. These Pills are very useful where patients cannot obtain a doctor, and there are thousands of towns in the United States where there is not a medical man within one hund- red miles. The following letter from Daniel Bissell, of l^ewcomb, Essex County, JSTew York, who was supervisor of the town for twenty years, may be important. I consider it my duty to publish it here : MR. BISSELL' S LETTER. Four persons cured of Small-Pox hy purging with JBrandreth's Pills. Newcomb, Essex Co., K Y., Sept. 13th, 1861. Doctor Benjamin Brandreth, New York. Dear Sir : In our family we have used your excellent Pills for several years, and have found them to be a never-failing remedy in mild and severe cases of sickness, but their full value we did not fully appreciate until last winter, when the Small-Pox visited so many fam- ilies in this and the surrounding towns. I was first attacked, and supposed I had a cold ; took four Pills and some warm drinks ; next day no better, took four more ; still no better, and my wife said I should take eight — did so, and then the SmaU-Pox began to show itself! On the fifth day took to my bed, and in less than four days was covered from head to foot with pustules. I continued to use the Pills daily, and took no other medicine whatever Small-Pox from impiir rity of the blood. The use of purgaUves. 22 THE DOCTRINE OF PURGATION. except your Vegetable ITniversal Pills. The Pox was less than four days in coming to a head, and in about the sauio time they dried up. I began to attend some to my stock in about two weeks, but in three weeks I was attending to my regular farming business, having quite recovered my usual health. I took eighty Pills during my sickness, in doses of four to eight Pills, according to effect, being careful to procure two or three evacuations a day ; and "though covered from head to foot with the disease, yet it has not left a mark upon me, which is one of the benefits said certainly to be secured by the use of Brandreth's Pills. I and my fiimily found this to be so in our experience of their effects in this fell disease. My wife, well known as Aunt Polly for one hundred miles around us, was attacked with the disease about the time 1 was getting well of it. From the first she understood it was the Small-Pox, and prepared herself to combat its virulence by a free use of the Pills. In six days, and while confined to her bed, and scarcely able to move from excessive weakness, Bhe used twenty-six Pills, or a little over an average of four Pills per day. And what was the consequence of this continued purging with Brandreth's Pills ? On Tuesday she was obliged to take to her bed; by Friday the pustules were all filled; and by the following Tuesday she had dressed herself! and in one week after was attending to her regular house- hold duties, to the astonishment of all her neighbors. One fact deserves notice : although she was covered with the disease, yet it has left no mark whatever on her skin, which bears no evidence of the awful ordeal it has passed under. Mrs. Wetherbee, my daughter, her husband, and their only child, were all stricken down by the Small-Pox. Mrs. W. had it light, and only some seven pustules came out. She used thirty Pills in fourteen days. Alonzo, her husband, had a severe attack, and took the Pills all through it, the number not noted. They both recovered in fourteen days from its com- mencement. Their little boy, Daniel, about fifteen months old, had the disease badly; we had little hope to save him. He was covered from head to feet ; he was like a huge scab; and for days he lay insensible. We all supposed he would die — that nothing could save him. His bowels had been confined for several days, and my wife said this must be reme- died — that perhaps if the boy could be purged he might revive. She read over yours and Dr. Lull's experience, and gave him one Pill, crushed, in some warm water. The Pill pro- duced no effect, but she was impressed with your remarks upon the necessity and import- ance of having the bowels purged in Small-Pox, and in all serious sickness whatever ; so she gave him another Pill. Still no effect. She then pounded three Pills, and added warm water, and gave them to the boy at once. Still no effect. There the little sufferer lay with- out motion, except the rapid breathing and peculiar signs of speedy dissolution evident to all. If he died, it would be said he might have got well had his bowels only been opened, and we then commenced to give him three Pills in two hours, or at the rate of one and one- half per hour. When this child of fifteen months had taken thirteen Pills, they operated, and most fully. The stools were black as pitch, and most offensive. Every one was satisfied that it was death and mortified matter which the Pills had brought away, and that the Pills had saved another life, through the Providence of God. In an hour after the Pills commenced to operate he began to revive, and took some re- freshment. He continued to improve until he got well. He is not marked with the disease. It seems proper to state that, though it took thirteen Pills to open his bowels, yet two days after he had a full natural evacuation without medicine, and his bowels have been regular up to this day, which is nearly nine months from the time of his sickness, nor has he used a Pill since. He is as lively, intelligent, and healthy a boy as can be seen. His parents will ever be grateful to you, and they and myself and wife desire you to publish this letter, which, if need be, can be certified to by all the residents of this and the adjoining towns. I am, respectfully, yours, DANIEL BISSELL, ** For many years Supervisor of the Town. We certify to the truth of the above. (Signed) — ^Polly Bissell ; Alonzo Wetherbee; Mart Wetherbee; Russell Root, Postmaster, Schroon River; Erastus P. Root; Thomas R. Carey, Justice of the Peace, Town of Long Lake ; Cyrus H, Kellogg, Supervisor of Town of Long Lake, 1860; William Wood, Commissioner of Roads, Town of Long Lake ; Josiah Wood, Raquette Lake ; Wm. Helms, Forked Lake ; W. H. Plumbley, Forked Lake ; Amos Hough, Forked Lake ; Ezekiel Palmer, Long Lake Hotel. ANOTHER CURE OF SMALL-POX. HOW TWO MEN WERE TREATED. I may also in this connection introduce the following statement of Joseph Daily, of No. 4 Union Square, New York : Joseph Malone and Henry Downs, acquaintances, on the same day were taken sick. Malone took ten Pills of Brandreth's ; next day, feeling no better, he took six more : still feeling no better, he took four more the third day ; fourth day better, got up and dressed himself, when, to his great astonishment, he observed large pimples on his face ; it was in Worms from Discid THE DOCTRINE OF PURGATION. 23 fact covered with Pox. Upon a further examination he found that they were coming out all over him; even the soles of his feet were full. Malone used the Pills more or less every day until he was perfectly recovered, which was within three weeks from the first day of sick- ness, when he was again at his business. Though covered from head to foot with the Pox they did not leave a mark behind. Henry Downs when taken sick called in a doctor, who discovered on the third day the true nature of the disease, and sent his patient to the Small-Pox Hospital on Blackwell's Island. There he remained two months, and then was discharged cured. He lost an eye while in the Hospital, and was so marked that his nearest friends hardly knew him. These facts will bear the strictest investigation. WOEMS. 93. A gross, viscid and crude humor is the. material cause of worms, which having got the beginning of corruption in the stomach, is quickly carried into the guts, and there it putrefies, having not acquired the '^hZmorr^at form of laudable chyle in the first concoction. This, for that it is viscid, inS Intes- tenaciously adheres to the guts, neither is it easily evacuated with the %^l^ ^^r^ other excrements ; therefore, by delay it further putrefies, and by the fl'a^*^^*- efficacy of heat, it turns into the matter and nourishment of worms (p. 765). In this disease there is but one indication, that is the casting out of the worms forth of the body, as being such that in their whole kind are against nature. . . . Now as such things breed of a putrid matter, the patient shall he purged, and the putrefaction repressed. . . . Oil of olives kills worms. ajst> so do all bitter things (p. Y67). Brandreth's Pills are infallible as a cure for worms, with or without olive oil. 94. Leprosy proceeds from impurity of hlood. — You must understand that the cause of the leprosy by the retention of the superfmities, happens uatu'o^' because the corrupt blood is not evacuated, but regurgitates over the Leprosy— whole body, and corrupts the blood that should nourish all the members, iiJT orfhe wherefore the assimilative faculty cannot well assimilate by reason of uau'iSfm- the corruption and default of the juice, and thus, in conclusion, the ^Jlvilit Tts leprosy is caused. The antecedent causes are the humors disposed to relJnCTatiJn adustion and corruption into melancholy by torrid heat. . . . Galen (ad Glauconem, lib. 1, cap. 11.) defines it : " An effusion of troubled or gross blood into the veins and habit of the whole body " (pp. Y69, YO). A cooling diet and purging shall be prescribed to evacuate the impurity of the hlood and mitigate the heat of the liver (ibid. ; cf. 68 ; cf. Yl, 82, 93 ; Hippoc. 42, 60). 95. Hydrophobia, — Such as have not their animal faculty as yet Hydropho- overcome by the malignity of the raging venom must have strong pur- ^purgatlvef gatives given them. For it is a part of extreme and dangerous madness Aaration and fitness ojf' '^l^%€d)s- corrupt liumors to take that infection (p. 819). the bodv °^ Humors putrify either from fullness which breeds obstruction, or bj distemperate excess, or by admixture of corrupt matter (p. 820). 97. I say that the pestilence does depend on the default of the air ; Abscesses this default, being drawn through the passages of the body, does at length pierce into the entrails, as we may understand by the abscesses that break out, by reason that nature using the strength of the expul- sive faculty, drives forth whatever is noisome and hurtful (p. 84:5V 98. The physician must not let blood, for when nature is debilitated by this evacuation and the spirits, together with the hlood, exhausted, the Tcuu^^^^^ venomous air will soon pierce and be received into the empty body, where it exercises its tyranny to its utter destruction. ... If there be strong great fullness in the body, especially in the beginning, . . then it is ^duiu ^pur^- lawful to purge strongly. ... If you call to mind the proper indica- ing saves, tions, purging shall seem necessary, and that must be prescribed as the case requires, rightly considering that the disease is sudden, and requires medicines that may with all speed drive out of the body the hurtful humor wherein the noisome quality does lurk and is hidden (pp. 846, 47). 99. Concussion of the Brain. — By a heavy blow or the like occasion, the veins and arteries of the^head may be broken. From hence pro- concussion cccds the afflux of blood running between the skull and membranes, or Purgation else betwccn the membranes and brain. The blood congealing there, causes vehement pain, and the eyes become blind, vomiting is caused, the mouth of the stomach suffering together with the brain, by reason of the nerves of the sixth conjugation, which run from the brain thither, and fi^om thence are spread all over the ventricle ; whence, becoming a partaker of the offense, it contracts itself, and is presently, as if it were, overturned ; whence first these things that are therein contained are expelled, and then such as may flow thither from the neighboring parts, as the liver and gall, from all which bile is first expelled (p. 351). Brandreth's Pills in these cases purge in from thirty to sixty minutes. 100. To cure a l)rohen and dislocated hone is to restore it to its In frac- former figure and site ; that is, first to restore the bone to its place ; &07iesandaii sccoud, to bring it to stay, being so restored; third, to hinder the opIrdii!)ns increase of malign symptoms and accidents, or else if they happen to Sr'fhebiood temper and correct their malignity. . . . For this purpose we drive away the dsfluxion ready to fall down upon the part by medicines, repel- ling the humor and strengthening the part, or by appointing a good diet, hinder the begetting of excrements in the body, and divert them hy purging (pp. 565, ^'o). T^OTE. — The importance of purging and the reasons therefor are strongly presented by Ambrose Parey, and will have weight with sensible men, in or outside of uhe profession indicated. THE DOCTRINE OF PURGATION. 25 Sanctoeius, M. D., Prof, of Physic at Venice ; Ars. de Statica medi- cina, Venice^ 1614. Aphorisms^ translated hy John Quincy, M. D. London, 1720 101. If there daily he an addition of what is wanting, and a suhtrac- The great ticm of wha,t abounds, in due quantity and quality, lost health may he S?Sf ^* ^i restored, and the present preserved. (Aph. 1, sect. 1.) disorgani- zation and reorga/niza- tion. He only who knows how much and when the body does more or less insensibly perspire, will be able to discern when and what is to be added or taken away, either fm* the recovery or preservation of health (Aph. 3). IS'oTE. — Nature herself does all these things, provided we relieve the body by purgation ; for innocent purgatives take out no humors but those which are depraved. 102. Insensihle perspiration is either made hy the pores of the body, which is all over perspirable, and covered with a skin like a net, or it is performed hv respiration through the mouth, which usually in the space '*io'>h tow it r> T . i 1 2 1 li' -\ r s. ^ y\ is performed. of one day amounts to about halt a pound (Aph. 5). Note. — Should either of these processes of the skin or the lungs be partially suspended, we have only to increase by purgation the activity of the bowels, this organ measurably taking upon itself their work, they partially resting the while ; then both lungs and skin will soon regain their healthy functions. Insensible persjnra- 103. If the body increases beyond its usual weight without eating or gfauc me- drinking more than customary, there must either be a retention of the f^j^^amentS sensible excrements, or an abstraction of the perspirable matter (Aph. 9). principles. The body continues in the same state of health as long as it returns to its wonted weight, without any increase of the sensible evacuations ; but if it comes to its standard by larger discharges, either by stool or urine, than ordinary, it then begins to decline from its former health. (Aph. 10; cf. Parey, Yl, 82, 93, 94 ; cf. Hippoc, 44, 46.) 104. From too great fullness arise bad qualities, but none vice versa (Aph. 18). Too great a weight and fullness may be lessened by sensible reqir^e? or insensible evacuations, either of digested or undigested matter, and it is good so to do (Aph. 19). Plethora requires evacucition. Sweat (or 105. That perspiration which is beneficial, and most clears the body of superfluous matter, is not what goes off with sweat, but that insensi- ble steam or vapor (Aph. 21). . . . which becomes sensible when there viable" per- is too great a supply, or upon faintings, or upon violent motions (Aph. Unhealthy. 22). Insensible perspiration accompanied with sweat is bad, because sweat diminishes the strength of the fibers. (Aph. 23 ; cf., Hipp. 29, 43.) When persons faint from severe purging, I have always observed that when they came to, the countenance appeared relieved from great anxiety ; perhaps a congestion was broken up, or some troublesome humor removed. 106. The body is not presently thrown into a disease by an external injury, unless some of the viscera be first disposed to receive its impres- Predispo- 26 THE DOCTRINE OF PURGATION. sition for, sioiis, wliicli predispositioii may be known by a greater or less weight SL orad- than is customary, and that not without some considerable uneasiness rancing di.^ (Apli. 39). The tirst imprcssious of a disease are much more easily movecritdi- discernible from the changes of an unusual perspiration', than from the ^Z^7lfa!'e disorders of any of the other functions (Aph. 42). If, upon weighing, J^^j i>"'w- the perspirable matter appears to have been obstructed, and there is neither increase of sweat nor urine for some days after, there is a great deal of danger of a putrefaction of the detained crudities (Aph. 43). If the obstructed matter can neither be removed by nature nor a feverish heat, there is immediate danger of a malignant fever. (Aph. 46 ; cf. Hipp. 17; cf. Hipp., 37.) 107. The excrements of the guts which are well digested, are large Evacua- ^^ bulk, but light in weight ; they swim because of the included air, «Mw^, when and what is ejected at once seldom exceeds the third of a pound (Aph. 72). 108. Importance of Ventilation to Invpercejpti'ble P<9r65'.— Nothing more tends to prevent a corruption of the hnmors than plentiful ventila- tion^^of^fhe tion; not only by that which is drawn in by the lungs, but what is lSfs(acUve drawu in through the imperceptible pores. (Aph. 120; cf. Hipp., 10, and nega- 55 and 13, 26.) tive). ' ^ 109. The plague is communicated not by any immediate contact, but Pestiim- either by drawing in infections air or the steams of tainted furniture ; S *Yow ^^^ ^^ ^^ ^^^^ • ^^^^ vital spirits are infected by the air, and from the propagated, infectcd spirits the hlood is coagiilated^ which produces hlach spots, car- and^^cured huncles and huboes^ and if not sufficiently discharged^ occasion death; but ^y^py^rga- ^^ .^i^g ^11 thrown out, they escape. (Aph. 127; cf. Parey, 94). The above shows the absolute necessity of Brandreth's Pills in Plague, because they purge safely. Air-\ii H^- The external air which passes through the arteries into the ^influence^^ body may render the body heavier or lighter ; lighter if it be subtle body. and warm, and heavier when thick and moist (Aph. 3, sect. II). In a foggy air perspiration is lessened, the pores are obstructed, and the fibers weakened and not rendered more firm ; and the weight of the retained matter is both perceivable and injurious. (Aph. 8 ; cf 103, 106, 109.) ^u^mer- Vll. Temperate persons weigh in summer time about three pounds less complaint: than in the winter (Aph. 23). That lassitude or weariness which is per- how It en- . , , . ^ .^ . J -. 1 1 T • 1 1 • 1 Bues. itscure cciva Die lu summcr time is not because the body is then heavier, but ^^i^r^to because it is then rendered weaker (Aph. 24). In summer time the ^^ItructJi'' ^C)dy is not uneasy from the heat of the air immediately, for every part tnaUer. of the body is even then hotter than the external air, but because at such times there is not a sufficient coldness to concentrate the natural heat. By which means it becomes so scattered that it cannot drive out the persjcrirable matter., in its own nature hot, by insensible steams ; which matter, by being retained, acquires a sharpness, and is really the cause of that uneasiness we are under from a sense of the summer heat (Aph. 27, sect. 1) THE DOCTRINE OF PURGATION. 27 112. When to Purge. — The autumn is unhealthfiil, both because per- Autumnal spiration lessens upon the supervening cold, and because that which is ob- cautestTw^e structed acquires an acrimony and a corrosive quality (Aph. 42). They \if^t,j'^a^X who are accustomed to a distemper in winter, that arises yV6»m a fullness mbnious ao- qf humors, ought to purge in autumn (Aph. 48). tSa!^^^' Note, — Our experience is, purge only when the body calls for it — when we have pain or oppression, or the bowels are costive. 113. But for such diseases as arise from noxious qualities, ^urgvug spring the ought rather to be used in the spring than autumn, because in the hot pit^^^n^Jbr weather such qualities grow worse more than in the wintef (Aph. 49 ; of. Parey, 86). coni^tituW ri- al diseases. 114. If the obstructed perspirable matter acquires an acrimony, it pro- . Acrimony duces fevers and inflaminations / but when it offends only in quantity, and'^'"^^^ ^ super- abundance it causes apostumations, distillations, and cachexies (Aph. 51). caSd by purga- tion. 115. When a full meal is not perfectly digested, it is to be known by an insensiue increase of weight, for the body will not then perspire well ; but an l^fretion- empty stomach is filled with vapors (Aph. 12, sect. 3 ; cf. Apo. 5, sect. 1.) JJ^!? J^^, ^^^de'- Robust persons discharge their food for the most part by perspiration ; pending on those not so strong by urine ; and the weak chiefly by an indigested ai stren^gtT" chyle (Aph. 14). A full or an empty stomach lessens perspiration ; for a full one diverts it by corruption of the aliment, and an empty one draws it back, that it may be filled (Aph. 11), and the obstructed mat- ter will acquire a sharpness, whence the body will be subject to distem- pered heat (Aph. 15). 116. When a person seems to himself lighter than he really is, it is a sensation very good sign, because it arises from a perfect digestion of all the juices ofi»eaith. (Aph. 19). 117. That sort of food best perspires, and aifords the most suitable what is nourishment, whose weight is not perceived in the belly (Aph. 28). foo^^^^^^ 118. N^othing more frequently interrupts sleep than a putrefaction of watchful- the food, such is the sympathy between the stomach and the brain (Aph. mo?bid mS 40, sect. 4). From eating comes sleep ; from sleep digestion, and from *^]^^^S?/ digestion a good perspiration (Aph. 59 ; cf. Parey, 99). o^ brain and 119. By exercise bodies are rendered lighter ; for all the parts, espe- Digestion cially ligaments and muscles, are cleared of their excrements by motion ; ll'SZ^ t1£ the perspirable matter is fitted for exhalation, and the spirits rendered '^°*^^- firmer (Aph. 9, sect. 5). Exercise promotes both the sensible and in- sensible evacuations ; but rest only the insensible (Aph. 10). 120'. The heavy part of the perspirable matter beina; more than usuallv " ^f^^^^' . • 1 • ;i 1 1 'i '11 T j_ ^ T ■. '^ ness'' from retained m the body, it will dispose a person to tear and sorrow ; but obstrncted the lighter part being obstructed, to anger or joy (Aph. 5, sect. Y). Therefo^ 28 THE DOCTRINE OF PURGATION. Haevey, William, De. — The works of, written 1628-51/ transl. hj BoU. Willis, M. D., andpuUished ly the Sydenham Society. London, 1846-47. tb?w3^" 121. The blood acts with forces superior to the forces of the elements. As the instrument of the Great Workman, no one can ever sufficiently extol its admirable, its divine faculties. . . It penetrates everywhere, and is ubiquitous ; abstracted, the soul or the life, too, is gone, so that the blood does not seem to differ in any respect from the soul, or the life (anima) itself. At all events it is to be regarded as the substance whose act is the soul or the life. . . In one way the hlood is part of the hody, hut in another way is the beginning and cause of all that is contained in the animal hody. . . That which is abundantly nourished by it, in- creases ; what is not sufficiently supplied, shrinks ; what is perfectly nourished, preserves health ; what is not perfectly nourished, falls into diseases (pp. 510, 11). vitiaud, 122. Yitiated states and plethora of the blood are causes of a whole iiood. ];^Qgt of diseases (p. 391 ; cf. Hippocr. Works, p. 262, Vol. I., Aphor. 22, sect. 2 ; cf. Parey, 68-99). i^a^ethe 123. The physiological consideration of the things which are accord- mediSLe ""^ ^^^ ^^ uaturc is to be first undertaken by medical men, since that which '^^^' is in conformity with nature is right, and serves as a rule both to itself and to that which is amiss (p. 90 ; Hippocr. Works, p. 102, Yol. I., p. 360, Yol. I). The timid 124. N"ot yielding implicitly to the truth, he fears to speak out thrnewdoc^ plainly, "lest he offend the ancient physic" (p. 91). ^ 125. Who will not see that the precepts he has received from his ^ie/ofHa?- teachers are false; or who thinks it unseemly to give up accredited vey'stime. ^p^^Q^Q^g . ^^ ^\^q regards it as in some sort criminal to call in question doctrines that have descended through a long sifccession of ages, and carry the authority of the ancients ; to all these I reply : that the facts cognizable ly the senses wait upon no opinions, and that the works of th^'^^'Sdest ^^'^^^^ ^^^ '^^ ^<^ antiquity ^ ; for, indeed, there is nothing either more authority.^^ anclent or of higher authority than nature (p. 123 ; cf. Hippocr. 47). • The Uood ,._ __^ 126. The Uood is the generative part, the fountain of life, the first to ^'^^' live, the last to die^ and the primary seat of the soul (p. 3Yf). The blood is both the author and preserver of the hody / it is the principal element, moreover, and that in which the vital principle (ani- ma) has its dwelling place. . . The blood, moreover, is that alone which lives and is possessed of heat while life continues (p. 379 ; cf pp. 510, 11). THE DOCTRINE OF PURGATION. 29 Collins, Samuel, M. D., System of Anatomy. London^ 1685. 127. Cathartics do not only affect the hlood at a distance, but also the aSJ^nSV- villous coat and nervous filaments, which do immediately disturb them cines act on with troublesome stroaks preceding from the pungent particles of pur- lnd^*°Ste?- gatives, vellicating the inward coat of the stomach as a tender compage Jitfon^o/the beset with nervous fibrils, which, irritated by sharp medicines, spew out intestinal --•' '- _«/. _i - -7r__ nerves, stim- the serous liquor out of the excretore ducts, derived from the glands of the mating mteStmeS. motion and The purgation extract of medicines first produced by the ferments the^'^mucous of the stomach, and afterwards imparted to the intestines, does highly matter. excite the nervous and carnous fibers, and gives a most troublesome sensation to the inward coat of the guts finely dressed with fibrils ; and afterwards afiects the excretory vessels of the pancreas and hepatic ducts with a kind of convulsive motion, making them disgorge their pancreatic and bilious recrements, into the larger receptacle of the intestines. And not only the feces of the hlood, secreted from it in the glands of the liver and pancreas, are thrown into the guts by the excitement of the nervous and carnous fibers, but also the extremities of the arteries and excretory vessels belonging to the glands, are opened by the sharp and aperient qualities of the purgatives, unloching the secret pores of the inward coat of the intestines lined with a mucous meatier, which is scraped off hy the cleansing qualities of purgatives^ leaving the intestines exposed to the active power of raking medicines, which force open the extremities of the arteries (p. 369, vol. I). 1 28. The concoctive faculty of the intestines is disaffected ; first, as it pathology is wholly abolished, when no chyle, or very little, is extracted in the tmes.^ stomach or intestines. This evil proceeds from the want of natural heat deficient primarily in the blood, and from a defect of good succus pan- from^^^^^ot creaticus, and bilious liquor, and a laudable serous and nervous juice, stmcUon of not being imparted by the extremities of the arteries and nerves to the laidpZrl crude aliment lodged in the guts. This disorder is commonly called cnvehjpvr- lienteria, an unnatural excretion of the aliment, little or no ways altered, 6'«*^'^^^- wherein its compage is not well opened by due ferments, and a secretion made of the alimentary liquor from the grosser feces (p. 370). This obstruction of the hepatic and pancreatic ducts is cured by aperient medi- cines (p. 371). 129. Another disorder of the intestines near akin to the former, as caeiiat differing from it in degree, is the lessened concoction, commonly styled '^{fnferfeJt caeliac affection, wherein the food is in some sort digested, and remains digestion confused, as not secreted from the gross parts, because the chyle is not «^T compt well attenuated by the pancreatic and bilious liquor, and serous and fScuifur^'J nervous juice, which are destitute of volatile salt, oily and spirituous ■^'^^^^: ^r^'al particles, so as to render the chyle fluid in the intestines ; whereupon the *»« medi- clammy chyle embodying with the crude aliment, is excreted by the ex- ^^"'^' pulsion faculty (p. 370). This distemper is cured by the same means as a lienteria (p. 371). 130. The third indisposition of the concoctive faculty of the intestines imper/ect digestion 30 THE DOCTRINE OE PURGATION. from acrid 1* it^ depravcd action^ produced by ill ferments of sharp hilioios^ and acrid Pm-'gr^' _pi^^iicreafic llquoi^ vitiating the extracted aliment in the guts, and after- wards spoiling the mass of hlood^ when it is received into association with it in the blood-vessels (p. 370). It denotes gentle aperient medicines (p. 371 ; cf. Parej, 94). indige^- 131. Another disaffection of the intestines, and that none of the least disorders'^^Sf bccause it concerns the nutrition of the whole body, is when the ^utivi^fdcui- distrihutive faoulty of the chyle is either wholly taken away or much % 1^^ ^^^ lessened, which may proceed either from the clamminess of the chyle, lisJlitj/ If or from the grossness of pituitous humors, more or less obstructing the humors. orifices of the lacteal vessels seated in the intestines. The cure of this disease may be assisted with a light diet and medicines promoting the digestion (p. 371). sioicness 132. The intestines are also incident to divers diseases in reference to from'^JfiS their expulsive faculty^ when the peristaltic motion is too slow, or too iveness of quick, or aggrieved with the discomposure of pain. Purgatives stimulate them to acfi nui nerves. The slowucss of the motiou of the guts proceeds either from the torpid indisposition of the nervous coat, not resenting the irritation by gross excrements, when the nervous fibrils inserted into the inward coat of the intestines have their acute sense lessened, proceeding from tlie want of animal spirits intercepted first in the fibrous parts of the brain, and by consequence in the nerves of the guts, produced by cephalic diseases, compressing or obstructing the fibrils seated in the brain. This dis- affection is cured by proper methods and medicines relating to the dis- eases of the head (p. 371). In all the diseases of the hrain, Collins recommends purgatives to a greater or less extent (pp. 1133, 1134, 1138, 1145, 1153, 1163, 1169, 1181, 1194, 1199 ; voL II; cf. Sanctorius, 118). Torpor of 133. The slowness of the peristaltic motion, incident to the guts, may unes *from ^^ ^^^o dcrivcd from narcotic medicines, dulling the acute sense of the narcotics norvos which terminate into the inward tunicle of the intestines, where- movX' by upou they are not sensible of their burden, when they are oppressed with gaS.^^^' excrements. This disease may admit a cure by strong purgatives and sharp clysters (p. 372). Hardened 134. The rcmissuess of the expulsive power of the guts may also mofer^ by arisc from the viscid and indurated contents, produced by ill concoction ; jjurgat^es. ^^ other from the heat of the guts, exhausting the liquid parts of the excrements ; the guts being overcharged with excrements, purgatives may be advised (p. 372 ; cf. Hippocr. 13, 25, 26). Lientery, 135. The over-hasty motion of the guts is made in 2i lientery 2^^^ mseanddi- casUac disease, proceeding from the quantity of crude and indigested exIitedpeT- aliment provoking the nervous and carnous fibrils to excretion. This ^taitic mo^- clisaffectiou of the guts is visible also in diarrhea proceeding from salt bT' pur'ga- phlegm and from bilious and serous excrements discomposing the tender ^'^^*' compage of the guts, and irritating them to expulsion. The cure of TPIE DOCTRINE OF PURGATION, 31 tins disease is performed by lenient and astringent purgatives (p. 372 ; cf. Sanctorius, 103; Hippocr. 44, 45). 136. Inflammations of the guts producing dysenteries are most com- Dysmury monly seated in the great gut, which, proceeding from a quantity of SwfprT blood impelled by the mesenteric arteries into the intestines, some part of ^talnati^n which is stagnant in the substance of the bowels, and other parts are of J"^i'^^« transmitted sometimes into the small guts, where it seldom makes any -boweu. long stay, as, being thrown from there into the colon, wherein the blood is long retained ; whereupon the tender frame of the coats is corroded by the sharp blood confined in the deep cavities of the colon (p. 3Y2), The vitiated expulsive faculty of the guts coming from inflammations, and from an ill mass of blood, is cured by clysters made of healing medicines and by purgatives (p. 373 ; cf. Sanctorius,103, 106, 109, 110). 137. The iliac passion proceeds from divers causes, sometimes from the luacpas- small guts twisted^ other times entangled and tied in knots ^ and also fjj^^ .^ ^^^ when they shoot downwards and upwards into one another. It may be smnii guts derived from astringents unduly used, and from a stoppage of the intes- muiauon of tines by viscious matter from hardened excrements, and from flatulent gtnerSiy^ac^ matter contained in the guts intercepting the passage of the gross ^X^^Sllle- feces. . . Now and then the upper shoots into the lower, and sometimes ness of the the lower into the upper part of the small intestines, which are much whkh^is re= distended in several places, and in other parts contracted for some space ^^rl^atw"^^ both above and below ; whereupon the free play of wind being checked, medicines. the patient is highly tortured with pain, and, to ease himself, puts his body in divers postures by various agitations and flexures of it. A re- laxation is made of some part of the guts adjoining the contracted parts, which, being moved forward by the pressure of wind toward the relaxed intestines, force them into the next expanded parts of the guts, which are afterwards closed up by the duplicature of them, entirely intercept- ing the passage of excrements. And when in this miserable distemper the lower part of the guts is thrust into the cavity of the upper, the pressing down of the excrements, made by art in purgative medicines, discharges the insinuation of the lower gut into the upper (pp. 376, 76). . The iliac passion may arise out of a gross alimentary liquor or phlegm concreted in the intestines, wholly shutting up the passage of them ; whence ensues a recoiling of the excrements upward, produced by the irregular contraction of the fleshy flbers (p. 377). This disease often happens upon a long suppression of natural evacuations l)y stool, gener- ated by a load of hard excrements, long residing in the guts, productive of intolerable pains (p. 378 ; cf Hippocr. 38, 41, 44). 138. The colic is near akin to the iliac passion in the situation of the (cf. Parey. subject and in the cause of the disease, both proceeding from sharp ^^'^ humors productive of vexatious pains, and from the great obstruction ^^^^ . ^^_ and tension of the guts, caused by a quantity of gross excreTuents, and cumulation more thin and flatulent matter (p. 379). This disease takes up its man- fng^^^ood, sion, if not solely, yet chiefly, in the colon. Colic pains are generally tfousZ^attir felt in the lower apart/ment of the abdomen, accompanied with nausea, and fi&tuien- vomiting, suppression of stools, pains in the hack, &c. . . Colic, accom- ^^' panied with heat and beating pains, arises from blood impelled out of /^ symp^ 32 THE DOCTRINE OF PURGATION. the terminations of the capillary mesenteric arteries into the substance of the coats of the colon ; piercing and fixed pains come from sharp pancreatic licpor blended with viscid phlegm, or bilious hnmors lodged Tvithin the coats of the guts, which produce pungent and wandering pains (pp. 380, 81)! . This disease denotes purging and alterative medi- cines (p. 382). ' Active.re- 139. I conccivc the carnous and nervous fibers are much weakened ?5?S ^tile by the inflation of the coats of the intestines, whereupon the irritation ^"'■^- of the medicines is not easily felt, and the carnous fibers do not con- tract ; upon this account strong purgatives must be given, or rather gen- tle, often repeated, assisted with purgative clysters, wdiich excite the peristaltic motion of the guts to discharge the indigested aliment or gross vitreous phlegm, or indurated excrements (p. 384 ; cf. Hippocr. 55 ; Coll. 134). Abscesses and TJlcers of the mer sentery. Pain^ of the hack and other diseases of tka mesente- ry — their causes and cure hj pur- gation. 140. Abscesses and ulcers of the mesentery are cured by gentle purga- tives and proper drying diet-drinks (p. 393). 141. Great pains in the back are not the disafifection of the colon only, but of the m.esentery, too. . . Mesenteric affections are often de- rived from the serous feculencies of the blood, impelled out of the capil- lary arteries into the substance of the mesentery, and from flatulent matter distending the fibers of the mesentery. A cure may be attempted by emollient and discutient clysters and by purgatives, gradually increas- ing their strength, and by fomentations (p. 395). Diarrhea 142. When paticuts labor under a great diarrhea, I conceive it very '^auL.^^^' dangerous to advise powerful astringents until nature has fully discharged herself, or art emptied the guts of gross and more thin excrements (p. 3Y6 ; cf. Parey, 92, and Hippocr. 2). ^ .^^ 143. The immoderate use of opiates produces apoplexy, the drug the cause of stupifvinff and relaxing the nerves, and causinsr the stagnation of the apoplexy, ^ood in the cortcx (pp. 1128, 1129). Apoplexy, 1^4:.' The slccpy diseases (apoplexy, earns, coma, lethargy), being itroS^pur- ^'^^ ^^ *^^^^ causes, are much alike in their cures, too. . Strong purga- gation. tivcs may be given, and after a purgative has been celebrated, vomito- ries may be administered (pp. 1131, 1132, 1133). Vertigo- 145. Yertigkious symptoms arise from irritation of the nervous &/SS- fibrils of the stomach, intestines, liver, pancreas, spleen and kidneys, tmMnerves. proceeding from sharp recrements, which, offending the fibrils of the viscera, taking their origin from the brain, give a lightness to it (p. 1136) ; and as to the preservatory indication in an ill habit of the bodv, purgatives may be applied (p. 1138 ; cf. 132). Deiirivm 146. In phreuitis and paraphrenitis, produced by an undue effer- eJSiluon vescence of the blood caused by heterogeneous particles, or by the blood o£the bow- being poisoned with malignant qualities (p. 1140), which is induced by serous recrements vitiating the nervous liquor (p. 1143), clysters are THE DOCTRINE OF PURGATION. 33 very successful to empty the howels of excrements and winds (p. 1145 ; cf. tarey, 94 ; Sanctorius, 109). 14Y. Melancholy being produced by vitiated hlood and corrupt humors ly^-^^^J!^^^ in the viscera (pp.' 1150, 1151), is cured by vomitories and purgatives, 'morua removing the gross phlegm from the stomach and discharging gross, ^e tiood"' acid, and saline recrements from the blood (p. 1153). 148. Mania borrows its first rise from an ill mass of blood, caused Marvia. by the distemper of the hepatic glands not secreting the bilious from ^loM^ *Jy the more laudable parts of the blood (p. 1159). Btrang purgatives are ^'^Sf/^'^' used with advantage in this stubborn malady, as they purify the blood and nervous liquor (p. 1163). 149. Frequent and large doses of opiates incrassate the mass of the j.?^^c? mo- blood (p. 1167) and nervous liquor, rendering them effete and vapid, so pishness & that the brain cannot accomplish the acts of sense and reason, making «^^^*'^*^- men mopes and sots. To refine the hlood^ purging medicines, prepared with cephalics, may be very proper in those diseases (p. 1169). 150. The indication to take away the cause of epilepsy is principally fro^t^^tti. founded in rectifying an ill mass of hlood and nervous liquor, which ^f^ f^^^ ^^ depends much upon a laudable state of the viscera, so that the ill diathe- sis of the blood and viscera is taken away by vomiting, purging, and bleeding (p. 1181). 151. Palsy. — The motive faculty is impeded or abolished, because PaUyirom. the origins of the nerves are obstructed by the grossness of the nervous ^eS^n*The" liquor, which may arise from a thick, feculent, albuminous part in the ^^^^^^ ^^^ blood (p. 1193). A palsy sometimes succeeds severe pains of the stomach imperfect and intestines (p. 1194), which are produced by an accumulation of bilious The^rSsfep and excrementitious matter and hardened feces and dilatation by flatu- ^p^lauon.' lency, compressing the beginning of the vertebral nerves and intercept- ing the current of the circulating fluid (p. 1195). The antecedent cause of palsy is an ill mass of hlood generated by a bad diet, hard of digestion (p. 1196). Yomitories may be advised in a foul stomach, but purgatives and alteratives for a habitual palsy (p. 1199). In a palsy derived from an evident cause — a fall, stroke, or wound — the apertion of a vein may be proper, after an emollient and discutient clyster has been administered and rejected (p. 1198 ; cf. 139 ; Parey, 83 ; cf 136, 137, 138). Sydenham, Thomas, M. D. The whole Works of that excellent practical Sydenham. Physician, written about 1686. Transl. Dr. Pechey. London, 1701. 152. Though a purge does for the present raise a greater tumult in Purgatives the blood and other humors, on the day it is taken, and in the operation, ^o'SlestTiTd than was before, yet this injury will be sufficiently made up by the ad- ^^^*- vantage that presently follows ; for it is found by experience that purg- ing quells a fever sooner and better than any other remedy whatever, both as it expels those filthy humors from the body, by which, as the antecedent cause, the fever was occasioned / and if they were not peccant before, yet, at length being heated, concocted and thickened by the fever, 34 THE DOCTRINE OF PURGATION. Filth!/ hu- ^\^^ miicli to render it more lasting (p. 432 ; cf. Hipp. "Works, L, 174; Tcedenr W. Harvej, 391; Sanctoriiis, 103, 106, 109, 110; Collins, 136-138, 151). cause. Sweating 153. Purging preferable to ^Sweating. — . . . On the contrary, as ing '^'?om- that method which is busied in eliminating the febrile matters through ihl^h na- ^lie pores of the skin is less certain, so it is more troublesome and fe"elf"'^h ^^^^ic>iis ; for by it the disease is very often protracted many weeks, and siceating,^ the life of the patient thereby endangered. . . . For this reason I insist, SiVehyput- upon good grounds, that purging is more powerful than any other gativts. method for the subduing fevers of most kinds, for though sw^eating is nature's own method by which she casts out febrile matters, and is more sons given geuuiue and commodious than the rest, when nature is left to itself most excel- ^^ j^^^^ digosts the aforcsaid matter, and then, when it is well concocted, gently expels it through the- habit of the body. Yet art, how much soever it may seem to imitate nature, cannot arrogate to itself the privilege that it is able to cure fever certainly by sweating. For, first, art knows not by what means the peccant matter should be fitly prepared to undergo expulsion ; and if it should know this, yet it has no certain signs by which it should be admonished of the due preparation of it ; so that also it is unavoidably ignorant of the fit time for provoking sweat, which it is very dangerous to provoke rashly; while if the physician should, by purging, miss his aim in curing the patient, yet he will not hurt him (pp. 432-34 ; cf. Gid. Harvey, p. 286 ; cf. Hipp. 29, 43 ; Sanctorius, 105 ; Parey, 69 ; Hipp. 9.) 1^^ The above a highly important article. f^<^^"^ 154. If the humors are retained longer in the body than they ought, Diseases^va- either bccause nature cannot concoct them and afterwards expel them, portio^^To or because they have contracted a morbific disposition, they become '^SaSr^^'l^ exalted into a substantial form or species, which discovers itself by this morbid mat- or that disordcr, that is a2:reeable with its own essence. ters. ' ^ uke pro- The symptoms of disease^ though to the less wary they may seem to arise from the nature of the part which the humor possesses^ are really disorders arising from this or that specific exaltation or specification of some juice in the hody. For nature is as methodical in producing and ripening these as of plants and animals, unless the order of it be dis- turbed by some extrinsic thing (as purgation). The species of diseases depend on those humors from whence they were generated. (Preface.) In Chronic 165. Chronic Discascs. — Nature has not an effectual method in these SsS^T' diseases, to eject the morbific matter, as in acute, whereby, we assisting and aiming at the right mark, the disease may be cured. (Preface.) Note, — ^Purgation usually changes tlie chronic into an acute disease by assisting nature to expel impurities ; thus the blood becomes endowed with greater vitality. Disease^ 156. A discasc is nothing but nature's endeavor to thrust forth, with ** ej^t at^ all her might, the morbific matter for the health of the patient, though '^^ the cause of it be contrary to nature (p. 1 ; cf. Hipp. Aph. 2. sect. I ; Sanctorius, 106.) THE DOCTRINE OF PURGATION. 35 157. Irrtjpurities mixed with the blood affect the whole with a mor- why na- bific contagion, partly from the yarious ferments or putrefaction of TJ^eiimpu- humors which are detained in the body beyond their due time, because ^*^^«- it was not able to digest or evacuate them^ either upon the account of their hulk heing too great, or the incongruity of their quality (pp. 1, 2). 158. What is the Gout but ^Nature's contrivance to purify the blood ^^^*- of old men (p. 2) ? 159. Purification. — Nature performs this office, sometimes quicker, F&cers— sometimes slower, for when she requires the help of 2. fever, whereby she ce^sTof^cSJe' may be able to separate the vitiated particles from the blood, and after- ^J^°^ ^^'^^ wards expel them, the whole business is done in the mass of the blood, any cause and that by violent motion of the parts. . . . When this kind of matter i^esJlmpZ- is fixed to any part which is unable to exclude it, either upon the ac- 2l?&c ^nd count of its conformation, as it is in the morbific matter of a palsy that r,?^^^%, the nerves are stufied with, or upon the account of a continued flux of low. hemrl new matter, wherewith the blood is vitiated, which is only disposed to cessaryf^^ carry it ofi*, does oppress and overwhelm the part. 1 say in these cases the matter is very slowly or not at all concocted, and so diseases that proceed from such unconcocted matters are, and are called, chronic (pp. 2, 3 ; Cf. p. 432 ; 19. ; W. Harv. 90, 391 ; Sanctorius, 112). 160. He will not be mistaken much who should affirm that more Diseases diseases arise hence, viz., from the omission of purqinq after autumnal •^^/"* ^*^* diseases, than from any other cause whatever (p. 21 ; Cf. Hipp. Aph, uon. 12, II. ; 43, 56, YI. ; Works, TOT, II. ; T28, II. ; Aph. 32, lY). 161. All means to avoid disease or infection are useless, if the hody is furnished with humors disposed to receive the infection (p. 59 ; cf diseaslfthe HippOC. W. 102, I). Se^pure."""'* 162. Cholera. — Should I restrain the first effort with narcotic medi- cuura- cines and other astringents, whilst I hindered natural evacuation, and de- ^|/[*^^^^^* tained the humors against nature, the sick would undoubtedly be destroyed by the intestine war, his enemy being kept in his bowels (p. 115 ; cf. Hipp. Aph. 2, I. ; 21, I ; Collins, 142). 163; ^denham on Hippocrates, Nature and Disease. — The excellent mppo rates' Hippocrates who arrived at the top of physic, laid this solid foundation ^^r^' cure's for building the art of physic upon, viz., i^ature cures disease, and he f^'^'^gi^^ delivered plainly the phenomena of every disease, without pressing any piyadescnp- hypothesis into his service. He also delivered some rules gathered from lure. ° Art of the observation of that method that nature uses in promoting and '^^t^'i^^'J^ removing diseases, and of these things consisted the theory of the divtne ^'^''« opiy ^y old man . . . This theory was nothing else but an exquisite description S^simpie. of nature ', it was reasonable that in practice his only aim should be to relieve her, when she was oppressed, by the best means he could ; and therefore he allowed no other province for art than the succouring of nature when she was weak, the restraining her when she was outjrageous. 36 THE DOCTRINE OF PURGATION. and the reducing her to order^ and to do all this in that way and manner, wherehy nature endea^vours to expel diseases ; for the sagacious man per- ceived that nature judges diseases, and does in all, being helped by a few simple forms of remedies, and sometimes without any (preface ; cf pp. 432, 2-3 ; W. Harvey 123). \%^. Bcarlei Fever. — I reckon this disease is nothing else than a Fever. ^^ moderate effervescence of the blood, occasioned by the heat of the fore- going summer, or some other way, and therefore I do nothing to hinder the depuration of the blood and the ejecting of the peccant matter through the pores of the skin, which is easily done by the blood itself. PurgaUves 166. But when the scales are gone off and the symptoms ceased, I think ci^e."" other it propcr to PURGE the sick with some gentle medicine that is agreeable to stroy/^^ ^ his age and strength ; and by this simple and plain natural method, this name of a disease, for it is scarce anything more, may be easily and safely removed. Whereas, on the contrary, if we disturb nature by cordials and other needless remedies too learnedly thrust in secunduim artem^ the disease is hightened and the sick dies by the over-officiousness of the physician (pp. 189-90). 166. I think pleurisy is a fever originating in a proper and peculiar a mtuTaf ?t- inflammation of the blood, an inflammation by the means of which tempt to cure natuTc doposits the peccant matter in the pleurae. Sometimes she lays by ehmtn at- . i i • i /> i t i • • rm • t rv> ing morbid it ou the luug itseli, and then there comes a peripneumonia, ihis diners metiood.^^ from the pleurisy only in degree. It exhibits the results of the same cause with greater intensity. (Society's Ed., vol. I., p. 247.) Harvey Gideon, M. D. The Vanities of Philosophy and Physick. Zd edit. London^ 1702. 167. 1st. Things in philosophy and medicine which we do not know, Uncertain- ^^® bcyoud all mauucr of comparison more than those things we do ty in medi- kuOW. 2d. The greatest part of these things in medicine, which we pretend to know, is conjectural and uncertain. 3d, Many if not most of these things which we do peremptorily affirm to be this or that, to be caused by this or that, or to cause and effect this or that, are or may be proved to be false (pp. 7, 8 ; cf. Parey, m ; cf. W. Harvey, 124-126). Tfi.& Hood 168. The antecedent causes of most diseases are the fluid parts of the dSeSse^ ^^ blood, the fluid animal lynvpha^ the glandulous lympha, and the- hlood being vitiated (p. 139 ; cf. F. Harvey, p. 391). Theory of 1^9. How True.— Thc wcakucss of the stomach and its faintly per- forming its office, is only occasioned by the debility of the stomach- nerves, and their various branches, by being plastered up by too much fleam^ gross and acid dregs^ indigestible rneals^ or offensive drinJcs^ or other matter admitted into the stomach, which, by lodging there too long, assume a corroding quality. . . . (cf. Sydenh., Prof.). THE DOCTRINE OF PURGATION. 37 170. This supposed, I do believe, and have experimentally observed, that all those corroborations of the stomach, whose virtue is commonly eifrl^^^o asserted to consist in a gentle restrictive and warming quality — whereby notstrength- these slimy humors are more iirmly cemented — so far from contributing the least strength to the stomach, being long continued, do carry danger with them (p. 227). 171. The only means I have hitherto found to strengthen the stom- ach are proper abstersive medicines, gently wiping off those clammy sub- stances from the tunic of the stomach, and the terminations of the nervous branches. . . . Do only heep your stomach clean^ you will certainly pre- serve its strength, and jprevent most diseases (p. 228 ; cf. Hipp. Aph. 8, sect. II. ; Parey, 87). Purgatives the only strength- eners. 172. Herodotus (in Euterpe) who was contemporary with Hippoc- rates, tells us that the Egyptians, to whom the first invention of physic is ascribed, used to take purging-physic, for three days together every ^f'^tTli month, for no other purpose than to cleanse their stomachs, knowing they among the could be subject to no diseases but what the foulness of their stomachs E^^^tians. might occasion, in regard their bodies were strong, and their air the most clear and temperate in the world, (p. 232). 173. It is not to be understood, where a heap and weight of crudities is accumulated, that gently absterging remedies can have power to disen- gage the stomach, any more than a wet mop can be supposed to rid a room of a heap of rubbish, — in which case something more stimulating is re- quired, that may be used in all seasons of the year, be it sultry or freezing, without the inconvenience of confinement to diet or warmth of air, or without ofience to the stomach, or putting the body into any disorder ; to which purposes the pill I here now describe, I have experimentally found to be effectively answering in most respects, (p. 228). I'uU pur- gation. Brandreth's Pills are superior to the following in all tlie elements of cleansing physic. . 174. Take one ounce of the clearest shining aloes ; powder it in a mortar, covered over with a brown paper having a hole in the middle for a passage to the pestle. Observe to anoint thinly the bottom of the mortar and pestle with a little Florence oil, to keep it from sticking to the bottom. When it is reduced to a gross powder, by grinding it with the pestle you must bring it to a smooth fineness. Put the powder into, a small glazed flat-bottomed earthen pan, that will contain about half a pint, pouring upon it about a quarter of a pint of water, wherein has been dissolved 2 drams of Spanish juice of Liquorish, which is done by slicing it very small and setting the water in a porringer over a gentle heat ; place this same earthen pan into one somewhat bigger, having sand in the bottom to the height of an inch, and afterwards filling _ it up to the brim. Set them over two piles of bricks of three or four bricks laid fiat. The piles must stand at such a distance, that they may reach the edges of the bigger pan to support it. Then make a moderate fire of charcoal un- der it, to heat the same, to cause the superfluous moisture to be evaporated, The ffar- eyPill. 38 THE DOCTRINE OF PURGATION. until tlie aloes is brought to tlie thickness of honey. Or you may, by drop- ping two or three drops on the back-side of a plate, to cool, make a trial whether it be reduced to the consistence of dough ; for if it be over- done, the mass being rendered brittle, will not only lose most of its virtue, but also its aptness of being framed into pills ; and if it be not evaporated enough, it will be sticky, and not apt to be brought into a mass. The lesser pan being taken off, when the evaporation is sufficient, before it is quite cold, you must with a spatula or slice take out the mass, and between your fingers, being a little anointed with Florence oil to pre- vent the sticking, roll it into a round ball, which you may keep in a sheep's-bladder, being likewise thoroughly wetted over on the inside with the same oil, for many months, if necessary. A small piece of this mass being formed into 6, 7, 8, or 9 little pills of the bigness of a pepper-corn, is a dose sufficient to give two or three motions. The safeness of this medicine adds much to its character, since the taking of one pill, or two, more or less, imparts *as little hazard, as the taking it very often, or in any kind of season, be it hot or cold, &c. . . . By the addition of the use of Liquorish, the aloe is designed to be obtused in its too purgative qualities, whereby it is apt to raise the piles, and become somewhat less precipitating, &c. The same correction may be obtained by taking a large handful of Bug- loss or Borrage-leaves, and stirring half a pint of warm water with them in the bruising, and clarified by subsidence in letting it stand in a cellar for a day or two, and pouring it off the feces or dregs in the bottom. This evaporated in the same manner, will produce a mass almost equal in goodness to the former, (pp. 223 — -5). The whole of what follows in Paragraph 175 is equally applicable to Brandreth's Pills, whose virtues far exceed all other cleansing medicines the world has yet seen. 175. I cannot but heretofore observe, that the use of these pills, though frequently taken, according to the time the stomach, by reason of its degree of weakness in the digestive faculty, may require, does in anywise Purgatives debilitate those that may properly use them ; but on the contrary, rath- do^not weak. ^^. (3Qpj.Qi3Qi.ate their stomach by assisting it, to throw off that heap of rub- bish and crude humors, which those that eat and drink plentifully, and either live sedentary lives, as many that are educated to professions, or others that are not used to exercise or labor, are subject to engender, especially if naturally of a weak constitution or of an advanced age. (p. 235). (cf. Hipp. Aph. 8. Sect. I). . . For three or four days succeed- ing the use of these pills, a good £Jlixer proprietatis taken morning and evening, in a proportionate dose, has, by my observation, ever had the good effect of preserving health and preventing disease, (p. 235.) (cf. Sydenh. 153). 1T6. As lesser purgatives do rather contribute strength, by their con- pv/rgaimM sequcucc, SO the greater^ being properly used, do not carry that danger strengthen with them pcoplc commouly imagine, since I have known many that, weaken. ' for three months successively, have taken strong churlish purging pills, ev- ery morning, some few days only omitted. I may say some have swallowed a bottle of strong purgative pills in a few years, and lived in full health THE DOCTRINE OF PURGATION. 39 to a remarkable old age, and not without a libertine mode of eating and drinking. Whence it is apparent, that the toughness of the nerves, upon which the strength and action of the bowels only depend, does suifer as little by the strongest purgatives, as an Indian cane by a thousand times bending, which notwithstanding will recover its former figure and full strength, (p. 236), (cf p. 223). Our experience and the experience of all who have used Brandreth's Pills confirm these remarks on bleeding. 177. It were to be wished that bleeding could be admitted with the same safety, of which it may be justly said, that the lancet has, and does in proportion kill more men, than the sword ; and it is as commonly observed, that those physicians who do so generally practice it, know little else what to do. (p. 236.) ... It is a consequence an idiot infers, because a person having been bled eight or ten times in a great distemper, does recover his health, he owes the benefit of it to the bleedings, whereas it ought rather to be said, neither the distemper nor the bleeding could kill him. (p. 237). ON LAUDA]SrUM. 178. I stand amazed at the folly of mankind that is so easily allured, by vain boasting and mendacious encomiums upon Laudanum Uquidum^ Laudanvm plainly prepared or disguised ; to the frequent and constant use whereof '"^^^ ®^^'^- a man being once debauched, under the pretence of ease, and quieting himself of a few gripes, fumes or vapors, he can no more leave it off for a fortnight, a week, or a day, than a laborer his bread and cheese, or a man throw off his coat and waistcoat in a hard winter, or a brandy- drinker forsake his spirits and return to small-beer. Using onesself to such plain or disguised opiates, after some months or a few years, is like making a contract with the devil to live easy and well for a few years, upon condition he shall have his soul to torment afterwards. For certain it is, that the familiar use of opiates, after some months or- very few years, does wholly desist from being friendly, by suffering your trouble or distemper to return in a more horrible manner, or create a new one incomparably worse than the former, or strangles you with an apoplexy. Or some other soporous distemper, which is most amply proved by those that make opium their sacred refuge in every fit of the gout, colic or stone, who seldom or never fail of a speedy exit, by some incurable dis- ease of the brain in " very few years. And those that do advise such a lethiferous remedy for a common use to their patients, have a greater title to a halter labelled with an inscription of " Mathews' Pills," or " Pacific Drops," than those that murder a man on the highway, (pp. 237-38.) ... In short all strong narcotic medicines occasion weakness of the stomach-nerves, numbness, palsies, lethargies, loss of memory and dullness of understanding, diminish and deprave all the offices, actions or operations of the bowels, suppress the appetite, occasion a wildish countenence and paleness, and at last, upon long usage, usher in death (pp. 238-39.) (cf. Collins, 133). • 40 THE DOCTRINE OF PURGATION. Purgation preserves and pre- vents. 179. To preserve health and prevent disease in valetudinary consti- tutions — for strong, vigorous bodies stand in no need of other preserva- tions or preventives, than moderation in their nonnaturals^ the know- ledge and sense whereof nature has implanted in all other animals, as well as in man — no better ways and means can be used, than applying at certain intervals to those cleansers and abstersers before mentioned, (p. 239). Hemorr- Aoides. Harvey'' s Liniment. 180. For those subject to Hemorrhoides, the following Liniment Electuary is recommended. Four ounces best Cassia Fistularis, newly drawn and evaporated to a consistency — the manner of doing it you may read in a treatise called the " Family Physician and House Apothecary " — Rhubarb, powdered, while Mechoacan, grated and powdered, and clean Rhenish (not cream of) Tartar powdered, of each a quarter of an ounce, Sweet Fennelseeds, powdered, a dram and a half, Syrup of Mash- Mallows, as much as will suffice to make them into an electuary, (pp. 239-40). Take half an ounce or an ounce, dissolved in a quarter of a pint of thin gruel, barley-water, po§set, or thin chicken-broth, according to directions given concerning the aloetics. (p. 240). Har'vey\ Emetic. 181. In Headaches from over-eating or drinking^ in Apoplexies^ Palsies, Fevers, c&g., when purging medicines are too tedious in their transportation through so long a space, as the roundabout of the guts, a vomit that will throw up immediately through the gullet, by a short passage, the whole burden at once and operate kindly, without disturb- ing any of the other bowels, or raise a mud in the humors — antimonial vomits are excluded, as being too long before they operate, too churlish in disturbing all the bowels, and exciting a violent commotion in the humors. Ipecacuanha, that new fangle, brought by the French from the West Indies, is the root dried of a mere common j^Wc^^s whereof, in the places where it grows, you may buy a cartload for a two-penny looking- glass, or a penny-worth of bugles, though at Paris they have the confi- dence of selling it at thirty or forty livres a pound, — which, notwith- standing, our asarum-root does far exceed in the operation — than which there can not be a more unacceptable drug to the taste in the world, &c. . . Take the purest White Vitriol, one and a half ounce, being pow- dered and ground very fine, put it into a glas^ bottle-bolt-head, pour upon one and a half pint of springwater, and half a pint of clean English Spirits, once rectified, which they call Double Spirits. Close your boft- head with a cork and a wet bladder over it, tied with packthread. Place the bolt-head standing upright in a sandbath and let it digest, with a moderate warmth, twenty-four hours. But remember to shake the bolt-head very well, before you place it in the sand. After this digestion decant the liquor gently into a glass funnel, wherein is placed a coffin of cap-paper folded according to art, and so let it filtrate into a glass bottle. When it is almost quite passed through to the quantity of a spoonful, take out the funnel and throw away what is left. If you filtrate it a second time over, it will be the clearer and more depurated. This is a very easy, 'gentle and safe vomit, operates nimbly, and for cheapness ex- ceeds all others. It may be kept always ready upon every occasion, without making aity bustle, and so lasting, that its virtue continues for THE DOCTRINE OF PURGATION. 41 many years ; and for the most part it will move a stool or two, whereby it carries oii" those crudities that are remaining in the stomach, or that are escaped into the guts. When you find occasion for using the vomit, you must pour out three, four or five spoonfuls, according to your easi- ness or difficulty to vomit; ])ut commonly three spoonfuls is enough. This must be mixed with double the proportion of vi^arm small-beer or v^arm w^ater, wherein a little Carduus has been boiled, or thin gruel ; then drink it off. If this do not operate in a quarter of an hour, take a spoonful or two more, or you may load yourself with carduus boiled in water until you vomit. This may be taken safely in the beginning of most distempers without any further consultation, (pp. 244-45). Gideon makes a grave mistake in respect to Ipecacuanha. It is one of the best and most safe roots ever applied to the use of man, as a vomit or purgative. It is one of the ingredi- ents of Brandreth's Pills. When a vomit is needed take four Pills, and drink hot boneset tea, and your stomach will surely discharge its contents. 182. About throwing off the febrile matters by sweat. ^ . . . Whether diaphoretics ought to be used before the declination theKeand of a fever, at which time only they appear to be healthful in assisting f^p^S^ nature to throw off, for it must be owned by all experienced practition- ers that the causa febrilis, be it vicious humors, heterogenous particles, or what other offensive they are pleased to allow, must be first sub- dued, or digested and separated, before it can be expelled by sweat ; and therefore, should you exhibit the largest doses of diaphoretics that nature can possibly bear, and second them by loading the patient with a num- ber of bedclothes, he will scarcely be brought to sweating ; and if, per- adventure, he should happen to be forced into a sweat at the augment or state of the fever, it must be a very great detriment. . . Supposing, fictitiously, that diaphoretics were proper, the uncertainty of their oper- ation would often occasion a failure of the effect that is expected from them. Purgatives and vomitories seldom or never fail in their operation, if justly dosed, but sudorifics and diuretics very often, though adminis- tered in great quantities (p. 286 :■ cf. Sydenh., pp. 432-434). The advantage of Brandreth's Pills is that they require no care, and whether taken in large or small doses are sure to be of service. In full doses the beneficial effects in all se- vere diseases are at once evident. And when the system requires a vomit they usually act on the upper passages of the stomach. But the additional use of hot boneset tea, after a dose of four or six pills, is sure to act as an emetic and without any danger. Some gruel should be ready for the patient to take after the vomiting is over ; this is needed, when sleep will follow. Haevey, James, M. D. Prcesagium Medicum. London^ 1720. 183. In delirious distempers great hopes of recovery are had from all sorts of evacuations, chiefiy because they check the velocity of the d^u^^^ ^ blood, diminishing its quantity, take off its obstruction, and relax the nerves (p. 10). 184. Pains, especially if they be fixed a long time in any of the 42 THE DOCTRINE OF PURGATION. noble viscera, impair tlie strength of the patient, and obstruct the circu- impiltier'^ hition of the blood, concoction, and secretion of the humors. . . But in acute disease it is accounted a sign of recovery when pains invade the legs and feet, and happen upon a crisis or signs of it. 185. But though such pains speak an impetus of the blood and force Th6 Crisis, ^f iiature to throw off the matter of the disease upon those more igno- ble parts, yet, when they go off without any apparent cause, as the ad- ministration of medicine, or natural evacuations, the huTnors may he justly suspected to have returned into the mass of hlood^^ by which the case is rendered more dangerous than it was, and a happy event of a crisis in acute distempers, depending upon mere chance, or a favorable turn of nature, is always uncertain and never to be relied on (p. 30 ; cf. Sydenh. 432: M. Harv. 391 ; G. Harv. 139 ; Collins, 130V Uq^ na- 1^^- I^ ^^® ordinary and natural motion of fluids that serve either ture removes for nutritiou or cxcrction there are necessary passages or channels OT ^otherwise through whicli they run easily, but in extraordinary cases, as all diseases ^s^ses of ^^^^ nature finds out extraordinary ways by which it throws out the noxious matter, or at least puts it in a less dangerous place (p. 43 ; cf. Hippoc, Edinb. ed. Epidem., lib. ii., sect. 5 ; Parey, 69). 187. The animal life depends upon many and different causes, and Ufe, Health an integrity of all the parts of the body, especially those that are prin- ^ease. cipal, as the head, heart, arteries, and veins, and the liquors that run in them, namely, the blood, chyle, &c. But because our bodies cannot always continue in the same state, its parts, both solid and fluid, being worn, consumed, and dissipated by continued motion, there must be a continual supply of food for its reparation, as well as proper instruments and vessels, in which it may be prepared and made fit for that nurpose. The Stom- 188. N'ature, therefore, has contrived the stomach.^ intestines^ and glands^ in which, by a wonderful mechanism, our food is pounded and aoC ^'^"' concocted, and its grosser parts separated from those that are more fine and subtle, the one for the preservation of life, and the other as the useless, to be thrown out by emunctories ordained for that end. But when those instruments are defective — which often happens — and the muscular force of the stomach is insufiicient to grind the food and make a chyle of fine parts, that which we receive for nourishment and repara- tion of our hodies not heing duly prepared^ is so far from heing useful that it is rather hurtful to us. For this unconcocted food or crudity entering into the mass of hlood^ renders it viscious, tough, and of a clary substance, unfit for motion and circulation, and the cause of most dis- eases (cf. Collins, 137 ; Sanctorius, 109, 101*). . . 189. "Whatever, therefore, is useless to the body, or inconsistent with the hlood, must he separated from it, that it may be preserved in a per- * At these times an extra dose of Brandreth's Pills should be administered. THE DOCTRINE OF PURGATION. 43 feet state. Hence the endeavors of nature^ and the contrivance of the intestines^ cuticular glands^ and other emunctories appropriated indeed une^^ "^and to their jpecxdiar excrements^ hut soTuel/imes com,mwi to all or most of them (p. 92 ; G. Harvey, 16B). their vica- rious office. 190. Evacuations by sweat are to be attempted with the greatest caution, not indiscriminately by all persons nor at all times. For if Forced medicines to procure it be given when the blood is of a texture not open f^-" a^ger enough — which it cannot be near the beginning of most feverish dis- turbances—or when too heterogeneous substances abound in it, forced sweats oftener dispose the blood to stagnate in the tender vessels of the brain and nerves than to separate its noxious particles at the designed secretory parts (p. 129 ; c£ Sydenh., pp. 432-434 ; Gid. Harv., p. 286) Assist na- 191. Nature — by which I mean the eifects of matter and motion, according to the laws and constitution of animal economy — is indeed ture by pro- the great physician and cure of disease; so that now-a-days several dis- ^awmT. ^ turbances are happily taken off by the slightest remedies, or by a mere abstinence from them. But, in acute diseases^ the die is cast for life or death, and in this case nature is not to be altogether relied on ; neither must we, as the advocates for the doctrine of crisis, patiently wait for the issue of the conflict between nature and the disease, the peccant humors of some fevers being sometimes so stubborn, that art must in- terjpose to promote their evacuation some other way. (pp. 207-8.) (Cf. p. 92 Sydenham, 163, 166.) WiLLAisr, J., M. D., An Essay on the Kinoes Evil. London. 1735. ' ' ' ^ ^ ' Diminish the morbid 192. The diminution of the morbific matter, hoth in the primae vim ^q^*^\^^^ and tohole hody. i-s to be effected by cleansing; that canal, and evacuatins^ *^« <^(^^se. of the morbific matter out of it ; and ' by this means we cannot fail of lessening its quantity in every other part of thehody. (p. 21.) (Cf. J. Hamilton, 218.) • Purging with Brandretli's Pills infallibly lessens the quantity of impurities ; and as they are harmless to the most tender age, or the weakest or most feeble, they can be used every or every other day, reducing the sum of unhealthy matters contained in the body, and thus taking an extinguisher or weight from the blood, whose vitality becomes thereby increased, and all the parts of the body be duly nourished into £• renewed life and vigor. Pringle, Sie John, M. D., on the .Diseases of the Armies. London^ 1753. U Ed., 1761. 193. Early Sweats. — It has been usual to give the theriaca, or some ^^^^^ other hot medicine for this purpose ; but all such increase the fever, if sweats. they fail in bringing out the sweat (p. 131), 194. The hilious or remitting fever of the camp begins with chilli- ness, lassitude, pains of the head and bones, and a disorder at the stom- and'^remit- ach. At night the fever runs high, the heat and thirst are great, the sym'pSms!"" 44 THE DOCTRINE OF PURGATION. tongue is parched, the head aches violently, the patient gets no better and often becomes delirions, but generally in the morning a perfect sweat brings on a remission of all the symptoms ; in the evening the paroxysm returns. These periods go on daily, till the fever changes insensibly either into a continued, or into an intermitting form. Some- times loose stools carri^ of the fit and supply the sweats. Although the effort^atjj^re f^yQ^ most frequently appears in the form of a quotidian, yet sometimes when evacti- it is to bc sccu in a tcrtiau shape I rememher of no natural evacua- poice\fui'^ lions malcing a complete cure^ unless when a violent discharge super- 'veiied of the corrupted Mle, or other humors which seemed to he the cause of the disease (pp. 165-6Y). (Cf. J. Harvey, 190.) Nature's Sweat 195. When the sweat is abundant, the putrid parts of the blood are, either wholly or in some degree, expelled, after which the fever is either entirely cured, abated or brought to intermit, (p. 183,) (cf. 194.) Evaeua- 196. On MUous fevcrs in Britain. — Instead of evacuating or correct- iioTis pre- \^„ what is amiss, we often neelect it, till it ends in obstructions of the vent many ,& m t \ ^ n t • , > i , n forms of mscera. So that hence may proceed nervous complaints without lever, sease. ^^ fevers of a nervous hind, instead of fluxes, interiniiting or remitting fevers, the common consequences of a more sudden and thorough cor- ruption of the humors, (p. 200.) (Cf. Collins, 132, 135.) Why the 197. Wc may observe that the fibres are more relaxed in the spring th??tt?st ^^ "^^^^ ^^ *^® winter ; hence that the body becoming more plethoric, the season to humors wiU then be apter to corrupt, upon any suppression of perspira- ^^^^' tion. And this may perhaps be forwarded by the eflhwia arising from all putrid substances which, being locked up during the cold of winter, are then set at liberty by the greater heat of the sun. (p. 201.) 198. Dysentery. — We must at all times attend less to the dose than to ifceifeM^X ^^ ^ff^^t^^ which are never to be judged of by i\iQ frequency but by the servations laroencss of the stools, and the relief the patient finds from the qripes the we of and tenesmus after the operation. The motions are generally more fre- purgatwes. q^^gj^^ from the disease alone than from the purgation. As on the one hand, the physician must avoid all the rough and stimulating purges, so on the other hand, he is not to spare those of a lenient kind. (p. 240.) The necessity of continuing the physic is to be determined more by the awi^'a^trin- obstiuacy of. the gripes and tenesmus, than by blood in the stools. nfitf dan'^^er- ^^^^^<^'^^ such frcquent evacuations, it is in vain to attempt a cure • as all ous pallia- opiates and astringents by themselves only palliate and render the disease ^*'^^*" more fatal in the end. (p. 241.) (Cf. Sydenham, 162 ; Hippocr. 8. G. Harvey, 175, 176.) 199. As to opiates, it were better they were never used at all, than ■^/?r/* ^ given before the first passages were thoroughly cleansed ; for though they afford some ease, yet by penning up the wind and corrupted humors, THEY FIX THE CAUSE. This I prcsumc to affirm from repeated experience. 1 am well assured, that the fluxes I have seen in the army, are never to be cured without evacuations, (p. 241-42.) (Cf. J. Harvey, 191.) 'cauH6 " of the disease. THE DOCTRINE OF PURGATION. 45 200. In some cases the patient would seem likely to recover, but would relapse upon voiding hard scybala which, coming away in small fecesThe^'*^ parcels for several days together, made a constant irritation. These, easerto**be therefore, were to be speedily removed by a full dose of rhubarb with J^^^^^^^J®' manna, or by some other lenient physic, (pp. 245-46.) (Cf. Collins, lescence en- 134, 139, 151.) 201. Palsy. — Of purgatives the most active should be selected, and such as influence most energetically the principal secreting Viscera ; as paUy— calomel, colocynth, jalap, scammony, &c. In paraplegia^ and even in g^SoSs. ^"''' hemiplegia^ the bowels are very torpid, and require repeated and full ^^^^l^^ doses of ihose^ and even of still more energetic cathartics, as cro ton-oil, gia. or elaterium, in some obstinate cases. In many cases recourse should also be had to purgative enemata. It is not merely necessary regularly to evacuate fecal matters by means of these, but to employ them so, as to derive from the cerebro-spinal axis any increased flow of blood to it, which may have occasioned, or prolonged the attack. Indeed,^ with these conjoined objects, they are advised by Halle^ Dalherg, Brodie^ and others, who have insisted on their use. (p. 242.) (Cf. J. Harvey, 183 ; J, Harvey, 171, 175, 179.) I have advertised the above sentiments for forty years, at an outlay of more than a mil- J lion of dollars, and long before I saw the above able remarks, j I now insert the following testimony, which applies well to Sir John's remarks. The following was published in 1863. It tells its own story : SANITARY COMMISSION. " "What is it doing to economize the Life and Health of our Soldiers ?" " Is it using all the means Providence has placed within its reach, or is it stiff-necked, and determined that so great a remedy as BRANDRETH'S PILLS shall not be used to econ- omize the life and health of our Soldiers ?" Sagacious men believe that the administration of BRANDRETH'S PILLS, in its " Homes" and as " Special Relief " would more than quadruple the present value to the " Life and Health of our Soldiers." Let the following testimony from sixty returned volunteers be studied by members of the United States Sanitary Commission. If the statements be true, can they be doing their duty as Christian Men in not using the means Providence has placed within their reach ? FRIENDS OF SOLDIERS— READ . JBrandreth's Pills protect from the arrows of disease, usually as fatal to soldiers as the bul- lets of the foe. j Sing Sing, October 26, 1863. | We, the undersigned, surviving members of Company F, Seventeenth JN". Y. Volunteers, hereby certify that we have used Brandreth's Pills during our two years' service, and to them we attribute the fact that our constitutions are uninjured by the necessary hardships and privations of a soldier's life in the field. In costiveness, colds, chills, diarrhoea, dysen- i tery, and typhoid fever, their prompt use cured us in a few days. Our health was often ; restored without having been entered on the sick list ; in fact, a single dose of four or five • |j pills usually cured what, under the regular treatment, would have been a serious sickness. |l Others, who appeared to be sick in no way different to us, but who used the remedies pre- I scribed by the regimental surgeon, either died or were sick for weeks in the hospital. I When we left Sing Sing, in June, 1861, you gave us a supply of these Pills, and we feel sure, from our experience, that if every soldier was supplied with this medicine, the gen- ■ eral health of the army would be greatly improved. For ourselves, it is our sole remedy, ! answering all our wants in the way of physic, and we have known and tested it from our j childhood, and our parents before us. ! | 46 THE DOCTRINE OF PTTRGATION. John Yickars, Captain; J.J, Smith, \st Lieutenant ; "William See, \st Sergeant; G. H. Dearing, '■2,d Sergeant ; Dennis Shay, Zd Sergeant ; Patrick Cullen, Ath Sergeant ; Benj. F. Brown, \d. Corporal; Wm, Mathers, 2c? Corporal ; Noah W. Miller, 3c? Corporal ; Theodore QvoiwX, Drummer ; Geo. B. Coe, Drummer. Francis J. Jenning, William W. Campbell, William J. Charlton, Albert Wesley, John W. Griffin, William Holmes, William W. Rider, Martin See, George Ackerly, Hiram Seagle, Alfred Wilkins, William Griffin, George Ayles, William J, P. Hewett, John L. Branden- burgh, Thomas A. Barlow, Henry Hannah, William Waldron, John Conover, Jacob Baker, Lewis B. Coy, Albert Lane, Ellis Jones, Wm. Van Wert, James B. Crofut, Roscoe K. Wat- son, Frederick Hunt, William Tuttle, Jotham Carpenter, Charles Wright, Sanford Olmstead, Fuller Carpenter, James Bentley, Robert W. Westcott, Jacob H. Byckman, John M. Bodine, James N. Hines, Edward Waldron, Warren Wright, David Baker, T. B. Lane, 1st Lieut. 38th N. Y. Vols. ; M. C. Larle, 1st Sergt. Co. D, l'7th K Y, Yols. ; Wm. Knight, Co. I, 6th N". Y. Artillery; Millard F. Lanning, Musician, 1st N. Y, Yols.; Wm. Ivenney, Co. R. Berdan's Sharpshooters ; Cassius Bishop, Co. E, 38th N, Y. Yols. ; Elliot See, Co. B, 38th N. Y, Yols. ; Daniel GiUis, Sergt. Co. B, 3d K Y. Yols, ; Caleb S, Frisbie, Co. B, 5th K Y. Yols, State of New York, Westchester Co,, ss, : I, William M, Skinner, a Notary Public, duly commissioned and sworn, residing in the village of Sing Sing, County and State aforesaid, do hereby certify that the names of the sixty persons subscribed to the Certificate hereto annexed, dated October 26, 1863, concern- the value and efficacy of Brandreth's Pills, beginning with Capt. John Yickars and ending with Caleb S. Frisbie, were signed in my presence, and that I, at their request, witnessed their signatures to said Certificate, I further certify that I am well acquainted with all who signed said Certificate, and know them, individually, to be men of truth and veracity. In witness whereof, I have hereunto subscribed my name and affixed my official seal, this eleventh day of January, one thousand eight hundred and sixty-four, WM. M. SKINNER, Notary Public. State of New York, County of Westchester, ss. : I, Hiram P. Rowell, Clerk of the County aforesaid, and also Clerk of the Courts in and for said County, do hereby certify that Wm. M. Skinner, Esq., whose name is subscribed to the Certificate of the Proof or acknowledgment of the annexed Instrument, and indorsed thereon, was, on the day of the date of the said Certificate, a Notary Public, in and for said County, residing in the said County, appointed and sworn, and duly authorized to take the same according to the laws of the said State, And further, that I am well acquainted with the handwriting of the said Notary Public, and verily believe that the signatiA'e to the said Certificate is genuine. In testimony whereof, I have herevmto set my hand, and affixed the seal of the said Courts and County, the 12th day of January, 1864, HIRAM P. ROWELL, Clerk. Cullen, William, M. D.^ First principles of medicine^ London, Fmers. 202. Fevers. — Sweating employed to pre Yent intermittent fevers, has ojieT '''dun- often changed them into continued fever, which is always dangerous. gerous. (^^ ^q^^ Urging the sweat, may produce hurtful determination to some of the internal parts, and may be attended with very great danger, (p. 166. f.) HoBEETSON, Robert, M. D., An essay on fevers, dhc. &c. JRobinson, 1790. 203. Idiopathic fever. — Whenever men complain of being seized with chilliness, or alternate chills and heats, headaches, sickness at stom- THE DOCTRINE OF PURGATION. 47 acli, universal pains, or as the sick express themselves " pains all over them ; or pains in all their bones, or joints, especially in their loins and nf^Zerai back, with less or more debility ;" and if their countenance is at the same ^^«^«c«er-. time obviously diseased, whatever the other symptoms accompanying these are, I can, from experience, assure the reader, that a most virulent infection is present (p. 59). 204. Whatever has a tendency to debilitate the system^ may either fe^'J^tg aJi be a remote or aproximate cause of fever, according to the constitution of ^J«^ ^^^^^' the patients. A sufficient reason may be assigned for many people being tem. seized with fever at the same time ; which is, their being exposed to the same debilitating powers of lieat, cold, draught, or wet, or sudden changes of these (p. 88). Miller, Edward, M, D., Inquiry concerning cutaneous perspiration and the operation and' uses of sudorific remedies. New Yorh, 1Y98. Medical Repository, 1798, Vol. II.; See Med. <& Phys. Journ. 1799, Vol. I 205. That sudorifics can not he usefully employed as a general remedy pevers^x^ \b. fevers., \% apparent from the fatal course pursued by many of these not cured by diseases, notwithstanding the most copious, universal, and continued sweats, spontaneously taking place. The memorable sweating sickness, which first appeared in England, towards the close of the fifteenth cen- tury, and was one of the most fatal epidemics on medical record, affords ample proof of this position (Journ. p. 288). 206. On the whole it may be concluded, that much of the use of Errors sudorifics has arisen from mistaken doctrines, concerning the nature of ^ ^\ng!^^ ' perspiration and of fever, particularly from the erroneous opinions, that the matter of perspiration is excrementitious ; that its occasional obstruc- tion is noxious ; that it ought as much as possible to be eliminated from the system ; and that it is only carried off, in considerable quantity, when discoverable by sight or touch (ibid). 207. It may be also concluded, that sudorific remedies, especially those of the more powerful kind, are, in general, highly unsafe, and cal- umafl'^^^d culated to augiment the molence of infiammatory and malignant f eiders y ^^jtirious. and, that though they may succeed in some cases of less violence, or by a favorable concurrence of circumstances, yet they are so constantly liable to produce mischief, and exasperate the disease, that the abuse, on the whole, must be pronounced greatly to overbalance the use (ibid). Selle, H., M. D., Professor in the University of Berlin ; new con- tributions to physical and medical hrwwledge, Berlin, 1798. See Med. & Phys. Journ. 1799, Vol. I. 208. Puerperal fever. — This disease originates in an accumulation of "?S Puerperal from ccv/mula- Gorrupted humors in the abdomen, which humors have either been al- *l^2 ""ImtZr ready separated in the form of milk, or intended by nature to be so. in the oMo- 48 THE DOCTRINE OE PURGATION. The causes of this accumulation may be various, but are principall}^ an epidemic miasma, passions, sudden cold, and inflammation (Part III. p. 92). In corroboration of Professor Selle's theory, Dr. Hermbsteadt has proved by chemical experiments, that the fluid matter found in the cavi- ties of the abdomen was virtually rnilh. It deserves, however, to be remarked, that the fat of tlie omentum and the mesentery, being dissol- ved by the febrile heat, may combine with the extravasated lymph, so as to produce a fluid of a more or less viscid consistence, and resembling milk in its external characters (Journ. p. 387). Bache, William, M. D.. On a successful case of Asthma, Bvrming- ham,ll9d. Bee Med. & Phys. Jouen. 1799, Vol. II. 209. I became convinced that an acid pervaded the whole of the '^eteS-etiol circulating system, and I presumed that it existed in a morbid degree, the cause, either as to quantity or strength, and was the exciting cause of the spasmodic affections observable m the lungs, and other membranous parts, to which it might occasionally be applied, probably sometimes in a gase- ous state, and at others in a more dense and concentrated one, and per- haps variously combined. The indications of cure suggested to my mind were to restrain its influence, and my attention was principally directed to the state of the stomach, the bowels, the expectorations, the Md- neys and the shin (p. 141). CoNEADi, D. G. C, M. D., Besiderit^ Physician at Nwthetm, Ger- many. Practical rema/rTcs on the most prevailing species of cramp, in the stomach. See Med. & Phys. Jotjkn. 1799, Yol. I 210. The affection is not violent in the beginning, but a pressure, and Cramp in stricturc, and griping, rather than an acute pain, is felt in the region of *its*^ca5??' ^^ stomach. The patient has an oppressive sensation, as if something, neglect ^ of not uulikc a nail, were fixed behind the stomach : if the attack increases fiTe'cSeindi- in violcnce, he complains of stitches in the breast and towards the back, causl^^ *^^ and endeavors to procure relief by shifting his posture. The principal paroxysms are observed to take place generally in the afternoon, in con- sequence of bodily exercise immediately after dinner, the use of acid food and drink — and particularly after giving way to gusts of passion, such as terror, anger, grief, and anxiety. This affection is often contracted by persons subject to passionate emo-' tions, on their neglecting to take an emetic occasionally • it is not, in general, attended with acidity, but rather and most frequently is pro- duced by a bilious acrimony ; and it at length almost invariably degene- rates into a nervous habit (Jour. p. 49). THE DOCTRINE OF PURGATION. 49 Denman, Thomas, M. D.^ On a ease of -dropsy in the ovariuwj. See Med. & Phys. Jouen. 1Y99, Vol. 11. 211. After giving the history of a female patient, who had suffered Dropsy of from violent pains in her bowels, tension of the abdomen, and much iiomcollu- soreness on pressure, accompanied with vomiting, constipation, and fre- -P"^'^^- quent fainting, symptoms which were chiefly relieved by clysters and gentle purgatives, hemorrhages from the uterus, violent pain in the low- est part of the back, and, on pressure upon the sacrum or hip, in the neighboring parts. Dr. Denman says : There was great tension and pain above the " ossa pubis," and the whole hypogastric region was full and hard. She discovered a large hard tumor, extending to the right side of the navel, the increase of which w^as so rapid that in the course of a few days it occupied the whole abdomen. She was then freed from pain in all the parts contained in the pelvis, could lie on either side, and walk much better. She frequently after this had slight shivering fits, and a sense of coldness down her back, followed by restlessness and feverish heat, especially in her hands and feet in the evening, which went off with a free perspiration toward morning. Her pulse was at all times very quick.. Though one or more stools had leen regularly procured every day, an immense quantity of hardened faeces, of a large volume, were now discharged for three or four successive days, by which her size was much lessened. She had been treated for sciatica. When I first Regular visited her, the whole abdomen was distended by a circumscribed tumor wacuaTion springing from the right side, near the groin, thence extending across, fecir^ac^u- and high up in the abdomen, and I thought I could feel an obscure flue- ^uiation. tuation in it. 1 could also feel an angle of the tumor in the posterior part of the pelvis, by which the " os uteri " was projected so high and so far forwards as to be almost beyond my reach, as is the case in the retroversion of the uterus. She was not pregnant. I did not therefore hesitate in the opinion that it was a dropsy of the ovarium ; and by sup- posing this, early in the disease, to have dropped low down in the pelvis, and afterwards to have risen according to its increase, all the symptoms which had occurred could be satisfactorily explained. I directed only a strong purging draught. On the following day, she informed me that after suffering considerable pain in the bowels, she had four or ^yq copious motions, and that after every motion she was sensible of her size decreasing. The motions were unusually offensive, and, before they came away, the desire to expel them was unnaturally urgent and pain- ful. On examining them, I found that they almost wholly consisted of a gelatinous fluid, with many streaks of blood, and with little or no mix- anf^J^SJS- ture of faeces. Instead of feeling weakened by the evacuation, the lf'\g^'^*^^" patient felt herself very much relieved. The medicine was continued for two days more, producing the same number of motions ; the swelling of the abdomen had gone, the os uteri had descended into its proper posi- tion, and no tumor whatever remained in the cavity of the pelvis. I concluded that, in consequence of preceding inflammation, an adhesion had taken place between the cyst of the tumor and some part of the in- testine, probably the rectum, the adhering portion of the bowels had given way, and, by that opening, the contents of the tamor had been evacuated. She was perfectly restored to health (pp. 20, 22). Let the reader examine the Van Wart case at the end of these quotations. 50 THE DOCTRINE OF PURGATION. IIexdekson, Stewart, Sicrg. Practical remarks on the diseases wli ich occurred on hoard of II. M. Ship Astrea, on the Jamaica station^ &c. See Med. & Phys. Joukn. 1799, Vol. I. 212. Remittent or Marsh-fever. — This fever, the legitimate offspring f(vtT\x^ of all hot climates, especially where marshes abound, is the autumnal marsh efflu- ^^'^^^^^ ^f ^xLost parts of EuTopc, onlj appearing in a milder degree. It '"^^SE^FE- ^'^^ been described under various names — hilious^ yellow^ Jamaica^ Sene- TEK,"butun- gal^ and in Bengal, j?t^c^<2 — but multiplying distinctions which do not mldifica-^^''* exist only serves" to perplex and mislead, for it will he found to he the tions. same individual disease^ under different modifications^ depending on constitution, season of the year, and local situation. The cause of this fever, in all its varieties, is marsh effluvia. We find that in some places at the Cape of Good Hope, where no such cause exists, this fever is un- known. We likewise find that strangers are more liable to be afiected by this noxious effluvia, and have the disease in a more formidable de- gree, than the natives of the country, whose constitutions acquire a cer- tain power of resisting it from habitual exposure : at the same time, its effects on them are obvious, by shortening the duration of life. I do not think that the original disease produced by this miasma is infectious, but that it may alter its type and become highly contagious from con- current causes ; as from too many diseased bodies being crowded to- gether, without paying sufficient attention to ventilation and cleanliness, (p. 141.) This noxious exhalation enters the system either by the lungs, the skin, or stomach ; but the manner in which it produces those symp- toms of disease which characterize the fever does not appear to be well understood. We can only perceive its general effects on the system; and that it may lurk for a certain time in the habit before morbid move- ments take place (ibid). inCTeafrthe ^^^- ^^ ^ociqh uot bclow uor above the common standard of health, biuous secre- although there were marks of irritation and inflammatory diathesis, it gcSives^cBx- sccmcd uot Sufficient to justify blood-letting ; which I considered would ry It away, j^^y^ diminished the vital power. Antimonial emetics were not used, having always observed that they increased the irritahility of the stom- ach, which is the most troublesome symptom attending this form of the fever. I, therefore, thought it more advisable to employ mercurial ^w/'- gatives^ which had a very good effect in carrying off the hilious sordes collected in the fi/rst passages / emetics were sometimes given ; James' powder with camphor, to promote perspiration, and effect a complete re- mission (p. 143). Jfrom^coM ^^^- Pysentcry. This disease is not limited or peculiar to any cli- and wet ob- mate, uor is there any natural cause known to produce it : if it were oc- pe^pbation^ casioucd by any particular quality in the air, the natives, as well as sea- fn^ tbT flow ^6n and soldiers, would be attacked with it, but we find this is not the °l ^-^t^s *° case. For, when the dysentery was raging among the British troops at tines!^ the Cape of Good Hope, not one of the inhabitants were seized with it, nor is it a disease known among them. Whenever it becomes epidemic among the inhabitants of any country, it may always be traced to infec- tion introduced ; it being the constant attendant on camps, and the The cure scourgc of an army more destructive than any other enemy. I, there- ^Ln^lT'the foi^e, consider it an artificial disease. Gold and dampness, when the m^h and "body is uot Sufficiently covered, by obstructing perspiration, and increas- THE DOCTKINE OF PURGATION. 51 ing the determination of tlie fluids to the intestines, sometimes combined with febrile miasma, produce the whole phenomena of dysentery. In the treatment of this disease, I generally began with an emetic of ipecac- uanha ; bleeding was never employed, Uinless the patient was of a strong plethoric habit ; purges of salts or rhubarb with calomel were frequently repeated ; emollient injections and fomentations were of use, when the pains were wandering, and large blisters in every instance removed the pain where it was fixed (p. 23T). 216. Diarrhma generally arose from relaxation brought on by eating ^.^urTti?'* unripe fruits, and committing other irregularities. It was easily re- cures. moved by lenient purgatives (ibid). 216. Hepatic corrvplaints were brought on by violent exercise in the sun, joined to the abuse of spirits. Symptoms: pain in the side, some LimrCom- difficulty in respiration, pulse full and frequent, sometimes pain in the ^Se by shoulder, and about the region of the liver, which, when pressed, was at- «««''««^^<'«'- tended with a catching and troublesome cough. Bleeding, calomel purges, a blister to the side, sometimes mercury in small doses, were alternately resorted to, until health was perfectly restored (ibid). 217. Spasmodic affections were mostly confined to the abdominal Cramp of mscera^ and brought on by lying on the deck in the night. The patients ^^^^tTuf*" complained of excruciating pain and stricture, commonly about the um- ^^emed *^^ bilical region, nausea, and sometimes vomiting. If fomentations did not cure the pain, a large blister was applied ; calomel with jalap taken in- ternally and clysters given, until stools were procured, which removed the complaint (p. 238). HuGGAN, A., M. i>., On the Croup, Plymouth, 1799. See Med. & Phts. Jofen. 1800 Vol. III. 218. In a manuscript copy of the late Dr. Gregory's Zectures,! found Croup, a caution respecting hleeding in children, even with leeches, as apt to bring on fits. Now, if the learned professor's admonition was the re- sult of experience — and a case which I myself once saw, leaves me little un^^^dan- room to doubt it — what have we not to dread from taking blood away (Jfous in in a large stream from infants ? (p. 57.) . . . With regard to blood-let- altogether an ting in general, as a means of cure in inflammation, synocha, (&c., let me and'^^SS^ss ask, whence the necessity of diminishing the quantity of hlood in such F^ctice, in diseases f or what proof have we that the quantity of blood heing increas- TonlT'^'ew ed, — allowing, however, that it actually is ^o,—is the increase of it the ^^^"^^^/i?^^^*- cause of evil f By taking blood away we undoubtedly lessen the quan- tity of it, but do we really diminish the hulk of the circulating flu'ds, and contract the size of the bloodvessels f This is but doubtful ; for, it is more than probable that from the loss of blood the secretions are dimin- isfEVERNE^- ished, and absorption of moisture from the atmosphere increased, (p. cssary, sel 58.) . . From the prevalence of bleeding in inflammatory diseases, some often hurt- have, either from prejudice in its favor, or from want of proper discrim- ination, used it copiously in genuine typhus, accompanied, as it some- times is, with thoracic pains, dhc. The result of such practice will be obvious (p. 59). FUL, SOME- TIMES FATAL. 52 THE DOCTRINE OF PURGATION. Upon the whole I think that I am sufficiently warranted^ from experi- ence, to draw the following conclusions respecting the use of venesection in the practice of medicine, viz. : That it is nevee necessary, seldom SAFE, often hurtful, AND SOMETIMES FATAL (p. 60). Miller, E., M. D., On the effects of Abstinence on the approach of Acute Diseases. See Medical & Physical Journ. London, 1799, Vol. I. Moderate 7iai>its of p.'-e erve health. 219. If the art of preserving health and prolonging life chiefly con- life p^revent g^gt in 2i frugal and sparing use of stimuli, and adapting them with cau- tion and skill to the fluctuating circumstances of the vital principle, we shall surely find still stronger motives to apply this doctrine at the ap- proach and in the treatment of diseases, when noxious powers of such preternatural violence invade the body, baffle every remedy, and stimu- late it to death. The regulations of this vital principle, here denomina- ted excitability, the preservation of it when present, and its restoration when deficient, the restraint of the excitement within the bounds of noLoderation, the prohibition of all wasteful and undermining excesses, will probably hereafter, at some more enlightened era of medicine, form a system of rules for the management of health and the prevention of disease, for the enjoyment of sense and the refinement of intellect, which, instead of the present feverish dream of human life, will present a con- summation of improvement and happiness which we now ascribe to su- perior beings (Journ. p. 45). Abstinence 220. If I do not mistake, it has been proved, that abstinence will be of "Jir^aif- often a complete, generally a useful, and almost always a safe means TO ^s thrad- ^f obviating the approach of acute diseases. And, in a word, if it were vance of dis- possiblc to offcr to mankind a maxim of universal application to the treatment of incipient fevers, in all their variations and circumstances, I should be inclined to hazard the following aphorism : When symptoms denoting the approach of acute diseases are discovered, abstain, for a proper length of time, from all aliment (ibid). In the place of abstinence from all aliment, purgation is the method which experience has proved safe and effectual, both as a preventive and cure for acute or chronic or incipient affections. Brandreth's Pills and weak oat-meal gruel for a few days will do more good than abstaining from food, or half starving for weeks. And purging with these pills never weak- ens the vital forces, which cannot be said of the other plan. I think that the starving method is next in evil effects to bleeding. One takes the life out, the other prevents its renewal. It is effete matters, impure humors, floating in the blood or settling upon some organ, that cause all general or local disease. Purging takes these out, and, being done, the health is often restored at once. If you have poisonous matters about you, get rid of them as soon as possible. This is the sensible way. Starving does not get rid of them, it only reduces your life, your power to feel, that is all ; places you nearer the grave. While every dose of Brandreth's Pills takes the death principle away, and places a greater distance between the sick and the grave. I^ooTH, J., M. D., Superintendent- General of the hospitals in British America. Letter on the treatment of dysenteries and other autumnal dis- eases, to Dr. Mitchell, Quebec^ Jan. 24, 1Y99. See Medical Reposiiory, Vol. LL.p. 43Y, quoted in Med. & Phys. Journ. 1799, Vol. LL 221. Having seen, in the course of my practice, a great number of ((uti(/mnal disf.asefi — purr/ation the cure. THE DOCTRINE OF PURGATION. 53 dysenteric cases, and having experienced the inefficacy, in g-eneral, of the usual mode of practice, I was induced to try the effects of the several and^*^otS purgatives now in use, with the view of ascertaining how far any one was preferable to the others, in the treatment of dysenteric patients. Experience soon taught me that the neutralized tartarit of potass was the most salutary in its effects ; and of course I have always, since that discovery, had recourse to it in dysenteries and other autumnal diseases, with the greatest success, hoth in children and adults (Journ. p. 181). Skkimshiee, J., M. D,, €ases of Fractured Skull, Wisheach, 1799. See Med. & Phys. Jouen. 1800, Vol. III. 222. A boy four years of age had fallen from a height of ten feet Fractured upon a brick pavement. He vomited soon after he was taken up, and «^«^^- complained of a bruise on his head, but seemed otherwise quite well. There was a very evident depression of the right temporal bone, and fracture of the right parietal bone. Merely a spirituous embrocation and a gentle laxative was given. On the next day the depression was Purgatives, considerably less. Wo one had symptom had come on, but as the physic Wer^S^^-^ had not operated, I ordered an enema, took six ounces of blood from the boweis" ^rt arm, and ordered a strictly antiphlogistic regimen for three weeks ; in r'^j^ ' t^e ar few days the depressed bone had risen to its natural situation, and in toms aSS- a few weeks every trace of it had disappeared (Journ. p. 28). LndbriS^ Another boy, nine years of age, fell from a cart-horse upon a stone pavement and the wheel of the cart passed over his head. I found the whole left side of his head very much flattened, the temporal and great part of the parietal bone being very much depressed ; besides, there was a fracture of both bones, which crossed the squamose suture. The boy was comatose, but roused for a moment when spoken to. His breath- ing was laborious, pupils dilated, pulse of natural velocity, but intermit- ting. He had vomited several times, had hied much from the nose, and likewise from the right ear. Trepanning was proposed, but the parents objecting, the antiphlogistic plan was all that was left us. He, accord- ingly, was bled and an enema administered. The clyster had not oper- ated, neither a purgative given on the second day ; the depression kept on lessening, but the boy remained comatose ; another aperient was given, and on the third day a purgative enema produced a copious stool ; the symptoms abated, and disappeared after a repetition of the enema, the bowels now being opened (Journ. pp. 28-29). Suttoint, T., M. D., Considerations Regarding Pulmonary Consumption. London, 1Y99. See Med. and Phts. Joijkn., 1801, vol. YI. 223. The^^^ symptoms of disease were in the howels, and by degrees the disorder became a confirmed phthisis pulmonalis. Hence I was led uon'^^o- to suspect the emaciation and dehility to he induced hy some disease of sympathy the oMaminal viscera, which, however, I could not account for in any ^X^ofthe"" other way except by supposing the mesenteric glands to be obstructed, ^^^f/f'^^J^ as the symptoms led to no suspicions of any other cause or causes that ^^SeLr"^ could be considered as adequate to produce such effects. I have seen 2/yf ""^^^^ several cases where affections of the howels preceded the pulmonic symp- Consfunvp' 54 THE DOCTRINE OF PURGATION. Purgatives and emetics cure. to?ns. It is a very common thing for patients, in protracted d/i/senteries, to have jpul mom c affections hefore death ; and it frequently happens that diseases of the abdominal viscera are, in tlieir latter stages, accompanied by pulmonary consimiption. By writers on this disease the ."tabes me- senterica " is mentioned as sometimes accompanying it. . . Hence, it ap- pears to me that phthisis pulmonalis is caused hy a disease in the mesen- teric glands, and that the tubercles in the lungs, and some other of its symptoms, are excited by sympathy (Journ., pp. 89, 90). "224. For, an increased action may be produced by exciting an in- creased motion in the contiguous parts, v^hich may be effected by the use of emetics and purgatives, which promote a greater motion in the intes- tinal canal, and, from their contiguity, in all probability, communicate some of it to the mesenteric glands (Journ., p. 90). Hydroce- phalus, like all dropsies caused by an abun- dance of fluids which cannot be ab- sorbed. Purgatives remove the cause of disease. White, W., Sm*g., Remarks on Hydrocephalus Internus. Bath, 1Y99. 8ee Med. and Phts. Jouen., 1800, vol. III. 225. Case of hydrocephalus given. He took small doses of calomel combined with digitalis. As purgatives produced no effect in stimula- ting the intestines, clysters were resorted to for that purpose. After a fortnight, evident symptoms of amendment took place, and he soon re- covered (Journ., p. 113). Dr. Whytt, to whom we are greatly indebted for a very minute description of the symptoms usually attendant on the disease, observes : '' The immediate cause of every hind of dropsy is the same, viz., such a state of the parts as makes the exhalent arteries throw out a greater quantity of fluids than the absorbents can take wp.^^ Which state, from what he afterwards mentions, he evidently considered as con- sisting in debility (p. 117). Purging is -necessary, not only on account of lessening the determination to the head, but particularly as the symp- toms, which proceed merely from fullness in the stomach and bowels, have been frequently soon removed by evacuating the bowels (p. 119). Caesok, William, M. D., Letter on the Applicability of Mercurial Prep- arations in Children'' s Diseases. Birmingham, 1800. See Med, AND Phys. Joukn., 1800, vol. IV.- 226. For several years I have been dissatisfied with the general and indiscriminate use of calomel in the diseases of children ', I am not more certain of any one fact that pertains to medicine than that I have seen many children who have fallen a sacrifice to the improper application of this medicine. Calomel, when mixed with susrar, forms a medicine Inf'imMle diseases. Quomei ^jf^jg meaicme. vjaiomei, wnen mixea witn sus^ar, never safe ' O " in minute agreeable to the palate of the child ; its exhibition is easy to the mother a^poilon.^"^^ or nurse, and it may with safety he cfiven as a purge, when a pur^e is indicated. gwen as a purge, wnen a purge When given as a purge, its action is confined to the first pas- sages ; but when the dose infrequently repeated, either for the purpose of obviating habitual costiveness, or with any other intention, it is absorbed by the lymphatics, and enters the system, by the action of which it is de- composed, . . . and that state of the system produced which is called mercurial fever . Although mercury does not appear to have so power- ful an action on the salivary glands of children as it has on adults, yet I apprehend its general effects upon the system are greater. The mer- curial fever in adults soon runs into indirect debility. THE DOCTRINE OF PURGATION. 55 227. The injurious consequences likely to flow to children from the high degree of excitation and extreme succeeding debility produced by cephliu8'\& a mercurial course I wish to impress upon your readers. Mercury has '^auced thtm been erroneously held forth as a specific in hydrocephalus, and is often cured or pre- given as a preventive of that fatal malady. Hydrocephalus appears to merluri/. ^ be the result of debility succeeding too high an action of the vessels of the brain. If so, can any medicine more powerfully produce hydro- cephalus than mercurial calces? (Journ., p. 411.) Chapman, John, Sur., Oases of Injuries of the Head, with Observations. Amjpthill, 1800. See Med. and Phys. Journ., 1800, vol. III. 228. The fondness for trepanning, so much inculcated by Mr. Pott, and so very anxiously supported by Mr. Benjamin Bell, has justly met with two very able antagonists in Mr. John Bell and Mr. Abernethy (p. 31, Journ). Every man, previous to applying the trepan, ought to ask himself for what he is going to trepan ? " To think that a fractured skull is a chief cause, or even an absolute sign of danger, is a very erro- inivjwries neous notion ; it is not the damage done to the skull, but the injury to ^/ J,'^^ ^^«^. the brain, that is the cause of danger ; and the fracture of the skull is operation but a faint, uncertain mark of the harm done to the brain " {J. BelVs ^"^t^ft^^ Discourses on Wounds of the Head, p. 137). Again : " There is still '^{tngX^ but one motive for applying the trephine, viz., to relieve the brain from v^rge, and compression" (ibid., p. 144). tefmile, the N^ow, I am speaking of aifections of the brain, I cannot forbear ob- ^ITLcS.^^ serving that I have long been dissatisfied with the Edinburgh treatment of concussions of the brain, viz., with cordials, wine, and stimulants. My ideas on this subject are so exactly consonant to what has been said by Mr. Abernethy {Surgical Essays, vol. HI, pp. 59, 60), that I shall therefore refer my readers to his Essays (Journ., pp. 33, 34). iV. B. Abernethy employs purgatives, bleeding, and antiphlogistic regimen. FowLE, William, M. D., ^ Practical Treatise on the Different Fevers of the West Indies, and their Diagnostic Symptoms. london, 1800. See Med. and Phys. Jouen., 1800, vol. IV. 229. Very early after my arrival in the country I observed thsit per- sons attacked with fevers, in almost any situation, very generally became Yeiiow/e- YELLow. This soon led me to conceive it merely a concomitant symptom, InautT^^' and by no means such as could be sufiicientlv characteristic of anv one .^^hout par /> ^ - . '11 •• -iiT T "^ ^J^iv> ticularmean lever to give it a particular denomination ; it also led me to discover the i^g-the dis cause of the variety of symptoms attributed by different authors to the yellow fever, and to account for successful methods of cure which were often diametrically opposite to each other. The longer I remained in the country the more I was convinced of the danger attendant on giving a name to one disease from a symptom common to so many (Journ., p 355). Dr. Fowle divides the fevers of the West Indies according to their appearances into intermittents, remittents, ardent fever, and the malig- nant or jail fever. ease a com- monfever. 56 THE DOCTRINE OF PURGATION. GeoghegA]!^, Edward, Surg., On Strangulated Hernia. Dvhlin^ 1800. See Med. and Phys. Journ., 1800, vol. lY. 230. Let us for a moment consider the state of the parts : A portion of the intestine lies without an aperture, through which it is too large to tfdhenii^a.' P'^>5S ; the qucstiou then arises, what occasions its bulk ? Surely, the tUic^^of'l\xe i^^ture of the part, the touch, and all the circumstances of the case, case indicat- clcarlj evince it to he flatus^ and sometimes together with excrement and uon!'^''^^"''^' an inflamed intestine^ ^^\\o^q functions are so far deranged that it cannot act upon its natural contents^ so as to move them in their ordinary course. . . Nothing can be more obvious than that every effort should be made to lessen the hulk of the hernia, and none to push it through the ring ; it will pass in of itself after the air has been extracted (Journ., p. 318). Purging with Brandreth's Pills is what is needed. Magennis, J., M. D., On Epilepsy. Birmingham., 1800. See Med. AND Phys. Journ., 1800, vol. lY. Th?to?^or 231. I observed in these patients, and in most others who have long ach^and^S- l^borcd uudcr this untoward disease, a dullness of apprehension, a par- testines re- ticular s^arc and vacuum of countenance, a dilated pupil, and an inabil- ^fui ^^^ ity of the iris to contract on the admission of light, accompanied with purges.^ stupor and a general irritability of the muscular fiber. This torpor ex- tends to the stomach and intestinal canal ^ as those people subject to the disorder usually require the most active cathartics and emetics to excite the primse viae into action (Journ., p. 419). Reeve, R., Surg., On a Successful Ca^e of Hydrocephalus. See Med. AND Phys. Journ., 1800, vol. III. 232. Hydrocephalus internus. — The author's own child, at the age of eight months, in December, 1798, could stand alone, and had every ap- pearance of a healthy, forward child. His temper was unusually placid. Case of and his spirits invariably good. Towards the end of the month he be- cephaius^"' came extremely costive, and though medicine for a time relieved him, "^^eceZity^ot ^^ was frequently and violently seized with pain in the abdomen, which full contin- ^vas generally mitiarated by a clyster. . . He ceased to ^row, except the fui '' purga- head, which, towards the end of January, 1799, was perceptibly increased ^^^ntestinai^ in sizc, and his costiveness was become so obstinate as scarcely to yield canal. to the Hiost active purgatives. It was this singular state of the alimen- tary canal, which had existed upwards of six weeks, that first led me to suspect some material derangement in the state of the brain. On the 12th of February he was convulsed in the night, took antimon tartaris in small doses, with little or no effect, and on the following day castor oil, which was repeated a second time, before any motion was produced ; the abdomen was very hard, and of an extraordinary size; the stools of a clay color, and of such an adhesive nature that they could not easily be separated from his napkins ; his urine high-colored, secreted in large quantities, and gave a yellow tinge to his linen. James' powders were given, but fever and delirium set in, with a voracious appetite, and all the symptoms of hydrocephalus. Calomel given as purgative in the be- THE DOCTRINE OF PURGATION. 57 ginning of March was charged with mercurial friction, but all hope of his recovery was lost ; he cried much, had much pain in his bowels, which were distended by flatus to an alarming degree, and the only relief that could be obtained was by clysters. A blister that was applied to the anterior fontanelle was kept" open and discharged copiously, and in April he commenced slowly to recover. . . ISTow his bowels are quite restored, and he has left off all medicine (Journ., pp. 61-64). Brandreth's Pills could have saved all this pain and suflFering. UNwms, David, Surg., On Febrifuge Medicines. See Med. and Phys. JouEN., 1800, vol. IV. 233. A derangement of the nervous system, occasioning general de- Femr. lility, is an invariable attendant oji fevers of every denomination^ and to b^^onb fe-^ this single cause, dehility. are all the svmptoms which occur under differ- ^^r," one • •> X CG'tCS^ but ent circumstances of constitution, situation, habit, &c., of the patients different to be referred; for, notwithstanding the minute division and extensive tiona^^^^^*^' classification which have been adopted by nosological and systematic writers on febrile affections, there appears to be no sjpecific or abstract difference in the diseases themselves^ the variety of appearance w^hich they assume being totally dependent upon the state of the constitution receiv- ing the affection. Thus, the same causes operating upon a person of a sanguine temperament and plethoric habit will occasion the disease which has obtained the appellation of inflammatory fever., with symptoms of vascular excitement, which, on a patient of a contrary description, will be productive of a typhus or nervous fever (p. 64). 234. When the quickness, smallness, and irregularity of arterial pul- thfconsSt- sation, distressing pains in the head, extreme oppression of the mind, s^^f^o^^^^g^ and other symptoms are present, denoting the highest state of nervous moved, debility, a dose of powdered antimony, in such quantity as to create a sympath*yf^ slight nausea of the stomach, will often reduce the pulse to its proper %^^^'"^^^' standard, and, by inducing a regularity and due proportion between the stomach. action and reaction of the system, will effectually arrest the further pro- gress of the disease. Woodward, W., Surg., On Infantile Diseases. See Med. & Phys. JouKN. 1800, Vol. IV. 235. There is a liquor in the bowels of infants and many other ani- mals, when they are born, which is necessary to be carried off ; the medi- infanuu cine which nature has provided for that purpose is the mother^ fl/rst ^ The^mW^- milk ; this, indeed, answers every purpose, and effectually; but we ^""^f^g ^j^/^* think some drugs forced down the child's throat will do much better — meaidne. the composition of which varies, according to the fancy of the good woman who presides at the birth. . . . We see that notwithstanding the many moving calls of natural instinct in the child to suck the mother's breast, yet the usual practice is to deny that indulgence till the third day after the birth ; by that time, the suppression of the natural evacuations The natu- ral t vacua 58 THE DOCTRINE OF PURGATION. of ilw m ilk usual] J hriiujs on a fever ^ tlie consequence of which is often fatal to the mother^ or puts it out of her power to suckle tlie child at 'ind^Ture? ^^^^^^ time. The sudden swelling of the breasts, which commonly hap- miik-fever. pens about the third day, is another bad consequence of this delay. When the breasts become thus suddenly and greatly distended, a child is not only utterly unable to suck, but, by its cries and struggling, fa- tigues and heats both itself and the mother ; this is another cause which prevents nursing. . . . The gentlemen of the Lying-in-Hospital in Lon- don ordered the children to be put to the mother's breast as soon as they showed a desire for it, which was generally within ten or twelve hours aftei' birth ; this rendered the usual dose of physic unnecessary ; the milk-fever was prevented ; the milk flowed gradually and easily into the breasts, which before were apparently empty, and things went on in the natural way. If a mother is determined not to nurse her own infant, she should, for her own sake, suckle it at least three or four weeks, and then wean it by degrees from her own breast. In this way the more immediate danger arising from repelling the milk is prevented (pp. 43-44). The miai 236. There is, in truth, a greater luxuriancy of life and health in energy i" - - - ■ - ' . ^ .. -,„«/ , ._ children infancy than in any other period of life. Infants, we acknowledge, are £^aduit?^° more delicately sensible to injury than those in advanced life ; but to bleeding compcusato this, their fibres and vessels are more capable of distension, riout to'"^iC their whole system is more flexible, their fluids are less acrid, and less Ser^^^^^ disposed to putrescence ; they hear all evacuations niore easily^ except that of hlood ^ and, which is an important circumstance in their favor, they never sufler from the terrors of a distracted imagination. . . . Children recover from diseases under such circumstances as are never survived by adults ; if they waste more quickly under sickness, their re- covery is quick in proportion and more complete than in older people ; in short, a physician ought never to despair of a child's life while it con- tinues to breathe (p. 43). MooEE, James, Surg.^ A case of Synocha^ London^ 1801. See Med. & Phys. Joijkn., 1801, Vol V. Synocha , /,.-,. . -, . is a common 237. Synoc/ia, OY fUTC %nflaifnmatory fever ^ is a disease so rare m this oPhigh'^dl- country that many experienced practitioners have doubted its existence. Stion°^ iTd Here follows a case : — The treatment employed during the Ave days he longer dura- ^g^g uudcr uiy chargo consisted simply of two purgatives, and a draught of one-fourth of a grain of tartar emetic, and two drachms of the acetate Pwrgation. ammouia water, which was exhibited regularly every six hours. (Journ. p. 233.) Synocha certainly very much resembles the symptomatic fever at- tendant upon phlegmon ; the common ephemera is undoubtedly of the same species, and the synocha seems to be precisely the same malady, in a more violent degree, and running on for a longer period, (ibid. p. 234.) n>/dro- THE DOCTRINE OF PURGATION. 59 pRicARDS, J., Surg., On Ilijdrocephalus, Brentford, 1801. See Med. & PiiYS. JouKN., IbOl, Vol, v. 238. Case of a boy, 8 years of age, strong purgatives given : This produced verf/ brisk evacuations at each time of repeating it (every other morning) ; after each repetition, however, he appeared better and more rnued ///'/•- lively. The plan was continued for several weeks, during which every ^'^^^.l^^^Jjil symptom of the disease gradually subsided, until his pristine state of «'^'' ^.^^ "'■ health was completely renewed. (Journ. p. 344.) weakenrtL Therefore it appears to me, that drastic ^purgatives, frequently ad- ^^^^^'^^ ministered, have a much fairer chance of success by increasing very pow- erfully the action of the absorbents, while they do not produce that debility of the system which is the consequence of mercury (ibid. p. 345). Savaeesi, Antonio, M. D., Physician to the French Army in Egypt, on the Cure and Prevention of the Endemic Ophthalmia of that Coun- try. Transl. by G. Plane, M. P., London, 1801. See Med. and Phys. Jouen., 1801, vol. VI. 239. Pr. Savaresi first divides this complaint into the sthenic and asthenic ; the one depending oif an excess, the other on a defect, of tone. Ophthalmia The former effects the bulb of the eye ; the latter sometimes the " sar- ?ieties!^ ^*" sus," sometimes the "tunica conjunctiva." j^sfremedy In the beginning I purge in all the three species, without distinction, "po^^ ^^^^ with an ounce of magnesia vitrolata, otherwise called Epsom salts. The v^^Xs. sthenic ophthalmia requires very close and strict attention, inasmuch as the cure depends on the efficiency of the first remedies. After this, top- ical remedies, as emollient colly ria, are employed, and low diet. As preventive, he recommends avoiding exposure to the sun with the head uncovered, and to the night dew, abstaining from salted food, avoid- ing cold after being heated, and attention to the intestinal evacuations (Jonrn., pp. 357-359). Tainsh, W., Surgo, Accoimt of Some Cases of the Plague, which occur- red on board of a British ship-ofwar on the coast of Syria. See Med. and Phys. Journ, 1801, vol. Y. 240. Plague. — Mr. Tainsh employed, after removing all clothes from the patients, and washing them with soap over the . whole body, powerful repeated evacuations of the bowels by emetics and laxative clys- ters. The sick used to discharge "«^ enormous quantity of bile, viscid Td Imfcwi- Plcigue.. Potverfnl sordes, and tough phlegm,^^ 2,u.di the stools gave the sick evidently much thfcau^r relief; when a bitter taste and nausea continued, emetics were repeated, which cleared the stomach of a large quantity of disagreeable matter, which gave great ease. After thus removing the cause of the disease, a strengthening treatment was pursued, and the buboes treated by poul- tices (Journ., pp. 539-541). 60 THE DOCTRINE OF PURGATION. Yage, T., M. D., CnMoisms on the Ireatment of Venereal Di London^ 1801. See Med. and Phys. Joukn., 1802, ml. YIII. 211. Opiates are usually and properly given, in the intention of Opium re- mitigating severe pains in tlie venereal disease ; but, notwithstanding ♦wrrajw sy.^- their utilit}^, a free and frequent use of them always induces a relaxation '^']Siu1sbes^^" of the system^ and debilitates the chylifio orgaris, which are primary things to guard against in mercurial courses. Although both these effects of opium appear to spring from one common source, by producing a ner- vous, sedative stupefaction, yet some observation in practice inclined me to suppose that ease may be procured without any concomitant debility (Journ., p. 8). ckylijica- turn. 212. Ifercury, however, with all its anti-venereal properties, is natu- Mercury ^<^^2/ inimical to the nervous system^ and exerts its injurious effects, in breaks some de2:ree or other, in the most judicious use of it. When it is ex- hibited too copiously, and suddenly, it is apt to produce violent eiiects, as great sioelUng of the head and tongue^ apoplexy, &c., because it breahs down the Mood before any outlet is prepared for its evacuation. When its use is gradual, these effects will be moderate, but they will accumu- late in time to considerable injuries of the same nature. The most vio- lent and mildest effects of remedies are produced upon the same princi- ple., and the former are frequently the cfnly index to explain the latter,- which would otherwise be too minute for observation (Journ., p. 9). d(nc7i the blood Axiom. The two causes of mercurial disease. Parallel between lead and mercury. 213. The infirmities which arise from the use of mercitry appear to originate y^m two principal sources: one is its dissolution of the hlood, by which a redundance of serum is forced into the interstices of the cel- lular substance of the muscular, vascular, and nervous systems ; in con- sequence of which the gluten, which gives strength and stability to the solids, becomes relaxed, and the different functions of the animal economy so debilitated as to be incapable to be properly actuated by the nervous influence, while the nervous system itself may remain in a tolerable condition. The other source of infirmity, on the. contrary, is when the nervous system has heen left impaired and cannot invigorate these func- tions, which may not have suffered any considerable detriment. For, it is experimentally ascertained, that if the nerves of any part are injured, either at their origin or in their course, that part will become propor- tionally inert in its office (Journ., p. 9). The effects of mercury are somewhat similar to those of lead ; both have power to produce paralytic affections ; both, in a weaker degree, abate inflammations and mitigate pain ; and the imbecility of both re^ main after they have been quite expelled from the habit (Journ., p. 10). 211. In considering the dyspeptic symptoms of this or any other dis- Dyspeptic casc, it appears to be generally conceived that the cause of them is the ivomsyZpa- wcakucss of the stomach alone. This opinion has probably led to some ^\h ^intT^ important mistakes in practice ; for this organ is not less subject to be tines&n&the affcctcd by causcs, and the condition of parts remote from itself, than it whole ays- ^^ capable of affecting the whole system. Thus an indolence of the in- Hon. THE DOCTRINE OF PURGATION. 61 testines, or a diminution pf their action in any part^ from the pylorus to the rectum, will produce nausea and indigestion^ even when the stomach removT^thl itself may be in a good condition ; and hence it is that often a cathartic amSSt- will remove tliese symptoms by giving an additional irritation to tlie «^«^ intesH- obstructed and enervated parts. In general, however, here the stomach promoting' participates of the mercurial debility^ and corroborating aperients be- uonoi^good come requisite. In regard to the inertness of the intestinal action, it ciyiificJ^^ may be further noted that it frequently proceeds from a deficiency of the " hile^ which a cathartic stimulus is likely to prevent, for undoubtedly this secretion depends much upon the proper action of the duodenum. But the chief utility of the bile results from its chylific property, which ap- pears to consist, in a great measure, of mixing the oily and aqueous parts of the aliment, and assimilating them into a uniform liquid. This great importance of the hepatic secretion^ whenever it appears de- fective^ demamds immediate assistance hy active purgative medicvne (p. '172). A.iJLD, Isaac, M. D., of Edisto^ S. O., Case of Acute Bilious Fever read hefore the Medical Society of South Carolina, 1802. See Med. an-d Phts. Jouen., 1808, Vol. XIX. 245. Case. — A young man who had spent a month in the country, on the morning after his return complained of slight chilliness and a ious^'/t... dull pain at the pit of his stomach, which soon after terminated in exces- iow"^^?ever) sive vomitina, violent fever, and intense pain in his head. These symp- symptoms: toms continued without abatement until about three o'clock in the preceding afternoon, when they suffered considerable remission. At this time I saw him. I found that so general a suffusion of l)ile through the System had taken place as to resemble a person laborinp; under iaundice, with ^head and Acute hil' and attend- ing, fere)- and cJiills, pains in the stomach, the exception of the eyes, which were slightly inflamed. His bovv^els ^vomiting, were obstinately bound, having been in a state of constipation for the two or three previous days. His tongue was moist, the edges inflamed, the top white, excepting the middle, down which ran a yellow streak (Journ., p. 106). Cure : P'noerfnl purg Hon, removing 246. Treatment. — As his pulse, which was slow and irregular, seemed now to forbid the lancet, though there was still some pain in the head, and costiveness and debility appeared to be the principal inconveniences under which he labored, I contented myself wdth leaving for him tivo smart purges of calomel and jalap, with directions to take one immedi- the cause ately, and the other in four hours, if the first did not procure eight or muiation'oi ten copious stools. On visiting him again, about nine o'clock, I found ^J"/' J^i3 that he had taken both his purges with the happiest eflect ; they w^ere then f^<^^^- operating briskly, and had already produced several large evacuations of hard, darh, and very foetid fmces. The pain had entirely left his head, his pulse had become regular and more full, a gentle moisture had over- Natural spread his skin ; his stomach had recovered much of its usual tone, and this was accompanied with desire for food. On the next morning he had left his bed with an assurance that he felt himself quite free from indis- '[abloiuteiy position. The discharges from his bowels were still kept up, but had Tcf'ionof^t^l entirely lost their foetor, and appeared to consist chiefly of healthy-look- P^Jfeatment. stools suc- ceeding mor- bid evacua- tions do not 6-2 THE DOCTRINE OF PURGATION. ing bile. Ilis skin liad become much clearer, as bad bis urine, wbicb before was of a deep bilious bue. I suggested tlie propriety of bis taking gentle purgatives for a day or two longer • hut this advice^ from tbe comfortable state of bis feelings, he declined^ and I, of course, left bim. On tbe tbird morning after this* Aicfuicon- ^ ^"^^ ^^^* ^^^' ^^ attend in all possible baste, as tbe patient was supposed ^^hn'^V'^'f ^^ ^^ ^.y^^g- I found bim speecbless, bis jaws were fixed, as also were purgaimi. liis cjes, wliicli wcrc nearly closed ; be bad no pulse at tbe wrists, bis feet, legs, and knees were perfectly cold, and bis stools, wbicb were black and very oifensive, came from bim involuntarily; bis breathing bad been very laborious, but now it appeared to be free from anxiety. I was informed that tbe day I left bim tbe pain in bis bead and tbe fever bad returned witli its former violence, and bad continued without any dimi- nution until this morning, when it terminated in tbe comatose state de- scribed. The cure was hereafter effected by nitric acid and blisters, which restored the vitality of the patient, and by a continued applica- tion of that acid and strong purgatives, which carried off large masses of very foetid, hardened faeces (Journ., pp. 106-109). Eruptive disease of the head. Physiology. Badgek, John, Surg., On a singular hind of Erujptive Disease. See Med. and Phys. Journ., 1802, Vol. YIIL 247. The first opportunity of witnessing this disease was at Putney, in tbe month of July, 1801 ; it seemed to be confined to children only of a certain age, having never seen a child affected with it before seven nor after fifteen years, though equally exposed, as it was evidently infec- tious to them. It commences with a slight fever, which continues three or four days ; it then increases ; nausea, and sometimes vomiting, attend (in one or two instances I have observed the patients to complam of vio- lent sickness after they were put to bed), with pain in the head and loins ; it is then succeeded by an eruption containing a well-matured pus ; the pustules are large and very thick about the head, resembling those of small-pox ; and in every case I have seen they have been con- fined to the head, particularly to the scalp. Tbe bowels during the jpro- gress of the disease were umtsually constijoated^ and, in one or two in- stances, not only tbe body but the face likewise was much swelled. Tbe first two or three cases I bad not an opportunity of seeing till after the eruption had taken place to a great extent, covering almost the whole of tbe scalp. • Treatment by cleanli- ness^ with spare diet and purga- tion. 24:8. The hair was shaved ofi" as close as possible, tar ointment and a mild purgative applied ; but this treatment produced no amendments, the ointment rather increasing the number of pustules. I ordered, there- fore, the bead to be kept clean with warm soap and water, the patient to use a spare diet, and the bowels kept open with an active purgative once or twice a week, or " pro re nata," and a few drops of antimonial wine given once in four or six hours, till the feverish symptoms had sub- sided. This plan was pursued for several days without having at all mitigated the complaint, though it seemed, undejr every circumstance, to be the best mode of treatment that could be adopted. Accordingly it was continued for a few days longer, at which period the pulse became regular, tbe pain in the head and loins was removed, the pustules began THE DOCTKINE OF PURGATION. 63 to dry off, and in about a week the complaint entirely ceased (Joum., pp. 106, 107). CuEEiE, William, M. D., Observations on the Treatfrnent of the Malig- nant Yellow Fever ivhich prevailed partially in the City and Liber- ties of Philadeljphia in the summer and autumn of 1802. Phila- delphia, 1802. See Med. and Phys. Jouen., 1803, Vol. IX. 249. Merciory was generally employed both internally and externally for the purpose of exciting salivation as speedily as possible, both at the Yeiioio/e hospital and in private practice ; bnt, if I can trust my observations, seldom with success, excepting where employed at the very commence- ment of the disease, and so conducted as to affect the mouth before the dangerous symptoms of the second stage had time to make their appear- Mercury '^^^^^' ^ ^ seldom use- When employed in the second stage of the disease, at which time the -^fiL^^ta^^^ predominant symptoms are generally disordered stomach, restlessness, op- auninteiy pression, and deep sighing, and a countenance that denotes great misery, JJ^^"'^^"^'° ver. stage move the worst symp' ■ toms. it constantly aggravated the disease, and hurried on the fatal symptoms of hlaclc vomiting. In this stage of the disease, when the recited symptoms predomina- ted, the frequent exhibition of mild laxatives in small doses, particularly Rochelle salts, soda phosphorata, soluble tartar, castor oil, senna, and ^Y,^^*^?- n 111 11 iii'Ti .' and i"a;«rz /./ cream oi tartar, and when these could not be obtained, laxatives and ^'^"-^^ x.^- clysters, were the most successfid remedies, especially when aided by blisters to the stomach, wrists and ankles, at the same time. A solution of carbonate of soda in water, which is much more pal- atable than the vegetable alkali, followed immedia,tely by a tablespoon- ful of diluted lemon juice, or cream of tartar in water, had also some- times the effect of allaying the distressing propensity to puke. But these, as well as every other means that I have seen tried, too frequently failed of affording relief (pp. 98, 99 Journ.) [If mild laxatives were frequently apt to allay the worst symptoms, it is reasonable to expect complete success from active purges?^ 250. In this state of the stomach the internal' use of mercury, either alone or when combined with opium, always increased the distressing and^opium propensity to puke ; and, when it failed to operate by stool, it aggravated ^^f "f ^^^ every symptom of the disease (Journ., p. 100), toms. 251. In cases where the disease began with strong action of the arte- ries, severe pain in the head, bach and limbs, with little or no sickness at Active stomach, bleeding, purging with active medicines, and the strict observ- ^22'"* ance of every part of the antiphlogistic regimen, generally occasioned ^yitii ^epie- a partial solution of the fever on the third, and a complete solution on the fifth, day from the attack (Journ., p. 101). 04 THE DOCTRINE OF PURGATION. TTeberden, William, M. D., Commentaries on the History and Cure of Diseases. Lcmdon^ 1802. 252. A diarrhoea arises from a variety of causes, most of wliicli are void of all danger, and are easily removed. It is often hrought on 'by that marrJuva P^iver which is exerted in every part of the body of freeing itself from Nature's wa'y anything jpainf id and oppressi'iie. Not only the mischief from the nox- ious qnalities and improper quantities of what has been taken, and im- mediately offends the stomach, are carried off by means of a diarrhoea^ but liheivise many disorders of remote parts or of the whole body are, by the self oorrecting powers of an animal body, determined to the bowels, and thence discharged by diarrhoea. It is frequently useful to cooperate wuhnai^r! witli nature in promoting this evacuation. (Chap. XXYII.) (Cf. Coll. ■ 136, 143 ; Pringle, 200.) 253. Dysentery. — The usual methods of treating this malady, with ^xTtT^ which I was acquainted, of ten failed of procuring ease^ and of preventing by remov- its ending fatally. It appeared that in a dysentery some hurtful humors ufic^mat- had been deposited in the intestines, which threw them into such disor- derly agitation as to hinder the expulsion of what had offended them Purgatives were administered with the double good effect, both of afford- ing present ease, and afterwards of entirely removing, by effectual evac- uations, the cause of the disorder. (Chap. XXXL) 254. Icterus {Jaundice). — Good effects may with reason be expected from purging medicines, by their increasing the natural motions of the intestines and soliciting a greater flow of bile as well as of all the other humors which are poured into them. ' Mercurial purges have been pre- _,otherand fei't-ed by some practitioners, but there appears nothing in the hnown safe^'purga- power s of mcrcury pcctdiarly usefd in dislodging a biliary concretion, and the preference should be given to those purges wich act with the most ease, and may be continued with the greatest safety. (Chap. L.) (Cf. 251.) tet Javmdice. Avoid mer- cury, but use Colic. cure. Evacua- 255. Ileus {Colic). — The peculiar and distinguishing symptom which characterizes the inflammatory colic in the very beginning is cos- PwrgatiAiel tivcncss, which it is always extremely difficult, and too often impossible, to conquer. As soon as a discharge downwards can be procured in a copious manner, the patient perceives a quick abatement of all his mis- uons^"'mM%\. ery, and is often restored to health. But it is not from one or two small ^eda^iT'co- cvacuatious that we can entertain much hope of the distemper beginning ^stfrTre^o?^' ^^ Z^^^ way. This has happened on the first or second day, from the ery. excrement which was lodged in or near the rectum, far below the seat of mischief. And later in the distemper, a very small portion of that liquid matter with which the bowels are deluged has seemed to have been forced downwards, while the disease was every hour growing worse. Such inefficacious evacutions have been observed more than once or twice in the course of this illness, without saving the patient's life "Warm baths, fomentations, &c., are serviceable helps in dis- posing the bowels to yield to the power of cathartic medicines, by the fail- ure or siiccess of which the life or death of the patient 'must at last be determined. (Chap. LI.) (Cf. Hipp. 12, 38, 41, 45, 57. Parep, 85, 87.) Apoplexy. Evacuation of the bow- THE DOCTRINE OF PURGATION. 65 * Ttro. — On Apoplexy. See Med. & Phys. Journ., 1802. Vol. YIIL {Controversy between Mr. Crowfoot and Dr. Lang slow on the questixm whether emetics or Heeding he applicable in apoplexy f 256. In addition to tlie testimonies adduced by Pyrrho (one of the writers participating in the controversy), I shall only add, that Baglivi^ who divided apoplexy into sanguineous and pituitous, observes : " Arcanum in sanguineis est phlebotomia. In pituitosis contra emeti- eis by pur- Gum^ aut purgans vehimens. Sunt qui apoplexia (pituistosa scilicet) lib- ltmiimg\ erati sunt, hausto singulis mensibus vomitivo ex infuso pra3dicto (infus. ^p^elmt'^^ croc, metal cum vino)." *. . . .Aretaeus does not recommend emetics, but observes : "if the sacred purge should excite vomiting, it is not to be restrained, because it evacuates pituita, the cause of the disease, and rouses the patient by imparting a degree of vigor." Boerhaave, among the general evacuants to be used in this disease, mentions ^vomits and strong purges*., though he adds, there is something uncertain in their action. Vanswieten^ also, in his Commentaries upon this Aphorism (1026), observes, that emetics ought not to be condemned in this dis- ease, and are often useful, because they evacuate pituita ; though he afterwards ihivikB purgal/ims less ohjectianable, (Journ., pp. 68-69.) Bardsley, Samuel Argent, M. D., Physician to the Manchester In- firmary^ Dispensary anfid Lunatic Hospital. An Account of the Epidemic Catarrhal Fever or Lnfluenza in Manchester^ (&c. See Med. AifD Phys. Journ., 1803, Yol, LX. 257. Emetics were found highly beneficial on the first attack ; in- deed, the frequent occurrence of spontaneous nausea and sickness pointed innuenm. out their use. They scarcely ever failed to relieve the urgent symptoms f^"'sZm^aSi of pain in the head and stricture of the breast. To obviate costiveness, «^^^ ^^'^/^^^« and at the same time to cleanse the primse vise, moderate doses of calo- symptoms; mel, with rhubarb and antimonial powders combined, were exhibited with cfeallT^"'' excellent efi'ects. . . Opiates were seldom employed during the first stage *^®°^- of the disorder, as they had a tendency to exasperate the complaints of the head and chest, and increase restlessness and feverish heat (Journ., pp.525, 526). KmGLAKE, Robert, M. D., On Lnfluenza. See Med. and Phys. Journ., 1803, Yol. LX. 258. My experience authorizes me to say that the benefit of abstract- ing heat, by atmospheric exposure, light bed-clothes, copious dilution with cold water, and avoiding stimulants of every description, will purgSes almost certainly rescue the patient from danger, and leave nothing more ^^Ji^ine re- for medicine to do than gently to move the bowels in case of costiveness, quired, and, at most, to aid the refrigerant plan by the milder sudorifics (Journ., p. 520). a In the sanguineous, phlebotomy is the arcanum. In the pituitous, on the contrary, emetics or strong purgatives. Some people remain free from apoplexy by taking every month a draught of aforesaid vomitive infusions. (Inf. croc, metal, c. vino.) 66 THE DOCTRINE OF PURGATION. 259. It is an erroneous notion that occasional refrigeration and ab- eraui^phfn stinence in disease weaken more than a heating and stimulating treat- contended nient. The native energy of healthy power is certainly reduced both by the abstraction and increase of excitement, but by its due diminution vital force maybe said to be nursed, while undue stimulant agency tends to dissipate it even to extinction ; hence a moderate negation of. excite- ment debilitates much less directly than its excessive employ does indi- rectly (Journ., pp. 519, 520 ; Remark). Our method for the cure of Influenza is to purge very freely withBrandreth's Pills, six pills every twelve hours the first day. Keeping' in bed as much as possible ; oatmeal gruel or light broth ; if the head is very painful, feet in hot water with mustard or wood ashes; if throat is sore, gargle with weak alum-water ; outward applications are the Allcock Plas- ter, mustard poultice, red pepper, or any stimulating liniment. When the skin of the throat becomes a little red, the outward applications dispensed with. Should a choking sensation be felt, or the breathing be difficult, four Brandreth's Pills must be taken every four hours, or even oftener, until relief is experienced. O'Beene, p., Surg., Observations on the Fevers in Hot Climates. Lon- don^ 1803. Bee Med. and Phys. Journ., 1803, Vol. X. Yellow f 6' ver. 260. The more severe in symptoms, and dangerous in effect, any dis- ease is, the more necessary the investigation of, and researches after, methods of cure must be fully impressive on every mind ; it is scarcely necessary to add that perhaps none comes more strongly under this de- scription than that generally termed yellow fever j none, therefore, more Its com- interesting claims our attention. T^m^uma^' In the commencement, generally nausea, pain in the head, loins and and general hams, succecd ; dry surface, increased pulse, but not to be depended on, course. varying from 80 to 140, chills, anxiety, sighing, prostration of strength ; vomiting soon takes place, and not unfrequently is the first indication of the disease. The vessels of the tunica conjunctiva become turgid, and a yellow tinge of that membrane takes place, frequently extending over the body. Notwithstanding this circumstance gives rise to the name usually given this complaint, it is by no means a constant attendant, and in many totally wanting. Watchfulness and desire to sleep, without being able to effect it ; whilst in others constant dozing, pain and sensa- tion of heat in the stomach, great thirst ; vomited matter gradually changes from yellow to dark green, and at length perfect black. Clammy skin, sometimes petechise, but unfrequent ; stupor or violent delirium succeed ; paroxysms of vomiting become more rapid, and many expire in one of those paroxysms too shocking to describe, whilst others placidly resign exhausted nature (Journ., pp. 36, 37). 261. No disease perhaps exhibits a greater variety of symptoms, and and sudden oftcn Icss to be depended on, than this ; sometimes it goes on with every cJumges. favorable appearance, suddenly changes to the worst, and patients, ap- parently almost in a state of convalescence, expire in an hour or two. This is a melancholy fact (Journ., p. 37). 262. The symptoms that we may call favorable are, settled state of the stomach, lessened headache, eyes lively, formation of pustules over The/T0ve salutary (ibid.) The TREAT- AT ALL EVENTS ; emetics ad- missible with 265. Our first and principal attention should be directed to clearing the first passages, and to heep them free during the disease being of the greatest importance. ment Emetics are by many laid entirely aside, on the principle of increas- ing the already irritable state of the stomach. That a great deal of i^ t^e ^ caution and discrimination in their use is extremely necessary must be purgation allowed; but I am decidedly of opinion much benefit is to be obtained by them. Where nausea or slight vomiting occurs, ipecacuanha is the best; but if the vomiting, be more severe, an infusion of chamomile will caution, answer every intention. Cathartics. — Calomel, combined with powder of jalap, is perhaps one of the best ; the irritating quality of the neutral salts seldom makes them advisable. 266, Blood-letting has been advised by some of the most respectable Bleeding authorities ; I shall therefore only observe that I never saw it used with afJays^hurt- adA)antage I on the G0Yiiv2LYj, I always thought it of disservice {Souytl., ^"^^^ p. 38). _ • m 26Y. Our next intentions must be directed towards lessening the inthe.^6c- irritable state of the stomach, supporting the strength, and resisting that one/ ntage, tendency to putrescency that exists in this disorder. pSar^^^ Notwithstanding the- great variety of opinions that have been, and the'^^^l^S* still are, on this subject, calomel ^v^ill still perhaps be found the most musthekept successful medicine hitherto employed, and, in general, I have but little "^ "' ' doubt its want of success in many instances may be attributed to the manner of giving it, or want of atten'ion to the state of the bowels. Cal- omel if not given in large quantities quickly repeated had better not be given at all. I have used from five to eight grains every two hours, and sometimes every hour, combined with three grains of the antimonial powder, until a diaphoresis was induced, when the latter was omitted, and the calomel continued until the effect was evident, as metallic taste, foetid breath, or sore mouth. When a gentle salivation is raised, desist constantly /fee. 68 THE DOCTRINE OF PURGATION. Sxtenial remedies. Enemas. Opium and tarh useless. in frequency, yet continne so as to keep up the effect of the mercury ; the criterion of its success may be determined by its action or non-action. When a speedy and copious salivation comes on, tlie most happy effects may be looked for ; while the contrary prove the reverse. And here ao-^in let me observe that the most minute attention m.ust he paid to Tceep tKe howels free., for which purpose enemas are the best (Journ., pp. 38, 39). 268. Blisters, although uncertain, are of great utility both in pre- venting delirium and lessening vomiting, applied to the region of the stomach. General warm hath is of the utmost service, or, where that cannot be conveniently had, washing all over with warm water (Journ., p. 39). 269. Of all remedies in use for this disease, excepting calomel, per- haps none are of more real service than enemas, and the more simple the better — such as warm water, oil and vinegar ; but on the increased vas- cular action and heat subsiding, enemas composed of orchis, sago, or portable broth ; this last I have found of such uncommon service as makes me wish most strongly to impress the use of it ; in many cases, where animation seemed nearly exhausted, recovery was the unexpected and welcome effect of this salutary practice (ibid.) 270. Opium I have found of little, if any, service, in any stage. Cinchona appears to me evidently of disservice until the patient is in a convalescent state (ibid.) Brandrefh's Pills are in every respect superior to calomel as a purge, and they leave no evil after effects. PoTTEE, Nathahiel, M. D. Letter on the Epidemic Distempers of the year 1802. Baltimore, 1803. See Med. and Phys. Jouen., 1804, vol. XI. 271. The cure of measles this year may be almost reduced to two Measles, simple remedies, hlood-letting and purging. For, when these were used Purging \^ time, and carried to a sufficient extent, little or nothing remained to ployed c«res be douc. Thcsc rcmedics were no less efficacious in removing the im- vmts^hliA mediate symptoms than in removing the ^onsequences of the disease. ^' This will be sufficiently apparent when we enumerate the deplorable train of consequences that followed their neglect (Journ., Y, 312). conse- quences. Purgatives cure by car- rying off the morbid rnatt&r. 272. Purging was a very useful remedy, and required to be repeated every second day, or oftener, as there was a constant reaccwnulation of that green and acrid matter that was sometimes ejected from the stom- ach on the first attack ; and this disposition commonly lasted four or ^YQ days. Where purging was neglected in the commencement, the evacuations from the intestines were often of a darh green, hroimi or hlack complexion, just as it happens in other malignant fevers (Jom-n., p. 313V 273. Antimonials were certainly improper remedies in this disease ; they depressed the pulse, and seemed to act too much like the causes of the disease. Are not antimonials equally unfit remedies in all malignant THE DOCTRINE OF PURGATION. 69 fevers, where the tendency to indirect debility is great, and more espe- cially in those called contagions, where the " vis nocens " is so prone to niat^^^t^ induce the same state of the system ? gether inju- '^ ' rious ; hlis- ters and opi- Blisters were equally inapplicable in the first state of the disease, uTmafclX. but co-operate powerfully with emetics in arresting the progress of indi- ^^^^^^^^'^^ rect debility in the advanced state of measles, and sometimes called forth dormant excitement to great advantage. Opium was also inadmissible in all its forms, unless toward the latter state, when fever did not contraindicate its prescription for the cough, which was often the last troublesome symptom, and seeminglv occa- sioned by the action of a small portion of the pulmonary vessels (Journ. p. 314.) Power, Geoege, Surg.^ Assistant Surgeon to the Tweniy-tliiTd Regiment of Foot, Royal Welsh Fusileers. Attempt to investigate the cause of the Egyptian Ophthalmia, <&g. See Med. and Phys. Joukn., 1803, vol. tX, 274. The next local cause of Ophthalmia in Egypt is the custom of sleeping at night in the open air, imbibing with every inspiration, and ophthai- absorbing at every pore, the putrid virus contained in the descending '^^^^^^^^^ ^^ dews. . . . Thus in a system peculiarly debilitated, and unable to resist ntght-dew all its powers combined, it produces that highly putrid fever called mauf p^?o- plague. In a patient less relaxed, as the habit of the body determines enf dfseSs the disease either to the surface of the skin or to the intestines, an erup- according to tive fever or dysentery is produced ; and when the putrid virus is but tio^n.^ ^^^°^^" partially applied, to the eyes for instance, or to the month, or even on the surface of the body, ophthalmia, ulcerated fauces, or ichorous hlotches on the skin ensue (Journ., p. 78). 275. As the author freqently refers to a treatise of the French Sur- geon Bruant, it will be of interest to know what this writer says on the cure : " This disease is frequently cured by the simple operation of na- Naturein^ ture, and without any assistance from art ; and indeed we may affirm dicate^i the with truth that nothtng so much opposes the cure as too great a profusion evaJuaUon. of remedies, especially topical. Some patients have been relieved by an eruption coming on at the temples ; others, and the greater number, by a slight diarrhoea ; and hence, to act conformably to the views of nature, I have encouraged a discharge from the bowels during the whole dura- tion of the disease, by employing tamarinds or other laxative titans (Desgenettes Histoire Medicale de I'armee de TOrient. — Journ. p. 580). Wadlet, T. W., Surg., on the Prevailing Epidemic Influenza. Stow on the Wold 1803. See Med. and Phts. Jouen., 1803, vol. IX. 276. First, the exhibition of an emetic was always promised, which seldom failed of evacuating the stomach of a darh colored, greenish, and most offensive fluid. Aperients were always rejected when given before 70 THE DOCTRINE OF PURGATION. {rom^bi/io^^ ail emetic, and an enema was fonnd of no service. The pain in the ncciimuia- head was constantly lessened and frequently removed by the vomit, and IhirkioS!^^ ^ freer expectoration sometimes relieved the congh. When costiveness maiZ'^'^' ^^'*^^ ^ ^'^^T urgent symptom an active picrgative was given, which never cu>y by failed of Ibeing folloived hy stools of a peculiar fmtor and hlach color ^ theSuse/ and tliis state of the alvine discharge often accompanied the disease throughout (Journ. p. 516). Medicus, Practical Observations on the Treatment of the Scarlet Fever and Sore Throat See Med. and Phts. Jouen., 1804, vol. XII. 2TT. It is well known that many pass very safely through the scarlet ve^^y^hen fcver^ in its mild state, with little or no medical assistance. But when qi^res' Tut ^^^ ^^^^^ statc mcdiciucs are administered, I fear the cure is, by the inge- littie medical nious theoTctical practitioner, ascribed too often to their effects and not to the mildness of the disease, especially if some fashionable medicine has been prescribed. Hence remedies undeservedly creep into prac- tice, and, I fear, in serioas cases frequently supersede the use of those which have long stood the test of sound practical experience. The cause I pretend not to -account for the source or origin of the scarlet fever ~iZitur\n ^^^ sore throat, but am well satisfied that the " fomes morbi " of the mnii"T^^~ ^is^^se, however generated, lurh in the howels. Under this con^dction moved^by^ I cujoin them to oe well cleared., in whatever stage or however violent the purgatwes. g^g^Q^g^ jy^gjy j^^ ^rheu I first scc the patient, if I suspect that such necessary treatment has not been before observed. The very foetid smell of the evacuation, and the relief such evacuation immediately procures^ strongly . prove to m.e the necessity of purgatives^ and I may add, from reiterated observations, that the longer they are delayed the more severe proves Briskpur- the discase. Many practitioners, alarmed at apparent debility, are de- Q OttOTh OOPS tJ X, / J. X t/ / not hurt, but teiTcd from exhibiting brisk cathartics lest their operation should irre- *^the vUar coverably sink the patient. Such apprehensions would be justly power. founded if purgatives were administered without due discriminating attention to age, constitution, and immediate state of the patient. But where such attention is paid, I have never seen any mischief arise ; on the contrary, the most salutary effects have taken place merely from the howels being relieved from the contained accumulated foetid fceces, and hence every febrile symptom becomes milder., and the vital powers inwigorated., not debilitated (Journ., pp. 26, 26). Patteeson, W., M. D., Case of Brainular Affection from an Internal Cause. Londonderry, 1804. See Med. aotd Phys. Jouen., 1804, Vol XII. 2Y8. A gentleman, aged above sixty years, was suddenly attacked Apopieoyy. with a sevcre pain in his forehead, accompanied with so much megrim ^lllpda- ^^*^ stomach sickness as would have caused him to fall had he not re- touncharao ccivcd support ; to these symptoms was added coldness. He was put to bed ; blood-letting pretty ' largely in the arm ; purging, and blistering the back, legs and head, in succession, were employed. Four days after the seizure, when I was called, I found him in bed complaining grievously THE DOCTRINE OF PURGATION. 71 of a violent pain in the forehead, together with an irksome stricture in the eyeballs and surrounding teguments. The functions of the brain were purgation impaired by a degree of stupor, attended frequently with incoherent '^/^^i^^^.^f® mutterings. His pulse was unequal, laboring, and accelerated with a the head Hm tenseness in the vessel ; the temporal arteries throbbed considerably, but tlTeqimh- were uniform in their action. The countenance was sometimes pale, ci^cuSuon sometimes reddish, and at other times suffused with a bluish tinge ; the eyes were languid, and the sense of vision much diminished, at periods almost lost. The temperature of the skin was sometimes pretty high, more frequently below the medium warmth, and generally felt languid and flaccid. There was sometimes an urgent thirst, but for solids little or no appetite. His stomach, indeed, continued to have a loathing, and so retrograde a disposition as to approach vomiting, which he himself considered to proceed from vitiated bile. His bowels were sluggish, and had not emptied themselves since the operation of the laxative medicine, which was a space of thirty-six hours before I saw him. He was rest- less, and when he seemed to sleep it was a morbid comatose state rather than a salutary repose. The organs of respiration did not appear par- ticularly engaged, and the urinary organs were equally unaffected. From the preceding phenomena I concluded that there existed a de- termination of blood to the head, with increased tension of the arteries of the part. Under this impression, I ordered local evacuations, by means of numerous leeches to the temples, and a hrisk cathartic to excite and empty the bowels, as well as to promote an equilibrium in the gen- eral circulation. The first application of leeches procured a sensible relief, and therefore it was repeated. The cathartic was not active enough in its operation, and accordingly a stronger one, composed of calomel and aloes, was given, and with manifest advantage. The stupor in a short time decreased, and was succeeded by a loud talkative raving, accom- panied with unconsciousness of persons and things around him, of which inattentive state a remnant continued for several days. The delirious condition lasted for some hours, and was followed by a profound sleep, attended with a stertor resembling that of apoplexy, but distinguishable from it by softness and equable movement in the pulse. This change was the harbinger of convalescence, which gradually but slowly took place. Considering the phenomena of this case, I am led to conceive that we would be justifiable in setting it down as a decided instance of apo- plexy ; but certainly it was rather of an anomalous description, as it assumed many of the features of a species of erysipelas which takes place in the membranes and vessels of the brain in the evening of life (Journ., pp. 109-111). Pearson, A., Surg., in the service of the East India Company. Some Observations on the Pathology and Prevailing Diseases of Warm Climates. London. 1804. See Med. and Phys. Jotjkn., 1804, Vol. XL 279. On Acclimation. — In the first change from a cold to a hot cli- mate it was formerly the practice to bleed indiscriminately ; it is now per 72 THE DOCTRINE OE PURGATION. liaps too generally omitted, as it might be often employed to obviate or is^('[/S'ami veinove disease arising from inflammatory congestion. Pi^/'^m^ lias also b)7^prereu- ^^^^'^^ rceommended fov unimrsal adoption • and when we reflect that the tire of cji- coustitutloii l)oth admits and requires this evacuation more frequently in eases!' *" wami than in cold climates, and hears it better, its ntility will be found • as probable as experience proves it to be. The neutral salts have been generally prescribed, and these are certainly of the most universal appli- cation and use ; but vegetable purgatives will be best for frequent use. (Inf. sennse et temarind, p. rhei. et kali tartar, separately or combined ; of the former 3j. to 5 i-, and J j.to § ii. of the latter.) Occasionally four or five grains of calomel may be taken with much advantage, from its eflect in stimulating the mucous or biliary excretories, when some of the laxatives above specified ought to be given next morning. The day on which any of these remedies are given ought to be one of peculiar mod- eration, and dilution with barley-water or rice gruel attended to. With regard to the use of tonics, or antiseptics, the indications for Deuuty employing them, and their utility, are much less than is generally sup- Sity^o^S" posed. The feeling of debility is often fallacious, and produced hy the cretion. organs being overloaded^ or a biliary absorption (Journ., pp. 161, 162). 280. In the warm climates the attacks oi febrile disease are gener- FeDers ^J accompauicd with symptoms of bilious absorption^ and torpor of the The symp- intestinal canal, and with a greater or less tendency to remission. The cSi pwga- treatment recommended by authors is very contradictory ; some advising gi^ii^g""^^' a continued and severe evacuant plan, while others administer bark on every appearance of remission, and even without waiting for it. If purging with calomel and neutral salts is assiduously practiced in the first days, giving intermediately mild diaphoretic and antimonial medi- cine, the use of bark will be found unnecessary (Journ., p. 201). 281. I am doubtful if the genuine remittent fever appears without a Miasmata previous cxposurc to the exhalation of marshes, or that from rank vege- the cause tatiou I aud the distinct remissions and exacerbations described in books act upon the are not irequently to be met with. . . It is frequently some time ajter ^prTsling ih.1 the application of the remote causes before the disease coTnes on. . . The ^mutcuiaf' debilitating effect of the marsh-miasmata is generally recognized, and it actvoipy, IS probable that the nervous energy and muscular irritability are much and suddenly impaired by their impression upon the sensorium ; the powers of circulatiDg the mass of blood are for a time diminished ; from that, irregular actions of the vessels of different viscera, a relative degree of plethora and inflammation takes place, while, from the excretories being similarly affected, the power which the economy possesses to rid itself of an excess of heat is abated. In such a state it is not surprising that congestions should take place in the brain and glandular viscera (Journ., pp. 201, 202). BEiiTNioN, Thomas, Su/rg., on the Gibraltar Fever. Gibraltar, 1805. See Med. and Phys. Jouen., 1805, vol. XIY. rauar?f?ver ^^^' ^^ ^hc first the patient is seized, without any previous notice, fevTlrtak- ^'^^^ giddiness, pain of the head, slight sickness at stomach, darting inl^Sfthe pains from the head to the back, and spasmodic affections of the calves pS?%e? of the legs. The breathing was very hot, incessant sighing, the greatest Kui^'^^°'^ dejection of spirits. The tongue was in the beginning white ; a bad THE DOCTRINE OF PURGATION. 73 taste was complained of; the sense of smelling was iiriperfect or de- ? raved ; the visage extremely distressed, and unwillingness to speak, 'he countenance on the first attack became suddenly sallow ; in a very short time, however, it became red, fulland bloated, with the exact ap- pearances of intoxication. Drowsiness and sleep followed in a few hours, when a little moisture came out on the skin. This appearance, however, ^ at this stage was delusive ; it suddenly left the patient, and was succeeded by the most intense heat, that gave a smarting sensation to the fingers when applied to the skin. There was at this time a most uncommon and offensive smell from the whole body. The eyes were now much inflamed; there was violent pain in the temples and over the arches of the eye- brows, darting to the orbits. The pulse from first to last was greg^tly increased, but never so strong and firm as in inflammatory diseases ; the thh'st less than generally in acute diseases. There was strong pulsation in the carotid arteries, and an evident enlargement of the jugiilar vein. The color of the skin approximated that of the lilac, cocklicoque, violet or poppy, and changed as the disease advanced to a deep yellow. By the early administration of strong emetics and jpurgatives on the first attach, the yellowness seldom appeared, and every other had sym^ptom was averted (Journ., pp. 137-138). 283. When these had not been exhibited, and in cases where the dis- ease from first appeared in a more aggravated form, the second set of symptoms soon appeared ; the patient was very comatose, much tremor of the limbs, frequently an incessant vomiting of black matter, with convulsive hiccough ; the eyes were drawn in a direction alternately from the nose to the temples in a frightful manner, with nearly total blind- ness. The skin was now parched with burning heat, or covered with a clammy offensive sweat. The body was covered with petechise and vibices, swellings appeared in the armpits and groins, often degenerating into abscesses ; foul gangrenous sores on the back, and carbuncles on different parts of the body. There were hemorrhages from the nose, ears, mouth, and pores of the body, with every appearance of a total dissolution of the blood-vessels. Then the fgeces and urine were passed involuntarily, and the other usual symptoms indicated speedy dissolu- tion (Journ., p. 138). 284. My first step was invariably to put the patient into a warm bath, then to rub the body well with soaped flannel, and put him to bed. If the powers of life were strong a solution of tartar emetic and glauber salts was given, which generally operated smartly both on stomach and bowels, so that I frequently had little more to do but remove the debil- ity, the patients being often well on the third day. If the solution, per- severed in, did not operate, the stomach and bowels being very insensible, I gave calomel either alone or combined with jalap and the compound extract of colocynth, I endeavored by all means to keep up the alvine discharge ; when obtained, the patient was' perfectly relieved and free from fever ; if not, the fourth or fifth day put an end to all enquiry. After procuring evacuation, I prescribed saline medicines, when little fever remained ; but when the disease continued after the third day, it turned out to be the severest typhus. Opiii^n or harh did not succeed ; when liberally given, I perceived them evidently doing mischief (Journ., p. 139). Symptoms of the first stage avert- ed by emet- ics and strong purges. The symp- tom,8 of the second stagA and the close. The treat- ment hy full e'vacuation of stom,aeh and howels. r4: THE DOCTRINE OF PURGATION. Clark, Thomas, Snrg., Observations on the Nature and Cure of Fevers and .Diseases of the West and East Indies^ and of America^ c&c. Edinburgh, 1805. See Med. and Phys. Jouen., 1806, Vol. XY. dtsentert. 285. Dysentery. — Having, in violent cases, often found the remedies i-mJtic"'sib- ^^^ described, or any others that I had tried, ineffectual, I at last had *''"\i?o in recourse to the use of emetic substances in the way of injections. I did pifes''„ndin- not adopt thcse, however, till I had reflected very seriously and reasoned ■S"the"'rec- verv fully on the subject. The other remedies already mentioned, except turn, &c. injections, were administered at the same time. From much experience I do not hesitate to assert that they have been, and, I believe I may venture to say, will be, found extremely beneficial in dysentery. It ap- pears to me more than probable that they will also prove useful in cases of piles, and, in short, in all kinds of inflammation affecting the rectum arid parts adjoining. When given early in the disease they generally afford immediate relief, and sometimes one or two injections effect a cure. When they have not been used until the advanced stages the patients experience more uneasiness from them, particularly on their first being thrown up ; but if they can be prevailed upon to keep them for a min- ute or two, the uneasiness in a great measure ceases, and they are often able to retain them for a considerable length of time. The manner in which these injections operate is for the most part as follows : In the incipient stages of the disease, even when attended with vio- lent pain and tenesmus, and all the more violent symptoms of this dis- ease, immediate relief is almost constantly experienced from them ; and nJ^how^l' ^^1 ^^^ commonly retained for a considerable length of time with little operate. or uo uneasiucss. At length an effort to go to stool comes on, and several copious natural evacuations, mixed with mucous, are procured ; and in the more violent cases several evacuations of slime, or mucous alone^ or intermixed with hlood, succeed to the natural stools, accompanied with little or no straining. After this, the patient commonly remains for a number of hours without any symptoms of disease, and in some in- stances it does not return. Those injections do not appear to occasion vomiting, or even to in- crease the irritability of stomach that may have previously existed. ^mL the' They probably assist in increasing perspiration, however. I do not secretion of belicvc that thcv Operate very powerfully in that way : at least, in some mucous and ^ ^ "^ ,^ . . *^ •! i i • .' . -, carry it off cascs, 1 havc louud it impossiblc to produce a copious perspiration by mthouTpo- ipecacuanha, both in the form of injection, and also at the same time Si^InT^ given by the mouth, in considerable quantities. movl the in- Xhe solutaru effects of these iniections appear to me to depend chiefly from the in- upou thcir cxcitiug a COPIOUS secretion oj mucous irom the internal coat nai^knd rec- of the great guts, and thereby removing the inflammation affecting turn. them. I have known a few ounces of this injection give immediate and permanent relief in several instances of very painful inflammatory affec- tions about the extremity of the rectum ; a copious secretion of mucous, resembling the white of eggs, being produced. I generally have given two, and sometimes three, in the course of Their ap- tweuty-fouT hours. The best general rule, I believe, is to administer pUcation. injectious whenever the more violent symptoms of dysentery return, or tlireaten to do so. THE DOCTRINE OF PURGx\TION. 75 Strangury^ which frequently accompanies violent cases of dysentery, will be found very seldom troublesome when these injections are used ; xf^2vS^% the reason why it is not so must appear obvious to every one. |f'^ '"j«<^- The form of injection which I have found to answer best has been about three drachms of ipecacuanha root, bruised, and boiled down in a i\i&pre- quart of water to one pint, and given at once as a clyster. From ten to (he'enema"^ twenty grains o^ tartar emetic, dissolved in a pint of warm water, will produce nearly similar effects (Journ., pp. 85-8 Y). Dys^entery and Diarrhea. — These affections of the bowels are Nature's efforts to expel diseased matters from the blood, and must never be suppressed ; but nature must be assisted by a free use of Erandreth's Pills, which are absolutely certain to cui*e if used before the powers of life are exhausted. Dr. Clai'k's method is vastly superior to opium or any of the astringent remedies so readily prescribed by the generality of medical men. But Brandreth's Pills are certain and commit no mistakes. If convenient, an ejection of pure water, about summer heat, will be found to comfort the bowels, but the cure depends upon purging the humors from the blood. Hamiltois^, James, M. D., Physician to the Boyal Infirmary and various Hospitals in Edinburgh. Observations on the Utility and Admin- istration of Purgative Medicines in Various Diseases. Edinburgh. 1805, %th edit, 1833. 2^6. The history of medicine clearly shows that theory or reasoning- has contributed in no small degree to impede its progress. v.^ltll'^ Let it be our endeavor, by circumspect induction Irom facts, to estab- {^"f^ ;*."■ lish sound principles which may lead to the discovery of other facts, and medicine!' these again to the introduction of more general doctrines, or a compre hensive and connected theory of medicine (p. 21). 2-^7. The nutritious part of our food is prepared and separated by The mode the changes which it undergoes in the mouth, oesophagus, stomach, and, of '/^'f^e.^.'fw?. with the assistance of fluids secreted from the liver, pancreas, and spleen, of the stom- is perfected in the smaller intestines ; while the lacteal vessels, opening on their internal surface, absorb and convey the nutrimental fluid into the circulating system. The residue of the food, which is not adapted to aflbrd nourishment, constitutes part of the fecal evacuation which is - made directly from the intestinal canal (p. 21). 288. This fecal residue is discharged into the more capacious colon, ^^ ^^^^^ where the ilium enters it by a lateral opening, so contrived that the contents of the colon cannot be returned. This circumstance makes a distinction between the functions of the smaller and larger intestines. The big and which is not commonly noticed. The former complete the preparation ^^^}l ^ntes- of the nourishment, and afford opportunity of its being absorbed; while the latter receive and detain the fecal part till after it has accumulated, and, perhaps, undergone certain changes, when it is voided in a given quantity and at stated intervals (p. 22). uch and in- fixes. 289. Besides, the intestines exhale and throw of fluids which have ^ ^^^ become noxious in consequence of changes which they undergo in the function of Z^-/.. rm. - •__j___^'„_i 1 ^^-. 4.*.^^ r. — .^ — ^1^^ ^l^„l.l^ ^J? the intes- body. The intestinal canal, therefore, serves the double purpose of repairing waste and of preventing decay. In this latter function, which I am solely to consider, the intestines co-operate with the other secretory tines. 76 THE DOCTRINE OF PURGATION. /unction of organs. Pretention of fecal matter causes dis- ease ; regu- lar diges- tion neces- sary for health. organs, the skin, the hmgs and kidney. All these organs have, in re- spect of this their common relation to the system, a dependence upon one another, and any of them will compensate, to a certain extent and for a limited time, the interrnpted action of the others. Nevertheless, their full activity is necessary to the enjoyment of perfect health, and the contin- uance of life ; and the regularity of the intestinal evacuation is connected in a particular manner with the well-being and healthy state of the stomach and intestines themselves. The urine and perspirable matter pass oif immediately after being secreted, and do not load the organs which separate them. The unnatural detention of these excretions has indeed a more of less remote, and often fatal, effect upon the general system, but the skin and the kidney remain uninjured. It is otherwise with the intestines : secluded from that communication with the atmos- phere by which the perspirable matter is carried off, and unprovided with an appendage resembling the urinary bladder connected with the kidneys, they are the reservoirs of fecal matter as it is poured out, which they retain till the accustomed period of evacuation comes round. Dif- ferent circumstances are apt to induce irregularity in this evacuation ; these, together with the facility with which the larger intestines admit of distension without uneasiness being excited, give frequent oppor- tunity for a progressive accumulation of faeces, whence arise interrupted action of the stomach and smaller intestines, and consequent dangerous and fatal ailments (p. 22). Evacua- tions. — Their ap- pearance indicati've of either health or de- rangement of the bowels. 290. In infancy, the alvine evacuation is frequent, and the faeces are abundant and fluid. In mature years the body is generally moved once in twenty-four hours, and the faeces, although soft, preserve a form too well known to require description ; they are of a yellow color, and they emit a peculiar odor. When, therefore, the faeces are evacuated less frequently than the age of a person demands ; when tliey are indurated ; when they change their natural color and odor, derangement of the stomach and bowels is indicated, and the approach of disease, if dis- ease be not already formed, is to be apprehended. For it is not to be imagined that organs of so great importance in the animal economy as the stomach and bowelsare, can belong in a state of inaction, and the general health remain unimpaired (p. 23). Peristal- tic motion of the bow- els, if inter- rupted by conatipa- tion. CHUses excrementi- tious (iccu- mulatiorifi producing dAsea se. Its cure by purgation. 291. ThQ propulsion of the contents of the intestines is effected by means of a vermicular, or, as it has been called, a peristaltic motion of the bowels from above downwards ; hence torpor, or loss of tone in the muscular coat of the intestines, by which this motion is thought to be interrupted, is understood to be the cause of much distress, and tonic or stimulant medicines are employed to remedy this torpid state. I use this language, and speak of torpor of the bowels, although my ideas respecting it do not correspond with those of others. I am inclined to think that the symptoms referred to loss of tone proceed, in many occasions, more directly from the impeded peristaltic motion, the conse- quence of constipation. In this situation we may easily understand that the distended colon cannot, for want of space, receive the contents of the smaller intestines, which will of course stagnate throughout the whole canal ; the action of which being thus interrupted, will soon alto- g ether cease, and be at last inverted. The various ailments which THE DOCTRINE OF PURGATION. 77 thence ensue, are daily before our eyes ; and tlie relief which, under these circumstances, we observe to follow soon after the exhibition of a purgative, and the cessation of complaint which takes place upon its operating freelv by stool, are in proof that this opinion is well founded. If^ again, loejarther consider that the greater part of the exhalations made into the cavity of the intestines is exerementitious, and will, if re- tained heyond the usual period, undergo changes and acquire injurious acrimony : and if, moreover, we advert to the sympathy which many of the organs of the complicated animal frame have with the stomach and intestines, we cannot but recognize the great influence which these must possess over the comfort, the health, and the life of the individual (p. 24). 292. These are weighty considerations, and ought to excite our attention to any irregularity of the alvine evacuation. The necessity of this will farther appear when we reflect that many circumstances, unavoid- able in social life, expose mankind in a peculiar manner to constipation ; ccmsUpa- such as improper food, intemperance, sedentary occupations in confined ^lu^"^*^ or otherwise tainted air. Besides, in a therapeutic view, we are encour- aged to exercise this attention. It is admitted that diaphoretic and constant diuretic medicines employed to remedy interrupted secretion by the Sf^^^stSe of skin and kidney, operate circuitously, often possess deleterious qualities, ^^^f^ l^ecom- or are uncertain and irregular in their eflfects ; while the means of re- mendabie. moving constipation act directly on the seat of disease, are safe, and seldom disappoint us in the attainment of our object (p. 25). 293. In the dawn of physic, purgatives were employed. But, although they have been recommended hy the earlier as well as hy later g^uve meth- writers, and although the indications they are meant to fulfill have been o^^,. however an object of attention to the practitioners in all ages, yet I do not think sufflcienul that the extent of their utility has been always clearly perceived, or that atel/^^^' their administration has been always properly directed (p. 27). 294. Another objection to the use of purgatives is urged with a force that seems to carry conviction along with it. It is observed that tlie reguZtel\iQ constant application of stimulating articiles creates a habit not f^nly of of^purgadve using them, but entails also the necessity of occasionally increasing their medicines, stimulating power. Habit or custom will indeed reconcile us to the im- pression produced* by unusual stimuli, and will counteract their effect in such a manner, that if the stimulus be suddenly withdrawn, or, which is the same thing, be not gradually increased, the functions of the organ to which it had been applied will become languid and irregular. This law of the economy no doubt extends to the promiscuous use of purga- tives given unnecessarily during the enjoyment of perfect health. In many instances, however, of disease, constipation and accumulation of fseces demand this stimulus to restore the healthy state of the intestines, and to promote the expulsion of their indurated contents. In propor- tion as these objects are accomplished, the stimulus from the same pur- gative becomes more and more powerful ; and so little is the necessity for continuing it, or for increasing its dose, that, on the contrary, were How excre- mentitious 78 THE DOCTRINE OF PURGATION. not the activity of tlie purgative diminished, or were it not withdrawn altogether, as convalescence advances, we should be in danger of in- ducing weakness bj an excess of purging (p. 29). (Cf. Hipp. 16.) 295. Purgative medicine»^ properly administered, will not induce REMo^^^^^de- debil'ty J on the contrary^ the bowels being excited to propel their con- hiiity. tents, their functions are restored, appetite and digestion improved, and the patient, so far from being weakened, is nourished, supported, and strengthened. (29.) 296. Purgative medicines have also been thought unnecessary on this account, that in many diseases little food is taken ; and, therefore, regular alvine evacuations are neither requisite nor to be expected. The residue of food unfit for the jpur pose of nutrition contributes^ no doubt ^ its ^t Ins art share of feculent matter / yet the abundant secretion from different or- "^Sthout gcii^8^ and the exhalation of excrementitious fluids made into the cavity much food, of the intestines^ constitute the bulk of the faeces collected within them. ^L^uS- So long, therefore, as fluid is supplied, and so long as the circulation is ^^^- supported, it is equally easy to understand how faeces are produced, independently of much solid food, as to perceive the necessity of their daily evacuation during the course of fever, and of other diseases of long continuance (p. 30). 297. I refer the superior utility of purgatvve medicines in typhus fever to the circumstance of their operating throughout the whole extent fJoer^^^ of the intestinal canal^ the healthy functions of which are essential to Pwrgation ^]^q recovcrv, iu a manner that is consonant to the course of nature, by cures, and ^^•^. V ' n. -^ i t t , . • i why coriHo. propclling its coutcnts irom above downwards, and to their movmg and nunt^ to '^ '■•(.Qj^pigi^eiy evacuating the feculent matter, which in this case becomes offensive and irritating (p. 35). 298. More extended experience confirmed these conjectures ; and I fr^T^g^n- was gradually encouraged to give purgative medicines during the course ningtoend. ^f typhus from the Commencement to the termination of the disease (ibid.) Full pur- 299. I have directed a strict attention to this practice for a long time, and I am now thoroughly persuaded that the full and regular gatiou fits evacuition of the bowels relieves the oppression of the stomachy cleans the ^effecu!^^ loaded and parched tongue^ and mitigates thirsty restlessness, and heat of surface, and that thus the later and more formidable impression on the nervous system is prevented, recovery more certainly and speedily pro- moted, and the danger of relapsing into fever much diminished (ibid.) Purgation ^^^- Fc)r many years past I have found wine to be less necessary (in T/rrS'^^e- typhus fever) than I formerly thought. . . This chiefly attributed to the moving de- purgativc mediciucs which I employed with freedom, obviating and re- buity. moving symptoms of debility. This doctrine is at variance with that THE DOCTRINE OF PURGATION. 79 which is commonly entertained, but I am confident it is consonant to the fact (p. 36). 301. The complete and regular evacuation of the boivels, in the course ^eSg oi fever ^ is the object to be obtained (ibid.) Purgation needful in fever. 302. T\\Q early exhibition of pv/pgatives tqWqyq^ the first symptoms, Early pur- prevents the accession of more formidable ones, and thus cuts short the ^^^^^^^ disease (p. 3Y). gallon an 303. I had learned that the symptoms of debility which take place in purgation typhus fever ^ so far from being increased, were obviously relieved by the ifjlty^-^ %'. evacuation of the bowels. I have never in scandatina, in a long course of p'j;^* / cures experience, witnessed sickness and fainting, which some authors have so ver, and much dreaded; neither have I observed revulsion from the surface of the body and premature fading, or, in common language, " striking in " of the efflorescence, to follow the exhibition of purgatives (p. 45). Accordingly no variety of the disease has hitherto prevented me from following out this practice to the extent which I have found neces- sary (p. 46). causes no striking in. 304. Purgative medicines are useful in removing dropsical swellings dropsical the consequence of scarlatina, when the weakness of the patient is often sweiimg very great. Purgatives also afford a means of preventing this swelling, aEemoved and other derangements of health (ibid.) by purga- tion. 305. When I consider the languor and lassitude which precede mar- asmus., instead of adopting the common opinion of its being occasioned by worms, I am more disposed to think that a torpid state., or weakened^ action of the alimentary canal., is the immediate cause of the disease. From this proceed costiveness^^ distention of the bowels, and a peculiar irritation, the consequence of remora of the fcecesj and I have accord- ingly been long in the habit of employing purgative medicines for the cure of marasmus y the object is to remove indurated and foetid faeces, the accumulation perhaps of months, and as this object is accomplishing, the gradual return of appetite and vigor mark the progress of recov- ery (p. 59). Marasmus from torpid bowels, con- sequent, dis- eases and their cure by purgatives. 306. Epilepsy, than which no disease is so afflicting to the patient, is frequently the effect of particular irritation of the mind or body. Prac- titioners enumerate worms in the intestines, or marasmus, among the causes of epilepsy. Surely this will induce us, on the first attack of epi- Purging lepsy in children, arising from an uncertain cause, to set on foot the most to^be 'taken. decided and active course of purgative medicines, lest we perad venture allow the disease to strike root, while we are idly employed in the exhi- bition of inert and useless vermifuge medicines, or are groping in the dark in quest of other causes of the disease, or of uncertain remedies for their removal (pp. 63, 64). 80 THE DOCTRINE OF PURGATION. 307. Chlorosis. — The slightest attention to the history of the disease evinces that costiveness precedes and accompanies the other symptoms. Costive /less induces the jecident odor of the breathy disordered stomachy f^JlL'^I *'"*" ^'^^^ ^f appcilte^ and impaired digestion. These preclude a sufficient supply of nourisMnent at a period of growth when it is most wanted ; hence paleness^ laxity^ flaccidity, the nervous symptoms^ wasting of the Qnuscidar fleshy languor^ debility^ the retention of the menses^ the suspen- sion of other secretions^ serous effusions, dropsy, and death (p. 11). Chlorosis Fearful re- ilts of tiveness 308. The greater capacity of the female pelvis gives more room for that part of the intestinal canal which is contained within it to dilate, requirTf nil aud, of courso, to admit of greater accumulation of feculent matter, which, purgatwn^ Iji pj.Qpg-pfiQi^ f^ {fg femora, becomes more and more abundant, and more Women more mea. impacted. Hence costiveness is more obstinate, and chlorosis and other clise (ses originating in costiveness, are more severe and are of more diffi- cult cure in thefer)iale than the male (p. Y2). To escape ^^^- Grrcat attention and assiduity is requisite in the exhibition of failure purfi^ativo mediciucs in chlorosis, and the frequency of its repetition must ixj and fear- bc Varied accordiug to circumstances, w^hich can only be ascertained by lessiy. ^i^Q inspection of the " alvine egestaP The practitioner who is not aware Inspect ^^ ^^^% and who, yielding to the importunity of his patients, or the TEE STOOLS, caprice of their relations, does not steadily pursue his plan of cure, will be disappointed, his abilities will be called in question, and his practice vilified and neglected (p. Y3). 310. The symptoms (of hysteria) undoubtedly denote a preternatural an^^airits offcction of the stomach and alimentary canal. In my opinion they ^m™?ed™b^^ afford conclusive evidence that this affection is primary, and that the purgation, other iTiultifarious symptoms of hysteria depend upon it (p. 87). The first purgatives that we use may seem on some occasions to aggravate gSve^lrri- ^^^ symptoms, but the practice must not be deserted on that account. tation soon The additional irritation which pier gati'iSes r)%ay give in the first instance soon passes away, and perseverance in the use of them removes that irrita- tion which gave rise to the disease, which, of course, disappears in pro- portion as the bowels are relieved of the oppressive mass of accumulated faeces (p. 88). 311. St. Titus' Dance. — Powerful purgatives must be given in suc- cessive doses, in such manner that the latter doses may support the effect St. Vitus' of the former, till the movement and expulsion of the accumulated mat- Let the ter are effected, when symptoms of returning health appear. Whoever S'^SSS undertakes the cure of chorea by purgative medicines must be decided C'^^'fr' doses and firm to his purpose. The confidence which he assumes is necessary dangerous, to Carry home to the friends of the patient conviction of ultimate suc- and^^Sve- cess. Their prejudices will otherwise throw insurmountable obstacles in his way. Half measures in instances of this kind will prove unsuccess- ful, and were it not for perseverance in unloading the alimentary canal, the disease would be prolonged, would place the patient in danger, and thus bring into discredit a practice which promises certain safety (p. 97). rancs sue- \Hj'ul. THE DOCTRIiNK OF PURGATION. 81 312. The agonizing spasms, the prominent symptoms of tetanus, hav^ arrested the notice of every one. To resolve the spasm and to cure the cannot be* disease have been conceived to be one and the same thing. Accordingly, ,, Ss/S?- opium, musk, v^arm bathing, cold bathing, and mercury, have been em- modicH^' ployed in tetanus. But have they mitigated the severity of tetanus or ^md^ /uii obviated its fatal tendency ? " The records of physic bear a sad testi- ^^^J7««*"^^- mony in the negative." However just these observations may be, I should yet have been sorry to have advanced anything to shake the tot- tering fabric of medical practice in tetanus unless I, thought it had been in my power to substitute one more efficacious, originating in other terin^g^fabSc views of the disease. These views, I apprehend, will warrant the expec- ^^^ ™.^f ,my^ removed, the strength and vigor of the system will return. Have we Hernia. Purgatives useful as cooling sed- ativeft^ re- moving the irritation in the primEe viae, and pro- moting the reduction. THE DOCTRINE OF PURGATION. 89 not often seen the debility which attends some of the complaints of in- fancy removed, as well as the disease of which it was a symptom, by evacuating the howels ; and nausea^ and anorexia, with all the depress- ing symptoms of dyspepsia, how often alleviated ly a Irislc purgative f (p. 100). 345. If we would follow out this practice on general principles, we must emulate the whole effect of our remedies. Sometimes we empty the Effects of bowels simply ; at others we promote an increased secretion of fluids by JreeTofpS- purgative medicines. In some cases it appears suflicient to unload the bowels of their contents accumulated by long retention, and thereby relieve the system from the eifects of this local irritation ; but in others, and especially in those in which a freer and more continued purging be- comes necessary before the symptoms yield, we hring off not only the contents of the howels which are out of the course of circulation, we eliminate also the secretory organs which terminate in the intestin(^ canal — the obstruction, torpor, or deranged actions of which may have 'been a chief cause of the morbid actions of other parts of the system (ibid.) gation. In propor- 346. We are surely authorized to make this inference from cases in which the purging is continued for weeks, to the exhibition of three or tion ar*the four stools daily, with progressive relief of the morbid symptoms, with matZrs^re improved looks and strength, and at length followed by the perfect cure ^l^feamis of a complicated disease. In other cases we find the cure advancing restored. with the discharge of fetid stools of a bilious appearance, or black and greenish color (p. 101). 34Y. Having been an eye-witness of Dr. Hamilton's practice, I could '^he danger not avoid being struck with its simplicity and success, and adopting it ^purgiZg^ as my own. Much dissatisfaction may have arisen among practitioners, «^#cie7i%. from the unwillingness of patients to submit to a repetition of purga- tives, who all esteem purging a debilitating operation, and think them- selves " far too nervous " to undergo it with impunity. Many too, I believe, are disappointed in their hopes of vure, by stopping short of the wished-for point (ibid 1807, vol. III. p. 144). 348. Both these evils may arise from a neglect on the part of the ^^^^ medical adviser. I mean, not inspecting the stools. If the practitioner amTnl^m be too much an " emunctse naris homo " to submit to such a drudgery, ^*°^^^' let him go on trusting to remedies that have long failed, or rather let him lay aside the practice of medicine altogether. It is only by daily inspection of the stools that the purging can be regulated j for, as long as they exhibit moebid appearances, so long are purgatives necessary, and no longer. When the stools are not seen, the patient conceives that he is discharg- ing far more than you are aware of, and more than his constitution can bear. By an earnest inquiry after them and a strict injunction that the whole may be saved, together with an occasional appeal to the patient, whether such matters can remain in the body with impunity, I have never failed in inducing a cheerful submission to the plan, and the pa- 90 THE DOCTRINE OF PURGATION. tieiit at last looks for tlie repetition of the doses as a sure relief from the misery he is siilFermg. Having premised these remarks, which arise from the objections of several medical friends, I proceed to the relation of two cases, not picked out as proving more than others, but as exhib- iting the obstinacy of the disease, and the ultimate advantages derived from a steady perseverance in the purgative plan (p. 145). Here follow the cases : . • Walsh, 'E., Jf. D. An account of a malignant fever, which appeared in the Garrison of Quebec during the Autumn of 1805, with some preliminary observations on the diseases of the Canadas. London^ 1806. See Med. and Phys. Journ. 1806, vol. XV. Lake/ever. ^^^- ^<^^^ Fever. — The curo of this fever is not less easy and cer- Emetic and ^^iu at its Commencement, than difficult in its advanced stasres. An es. antimonial emetic, followed by a brisk purge, with attention to regimen lor two or three days, seldom failed of curing it on the access. But if this was neglected, and the disease far advanced, such a torpor of the system was induced as frequently rendered ineffectual the most active medicines (Journ., p. 448). Dr. Walsh characterizes the malignant fever at Quebec exactly like Mr. Bennion describes the fever at Gibraltar, and has employed the same remedies against it ; confer, therefore, Bennion on the Gibraltar Fever (Journ., pp. 451-453). Cheyne, J., M. D. Observations on the Effect of Purgative Medi- cines. London, 1808. See Edinb. Med. and Surg. Journ., 1808, vol. IV. I'iU antf tives. 350. Case of a youth who, in consequence of a fall, was subject for inability To a yeo/p to mjost distressing fits, intense pains, etc., and who, in conse- hy purg^a- qucuce, had lost the power of walking. (Case given.) This boy in about two months w^as restored to health. During this period he used a great quantity of strong cathartic medicine. A scruple of aloes and ten grains of gamboge were^iven daily for several weeks before his stools became natural ; and as his stools became large, loose and natural, the fits left him and he recovered the use of his limbs. About the end of my attendance, when his bowels were acting more naturally, one pill of the same kind, of which it before required sometimes ten to produce the desired effect, was a sufficient dose (pp. 310, 311). In this case our practice is supported by analogies drawn from the successful treatment of other diseases where, along with convulsions or aff^uons!'^ spasmodic affections, we have also been able to detect a great degree of foulness in the bowels. It is in compliance with a common idiom that I use the expression of foulness of the bowels. I am persuaded that such a state cannot, with any propriety, be said to exist. Take the Infantile ,^iQy^ infantile remittent of D7\ Batter, or the marasmus of Dr. Ham- ilton- — we have a train of symptoms supposed to be induced by foulness of the bowels ; and the appellation seems to be countenanced by what is observed during the cure, the effects of the purging medicines Fetid stools, employed. By these medicines stools are procured, at first darJc^ slim/y marasmus. THE DOCTRINE OF PURGATION. 91 a/nd fetid^ which perhaps, for a considerable time, have nothing of the appearance of natural faeces ; the evacuations seem merely a collection of vitiated secretions, but at last^ hy pursuing the purgative plan^ large natural stools are evacuated, and it is generally supposed that these stools have been all the wliile lodged in the. intestines, and that our medicines were not powerful enough at once to expel them — that the dis- ease was solely from an accumulation of fecal matter (p. 312). 351. But the fact is, that these critical stools are produced hy the restoration of the viscera to a healthy condition. The purgative medi- cine employed is useful, not so much by removing the accumulations.^ but that it stimulates the howels. By the steady application of this stimulus the visceral functions are restored. The bilious and slimy stools are expelled, the light food is concocted, and from the fecal resi- duum, with the increased supply of gall, of gastric and pancreatic fluids, and the secretions from the large intestines, in consequence of the reno- vation of the organs supplying these fluids, the large natural stools are produced and the disease resolved. Were the bowels in a healthy con- dition, they would be acted upon by what at all other times is their natural stimulus, and, consequently, they would not admit of this sup- posed accumulation. If there be accumulation, the torpid state of the intestines is the cause of it ; but the disease may exist without any accu- mulation whatever (p. 312). 352. In dysentery., where hardened faeces are lodged in the bowels, we see a constant succession of unsatisfactory stools, and of these stools the hard fgeces or scybala would seem often to be the cause. For, it is observed by every practical writer, that when, by proper purgatives, the scybala are evacuated, there is immediately a remission of the most urgent symptoms, in particular of the tenesmus, and frequent mucous stools (p. 313). Powerful purgation. Critical evacuations hy stool. Critical or fetid stools indicate re- moval of dis- ease and re- turn of healthy ac- tion. Dysentery from scybala. 353. Hydrocephalus. — The cure. The exhibition of the largest dose which can be safely prescribed of some powerful cathartic medicine., two, three, or four times a day ; and this continued for several days, or until natural stools are produced. The advantage of keeping the intes- tinal canal under the continual influence of a stim^ulus, I have, in various instances, found to be so great, that I am induced to repeat the declaration of my belief, that the happiest result may be expected from this measure. {Essay on Hydrocephalus Acutus, Edinb., 1808 ; ibid., p. 346.) Water in the brain — cure by the fullest pur- gation. Gat, M., M. D., An Essay on the Nature and Ireatment of Apoplexy. Paris^ 1808. Translated hy Ed. Copeman, Surg^with an Ap- pendix. XYI. London, 1843. See Brit, aj^d Foe. Med. Eev., 1843, Vol. 354. This treatise proves that hleeding is injurious in aU cases of apoplexy, and that the primary cause is always to be found in the primes vise ; tlmt purgatives are indicated in every case, except when the attack follows a full meal, when emetics should be first administered (Rev., 272). Apoplexy. Ntverhle&dy but purge. 9'2 THE DOCTRINE OF PURGATION. Halldday, Andrew, M. D., On Epilepsy. AND Phys. Journ., 1808, Vol. XIX. Blcmdford, 1808. See Med. Epilepsy h-om.iC0rms. Continued purgation removes the cause by carryingoff accumula- tion of onorhid onatter in the intes- tines. 355. Case given of a girl of five years old who was subject to fits with violent contraction of the limbs, had an unnaturally voracious and de- praved appetite, and could articulate but very few words, however she understood what was said to her. Upon an attentive consideration of this case, it occurred to me that purgatives were likely to be of service, and from my intimate acquaint- ance with the practice of that justly-celebrated physician, Dr. Hamilton^ of Edinburgh, I entered upon the treatment with great confidence, and did not hesitate to promise success to the parents of the girl if they would faithfully and implicitly follow my directions. I confess that I had my fears lest there should be some organic disease ; yet the pulse, though rather slow, was regular. The bowels, I was told, were very irregular, but generally costive ; I felt the abdomen very tumid ; and notwithstanding the feebleness and emaciated state of the patient, I felt convinced that no time was to be lost ; I therefore ordered an active purgative. The fits recurring and no stool being procured, infusion of senna was given, one ounce every half hour, which produced several scanty^ fluid moUons, of a greenish color ^ and highly fetid. Both medicines were continued for four days, without alteration in the state of the patient or her bowels, several lumbrici were voided, the fits had rather increased in violence; on the fifth day she had two motions, the last very copious.^ consisting chiefl/y of hardened scyhala.^ and containing two worms ; fits returned only during the night. Three days more brought more large evacuations of the same kind, diminished voracious- ness, and less severity of fits which occurred during the nights. From this time (the 6th of January) to the 20th, I continued the exhibition of calomel and rhubarb, and the senna occasionally, never intermitting more than one day. The quantity of feculent matter which she passed during that period is beyond conception. Her appetite began to flag about the 14th, and on the 16th her mother informed me that she had not had a fit for twenty-four hours ; on the 17th she had one very severe fit, but remained free from them again till the 20th, when she had one which did not continue above ten minutes. During this period she had voided three lumbrici. The fits gradually abated, the appetite became natural, while purging pills were continued so as to secure a regular alvine discharge (Journ., pp. 305-308). Large doses SinA perse- verance se- cure SUCCESS. 356. Thus far the purgatives have fully answered my expectations. The child appears to be cured of her fits, but I am afraid she will remain an idiot while she lives. The doses of medicine that were necessary to move her bowels were very large, and also the length of time which elapsed hefore the howels could be said to he properly moved, for I con- ceive that she had no proper motion till the seventh day. The large doses of medicine which were necessary may be accounted for, perhaps, from the state of the sensorium ; and the difficulty which there was in moving the bowels was, no doubt, owing to the great accumulation which had taken place (p. 308). THE DOCTRINE OF PURGATION. 357. Though the fits are removed at present, I fear they will be apt to return, unless great GO/re is taken to keep her howels open for some considerable tiine^ until the predisposil/ionfrom habit is overcome, anct the bowels are restored to their natural tone / but if this is attended to, I ain certain the cure will be complete. This case, then, I would say, tends to corroborate the very valuable observations of Dr. James Ham- ilton, but indeed those observations stand in no need of any such testi- mony ; for Dr. Hamilton has proved every position which he has advanced by facts that never can be controverted. The novelty, the sim- plicity, a/nd the efficacy of Dr. HamiltorC s practice attracted much notice on the first appearance of his invaluable work ; and as the doctor did not venture to give his discoveries to the world till experience had most fully confirmed them, he was able to speak with certainty ; and I will venture to affirm that if purgatives hawe failed in any instance to piA duce the effects which Dr. Hamilton's observations have so incontestibly proved them capable of producing, that that failure is to be attributed more to the prescriber than to the medicine prescribed (Journ p. 309). It is neces- sary to estab- lish regv^ larity of al- vine evacua- tions in or- der to secure health. The purga- tive plan of treatment and Hamil- toTi's doc- trine vindi- cated. 358. I liave often heard it argued, by those who were unwilling to give too much credit to Dr. Hamilton, as was generally allowed, that though no doubt the cases which he had related seemed to prove the good effects of purgatives, yet that many of those cases — for example, his cases of typhus fever — were so trifling that any other remedy would have done as well as purgatives. And, moreover, it has been often hinted that though this practice may do very well in the north, and in the Koyal Infirmary of Edinburgh, yet that it is by no means calculated for the delicate constitutions of this country. 1 shall only say, that those who have witnessed Dr. Hamilton'' s practice have been fully con- vinced of the good effects of purgatives in severe as well as slight cases of fever ; and, indeed, had the doctor felt any anxiety about this, he might have filled the second number of his appendix with cases more severe than any he has given. With regard to the second hint, I can add my testimony to that of Dr. Morgam., of Dover. (See Edinb. M. and S. Journ., 1807, April 1.) I have prescribed purgatives in different diseases since my residence in England, and have found their effects uniformly the same as in the north. While I resided at Halesworth, in Suffolk, I attended Robert White, of Walpole, with Mr. Walker, surgeon, in one of the worst cases of typhus I ever saw. The disease was speedily subdued by pur- gatives. The bolus jalapse compositus had the same good effect in Suf- folk as in the Royal Infirmary of Edinburgh (Journ., pp. 309, 310). Typhus. Further vin- dication of the purga- tive plan and Hamil- ton'' s prac- tice. Watt, Robert, M. D., Cases of Diabetes, Consumption, dsc, with Ob- servations on the History and Treatment of Disease in Paisley, 1808. See Edinb. Med. & Sukg. Jour., 1809, Vol. V. 359. The functions of the lungs are twofold : to assimilate the new materials supplied by the digestive organs, and to preserve the blood in a healthy state. In health there must be a due balance between the di- gestive and assimilative organs. If this balance be disturbed, disease ensues (p. 93). The lungs; —health and disease. 94 THE DOCTRINE OF PURGATION. Ohy^C' 360. If more chyle be thrown upon the lungs than they can assimi- late, it must remain an incumbrance upon the system, or he discha/rged iSj one or other of the excretories (p. 94). 361. The hlood may he deteriorated, and yet support life, in an im- perfect manner. The vessels which increase and repair the solids may be in want of proper materials, though the system w^ere overcharged with blood. The nervous system being deprived of its natm'al support from these vessels, acquires a depraved sensibility, and all the phenomena follow which we ,have described as attending a diseased habit. The greatest number of secreting organs are idle for the want of arterial hlood, the only stimulus %Dhich can call them into action. The liver receiving its stimulus from venous blood, has more to do than in health ; ice arise " bilious complaints " which, with low spirits, prostration of *ength, &c., generally mark the first stage of disease (p. 94). 362. If the system possesses sufiicient vigor, reaction takes place; and goes on to a proper crisis. ... In place of fever the balance is often restored by a critical evacuation. If the superfluous matter take to the intestines, it produces dia/rrhma / if to the kidneys, diahetes / if to the uterus, menorrhagia ; if to the skin, profuse perspiration. If the re- action fail to produce a salutary crisis, the system falls back, collects new vigor and resumes the conflict, as in intermittent fever, and other periodical diseases. In other instances, such as hypochondriasis, it re- peats the same thing over again, or tries other means of relief, and is thus said to counterfeit every disease ; that is, it employs many efforts to throw off the incumhrance, but is generally unequal to the task. Af- ter a longer or shorter struggle, a conffrmed phthisis, diahetes, diarrhoea, dropsy, or some other disease, terminates the patient's sufferings (p. 95). 363. In every period of the history of medicine, there has not only been practice opposed to practice and theory to theory, but one fashion has succeeded another with astonishing rapidity. One practitioner treats burns and scalds by heating, another by cooling applications ; one cures the gout by carefully wrapping the feet in flannel, another by plunging them in cold water ; one combats fevers with wine and opium, another by gruel and purgatives. These, though abundantly striking, are but a small sample of the oppositions in medicine. To notice the fashions would be to enumerate the various articles which, from time to time, have entered the materia medica, and almost every possible man- ner in which these can be prepared and compounded. (Journ, 1810, Yol. YI, p. 287.) AbayA'' spe- 364. From a belief that there is no disease without a corresponding cificsy remedy, medical men have been much in search of antidotes. The task of finding a specific for each disorder, reminds me of the labor of the Chinese in inventing a distinct character for every word in their lan- guage. However numerous and diversified the hair-splitting systems of nosology may represent diseases, the mea/ns of cure, like the simple sounds in language, are few o/nd ohvious. Galen remarked that hleed- ing a/nd purging were the two legs of physic, and it is douhtful how Purgatives /^^ ^^^ ^^^ ^^^ ^^^^ improvcd hy the legs which have since heen added ih^^'UgsoS (ibid.) The hlood. The nerves. Secreting organs. The liver. •' Bilious com- plaints" debility. Reaction. Ontical evacuation : Diarrhoea — intestines ; Diabetes — kidneys ; Menorrhagia — uterus ; Perspiration — skin. Hypochon- driasis — its causes, course, and end, if im- pu'ities are not remov- Vagaries of medical practice. I THE DOCTRINE OF PURGATION. 95 Beiggs, H., M. D., Physieicm of the Royal Dispensa/py of Liverpool ; History of a case of tetanus cured hy purgatives. Liverpool^ 1809. See Edinb. Med. & Surg. Jouen.. 1809, Vol. V. 865. Remarkable case of Luke Gaskell, given in detail. — The cure was perfect in four weeks. On the fourth day of the case, L>r. JBriggs says : — " I had all along been aware of the awful responsibility I in- currred by departing so widely from the usual practice in tetanus, and now my resolution failed me altogether. I was terrified with the ap- prehension that I had already delayed the free exhibition of opiates too long, while yet I was loth to relinquish the use of purgatives (p. 154). On a cool review, I asked myself whether, if the case should prove fatally, as I then feared it would, I could with justice affirm, that purga- tion had heen fairly tried a/nd failed, whether on the contrary the ex- acerbations that had occurred ought not to be ascribed to the interrup- tion of the plan, rather than to the plan itself? (p. 155). Finally, I con- cluded to adhere to the plan of purgation, and to discontinue the inter- nal use of opium (ibid). 366. After the cure, he says : — '' If there be any point in medicine, on which, after having been engaged in dispensatory practice for sixteen years, I have arrived at any certain conclusion, it is this, that in gastro- dynia, and many other spasmodic affections, hrisJc purgatives will be found incomparably tetter antispasmodics than any of that tribe to which this epithet is usually applied. I believe, too, that their operation is strictly antispasmodic — that their first effect is, to supersede the spasmodic action ; for I have often known complete relief to be obtained before a stool was procured, in so much, that I have more than once been asked by patients, ' if I had not given them laudanum V '' (p. 161). I am inclined to think, that the more drastic purges were laid aside for no sufficient reason. . . The more active purgatives appear literally to have possessed antispasmodic virtues (p. 162). The quantity of medicine taken from first to last for twenty-five days is certainly very large, as follows : — calomel 320 grains, scammo- ny 340 grains, gamboge 126 grains, powdered jalap 6 ounces, infusion of senna with tincture lOf pounds, colocy nth-pill nearly 2 ounces, of' which the greater part was taken within the first week. During forty-eight hours (on the 5th and 6th days) was given scam- mony 210 grains, gamboge 89 grains, jalap IJ ounce, infusion of senna 2|- pounds, calomel 80 grains ; and all this without causing sickness or griping, but on the contrary with most decided benefit (ibid.) Locked-ja/i/} — remark- able case ; cure by pow- erful jmr- gaiion. " Nil (lenpe- romdv/m,.'''' Spasms of the stomach. Purgatives the best " antispas- modics." Drastic purges. 367. In short, if a remedy be indicated at all, surely the dose should be regulated, not only by' weight and measure, but by the effoct. And when there is such a strong concatenation of morbid actions, as in tetanus, it might perhaps have been expected, a priori, as it h.^'S, proved in fact, that nothing but the most active purges, in large doses, and freqtcently re- peated, would avail to break the train (p. 163). The whole quantity of opium taken was 100 drops in two days, and so far from answering any good end, it seems manifestly to have prevented sleep, as well as to have tmpeded the operation of the purgatives (p. 164). This is the most important evidence, in respect to purgatives, we have yet published. Our directions for the use of Brandreth's Pills need no modification. Dose, from 2 to 20, or any quantity required to purge. The effect, notthequan tity of the dose to be considered. unit. 06 THE DOCTRINE OF PURGATION. Rush, Benjainiin. M. D., Medical Inquiries, 4 vols. Philadelphia, 1809. iH^^ease a 368. There is hut one fever. However different tlie predisposing, remote, or exciting causes ot fever may be, still I repeat, there can be but one fever (vol. III., p. 16). All forms 369. I infer tbe unity of fever, further, from the sameness of the "^treJc.!'' pi'oducts or effects of all its different forms (ibid., p. 17). All ordinary sa!wumr- I'S'^'er being seated in the blood-vessels, it follows, of course, that all ous system, those local affcctions we call pleurisy, angina, internal dropsy of the brain, pulmonary consumption, and inflammation of the liver, stomach, bowels, and lungs, are symptoms only of an original and primary dis- ease in the sanguiferous system. The truth of this proposition is ob- vious, from the above local affections succeeding primary fever, and from their alternating so frequently with each other. There heing hut one fever, of course I do not admit of its artificial division into genera and species (ibid. p. 33). '^'arrarwe^^ 370. Pulmono/py consumption is sometimes t/ra/nsferred into head- mentsQi^%- achc, rheumatism, dia/rrhma and mania. The hilious fever often ap- tfonabie S pcars in the same person in the form of colic, dysentery, inflammation useless. ^£ ^^ liver, lungs and brain, in the course of ^yq or six days. Phreni- tis, gastritis, enteritis, nephritis, and rheumatism — all appear at the same time in gout and yellow fever. . . . Much mischief has heen done hy nosological arrangement of diseases. They erect imaginary houn- daries hetween things which are of homogeneous nature (ibid., p. 34). consequen- 371. They gratify indolence in a physician by fixing his attention ciai°no^^n- "upon the uamo of a disease, and thereby leading him to neglect the ciature. ranging state of the system. They moreover lay a foundation for dis- putes among physicians by diverting their attention from the simple, predisposing and proximate to the numerous remote and exciting causes of disease, or to their more numerous and complicated effects (ibid., p. 35). The mate- 372. T\iQ y^\io\q materia medica is infected with the ^<^^e/WZ ^<9^- 7^^^£t- quences of the nomenclature of diseases, for every article in it is pointed only^ against their names, and hence the origin of the numerous contra- dictions among authors who describe the virtues and doses of the same medicine (ibid). ^fomtngr"^ 373. By the rejection of the artificial arrangement of diseases, a when the rcvolution must follow in medicine. Observation and judgment will mS^SiXl take the place of reading and memory, and prescriptions will be con- edgS^and ^"^^^ ^^ cxistiug circumstauccs. The road to knowledge in medicine acted upon, "by this mcaus Will likewise be shortened, so that a young man will be able to qualify himself to practice physic at as much less expense than formerly, as a child would have to read and write by the help of the ' Roman alphabet, instead of Chinese characters (ibid, pp. 34, 35). action of purgatives. THE DOCTRINE OF PURGATION. 97 374. The efficacy of this remedy (purgation) in the cure of dropsie:^, has been acknowledged by physicians in all ages and countries (vol. II, p. 182). Both drastic (md gentle purgatives act by diminishing the ac- tion of the arterial system, and thereby promote the ahsorption and discharge (ibid. p. 183). 375. However varied morbid actions may be in their causes^ seats ah diseases and effects, they are all of the same nature, and the time will probably (Ipothe^m^) come when the whole nomenclature of morbid actions will be absorbed in the simple name of " Disease " (ibid., p. 234). 376. A m^ild remittent, and yellow fever are different grades of the 4,?^*f^5^: same disease (ibid., p. 256). auuted yei- low f&oer. 377. If we mean by gout a primary affection of the joints, we have Gout;—& gained nothing by assuming that name ; but if we mean by it a disease S Srai which consists simply of morhid excitement iwoited hy debility y and dis- mST^this posed to invade every part of the body, we conform our ideas to facts, ^^^w ^jmpii- and thus sim^plify theory and practice in chronic diseases (ibid., p. 272). and practice '^ in chronic diseases. 378. The gout affects most of the viscera. In the hrain it produces ^out, con- headache, vertigo, coma, apoplexy and palsy ; in the lungs, pneumonia, ^Jt'j^'JP^^^J' notha, asthma, hemoptysis, consumption; in the throat, inflammatory aii diseases angina ; in the uterus, hemorrhagia uterina ; in the hidneys, strangury, ^^"""^auLT^ diabetes, and calculi ; in the liver, inflammation, suppuration, melea, schirrhus, gall-stones and jaundice (ibid., pp. 258, 259). All these dis- eases ha/oe hut one cause, and they are exactly the same, however differ- ent the stimulus may be from which they are derived (ilDid., p. 261). 379. Thus rheumatism, the gout, the measles, small-pox, the different Local ageo- species of cynanche — all furnish examples of the connection of local ^Inl^r^fdia- affections with general diseases ; but the apoplexy and the pneumony ease. furnish the most striking analogy of local affections succeeding a general disease of the system (ibid., p. 86). 380. Pneumony is apoplexy of the lungs, allowing only for the dif- pneumowy. ference of situation and structure (ibid., p. 87). 381. After the production of predisposing debility of the system unity of dis- from the action of remote causes, thefljuids are determined to the weak- demonSatT-'^ est parts of the body. Hence the effusion of serum or blood takes place ed. in the lungs. When serum is effused, a pituitous or purulent expectora- tion takes place ; when blood is discharged a disease is produced which has been called hemoptysis. The pneumony is produced by remote exciting causes which act on the whole system (ibid.) . . The expectora- tion which terminates the disease in health is always the effect of effu- sions produced by a general disease (ibid., pp. 87, 88). 382. "Who has not seen ih.Q pulmonary symptoms alternately relieved uon-na^txae and reproduced by the appearance or cessation of a diarrhoea or pains in J,"^^ IpSr the bowels? (Ibid., p. 85.) ^aSl.^'"*'' 1 THE DOCTEINE OF PURGATION. of disease. The re:og- nition of this doctrine is of the 7i ig7i est importan ce to human- ity. Experience of Dr. Rush, 383. Science has mucli to deplore from the inaltiplicity of diseases. It is as repugnant to truth in medicine as polytheism is to truth in reli- gion. The physician who considers every different affection of the dif- ferent systems in the body, or every affection of different parts of the same system, as distinct diseases, when they arise from one cause, resem- bles the Indian or African savage who considers water, dew, ice, frost and snow, as distinct essences ; while the physician who considers the morbid affections of every part of the body, however diversified they may be in their form or degrees, as derived from one canse, resembles the philosopher who considers dew, ice, frost and snow, a^ different modilications of water, and as derived simply from the absence of heat (vol. III., pp. 146, 14Y). Humanity has likewise much to deplore from this paganism in medi- cine. The sword will probably be sheathed forever as an instrument of death before physicians will cease to add to the mortality of mankind \)j prescribing for the names of diseases (ibid., p. 147. Account of the bilious yellow fever of 1793). 384. Sow Dr. Hush came to helieve in the efficacy of purgation. — Condensed from pp. 222-230, vol. III. : I gave gentle purges and vomits, bark in all its usual forms, applied blisters to the limbs, neck and head, attempted to rouse the system by wrapping the whole body in blankets dipped in warm vinegar (p. 223), rubbed the right side with mercurial ointment, with a view of exciting the system throughthe liver ; none of these remedies were of any service. I returned to bark, wine, and the use of cold water (p. 224). . . Had the authority of Dr. Cleghorn for the former, who says : " The bark, by bracing the solids, enables them to throw off the excrementitious fluids by the proper emunctories," &c. N^o better success, however, attended my efforts (p. 225). . . I ransacked my library, and pored over every book that treated of yellow fever (p. 226). . . I recollected that I had among some old papers a manuscript account of the yellow fever as it prevailed in Yirginia in 1741, which had been put into my hands by Dr. Franklin, a short time before his death. I now read it a second time, and paused upon every sentence. I was struck with the following passages (p. 227) : 385. {Dr. FranTdin^ loquitur): "It must be remarked that this evacuation (meaning the purges) is more necessary in this than in most other fevers. The abdominal viscera are the parts principally affected in this disease, but by this timely evacuation their feculent corruptible contents are discharged before they corrupt and produce any ill effects ; and their various emunctories and secerning vessels are set open, so as to allow a free discharge of their contents, and consequently a security to the parts themselves during the course of the disease. By this evacua- tion the very minea of the disease, proceeding from the putrid miasmata fermenting with the bilious and other humors of the body, is sometimes eradicated hy the timely emptying the abdominal viscera, in which it first fixes, after which a gentle sweat does, as it were, nip it in the bud " (ibid.) Pv/rgauon 386. '^ When the primce vice, but especially the stomach, is loaded sweoThpte- with an offensive matter, or contracted and convulsed with the irritation Fkanklin on YELLOW- FEVER. Purgation in- dispensable. The abdom- inal viscera chiefly af- fected. THE DOCTRINE OF PURGATION. 99 of its stimulus, there is no procuring a laudable sweat till tliat is re- moving im moved ; after which a necessary quantity of sweat breaks out of its own wh?cT** pre accord, these parts promoting it, when, by an absterging medicine, they are eased of the burden or stimulus which oppresses them" (p. 228). vent exuda- tion. 387. " All these acute putrid fevers require some evacuation to bring ah fevers them to a perfect crisis and solution, and that even by stools, which must gation. be promoted by art, when nature does not do the business herself" (ibid.) 388. " On this account, an ill-timed scrupulousness about the weak- The weaker ness of the hody is of had consequence in these circumstances ; for it is the g'JeS that which seems chiefly to make evacuations necessary, which nature is ^^rfulipul ever attempting, after the humors are fit to be expelled, but is not aation. able to accomplish for the most part in this disease. And I can afiirm that I have given a purge in this case when the pulse has been so low that it could hardly be felt, and the debility extreme, yet both one and the other have been restored by it " (pp. 228, 229). use- 389. Here I paused. A new train of ideas suddenly broke in upon weak my mind. I supposed that my want of success, in several of the cases fesgf** in which I attempted the cure by purging, was owing to the feebleness of my purges (ib., p. 230). 390. By full and continued purgation I cured perfectly four out of Astonishing the f/rst five patients^ notwithstanding some of them were advanced sev- fufgaHn— eral days in the disease. One gentleman had passed twelve hours with- {J® diad ' rE out a pulse, and with a cold sweat on his limbs. His relations had given stored to Ufe. him over. Dr. MitchelVs account of the effect of purging in raising the pulse excited a hope that he might be ^ved, provided his bowels could be opened. Purges were given to him three or four times a day ; at length they operated and produced trwo copious fetid stools. His pulse rose immediately. A universal moisture on his skin succeeded. In a few days he was out of danger, and soon afterwards appeared in the streets in good health (p. 232). . . In three days he had taken eighty grains of calomel, and rather more than that quantity of rhubarb and jalap (ibid.) 391. This practice could be said to be almost uniformly effectual in caiomeiwith all those cases which I wa^ able to attend. . . Many used calomel in opi "' "" connection with bark, winl| and laudanum, without any good effects. . . ^^^® I can never forget the transport with which Dr. Pennington ran across bark or um use- Dr. Pen- Third Street to inform me " that after he began to ^iyq strong purgatives mngtona^nA the disease yielded in every case'''' (ibid., p. 235). pSg^f. loices. 392. Never did I experience such sublime joy as I now felt in con- Br.Rushre. templating the success of my remedies. It repaid me for ail the toils and studies of my life. The reader will not wonder at this joyful state of my mind when I add a short extract from my note-book of the 10th September : " Thank G-od ! out of one hundred patients, whom I have visited or prescribed for, this day, I have lost noneP'' (Ibid., p. 234.) 100 THE DOCTRINE OF PTJRGATION. All kinds of pui^es used ; the great ob- ject being ./>■«« stools a day. 393. My practice was, to give a purge every day while the fever con- tinued. I used castor-oil, salts, cream of tai'tar, rhubarb. Calomel and jalap were often ineifectual, then I added gamboge. The purges seldom answered the intention for which they were given unless they produced four or live stools a day (ibid., p. 240). . . When piirges were rejected or slow in their operation, I always directed opening clysters e^ery two hours (ibid., p. 241). The advan- tages of purgation stated in seven propo- sitions. 394. The effects of purging were as follows : 1. It raised the pulse when low, and reduced it when it was preter- naturally tense or full. 2. It revived and strengthened the patient. This was evident m many cases in the facility with which patients who had staggered to^ a close-stool walked back to their bed after a copious evacuation. 3. It abated the painful symptoms of the fever. 4. It frequently produced sweating, when given on the first or second day of the fever, after the most powerful sudorifics had been given to no purpose. 5. It sometimes checked the vomiting which occurred in the begin- ning of the disease, and it always assisted in preventing the more alarm- ing occurrence of that symptom about the fourth and fifth day. 6. Removed obstruction from the lymphatic system. 7. Discharged the bile through the bowels as soon and fast as it was secreted, and prevented, in most cases, yellov/ness of the skin (ibid., p. 243). Sympathy. The weakest part suffers. Xo amount of fjurga^ tion injuri- ous. Cures ob- tained by- very large 395. One of the laws of sensation is, that certain impressions which excite neither sensation nor motion in the part of the body to which they are applied, excite both in another part. Thus worms, which are not felt in the stomach or bowels, often produce a troublesome sensation in the throat. . . In like mannSr the irritants which produce fever, in ordinary cases pass through the bloodvessels, and convey their usual morbid effects into a remote part of the body, which has been prepared to receive them by previous debility (ibid., pp. 60, 61). 396. It is not an easy thing to affect life, or even subsequent health, hy copious or frequent purging. Dr. KirMand (Treatise on Inflamma tory Rheumatism, vol. I., p. 407) mentions a remarkable case of a gen- tleman who was cured of a rheumatisnh by a purge which gave him between forty and fifty stools. This patient " had been previously affected by his disease sixteen or eighteen weeks." ^. Mosely not only proves the safety, but establishes the efficacy of numerous and copious stools in the yellow fever. Dr. Say probably owes his life to three-and-twenty stools, procured by a dose of calomel and gamboge, taken by my advice. Dr. Bedman was purged until he fainted by a dose of the same medi- cine (ibid., pp. 243, 244). n^lT^km ^^'^' -^^^ ^^*^ ^^^ suppose that a dozen or twenty stools in a day but the'^dia- could endanger Life that has seen a diarrhoeaaojiiimjie for several months, Sr causae of attended with fifteen or twent/y stools a da/y, without making even a mate- * riiaa.'' 'rial breach in the constituticmj f Hence Dr. Hillary (Diseases of Bar- THE DOCTRINE OF PURGATION, 101 badoes, p. 212) has justly remarked, that " it rarely or never happens that the purging in this disease^ though violent^ takes the patient off^ hut the fever and inflammation of the howelsy Dr. Clarh (Diseases in Yoyages to the Hot Climates, vol. II., p. 322) in like manner remarks that evacu- ations do not destroy life in the dysentery, but the fever, with the emacia- tion and mortification which attend and follow the disease (ibid., p. 245). 398. I have remarked in the history of this fever that it was often cured on the first or second day by a copious sweat. It would be absurd to suppose that the miasmata which produced the disease were discharged in this manner from the body. The sweat seemed to cure the fever only hy lessening the quantity of the fluids., and thus gradually removing the depression of the system. . , The reason why a few strong purgatives cured the disease at its first appearance was, because they abstracted in a gradual manner some of the immense portion of stimulus under which the arterial system labored, and thus gradually relieved it from its low and weakening degrees of depression. . . Bleeding was fatal in these cases, probably because it removed this depression in too sudden a man- ner (ibid., pp. 277-279). Sweats (crises) and pttrffes. Bleeding fatal. 399. BoA^on Humboldt informed me that Dr. Caristo had assured him that barh hastened death in every case in which it was given in the yel- low fever of Vera Cruz. If, in any instance, it was inoffensive or did service in our fever, I suspect it must have acted upon the bowels as a purgative. Dr. Sydenham says that barTc cured intermittents hy this evacuation., and Wm. Bruce says it operated in the same way when it cured the bilious fevers at Massuat (ibid., p. 293). Barh destructive except when it acts as pm'gatwe. 400. The result: Whilst Dr. Rush was working from eighteen to twenty hours a day, anr^'iauda- healing and saving by hundreds, the old-school physicians, who derided °"'"- his innovations, persisted in the use of barh, wine, and laudanum, and thus succeeded in hilling their patients ''''secundum artem.^^ 401. The Rev. Mr. Fleming, one of the ministers of the Catholic clerical evt- church, carried the purging powders in his pocket, and gave them to his vorS purga- poor parishioners with great success. He informed me that he had ad- *^°"* vised four of our physicians, whom he had met a day or two before, " to renounce the pride of science, and to adopt the new mode of practice, for that he had witnessed its good effects in many cases " (ibid., p. 314). 402. Reason and humanity OAJoahe from their long repose in medi- cine, and unite in proclaiming that it is time to tahe the cure of pestilen- tial epidemics out of the hands of physicians, and to place it into the hands of the people ^ . . The safety of consigning to the people the cure of pestilential fevers, especially the yellow fever and the plague, is established by the simplicity and uniformity of their causes and of their remedies. 403. Dr. Lind has remarked that a greater proportion of sailors who had no physician recovered from the fever than of those who had the Reason and humanity are opposed to medical monopoly. Popular com pared with medical treatment. 102 THE DOCTRINE OF PURGATION. The worst best iiiedical attendance. The fresh air of the deck of a ship, a purge 'f coki water, pro" cordial juleps of the physician (ibid., p. 319). t^y^slSpieS of salt water, and the use of cold water, probably triumphed' over the to cm-e Other medi- cal mo7iopo- lies consid- ered and their h 7/m bu{7 de- nounced. Medicalmo- napoly fur- ther consid- ered. Medical ig- norance and contradic- tions. tt04:. For a lon^ while air^ water, and even the light of the sun, were dealt out hy physicians to their patients with a sparing hand. They possessed for several centuries the same monopoly of many artificial remedies. But a new order of things is rising in medicine (ibid., p. 320). It is not more necessary that a patient should be ignorant of the medicine he takes, to be cured by it, than the business of government should be conducted with secrecy in order to secure obedience t(5 just laws. Much less is it necessary that the means of life should be pre- scribed in a dead language, or dictated with the solemn pomp of a ne- cromancer. The effects of imposture in anything are like the artificial health produced by the use of ardent spirits. Its vigor is temporary, and is always followed by misery and death (ibid., p. 321). 405. I would as soon believe that ratafia was intended by the author of nature to be the only drink of man, instead of water, as believe that the knowledge of what relates to the health and lives of a whole city or nation should be confined to one, and that a small and privileged order of men. But what have physicians, and what have universities and medical societies done, after the labor and studies of so many centuries, towards lessening the mortality of pestilential fevers ? They have either copied or contradicted each other in all their publications. Plagues and malignant fevers are still leagued with war and famine in their ravages upon human life (ibid., p. 323 ; cf. Asclepiades, 63). 406. A Mohammedan and a Jew might as well attempt to worship Why Dr. the Suprcmc Bein2f in the same temple, and throusih the medium of the Rush would ^ . o . . i? ^ '•, ' '^^ J i.' never "con- samc ccremonies, as physicians oi opposite principles and practice at- ^thVb^k-^ tempt to confer about the life of the same patient. What is done in j^^eand^au- conscquencc of such negotiations (for they are not consultations) is the ineffectual result of neutralized opinions ; and, wherever they take place, should be considered as the effect of a criminal compact between physi- cians to assess the property of the patients, by a shameful prostitution of the dictates of their consciences. . . The extremity of wrong in medicine, as in morals and governments, is often a less mischief than that mixture of right and wrong which serves, by palliating, to perpetuate the evil (ibid., p. 349). Purrje until 407. In one very malignant case the most drastic purgatives brought BLAcrcFETm) away, hy fifty evacuations, nothing but natural stools. Y^q purges were conUnued, and finally hlachfmces were discharged, which produced im- F^CES — cri- sis — come fSot*''*^ ^^^^'^^^ r6Z^^(ibid., p. 375) 408. I observed the same relief from large evacuations of fetid hile in This plan the epidemic of 1797 that I have remarked in the fever of 1793. Mr. moveadehU' Bvyce has taken notice of the same salutary effects frqm similar evacua- ^*y'' tions in yellow fever on board the Busbridge Indiaman in 179^. "It was observable that the more darh colored and fetid such discharges were the more early and certainly did the symptoms disappear. Their good THE DOCTRINE OF PUKGATION. . 103 effects were so instantaneous that I have often seen a man carried upon deck, perfectly delirious with subsultus tendinum, and in a state of the greatest apparent debility, who, after one or two copious evacuations of this hind, has returned of himself, astonished at his newly-acquired strength " (Annals of Medicine, p. 123). . 409. Very different a/re the effects of tonic remedies when giA)en to re- move this apparent dehilii/y. The clown who supposes the crooked ap- whilst toniA pearance of a stick, when thrust into a pail of water, to be real, does not TSy. err more against the laws of light than that physician errs against a law of the animal economy who mistakes the debility which arises from oppression for an exhausted state of the system, and attempts to remove it by stimulating medicines (vol. lY,, p. 38). INTEKESTING ARTICLE. Baelow, Edward, M. D., Pathological and Practical Observations. Bath, 1810. See Edinb. Med. and Sueg. Journ., 1814, Vol. X. 410. Purgatives are of three sorts : some evacuating the fecal con- Purgatu^es tents of the intestines ; others acting on their exhalent arteries, and pro- V&T'^^lner, ducing copious watery stools — and a third class stimulating the mucous fe7y'^°s^toSs] follicles which so abundantly line the intestines and causing; them to expeimu- T 1 1 . 1 TTTi IT 1 c^'^^ matter, expel the mucous matters they so copiously secrete. When the bowels first, in inac- are merely inactive, their secretions healthy, and no constitutional disease the''^"bowe°is, present, the simple aperients of the first class suffice to obviate costive- co^KiSf • ness and prevent feculent accumulations. The second are requisite .second, m when, in addition to unloading the intestines, it is desirable to abate tion or\eve?i internal action or allay fever, by reducing the quantity of the circulating ^'drcSng^ fluid ; and the third are required either when the mucous secretions are f^ ^orwdu ' so morbid as to give rise to diseases, or when they are too copiously gen- or super- erated in consequence of increased action of the vascular system (pp. of mucous 431, 432). secretions. Brandreth's Pills in one medicine accomplish the three indications required. In doses of from one to four Pills, they evacuate the fecal contents of the intestines ; from four to six they operate upon the exhalent arteries and produce copious watery stools ; in doses of from six to ten pills they stimulate the mucous follicles which so abundantly line the intestines, causing stools of pure mucous. In headaches, dyspepsia, apoplectic and paralytic symp- toms, and in gout and rheumatism, no cure can be obtained withovit the expulsion of large quantities of this mucous, which Brandreth's Pills effect with entire safety, 411. "When it is considered that the diseases of repletion are by far Diseases of the most numerous that the human body is liable to ; that the cMmenta- **p^gSe7 TV canal affords one of the most important outlets for discharMff the ^,^°°°* ^® 1 1 i> L^ , ,^ , •, • -\ ••! I' ^.°.T dispensed redun Clancy oi the system ; that it is also a principal one tor gettmg rid with to re- of the excrementitious impurities, with which in such diseases the hlood "^cJem^ntf-''' is speedily adulterated, and that the diseased secretions which accumu- ^'^omThe^'^ late within it are oftentimes a means of continuing, of complicating, ^^od, and even of creating various diseases in different parts of the body, the value of purgatives cannot fail to be duly appreciated. It remains for me to show that such f)iorhid secretions do exist within ^orwd se- the stomach and intestines, and that they do produce therein the effects cretions in now attributed to them, being the direct cause of some local complaints, intStines^"^ while they beget also, hy remote sympathies^ diseases in distant parts (p. sympathy. 432). ease. 104 . THE DOCTRINE OF PURGATION. 412. Of the existence of superabundant mucous in the stomach and ^'X'"*' intestines during inflammatory complaints, sufficient proof will be oMntfstfnes ^^^rdcd mcrelj by inspecting the discharges brought off by particular and stomach, evacuants, or occasioually by the natural efforts. With respect to the stomach this examination may mislead, if only superficial ; for the mucous being clear and colorless, is not readily distinguishable from the watery fluid surrounding it ; if, however, a rod or wire is passed through the liquor, and elevated, it will raise the mucous existing therein, and sufficiently manifest its dense and viscid nature (p. 433). superabun- 4^3 It is this mucous that is produced by increased arterial action, dant mucous n^ • ^ iiPii ^ • .itt,' creates dis- aiiectmg tlic uiucous giauds ol the stomach m common with all the other parts. To it, and to the action which produces it, superseding the healthy action of these parts, do I attribute the incipient nausea of fever a«=SheIc- ^^^^ ^^ constitutional inflammation ; and its expulsion I deem important, tion^ of the both as removlng an injurious accumulation, and as enabling the secret- ^^SpSg"^ ^^^ vessels, thus disencumbered, to continue those efforts, whose direct mucous. tendency is to relieve the general circulation, however inadequate they may be, when unassisted, to accomplish this purpose. Similar secretions are going forward also at such times throughout the whole course of the intestinal canal, and are evidenced by the quantity of mucous which a dose of calomel or antimony, administered under such circumstances, uniformly expels (ibid). Eow to se- 4:14. The want of sufficient attention being given to the peculiar ^tives^—' ^'^^^^ produced by different purgatives, may perhaps suffice to account when the mu- for the Uncertainty and indecision which still prevail in their employ- is^'^'of Te^cent mcut. If this mucous niatter is recently formed, and in no great abund- dZ^icTmf- aiice, a common purgative of the drastic hind will suffice to remove it, J^^; together with all such fecal lodgments as may have taken place in the intestines. A source of injurious irritation is thus removed • the various secreting and excreting vessels are left free to perform their natural func- tions ; and the progress of nature, in her force to restore health, goes for- when it is of ward uninterruptedly. If the mucous secretions are of older format/ion ti°on, p^er- and Consequently more viscid, more tenacious and more difficultly expelled, mes^^^'^' th.e common purgatives fail to give relief, and a doubt is cast on the pro- priety of employing them, and on the vera(3ity of previous reports of successful cures. The error here, however, is in employing a piirgative Salts ineffec- inadequate to producing the effect required. ... If saline purgatives tuai ^-^Q giv^ with the expectation of cleansing the intestines when loaded with mucous secretions, they will very imperfectly effect this purpose (pp. 433, 434). Large quan- 41^5^ ^j^g quantity of this mucous secreted in acute diseases is very titles of mu- .TiiTTiii 1 !• • T '^ cous from considerable. It lines both the stomach and intestines, and causes many eases binder powcrful mcdicincs to pass through them without producing: their ordi- of many^pur° nary cffccts ; for, in consequence of the interposed mucous, the medicines gatives. Gomc Only imperfectly or not at all in contact with the living fibre, which alone they are capable of stimulating. It passes through, therefore, as if either the living fibre were torpid, or the medicine inert, when neither supposition is correct^ and to mistake and accident we are occasionally THE DOCTRINE OF PURGATION. 105 indebted for illustration of this subject, which perhaps regular prac- tice would more slow^ly and imperfectly afford us. For the errors of ^oftTn w* dispensers and the stupidity of patients have not unfrequently afforded me instances of inordinate doses of purgaUve medicines being given, "^^^rt, with only moderate and salutary operation (p. 434). h'ut moder- ate opera- 416. Case of scarlatina given. — Purgatives were, in consequence, s^riauna. thenceforward more freely employed, and the effect regarded more thorn, and^ not^the the dose necessary for producing it ; and although the inflammatory ^oSderei fever ran high, and was not allayed for many days, there did not occur a speck of ulceration on either tonsil. Neither did any of the ordinary sequelae attend the disease, but the recovery was progressive and com- plete. We may hence infer the difficulty of establishing the precise doses of medicines to be admitted, and must be conscious of the superior ad- vantage of attending solely to the sensible operation^ when this is capable of being ascertained, disregarding altogether the quantity of medAcine necessary for effecting it. This is always possible with respect to purga- tive medicines, and to be accomplished by regular inspection of the alvme inspection evacuations^ without which the practitioner must remain in much doubt '^iaUonTx^Q- concerning some of the mobt important operations going forward within ommended. the body, and must labor under great disadvantages in accurately apply- ing the remedies it is necessary to employ (p. 435). 417. Morbid secretions are very frequently formed in the stom- MorWd mat- ach, which occasion a large proportion of gastrric diseases. To par- stomach oc- ticularize only one. Conceiving the pain in gastrodynia to proceed '^'^^tHc au-^' from a contractile effort of the stomach to throw off from its surface the Aa^H' . mucous which offends it, I have for many years laid aside the use of dynAa. opium and stimulants., which merely repress the effect, without at all re- m.oving the cause, and which even tend to add to this by stimulating the ^§J3aS? glands to increased secretion of the offending mucous, and have trusted ^^ ^^ot re- solely to such medicines as act hy expelling that matter, to whose presence c^J—pur- I attribute the complaint. . . ^ ^^dlhe"''' I own I am averse to relieving the pain by opium, or by any means ^'^Ste?^ but a removal of the offending matter — as the relief to pain consequent upon such evacuation may be relied on as announcing the radical cure of the complaint. In some hundred cases that I have now treated on these principles I have in no instance given a grain of opium, or failed in giving decided relief Almost the only medicine I employ as a purga- tive compound consists of extract of colocynth, calomel, and antimonial powder (p. 436). 418. The disease of colic I believe to \>e precisely analogous with gas- coii<^ns trodynia, both in its pathology and treatment, and to differ only in being treatment, more prone to pass into inflammation. The remote sympathies which different parts of the body evince under disordered condition of the stomach and digestive organs have often engaged the attention of prac- titioners (p. 43Y). 419. I have mentioned that in all complaints attended with fever, or conZutl'i^ constitutional inflammation, the gastric and intestine secretions are ^^i^^"^ IOC THE DOCTEINE OF PURGATION. quickly increased. Accumulations of morbid secretions oftentimes take ci4^timS'^and pkicc in tlic alimentary canal, of slow and gradual formation, and not increased ar- referable by any well-marked connection to a state of generally increased tenal action. , • i /• "^ mi x» j. i. i °- i i . i arterial action, ilie former state may even be superinduced upon the latter, and thus an additional complication, both of diseased action and of diseased condition, ensue. A disease, in which this morbid state of the secretions exerts considerable influence, is rheumatism (ibid.) Cases Rheuma- j> ^ ^ ^ . tism. ' lOllOW : Gout. 420. Admitting, then, the pathology to be correct which attributes cure^by' gout to the existcucc of a state of plethora and inflammation in the Mood- ■pnrgatives. q^^gg^ig^ ^iid the influence of vitiated secretions within the alimentary canal — which latter may be regarded in a great degree as the natural product of the former — does it not seem to be fully w^ithin our power to bring this hitherto intractable disease under the control of rational prac- tice ? And may we not hope to treat it as eflectually, and much more safely, by the well-ascertained powers of such a remedy as a combina- tion of colocynth, calomel, and antimony presents us with, as by the less manageable means of white hellebore, or the precarious and uncertain CoicMoum. u g^^ medicinale," i. e.. " colchicum f^ (P. 441.) AppUcabieto 421. The means I would recommend are advocated not for their ^^'^Piiif^'^ possessing any secret or unexplained power ov^r disease, but from their \,^\x\^^ jpointed out hya rational pathology, and fully established, both with respect to their safety and efficacy, hy extensive experience (ibid.) B. G. B., Observations on the Treatment of the Sich returned from Corunna. See Edinb. Med. and Sueg. Jotjen., 1810, Vol. VI. jFevers. '^^2. There appears too great a desire of discovering something like c.domei— ^ specific for fever to the very great neglect of obtaining evacuations. persede pur- Galomcl sccms to be regarded in this way, and is abundantly employed cuiei— soie^- with a vicw of producing some particular irritation of the system that asa^zSva- ^^ arrest the progress of or remove the complaint. tvoe. Whatever this medicine may do, after evacuations have been prom- ised, I feel certain of one thing, that it will never supersede the neces- sity of evacuations in fever ; and I question very much if its good effects in fever, and in all inflammatory complaints, do not depend upon its evacuating qualities (p. 170); Br. Freind ^2^- Those, howevcr, who attempt to cure inflammatory fever, or in- ^on f^e^e^^^— flammation, by any other means than by evacuation of some sort or other, ''alone can will losc many an opportunity for doing good / and, in. confirmation of *^VthS^' this opinion, 1 will quote the authority of the very learned Dr. Freind: ^' Hoc unum libi spondeo te experiundo comprobaturum, quod silicet ex febribus multse evacuantibus solis, etiam si hand alio fueris remedio usus, cedere consuescant ; vix ullse antem, quae paulo vehementius in- valuerint, medicina qualicunque, si ab hoc evacuandi instituto decesseris, restingui possint." (Commentaries on 1st and 3d books Hippocrates.) Dr. Freind here observes that many fevers will yield to evacuations alone, when no other remedy is used j biot scarcely any will be removed^ death. THE DOCTRINE OF PURGATION. 107 when the fever is great, hy any remedy whatever, if evacuations are not employed. I have no hesitation in saying, when this plan is speedily adopted, that the most beneficial effects will generally result, and that a great many cases of inflamm.atory fever which would otherwise have ended fatally, or become putrid, and have been protracted for a fort- night or three weeks, or even longer, will hy this system terminate favo7-- ably in a weeh (pp. ITO, 171). TuoMEY, Martin, M. D., A Treatise on the Principal Diseases of Dub- lin. Duhlin^ 1810. 424. Bilious fever. — Purgatives must he steadily persevered in ismmsfe' throughout the complaint, for it is upon them we must chiefly rely for ver. success ; and as tlie acoumidation of foul matters in the alimentary canal is constantly and copiously produced, so there is no disease in which the free and regular use of purgatives causes less distress or gives more uni- form relief. It frequently happens that from the operation of a purga- copious tive a large quantity of foul excrements come away ; and yet in ten or evatu/uoL twelve hours after there is another large evacuation, so as often to cause ^^Shhxxt ■just surprise how so much could be venerated in so short a time : and induce these copious and loul evacuations continue tor several successive days without inducin^^roportionate weakness, but, on the contrary, they procure great mffl^ation of the symptoms. Even delicate and young females are relieved, without heing exhausted, by these evacuations (p. 8). no weakness. E'vaouO' 425. So far from producing weakness, we have often observed with j^^aoua- pleasure the renewal of strength, which these evacuations occasion, when nons give a languor or depression of the animal powers, even to faintness, had pre- remove de- viously existed. But we have likewise remarked that, as soon as the ^^^^*^' alvine excretions have assumed a natural appearance, a much smaller evacuation has actually produced a considerable reduction of strength (p. 9). 426. It is remarkable that we are disappointed of any substantial ^^jj^p^^gg improvement in the state of our patient whilst the darhfceces remain are critical. behind, notwithstanding the quantity of the evacuations procured (ibid). BucHAN, A. P., M. D., Bisnomia. London^ 1811. 427. Is it credible that a human infant should be so imperfectly or- chudhood ganized that it cannot pass over the years of childhood, naturally the c(aomei. most healthy period of life, except the biliary system be ever and anon expurgated by calomel ? or that the early and habitual use of this min- eral poison can be unattended with injurious consequences? Perhaps the time may come, when the most judicious plan of curing internal as timeto^come well as external complaints,will be acknowledged to consist in removing all impediments to the natural exertions made by the vital energy to re- store health (p. 71). 108 THE DOGTRINE OF PURGATION. Clark, Joseph, M. D., On the JBilious Colic and Convulsions of Early Infancy. Diiblin^ 1811. See Transactions of the Eoyal Irish Academy, 1811, Vol. XL Childhoorl— Loiivulsions —the old 1:28. In the beginning of my practice, as long as I pursned tlie beaten track of emplo^^ing mixtures of rhubarb and magnesia, solution of man- ^pRQlSra ^^''^ ^^^ fennel-water, chalk, musk, opium, and blisters, recovery from con- thecure/ vulsions iu early infancy was a rare occurrence. After six years' close attention to the subject I am convinced that in colic and convulsions nothing but a hrisk expidsion of the contents of the howels is likely to afford permanent relief. A dose or two of castor-oil, or a common pur- gative enema, may remove slight attacks of this nature. It is in general after the failure of such measures that a physician's advice is required (p. 124). Evacua- tions — as the quantity so is the relief. 4:29. The purgation must he very active and continuous to be efficient. In the course of recovery the quantity of evacuation seldom fails to as- tonish the attendants, who cannot well comprehend whence it all can be derived. The relief obtained is uniformly proportioned to the quantity discharged (ibid.) Typhus. — Many of its symptoms from wanting iecnrboni- zaUon of the, Mood. Intermittent or remittent form — causes of. Armstrong, John, M. D. Observations on the Origin^ Nature and Treatment of Tyvhus Fever — m Medical Intelpgencer, 1812. 430. The want of due decarbonization of the blood is the cause of many of the most remarkable symptoms attendant on typhus. Blood not duly decarbonized, operates more or less as a narcotic on the brain, and tends materially to influence the animal heat and the heart's action ; and hence partly arise the muddled state of the brain, the smothered heat of the surface, and the soft, compressible pulse, &c. Why typhus-fever assumes in one person an intermittent, and in another the remittent or continued form, is most probably owing^ to the dose of the poison, or^the condition of the recipient, or both conjoined (Med. Int., ]S"o. 30, May, 1812).* The Morbid Anatomy of the Bowels, Liver and Stomach. London, 1828. Small-pox, 431. The contagions of small-pox, measles and scarlatina first ope- sTariitina rate OH the blood, and that fluid being thereby changed, the solids are ■" ^Ifsts^^^' specifically affected, especially the skin and mucous membranes of the air-passages ; and these affections, too, if left to themselves, and even Nature com- oftcH in dcspitc of mcdical applications, have a determinate course, the tidarflowing blood appoMrenthj , like the water of the Thames, requiring a certain time river, y^^ ^-f^g purification, which it effects, perhaps, by throwing off the efete and superfluous matters, through the secretions and excretions (Art. 1, p. 10). Letter to Dr. Boot, contained in Dr. Booths edition of Armstrong'^ s Worhs. Much learn- 432. I havc Hcvcr yet met with a lea/rned physician who was a good foilyfn^praS i^^*^^^*<^^^^' -^^ ^^^ bcdslde such mcu are "lost in the conflict of au- tical matters, thoritv. THE DOCTRINE OF PURGATION. 109 Hartz, "William, M. D. On the use of Purgatives in Purpu/ra. PuUin^ 1813. See Edinb. Sueg. and Med. Journ., Vol. IX. 433. Purpura. — Convinced by my previous ill success of tne ineffi- cacy of mere tonics in bad cases, and favorably impressed by the occur- rence of cholera previous to the appearance of the petechige, I determined in this case to direct my whole attention to the state of the abdominal viscera, and accordingly prescribed hrish purgatives. From the good effects of the first, I directed its repetition for a few successive nights. To my surprise the hemorrhage soon ceased, the spots rapidly disap- peared, and in less than ten days the patient recovered, under every possible disadvantage of constitution, of air, and of diet. Encouraged, by the unexpected'result of this unpromising case, I no longer hesitated in employing purgatives., and trusting to them only in both species of the complaint. It was often necessary, however, to purge to a great extent (p. 186). Purpura — the regular practice un- successful — purgation cures. Important case. Full and free purgation re- quired. 434. It appears from the observations of Purserius, that Strach ^w^- ^o^Q^ peteohicB to originateyrwTi vitiated hile in theprimm vice, and from a tenacious mucus adhering to the intestines, and that he accordingly proposed strong cathartics as the proper remedy for the disease. I have carried this theory farther, and have, not without advantage, allowed it to influence my practice in typhus^ when petechise are present, and many very desperate cases have appeared to me to owe their recovery^ almost from the jaws of death^ to purgatives (p. 187). Typhus. Petechiae from vitiated bile. the powerful and repeated interposition of Medicus. Vol. XL On Pathology. — See EomB. Med. & Surg. Jour. 1815. 435. Disordered actions of the human body are, generally speaking, the means which nature employs for the expulsion or removal of offend- ing agents ; thus if the stomach be excited to vomit^ the cause producing that disturbance is removed by that action ; thus also diarrhoeas carry off noxious matters ; and the emunctories of the body are generally cleared out for the same purpose (p. 335). As a machine, the human body may be said to '' go," at the same time that it includes powers for repairing all injuries that otherwise would prevent its going, and these reparatory processes include almost all the symptoms of disease (p. 336). Natural cure, by vom- iting, diar- rhoea, etc. 436. We will suppose, for example, that the stomach, unable to per- form healthy digestion, presents to the liver, as it passes to the duodenmn, an ill-concocted chyme or chyle. Does it not become necessary that the liver should pour forth a bile suited to the purpose it has to answer ? — a purpose far different from what would be required if a healthful digestion had taken place in the stomach. Such a bile cannot be deemed improper, since it answers the purpose for which it was intended, name- ly, of carrying through the bowels what was noxious, and of effectually The stomach — vicarious function of the liver. no THE DOCTRINE OF PURGATION. assisting in assimilating such parts as are healtliy and proper. To attack tlie liver, therefore, because it lias done its dntj, would be adding to the jfistai-es of evils whicli already excited its powers, and would be exliausting those practice — ,, . , ^ -, ^ .^ i • i • , t /> i" checking the meaus 01 rcsistauce and reaction which were appointed for the most fuiKUorp?o- beneiicent of purposes. To oblige, by medicine, the stomach to retain ^cl^mpjaint' such sicbstances as, \\\ a state undisturbed by medicine, it would reject, is the readiest conceivable method of calling forth the symptoms of " liver affection^^ and a general disturha/nce of the alimentary functions. And thus it happens that the more extended reactions of the constitution follow these circumstances, and thus, by a very easy process of reasoning, shall we arrive at those causes which produce gout, asthma, cutaneous diseases, and in short a long train ^f grievous maladies (p. 336.) 437. During healthful digestion, feelings are excited far different from those which arise when the meal has not been regulated by mode- Teltorr^ ration and sobriety ; and how often are means applied to appease the ^^ge^Ln.^" tumult occasioned at such times, and thus so many noxious agents are introduced, which become all the causes of great and extended future mischief (p. 337). 4:38. It has been said that foulness of the bowels is a common cause a^llwds— of disease. It appears to me that when the bowels produce the foulness, curative. g^ often obscrvcd, such foulness proves curative. It is a reaction of the liver (?) against a constitutional disturbance, which in the end proves curative. Immediately on discovering this foulness, we feel satisfied that on its removal the various symptoms of disease will disappear (p. 339). 439. There is a balance in the constitution consistent with every nat- tending to^ ural cffort ; it may be called the diathesis, such as gout, and a variety of bhrcoStu- other inflammatory affections, and these states of balance involve their ion. own series of phenomena. Thus the head may be oppressed with a super- abundance of blood, and may be liable to affections under one form or series ; another may involve rheumatism ; another, gout, &c. ; and all of them, extended reactions of the system, tending towards a reparation of the constitution. It may be observed that foulness of the bowels cannot exist to the full extent at which it appears at any one period ; for the quantity that on some occasions is discharged would be more than the canal was capa- ble of containing. It must, therefore, be the result of successive deposi- tions from some great secreting organs. For instance, during the exist- ence of disease, wherein there are great determinations of blood, ape- rient medicines bring away evacuations of no particular character ; but after a, little time the circwmstances of the case alter / heavy, lumpy, and discolored evacuations begin to appear, and contin ue to be parted with. As soon as these appearances arise, the symptoms of the original disorder begin to diminish, and^ in the course of a short time, disappear altogether. It must have occurred to every practitioner who has strictly examined these circumstances, that he has found a difficulty in accounting for the quality and extent of this collection of foulness (p. 339). THE BOCTEINE OF PURGATION. Ill 440. It must also have been frequently observed that affections of fe?id\tai the head, epilepsy, chorea, local diseases of various kinds, and great and break^be extended affections of the slcin, have all given way as soon as the howels power of dis- have expelled a qicantity of foul and fetid evacuation. During the ^duc^reSc-" progress, however, of these maladies, the bowels have not shown the same *'*'°^* character until the disorders have attained a particular stage, and then the progress towards health is decided. Could we succeed in bringing about this stage, many very grievous maladies might be cured ; that is, we might induce thereby the various organs of the alimentary canal to render the more extended reaction of the system unnecessary. I do not mean to deny that there is occasionally a very great accumulation in the howels, so foul a state of them that worms occur, which appear there to worms. have found a proper nidus ; and that other great sympathetic affections take place arising from these accumulations (ibid). 441. If we trace these affections, we shall find many natural efforts r^^^ natural made to remove such accumulations and foulness ; and even that many ^"^^7^^^^: very distant reactions occur tending to relieve the body of the griev- tion. ance. Thus the hlood returning through the " vena portce,^^ is delayed, and as the heart acts uniformly, more blood flows to the head than usu- ^ts coS^r ally, in consequence of tTiis remora in the return of blood from the lower circulation. This fullness of blood in the head occasions many reactions, amongst which we may rank epilepsy, which shakes the whole EpUepsy. body in convulsions, and is the means of removing worms and other foul- ness from the bowels, as under the influence of that disorder the alvine and urinary excretioi* are violently expelled (pp. 338, 339). 442. Why disease and cure are units, physiologically accounted for. f^*/"^^^f — The tendency of disease is either to spontaneous cure or to the exlAnc- tion of life (p. 340). 443. The human stomach is an organ endowed by nature with the ^^'JfJJgf'^ most complex properties of any in the body, and forming a centre of mate relation sympathy between our corporal and mental parts of more exquisite wh^\e body. qualifications than even the brain itself. Yet the knife and eye of the anatomist do not discover the whole importance of the station it holds Sympathy m the economy. W e must look to the livmg system lor those nice con- through nections of cause and effect, and that source of association which gives o^rgans^suffer it a relation to so many organs, both in the healthy and disordered state, one^'^may ^be .... We find all those viscera which assist in preparing the chyle and the saved. assimilation of food, joined in a circle of nervous communication of which the stomach is the centre. One portion of nerves is distributed over the whole, so that, while they are employed in one purpose, disor- der cannot take place in any one of them without the whole being thrown into confusion. These associated organs are regulated in their apparently disturbed state by laws tending to the relief of that pertur- bation. By these associated powers the causes of perturbation are removed, and the effects of such reaction are eventually rendered harm- less. (Condensed from pp. 345 to ult.) 444. The nerves of the stomach are connected, through the great sy m- i.ungs, heart, pathetic nerve, with almost every other nerve in the hody. The lungs, nt^wm^'U- 112 THE DOCTRINE OF PURGATION. lation tcith the stomach, and act with it in the "cm- rative pro- cess" which is removal of noxious and offending agents. heart, and diaphragm, are also furnished with nerves which communi- cate with the great sympathetic. This nerve is the grand link or chain which connects the vital, animal, and natnral fnnctions with each other. It is no very difficult matted' to trace the curative actions that take place in consequence of this nervous cowaection — how the heart may vary its pnlsations agreeably to the impulse it receives through this nerve ; how the liver and intestines are apprised of the necessity of varied exertions, agreeably to the kind of digestion that is to pass the sphere of their du- ties, &c. ; all, I say, for the beneficent purpose of ultimately removing from the system the noxious influence of offending agents, such influ- ence as, were it not for those wise provisions of nature, would prove destructive to the human frame (ibid). More of this " curative process." If the stom- ach is unfit to effect this cure, excite with purgO' lives. 445. These several reactions of the body seem all calculated to become efiectual, when the system is in a state agreeable to the laws of nature. A really curative process may be so far altered in its ulti- mate results I>y improper habits of life^ that it may not be enabled to answer the purpose intended, or it may run into an excess, and even occasion detriment to the subject (ibid). The " cura- tive process" — conclu- sion. 446. We now see why the operations of the stomach, liver, and bowels are so effectual in removing very great and extended disorders of the system; and ^^hy, when required, such medicines as call forth these reactions of the stomach andprimm vice, are the true means of cure. So that, whether a disorder originates in the stom%ph, proceeds to distant organs through the stomach, or is a disease arising primarily in a distant part of the frame — still such reaictions are capable of anording relief (ibid., p. 345, sq., cf.). Peitchaiid, J. C, M. D. Remarlis on the Treatment of Epilepsy a/ad some other Nervous Diseases. Bee Med. and Phys. Jouen., 1815, Vol. XL Nerioous ddseases — cure by pur- gatives. Epilepsy. Neurosis. Mania. 44Y. I consider the introduction of the free use of evacuating reme- dies into the treatment of nervous diseases as one of the greatest im- provements of the medical art which has taken place of late years. Imperfect as our knowledge confessedly is with respect to the pathology of nervous diseases, and inadequate as our remedies frequently prove themselves to be, we have yet the satisfaction of perceiving that we are evidently in the right path ; and that, when we have not the means of cure in our power, we can at least often palliate^ without incurring the risk of making raatters vjorse than we found them (p. 459). — Cases of cures of epilepsy given. 448. I have tried the use of evacuant remedies in several other dis- orders of the class neurosis with success / but in none with more singu- lar advantage than in mania., in which distemper I have had extensive opportunities of witnessing their effects, having been for some years one of the physicians to a hospital where a great number of lunatics were admitted. I am firmly persuaded that if medical practitioners would depend more on pfuysical and less on moral remedies^ they would succeed THE DOCTRINE OF PURGATION. 113 in a greater proportion of cases, especially recent ojies, than generally happens (p. 456). 449. Indications to be obtained by the use of purgatives are : 1. By removing sordes from the intestinal canal. JndicaUona I am every day surprised at the prodigious accumulation of ^ C^"' fecal matters which I find to take place in the intestinal canals of patients of all years. 2. As depleting the system. 3. As determining the fluids from the head. 4. As setting up a new action in the system. 5. Purging is a powerful means of sPimulating the absorbent sys- tem, as we witness its effects on dropsical patients. 6. A course of moderate purgation is one of the most efficient methods of invigorating the digestive organs, improving appe- tite, and removing visceral obstructions (p. 466). Dickson, D. J. H., M. D., Superintending Physician to the Russian Fleet. On the Utility of Depletion in a Fever among the Russian Sailors. See Edinb. Med. and. Surg. Journ., 1816, Vol. XII. 450. It is now well understood that the value of purgatives is not p-argames limited to the mere removal of the fecal contents of the bowels, but that i^umuJd. "^^ they may be so managed as to obviate or relieve a tendency to topical congestions elsewhere, and also to produce a considerable effect upon the general system^ by the increased quantity of fluids they cause the various Action on glands and exhalent arteries to pour into the intestines. Thus they be- f^hauntar- come more universally useful in diseases in general, in proportion as ^^^*^*- they are more uniformly applicable. ... They were here considered not only indispensably requisite in the flrst instance, and assisted by enemas, when necessary ; but they were liberally exhibited throughout the disease ; and very often the bowels could not be kept sufficiently active unless they were repeated day after day (p. 175). 461. Though not a new, it is a very important observation, that all inspect m uncertainty as to their full operation can only be removed by inspection, evacuation without which the practitioner is very apt to be led to imagine by the . exact miffi- patient from his own report, or that of. the nurse, that he has been suffi- gation^^^' ciently purged, when, at most, he may have had only two or three par- tial scanty dejections. . . While we are producing foul, dark, fetid evacuations, we may naturally expect that we are benefiting and relieving the patient By those that have not had much acquaintance with fevers it is hardly possible to calculate the quantity of medicine sometimes re- quired to overcome the torpor of the %ntestinal canal, the morbid accumu- lations that have been discha/rged after repeated purga-^ons, and in some cases the speediness of their reproduction (p. 1Y5). 452. In tropical fevers especially, I have seen very striking exam- Tropical pies of the abatement of fever and delirium after the operation of pur- ^^ ' gatives, and it is therefore of great consequence to be aware that the febrile symptoms are often maintained or renewed by the retention of 114 THE DOCTRINE OF PTIKGA^PION. Put'fftS ynu<//.v, or other morhid contents of the intestines, as also of the quantity of dark-colored offensive matter that is often discharged after the patient hasheoi thougJit stiff ciently purged, and its speedy ac- cumulation in some cases, in order to estimate the extent to which it may be necessary to versistin the use of eiimuations (p. 176). !Naval Sueoeon. Medical Topography of New Orleans-^ with an account of the principal diseases that affected our Fleet and Army on the last Expedition against that City. See Edinb. Med. & Surg. JouRN., 1816, Vol. XIL Dysentery — its origin from the liter. Morbid mat- ters the cause which must be re- moved. They injure the fabric of the passages — cause jiux^ ulcerations, etc. 453. Dysentery. — In short, to give a condensed view of the whole matter, the phenomena of the cases that recovered, as well as the mor- bid appearances of those that died, impressed upon my mind a convic- tion that the diseased condition of the liver was the soil from which dysentery drew its 'malignant growth, strength, and mcrture. This was the " fons et origo mali," by it the dysentery was excited, and only hy its removal could the disease he removed. 1 can readily conceive that from the disease of any gland, the fluid it secretes may acquire acrimo- nious properties sufficient to injure the fabric of the passages through which it is destined to pass. "We generally observe in dyspeptic complaints, or after a period of constipation, when the bile, from remora in the bowels, becomes morbid in quantity or quality, either that spontaneous diarrhoea comes on, or, after a brisk cathartic has been exhibited, that the dislodged bile excites a sensation in the rectum, as if boiling lead were voided. When the state of the liver is still more morbid, may not the bile acquire the property of exciting fmx, and of excoriating a/nd ulcerati/ng the villous coat of the colon and rectum f (Pp. 142, 143.) Typhus and the bugbear '■'' debit ty .'■'' Calomel and James' pow- der. Neglect of evacuation, — its conse- quence in ty- phus. Bark, wine, opium. 454. The imaginations of professional men in tropical climates were formerly held in subjection by that bugbear, debility, and its train of needless horrors. Systems of nosology had been pleased to style the dis- order " typhus icterodes / " consequjently active depletion was carefully shunned. The practitioner stood fidgeting with his calomel and his James' powder. The disease toolc its hue from the species of treatment employed at first. The neglect of evacuation allowed the excitement to riot and revel unchecked; hence ch-me petechim, hemorrhages, &c. . . Then indeed the disease was pronounced " malignant, pestilent, and highly putrescents^ and the golden opportunity occurred for throwing in — as the phase is — his bark, his wine, and his opium against that de- bility, about which at a wrong time he was over-solicitous. That caba- listical word " typhus,^^ I verily believe, has slain its thousands and its tens of thousands (pp. 147, 148). Dropes, Richard L., Surg., RemarTcs on some Remedies which are Used in Fevers. jLondon, 1817. See Edinb. Med. and Surg. Journ., 1817, Vol. XIIL Fevers.— 455. Fevers. — Fmetics, I am convinced from experience, have most fUaphl^et- frequently proved injurious, and have seldom failed to aggravate the ics,a.ndpur- symptoms in a very obvious manner. The great concussion they give THE DOCTRINE OF PURGATION. 115 the whole systern^ particularly the hrain^ almost invariably increased the ^if^^'*^^^' violent pain so often felt in the head, and especially over the eyeballs; tuksuprem- and this, it is to be presumed, by increasing the morbid action of the latter main- vessels of the encephalon. The only cases in which emetics are admissi- Jjoved. ^°'' hie are those in which an obstinate vomiting takes place, owing to some crudities in the stomach, which require to be evacuated (p. 59). 456. Diaphoretics. — I believe that it is on the principle of the heat sudorifica of the body being morbidly increased, owing to obstructed perspiration, JfoXand^b^y that sudorifics are prescribed for the purpose of removing this obstruc- "^^'^^^^orfh tion, and lowering the temperature. However, I conceive this practice a cure. is not well founded. Diaphoretics^ before they can have the desired effect, almost always increase the marhid act/ion^ and most ohviously Jiawe an injurious tendency. Besides, we have other means of lessening vas- cular action and reducing morbid heat without being attended with the same inconvenience as sudorifics. Every day we see patients attacked with fever completely recover without there being the smallest tendency to a diaphoresis through its wliole course. When these medicines have heen chiefly relied on^ J have always observed the disease to he much pro- tracted^ and the cure extremely tedious (p. 60). 457. Purgatmes. — The generality of physicians place too little de- t^^o'Sf reu- pendence on these., and trust too much to other remedies. I know of no ^^^^^^^f^n general means attended with so much success as the liberal employment in large of catha/rtics. They should be given in large doses, and often refeated, replatecu^*^" till the patient hecomes convalescent, which is generally in a few days from their first employment (ibid.) 458. When given merely as aperients their effects are only trifling; Aperient and but when administered with sufficient freedom, with a determination of f?ii p"fP ,1 ."^ i. ' /,, J. ' -L ' ti^e action REDUCING- INFLAMMATION, ttieir curativc powcrs are often astomsmng contrasted. Wilson, Andrew, M. D., Practical Observations on the Action %f Mor- bid Sympathies. Edinburgh, 1818. ♦ 459. IS'erves possess muscular fibers and blood-vessels, and are subject mrvous to foreign influences ; and the condition of the blood must injhuence their from impure actions by influencing their secretion (text condensed from pp. 20, 21, and 82). blood. 460. There is no department of the nervous system by which, if cer- Sympathy tain or peculiar irritating causes are applied, some other department of ° the same system may not be influenced, so as to draw the organ to which they belong into morbid action by sympathetic afiinity (pp. 165, 166). MorMd matters in 461. Certain acrimomous matters applied to the extremities of the gastric and aVvine nerves give a variety of deranged actions of the brain, the stoniach although otherwise in a sound state, and the accelerated pulse of the de?s of ^°the whole arterial system, from inflammation found in a small portion of its capillary branches, is at once perceptible both to the eye and touch. . . brain, strict- ures, etc. lie THE DOCTRINE 01^' PURGATION. Gastric f'rritafio/i gives sjmsmodic affections of the lladder and Md- neys. . . Irritation "of tlie lower extremities will excite nausea and vom- iting (pp. 166, 167). The body a -162. Of all tlie organs of tlie human body the gastric and alvine de- bid ''mJmlre pjii'tment is that whicfi is most extensively and constantly exposed to the derange any actiou of thesc causes ; a surface which extends from the cardia to the pt?t o7^the rectum, every part of which is provided with nerves of the greatest sen- ^^'^- sibility (pp. 167, 168). causes. Fever— its 463. Fevev is excited hy acrimonious irritation in the alimentary carial^ or by the increased secretions which take place in the liver and other abdominal glands (p. 19). Heart-dis- 464. The natural and healthy action of the heart and the whole vas- the digestive cular systciu is impaired and reduced below its natural standard, as '^^^^^^- exhibited \\\ palpitations^ languid pulse ^ torpor of the limbs, syncope, and even death itself, in consequence of the mere application of a peculiar offensive substance to the digestive organs (p. 19). This paragraph applies to and explains the action of poisons. Typhus and 465. The approach of typhus and yellow fever is at all times attended ^caus^d^by^ by decided symptoms of an existing diseased state of the stomach and infect^onact- ^Qy^^i^^ ^^ ^^^ ^ith thoso sigus which are known to point out their con- impuHties. tcuts to be of a morbid, irritating nature; but whenever the alimentary canal happens to be loaded with irritating matter, some derangement of the healthy operation, either of the general system or of some particular organ of the body, is the certain result ; and when this state happens to be united with any other cause of fever (as infections), its effects are Purge with, always thereby much aggravated. It is therefore reasonable to use out delay, ^^^y^y ^xcrtion in such cases to expel it as quickly as possible (pp. 107, 108). Malignant 466.*The mcthod which the most eminent practitioners have adopted fi/pSnce fi"om experience as the most advantageous is by discharging from the teaches p Mr- primoB vicB, as expcdiHously as possible, their irritating and offensive Copious de- contents, and in reducing the febrile heat by cold applications (p. 128). ^ViieTcme' It is also worthy of remark, as it further demonstrates the agency of a^ Ju^rvSJ ^^^ contents of the stomach and intestines, in producing organic inflam- ing cause of matiou, that in these cases which terminate mostfoAiorcMy the stools are all along abundant and bilious, with some occasional bilious vomiting ; and that by these free discharges, the intestinal contents being carried out of the body as they are collected, their agency as a supervening cause of the febrile state is greatly removed, and they are not left to ac- quire that degree of acrimony which is necessary to the establishment of inflammation (pp. 129, 130). Acute rheu' 467. A powerful morbid sympathy is called into action (in acute iJsuit ?f irri- rhcumatism), and becomes established betwixt the irritated digestive w? wgan?' organs and the ligaments of the joints ; the adjoining tendonous expan- cause IS moved. THE DOCTRINE OF PURGATION. 117 sions, the membrane of the muscles, and occasionally the muscles them- Pains con- selves, often forming organic obstructions, and exhibiting all the severe ti°e"*^priraSry phenomena of acute rheumatis'm (p. 210). . . The j^ima/ry cause in the digestive organs is entirely overlooked, and so is left to continue its action v^ith full vigor ; consequently the daily repetition of the spas- modic paroxysm depending upon it, keeps up the local inflammation on the sympathizing membranes, and often extends it (p. 220). 468. These shiftings of the pains, and change of place from one part Atonicrheu- of the body to another, depend on the occasional change of place of the Pa^'f^Tift, irritating matter contained in the intestines, to one vv^ith wliich some ^id^^matteTs other distinct part of the body iias a more direct sympathetic affinity change their than that which the pain has left (p. 249). location. Atonic rlieumatiam 469. The character of atonic rheumatisTn consists in a painful affec- tion of some muscular parts, or of their membranes. The pains are not —its charac- so severe as in acute rheumatism ; they very frequently wander from one part of the body to another, although it often happens that they re- main fixed in one part for a long time. . . A particular muscle, or a portion of its fibers, become frequently so affected by the sympathetic spasm as to be impeded in its free action ; the pain being constantly aggravated by the slightest movement of the part, although quite easy when the muscle is at rest (p. 24Y). 470. The remote cause of these phenomena is decidedly seated in the '^^^^^^^^^^ digestive organs in atonic as well as in acute rheumatism. They are in matic com- their nature spasmodic, only the seat of the morbid sympathy most com- ^Jhe°t?i^esJ-° monly appears to be one less susceptible of that inflammation which forms the secondary disease of acute rheumatism (p. 248). tve organs. 471. In the treatment of acute rheumiatism much attention is due to thecau^s^the the state and circumstances attendinej the primary agastric fever. Expe- mostfre-. rience has supported the opmion that, ^n jproportion as the primary is reqwired. cause of disease is removed^ the sym/pathetic effect on the membranes of the joints hegins also to suhside (p. 221). In order to accomplish this object the most free evacuations from the stomach and intestines are re- quired^ and the patient generally bears them well (p. 222). 472. But of a much more painful nature than the atonic rheumatism , Lumbago, 1 /»77 •••77 1 •7'7» "''^P disease, are the cases ol lumbago., sciatica^ tic douloureux^ 2iiia periodical or inter- and uc-doii- mitting rheumatism. They are with great certainty to be traced from from^dtSse the same remote cause, and, like the former, are only sometimes attended menta,.yca- with gastric fever, but are uniformly associated with decided signs of a ^«^' diseased state of the alimentary canal (p. 24(1). 473. All local applications^ independent of clearing the alimentary ^^ii^JtZ canal from its contained acrimony, can go no further than merely to pal- only paiii- liate the effect of this cause^ but without curing the disease, which will cause mutt not happen while the power of the other remains in action (p. 257). \l cJr^'^^^'* 118 THE DOCTRINE OF PURGATION. ^cdre'^b-''' '^^'^' ^^^y^W^^^^ is intimately connected with the state of the diges- removing tivc oi'gans, wliich is clearly demonstrated by the well-known fact of its *^' cause.^^** appearing in various degrees on the skin, m consequence of certain Tcinds of food aaving heen taken into the stomachy and this not only in too short a space of time after to admit of the chyle impregnated by them to be taken into the circulation, but while they as yet remained in the stomach, and the inflammation disapjpearing as soon as those contents were thrown off {-g. 371). Sore-throat 475. Froui the great similarity of the general symptoms exhibited in /2c6r"from scarUt fcver to those exhibited in typhus fever, it will be obvious that stomach- the treatment here ought to be very similar to that adopted to those under typhus ; which is, in the first place, pointed to the mitigation of the two great supervening causes of fever — irritation in the primoe vim and excess of caloric — especially to that which is seated within the diges- tive organs ; the very exhalations from which, ascending to the fauces, do, beyond a doulft, tend to heep up the inflammation, and, consequently, the ulcerated state (pp. 142, 143). Purgation 476. That free evacuations increase debility is in reality an un- biuty^^ and foundcd appvehensiou. . , Whatever will act upon the morbid cause, so si^enath ^^ ^^ evacuate it from the body, so far from weakening, will assuredly tend to restoration of the strength ^ and this is a fact which unvarying experience has proved in every instance where nature has not been already exhausted by other means (pp. 60, 61). The advan- 477. The intention is not merely to preserve the bowels soft, but to purgaUoZ discharge from the intestines a lurking cause of disease ', to accomplish which purpose very full evacuations are always necessary, procured by Examina- the help of the m^ost active purgatives administered in appropriate doses ; jections. remarking the nature of what comes off till it puts on a healthy ap- pearance (p. 62). Impurities far more weakening 478. To restore health, purgatives must be perseveringly applied (in typhus fever), as it is certain that the retention of any sort of noxious than the matter %n the pr%m(B vioi, the tendency of which is m general to lessen gatioiu"^' the energy of the nervous system, is inflnitely more debilitating to the human frame than the temporary fatigue attendant on the moderate operation either of an emetic or purgative medicine, besides the harm which may ensue from the noxious matters being partially reabsorbed (pp. no, 111). Measles. 479. That a state of morbid sympathy betwixt the stomach and Swee/ lungs does actually exist in many cases of measles I believe to be cer- ^*iSig^8^— °^ tain. My belief is founded on the very great relief from pneumonic aS^ mau symptoms received by a free discha/rge of acrid matter from the stomach ters 'awa.y. and iutcstines — a relief which can be accounted for from no other law of the animal economy. Repeated bleedings will, no doubt, tend to ^^l?d^^ lessen the vascular action, but probably in no high degree, while the miUpurga- secoudary cause of fever continues to give its irritation to the nerves of u&eies^sj'^nd the stomach and bowels ; and it is obvious that venesection cannot act as ^^^' a means of removing this cause, neither, indeed, are the more lenient THE DOCTRINE OF PURGATION. 119 cathartics to be depended on for this purpose ; for although they will to a certainty open the bowels, yet they very frequently pass along and leave the offending cause hehind. It is the more active powers oi drastic pur- gatives alone which are here to le confided in (pp, 136, 137). Hamilton, Jr., John. Edinburgh^ 1819. On the Use and Abuse of Mercurial Remedies. 480. In pleurisy, from the time that the influence of mercury be- comes evident, the general strength rapidly declines (p. Y). 481. If there be ulcerations in any part of the body, they must as certainly degenerate into malignant sores, under the influence of mer- cury, as blistered surfaces or scarifications mortify in cases where the living powers are much exhausted (p. 9). Pleurisy-^ baneful effects of mercury. Ulcers — become ma* lignant by mercury. Johnson, James, M. D. Critical amd Exflam^atory Remarhs in his Periodical, Medico-Chikukgical Review, established' in 1819. 482. Purgatives in intestinal inflarnimation have been objected to intestinal on the ground that they are quickly rejected by vomiting ; but this ob- ^""^tZT^' jection is not valid. . . If the first purgative be rejected, it is repeated ^yes'SIf' by Pr. Pring in an hour or two, and so on, with various forms of pur- ^^^ .stomach gatives, until the bowels are opened, when in general we find the ball IndThe cure at our own feet (vol. lY., 1823, p. 259). ^^ ^^^°^^- 483. Pr. Pring says, " typhus has two origins, one from external Typhus— affection, and the other from a spontaneo^pUgjeneration of disease in the ^*^ °"^^°' subject affected by it " (ibid., p. 250). 'W Apoplexy 484. His favorite practice is purgation of a very active kind (Pr., p. f^o"^^^?^ 102) ; has seen his patients stimulated into fatal apoplexy (ibid., p. lants. 251). 485. In the treatment of any form of chronic disease, whether in Chronic du the digestive organs or elsewhere, purgatives frequently increase the symptoms at first, an effect which is rather desirable than otherwise, and it proves that the remedy has a relation with the disease, and is capable of subverting this state, if continued for a sufficient length of time (ibid., p. 275). eases. Effect of purgatives showing the remedy to have a rela- tion with the disease. By the use of Brandreth's Pills the vital forces change chronic affections into acute. Then further purgation with them soon effects a cure. 486. Pr. Ahercrorribie is of opinion that the only remedies of real Epilepsy. eflficacy in epilepsy q^yq purgatives and a strict vegetable diet, wath total purgative!. abstinence from strong liquors (ibid., pp. 127, 128). 487. Constipation in Pregna/ncy. — Pe Lemazurien was sent for on the 8th of July, 1823, to see a woman in the seventh month of her pregnancy. Abdomen much distended, transverse arch of the colon Constipa- tion. 120 THE DOCTRINE OF PURGATION. Fatal con?e- queuces of the lugltx'f of jturffa- tioti injj/'eg- nancy. greatly distended, pulse and appetite feeble, dyspnoea, sleeplessness, iaintness, pains in the loins. Lavements were ordered, but it was deter- mined to wait till the acconchment was over before the evacuation of the bowels should be attempted. After child-birth, clysters being employed, the fecal accumulation appeared to break up, and there was an evacuation of two or three pounds of hard brown fetid matter, but there remained a collection too large for expulsion. The patient was worn down by nausea, fever, col- icky and other pains, and died 21st September. The colon from the csecum to the rectum was found to be intensely inflamed. It was a foot in circumference throughout its whole length, was filled with gas and with 13-| pounds (French) of solid faeces (1824, voL I., pp. 233, 234). This case was simple. Two or three doses of Brandreth's Pills would have certainly re- lieved, by thoroughly removing all the fecal contents of the bowels. And no danger incur- red at any period of gestation to either mother or child by the use of this safe but certain medicine. Epilepsy. 488. Epihjpsy. — The views of Dr. Chwpman coincide with those of The cause -^^' P'^'^ichaTci^ iu placing the cause of apoplexy very frequently in the seated in the bowels. He was led to the use of purgatives by the total failure of the re°mOTed°by Ordinary plans of treating the disease : " it will not do^ however ^^^ he says, plfgauofi. " merely to evacuate the hoijoels ; cathartics must he repeated day after day without interruption^ unless absolutely forbid by circumstances " (vol. lY., 1823, p. 73). Nervous diseases from retained ex- cretions. Neuralgia from morbid matter in the blood, which acts on the part predis- posed, to in- duce local disease. 489. The retention of hilia/ry, urinary^ intestinal and cuta/ineous excretions is often the remote cause of diseases of the nervous system, as well of the neuralgic £iS> of the spasmodic and ma/niacal groups (New Series, 1852, vol. X., P- ^^)# 490. Whenever there exists " induced local susceptibility " morhid elements in the hlood act most obviously in inducing neuralgia. Mala- ria may be present therein, yet remain latent and harmless until this state occurs. So also the materies morhi of rheumatism or gout may fly about until it is specially manifested in some locality rendered more susceptible by predisposing causes. It may be observed that poisons in general have a specific elective afiinity for certain portions of the nervous system (New Ser., 1852, vol. X. p. 103). Ail our 491. We find that under certain circumstances a drug does good, and medidne^is wc cmploy it whcu tliosc couditious present themselves. The modus rimce.^^^^ Operandi is often totally unknown, and though it would be very satisfac- tory to know it, yet we can dispense with it, and from experience alone prescribe our remedies with very considerable success (E"ew Ser., 1851, vol. YIIL, p. 204). Erysipelas from retain- ed and pu- trid foBces. 492. The condition of the alimentary canal should be carefully watched in erysipelas, for we have long suspected that it arises more frequently from its derangement than the generality of the profession are aware. Excrenfientitious matter allowed to putrvfy in the fecal tube will not only operate as an irritant upon the whole system, but from the close and constant sympathy which holds between the cutaneous and THE DOCTRINE OF PURGATION. 121 mucous surfaces, may be expected to exert a deleterious influence more immediately upon the skin. Hence the erysvpelas Mlcosum and gasi/ri- cum of many writers (p. 371, Ser. I., 1828, vol. IX). 493. In the concluding stages of iliQ putrid fevers^ when the bowels Putrid had been long neglected before assistance was procured, we have seen SlSom' the most tedious and inveterate forms of the disease (ibid). T r ? / Malignojnt pleurisy. Bleeding destroys. Tonics use- less, even in- jurious. Purgation saves. 521. The prudent physician will of course carefully abstain from the use of blood-letting and other depleting remedies (in malignant pleu- risy). But he will not certainly guard against debility hy the excessive use of hrandy and ardent spirits. So far from promoting the excre- tions of the system they actually restrain those very evacuations which it should be an object to promote, and hy which alone we are enabled to counteract the typhoid state of the body in this or any other febrile disease (p. 197— Letter of Dr. Hosack's to Dr. T. E. Beck, Feb. 3d, 1813, on the fatal epidemic prevailing at Albany). Brandy and all alcoholic stimulants retard the decarbonization of the blood, because the oxygen of the atmosphere has greater affinity for alcohol than it has for carbonic acid. THE DOCTRINE OF PURGATION. 127 522. Gout is exclusively an inflammatory disease of the whole sys- tem as well as of the part affected. Apoplexy^ palsy ^ angina pectoris^ asthma, habitual catarrh, eruptions on the shin, obstructed viscera, and dropsy, arise from the same habit of body and from the same causes — the effects of an overloaded state of the blood-vessels (pp. 234, 235). Good, John Mason, M. D., The Study of Medicine, 1825. 5 Vols. London, Various dis- eases from retenUon of impurities. 523. Toothache is often produced by a remote cause, as sordes, in the stomach (vol. I., p. 41), or whatever tends to render the fluids acrimo- nious, as long use of mercury. Chronic rheumatism, or acrimony in the stomach, produces nervous toothache (ibid., p. 57). TootfiaoM from morbi(3 matter in the stomach ; — also newous toothache. 524. The grand proximate cause of cardialgia, gravel, and gout, is debility of the stomach, whence, among other evils, a morbid secretion of gastric juice. The debility is not confined to the stomach, but ex- tends to the intestinal canal and the other viscera. The debility is evident from the habitual costiveness which so pecu- liarly characterizes this affection. The imbecility of the liver is equally obvious from the small quantity of bile that seems to be secreted, or its altered and morbid hue, as evinced by the color of the faeces (ibid., p. 159). 525. The lungs are also in many instances apt to associate in the morbid action of the digestive organs, when it has become chronic, and to produce a peculiar variety of consumption — dyspeptic phthisis (ibid., p. 160). It must be obvious that, if the chyle which originates in the stomach should be conveyed to the lungs in an unhealthy condition, its peculiar stimulus must be changed in its mode or degree of action, and the lungs, in consequence, suffer (ibid., p. 163). The medical treatment : We must restore the debilitated organs '10 their proper tone (ibid., p. 164). Cardialgia, gravel, and gout, froni disorder ol the stomach. Costivenesi the habituai symptom. The limgs are impli- cated ; bad blood is made, and consump- tion fol- lows. 526. Colica — colic. — Among the chief causes, acrid, cold, or indi- gestible esculents, worms, calculous or other balls congested in the in- testines and obstructing their passage, as scybala and indurated faeces (ibid., p. 195). Cure. — Warm fomentations — clysters. Purgatives should be at- tempted by the mouth, though the vomiting is sometimes so incessant that we can get little or nothing to stay on the stomach. But the at- tempt must be made, and steadily persevered in (ibid., p. 196). Colic from acrid mat- ters. Persevere in purgativea. 527. Constipation. — As the faeces are forced forward by the peristal- ConsUpa, tic action of the intestines, it is obvious, whenever this action is weakened, MdTi^wers there must necessarily be a retardation, and, consequently, an accumu- thiSf *'^*^^' lation of faeces. In some instances this accumulation is prodigious. . , In one case which ended in death, the cause being mistaken for preg- interesting nancy, the colon measured in circumference twenty inches, and on dis- Tendedcofon! section was found to contain three gallons of faeces (ibid., pp. 232, 233). 128 THE DOCTRINE OF PURGATION. Variety of 528. Effects of conMi/poticni^ when long continued : pains in the head, nfani?t?ta- naiisea, febrile irritation, general uneasiness in the abdominal region, cluSi ^IxSa congestion in the abdominal organs, and hence an impeded circulation of tlie blood, piles, varices of the lower limbs, colic (ibid., p. 234). Powerful purgatives. 529. lilaxativesfail^ the more powerful purgatives must be had re- course to, till the patient cam. habituate himself to evacuate the howels at a certain hour every day (ibid., p. 235). Diarrhoea from acrid ingesta ; — purge. 530. Diarrhoea. — Chief causes: "" acridingesta^^ 2xA obstructed hile. Often antecedently to the looseness there is a sense of sickness, and per- haps a few slight torminal pains. But if the disorder do not prove its own remedy, it is easily removed by any common purgative medicine (ibid., p. 240). ictringents 531. It requircs to be restrained with caution / for a sudden cure, -theirimmi- ^nd cspccially a sudden transfer to a state of costiveness, has often pro- nent danger. duced some severe complaints, and, in one or two instances, epilepsy and phthisis (ibid.) Worms. Purge— and why. 532. Worms. — Dr. Heberden says : " Till some more certain remedy shall be discovered, nothing will be more serviceable than to keep the bowels loose. By their irritation they augment the secretion of mucous, in which also they involve themselves." By Tceeping the bowels loose we prevent the accumulation of this slimy material in which the worm burrows, and, if we have reason to believe that such accumulation has taken place, the best plan is to give active purgatives (ibid., p. 329). Piles— 533. Piles derive their existence perhaps in every instance from a physiology, ^^g^^ ^^^ varicosc state of the amal veins, covered with a slight thick- ening of the inner membrane of the rectum (ibid., p. 363). faces the cause. 534. Causes : — Local irritation produced by indurated and retained fcBces, congested state of the liver and adjoining viscera, (fee. If left to themselves, they swell into tumors, and become so painful as to pre- vent walking or sitting (ibid). '^^ISett. ^^^- JoM'i^^Ge is easily reproduced in those who are subject to it, symptoms in- by flatulencc, acrimonious or indigestible food. The bowels are for the ^^?u5e. ^ most part costive and moved with difficulty (ibid., p. 390). Tellow-gv/m —purge. 536. Yellow-gumi — -jaundice of infants. — A dose of any active pur- gative will generally be sufficient to remove the obstruction (ibid., p. 404). 537. Fever. — It was the opinion of Hippocrates that fever is an ?Sti?^° effort of nature to expel something hurtful from the body, either ingen- erated or introduced from without (vol. II., p. 44). THE DOCTRINE OF PURGATION. 129 All fevers ire from im- 538. There is no writer of the present day, perhaps, who has carried this view of the subject fartlier, or even so far, as Professor Franh, plTritieTfrom who regards typhus, plague, petechise, and all ^ pestilential fevers, and n,eeting\dth indeed nervous femrs of amy Icind, whether continued or remittent, not '—"-«♦-= only as proceeding from specific contagions in the same manner as ex- anthemas, but from contagions producing a like leaven in the system, and matured and thrown off through the various outlets of the body, by the same process of depuration (ibid., pp. 45, 46). impurities from with- in." Dr. Frank's opinion. 539. Typhus. — The term is derived from Hippocrates, and means to smoulder, or hum and smoke without vent. When a typhus has once arisen, the effluvium from the living body during its action is loaded with miasms of the same kind, completely elaborated as it passes off (ibid., p. 224). 540. Br. Haygarth and Dr. Bam^croft show from numerous cases, that the miasmatic poison of typhus., when received into the body, con- tinues in a latent state at least for seven days from the time of exposure to the contagion, before the fever commences. . . . A peculiar state of the hody gives a peculiar tendency hoth to gene rate and receive typhus.^ whilst some seem to be favored almost with a natural immunity (ibid., pp. 227, 228). Typhus. The body- exhales miasms. The typhus poison latent for seven days ; — frfe purgation will therefore remove the poison before it is elabora- ted. Dysentery., from the co- 541. Bysentery : — primary a disorder of the colon, so considered by Sydenham and Dr. Cheyne; — first gripings, then dejections, and the ion, -cure: fever follows. Sydenham's chief remedy was active purgation twice ^tuon.^^^' every other day, with warm diaphoretics on the days when the aperient was not employed (ibid., pp. 552-566, cond.). 542. Eruptive fevers. — ^Whenever any diseased action is taking place internally, there is a constant effort exhibited in the part, oi in the sys- tem generally, to lead it to the surface, where it can do but little mis- chief. . . It is by means of the fever that the disease works its own cure, for it is hereby that a general determination is made to the sur- face, and the morbid poison is thrown off from the system ; but the fever may be too violent, and from accidental causes of the wrong kind (vol. III., p. 5). 543. The grand principle in the treatment of small-pox, as of all the other exanthemas, is to moderate and heep under the fever j and how ever the plans that may have been most celebrated for their success may have varied in particular points, they have uniformly made this principle their polar star, and have consisted in different modifications of cold water, acid liquors, and purgative medicines — heat, cordials, and other stimulants having been abundantly proved to be the most effectual means of exasperating the disease and endangering life (ibid., p. 109). Br. Mead seems to have been almost indifferent as to the hind of purgatives employed, and certainly gave no preference to mercurial pre- parations. His idea was, that all were equally beneficial that would tend to lower the system ; and in this manner he accounts for the mild- ness of the disease after any great evacuation, natural or artificial (ibid.. Erupti'oefe- 'vers—a, nat- ural efifort to rid the sys- tem of mor- bid matter. The henefit of purga- tion pal- pable. Small-pox. The fever kept under by purga- tives. Strong evacuation the principle of cure. Stimulants increase the power of 130 THE DOCTRINE OF PURGATION. ffj/pochon- 54tl:. Ili/pochondria. — " The digestive organs are almost always tor- causes 7ndi- ^clp Soiiie kind of acrimoiiy is also almost found in the stomach, and catethecure. particularly that of acidity. The pain in the epigastrium may be re- lieved by the pressure of a belt broad enough to support the whole of the lower belly. Congestions in one or more of the abdominal viscera are a frequent result, and not unfrequently a primary cause. . . Hence w^e see why the hleeding piles are often so serviceable as to have obtained the name of " medicina hypochon.driacorum " (vol. lY., pp. 158, 159). Paeis, J. A., M. D., Pharmacology, Qth Ed., London, 1825. mumlnei' ^^^' Purgatives. — The extent of their importance and value were, dorsed. howcvcr, ucvcr justly appreciated until the valuable publication of Dr. Hamilton on this subject. . . . His practice has clearly proved that a state of bowels may exist in many diseases, giving rise to a retention of feculent matter, which will not be obviated by the occasional adminis- tration of a purgative, but which requires a continuation of the alvine stimulant, until the healthy action of the howels is re-established. Sines this view of tlie object has been adopted, numerous diseases have re- ceived alleviation from the use of purgatives that were formerly treated with a different class of remedies, and which were not sitpp)Osed to have any connection with the state of alvine evacuations (p. 167, vol. I.\ 546. Thus in fever the peristaltic motion of the intestines is dimin- ished, and their feculent contents are unduly retained, and, perhaps, in part absorbed, becoming of course a source of morbid irritation. This fact has been long understood, and the practice of administering cathar- tic medicines under such circumstances has been very generally adopted. Emptying 547. But um^tU the publication of Dr. Hamilton, physicians were "intestines ^ not awarc of the necessity of carrying the plan to an extent beyond that °deS^' of merely emptying the primoB vice, and they did not continue the free use of these remedies through the whole progress of the disease (ibid). pcKGATivEs 548. Cathartics are essentially serviceable, aiso, in several diseases of ^^neurosisT ^^ class ncurosis, which are generally intimately connected with a mor- bid condition of the alimentary passages (p. 168, ibid). 549. Chorea and hysteria have been very successfully treated in this manner. The diseases incident to puberty in both sexes are also best re- lieved by a course of purgative medicines, and their effects in chlorosis have conferred upon many of them the specific title of Eramenagogues (ibid). 550. But the therapeutical utility of cathartics extends beyond the mere feculent evacuations which they may occasion. In consequence of the stimulating action which some of them exert upon the exhalent ves- sels, they abstract a considerable portion of fluid fror)i the general current of the circulation, and are, on that account, beneficial as antiphlogistics (ibid). Dr. Paris is sciolistic as to the history of purgatiyes ; their use was better understood in the time of Parey (1620) than when Hamilton wrote (1794). Fever. The peristal- tic motion is diminished. in chorea, hysteria, chlorosis; (" Emmena- gogues.") Mso good as '''■ antiphlo- THE DOCTKINE OF PURGATION. 131 651. For the same reason they may act as powerful promoters of ah- They pro- sorption, for there exists an established relation between the powers of J?°^®*^^^'t^ exhalation and absorption, so that when the action of one is increased, that of the other is augmented. Certain purgatives, as I have just stated, exert their influence upon the neighboring organs, and are calculated \ not only to remove alvine sordes, but to detach and eliminaie foul con- gestions from the hiliary ducts and jpores (ibid., p. 169). Why not say the truth, and also remove congestions and relieve pain in the most distant organs. 652. There is no principle in physiology better established than that ^^l^j;^^\^ which considers vitality as a power engaged in a continual conflict with conflict with the physical^ chemicul and mechanical Ioajos to which every species of ^ ^ ^ ^' inanimate matter is invariably subject (ibid., p. 209). — And yet chemical remedies are constantly peesceibed hy the " SCIENTIFIC " physician ! AmsiE, Whitelaw, M. D., Materia Indica. London^ 1826. 563. Hepatitiso — A viscid and badly prepared bile, producing: ob- Jrvflamma- strnction and irritation, is the most immediate sonrce of evil, and so uve'-,^ from constantly does neglected constipation precede an attack of hepatitis, anT^'uf^hot that we cannot for a moment deny but that it must powerfully contri- fi!!^**f ^^^ 1 11 • 1 •"! IT*"?* T ScaSOIlS, bute towards hurrying on the organic derangement by oindwig up what should daily he carried off (p. 549). MoNAT and Henderson, Surgs.^ Narrative of the March of the \Zth Regiment of Foot^ from. Nuddeah to Berhampoor^ in 1826. See • Madras Journal, Vol. II. 654. Two individuals who were largely bled became convulsed and Bioodutung died, and after death it was found that, though the heart was empty, the Sit?u?e^a! vessels of the head were loaded with hlood. It was thus clearly indicated that, whatever it was that excited the hearfs inordinate action, blood- letting would not subdue it y for, as long as a drop of blood remained, it was sent to the head (Journ., p. 327). Andral, Jr., G., M. D., Clinique Medicate, Paris, 1827. , 556. In indigestion (embarras gastrique), consisting of loss of appe- indigestion. tite, bad taste in the month, loaded tongue, irregularity of the bowels, ^^p*"""^- sensation of constriction or weight at the epigastrium, and occasional nausea. This train of symptoms we have often seen to resist the appli- cation of leeches to the epigastrium, low diet, diluents, etc., and rapidly puT-gaUok give way to the exhibition of a brisk purgative. Do purgatives, by ex- *"^^ ^*' citing the stomach and bowels together with the auxiliary neighboring organs, re-estahVsh the power of digestion f Do these remedies change, in some unknown way, the mode of secretion in the liver and pancreas ? We know not. But this we know, that the treatment above mentioned is very efficacious, and that the antiphlogistic t/reatment is useless, if not ^cs'^iijuri- injurious (chap. lY. f). ous. Leeches do notlessfenthe irritation ; 13; THE DOCTRINE OE PURGATION. ninsfrative cage. pulsatiug Leeches, Nature sTiows the way to cure. 556. Andral, in illustration, gives many eases ; !No. YI. is se- lected. A young man entered tlie hospital with high fever, violent pain in the head, obstinate costiveness, and other symptoms, the pendiluvinm, lavements, and tisans were employed to no pm-pose. On the tenth day the patient was seized with spontaneous vomiting of a large quantity of green bile, which was followed by a smart purging of yellow liquid matter. Next day every symptom of his malady, was gone. The patient was discharged, " cured by Dame N'ature." — Andral asks, " Would not a 'brisk jpurgative or two in the beginning have cured the disorder f " Why of course they would. Six Brandreth's Pills given on the first or second day would have done it. '^mldfraie ^^'^^ J^'^'^9<^t^'^^S') ^J rcvulsiou, diminish the actvuity with which the the current fluids tcud to the part originally irritated and congested. . . But another modify ^the iuflueuce which has been less noticed, is that which they may have upon ^^iSu^od. *^^ composition of the bloody w^hich they must modify by means of the materials which they extract from it. It may be asked, what is the nature of their influence upon the blood, according to whether they chiefly excite the flow of perspiration, of mucous, or of bile, and what changes of composition they may occasion in the blood % This is un- doubtedly an interesting subject for investigation (Quoted in Copland's Diet., p. 250, vol. I, Art. Blood, § 160). Chambers, William, M. D., Physician to St. George's Hospital. On Continued Fever. See Beit, and Foe. Med. Rev., 1827, Vol. YI. 558. Continued Fever. — Those who have been in the habit of treat- ing this disease must have observed that in most instances, when pur- gatives have been early and steadily administered^ all the symptoms have in a short time yielded to them (Rev., p. 161). Fe/ver. Early and steady purgation. A Treatise on the N'ature and Cure of 1827. See British and Foe. Med. Rev. RTieuma- tism. Bleeding changes acute into chronic rheu- matism. Purgatives replace bleeding. Continue purgation until evacu- ations are healthy. Examine stools and urine. Sctjdamoee, Chaeles, M. D. Rheumatism. London.^ 1839, Vol. VII. 559. In no way is a degeneracy into chronic symptoms so certainly introduced as by that injudicious employment of general bleeding which enfeebles the constitution and still leaves the rheumatic disposition in great force (p. 70 — Brit, and For. Med. Rev., p. 343). 560. In proportion as we employ purgatives with judgment, so do we diminish the necessity of using the lancet (ibid). 561. In regard to the freedom and continuance of this treatment, we shall inform ourselves in great measure by the nature of the excre- tions, alvine and urinary ; for, while the forces are unnaturally dark., and the urine is dense^ of a deep color, (fee, it is incumbent upon us to make daily employment of purgative medicines (p. 96 — Rev., p. 344). Also continue purgation with Brandreth's Pills while severe pain continues, even if the stools are healthy. 562. A course of sarsaparilla often proves useful in that kind of chronic rheumatism w^hich is accompanied by general derangement of the constitution^ without the particular aflection of any internal organ. THE DOCTRINE OF PURGATION. 133 We see that, as the health of the system improves, morbid irritability lessens, the flesh of the patient increases, his looks and strength improve, and the rheumatic pains pass away (p. 370 — Rev. 353). Abercrombie, John, M. D., Pathological and PracUcal Researches on Diseases of the Stomachy <&c. Edinburgh^ 1828. 563. It has become a hind of fashion to refer symptoms to morbid conditions of the liver, without any good ground for considering them as being really connected with that organ. But as a practical man, anxious to be guided by observation alone, there are three classes of facts whicli have appeared to me worthy of much attention in reference to this sub- ject, namely : 1. That I have frequently seen such complaints get well under very mild treatment, as regulation of the bowels, and a little attention to diet ; 2. That I have seen ^uoi). patients jput through long and ruinous courses of mercury without any benefit, and afterwards found the com- plaint removed by a course of mild laxatives / and 3. That I have known patients die of other diseases while these alleged affections of the liver were going on, without being able to dis- cover in the liver, upon dissection, the smallest deviation from healthy structure (p. 320). 564. In chronic inflammation of the liver free and continued purging is expressly recommended (p. 361). Annesly, James, M. D., Researches into the Causes, Nature, and Treatment of Prevalent Diseases in India. Edinburgh, 1828. See Med. Chie. Rev., 1828, Vol. VHP Ser. L Dyspepsia and SUPPOSED chronic in- Jlammation of the liver cured by PURGATION. Mercury Real chron- ic inflam- mation of the Ivei — PUBGE FEEB- LY AND CON- TINUALLY. 565. Thus, in recruits and other strangers to the climate, on their arrival in India, when the biliary secretion is much increased, the tem- porary obstruction produced by exposure, wet, &c., often occasion the most formidable symptoms of disease, and when the obstruction is over- come, an immense quantity of vitiated bile is passed. It is reasonable to suppose, if the gall-bladder and ducts be over-distended with their contents, then vital contractility may be weakened, and thus the evil will be increased, until some internal or external cause supervenes,which shall enable the organ to throw off the load which oppresses it, and dis- charge its morbid secretion (Rev., p. 419). Feviers in the East In- Natural or artificial purgation alone can 566. The accumulation of mucous on the internal surfaces of the Mucous ob- duodenum may also obstruct the mouth of the common duct, and pre- c«S°o° fe* vent the flow of bile into the alimentary canal, until the obstruction be Ji^by'^pSgl- tion. overcome or removed (p. 307). Bayle, M., M. D., On the Inflnience of Gastric Affections in the Produc- tion of Mental Maladies. See Revue Medicale. Paris, 1828. 56Y. Mr. Bayle proves by numerous cases that chronic inflammatiwi of the mucous raembrane of the stomach and bowels produced various dT^dstoS- forms of insanity, and that the form of the mental hallucination was *<=^- often determined by the physical malady in the stomach. 134 THE DOCTRINE OF PURGATION. Brown, John, M. D., Medical Essays on Fever, <&g. London, 1828. pToduco? ^'^^^- Malaria produces intermittent and remittent fevers, cholera, dys- m;my dis- jy^jma, hHious diafv/ioBa, Uvcr disease, jaundice ; and Dr. McOullock cording to adds, rhcumatism and neuralgia (p. 46). Cooke, William, Surg., A Practical and Pathological Inquiry into the Sources and Effects of Derangement of the Digestive Organs. Lon- don, 1828. muiation-^— 569. In diseasG there will sometimes be fatal accu7)%ulation offceces uponrlporS lu tlio iutestines, when both the patient and attendants report that the tfon, buTeSl howels are frccly relieved (p. 129). amine. ^^lioif^' ^^^' ^^™'^s diseases arising from constipation cured hyfull purga- tion. notltmitent I^ cases of constipation we must be careful that the discharge of ~uoT^i:T' l<^ose motion does not deceive us, for this may happen without the bowels quired;— NO bciug Sufficiently acted upon. We ought never to he satisfied, in any u^&" *^^" serious case, without careful examination with the hand ^ for it will fre- quently happen, even after fluid dejections, that a large accumulation of fceces shall exist. Case. On the 12th of December, 1818, I was consulted respecting a little boy four years of age, who for several days had been unwell. I pre- scribed a dose of calomel, which, in the course of the day, affected his bowels three times, the m.otions heing loose and yellow. His diet con- sisted chiefly of fluid aliment, and of this he took but little. On the pg^gj.^ morning of the 13th he had considerable y^z^^T* remaining. A powerful purgation (calomel and jalap) was given. Early next morning he voided an excessive quantity of formed and hardened fceces, some parts of which were of a hlach color. After this evacuation the febrile symp- toms speedily subsided (p. 129). Impaired 571. J was cousultcd bv an elderly pjentleman who had been sufler- cured by iug uudcr chrouic and protracted derangement of the digestive organs, gItion!^^ and who believed that he had kept his bowels freely open by ordinary domestic aperients. A more efficient purgative was, however, prescribed, and to his surprise and comfort he voided as much solid excrement of a hrovm color as would more than half fill a large pot-de-chambre (p. 130). '^^ttiol—iis ^^^- Active purgati/ves are not only merely required in cases of accu- usefulness, mulatcd faeccs, but are sometimes useful by instituting morbid action, by setting up a temporary disease through the alimentary canal. Something may he attributed to the increased secretion, but the main- tenance of morbid action has sometimes considerable influence in con- trolling functional affections which did not originate from gastric dis- ease (pp. 131, 132). PaipitaUon 5Y3. In evideuce of this view is given a case of palpitation of the of the heart, ^g^.^,^ curcd by purgatiou (p. 132). THE DOCTRINE OF PURGATION. 135 5Y4. A case is given of peritoneal inflammaUon cured by full purga Peruoneai tion, when " both the practitioner and the nurse informed me that the ^"Jf"'^'"''- bowels were quite ojpen " (p. 130). 575. In the summer of 1824, I was called upon by a maiden lady aged 34. She informed me that for some months she had been in such a state of distress, from mental depressions that life had become com- pletely burdensome. She had neither inclination for food nor exercise. She slept but little and passed restless nights. I prescribed laxatives and sea air for a few weeks. She grew worse. On her return to the city, powerful purgatives were employed three times a day^ and in a w^eek she felt quite a different creature (pp. 192, 193). Mental deprenHion cured by ■powerful purgation. 576. In 1816, I attended a lady who had " not been well " for two years, during which period she had been under the care of a respectable medical gentleman without deriving advantage. She was also subject to pains in her right side^ appetite impaired^ countenance yellow^ rest disturbed. Employed active purgation (calomel and jalap). The first day she had twelve dejections ^ the others six or seven each. The pain soon ceased, appetite was good, countenance cheerful, and she was again feeling comfortable. She was now desired to take half the former dose of opening medi- cine every third night. In this case the constipation had existed so long that it seemed jt?^zf- dent to act freely on the howels at fifrst^ and grad%ially lessen the strength of the purgative (pp. 232, 233). Amenor- rlioia cured by full pur- fjation. Case. Continua- tion of the purgative treatment. 577. A lady in the ^^'y^^^^A month of pregnancy had been affected for some time with what was considered a guotidian ague. Every day, at nearly the same time, she was attacked with rigor and violent shiver- ings which continued for half or three-quarters of an hour, and was succeeded by hot and sweating stages. On being consulted I deemed it expedient to administer some opening medicine hefore other steps were taken. The hoioels heing freely acted upon in the course of the next twentyfour hours^ the fever did not return (pp. 285, 286). Quotidian ague during pregnancy cured by purgation. 578. A gentleman informed me that he was recently consulted re- Another case specting a family with ague. Barh had been frequently given without Bark useless. success. Finding that their howels were much disordered he prescribed some opening remedies^ intending to give quinine afterwards, but the ague had ceased (p. 286). Monro, Alexander, M. D., Morlid Anatomy of the Brain. London. 1828. See Med. Chir. Kev., Ser. Z, Vol. VIIL, 1828. 579. Hydrocephalus. — Brish cathartics are to be administered regu- Siriroceph- larly, especially at the outset and during the first period of the disease ; bV'reSed for the quantity of feculent matter contained within the intestines in wayVpurgl many cases is really surprising. One instance now occurs to us. The /f^l^ "'^^ patient was a young lady who, after an attack of fever, during which 136 THE DOCTRINE OF PURGATION. head symptoms predominated, and had not been opportunely nor snffi- case. eiently overcome, was seized with all the signs of water in the he-ad ; and as her bowels had been rather disposed to astringency throughout the fever, they became exceedingly torpid, indeed almost unraanage^ able, on the establishment of hydrocephalus. Five or six cmnmon doses of drastic purgatives were required 'before fetid stools. '^^^^ bowels would answer^ and fetid and bulky stools were daily passed for three weeks under this stimulation^ without any solid food having been taken during that time (p. 38 — ^Rev. p. 385). 580, And instituting a new and healthy action in the secretory appa- ratus by a degree of warmth and local remedies adapted to the sensibility of the part afiected (ibid). McKenzie, William, M. D., A Sketch of the Natural Cure of Dis- eases ; in Glasgow Medical Journal, February^ 1829. See Burr. & Foe. Med. Eev., 1847, Yol, XXIIL evS^^haSgl ^^1- The body is almost altogether fluid ; nine-tenths of it are so, i^l^^'i^ever and only one-tenth solid. The fluid parts a^e in a perpetual state of disease, change, being decomposed by one set of functions and recomposed by another. . . . Our fluids, by means of digestion, absorption, circula- tion, respiration, and secretion, are in a constant revolution. By these processes there is eflected an uninterrupted decay and restoration of the body ; and one can not doubt that the natural cure of diseases depends very much on the existence and on the perfection of this revolution. ISTay, it is extremely probable, that one of the principalintentions served in this mode of carrying on life is the prevention and removal of dis- ease (Rev. p. 587). By purgation with Brandreth's Pills we can change the entire body in from a third to half the time it is changed in the ordinary course of nature, and with entire safety. Case of Stephens, Henky, Surg. Treatise on Inflamed and Obstructed Hernia. London, 1829. See Med. Chie. Rev. Ser. Z, 1829, Yol. XL strangu- 582. Mr. Lawrcncc has, under the head of " slow strangulation," ^frfm™^ described a state of obstructed hernia from fecal accumulation, and tained fseces. without doubt such a stotc oftcn cxists (p. 62 — Rev. p. 112). Brandreth's Pills to this poor patient would have been the complete doctor, producing certain relief, and, in all probability, would have cured the rupture. Stokee, William, M. D. Treatise on Continued Fevers, c&c. Dublin, 1829. Typhus 583. Typhus fever is connected with morbid changes that previously '^^^' take place in the fluids, and produce morbid actions, and sometimes permanent change of structure in the solid parts. These changes are THE DOCTRINE OF PURGATION. 137 distinguishable from those which occur in inflammation^ and the morbid action excited relatively by these changes in the blood are also distinct. In inflammatory fever, increased action ; in typhus fever, debility is almost the immediate consequence (p. Y4). The remedies employed by me in mixed and typhoid fevers, and arranged according to their relative importance, are : Mixed fevers — cleanliness, ventilation, cool regimen, plentiful dil- uents, and purgatives. Typhoid fevers — yeast, wine, am^d aperients (p. 113). definition and modus procedendi, with purgative medicines. 684. In both ague and intermittent neuralgia, I believe the disor- dered function of digestion, and the consequent morbid condition of the chyle and of the other contents of the stomach, whether ultimately absorbed or carried into the sanguiferous system, or carried downward by theprimcB vice, become in their transit a chief cause of all the succeed- ing symptoms (p. 35Y). Ague and neuralgia from re- tained im- purities. 5^6, When these periodic diseases become, however, more estab- These impu- Ushed, it is probable that not only the fluids are further affected, but caus^^of^or- that consequent changes are excited, and hence the morbid condition of somIc du- the fluids may be the primia^^ source of organic disease (ibid). The following quotations establish the absolute necessity of having by us a purgative to which we may always apply with safety for relief; and we have it in Brandreth's Pills. Copland, James, M. D. Dictionary of Practical Medicine. London, 1830. JSTew Yorh Ed. by Dr. Ch. A. Lee, 1846-1852. 586. A belief is too generally entertained that fecal matters and sordes will not accumulate in the colon unless the patient has been con- stipated. But they m.ay collect in its cells, the more central part of the canal allowing daily evacuation y and they may even remain there for a considerable period, producing much irritation, and even a relaxed state of the bowels, thereby misleading the judgment of the prac- titioner as to the pathological state constituting the disorder. ... In many cases, when the morbid collections have become acrimonious, an irritative diarrhoea continues for some time, or recurs at intervals, before the morbid matters are fidly thrown off, owing to spasmodic constric- tions of parts of the bowels. . . On these occasions the evacuation is often preceded bv gripes, tenesmus, or a scalding sensation in the anus (vol. I., p. 450, Art. Colon, § 6). Fecal matter may accumulate where there is no con- stipation — watch and purge. Effects. 587. Purgations are used in order to occasion a local determination of blood, and thus derive it from the seat of disease, to evacuate the vis- — tS^ac- cera, increase the discharge from the mucous surface, and augment the ^Ss ^°^ secretions in adjoining organs (ibid., p. 218). 588. Y\\Q fetor, <&c., of the breath, and of the perspiration, &c., con- interrupted sequent upon interruption of the abdominal secretions, indicate that im- secretion- purities have accumulated in the circulation, and that they are being ac^w»»ofthe elimin ated by the lungs and the shin. So long as the vital energy is gln"'°^^ °^* Causes of 138 THE DOCTRINE OF PURGATION. sufficient for the due performance and harmony of the functions, inju- rious matters are seldom allowed to accumulate in the blood to the ex- tent of vitiating its constitution^ witliotit heing discharged frmn it hy means of one or move oi^gans. But as soon as this energy languishes, or is depressed by external influences and agents, and the blood is thereby either imperfectly formed or insufficiently animalized and depurated, some one of its ultimate elements or proximate constituents become ex- "disease? ccssive, aud the chief cause of disorder, which terminates either in the removal of the morbid accumulation^ or in a train of morbid actions and lesions (vol. L, p. 23 8, Art. Blood, § 116). Defective 589. Thus it will appear that changes in the secretions and in the cauS'ab- hlood itsclf are most influential in the production, perpetuation, and sorption of aggravation of disease. . . Thus, also, it will appear not only that hurt- uvTitiating ful mattcrs carried into the circulation, and ultimate elements or proxi- and^produc- ^ate constitueuts allowed to accumulate in it, owing to the imperfect ing disease, performance of some alimentary function, will be removed from it when the vital influence is sufficient for the task, but that both kinds of inju- rious agents will, according to their nature, become productive of a viti- ated state of the blood, of the secretions formed from it, and even of the various tissues themselves, when the state of vital manifestation is insuffi- cient to remove them from the frame (ibid,, p. 239, § llY, ibid.) Defective se- 590. I consider the grand path^^logical inference to be fully estab- creTion,ifnot lishcd : that the interru^on or obstruction of any important secreting or by^icarious cHifivnating function, if not compensated by the increased or modified duce°'«S- action of some other organs, vitiates the blood more or less ; and if such ted blood, vitiation be not soon removed, by the restoration of the function prima- rily afiected, or by the increased exercise of an analogous funcjtion, that still more important changes are produced in the blood, and ultimately in the soft solids, if the energies of life are insufficient to expel the cause of disturbance, to oppose the progress of change, and to excite actions of salutary tendency (ibid., p. 240, § 121, ibid.) Mirisma— 591. Miasmata produce a morbid impression on the nerves of organic action on life, followcd bv dcpressiou of the vital iufluence : the functions of diqes- orgamc life, . ' ,'• f -7 ^ • . . i, • i' . i? '^ ^ p impairing Uon and sccrctiou languish, and, owing to the imperiect periormance oi tkfn T*The' secretion and assimilation, the necessary changes are not fully effected Relcuon if ^'^ ^^^ blood, and thus the irritating and otherwise- injurious matters ac- thereissuffi. cumulate \A it. . . The vascular system becomes excited by the quantity "^—^^^7% and quality of its contents ; and when the vital energies are not too far noj^"*^' ^ depressed for its production, the excitement becomes general. The ac- celerated circulation has the eflect of exciting the organic functions, of restoring the secretions which were impeded or interrupted, and thereby of removing the morbid state of the circulating fluid, after which the return of health is rapid. When, however, salutary reaction is not brought about, owing to the morbid depression of the vital energies and to changes which had taken place in the blood, the vitiation of the blood jproceeds ', the secretions are also vitiated, the solids affected, one or more vital organs suffer in an especial manner, the energies of life are exhausted, and various organic lesions are induced, having reference to THE DOCTRINE OF PURGATION. 139 the previous state of the system, the kind of changes produced in the blood, and the agencies in operation during the progress of the disease (ibid., p. 240, § 125, ibid.) 692. M. Andral states that " he has often found in the hlood-vessels Morua/or- matioriH in body im- morbid matters to a Qurdy, friable matter^ of a dirty-gray color ^ and resembling either the S2 semi-concrete pus of chronic abscesses, or the sanies of malignant ulcers, ^^[^ or cephaloid matter, broken down and mixed with blood." And similar the ulod. instances are recorded by Bichat, Beclard, and Yelpeau. In all these cases, abscesses, tubercles, or other morbid formations, also existed in " some part of the body (ibid., p. 246, § 144, ibid.) 593. Morbid secretions should \iQ frequently evacuated^ in order that Evamau vital power may not be further reduced by their morhid impression on tions\^'tim others, until a salutary crisis is observed^ and the morbid state of the into" a hJ^od IS removed^ or until the soft solids are changed, their vital cohesion dftiJn.^ *^°°' is loosened, and disorganization ensues (ibid., p. 1046, Art. Sympathy, The mutual 616, There is very intimate connection existing between the state of excreting or^ the blood and the depurating offices of the mucous surface of the intes- talnedWcre- tines, cspccially of the large intestines. This surface, and more partic- duce^amon» ^^^^^l^' ^lie follicular glauds, may be considered as eliminating from the other eS^ bloocl reduudaut or decomposed blood globules, and much eifete mate- ^eSs^i. e!' rials, and as thereby contributing, with the other emunctories, to the ^chan'ge?^ puritv and healthy condition of this fluid. The connection subsisting between the functions of excreting viscera, not only as altering the con- dition of the blood, but also as affecting each other individually y the influence which the state of one depurating function exerts upon the others through the medium of the blood, as well as through that of the organic nervous system, and the mutual and conjoint operation of all these functions, not merely in changing the physical appearance and constitution of the blood and the states of vital influence, but also in occasioning structural alterations, are among the most important topics comprised'by a rational system of pathology (ibid., p. 1045, § 96, ibid). ^OT^ciou^s"^ 617. Predisposing causes of worms should, as much as possible, be mucous and Tcmovcd or Counteracted. In furtherance of this indication, the diet and ^sordes!^ the treatment should be adopted that are most efficacious in promoting the organic nervous force and the tone of the digestive organs, and in removing tenacious mucous and pituitous sordes, which often adhere to the digestive mucous surface, and which often forms the nidus in which the ova of parasites are lodged and hatched. It will generally be no- ticed that the secretions and excretions which in all persons form the principal part of ihe fecal discharge are seldom thrown off from the se- creting surfaces so quickly and entirely in the delicate and debilitated as in the robust and healthy, but remain or are retained in the former class of subjects, andbecome the soil in which these animals are reared (ibid., p. 1547, Art. Worms, § 158, B). Spasms. g^g^ Spasms of the voluntary or involuntary muscles. — Purgatives curebypwr- are generally beneficial, more especially when the liver or brain is con- gested, and when the spasm is connected with acidity and flatulence of the digestive canal, or with accumulation of morbid secretions, excre- tions and fecal matters, as when spasms occur in colic, or in the course of gout, rheumatism, hysteria, hypochondria, &c. In these, as well as in some cases of other diseases, not only are morbid excretions thus liable to accumulate, but the hlood becomes more or less contamiriated by effete materials, which the impaired functions of the emunctories fail of removing. .J?!r^.^^ ^19- In these circumstances purgatives should be selected with this the bowels vicw, uot merely oi evacuating the contents oi the bowels, but also of ^eimt promoting the functions of the excretory organs. When cerebral con- THE DOCTRINE OF PURGATION. 145 gestion is connected with tlie spasms, then active derivative purgatives ought to be exhibited hy the mouth and in enema (ibid., p. 931, Art. Spasms, § 31, 0). 620. But the most remarkable cause of the slow progress of the ther- Sowp^otrSs ajpeutical science is to be found in the highest and most legitimate ranks ^fj^g^f^re^me' of the medical profession — in the physicians themselves (§ 9) ; in wrong dies, and of estimates of the efficacy of particular medicines and agents (§ Y, D) ; in Sere^."^^"^^ erroneous, limited, or one-sided views of the causes, seats, nature and procession of diseases ; of medical doctrine (§ 4, 1.) ; medical jealousies and contentions ; opposing systems ; plans on means of cure ; jarring views as to the efficacy or operation of certain medicines ; opposite opinions in courts of justice, or otherwise appearing in public ; the publicity given to medical discussions have an unfavorable influence on the pub- lic, and prevent many from trusting to medical treatment (ibid., pp. 1130, 1131, Art. Therapeutics, § 12, I). 621. The blood is found altered in disease : 1. By a change in the proportion of its constituent elements; 2. By the addition of foreign matters (+) (cf. G. Harvey). How the Mood be- comes im- pure. AN HONEST PEOFESSOR. Maex, K. Z., M. D. Professor in the University of Gcettingen. eral Pathology. Gmttingen^ 1833. Gen- 622. The conscientious practitioner can resort but to few remedies ; for whenever the choice lies between what is harmless and what " heroic," he must unconditionally employ the former (Preface). Materia medlca. Chomel, M,,M. D., Clinical Lectures on Typhoid Fever. Paris^ 1834. See Beit. ajst> For. Med. Rev., 1836, Vol. 11. 623. In the stools of patients^ at the commencement of recovery from Typhoid typhoid fever, there are always scyhalcB; on which stools oFcon- Dr. John Conolly observes : If medicine had produced the same arwlys^^con- effect earlier, which nature did eventually, the symptoms would have tainscy&a/a. been milder, although the course of the disease would not have been cut short (Rev., p. 40). " The course of the disease would not have been cut short " may admit of a " perhaps." Laeiojec, R. T. H., M. D., a Treatise on Disease of the Chest. Trans- lated by John Forbes, M. D. London, 1834. 624. I would therefore lay it down as a valuable practical rule in chronic affections of the heart, that previously to having recourse to any remedies intended to act directly on it, we ought to be assured that the digestive organs are in a healthy state, that their mucous surfaces are Chronic heart-dis- etise. The first step to be taken; purgation. 10 146 THE DOCTRINE OF PURGATION. free from irritatimi^ their vascular system not morbidly distended^ and that the liver is performing its secreting function freely and regularly (p. 687). Let Brandreth's Pills be used in accordance with the printed directions, and there will be no medicines required to " act directly on the heart." The mucous coats will be freed from all irritating substances, when the liver and the heart will, as a rule, perform their functions freely and regularly. Clark, Jajmes, M. J)., A Treatise on Pulmonary Consumption^ and In- quiry into Causes^ Nature^ Prevention^ and Treatment of Tuber- Gidous aud Scrofulous Diseases in General. London^ 1835. See Bkit. and Fok. Med. Eev., 1835. Cacheicia- ^25. Dysjpcjpsia is the most fertile source of cachexia in every form ; ^om^' changeintiie blood, and othcrwise, by respiration, secretion, nutrition, and by loreign ^"'''- matters (ibid.) I THK DOCTRINE OF PURGATION. 159 684. In the treatment of this element of disesiiie— foreign morbid matter ^j in the hlood — the two indications which present themselves avQ^ first, to counteract the injurious operation of these matters / and second, to expel them from the system. We do not possess chemical antidotes which CAN ACT ON THE FOREIGN MATTER IN THE BLOOD WITHOUT INJURING THE BLOOD ITSELF. The othcv indication is more generally pursued, although little recognized by practitioners, to expel the offending matter from the system. The excretory organs, especially the hldneys and the alimentary canal, are the natural emunctories through which foreign and offending matters are expelled from the blood. Let us bear in mind how often fevers and other serious ailments seem to be carried off by spontaneous diarrhoea, diuresis, or perspiration (ibid., p. 122 ; Rev., p. 485). All chemical antidoten INJURE THE BLOOD, although they may expel morbid mat- ters from it. Expel these an nature does. Cozzi, L., Professor of Chymistry. Analysis of the Blood in a Case of Lead Colic, in Journal de Pharmacie. Paris, February, 1844. See Edinburgh Medical and Surgical Journal, 1844, Yol. LXII 685. Professor Cozzi, in analyzing the blood of a person severely Painters' affected with lead colic, discovered that the lead existed in the state of a Poison ' of salt, or of an oxyde of the metal, in the albumen of the blood (Ed. ^^"^ wo?d.*^^ Journ., p. 553). Houston, John, 1844. M. D., Introductory Lecture in Surgery. Dublin, The great mind of John Hunter saw and believed that the blood possessed in itself an independent life even while circulating loosely in the blood-vessels, but he knew not the nature and the seat of that vitality. The discovery was reserved for the physiologists of our days. There are particles, called globules, floating in this liquid, about the 3000th part of an inch in diameter, or so small that myriads of them are contained in a single drop. It has been ascertained respecting these globules that they are, each and all, endowed with a definite and uni- form shape, and with a development, in virtue of which they pass by successive transitions from a condition of origin to one of final evolu- tion — a veritable organization, in other words — properties which give them a claim to the title life, as much as those which justify the appli- cation of that term to the ovum, from which proud man himself dates his being. The atomic particles of which the blood is composed being thus individually alive, collectively they form a mass of which it may literally, as well as allegorically be said : " For it is the life of all flesh y the blood of it is for the life thereof ; for the life of the flesh is in the blood.''^ The globules are themselves, each and all, possessed of an independ- ent life. I have repeatedly w^atched them, and have shown them to others, when barst from their cell-membrane, performing sundry inde- pendent and apparently voluntary evolutions in the field of the micro- scope, until to the eye the whole looked like a moving mass of creeping things. In this view, then, the blood is doubly alive as exhibited — first in its forming and taking part in the repairs of the animal machine, and The Uood. Physiology. Bed corpus' cleH. Description of their indi- vidual vital- ity ; proved by micro- scopical ob- servation. The globules possessed of independent motion. natural out lets. Purae till 160 THE DOCTRINE OF PURGATION. secondly, in the independent movements possessed by the ultimate par- ticles of its matter (Lancet, Amer. Edit. 1845, vol. I., p. 214, +). PrDDUcK, John, M. D., On the Treatment of Indolent and Irritable Ulcers. london^ 1844. See Lancet, 1841, Vol. II ucers— 687. I regard the ulcer as a natural outlet or issue for the escape of certain morbid jprinciples frmn the bloody the retention or suppression of which would have occasioned diseases of a more dangerous tendency. . . the discharge Jf the ulccr or tlic issuc emit a disgusting odor and discharge freely, the !^^hen^''they neccssity for such a drain is unequivocal ; it cannot be closed without h^" eS*"^^^ risk of a worse disorder. But when the odor of the ulcer, or the issue, ceases to be disagreeable, and the discharge is moderate in quantity, and of a healthy quality, it admits of cure with perfect safety (Lane, p. 405). Baetlett, Elisha, M. D., Professor of Medicine in the University of Maryland ; Philosophy of Medicine^ Philadelphia^ 1845. On the recent Progress and future Prospects of Practical Medicine. See Beit, and Foe. Med. Kev., 1846, Vol. XXII. The materia ^^^- The Articlcs of the Materia Medica. — There is probably no medica. man more entirely sceptical in regard to their alleged properties and virtues than I am. There is no man who has been in the habit of using a smaller number of them. My own opinion is, that the number of substances endowed with active and peculiar or characteristic reme- dial properties is small. . . In many cases of disease all medicines, using the word in its common signification, are evils, and that they may be dispensed with, not merely with negative safety, but to the actual bene- fit of the subjects. . . The golden axiom of Chomel — that it is only the second law of therapeutics to do good., its first law being this, to do no harm — is gradually finding its way into the medical mind, preventing an incalculable amount of positive ill (Rev. p. 237). Assistnature ^^^' "'"^ ^^ comiug cvcry day to be more clearly seen that perhaps the orietthedis- most uuivcrsal and beneficial function of medical art consists in the removal and avoidance of those agents the action of which is to occasion or to aggra/vate disease^ thus giving the recuperative energies of the sys- tem their full sc pe and action^ and trusting to them when thus unem- barrassed and free for the cure of disease (ibid). Bm)D, Geoege, M. D., Professor of Medicine., King^s College, london. On Diseases of the Liver. London., 1845. Uver-dis- 690. In this country mercury has erenerally been resorted to, when the local symptoms have led to the suspicion that the Uver was dis- eased ; but I fear with no benefit to the patients. It has been well ob- served by Abercrombie : " On the liver-diseases of this country, mercury euse — and mercury. THE DOCTRINE OF PURGATION. 161 is often nsed in an indiscriminate manner, and with Yery undefined notions as to certain specific influence which it is supposed to exert over all the morbid conditions of this organ. If the liver be supposed to be in a state of torpor ^ mercury is given to excite it ; if in a state of acute inflammation^ mercury is given to moderate the inflammation and reduce its action " (p. 99), Ambiguous notions as to the actioD of mercury. CoPEMAN, Edward, Surg., A Collection of Cases of Explanatory Introduction. Vol. L London^ 1845. Bee lexy^ with an ANCET, 1845, 691. The following collection of cases is published with the view of furnishing sufficient data for determining the comparative merits of dif- ferent modes of treating apoplexy, and for judging of the expediency of resorting to bleeding for the cure of that disease (Introduction). Here follow 250 cases. The conclusion is, that bleeding, generally speaking, is so ineflectual a means of preventing the fatal termination of apoplexy, that it scarcely deserves the name of a remedy for this disease ; that the treatment without loss of blood was attended with the most success, and that the mortality of the disease increased i7i proportion to the extent to which the Heeding was carried ; the more copious the loss of blood the more fatal the disease (pp. 198, 199 ; Lane, p. 533). Bleeding fatal. The more blood is ab- stracted, the fewer are the chances of recovery. Maokin, Charles T., M. D., On the Acute form of Gout, with RemarTcs on its similarity to Acute Rheumatism, In lancet, American Edi- tion, Vol, I, 1845. 692. In a well-defined attack of gout, the pre-existing and gradually progressing derangement of all the organs which subserve the purposes of digestion and nutrition, coupled with the very remarkable increase of nervous irritability observable (as far as mj experience goes) inva- riably antecedent to a paroxysm, are sufficient, in a great measure, to warrant the conclusion that it is one of the most prominent examples of a local disease, depending solely for its origin on constitutional disturb- ance (p. 312). Gout; — & local disease from derangement of the digest- ive organs. 693. It is, in the established rules of modern practice, to be taken Modern by storm, to be driven from the system " vi et armis," and all the means ^^*^^*^^' which an already overgrown materia medica places within our reach, have been and are brought to bear against it. Patients are cured ; " they get well." . . . From the first recipe traced on sand by the staff of Anaximander or Therecydes (the inventors of writing) up to the last Mian's ^S- '' fiat mistura," have w^e one which we can positively say will produce a ion of Ms art. certain and definite effect? No, not one. Medicine is then, as yet, nothing save a nice balance of contingencies (pp. 312, 313). A knowledge of Brandreth's Pills would have changed this opinion. 694. The premonitory signs of its approach are generally to be found The precm- of a well-marked and definite character, so much so that in many in- ?SatS- stances he who has undergone a previous attack, can foretell with uner- '^se^%f evu 11 162 THE DOCTRINE OF PURGATION. ^"^si^wct^ riiio; certainty the coming of a "^25," as it is termed, some time anterior aruf^ intes- to t^ie appearanco of tlie unwelcome visitor. The Jirst symptom which REMOVAL "V excites observation, is a considerable increase of nervous irritability^ ^mlnTt^'^^^\l ^^^^ ^ ^Q\\eY'A2yeevishness and hastiness of manner. The sleep is restless Suute° The ^^^^ unrefreshing, disturbed with frightftd dreams^ tossing of the limbs, CURE. etc. The appetite (though not in variably) /a^^^ off. There is gastro-in- testinal derangement, with a sense of fidlness and oppression subsequent to meals ; dyspepsia and heartburn are pretty constantly present. As the symptoms become aggravated, the patient is annoyed ^\i\\ flatulence^ accompanied with sour eructations. . . . There is a bitter, or at all events, a vitiated taste in the mouth, espe- cially on lirst rising in the morning ; headache in those of plethoric habit ; the bowels are costive or relaxed — in either case the secretions are dark and offensive. The urine is of a saffron tinge, often scanty in quantity, and charged with lithic acid. These form the more remarka- ble prodromata, and, curiously enough, are observed to possess a distinctly intermittent character (p. 313). — These are, as the author expresses himself in another place, " not the ' hints^ but the ^positive directions^ laid down for the man- agement of the disease, for our guidance and. instruction, by Dame Na- ture'' (Lancet, A. E., Yol. I., p. 672). warning. The last 695. Of the near approach of the *^fit" the patient is warned by being seized at intervals with flying or transito7'y pains in different parts of the body, mostly affecting those portions of the frame already weakene(;l by previous illness (ibid.). The^arocB- gQg^ ^ most remarkable fact connected with the disappearance of ysm a salu- ^ •ii • 'ii 'pi* tary process the paroxysm IS that the patient, with the exception ot being more or cwre?"^""^"^ less crippled for a time, experiences a sort of general renovation of the system, and his state of health is better and more vigorous subsequently than prior to the fit. It seems as if the localization of this disease were a salutary process instituted by the " vis vitse " for the more effectual and complete removal 'of the cumulative disturbance of the general economy (ibid). The disease 697. I havo also obscrvcd that very slight causes will bring about the its ^Tppear- development of the elements of gouty inflammation, with which the sys- ances local. *tenn appears to be charged. I have known so trivial an accident as striking the great toe against a stone in walking produce a paroxysm. This peculiarity is often witnessed in those who are of confirmed gouty diathesis. Indeed, a man constitutionally subject to the disorder ap- pears " to wear his heart upon his sleeve," slight accidents, otherwise of no moment, being sufficient to induce an attack of this extraordinary disease (p. 314). Sara, Roberts, Professor of Medicine in the University of Milan. Sui Pregi e Doveri del Medico. Milan., 1845. Simple reme- 698. A physiciau of no great reputation would positively compromise his interests, if he limited himself to the prescription of simple remedies. THE DOCTRINE OF PURGATION. 163 The general ignorance obliges him to be a proselyte of the polyphar- macia / and indeed it is very easy to unite to any medicine a greater or less nmnber of substances which are quite incapable of modifying its properties. And it is also useful frequently to vary the medicines, because the public readily disbelieves in the knowledge of a physician who always prescribes the same remedies (p. 115). 699. The principal means of obtaining success in practice is to limit one's self to a reasonable system of expectation^ and to prescribe in cases in which no active medicine is clearly indicated^ substances incapable of exciting remarkable changes in the animal economy (p. 120). Humbug es- sential to the "profession." Success in practice — how to obtain. Tayloe, J., M. D., Clinical RemarTcs on Cancer. See Report of the University College Hospital in Lancet, 1845, Vol. II. YOO. The commonest way in which cancer is propagated is hy the circu- lation of the cancer- cells in the hlood, and the arrest of them in the capil- la/ries, when they multiply and form tumors. In this case (the reported one) there was no ulceration. The organs that are secondarily affected by cancer have always some connection with the seat of the primary disease. We can easily see the connection between cancer in the breast and lungs. In passing through the pulmonary capillaries the cancer- cells are arrested, and thus the cancer is formed (p. 602). Cancer — cells in the blood. Purge and in removing prevent their accumulation in the arte- ries. YoGEL, Julius, M. D., The Pathological Anatomy of the Human Body. Leipzig, 1845. See Beit, and Fok. Med. Eev., 1846, Vol. XXIL YOl. Gases may be developed in the human body from two distinct sources — i'covcLfood in the intestinal canal in the act of decoirvposition and from decomposition of the tissues of the body itself. The gases produced in the intestinal canal occasionally permeate through its walls into the peritoneal cavity (Rev., p. 324). Foul gases from decom- position. Waddt, J. M., M. D., On Puerperal Fever. See Lancet, 1845, Vol. I 702. When the intestines are hurdened with fecal accumulations the constitution becomes affected in various ways ; thus cerebral and vis- ceral congestions, phlebitis, &c., may be the result of pressure on the larger vessels. The intestines are distended beyond their tone, and give rise to flatulency, anorexia, indigestion, and there is ^Yobdihly absorption of putrid matters, which may all tend to promote a highly unfavorable state of the general system (p. 674). Effects of re- tained fzeces. 703. The phenomena of the typhoid and ataxic {nervous) fevers, whether common or puerperal, will be best explained as the consequences of poison — either generated within or introduced from without — the fever being strictly an effort of nature to throw off^ injurious matter from the living body (pp. 698, 699). Fever— \\\e effort of na- ture to elimi- nate poison. 164 THE DOCTRINE OF PURGATION. BemittenK^. T04:. jRemiUent and intermittent fencers — the consequence of nature's endeavors to elhninate a poison from the system by the biliary organs (ibid.) IMPOETAN^T QUESTIGJSrS. Tuipidity of '<'05. Does the rapidity of pulse (in fever) depend upon a law of na- thepuise. \^^yq to make up, by rapidity of distribution and change^ for a deficiency of vital principle in the blood, or is the heart directly stimulated into increased action hy morbid onatter in the blood f (Ibid.) Clendin-ning, De., Report to the Royal Medical and Chirurgical Soci- ety^ January 13, 1846. See Lancet, 1846, Yvl. I. Hydroceph- alus from 706. T. 8..Allen^ Surgeon to St. Marylebone Infirmary, has seen in srppRE^En more than 500 cases of diarrhoea in children^ whose ages varied from 3 DIARRHOEA. j^Qj^^]^g ^q ^ ycars, that in at least 6 to 1 the diarrhoea was symptomatic — a salutary effort of nature to relieve the system — to suppress which, by opiates and absorbents^ was to invite head-symptoms, hydrocephalus, convulsions^ and death (p. 101). Hall, Marshall, M. D., Practical Observations *and Suggestions. London, 1846. (+) refuge of ig- YOY. That invariable refuge of the timid and ignorant — the lancet ! norance. Milk-fever- 708. I am of Opinion that what is designated '' milhfever^^ is fre- pietion^vftii qu^eiitly symptomatic of the condition of the mammae. The remedy for ^ature's this febrile state is therefore depletion of the milk-ducts. As a preven- ^pv^gation. tiou of milk-absccss and milk-fever, and with other hygienic objects, the infant should be put to the breast at the moment it is born. If, in spite of this, the breasts become in the slightest degree tumid, or febrile action is set up, another and a stronger infant should be applied without delay. This is nature's mode of relief, and infinitely more efficacious than the application of leeches. . . The patient must take barley-water as her sole nourishment, and the bowels must be freely purged. Hareison, J. B., Surg., Essays on General Pathology. London, 1846- 47. (+) The Uood ^^^' -'-^ ^^ ^^^^ place, it is manifest that the presence oi foreign may become ruatter in the blood must induce a state of derangement. In the next Sr^mlf- place, it is equally clear that if the blood do not undergo those changes, ent modes. ^]^{(3i^ j^ jg dcstiucd to rcccive during its transmission through the lungs, it can no longer preserve its healthy constitution. In the third place, the blood itself may be imperfectly elaborated (ISTo. Y.) Medical men ^^^' "^^ ^^ ^^^^ kuowu that the faculty do not themselves take medi- have small Qines in thc samc manner that they prescribe them to be taken. They o^yJii ^"rli^^ have not, it must be owned, that large credence which they require from ^^^' others. There is not with them the regular taking of spoonfuls at stated intervals, and the expectancy and confidence of the forthcoming result, which they ask of others. THE DOCTRINE OF PURGATION. 165 Leeson, John, M. R. C. S. E. Liehig^s Philosophy applied in the Treatment of FuncUonal Derangement and Organic Disease. ^ London, 1846. ' 711. There are d^houi four hundred and ten preparations in the Ta^pUwr. pharmacopoeia of tlie Eoyal College of Physicians. Now, any practical *""^''^'^*^' man of ten or twenty years' standing must have found that four hund- red of these preparations are of little or no "lvalue whatever in the treat- ment of any form of disease, and that about the remainin^g ten might have assisted him in reducing, at one time or other, cases occurring in every department of his practice. I^early all the waters, confections, decoc- tions, extracts, infusions, liquids, mixtures, essential oils, spirits, tinctures, have little or no influence over any form of disease, when used as inter- nal or external remedies. Many of the mineral preparations are abso- lutely injurious in their effects under every circumstance, while the retention of other remedies is burlesque and nonsense (pp. 10, 11). 712. Fancy aluminum, antimony^ silver^ arsenic, harium^ hismuth^ Metallic calciuTn, copper^ iron^ mercury, magnesia, lead^ potassium^ sodium, zi/nc remedies, (all of which are to be found in the London pharmacopoeia of one hund- red years' standing, with the exception of barium and bismuth), as medical agents which are yet authoritatively retained, and which have been at one time or other plied as sovereign remedies for many invet- erate forms of disease, although most of them, if not all, are abandoned by every practitioner of standing and experience as the most dangerous applications for any kind of medical pu|!poses (pp. 12, 13). Magendie, M., M. D. Introdiictory Lecture in the College de France, 1846. Bee Lancet, 1846, Vol. L 713. When disease requires assistance, we may still by well-judged Assist nature intervention assist nature in overcoming the functional derangements ^^ ^^' which gave rise to the disease (p. 238). 714. Tartar emetic, when brought into contact with the blood, has Tartar- the power of dissolving the globules (p. 363, citation in the paper of *"*^^*''' Butler Lane, Surgeon). Wilson, J. A., M. D., On the True Gha/racter of Acute Rheumatism * in Lancet. 1846. (-{-) 715. Inflammation is but an expression of the nutritive function innammo' endered difficult for the time in particular structures. Inflamma- ^ii^ZT\ni tion originates no movement, creates no function, brings no new nature's elements into operation ; it is not an acquired principle, but an innate ^"'"°^* faculty held in trust by every living structure from the beginning, for the means of self-protection, and as a security under injury for redress. Thus considered the arthritis of acute rheuinatism is respected by the physicians as salutary under circumstances, and as working with the ^^tST fever to a cure. 166 THE DOCTRINE OE PURGATION. Acute rheu- matism. Opium and lancet ; — poison and bloodshed denounced. Localization of fevers according to the poisonous matter in the general cir- culation. Disease from change in the propor- tion of ~ the natural ele- ments of the hlood, The blood feels and 716. Opium i7h acute rheumatism.. — The healthy relations of this drug with the blood (and it is prescribed on no other indication) are not such as to authorize its employment in a disease whose principle of cure is one of unrestrained spontaneous action. TIT. These a]) proved princijples of cure hj poison and bloodshed rest professedl}^ on more than conjectural science for their authority ; they are not set forth diffidently, as the experimental misgivings, by small induction, of a theory yet to be realized, but are proclaimed as the dicta of a bold and successful experience ; they are blazoned as heroic mottoes above the vulgar host, that seeing them we may know our leaders and be prepared to follow them. T18. As the scarlet-fever localizes itself especially in the throat, the measles in the mucous lining membrane of the lungs, the epidemic typhus in the coecum and lower ilium, and the erysipelas fever in the integuments of the head and face, so is the rheumatic fever determined by special eifects of inflammation to the larger joints of the hody and the surrounding articular 'structures ; but the heat, swelling, and redness thus induced are no more the cause of the constitutional disturbance in acute rheumatism than the scarlet-rash, or the small-pox pustule of the fevers that bear their respective names. They are but the partial expression, by impaired nutrition, of a disorder that is general to the system. T19. Assuming the evil was in the blood, not so much from impuri- ties as a change in the relative proportions of its necessary elements, we might rationally expect the com'position of some structures or products to be more influenced than others by an excess or deficiency of prin- ciples important to their very existence, since the greater frequency with which particular parts are affected only indicates that the tissues of which they are composed, and the fluids which permeate to them, are such as to be especially affected by a morbific cause which prevails to a greater or less degree throughout the system. T20. There is in the hlood an independent faculty of sensation which by physiologists is not as yet acknowledged. In disease, as in health, it is sentient of its own states, as it is inceptive of its own actions, and through it we feel much of what, in idle phrase, is made exclusive to the nerve. Acute rTifv^ raat sm can cure itself. Bleeding, opiwm, and culoTTLel, if they do not kill, compli- cate the dis- order. T21. The fever of acute rheumatism is competent to the task of its own cure. Yet the patient is made to pay hy the lancet for its acuteness, and swallows every specific for gout and neuralgia in right of his rheu- matism. . . From this practice, there is reason to believe that many of the dangerous complications so frequent of late years in the pathology of acute rheumatism do in truth proceed. In the well known combin- ation of opium and calomel, this mischievous diligence of treatment receives its most frequent illustration. The objects proposed in this heroic formula are the immediate and complete extinction of fever, pain, and inflammation. It is a rude and empirical practice which seldom succeeds, and fail- ing of success is most injurious to the patient ; it has destroyed very THE DOCTRINE OF PURGATION. 167 many who, under less popular and energetic methods of treatment, cuffX'uri- would have recovered. . . patient! *^^ There is more wisdom, for there is less cruelty, in hommopatky^ hydro- pathy^ or animal magnetism. Yet the courage is with those who refuse to prescribe. Let young medical men ponder. Purgation Y22. Purgation. — Its simplicity ill accords with the impatient vio- -itSpUc lence and affected combinations of modern therapeutics ; yet of consti- '^^y- tutional methods of cure, no one, by long practical experience, has been more thoroughly approved. Y23. To secure effects by ]3erspiration, opiurn^ antimony.^ ipecacuanha^ ^^mt ammonia^ liave been imsparingly added to the system^ already taslced by an active disturbing principle, to its utmost means of resistance. Hence, from undue haste, violence, and inconsistency of action, a great loss of the credit which would otherwise have attached to the sweating practice in rheumatic fever. Imperfect sweating catcses offensive matters to remain in the ducts and pores. Sweating to be beneficial must come on spontaneously, with no aid from drugs,. Dick, Robeet, M. D., The Treatment of Dyspepsia. See Lancet, 184Y. Vol. L 724:. Ocecum. — In all cases of constipation or torpor of the bowels, consu-^ attention to the caecum is important. It is here that fecal accumulations ^^nlTik~thl are, on several accounts, apt to take place. The circimistance of the large ^Jjf^^^j^ 5^; howel here forming a cul-de-sac^ out of which, moreover, the fecal mat- flammatioa ter, during 14 or 16 out of the 24 hours, can only escape by a course dZTd/c^ce's. counter to gravity, disposes not a little to the collection there of excre- ment. And indeed, in most cases of constipation, in cases of chlorosis, &G., we shall generally both see and feel a fullness of this part, some- times of remarkable and even alarming extent and hardness. . . . And I have no doubt that in not a few cases a state of chronic irritation of (sub-) inflammation and even of ulceration of tlie mucous membrane of the caecum, is induced from the long contact with hardened fseces w^hich, moreover, have become preternaturally fetid and undergone certain irri- tating chemical decompositions. In such circumstances either round or irregular masses of a fatty looking substance may often be detected in the evacuations. This consists of inspissated mucus, secreted by a sur- face highly irritated or {sub-) inflamed. A slight prolongation or increase of such irritation will convert this inspissated discharge into a purulent one (Lane, p. 32). 725. In impure states of the fluids we prescribe purgatives on the The following assumption, namely, that if we, ly artificial means, afford ^^^^f^^'^ nature the opportunity, she will, by emunctories whose action we excite, discharge herself of morbid principles, Yetammg those that are healthy. This, indeed, is the grand general law, in faith of which we venture^ %n any case, artifi/iially to meddle with nature (ibid. p. 88). 168 THE DOCTRINE OF PURGATION. Sherwood, John Burdett, M. D., On Dyspepsia. London^ 1847. rH%ofdis- 720. I aiii of opinion that tlie proximate canse of all diseases con- ^^^' sists in scnne alteratimi hi the force, quantity, or quality of the circulat- ing fluid j and that, of those affecting the general system, vitiation of the hlood is an invariable accompanhnent (Preface). Johnson, Edward, M. D., On Ihfe, Health, ojnd Disease, Edition. New Torh, 1850. America/n Purgation ^^'^' Duvqation, like exercise, accelerates what Liebiq calls the choMge accelerates gf flatter — that is, the daily disorp-anization and reor2:anization of the i^e change J /. t t i' t t •, i ^ i -77 7-7 • i of matter, elements 01 the blood and vital organs, by more rapidl/y expelling the old and worn ont material and supplying its place with new (p. 96). Old age tue '728. There is bnt one legitimate canse of death, and that is old age. m^te ^?iuse If ^'^V ^<^^ ^'^^ whiU any of his organs is unimpaired, he dies pre- of death. maturely, and before he has fulfilled the final canse of his existence (p. 98). senith and 729. The health of the body depends upon the healthy performance Aiithe?egiti- of the nutritive actions, and disease consists in the unhealthy perform- S^*medfdne ^^^c of thcsc actious, or of ouc or more of them. Medicines, therefore, ^^ur^ative/ ^^^ ^^ ^'^<^^ value noT power over disease, excepting as they have the power of increasing or diminishing the activity of the nutritive actions, tion, secretion, circulation, (&c. (p. 88). If from indi- gestion or overfeeding our food does not become blood, the system is filled with gases^ etc. 730. We cannot derive any benefit from what we eat except from that portion of it which in due course becomes blood. All that we eat, there- fore, heyond what can he converted into Hood, is either changed into fat, or is left in the stomach and bowels to run into fermentation, serving no other purpose than to distend these organs with all sorts of pernicious a/nd offensive gases (pp. 81, 82), Irajjerfect digestion — {constipa- tion) — how- it impover- ishes and poisons the ilood. Good illus- tTation. 731. The result of improper digestion is that the necessary change which should be wrought upon the food in order that it may nourish our bodies, is very imperfectly effected — the chyme is of unsound quality. The next result is this : the chyme, by admixture with certain other juices which it meets with in the bowels, is destined to become chyle. But the chyme being of vicious quality, the chyle which is formed from it must also he vicious. At all events it must be deficient in quantity ; certainly it is impossible to suppose that as much perfect chyle can he elaborated out of had chyme as of good. You might as well hope to make as much good huiter out of had cream, or out of crea^n and water, as o%it of pure cream. The chyle, therefore, is deficient in quantity ; but this chyle is destined to become blood. The chyle, therefore, being deficient, the blood resulting from it must also be deficient (p. 125). Thehiood 732. Dut the hlood is in fact the real food on which the hody feeds, menton-L and this food being scantily supplied, the strength of course is ill-sup- body. ported. But there is another mischievous result of this condition of the stomach and bowels, beyond that of unhealthy and deficient gastric THE DOCTRINE OF PURGATION, 169 juice. In that condition of the health which I am endeavoring to describe, the stomach and bowels actually secrete air. It is a thoroughly established fact that air-wind— flatus — is actually formed from the blood, S'°lnT7t8 and poured into the stomach and bowels by those arteries which ought effects, to form only gastric juice. Now, this wind not only does no good in the stomach and bowels, but it does a vast deal of harm. For, besides the evil effects which it produces by its pernicious qualities, it molentVy distends these organs^ stretching and separating, and thus greatly weak- ening and destroying the firmness and compactness of their ultimate tissue (pp. 125, 126). Wegg, William, M. jD., Observations Relating to the Science am,d Art of Medicine. London^ 1851. 733. A highly important action of medicines upon the intestinal sur- face remains to be noticed, as affecting its excretory function. I do not mean the process which eliminates from the villous surface a fluid largely composed of water, containing the remains of the epithelium, &c., and which almost any irritating cause may excite, but the excretory function of the glands which thicTdy stud the surfaces of the howels^ and, fsjpe- cially those of the large intestines. Although the lungs, liver, kidneys, and skin contribute largely to the depuration of the body, there is little doubt that these glands contribute greatly to the same result, very proba- bly by expelling matter different from that which those other depurating organs eliminate (p. 213). Purgati/ve medicives — their action on the colon. Haspel, a., M. D., Medical Staff of the Algerian Army. Maladies de VAlgerie. Yol.X. Paris. 1852. See Med. Chir. Kev., ]S"ew Ser.. 1852, T34. In this season of the year {autumn in Algiers) every individual seems to be endowed with an especial susceptibility to the development of typhoid symptoms, when he becomes the subject of dysentery, inter- mittent or remittent fever. But these accessory phenomena, the stupefied countenance, the restlessness, heat of the belly, &c., quicJdy disajppean^, at the same time with the principal disease, under the influence of an evacuating plan of treatment. We must distrust the fulness of pulse, the false plethora, which manifest themselves during the prevalence of the great heats, and which seem to call for hleeding. If we yield to this perfidious indication, we find our patients fall into a state of adynamia, without the dysentery undergoing any amendment ; or, if the abstraction of blood produce any relief it is but temporary, to be speedily followed by a sensible aggravation of all the symptoms (p. 58). Malignant fevers ablkid. Purgation, the cure. Bleeding kills. 735. Mr. Haspel refers to the advantages derivable from purgatives, recorded by the old writers, and considers that their disuse in recent times has arisen rather from the prevalence of theoretical views of the inflammatory nature of diseases than as a result of experience. He speaks highly of emetics at the very outset of these diseases (pp. 9, 11, 39 ; Kev., pp. 106 sq.) Theory and practice. i'l 170 THE DOCTRINE OF PURGATION, Carpexter, C. Willloi B., M. D., Prinevples of Human Physiology. London^ 1853. Pure Mood 736. I firmlv believe that if the hlood of a person of sound constitu- cSagwns. ^^<^^^' ^^ l^ept in a state of perfect purity hy the moderate use of whole- some food and drink^ by the respiration of pure air, by adequate exer- cise not pushed to over-fatigue, and by personal cleanliness, he is as completely protected against the invasion of cholera as he who has been effectually and recently vaccinated is proof against small-pox. . . The same is true of all contagions and diseases, and hence the universal value of purgatives, which quickly restore the above conditions, if any aber- ration has taken place (chap. lY.) Dickson, Samuel H., M. D., Professor Med, College of South Carolina. Elements of Medicine. Philadelphia, 1855. ^oJ^lTh^ 737. The hlood is often indirectly poisoned by the influence of con- comes im- tingencies which prevent the elimination of such effete mattei's as must freely diS- be got rid of to keep it in a normal condition. We have reason to infer eased). ^j^^ existcuce within it of injurious ingredients, whose presence we can- not demonstrate by the ultimate results. The blood may thus become, so to speak, passively diseased (p. 111). ^IS!^purga- '^^^^ ^^ ^^ ^^^® ^^ influcma, purgatives aid in reducing to its proper tives. level the vascular excitement; while we " derive " from the head and throat hy determining to the gastric intestinal surface (p. 313). The Hood— 739. The blood is found altered in disease : i? ^becomes ^' ^J ^ chaugc lu the proportion of its constituent elements ; impure. 2. By the addition of foreign matters (p. 111). Demands careful attention. wiifitfor- 740^ ^ 2*reat variety of foreign matters may be absorbed into, mixed chymists With, auQ detected m the blood. Kramer lound m it silver, alter the ^fj^^Siellood. nitrate and chlorate had been taken. GEsterlein discerned globules of inercury in it, as Avell as in the saliva and urine of persons who had been taking mercurials. Heller found iodine and hromine in the blood of patients to whom these remedies had been administered. Nitrate, hy- driodate, and carhonate of potass, antimony, and carhonate and sulphate of iron have been found in similar circumstances. Quinine may be dis- covered in the urine, which it must reach through the vessels i and lead is shown in the gums and in the hrain of those poisoned by that metal (p. 111). COKSEQUElSrCES. other_ mpu- 741, T\iQ foreign matters which, as causes of diseases, enter the hlood, are not always, however, to be thus exhibited by chemical tests and re- agents; hut their presence ca7i he inferred as indisputahly ihovi^\ less j)alpably. . . Blood thus poisoned hecomes in its turn poisonous. The glands are irritated by it, and the secretions and excretions become mor- bid (p. 112). nties. THE DOCTRINE OF PURGATION. 171 742. The sugar excites the hidney into diabetes, the carbon and urea forms"o7di3 oppress the brain with coma. Its chemico-vital relation to the tissues ease induced undergoes essential changes, and infiltration and exudation, congestion, ?L.*"'^^^'^*' dropsy, and hemorrhage follow. It ceases to be nutritious, and atrophy and marasmus follow, or its nutrition is perverted and morbid, and we have hypertrophy, or deposition of scrofulous, tubercular, typhus or ' cancerous matter (ibid.) Bennett, John Henry, M. D., Editor of Edinbuegh Medical and Surgical Journal. 743. The mortality from pneumonia has diminished since large ^^^^^^^^ ^^ bleedings have been abandoned. (Present state of theory and practice pnmmonia. of medicine. Journ., Yol. I., 1856, p. 19.) Y44:. Pericarditis.— ^ovae few years gone by, the practice was to Pericar- meet the violence of the inflammation by the extremest antiphlogistic measures ; the lancet was plied with a most unsparing hand, and with the most unhesitating faith in the propriety of its use. But where are gjo^^jettin the believers in, or imitators of, such a practice now ? This " heroic and and mercury certain method," as it was called, of arresting the destructive agent — of *^°^*^®°^®^- exterminating the disease — has been convicted of error, and condemned by a late authority as " uncertain and very dangerous. '''' Again : " after hlood-letting, rapid induction of the mercurial influence is of the greatest consequence," wrote an authority in a most unhesitating style some fif- teen years ago. But now we find one of the most observing and practical physicians* among us admitting, that the firm faith which he himself once reposed in the efficacy of the remedy had been undermined by the truth-telling effects of further experience. In short, " the errors and absurdities," says Dr. Markham, " into which men have been led through this hastening to be wise — the fallacious and extraordinary proceedings in practice it has involved them in — he who is desirous of learning will find recorded on every page of the history of medicine. By thus casting dust in the eyes of others, and perverting our own wisdom, we raise up positive barriers to the advance of true knowledge ; for now the mist of delusion which our faulty haste has generated must be swept a\'7ay before the honest face of the simple fact can be made available to light our slow steps along the difficult passes of new knowledge (Journ., vol. I., 1866, pp. 1038, 1039). T45. The very discordant opinions which equally honest and equally Medical skilled observers maintain — observers not living in separate ages, or in ^p^ejudSar different countries, or in separate cities, but exercising their art upon stubbom- the same disease, under the same roof, in the same public hospitals — must have a meaning. Is it not one which is oftener than we care for to confess, responded to by our consciences at the bedside of the patient ? (ibid., p. 1039). * W. 0. Markham, M. D., in his " Diseases of the Heart, their Pathology, Diagnosis, and Treatment." London, 1856. 172 THE DOCTRINE OF PURGATION. iu,f!a»wui- YttO. IS^oiie but men ignorant of patlioloi>;y now talk of " knocking ther'weed- down '' inflammation with hlood letting^ or loith unercury. Indeed, why cufy cure?" ^l^^sc remedies are employed at all, lias^ to use the word of Dr. MarJc- Juwi, '' yet to he shown " (ibid., p. 1042). Bennett, J. Hughes, M. D., Professor of Medicine in the University of Edinhurgh. Observations on the Results of an Advanced Diag- nosis and Pathology^ etc. Edinbiirgh^ 1856. See Edinb. Med. and SuEG. JouKN., Yol. Z, 1856. Pastexpe- 747. Medicine is not a scientific art^ which is dependent for its theories— oi principles on the study of and commentary on the older writers. . . On "me'Scar the Contrary, it is the hooh of njjutwm-^ which is open to all, that we ought the^fSt — *^ peruse and study; and why should we read it through the eyes of the begin "de sagcs of former times, when the light of science was comparatively novo. the hlood. Bloodletting feeble and imperfect ? . . . The lesson which a careful study of history of medicine has forced upon me, is the necessity of reinvestigating, with all our improved modern appliances, the correctness or incorrect- ness of existing dogmas, in order to establish an improved practice for the future (Propos. I. ; Journ., p. 773). Small-pox. 748. Dr. Wm. Addison (Cell-therapeutics, 1856) correctly points out The pustules ^^^^ ill tlic distinctlvc eruptive fevers, such as small-pox, the numerous —the matter small abscessBs in the shin eliminate the morbid poison, which formerly creted from cxlstcd lu tlic blood, and are in this way essential to the cure. This provident action he denominates " Cell-therapeutics.'^'^ In all such cases experience has shown that time and a natural sequence of changes is is injurious! necessary for a restoration to health, and that the idea of cutting short such changes by bleeding is alihe erroneous in theory and injwious in practice (rropos. III. ; Journ., p. 777). ^^oodietting 749^ LaTffc and carlv bleedin^cs have been practiced under the idea — the theory ,. .«^. «/ */. i • !• n - 1 far more ap- that by diminishing the amount oi the circulating rluia — pw^gluon^ 1. The materies morbi in the blood would be diminished ^ 2. Less blood would flow into the inflamed parts ; • 3. That the increased quantity of blood in the parts would be les- sened ; and 4. That the character of the pulse was the index as to the amount of fluid that ought to be drawn (ibid. ; Journ., p. 776). ^mo^ves'^he^ 750. The carcful investigations of chemists, and especially those of good ^ and Andral and Gavarret, Simon, Becqueril and Rodier, and others, have baHo re- further shown us, that whilst venesections greatly deteriorate the blood, ™*^^ rendering it poorer in corpuscles and richer in water, they haA)e no effect in eliminating morbid products, and that in the vast majority of cases ELIMINATION IS IMPEDED BY BLOOD-LETTING (ibid. ; Joum., p. 778). inflamma- 751. Inflammation having occurred, the great work now to be accom- nat/tjuraid.^^ plislicd is to break up the exudation that has poured out, to remove the uve cure"?S pressure it exerts on the nerves and blood-vessels, and render the whole capable of being eliminated from the economy, either directly, by dis- charge externally, or indirectly, first, by passage into the blood, and secondly y by excretion through the em^mctories (ibid. ; Journ., p. 779). 8(Mme. THE DOCTRINE OF PURGATION. 173 Y52. jN'ow, it requires to be shown that draining the body of blood cannot in the slightest degree influence the congestion in the inflamed part. There the vessels are enlarged, the current of blood is arrested, the blood-corpuscles are closely aggregated together and distend the vascular tube, and are in no way affected hy the arterial current^ even when increased in its neighborhood. That opening a vein can alter this state of matters is scarcely to be conceived ; and if it could, how would this assist in removing the exudation which has coagulated outside the vessels ? (ibid. ; Journ., p. Y80.) 753. So far from getting rid of inflammation by weakening the pulse, we not only fail to do so, but prolong the time for the transformation of the exudation. This, indeed, is acknowledged by Louis^ Chomel and Grisolle^ who distinctly show that the progress of a pneumonia is nemer shortened ly Heeding (ibid. ; Journ., p. 781). 754. It is injurious to diminish hy hleeding the nutriti/ve processes themselves, when they are busily engaged in operating on the exudation, and eliminating the morbid products (ibid. ; Journ., p. 781). 755. The phenomena of fever and excitability following inflamma- tion^ have been wrongly interpreted. In themselves they are sanative^ and indicate the struggle which the economy is engaged in, when at- tempting to get rid of the diseased processes ; and we only diminish the chances of that struggle terminating favorably, by lessening the vital 'powers at such a critical juncture (ibid. ; Journ., p. 782). Inflamma- tory action described — bloodletting useless — in- dication for purgatives. Bleeding jjrolongs disease. Bleeding retards recovery. The crisis must not be interrupted by hleeding. 756. Assuming it as granted that in some cases the pain is/br a time relieving by bleeding, and that in pneicmonia the respiration tempora- rily becomes more free — at what cost are these advantages obtained, should the patient be so weakened as to be unable to rally ? Even if he does rally, a large Heeding almost always prolongs the disease (ibid.). Bleeding a dangerous palliative which pro- the 757. Clinical Lectures on the Principles and Practice of Medicine, non^o/m — lungs. New York Ed,, 1860, In all hepatization.^ the object of nature is to reconvert the solid exu- dation once again into fluid, whereby it can be partly evacuated from the bj'onchi, but principally absorbed into the blood., and excreted front the economy. Gradually the solid amorphous mass is converted into a fluid crowded with cells. This is pus. The cells, after passing through their natural life, die and break down, whereby the exudation is again reduced to a condition susceptible of absorption through the vascular walls, and once again mingles with the blood, but in an altered chemical condition. After undergoing various changes in the blood., the exudation is finally removed from the economy (pp. 265, 266). The natural and the pur- gative cure the same. PiCKFOED, J. H., M. D. Hygiene, London, 1858. 758. Malaria is modifled by altitude. If the elevation be consider- DUute the able, the temperature will necessarily restrict the fever to the intermit- >°^P""tyand 174 THE DOCTRINE OF PURGATION. yoti the disease hearo vailed upon Messrs. Zimmerman & Frazer to let him have a few dozen bo\e ;, He has now taken some thirty or forty boxes, and is so far recovered that he can walk with a CANE, and has full faith that he will recover entirely. He is so enthusiastic in favor of the pills, that he has cut your likeness from some of the package-labels and has posted it over his table, and frequcnll/ burns a candle before it (he is a Catholic) ; and when his friends come in he points to it, saying that this is the true "saint," ^^ my saint; all the rest I value nothing in comparison." This gentleman entirely recovered the use of his limbs, and is now one of the healthiest and soundest men in Buenos Ayres. Captain Berry, formerly of the New York Custom House, had also lost the use of his legs, and was obliged to use crutches. He resorted to Brandreth's Pills ; three months' vigorous use cured him of his rheumatism entirely. Cancer Cured. Mary H., wife of L. D. Grosvenor, of the United Society, Harvard, Mass., was cured of a cancer of many years' standing. " The prospect of ter- minating my life by the ravages of that insufferable scourge of humanity, the cancerous tumor, was certainly prevented by the timely and persevering use of Dr. Brandreth's Medicine, and a wonderful cure effected," Isaac W. Briggs, of 145 Suffolk Street, New York, says he has used Bran- dreth's Pills for thirty years, having commenced to use them in February, 1836, for dyspepsia and affection of the kidneys. He took Brandreth's Pills every day for thirteen months, and in March, 1837, became a perfectly sound, healthy man. Mr. Briggs will be pleased to answer any questions on this subject. July, 1866. United States Sanitary Commission, ) Wethersfield, Wyoming County, N. Y., June 27, 1865. j Doctor Brandreth : — This certifies that I have used your celebrated Pills for over twenty years, personally and in my family. When we are sick, in- stead of sending for a doctor, we use Brandreth's Pills. I believe if every one would adopt the same course, the doctors would have but little to do. I have traveled in fifteen States, and been in the army sixteen months, and necessarily exposed to much disease, yet by the use of your Pills occasionally, have secured my health through the biting winter's frost and the scorching summer's heat. 192 CURES BY PURGATION. In fact, Doctor, I feel, with your Pills in my pocket, safe from the attacks of disease. They seem to cleanse the blood and regulate the system, whether it be troubled with dizziness, diarrhoea, or costiveness. When out of sorts, I use them, and they always cure me. I would not be without them for four times their cost. I send this to you that others who know me may profit by it, wishing to do good to my fellow-beings. N. HIGLEY. Dyspepsia and Costiveness Cured. D. J. TENNY'S CASE.— iV^e?^ York Mentor, January 14, I860.— Whether the Brandreth's Pill is ever convertible into blood we will not now discuss. But our chief object at this time is to give a statement of a gentleman who says he has taken one of the Brandreth Pills for at least sixteen months, daily, or about 480 days in succession, and who says that at the end of that time he considered himself cured of Dyspepsia, attended by a constant costive state of the bowels, which had troubled him for a long time. This gentleman, Mr. Daniel Tenny, resides at the Astor House, in this city, and has been in the enjoyment of excellent health ever since he was cured by this treatment. He is an intelligent man, and there is no doubt of the truth of his statement. This proves, at least, that as many as one of the Pills prepared by Dr. Brandreth can be taken for nearly 500 days in succession without harm, and at the end of that time a dyspeptic and costive habit of body may be per- fectly cured. This could not be said of any of the cathartics in use by those who style themselves the Begular Faculty. Asthma Cured by Dp. Brandreth's Pills. The following cure of Asthma by the use of Dr. Benjamin Brandreth's Pills is authenticated by seventeen well-known respectable citizens of Green- wich, Conn. : This will certify that Thomas S. Brown, who had been for some time pre- vious much affected with asthmatical symptoms, was taken suddenly worse on the 12th of June last : he began to cough and raise phlegm, and in the course of twenty-four hours expectorated nearly two quarts of thick white jelly-looking matter. Three physicians pronounced it a nervous humid spasmodic Asthma, and after prescribing for some time, to no effect, the three consulted together, and finally declared that they could do him no good ; it would and must result in consumption, and death would ensue, and that in a very short time. The pain was excessive in all parts of his body ; and the difficulty of breathing was such as almost to cause strangulation. He was reduced to a mere skeleton, and finally gave himself up to death. After being in this miserable state nearly two months, he saw an advertisement of Dr. Brandreth's Vegetable Universal Pills, and immediately sent by Captain J. Waring, of Greenwich, for a 25-cent box, and found relief in the course of a few days. It is proper to say that he commenced with two pills at night, and two in the morning ; he found relief the second day, and encouraged thus to persevere with larger doses, he was soon able to sleep comfortable, and now, having taken them for about four months, according to the directions, is entirely recovered, and so far as we tan judge, CURES BY PURGATION. 193 entirely in consequence of taking the above Pills, which we have also used in our families, and have found them invaluable. James R. Mean, James Moore, Daniel S. Betts, Hannah Hitchcock, John H. Reynolds, James Mead, Abel Palmer, Thomas Bertram, Rev. R. Palmer, Isaac Olmsted, John R. Palmer, P. V. T. Jessup, Henry Bewsley, Stephen Waring, Samuel Jessup, Augustus Lyon, John Limpry. Mrs. Mary Blanchard, 206 Clermont Avenue, Brooklyn, was cured of Asthma of long standing by brandreth's pills. She is acquainted with other cases of persons cured of Asthma by the same remedy, and kindly permits reference. Painters' Colic Cured. Dr. Brandreth, Sir : — I am a painter by trade, and have frequently been troubled with slight attacks of colic, arising from contact with lead in the forms it is used in my business. My eyes have also been made somewhat weak from the same cause. Your pills have been my only medicine, and they have never failed to restore my health. For all the diseases incident to a painter, I think Bran- dreth's Pills a certain remedy. My journeymen, by my advice, always take them whenever their arms become paralyzed, or their bowels constipated, and they have been cured by a few doses. Painters will find your pills invaluable. Yours, &c., DENNIS NORTON. Sing Sing, March 23, 1865. Saint Vitus' Dance Cured, of Twenty-five Years' Standing, with Brand- reth's Vegetable Universal Pills. Sir : With the most grateful feelings and the highest consideration for you, I sit down to state one of the most remarkable cures perhaps you have ever received, and effected, sir, entirely with your never-to-be sufficiently praised Vegetable Universal, and, I might add, life-restoring Pills. The gratitude I feel makes me scarcely able to state the case, which would not, I am sure, be believed, were it not universally known in the town of Ware- ham, where we reside, and the miserable condition my dear wife, Lucy Hooker, has been in for the last twenty-five years, now restored to health and to her family, when for so many years she was considered to be beyond all human aid. For the last twenty-five years my wife has suffered from Saint Vitus' Dance, and a complication of diseases which the doctors only seemed to continue to make worse instead of better. Calomel and bleeding, tonics and blisters, then calomel and bleeding, tonics and blisters again. Every doctor round the coun- try at all famed was tried, until finally, she receiving no benefit, I thought I would try the mineral doctors no more, and therefore took her to Boston to Dr. Thomson. She went through several courses of his treatment, and ap- peared to gain some thereby. But alas ! she soon became as sick as ever. I 13 194 CURES BY PURGATION, then was obliged, she becoming suddenly worse, to send for two of the Ware- ham doctors again. They told me candidly she was beyond the powers of medicine, and that she must soon sink under her diseases. What was I to do "? I had often been recommended your pills, but always lield them in contempt. One medicine and one disease I could not understand. I told your agent, Abishia Barrows, of VVareham, what the doctors said. Again he strongly recommended the pills. 1 talked to my wife about them ; she said she would try, if there was any hope — hoped they might be blessed to her, but that she was resigned. I went for a box, and when 1 returned one of her doctors was in the room. He made a deal to do about it, said she could not bear them, they were too strong for her, she could not bear any kind of physic, that she would die in all probability from the effects of the first dose. The more he said in opposition the more Lucy was determined to try them, and actually took a dose of four pills in his presence, and while he was holding forth against them. Away went the doctor and reported through the town that I v/as killing my wife by giving her those Brandreth's Pills — those Prince of Quack's Pills — those Im- postor's Pills — and created quite an excitement. In the meantime she was receiving the benefit. The first dose of four had a most wonderful effect — no wonder at the state she was in. The corruption was indeed dreadful. She took six the next night, and the same results. Instead of their causing weakness, she became stronger, and able to sit up a little. She persevered, sometimes taking as many as twelve at night and seven in the morning. When her pains were severe she took larger doses, and she did the same if the appearance of the evacuations was bad — in fact we followed your printed directions most carefully. Sometimes she became worse — all the worst symptoms of the disorder pre- sented themselves. Often at such times have I trembled lest she should die ; but by persevering with the pills she soon recovered ; and after every attack of this kind she seemed to be more firmly established in the recovery of her health, or rather her health seemed stronger after each of these attacks.- At first, not only the doctors opposed her using the pills, but all her friends and relations ; they all considered that the pills would surely accelerate her death. But long since the tide of opinion has changed, and those who most opposed now most strongly recommend them. It is about sixteen months since she took the first dose. She has used in all one hundred and fifty-two boxes, all purchased of your agent in this place, Abi- shia Barrows. I consider that she is like one raised from the grave, to bless myself and family, and give your pills and a kind Providence all the praise. She has not enjoyed so good a state of health since she was a child, certainly not since we were married. The doctor who saw her take the first dose, I understand is entirely con- verted to your principles of curing diseases by continued purgation, and is try- ing to find out what your pills are made of But I believe he uses your pills in his practice — in fact I feel sure of it. The cures which have been made in our region since my wife's recovery are truly surprising. Every one that feels sick thinks of no other medicine than Dr. Brandreth's Pills. I hope, sir, you will come and favor our town by a visit ; you will find many .grateful hearts to welcome you. In the hope that you will live long to benefit mankind, I and my wife join in our mutual kind wishes and. grateful feelings, and remain. Very respectfully, WILLIAM HOOKER, LUCY HOOKER. Wareham, Barnstable Co., Mass., May 23, 1838. w CURES BY PURGATION. 195 Yellow Fever Cured. A gentleman, with whom I am well acquainted, writes as follows : " In 1838, at New Orleans, at the St. Charles Hotel, while at table taking dinner, before the soup was removed, I was taken with dizziness, dimness of sight, and confusion of ideas; in short, all the symptoms of yellow fever, though well five minutes before. I asked a waiter to lead me up to my room, for the confusion of mind and dizziness was so great, that I could never have found the way alone. When there, I took eight Brandreth's Vegetable Universal Pills, and laid down. I was watched carefully, and for three or four hours was partly delirious ; but in four hours the pills began to work, and my mind was clear enough to know my danger. Bleeding was recommended. ' Do you think,' said 1 to the doctor, ' I want depleting V ' Your life is not safe without it,' was the reply. ' Then I will take eight more Brandreth's Pills,' said I. Those on the top of the first eight, with plenty of Indian meal gruel, carried' me out of all danger, and half a dozen medium doses cured me entirely in less than a week. Those who want to be safe, should take a few doses of pills as a pre- ventive." Tenea, or Tapeworms, Entirely Eradicated with Brandreth's Pills. Reading, Fairfield County, Conn. Dr. Benjamin Brandreth : Bear Sir — I have been troubled with the tape worms for twelve years; many have come from me, from twenty to thirty feet long — more or less every day of shorter ones — every two or three weeks I had a sick time from them — pressure at stomach — heavy load — many have crawled from me while at work — injured my health so much that I was not able to work one half the time — spent a great deal of time and money in consulting physicians and taking their prescriptions — have been reduced very low by taking medicine, without effect — last fall heard of Brandreth's Pills as a Cure All — had but little faith in them, but was determined to try any, everything, I could find at all probable to cure, thinking that without some remedy I must be destroyed by them. I procured one box, took one dose, and one loorm came from me ten feet long ; took the second and third, which cleaned them all out, and I have not had one since. I have, however, taken several boxes of pills since, but have seen no appearance of worms. It is now ten months since, and I have gradually recovered my health, and ain now able to attend to my business as usual, and have no doubt that they are all extinct. When I was afflicted with worms, I wanted to con- sume three times as much food as I would if in good health. Now I take my regular meals, and am hearty and enjoying good health, and able. to do a good day's work. The last worm that came from me was twelve feet long. I have not the least doubt that it was Brandreth's Pills (your valuable Vegetable Med- icine) that effected the cure, as everything else that I could hear of was tried without effect. Yours very respectfully, and grateful servant, AARON T. DIMON. June 20, 1838. The above person is well known in Fairfield County. John B. Sanford, of Bridgeport, Conn., has assured me of his respectability. 196 CURES BY PURGATION. Cure of Pimples on the Face of Three Years' Continuance. Dr. Brandreth : Dear Sir : For some considerable period I have been troubled with an impurity or acridity of the blood, which seemed to be past cure. My face, in consequence, presented an unseemly collection of pimples. I was abstemious, and seldom tasted any beverage stronger than water, and yet, with all my care as to diet, my blood, got no better, and my appearance continued the same. My face all the time seemed as if it was held near a fire ; it seemed as if something was on it that might be brushed off. It was very annoying, and caused me much anxiety, not because it interfered with my personal appearance, which it did, but because it more or less affected my health, which was beginning to break down. I took very little medicine ; but when the above state of things had remained about the same for three years, I was induced to use your pills. I took them, in all, about one month — every day, or nearly so — taking no higher dose than five pills, and sometimes only one. I think, altogether, I did not use over four boxes. They cured me completely. My face is free from all pim- ples and inflammation, and my complexion perfectly clear. Gratitude has in- duced me to render this account, which you may publish. I am, with respect, yours, &;c., N. H. BAKER. Sing Sma, March 30, 1855. The following modest note from Mr. Bemis, of Dudley, Mass., for a supply, tells its own story : Dudley, December 7, 1853. B. Brandreth : Dear Sir — I have sold all the Pills I had of yours, and the money is ready when you will send my receipt. Please to send more Pills as soon as you can • — send to Webster Station. I have sold $117 worth of your Pills, and they give universal satisfaction. Yours, with respect, PHINEAS BEMIS. Brandreth's Pills Never Failing in DiarrhcBa and Dysentery. Read. Battery Anderson, Sept. 9, 1864. Dr. Brandreth, New York : Please find one dollar enclosed, for which send me that worth of your Pills, as I have used and given all I had. These Pills have cured all who took them for the diarrhoea in a few days. Some had the disease two or three months. The army doctors had failed to cure in all of these cases. I have found your Pills to be never-failing in diarrhoea, bilious affections, headache, and costiveness. How is it the Sanitary people do not give out your Pills ? Yours, with great respect, PAUL P. DUFOUR, Co. A, Thirteenth Heavy Artillery^ Bermuda Hundred^ Vd, II CURES BY PURGATION. 197 Captain Isaac Smith, of Sing Sing, says, thirty of Brandreth's Pills, taken according to directions, cured him of a very severe bronchial affection, after other means had failed, and he wishes his numerous friends to know the fact. Ilxtract from a letter dated Dawson, Iowa, April 24, 1866, to Dr. Brand- reth, from Andrew Logan, Esq. : " My wife became an invalid. Our physician represented her case as in- curable. I then called two other physicians, and the three held a consultation and pronounced her case consumption. I then discharged all the physicians and determined to trust to your Pills. I got five boxes, which she took accord- ing to the printed directions. By the time these were used up, there appeared a change in her condition for the better. I then bought fifteen boxes, and she continued to take them for three^ months, when her health was entirely re- stored." Original letter at 294 Canal Street. Pepsevepe in the Good Wopk. The Rev. Ezra Wilmarth, East Wilson, N. H., says : " He has seen the salutary effects of Brandreth's Pills in many cases, and is fully convinced of their great value ;" that he " thinks it his duty to recommend them wherever he knows there is sickness, and is confident that they are calculated to promote the general health of mankind." Nepvous Debility and Bilious Headache. Mr. Webber, whose case is mentioned below, is still living, a fine healthy man of over 67 years : William Wood Webber, of Grigg Street, Southsea, in the Borough of Portsmouth, England, bell-hanger, voluntarily cometh before me and maketh oath and saith, that he was for five years and upward dreadfully afflicted with a nervous debility of his whole system, attended with a bilious headache which prevented him (deponent) from attending to his business the greater part of that time. He (deponent) has sometimes been so violently affected as to fall down senseless, which had nigh once put an end to his existence. In this mel- ancholy state he was recommended to take Brandreth's Vegetable Universal Pills, and after taking them for four or five weeks, according to the directions, he was perfectly cured. It is necessary and essential to observe that after taking them six or eight times he was much worse ; but Dr. Brandreth informed him that such would be the symptoms, and prevailed upon him (deponent) to persevere, which he did ; he therefore went on, as above stated, and the most beneficial results followed. It is now six months since deponent was quite cured, and he has had no return of the said disorder, but keeps in the enjoyment of perfect health, which he entirely attributes to Brandreth's Pills, the Vegeta- ble Universal Medicine. WILLIAM WOOD WEBBER. Sworn at Portsea, in the said borough, this 15th ) day of December, 1831, before me, j ^ D. Spicer, Mayor. 198 CURES BY PURGATION. Indigestion and Disordered Liver. Brandrotli's Pills are warranted free from all mercury or other mineral. A gentleman writes : " I haye for years been afflicted with disordered liver and indigestion, and have been restored after years of suffering, merely by the use of some fifteen boxes of the Brandreth Pills. For several years I have been more dead than alive ; I have crawled about, for my locomotion could not be dignified by say- ing I walked. I had the best advice, but was blistered, bled, took blue pill and calomel until my mouth was sore, dieted, and drank mineral waters. At last I saw hope wiped out of my doctor's and relatives' looks — it was clear I was doomed. In fact this was to be expected ; for when I did get up in the morn- ing, I was more dead than alive ; 1 was unable to attend to any business, and exertion of any kind seemed too much for me to endure. In this sad state I read J. W. Webber's case, and also Mr. Cooke's, of Bennington ; these letters, with the advice of a friend, induced me to give the Brandreth Pills a trial. I began with only two pills, which purged gently ; in a few days I took two more, they also operated mildly : then I took four, feeling some apprehension about my bowels ; they operated finely, bringing away very slimy stools. I rested for a day or two, and then took two more ; then I took six, and at last I became fully convinced of the efficacy of purgation, as a cure for disease. I have taken as high as eight pills in twelve hours — but the dose must be in pro- portion to the sickness — inflammatory cases require strong doses, and all serious sickness where pain is present, the same. But with weak persons the plan is to begin easily, and sort of feel your way, taking larger doses as you proceed. . This method in the use of Brandreth's Pills has cured me, and re- stored to health one who had prepared himself for the grave." Letter from Arnold Buffum, THE PHILANTHROPIST. Cincinnati, Ohio, April 15, 1843. I)r. Brandreth : In the course of my life I have suffered often and much from sickness ; I think I have been under the care of physicians more than twenty different times, for weeks at a time. But for the last five years I have employed a physician but once, and then only for a single day ; not, however, because I have been exempt from frequent illness, but because I have found a far more speedy and effectual remedy in thy Pills, than I ever found in the medicines administered to me by my physicians. Wherever I go, I constantly carry a box of them with me, or at least a few of them wrapped in a paper in my vest pocket ; and whatever illness comes upon me, I invariably find relief from the use of them. Having been much occupied m travelling and public speaking, I have frequently taken severe cold, which before I used these pills, invariably resulted in soreness of the throat and chest, and a severe cough ; but latterly, though more exposed than ever, when I have taken a cold, by taking one or two pills at a time for two or three liights, I have invariably succeeded in removing all soreness of the throat and chest, and in effectually preventing the cold from set- tling on my lungs so as to produce a cough. Once during last winter, while travelling on horseback, and subject to much exposure, I was suddenly seized with a very sore throat, high fever, and entire prostration of strength and spirits, — by the use of two doses of the pills, CURES BY PURGATION. 199 and drinking freely of cold water, a copious perspiration was kept up, and in forty-two hours one of the most severe attacks which I ever experienced gave way ; and in two days more I was able to pursue my journey. At another time, continual exposure and daily exercise in public speaking brought on a severe lameness in the small of the back and kidneys, which became so exceedingly painful that I was forced to speak sitting ; not being able to stand on my feet ; at length the soreness extended quite through me, and the pain became so severe that I never closed my eyes during a whole night, and several times during that night I had serious doubts whether I would live till morning. I. took seven pills, which went to the seat of the disease, and as by magic, seemed to lay hold of it, and carried it all off, so that I attended a meeting on the same evening, and spoke without pain for more than two hours, and the pain has not returned since. I regard this as one of the most extraordinary cures that I have ever known, and I can truly say that, in a similar case, I would not exchange Brandreth's Pills for all the medicine of the drug store. I have used the Pills, and administered them to others on various other occasions, and, as far as I know, in no case without complete success. Especially have I found them altogether superior to any other medicine I have ever tried for colds, coughs, and soreness of the lungs. I consider that the maker of them especially serves the great cause of humanity, and I shall recommend them wherever I go. Thine respectfully, A. BUEFUM. In October 1843, Aaron Hamilton of Sing Sing, Westchester county, was taken suddenly sick in the night with great pain in his bowels and stomach. He took six Brandreth Pills, and in two hours took four more. In a little time he threw up two worms, and passed several downwards. He has enjoyed good health since. Dear Sir : St. Vitus' Dance and Scrofula Cured. Sing Sing, 3d January, 1843. It is with gratitude and esteem that I address you for the purpose of in- forming you of the beneficial effects which your Pills and External Remedy have had in restoring one of my sons to health, who had been sorely afflicted winter before last with St. Vitus' Dance, and for a period of ten months he was entirely helpless from the terrible disorder. He was also subject to the Scrofula in his neck. By the use of your Pills freely, and also applying the the External Remedy to the enlargements upon his neck, he has become en- tirely cured. He has been now well over a year ; and I trust, by the blessino- of Divine Providence, he will continue so. You are at perfect liberty to make what use you please with this commu- nication. I consider it a duty I owe to you to make it, and hope it may be the .means of extending the usefulness of your most excellent medicines. I remain yours, respectfully, H. M. REQUA. To Dr. Benjamin Brandreth, Spring Hill, Sing Sing. 200 CUBES BY PURGATION. Indigestion and Bilious Affection Cured, Sing Sing, January 14, 1843. Dear Sir : Tliis will certify that I have used your Vegetable Universal Pills for in- digestion and bilious complaint which had almost proved fatal to me. I had been under what was supposed good medical treatment, and used various advertised remedies, but Mdthout any good effect. I then made trial of your celebrated pills, which gave me immediate relief, and soon effected a perfect cure. I have since used them in my family with the best effect. They are the best and easiest purgative we ever used. I am, respectfully, yours, NICHOLAS FOWLER. Dr. B. Brandreth, Spring Hill, Sing Sing. Sing Sing State Prison, Feb. 4, 1843. • Dr. Brandreth, Bear Sir : About four years since, I had a very severe attack of the piles. I tried almost every remedy, but without any good effect upon my painful disease. I thought I would try one box of your Vegetable Universal Pills. I done so ; and before I had taken all the pills it contained, I began to feel the good effects of them ; and by the time I had taken four boxes of pills, I was entirely cured, and have never since been troubled with the painful and truly unpleasant disease. I entirely attribute my cure to your valuable and inestimable pills. Very truly yours, R. LENT, Architect, Sing Sing State Prison. Sing Sing, Jan. 24th, 1843. Dr. B. Brandreth, Dear Sir : If you alone were concerned in the present statement, the greater inducement for making it would be removed, for of course no testimony can' strengthen you in your convictions in relation to the value and efficiency of your Pills, which have already proved such a blessing to the thousands who have used them ; but I have looked out upon this vast expanse of creation, en- circling in its arms, as it does, thousands bowed down with sufferings similar to my own, who would gladly hasten to the same source that restored my health, if they were persuaded that they would meet with the same happy result. Therefore, Sir, it is that those thousands may be convinced, and profit by their conviction, as I have done, that induces me to state before the world a period of suffering, such as few have, and I hope few ever will know, and the permanent relief I received from your Pills ; but how to begin, I hardly know, to describe those extreme tortures that seized upon my arms, shoulders, side and face, having about ten years since contracted a very severe cold, causing a very severe fit of sickness, attended with an affection of the Liver, as was supposed, which was the consequence of my taking a great quantity of medicine — and I must say, I have not seen a well day since, until I commenced taking Brandreth's Pills. For the last ten years I have been afflicted with CURES BY PURGATION. 201 what is commonly called Salt Rheum and Erysipelas, at times covering and seeming determined to devour my whole body, and by making use of various means was enabled to check the disease from time to time, until early in June, 1841, my disease assumed a very different appearance; and unpleasant as the task now is to me, I will, for the sake of spreading light and knowledge in the world, give a few of the particulars of my case : swelling and painful affections of the joints, tumors formed under the skin with burning lacerating pains, and finally coming out in horrible sores, covering nearly the whole of the right arm, and penetrating almost to the bone, and spreading to my face, covering nearly half including the nose, making for the time an entire wreck of that organ ; from thence to my shoulder and side, and my whole body and limbs swollen in the most frightful manner. Residing at this time in one of tlie western cities of New York State, I had recourse to most of the eminent Phy- sicians of that part of the country ; and the most that they could do was to pronounce the disease a scrofulous affection, which it seems they were not pre- pared to combat. A change of air and climate was recommended, and in travel- ing I became acquainted with a lady from Sing Sing. She advised the use of Brandreth's Pills — but supposing that they could be of no use to me, as I had tried so many things, I thought little more of them at that time ; but after having endured the most excruciating tortures, and incurring great expense, I was, thank God, about six months since, by reading one of Dr. B.'s advertisements, and what I had heard about them, induced to purchase a box of Brandreth's Pills. Jealous of the article, I resolved not to have my imagination at all busy, but nevertheless to give them a fair trial, which I did, by taking accord- ing to the directions accompanying each box, as far as my feeble state would admit, two or three boxes. Overjoyed at the discovery of an article which I well knew improved my health, used them secretly for a few weeks, but be- coming convinced that Brandreth's Pills would cure me, I made bold to declare it. Sir, are you alone concerned to know if? I think not, for I know that the medicine that possesses the power to cure me is capable of conferring the same blessings upon thousands of others suffering, p'erhaps dying ; therefore, these are all concerned to know that they can be cured. In fact, all are concerned in the discovery of anything that tends to promote the happiness of the human race, for we are social beings and cannot suffer alone. Persons may doubt this statement as I have doubted similar ones, but be assured it is but too true ; and in giving it, I have unsolicited, to you, sir, and the world, if you choose to publish it, discharged a duty which I felt incumbent upon me in making it known for the benefit of those who choose to believe it, as I believe that I have been cured of a scrofulous affection of the worst possible character and of long stand- ing, by the use of less than twenty boxes of Brandreth's Universal Vegetable Pills, at an expense of less than Five Dollars, instead of chasing phantoms at a greater advance in fees, without any good results ; and when I look into the past, upon these solitary days and sleepless nights, I thank a kind Providence that it is as well with me as it is, and I thank you, sir, that you are enabled by your scientific researches to minister to our infirmities. RACHEL TURRELL. Fits Cured. This may certify that my son, of five years old, was attacked with epileptic fits, in 1837, and continued to be troubled with them for more than one year. After every other remedy had failed I tried the Brandreth's Pills, which effected a cure in about six months, and he has not been troubled with them since. DAVID CHAFFEE. Grafton Street, August 2, 1843. 202 CURES BY PURGATION. Mr. Wilson, of 135 Christie Street, for twelve years was afflicted with Chronic Rheumatism, and for the last three years was not able to walk ; has taken twelve boxes, the pain has entirely left his feet and knees, so that he is able to walk with comfort. Miss AY*****, a young lady residing in Hubert Street, had a severe pain in her knee, from which she suffered excruciating pains for upwards of three years, which confined her to bed almost all the time. Dr. Mott and several others of the faculty had bled, leeched, and blistered to no effect ; by taking Brand- reth's Pills she has perfectly recovered the use of her knee. Observations on tl\e above would be superfluous. Mr. G. Miller, of Harlaem, in September last, was dreadfully afflicted with Fever and Ague ; the attack generally came on him every day about 12 o'clock ; the disease had debilitated him in such a manner that his recovery was doubt- ful. A gentleman who has tested the goodness of Brandreth's Pills, in his own family, persuaded him to try the medicine. After the first box the Fever was perfectly cured, and by continuing taking the medicine for about six weeks, per- fect health was restored. Benj. Weeks, of Westchester, was violently afflicted with Dyspepsia; he could not take any food without the most unpleasant sensations in his chest, head, and bowels. His chest was so sore that the slightest pressure gave him pain ; his life was most miserable ; numerous were the medicines used ; and the skill of the first physicians tried in vain ; as a last recourse he took Brandreth's Universals, and in two months they effected a perfect cure. Worms. A young woman a short time since took these Pills for a violent pain in her side. After three doses she parted with a worm fourteen inches in length and one inch round ; she has since been perfectly well, and has kindly allowed Dr. B. to refer any one to her. Jt is a fact that there are good remedies, but it is very doubtful whether there are many good physicians. Extraordinary cures in which Brandreth's Pills have effected a perfect cure after the most eminent medical men had altogether failed : Mrs. Luther, of North Third Street, near Second Street, Williamsburg, for seventeen years was seriously afflicted with a violent pain in her left side, which often became very bad. The side was wearing to all appearance away, and just over the seat of the pain was a place you might have laid an egg in. Extreme .• The many flatter- ing notices you have received from respectable individuals, of the success of your Vegetable Universal Pills, render it unnecessary for me individually to eulogize, or those who are ignorant of the specific to censure. Having had ocular demonstration as well as bodily, J cannot refrain from expressing and publicly acknowledging the signal result and fmal cure of that dreadful disease laiown as Dyspepsia ; hoping such persons as may be afflicted with the above disease, this notice may influence some to make the experiment. You are at liberty to refer them to me voluntarily on my part. I remain your friend, JOHN A. STEVENS. Rheumatism. A gentleman who had lost the use of his limbs with Inflammatory Rheu- matism, and was so miserably afflicted that he could not turn in bed without assistance — the pains were violent in all parts of his body, but especially in his breast, back, arms and feet. This person took no other medicine than Brandreth's Pills — for two weeks he took 12 pills per day, and often as many as 20, and in three weeks he was able to get out ; and now, having persevered with them so as to produce copious evacuations every day, is at this time per- fectly cured ; it is not two months since he was first taken ill. Now, Dr. Brandreth would ask, would this have been the case with your bled man ? with the maji to whom mercury has been administered "? No ! he would have been in bed months, and his convalescence would have been tedious. The above gentleman is highly respectable, and can be referred to. A Running Ulcer of Three Years entirely. removed with Eight Boxes of Brandreth's Pills. Edward Brown, son of Mr. James Brown, St. James Street, Kingston, Ulster County, for three years had a running ulcer in his hip, which obliged him to be carried about ; the doctors were in daily attendance, and the best advice was had from New York. All did not relieve the poor child, who was not expected to recover. Brandreth's Pills were commenced with four months ago, and a decided change was effected before the third box was finished, and now, having taken eight boxes, is quite well. A little boy, aged four years, swallowed a pin, and, as a matter of course, his parents were much alarmed. Plis father called on Dr. Brandreth, who recommended him to give the child five or six pills per day, and no bad con- sequence would arise. This advice was taken, and on the fourth day powerful evacuations having been kept up, the pin was discharged, and not in the least corroded. Reference will be given to the parents, who are highly respectable. Mrs. S., in East Broadway, has been afflicted for nearly eight years with a bad leg, which prevented her going about. The sore was larger than the palm of the hand — she had had recourse to various dDctors, who frequently healed it up, but in a few weeks was as bad as ever. Brandreth's Pills were recom- mended, and in a short time her leg was perfectly healed, and she is again able to walk with pleasure and comfort, and the leg has every appearance of being perfectly sound. Reference as to the above can be made to Mr. Aaron Swartz, grocer^ corner of Pike Street and East Broadwa-y. CURES BY PURGATION. 207 Difficulty of Breathing Cured. Danbury, Conn., March 8, 1836. — Dr. Brandreth — Sir : Will you be good enough to send us some more of your Vegetable Universal Pills 1 there are many persons here taking them for every complaint, and all find relief I can say they are the best medicine I ever took, and I have tried almost everything, but found no relief until I took your Pills. My difficulty of breathing is greatly relieved, and I am getting well. Many are taking them here for the same com- plaint, and find them very good. Yours, respectfully, ELIZA MORRIS. Piles Cured. Messrs. Coggershall & Walters, of New Bedford, have forwarded me the following facts of that most painful and unpleasant disease, the Piles. The original letter can be seen at 187 Hudson Street. Mr. McFarlane, of New Bedford, has been laboring under that most dreadful disease, the Piles ; he has had them upwards of two years — has tried various things from different doc- tors, to no effect. Brandreth's Vegetable Universal Pills were had recourse to, and a complete cure is effected. He is now quite well. {^From the Louisville Enquirer?) Liver Complaint Cured. Newark, Dec. 25, 1886. Dr. B. Brandreth. Dear Sir : Having been afflicted for ten years with a most dreadful liver complaint and dropsy, and tried every remedy that could be thought of, I gave up all hope, went into the country, left my business, to die in peace ; but hear- ing of your invaluable medicine, I was induced to try it, not expecting to be any better. To my surprise, I had scarcely taken one box before I felt relief. I have since taken three boxes, and now I am well, by the blessing of God and the use of your medicine. If you think this will be any service to let suffering people know this fact, you are at liberty to publish the above. Yours, with kind respect, (Signed,) LEWIS TOMPKINSON. Dysentery and Deafness Cured, August 20th, 1835. Sir : Allow me to express my grateful feelings for the benefit I have expe- rienced in your Vegetable Universal Pills in the cure of Deafness, which I have been subject to nearly thirty years. I have frequently been under eminent aurists in London, who have invariably syringed me, and who have all said no other mode of treatment would be of service. The latter part of May I again lost my hearing, with continual unpleasant noises in my head. It was with difficulty I could hear any one speak ; knowing you were an English surgeon, I 208 CURES BY PURGATION. applied to you to be syringed, thinking that was the only remedy ; you refused . to operate, but told me a box of your pills would have the desired effect, and I was induced to try them, especially when I found that many persons had been cured of the same complaint. I have taken two boxes, which cost me fifty cents, and am happy to say, am completely cured. The dose I took was two or three at night, and twice during the time I took five. They never incon- venienced me in the least, and were remarkably easy in their operation— I certainly can recommend them to any one laboring under the same unpleasant disease. Permit me likewise to say my eldest daughter, two weeks since, had a dreadful Diarrhoea or Dysentery on her, which in two or three days reduced ijj^her frame, and I thought would have sent her to the grave. I immediately applied to you to know if the Vegetable Universal Pills would have the same beneficial effect en her as they had on myself; you told me to persevere and they would m.ake a cure — I had confidence in them, and am happy to say, by her taking from four to eight pills every night, the dreadful disease left in about a week. She is now well, and getting up her strength very fast. She took no other medicine whatever ; shs continues occasionally one or two pills at night. My family had used the Hygeian Medicine for upwards of twelve months, and found they could not leave them off, as Costiveness and Piles were sure to fol- low. Thank God, your Pills leave no such enemies behind them. I have no ) hesitation in saying, that your Vegetable Universal Pills are the safest and best medicine myself or family ever took. Make what use you think proper of this communication, and you are at liberty to refer any one to me, and I think I am only doing my duty in thanking you, through divine mer«y, for the benefit received. I am, sir, yours very truly, JAMES LANCE, 250 Eighteenth Street, near Broadway. Certificate of Joseph Goulden^ who has known the above Pills forty years : / hereby certify^ that J have known Brandreth's Vegetable Universal Pills for upwards of forty years ; they were used in my family connections, in the County of Dorset, England, since the year 1796, many of whom they cured of old standing complaints. JOSEPH GOULDEN. Bridgeport, Feb. 18, 1836, Disease of the Prostate Gland Cured. Henry Lathrop, of Edmonston, Otsego County, New York State, a respect- able farmer, was afflicted for more than a year with this most painful, and gen- erally incurable disease. Some of our highest medical men pronounced his case incurable, and advised him to settle his affairs, and patiently await the result, as it was not in the power of medicine to save him. Mr. Lathrop, before he went home, called upon me, and having stated his symptoms, I told him what his disease was, and in this I agreed with the doctors who had said he was incurable. But I also told him I felt confident that if he would persevere with my Pills they would cure him. Mr. Lathrop proved his confidence by purchasing six dozen boxes, which he took home with him, and in about three month§ he returned to me in New York City a cured man, having used the Pills CURES BY PURGATION. 209 as I directed. In fact, he said he never was better in his life. This was in 1835. Since that period Mr. Lathrop has administered the pills to upward of a thousand persons, all of whom, he assures me, have derived the most aston- ishing benefit from their use. New Bedford, Nov. 7, 1835. Dr. Brandreth — Sir : About eight weeks past I saw some of your Pills, and read one of your wrapping-papers, but thought it was, as thousands of such things are now- a-days, a mere speculative, money-catching thing — still I was advised to try them by persons who said they were most righteous Pills. I was, however, faithless of their value; bat my complaint grew so violent that I purchased two boxes, took them according to the directions, and found that they helped me much. My neighbors, knowing how long I had been afflicted, were anxious to know the result, and I informed them that I had received great benefit from the two boxes, which would induce me to purchase more. My wife for a long time had been in a poor state of health. She also took some, and found great ben- efit. And now, sir, excuse me while I detail some of my complaints, the main body of which seem as though the main springs of life were all fettered. DYSPEPSIA or INDIGESTION, Weakness of the Lungs, Nervousness, Rheumatism, SICK-HEADACHE, ASTHMA, GREAT LOSS OF APPE- TITE, LANGUOR, TREMOR, COSTIVENESS, etc., etc. Such have been my varied symptoms, but I must and will say, that I never took such medicine as your Pills, which seem to touch all parts of my complaints. I intend to persevere with them, and you may send me 500 boxes, which you must charge at the wholesale price. I am, sir, yours respectfully, SAMUEL S. ALBRO. Piles Cured. Messrs. Coggershall & Walters, of New Bedford, have forwarded me the following facts of that most painful and unpleasant disease, the Piles — the original letter can be seen at 187 Hudson Street. Mr. McFarlane, of New Bed- ford, has been laboring under that most dreadful disease, the Piles. He has had them upward of two years — has tried various things from different doctors to no effect. Brandreth's Vegetable Universal Pills were had recourse to, and a complete cure is effected — he is now quite well. Newburgh, N. Y., Nov. 4, 1835. Dr. Brandreth — Sir : I was induced some time since, by the persuasion of a friend, to try a box of your Pills. From the immediate relief and happy result I have re- ceived from the same, I cannot but recommend them to my friends, and par- ticularly to all invalids who may be afflicted with costiveness, not to despair until they have given your Vegetable Medicine a trial. Hoping you may be the means of making us poor creatures happy, and add to vour popularity and wealth, I remain your friend, J. W. SWIFT. You may refer, or make what use you please of this letter. — J. W. S, 14 210 CURES BY PURGATION. Extraordinary Cure of Rheumatism, Diarrhoea, and Affection of the Lungs. John Shaw, of Pembroket, Washington County, Maine, being duly swonij says that he was taken violently sick about six months since. The pains in his head, breast, back, left side, and instep beinj so bad that he was unable to help himself, and was taken into the Chelsea Hospital in the City of Boston. That after being in said hospital five weeks, Dr. Otis said he did not know what was the matter with him, and that he could do nothing for him, nor could he prescribe any medicine. That he, therefore, was conveyed from the Chelsea Hospital to the Sailor's Retreat on Staten Island. That he was there physicked with all sorts of medicine for a period of four months, suffering all the time the most heart-rending misery. That, besides the affection of his bones, he was troubled much with a disease of the lungs. Sometimes he would spit a quart of phlegm in the day. Besides this affection he had a bad diarrhoea, which had more or less attended him from the commencement of his sickness. That at times he dreaded a stool worse than he would have dreaded death. That he can compare the feeling to nothing save that of knives passing through his bowels. After suffer- ing worse than death at the Sailor's Retreat on Staten Island, the doctor told him that medicine was of no use to him — that he must try to stir about. At this time he was suffering the greatest misery. That his bones were so tender he could not bear the least pressure upon the elbow or upon the knee ; that his instep was most painful; that, as the doctor said he would give him no more medicine, he determined to procure some of Dr. Brandreth's Pills, which he did from 241 Broadway, New York. That he commenced with five pills, and sometimes increased the dose to eight. The first week's use so much ben- efited him that the doctor, not knowing what he was using, said, " Now, Shaw, you are looking like a man again. If you improve in this way you will soon be well." That he found every dose of the Brandreth Pills relieved him ; first, they cured him of the pain when at stool ; that they next cured the diarrhoea, and finally the pain in his bones. That the medicine seemed to add strength to him every day. He told the doctor yesterday, the 11th inst., that he felt himself well, and also that he owed his recovery to Brandreth's Pills, under Providence — that he had taken the medicine every day for nineteen days. That the doctor told him if he had known he had been taking that medicine, he should not have stayed another day in the house. He considers it his duty to make this public statement for the benefit of all similarly afflicted, that they may know where to find a medicine that will cure them. JOHN SHAW. John Shaw, being by me duly sworn this 12th day of April, 1842, did depose and say, that the foregoing statement is true. JOHN D. WHEELER, Commissioner of Deeds, Cure of Insanity. Newark, March 8, 1838. Respected Sir : I have long felt it resting on my mind as a duty, to com- municate by way of letter to you, sir, the great benefit I have received from using your invaluable Pills ; they have proved a great blessing to my health. For the last two years I have had my health renewed by taking them after other physicians had failed in their efforts to relieve me of a disease that was fast tending to dropsy, and bordering on to madness of mind — insomuch I was pronounced insane by most all who saw me. As I was incapable of having CURES BY PURGATION. 211 any charge of my family for nearly one year, a number of times I made an effort to take my life, but was prevented from so doing by that ever-watchful Eye that never slumbers nor sleeps. I am a living monument of the free mercy of the Lord to all who were witnesses of the disordered state that I was in when your medicine was thrown within my reach, and faith was given me to believe that it would relieve. I commenced taking it every night, and the first change I perceived about me was on the night after taking three doses. I felt a singular sensation in my ear, and on rubbing it, something gave way, that proved to be hard congealed wax. I felt such a relief of distress from my head, that I knew not what it could mean for some time, for the sound of my own voice appeared like another, and all sounds seemed different to my hear- ing from what they had for years past ; and for two weeks following the quan- tity of wax that came from out my ears would to many be pronounced too incredible to be relied on, unless they had seen for themselves, and my blood began to circulate more freely through my system, by gradually taking the pills which before had nearly ceased to move through my veins, and it appeared to me that my life was at times departing from the body. I could find nothing that animated or cheered my mind ; any way life had become a burden to me, but as my confidence strengthened in persevering with the pills, I found my life daily returning, and invigorating both body and mind, to the unspeakable joy of my family and friends; and since they have proved such a blessing to me, I have felt it my duty to recommend them to all with whom I have intercourse. Standing myself as a witness of their virtue in producing health of body, which, beyond a shadow of doubt, will give clearness of mind and ideas, which can- not be clear if those organs where knowledge lies are obstructed by disease, which thousands of our fellow-creatures are suffering under, and are still made worse by the treatment of our most popular physicians of the present day, by taking blood, and giving many things that are daily undermining and ruining the constitution forever, from having that strength that is natural for us, if we pursue the right course to obtain it by simple remedies instead of those of another kind, which is so unnatural as bleeding. The argument you lay before the public, and the experience I have had for myself on this important subject wherein life is at stake, has thoroughly convinced me that bleeding is injurious, and can and ought to be dispensed with, as it has been ascertained to a certainty that other means have been discovered that have the desired effect in producing health without proving so pernicious to the constitution as those mentioned. I have been instrumental of convincing many to take them, but the most are bound by that strong cord of prejudice which will not so much as admit plain facts to be true, but endeavor to paint them in a different color from the original ones given ; but I am encouraged that the time is nigh at hand, that people are awaking from their slumbers, and seeking after truth in all things respecting this life, as well as the life to come. It is true that error abounds on all sides, but we know that truth is of divine origin, and will prevail in spite of all opposition that is thrown in its way by all who love not our Lord Jesus in sincerity of heart, and are making every effort to amass wealth by imposing on the public in various ways to deceive the unwary ; but let them beware and take heed to themselves, that the curse of the Lord is upon their riches if their eye is not single to His glory and the good of their fellow-men. It is love that has urged me to speak in so plain a manner to one who is an entire stranger to me, and I hope it may be received by you, sir, as coming from one whose mind has been freed from prejudice, knowing that the motive I have in view is the good of my fellow-beings, whose welfare I feel deeply concerned in. Although moving in a very humble and obscure sphere of life, to which many are placed, may the Lord greatly bless and strengthen your efforts in the cause that you are engaged in, is the prayer of my heart. You are at liberty to make use of these lines as you thmk best. MARGARET E. A. SHATLAND. Dr. Brandreth, New York. 212 CURES BY PURGATION. St. Louis, November 28th, 183'7'. Gentlemen : I deem it a duty which I justly owe, not only to you, but to the whole community, to acknowledge the beneficial effects which have resulted to myself from the use of that highly serviceable medicine, Dr. Brandreth's Vegetable Universal Pills. About eight months since I was suddenly taken with the Dropsy in my feet, the surface of which was likewise covered with the Tetter. I had repeatedly taken the advice, and followed the prescriptions of several eminent physicians of St. Louis, but derived no benefit therefrom. I had also tried many experiments, and used every medicine that could be suggested, but without any visible abatement of the swelling, and they remained in this unnatural situation until my sufferings were alleviated by the aid of Dr. Brandreth's Pills. Shortly after 1 had commenced taking your medicine I dis- covered a visible alteration for the better ; the swelling gradually subsided, the Tetter entirely left, my bodily health daily improved, and my feet once more returned to their natural size. Two months have elapsed since my cure, and my feelings now warrant me in saying that through your instrumentality I have exchanged a painful disor- der for a good sound state of health. That suffering humanity may read, and benefit from this disclosure, I beg to subscribe myself, yours gratefully, MARGARET BROWN, St. Charles Street, St. Louis. To Messrs. Tousey &: Michael, St. Louis^ Mo. Carrolton, Greene County, 111., Oct. 5, 1837. Gentlemen : I beg leave to inform you that my sister was taken about three weeks since with a violent intermittent fever ; at my request she took two of Dr. Brandreth's Pills, which did not affect' her otherwise than by creating a faint sickness at the stomach. The next day she increased the dose, which operated powerfully. She took the third and fourth doses, after which she had no return of the fever, her strength increased rapidly, and her health has been good since. A sister of my wife had been in a decline for several months with strong symptoms of a confirmed consumption. She commenced taking Dr. Brand- reth's Pills, and before she had taken two small boxes in doses of three and four per day, a decided change for the better appeared. She still continues their use, and the glow of health is fast taking the place of her late consump- tive expression of countenance. She will persevere in their use from a positive conviction that her health will be perfectly re-established thereby. Other indi- vidual cases I could mention. Suffice it to say, that all who have used the PilU to my knowledge praise them. Very respectfully yours, M rp . r. a T • ' LUCIUS S. NORTON. Messrs. Tousey &; Co., St. Louis. New Orleans, 14th Jan., 1838. " He that is wise is wise for himself, and he that scoffeth (at Dr. Brand' reth's Pills) alone must bear it." — Listen, oh, ye incredulous ! hearken unto the voice of your friend, and neglect not the counsels of those who have learned wisdom from experience. Know, you that are slow of heart to believe, that I am a man who has suffered many afflictions from a hereditary diseased system* CURES BY PURGATION. ^13 From my youth up I have never known what it was to enjoy a moment of HEALTH, till lately. My disease has been a chronic headache and a severe de- bilitating weakness and faintness at the pit of the stomach, which diseases have been in a great measure removed by taking only TWO BOXES of Dr. Brandreth's Pills. I can now say, and with truth too, that I know what health is by experience ; and I would that I could raise my voice so high that all the earth might hear. Then would I proclaim the virtues of this invaluable medi- cine. But what is my aim in all this 1 Is it that I am interested in the sale of Dr. B.'s Pills ? Most assuredly, no ; I am in no way connected with their rise or downfall ; but I recommend them for the benefit of mankind, and especially to those who are to receive the most benefit from their use, my fellow- citizens of the South. S. FRIEND. Grand Gulf, March 6, 1838. Mr. Joseph B. Brockwat, Bea?' Sir : We wish you to send us some more of Dr. Brandreth's Pills, for we are entirely out. Since the people have found out we keep them they are called for every day. Send them by the first opportunity, and Oblige yours, &c., WHITEMAN & McFARREN, Warrenton, Miss., March 1, 1838: Mr. J. B. Brockwat, Agent for the sale of Brandreth''s Pills. Dear Sir : Enclosed we hand you ten dollars, the amount of the bill with which you furnished us some time since. The piUs we find very saleable, and the demand for them is very great ; in fact, so great is their reputed efficacy and virtue here, that we should feel ourselves in some degree guilty of crime, if we were to deprive them of so valuable a medicine. We wish you to send to us by some safe conveyance — by the captain or clerk of some boat in the trade — fifty dozen boxes Brandreth's Pills, and forward your bill to us on the usual terms. Very respectfully, your obedient servants, JOS. TEMPLETON &; CO. Port Gibson, Feb. 27, 1838. Mr. Joseph B. Brockway, • Dear Sir : Enclosed you have ten dollars in payment for fifty boxes of Brandreth's Pills, left with me some time since by your agent. For some length of time after receiving the agency, there was but little demand for the article, as people were afraid of some deception ; but since it has become known, the demand for it is rapidly increasing. I am now nearly destitute of the article, and as I have daily calls for it, wish you would send me a supply by Mr. O'Neilly — 20 doz. boxes would not be too large a quantity. Respectfully yours, D. Y. THOMAS. Mrs. Elwell's Case. MRS. EL WELL, then of Middlefield, Otsego Co., N. Y., was seriously attacked with inflammation of the stomach and bowels. She was given over by her physician, and a consultation of doctors was called. The decision was that she must die. She, however, partially recovered, but her stomach was in 214 CURES BY PUliGATION. a very deranged state. Very little action could be produced on the bowels by the most skillful of the profession. She continued for many months under the treatment of one doctor after another, gradually growing worse, and so truly, deplorable was her situation for four months before she tried the Brandreth Pills, that nothing passed her bowels except by the aid of the most powerful cathartics. Sometimes eighteen of one kind of pills were given to her, then say a dozen of another, and a portion of some other medicine, before action could be produced, and then so great was her distress that, for the whole of the four months above alluded to, she invariably fainted when anything passed her bowels. In January, 1837, she thought she would try Brandreth's Pills, and sent to my office in Cooperstown for a box. She took four pills. On going to bed, her husband enquired as to the effect of her new medicine. She replied, " that she did not feel any effect at all." He then said, that in the morning, if she took a dozen more, he guessed they would operate like all the rest of her medicine. She answered, she did not know but it would, for she did not expect anything would cure her. However, early in the morning her bowels were moved, and without pain or distress, and consequently without fainting, to the utter astonishment of Mr. Elwell, and the great joy of his wife. In the course of a few hours, they operated four times equally easy, and the consequence was she did not lie down through the day more than one hour. She had not for months been able to sit up one hour in a day. The next evening she took another dose of four pills with the same happy effects. On the third evening Mr. Elwell called on me and purchased a large supply of the pills, related the above facts, and said he never would be without the pills in his house if they could be obtained. It is now two years since the above facts occurred, and Mr. Elwell informs me that his wife soon recovered her health, that he has never had occasion to call in a doctor for her since, and that her health is now very good. ELISHA FOOTE. Cooperstown, Eeb. 22, 1839. Annual Report of IVIp. Sinclair Tousey, General Brandrethian Agent, Louisville, October 18, 1837. Dr. Brandreth : Dear Sir : It is now one year since I opened an office in this city for the ex- clusive sale of your Vegetable Universal Pills, the sale of which since that period has increased beyond my most sanguine expectations ; I have been compelled to establish an additional office in the city of St. Louis, Missouri, for the more convenient supplying of that section of country. I was induced to become your agent here in consequence of being convinced of the unrivalled health-producing qualities of your pills. My aunt they effectually cured of what is commonly called a Sick Headache, of about thirteen days' standing, which had often con- fined her to her bed for several weeks at a time. My mother they entirely cured of a violent pain in her side, with which she had been afflicted for several years ; myself they completely cured of habitual costiveness. These, together with numerous other cases that came under my observation while at New York, convinced me of their efficacy in every form and symptom of the only one disease, for I am a firm believer now in Brandrethianism. The pleasure I feel in making them known to my fellow-beings is more than I can well describe. I presume, sir, that you are aware that your Pills were not known to any extent anywhere to the West of the Alleghany Mountains previous to my introducing them in Louisville ; taking this into consideration, together with the fact that I CURES BY PURGATION. 215 am located in a fortress of M. D.'s (there is a medical college here) it makes my success and their unprecedented sale appear truly surprising. It affords me great pleasure to state that in every town where I have intro- duced these valuable pills that they have generally been received favorably, and their sale and popularity have invariably increased beyond all precedence, until scarcely any other medicine is used or thought of. The thousands of cures that have been effected by their use, together with thousands of testimonials received in their favor, have not only gone beyond my expectations, but they have perfectly astonished the bigoted enemies of the Brandrethian theory, and has, I am very happy to inform you, caused many, very many, who were formerly its bitterest enemies, to become its most zealous advocates. More than thirty-seven hundred of the most respectable of our citizens have voluntarily come forward and testified to the virtues of your medi- cine from their own experience. It now becomes my duty (which I think a pleasure), as your general agent for this section of country, to transmit you testimonials of a few of the very nu- merous cures effected by the use of your pills which have come under my own observation, and had I the liberty to use the name of every individual who has testified to their extraordinary virtues, it would not only astonish the Regulars, but it would cause the foundations of Esculapian practice to quake with fear, besides fdling at least one large volume. This, however, is not at all necessary, as the fame of the medicine is now spreading with such unparalleled rapidity that ere long its happy influence will be universally appreciated throughout the civilized world, and the only question invalids will ask will be, " Where can I cret Dr. Brandreth's Genuine Pills ?" Case I.— BILIOUS FEVER. Louisville, November 16, 1837. Mr. S. Tousey — Sir : I feel it a duty which I owe, not only to you but to the public generally, to acknowledge the great benefit which I have derived from the use of the Pills for which you are agent. I was attacked about six weeks since with chills and fever, from which I recovered in about three weeks, when I was almost immediately attacked with a bilious fever, from which I had great doubts of ever recovering. Fortunately, I was induced by some of my' friends to give Brandreth's Pills a trial ; and I now find myself, after the free use of these Pills for a few days, perfectly restored in health and able to attend to my business as usual. After finding the happy effects of these Pills upon myself, I was induced to give them to one of my children — a girl eight years old — who had been ill for some time, apparently in a decline. It gives me pleasure to inform you that she is gradually getting better since we first used the Pills, and I hope in another week to apprise you of her complete recovery. I am, sir, very respectfully yours, FELIX WOOD, ! Case II.— DISEASE OF THE LUNGS. Mr. Summers, City Pump Maker, has been afflicted with the above com- plaint for seven years ; he tried a great many medicines before commencing with Brandreth's Vegetable Universal Pills, but never derived any benefit com- pared to what he received from them. He strongly recommended them to all as the best family medicine he ever used. Mr. Summers is well known in Louisville. CURES BY PURGATION. Case III.— FEVER AND AGUE. Mr. H. Humphrey was violently attacked with the Fever and Ague, and after using but four boxes of the Pills he found himself perfectly cured and able to attend to his business right off. Such is the extraordinary efficacy of your Ileal th-restoring medicine, which makes friends of, and creates health in, all who use it. Long life to its maker. N. B. — Mr. H. resides in Third Street. Case IV.— ERUPTION OF THE SKIN. Mr. James Conklin was afflicted with an eruption of the skin, together with severe pains in all parts of his body. He used several highly recommended medicines previous to trying our Pills, but all to no purpose ; he has used only a few boxes of them, and is now entirely free from all eruptions, his skin being now perfectly cured, and his body is quite healthy in every respect — no pains, appetite good, sleeps well. As many as fifty or sixty cases of eruptions of the skin have occurred where your Pills have been used and cures effected in this city. Case V.— GENERAL DEBILITY. Mr. John Downing's wife has been troubled wiuu a general debility for a length of time ; she has tried a few boxes of Brandreth's Vegetable Universal Pills, and finds them of great benefit. She is encouraged to persevere with them, being convinced that they are the best medicine she ever tried — the opinion of all. Case VL— DYSPEPSIA. Mr. James Allen, residing in Clark Co., Indiana, has been afflicted with Dyspepsia for several years ; he has tried but three 25-cent boxes and is much better, his appetite being restored, and his chest is free from pain with which he was troubled so much. His digestive organs are become healthy — that is all, but that is everything. Mr. Stockton, the writer of the following letter, 's well known in this quar- ter of the country. Case VII.— CHILLS AND FEVER Mr. S. Tousey : I am compelled by an impulse of gratitude to acknowledge, not only to you, but to the public generally, the beneficial effects produced upon my son by the free use of Dr. Brandreth's Vegetable Universal Pills, for which you are agent. About six months since, my son, 15 years of age, was very suddenly attacked by that vile disease called Chills and Fever. He was occa- sionally so violently stricken with it, that I had given him up, and thought all medical aid was useless. I was prevailed upon by my friends and acquaint- ances to give Brandreth's Pills a trial, but it was a long time ere I was con- vinced of their efficacy ; I almost detested the idea, but my friends perse- veringly persuaded until I was compelled to yield, and I am happy to inform you that after the free use of these pills only thirteen days, he was thoroughly cured and restored to sound health, and I am now Dcrfectly convinced that they are the best medicine extant. Very respectfully yours, E. F. STOCKTON. Louisville, 20th September, 1837. CURES BY PURGATION. 217 Case VIII.— SWELLED LIMBS. Mr. H h has been afflicted for about 5 years with swelled limbs, accom- panied by very violent pains in every part of his body ; he was unable to attend to any business or obtain any rest by night. These symptoms were pro- duced by an excessive use of calomel. He used several bottles of Swain's Panacea and other remedies, but to little or no effect. He commenced with your Pills a short time since, and a few days ago he informed me the swellings had subsided, and the pain entirely left him. The Pills, to use his own words, " made him feel like a new man." In addition to the above, I would state, I have known a great many other cases similar to the above, where Brandreth's Pills have been used with the same happy results, all of which go to prove the extraordinary power of your medicine in removing the most inveterate diseases from the system. • Case IX.— LIVER COMPLAINT. Morgan County, Kentucky, Aug. 19, 1837. Mr. L. Tousey, Sir : It becomes my duty to acknowledge to you, and through you to the public, the great benefit my wife has derived from the use of Brandreth's Vege- table Universal Pills. About three years since my wife was brought very low with an attack of the Liver Complaint. A physician was employed, and after prescribing some time to no effect, he gave us this consoling information, that he could do her no good, and he thought nothing else would. After continuing in this miserable state some months, I was induced, from an advertisement which I read in the Louisville Journal, to give her some of Brandreth's Pills, thinking they could do her no harm if they done her no good ; and it gives me pleasure to inform you that, contrary to our expectations (for we considered her beyond the reach of medicine), she began to recover, and is now quite well. Should you consider this of any service to you, you are at liberty to publish it. Respectfully yours^ &;c., T. SMITH. Case X.— INFLAMMATORY RHEUMATISM, LOSS OF APPETITE, &c. Mr. James Johnson, residing in Grant County, Indiana, suffered for about three years with Inflammatory Rheumatism ; at times his feet were so much swollen that he could not get on his shoes ; besides this he was troubled with costiveness, being sometimes three or four days without a passage. In addition to this he had scarcely any appetite ; he had advice and medicine from several physicians, but without any benefit, except for a short time. He expected he never would again be blessed with good health. After reading numerous testi- monials in favor of Brandreth's Pills, and hearing them very highly recom- mended by some of his neighbors who had used them, he was persuaded to give them a trial, and now, after having used them about five weeks, he finds him- self able to put his shoes on and walk about as he used to do. Besides this his appetite is perfectly restored, his bowels also being regular and healthy. He says that he has an excellent appetite, and thinks Dr. B. should have a monu- ment erected to his memory for discovering so good a medicine. The following letter, from the Rev. M. W. Sellers, will no doubt be read with interest. Mr. Sellers is well known to numbers of our citizens here : :>18 CURES BY PURGATION. Case XI. Mr. S. Tousey, Dear Sir : I send you the following account of my case, and hope it may be of service to you in prevailing upon other persons to give Dr. Brandreth's Pills a trial. In the fall of 1833 I was attacked with a severe pain in my breast, which continued to increase until a pain in my stomach and side took place, which brought me very low. I took different medicines to remove it, . but to no eifect. I then applied to Drs. Luster and Constant, of Louisville. They pronounced it a severe case of Dyspepsia and Liver Complaint. I com- menced using their medicines, and found great relief in my side and stomach. I was in hopes a cure was effected, but the pain in my breast still remained. They then tried external applications to great length, with no success ; and last winter the pain had become more violent. Mr. R. Barnett, of your city, informed me of Brandreth's Pills. I told him I had tried the Hygeian Pills without deriving any benefit ; he told me BRANDRETH'S PILLS were the BEST. I then applied to you, as you may recollect, for some of these pills. It appeared to me at the time that my strength was so fast declining that I could not live long without some relief I commenced using the Pills, and shortly afterwards I was attacked with the pleurisy ; and as bleeding had become such a habit I was persuaded to be bled, but mended slowly, and at length I was more violently attacked with the same complaint again. It seemed to me that I could not live long. However, I took eight of Brandreth's Pills, and in the course of a few hours I felt better. I then took twelve more, and have had no pain in my side since. This encouraged me to continue their use for the pain in my breast, and I mended very fast. In one month I gained ten pounds in weight. I enjoy good health at present, and feel myself perfectly restored. I can say that Brandreth's Pills were the first medicine that appeared to relieve the pain in my breast, and in any case of sickness I would rather use these val- uable pills than any other medicine that I know of By experience of said pills in my family, particularly in my own case, I know them to be good; My mother who lives with me, nearly seventy ye „ s of age, has been afflicted with a urinary complaint for about ten years, and by using these Pills during the last summer is now entirely well. I have known several cases of fever and ague, two or three cases of scarlet fever, and other diseases that the human family is daily subject to, cured by the use of these pills ; several of my neighbors are using them for the breast complaint, and all find relief. I have no doubt but a great many other cures would have been effected by perseverance with the pills, but there is one great difficulty they labor under — timid purchasers com- mence using them and take one or two small doses, just about enough to make them feel a little queer, and get frightened and then away to the doctor, who takes great care to cry down the pills, knowing it stands them in hand to do so. I reside in Lettersburgh, Clark County, Indiana ; I have been a resident of said county more than twenty years, eleven years of that time I have been a minister of the Gospel, of the Baptist denomination. I am aware of the great opposition these pills labor under ; but let me ask one question, viz. : What food is best suited to our nature and health % I think the answer is, the vege- table. Then do not let us be opposed to the vegetable kingdom for our medicine. M. W. SELLERS. October 22, 1837. Annexed I send you extracts from letters received from my agents, which make the proof in favor of your Vegetable Universal Pills almost over- whelming. CURES BY PURGATION. 219 The following extract is from the Postmaster at Henderson, Kentucky, dated Henderson, October 14, 1837. The fame of Brandreth's Pills is on the increase here, and I am daily receiving assurances of their efficacy in every complaint — fever and ague of a most aggravated nature has been in almost every case speedily and effectually cured. Yours, &;c., &c., (Signed,) P. H. H. The following is from the Postmaster at Hutsonville, a small village in Illinois, dated August 16th, 1837 : As regards Brandreth's Pills, I believe they give universal satisfaction ; at all events, I cannot keep them on hand long — almost every person who has bought of them' recommend them to their friends and continue themselves to use them — the last lot you sent me of fifteen dozen boxes did not last sales of two weeks. I have sold upwards of ten dollars' worth in one day, at retail. The above speaks volumes in their praise. Another agent writes : They are deservedly becoming so popular that I shall be able to vend a great quantity of them. I could furnish you a valuable receipt of their efficacy from expe- rience in my own family. Not only this, but the whole neighborhood bear testimony of their beneficial effects. In conclusion, I send you the annexed letter from H. Foster, Esq., my agent at New Albany, five miles below Louisville : New Albany, November 23d, 1839. Case XII. Mr. S. TousEY : Your favor of 20th ult. was duly received as to the success of Dr. Brandreth's Pills ; I can state, in general terms, that I have sold about 160 dozen boxes of these pills, and have made a great deal of inquiry of those that have used them, and find they have been very beneficial to this community. I can recommend them with the utmost confidence. I can here state that last fall, when I became an agent, my wife was in a very low state of health, and had a very distressing cough ; she was apparently on the eve of going into a con- sumption — the use of ten boxes of the pills entirely restored her, and she has never failed since that time, when indisposed, to receive benefit from a single dose. I am yours, &c., HUGH FOSTER. You will perceive by the above testimonials that your medicine is justly in high repute in this part of the country, as it must be everywhere where it is introduced. I could, as I stated above, had I time and space, extend the list of testimonials of its efficacy to several hundred pages. I would state that I have sold, during the year past, nearly eighty-five thousand boxes of your Vegetable Universal Pills, and have not the least doubt but I shall be able to dispose of more than double this quantity during the coming year, as those that have been sold have established a reputation for them that will last as long as the body of man is subject to indisposition. My office in Louisville is 99 Fourth Street, near Jefferson ; and in St. Louis at 56^ Market Street, near Third. Wishing you every success, I remain, sir. Respectfully yours, S. TOUSEY. To Dr. Benjamin Brandreth, New York. 220 CURES BY PURGATION. Pleasantville, Mt. Pleasant, Westchester Co., June 10, 1859. Dr. B. Brandretii, My Dear S r: I have long been a friend of yours, because I verily believe your valuable pills saved my life. I have recommended them for nearly twenty years, and don't want any others in my store. In 1849 I took a heavy cold, and being much exposed for some days afterwards, it settled on my lungs. For three months I was terribly troubled with a hacking cough and profuse- night sweats, and reduced almost to a skeleton. I took various syrups and cor- dials, but found no relief. At last a friend, Jesse Baker, of Miles' Square, Westchester Co., said, " Hammond, why don't you try Brandreth's Pills, they may help you." I bought a box, and took some. They purged me freely — my last dejection being a thick,- viscid, yellow matter. I found myself greatly relieved at once, and within a week got entirely well. I recommend your pills to everybody, and they always do good. I shall always sell them, and I think they are the best medicine in the world for coughs, colds, consumption, and all kinds of sickness, for I know them by experience, having administered them to over one hundred cases of disease, and always cured. Yours truly, W. H. HAMMOND. Jaundice Cured. Mr. Benj. J. Stebbins, a highly respectable and well-known farmer of Pawlina, Dutchess County, N. Y., w^rites July 9th, 1859, that he was pros- trated with jaundice every spring and fall for years, in spite of all the efforts of physicians ; that he was cured by a few doses of Brandreth's Pills, and " has never suffered from the disease since." See prge 21 for testimonial from Supervisor Bissell, of Newcomb, as to cures of Fmall pox ; also, page 46, from sixty soldiers ; and page 151 as to cures of rheumatism. These testimonials are selected runningr through a period of nearly forty years, and to those who would learn have significance. B. BRANDRETH. ASIATIC CHOLERA: Purgatives the only Treatment with Hopes of Cure. OPINTON OF SIR THOMAS WATSON, M. D., F. R. S., Professor of Theory and Practice of Medicine in KINO''S COLLEGE, London, It is well known by the reading public that for forty years, Dr. Brandr^'th has recommended Brandreth's Pills for the cure of Asiatic cholera and all lax affections of the bowels, because they remove poisonous and offending matters safely from those important organs ; he being opposed to the use of opium and astringents on the principle that they dam up the disease in the body and lessen the chances of recovery. Dr. Brandreth, as early as 1834, says the Asiatic cholera is, in all cases, without exception, connected with a poisonously contaminated state of the blood or condition of the system, that will not maintain a healthy action of the heart and organs generally, causing a feeble circulation, shown by the pulse, which hardly beats over forty in a minute, which occasions stagnation in the blood vessels, and an accumulation in the vessels of the stomach, bowels, and liver, from which the evacuations are simply exudations. These symptoms arrest the secretions generally, but of the liver and kidneys in particu'ar, and constitute, in fact, the essence or essential attributes of the disease. He asks: What are the indications to be fulfilled, or the requirements of a rational treatment 1 Restore excitement to the heart and secretive organs, by divesting the blood of its poisonous qualities through the organs of the stomach and bowels, thus cleansing the liver and the kidneys, and restoring the heart to its proper action. With this view he recommends Brandreth's Pills as the Remedy, as universal experience has testified they excite the liver and all the secretions; in fact, their stimulating operation is general upon the whole system — upon the heart as well as upon the most remote membrane. These pills, therefore, in his opinion, fulfill the purpose of a sure, because rational treatment. After forty years of effort against the established practice, it is indeed a great gratification to know that his principles of cure have received the indorse- ment of the greatest liaht in the medical world. Sir Thomas Watson, M.D., r.R.S., recommends Evacuation as the cure for cholera, and condemns the use of opium and astringents. So early as 1831, Dr. Brandreth advocated the same method of cure which was successfully carried out in London. The same practice was very successfully- enforced in New York with Brandreth's Pills in 1834 and 1835, and again in 1848 and 1849. In June of this latter year the most undoubted evidence of their great curative qualities in Asiatic cholera was published editorially in the New York Sm, say June of that year. In 1853 and 1854, in 1865 and 1866, they were (221) 2^2 ASIATIC CHOLERA. the reliance of hundreds of thousands of families, and have seldom failed to cure Asiatic cholera, perhaps never when used in season. In fact, all recovered .who took them early, while those living where the disease was raging never had it, who used them occasionally, though constantly exposed. Yet Brandreth's Pills are not pretended to be an absolute preventive of the disease; nevertheless, common sense will tell every one that if a drain be opened and left free from filth, when a sudden addition of impure matters run that way, it would not overflow and poison the whole town, like one in a less free condition. So those using Brandreth's Pills, during the presence of cholera, will be safer than those who carry in their systems a load of impure humors, on which the disease may settle, and which Brandreth's Pills would have removed without csiiising any weakness, but actually appearing rather to increase the customary vigor. This same principle of evacuation, of purging, of cleansing, is equally applicable to rheumatism, bilious, and all painful diseases whatsoever. It has been tested by " time," and has not been found wanting. In fact he has strong reason to believe that the same high authority above quoted will ere long give in his adherence to the curative method of treatment by means of purgatives. Asiatic Cholera. Sir Thomas Watson on its Diffusion, Pathology, and Treatment. A valuable addition to our scant knowledge of the origin, nature, and dis- seminating media of Asiatic cholera has been issued from the press. Sir Thomas Watson, Bart., M.D., F.R.S., setting a commendable example to the med- ical profession, has published a revised edition of his " Lectures on Medicine." How necessary for the guidance of the pathological students who sat at the feet of Sir Thomas Watson a revised edition of his lectures had become, may be gathered from the fact that when the former edition was published — prior, be it observed, to the great visitation of cholera in 1865-6 — the learned doctor told his pupils, " whenever a suspicion arose that cholera w^as present in the community, not to try, in cases of diarrhoea, to carry off the presumed offend- ing matter, but to quiet the irritation, and to stop the flux as soon as possible by astringents, aromatics, and opiates." Whereas now^ while still entertain- ing no doubt that the true indication of treatment is to " stop the flux as soon as possible," he believes this may be best effected " by carrying off the offend- ing matter." Sir Thomas prepares the minds of his readers for the changes some of his opinions have undergone by observing that the last great visitation of cholera was " more fertile of instruction on many interesting points relative to the disease than any of the three preceding epidemics." In one very important particular Sir Thomas's views remain unchanged. He always held, and imagines that few of the original doubters remain unconverted to the doctrine that epidemic cholera is catching. He contends that it results from a material poison which is portable, capable of being conveyed from place to place, and communicated from person to person, or from inanimate substances to which it clings, such as articles of furniture or clothing. That the morbific matter floats als(j in the air, and may be wafted about by its currents, is a general and well- founded belief. Dr. Bailey says that when it travels over great distances, it uses the vehicle of human intercourse; but that it maybe diffused over smaller space, as from one part of a town to another, or from a tainted port to a ship anchored to leeward, by the movements of the atmosphere. With this opinion Sir Thomas concurs, and he adduces in support of it the following facts : The long migrations of the disease are not made rapidly. Its rate of prog- ress never exceeds, and is often slower than that of modern traveling. Its primary appearance in an island or a kingdom is always at its outer boundary. In our own country^ for example, it first planted its foot in a seaport town ou ASIATIC CHOLERA. 223 the east coast, over against the mainland where cholera was raging, and whence ships had very recently arrived. The same is true of its subsequent visitations. On the other hand, the crews of vessels sailing from healthy places remained free from the disease until they have entered an infected port, or held inter- course with an infected shore. Confirmation of these statements is given by Dr. Bryson, in his statistical report of the Royal Navy, published in 1868. He says : The medical records of the service have been searched in vain to discover an instance in which either cholera-morbus or yellow fever made its appearance amongst the ship's company unless one or more of the men or officers had pre- viously — within at most twenty-one days — been exposed in some house, ship, or locality where the infectious virus which emanates from persons ill of the one or the other of these diseases existed. The spontaneous origin of either malady far away from an infected locality is unknown in the naval service. This may be taken as conclusive, as it seems to be equally clear from the examples cited by Sir Thomas, that the atmosphere forms one of the vehicles of infection. For instance, the towns of San Roque and Gibraltar, five miles apart, were abruptly smitten by the plague, not only on the same day, but almost at the same moment. At a small town near Toulon the plague fell upon the place in the night, and thirty cases occurred simultaneously on the following day. A curious circumstance in connection with this impregnation of the atmos- phere with choleraic poison was recorded in the Dublin Morning Register respecting the first epidemic — that of 1832: In the demesne of the Marquis of Sligo, near Westport House, there is one of the largest rookeries in the west of Ireland. On the first or second day of the appearance of cholera in this place, I was astonished to observe that all the rooks had disappeared ; and for three weeks, during which the disease raged violently, these noisy tenants of the trees completely deserted their lofty habi- tations. In the meantime the revenue police found immense numbers of them lying dead upon the shore near Erris, about ten miles distant. Upon the decline of the malady ^vithin the last few days, several of the old birds have again appeared in the neighbourhood of the rookery ; but some of them seemed unable, from exhaustion, to reach their nests. The number of birds now in the rookery is not a sixth of what it was three months ago. During the outbreak at Constantinople, in 1865, a similar migration of birds took place. It was observed that all the sea-gulls which used to flit over the waters of the Bosphorus deserted the place, nor did they reappear till the dis- ease had departed, and the atmosphere had become pure once more. A striking proof that the air may be a vehicle of infection — that the poison may enter the lungs with the breath — is furnished by the fact that two pilots took the disease in consequence of having their open boat towed by a ten-fathom rope at a con- siderable distance astern of the steamship England, on board of which cholera was raging. They were never on board the vessel. Both of them had cholera, and one of them died of it. Both took the disease home and trans- mitted it to their familes, near Halifax, where the disease had been unknown for many years.* Notwithstanding these proofs that infection may enter the lungs of healthy bodies, it is still doubtful whether the disorder can become epidemic, except in certain conditions of the atmosphere. Mr. Gluisher has observed that each epidemic in London has been attended with a particular state of atmosphere, "characterized by a prevalent mist, thin in high places, dense in low." He goes on to enumerate other atniospheric characteristics observable during the prevalence of cholera : * A thin piece of muslin or a silk handkerchief tied over the mouth, would have prevented these pilots from taking the disease. 224 ASIATIC CHOLERA. A dense torpid mist, and air charged with the many impuriti<;>6' arising from the exhahitions of the river and adjoining marshes ; a deficiency of electricity ; and (as shown in 1854) a total absence of ozone, most probably destroyed by the decomposition of the organic matter with which the air in these situations is stronoly charged. More horrible than the knowledge that cholera may come to us in the air we breathe is the conjecture, now reduced almost to a certainty, that we may eat and drink the poison and so obtain the disorder — that the discharges FROM THE ALIMENTARY CANAL ARE AT ONCE THE. MAIN OUTLET FOR THE POISON, AND THE CHIEF SOURCE OF INFECTION. Dr. Snow has showH how easily por- tions of the rice-watH" excretions may come to adhere to our food during its preparation or consumption ; and the disgusting fact has been made too certain by the unchallengeable disclosures of the microscope that the water supplied for domestic purposes by the London water companies habitually contained visible particles of human ordure. In all the visitations of cholerar the disease w^as least virulent where pure water' was obtainable. Mr. Simon reported that " the population drinking dirty water appeared to .have 'suffered three and a half times as much mortality as the population drinking other water;" and the sudden, rapid outbreak of the disorder in the east of London, in 186G, was distinctly traceable to the unfiltered and infected water supplied by the East London Water Company. With respect to the propagation of the disease, Mr. Simon uses this strong lanojuaoje : It cannot be too distinctly understood that the person who contracts cholera in this country is ipso facto demonstrated, with almost absolute certainty, to have been exposed to excremental pollution. Excrement-sodden earth, ex- crement-reeking air, excrement-tainted water — these are for us the causes of cholera. Mr. Simon hopes that " for a population to be poisoned by its own excre- ment will some day be deemed ignominious and intolerable ;" and he says that the local conditions of safety are, above all, these two : Eirst, that by appropriate structural works all the excremental produce of the population shall be so promptly and so thoroughly removed, that the inhab- ited place, in its air and soil, shall be absolutely without fsecal impurities ; and, second, that the water supply of the population shall be derived from such sources, and conveyed in such channels^ that its contamination by excrement is impossible. It is shocking to think it should be otherwise now. (But no man can receive the disease unless there be those matters in the system capable of receiving it. All do not have it. How many 1 May the number not be increased ] Cer- tainly by using Brand reth's Pills.) See page 5fc^9, Vol. 2, of Sir Thomas Watson's Lectures, 1870, London, Longmans, Green & Co. " Haifa tumbler of fresh cholera dejecta found its way into a vessel of drink- ing water, the mixture being exposed to the heat of the sun during the day. Early the following morning nineteen persons drank from this pitcher. (The water attracted no attention either by its taste or smell.) They all remained perfectly well during the day, ate, drank, went to bed, and slept as- usual. One next morning was seized with cholera. Two were attacked the second morn- ing. On the third day two more were attacked. The remaining fourteen remained in their usual health, and were altogether untouched by the disease." These fourteen had nothing in their bowels or "blood on which the disease could fix and germinate. And this is how Brandreth's Pills save you from the chol- era, for these fourteen persons used Brandreth's Pills as their regular medicine when sick. m ASIATIC CHOLERA, 225 The poisok u*- the disease the cause of the thickening of the blood, not THE PURGING. ReAD THIS PART WITH GREAT ATTENTION. Our knowledge of the morbid anatomy of cholera has become more com- plete and more exact in consequence of the post-mortem inspections, in cases of death during collapse, made by Dr. Parkes, Dr. Johnson, Dr. Sutton, and others. It is acknowledged o;i all hands that the primary and sp:^cial danger in cholera lies in its n^iod of collapse. Now it was a v.Ty natural and plausible theory which attrilRed tliis state of collapse to a drain upon the blood by the prtjfuse and repeated fluxes from the stomach and bowels, whereby the blood, being robbed cf its more liquid ingredient^, and made thick like tar or treacle, became incapable of flowing freely, if .'it all, through its natural channels ; and thus the circulation coming ultimately to a stop, life stopped also. And the practice suggested, and put in force, as a direct corollary to tliis theory, was that of endeavoring to arrest the destructive flux by astringent drugs, and by opium, to sustain or urge on the lingering circulation, and to restore the spent sti'ength and the lost animal warmth by alcoholic and other stimulants. Upon similar grounds was advocated the dilution of the thickened blood by w^ater injected into the veins. It is affirmed, on the other hand, that the con- dition CALLED COLLAPSE IS NOT DUE TO THE EXCESSIVE DISCHARGES FROM THE BODY ; THAT THOSE DISCHARGES ARE REALLY ELIMINATIVE OF THE POISON OR OF THE PRODUCTS OF THE POISON WHICH CAUSED THE DISEASE, AND ARE TO BE PERMITTED OR EVEN ENCOURAGED RATHER THAN CHECKED ; AND, THEREFORE, THAT ASTRINGENTS AND OPIATES CAN DO NO GOOD, BUT ARE, ON THE CONTRARY, POSITIVELY HURTFUL. Sir Thomas combats the first-mentioned theory, and quotes Dr. Parkes to prove that the most hopeless cases arc those of collapse after very scanty dis- charges or with no discharges at all. Savs Dr. Parkes : It may confidently be asserted that there is no one who has seen much of cholera who does not know that, exclusive of the mildest forms of the disease^ a case with liiile vomiting or purging is more malignant and more rapidly fatal than one in which these are prominent symptoms. Castor Oil and Purgatives Recommended. Now as to treatment. Dr. Johnson, of Liverpool, also holds that " the phenomena of cholera result from the entrance of a peculiar poison into the blood, where it probably undergoes a rapid process of self-multiplication, and spoils certain of the blood constituents, which are then ej"Cted through the mucous membrane of the alimentary canal ; that the feelings of general op- pression and malaise sometimes experienced before the onset of the bowel symptoms are indicative of blood poisoning; that the copious discharges are expressive of the efforts of nature to throw off" a noxious material, and really form, therefore, a necessary part of the process of recovery ; and that if the pouring forth of the Vascular excretion be checked (as it can perhaps be by opium), the risk of fatal collapse is thereby increased. He declares that the results of his own practice, founded on these views, have amply justified them; and a considerable body of other evidence has now been furnished in support of the same plan. Sir T. Watson thinks it is plain that, if " elimination " be a condition of recovery, the method of elimination is nature's method, which art may help or hinder — help by the cleansing method, hinder by the astringent. It should be remembered that one dreadful symptom of cholera consists in very painful cramps of the larger muscles of the body, produced, it may be assumed, by the choleraic poison. Dr. Johnson supposes that the stoppage of the blood is caused by the -same poison acting upon the muscular fib:es of the minute pulmonary arteries. Ihe thickening of the blood is a consequence, and not a cause, of the arrested circulation and the collapse. The true explanation of S26 ASIATIC CHOLERA. the fact that mere diarrhoea, however profuse, does not thicken the blood, is probably, as Dr. Johnson suggests, that water is rapidly absorbed from the soft tissues, to take the place of that which escapes from the alimentary canal. Such is the theory which Sir Thomas Watson thinks a reasonable one. He says : " It is founded on a true analogy; it is consistent with the symptoms noticed during life, and with the conditions discovered after death. We may therefore legitimately regard it, until fairly refuted, as a sound as welljtea most ingenious and important theory. In truth, it derives stroing confiriSmon from the fact that it unlocks, like the right key, the whole of the pathological intricacies of the disease. Thus, the emptiness of the systemic arteries accounts for the ex- tinction of the pulse at the wrist, for the cadaverous sinking of the eye-balls and falling of the features, for the blueness and coldness of the skin, and for the absence of syncope. The circulation stops, not from debility of the heart, as in exhaustion, but in consequence of a direct mechanical impediment to the onward course of the blood. We can understand the importance of brandy against this condition ; and. how, on the other hand, bleeding may help, both by relaxing the spasm and by unloading the distended right heart, to restore the circulation.* In this explanation Dr. Johnson presses, plausibly enough, the singular effect of the injection of fluids into the veins of these patients. It appears that, to be most influential, the fluids must be hot ; and he concludes that they act not only by diluting the morbid blood, but chiefly relaxing, through their warmth, the spasm of the smaller arteries. The blood then flows on again, and the symptoms of collapse are for a time removed. Again, the husky whispering voice is owing not to muscular weakness, but to the small volume of the tidal air in the respiratory currents. As but little venous blood reaches the lung-tissue proper, there is but little demand for air to meet and decarbonize it. The respiration accordingly becomes shallow, and the vocal pipe, feebly blown through, refuses to speak. Under the temporary impulse of the warm injections, the voice regains its usual tone and note." It is evidently wrong to dam the choleraic poison and its products within the body. Even when those products have, in one sense, been separated from the system, they may produce highly noxious effects if they remain shut up in the stomach or bowels, there to ferment and decompose. Admitting, as we must, that a minute quantity of the morbid excretions swallowed with water may suffice to produce the disease, a large quantity retained, through Aveakness of the expulsive powers or otherwise, can scarcely be harmless. Rather may we expect that its expulsion will tend to liberate the patient from danger and dis- comfort; just as the opening of large abscesses, and the discharge of foul pus and imprisoned gases, are often seen to rescue, as if by magic, a sick man from apparently impending dissolution. Having arrived at these conclusions, Sir Thomas has not far to seek for con- firmation of the theory. Dr. McCloy and Dr. Robertson testify that — Of 375 cases of cholera admitted into the Liverpool Parish Infirmary in the last epidemic, 161 proved fatal — a gross mortality, under all the modes of treat- ment adopted, of 42.93 per cent. Of these cases, 91 were treated with astrin- gents and stimulants, camphor and iced water, applications of ice, and hypo- dermic (opiate) injections ; and the mortality per cent, of these cases was 71.42. Eighty-seven cases were treated with purgatives, and with a liberal use of food and alcohol ; and the mortality was 41.37 per cent. One hundred and ninety- * This advice as to brandy and bleeding is bad, and will do hurt if followed ; but worse than all will be the effect of the injection of fluids into the veins. When the disease is treated by purgatives, vegetable purgatives, by Brandreth's Pills, the collapse never occurs, everything arranges itself by nature's own efforts, she having been assisted by means of Brandreth's Pills, which never weaken. I i ''*Ji'-<;';"-4» ASIATIC CHOLERA. 227 seven cases were treated with castor oil only, and the mortality was 30.45 per cent. Dr. Brandreth affirms that over 90 per cent, recover when treated with his pills. Now, if this theory and practice in respect of cholera be true and right, the practice ought to be right in respect of the associated diarrhoea also ; and so, indeed, it is. Those who have largely tried it, strongly affirm that it is right, inasmuch as it is eminently successful. Dr. Johnson avers that he has found it so. And the concurring testimony of Drs. McCloy and Robertson confirms the soundness of the theory and practice. Their experience of diarrhoea was very extensive. Several thousand cases came under their observation in various dispensaries in and near Liverpool. Many were of a most severe choleraic type. The treatment they adopted was generally evacuant in its nature." Had Brandreth's Pills been used in the place of castor oil, the mortality would not have been over ten, and probably less than five per cent. ; in fact, on persons of sound constitutions, not one per cent. Remarks upon Cholera, Fevers, Small Pox, &c., dec. I now take pleasure in placing before the public a word further in reference to this disease, and other maladies arising from poison in the blood, among which I place cholera, small-pox, scarlet fever, yellow fever, typhoid fever, fever and ague, and all fevers without exception, including rheumatical and diptherit- ical. The maladies arise in the human body from the absorption of a specific poison, which seems capable of multiplying itself according to the condition of health of the patient when stricken down. Common sense tells us how little water it needs at the commencement of a fire to put it out, and the same prin- ciple is applicable to the getting out poison from the human body. A little energetic medicine in the beginning will do wonders in ridding the body of the poison, which much may be unable to achieve when it has got under a full head- way. So when a thing hurts, remove it, and in a choleraic attack, without the loss of a moment's time. We know that thousands of persons are living whom Brandreth's Pills have cured of this terrible disease, and we have the highest medical authority for their use. Such authority, indeed, tells us that the state of collapse is not due to the excessive discharges in cholera, but to the poison, which prevents the formation of carbonic acid by the union with the oxygen of the blood ; heat is not generated, but the blood remains charged with carbon, paralyzing the action of the heart, causing the slow pulse so observable in this disease, the dark skin and ghastly expression of countenance so awful in collapse. Then apply yourselves to the removal of the poison — and Brandreth's Pills are the remedy, safe, energetic, and sure ; safe, because they only act upon what is contrary to health ; energetic, because they act according to urgency of symp- toms; sure, because they never fail to produce purgation if given while sufficient vitality remains. Wait not for advice, but swallow six or eight at once, and continue with more or less according to urgency of disease, being guided also by bill of directions which are around each box. When you have produced bilious stools, or the disease moderates, the patient is safe. But Brandreth's Pills will do better for you than many doctors, and as much as any can. The diet should be good chicken broth, or from fresh mutton or beef. My opinion is, that broth made fro tn sheep's head is the most appropriate of all in affections of the bowels. It should be simmering a long time ; until the meat leaves the bone. When the pills have operated very thoroughly, ten drops of spirits of camphor in a half a wine glass of water seems to soothe, and can do no harm. But no spirits or astringent medicines should be used, because they dam up the poison if any remains, which may occasion a relapse. This seems to be a very easy method of treatment, and though the cholera is a frightful malady, yet, treated with purgatives, is a simple affair, and usually 228 ASIATIC CHOLERA. curable. But aro purgatives indeed a proper remedy? Let us see. The greater the amount of the intestinal discharges, the greater is the sum of poison removed, and the greater the chance of recovery ; while the most hopeless and la!al cases are lh«»se paticnis who have very scanty dischar-ges, or no discharges at j:ll. If the terrible collapse were owing to the drain upon ihe blood effected through the intestinal discharges, it would be prolonged, deepened, and rendered more pei'ilous by the continuance of those discharges. But patients recover from a state of collapse, Bran