TREATMENT 
 
 OF 
 
 FEVER 8c INFLAMMATION 
 
 S.S. SATCHWELL 
 
 1870 
 
 
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 in 2018 with funding from 
 University of North Carolina at Chapel Hill 
 
 https://archive.org/details/treatmentoffeverOOsatc 
 
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 TREATMENT 
 
 OF 
 
 FEVER AND INFLAMMATION. 
 
 antt essay 
 
 ON THE 
 
 TOPOGRAPHY AND PREVAILING DISEASES 
 
 OF 
 
 JIEW HAjHOVER COUJNTY, js|. C., 
 
 READ BEFORE THE ANNUAL MEETING OF THE 
 
 ortli Carolina jjjrdital jLrittj, 
 
 HELD AT 
 
 WILMINGTON, N. C., MAY 25, 1870, 
 
 BY 
 
 S. S. SATOHWELL, A.M., M.D. 
 
 OF 
 
 NEW HANOVER COUNTY, N. C. 
 
 Published by order of the Society. 
 
 )Vn.M!NGTON, K C. : 
 
 ENGELHARD & PRICE, STEAM POWER PRESS PRINTERS, 
 JOURNAL BUILDINGS. 
 
 I 
 
 1870. 
 

ERRATA. 
 
 f ’WS* 
 
 -o- 
 
 On page 15, line 5, country should read county. On same page a 
 period should occur after the word common, in line 8, and the word 
 while should begin a new sentence. On same page, line 18, the word 
 Trachsales should read Tracheales. 
 
 On page 17, line 14 from bottom, a period should occur after the 
 word condition , and the word while , which follows, should begin a new 
 sentence. After the word soils, on sime pa^e, line 10 from bottom, a 
 comma should follow, and the following word it s iould not begin with 
 a capital. 
 
 On page 19, line 1, the word revolution should read resolution. 
 On same page, line 15 from bottom, the word generate should read 
 general. 
 
 Oa page 21, line 17 from bottom, the name Brunet should read 
 Bennett. On same page, line 10 from bottom, the word is should 
 read as. 
 
 On page 22, line 26, from top, the word course should read 
 cause. On same page, line 12, from bottom, a period should follow 
 the word community and the following word more should begin a 
 new sentence. 
 
 On page 24, line 9, the word get should read yet. 
 
 On page 33, line 9 from top, the word offered should read op¬ 
 posed. On same page, line 6 from bottom, the word offered should read 
 opposed. 
 
 On page 38, line 11, from top, the words even played should read 
 employed. 
 
 i 
 
 On page 39, line 11, from bottom, a period should occur after the 
 word better, and the following word numerous should begin a new 
 sentence. 
 
 On page 42, last line, the word prevented should read perverted. 
 
 On page 44, line 21, from top, the word expedient should read 
 expectant. 
 
 On page 49, line 25, from top, a comma should take the place of a 
 period after the name Manson. 
 
 Other typographical errors occur in different portions of the Essay, 
 which it is hoped the reader will recognize to be such, as he proceeds, 
 and make accordingly the proper allowance. 
 

 
 
 
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TREATMENT 
 
 OF 
 
 FEVER AND INFLAMMATION. 
 
 AYJST ESSAY 
 
 ON THE 
 
 TOPOGRAPHY AND PREVAILING DISEASES 
 
 OF 
 
 JVIEW HANOVER COUNTY, JN. C., 
 
 BEAD BEFORE THE ANNUAL MEETING OF THE 
 
 HELD AT 
 
 WILMINGTON, N. 0., MAY 25, 1870, 
 
 BY 
 
 S. S. SAT OH WELL, 
 
 OF 
 
 NEW HANOVER COUNTY, N. C. 
 
 Published by order of the Society. 
 
 WWJWPN N P- 
 
 ENGELHARD & PRICE, STEAM POWER PRESS PRINTERS, 
 JOURNAL BUILDINGS. 
 
 1870. 
 

 
 \ V\ ^ 
 

 [APPENDIX c.] 
 
 ESSAY 
 
 Read before the Medical Society of the State of North Carolina, 
 at Rue Annual Meeting in Wilmington , May 2 5th, 1870; 
 
 BY 
 
 SATCHWELL, A. M., M. D., 
 
 OF 
 
 NEW HANOVER COUNTY, N. C. 
 
 -o- 
 
 Mr. President: 
 
 During each of its annual meetings, for the last three 
 years, this Society has honored me with a request to report 
 upon the Topography and Prevailing Diseases of New 
 Hanover County. The laborious duties incident to an ar¬ 
 duous country practice, conjoined with those constant in¬ 
 terruptions and sacrifices, which since the late war, more 
 than ever, attend the life of the true Physician and Surgeon 
 of this war-stricken Southern land, have prevented my res¬ 
 ponse to this generous call. And even now, the continuance 
 of these demands upon me enforce the conviction that I can 
 only hope to perform the task assigned me in a manner 
 incomplete and unsatisfactory to myself. To remain longer 
 silent, however, with the invitation still extended, would 
 argue, what I cannot acknowledge—either insensibility -to 
 duty on my part, or an indifference to the high claims, ol 
 the medical profession upon the members of this Association 
 to contribute, each his mite, to that medical fabric, broad, 
 strong and enduring, which the Society has been building up 
 
 W_ 
 
 
 j 
 
4 
 
 in North Carolina for the last eighteen years of its exis¬ 
 tence. Nor do I propose to allow the occasion to pass 
 without some allusions to certain well known heretical doc¬ 
 trines in relation to the modern treatment of congestive 
 fevers, acute internal inflammations and other inflammatory 
 diseases, which, through the medium of our Transactions 
 and other sources, have been of late so industriously pro¬ 
 mulgated to the medical world. But while, in the latter 
 part of this paper, I shall interpose some objections to the 
 extreme views of Todd, Bennett and others of their disciples 
 in this and other States and countries, I may remark that 
 my main purpose is to perform the more legitimate work 
 assigned me by the Society, as just referred to. The views 
 I have to offer upon points discussed in this notice of the 
 prevailing diseases of this Southeastern portion of the Stntc, 
 where most of my medical life has been spent in active 
 practice, are not claimed to be novel or original. They are 
 such, however, as my knowledge, experience and observa¬ 
 tion enable me to honestly entertain, feebly though I shall 
 express them. No little obscurity has always attended the 
 cause, nature and treatment of disease, in sj^ite of the sure 
 advances and brilliant triumphs of the ever-piogressive art 
 and science of our always noble profession. With all the- 
 floods of light which the progress in general culture and 
 knowledge of this age have shed upon the advancing civili¬ 
 zation of the world, it is strange that nothing scarcely seems 
 to be received as settled in morals, science, art, politics or 
 religion. It is mainly by a faithful collection and compari- 
 sion of facts that principles are established and medical 
 science advanced. It is by these means that such knowledge 
 is acquired and such legitimate deductions drawn as will 
 best enable us to attain the great practical end of medical 
 life— correct diagnosis and successful treatment. And it is 
 gratifying to know, that if we are to have in North Carolina 
 a Medical Digest worthy to serve as our best guide to prac¬ 
 tice, its best materials will be sought in the. accumulated and 
 accumulating facts and contributions of local Medical History . 
 
 TOPOGRAPHY. 
 
 New Hanover County embraces an area of about one 
 thousand (1,000) square miles, and contains, outside of 
 Wilmington, a population of about twenty thousand (20,000) 
 inhabitants. Besides the Ocean on the East, it joins Onslow, 
 Duplin, Sampson, Bladen, Columbus and Brunswick coun¬ 
 ties. It presents important meteorological, minerological and 
 agricultural conditions and relations. Its climate, natural 
 
resources, products, facilities for rapid and cheap transpor¬ 
 tation to the best markets, and admirable adaptation to the 
 production upon her generally fertile soil, of almost every 
 variety of agricultural and horticultual products, render 
 New Hanover not merely a desirable home for those already 
 here, but attractive to those of other portions of our own 
 and of other States and countries beyond the seas, who seek 
 new homes with a view of bettering their condition. While 
 thus of interest and attraction in a commercial, manufac¬ 
 turing and agricultural point of view, such is the range and 
 variety of its climate and other conditions, that it gives 
 origin to no inconsiderable number and variety of diseases; 
 and the medical enquirer can here find much to interest 
 him. Large navigable streams, known as North East, North 
 West and Black rivers, together with their numerous 
 tributaries, intersect and divide up the county and empty 
 their waters into the Cape Fear river. These various 
 streams present the usual borders, bottoms, swamps, lagoons 
 and unhealthy sites that here, as in similar situations, aro 
 attended with those terrestrial exhalations, termed malaria 
 and productive of malarious diseases. We have the customary 
 intermediate uplands, in some places constituting extensive 
 sand ridges, stretching, in some instances, to long distances. 
 The growth of timber is diversified, consisting principally of 
 cypress, sweet and black gum, poplar, oak, hickory, ash, 
 bay, pine, reed cane, dogwood, <fcc., with the exception of 
 her barren sand ridges, low prairie bottoms and gall-berry 
 thickets, the soil of this county is generally fertile and finely 
 adapted, in its general character, to the production of the 
 great Southern staple—cotton. The sub-soil is mostly clay, 
 some of it silicious, other portions mixed in these, respects. 
 A large belt of country, known as Rocky Point, divided by 
 that great artery of our trade, vitality and prosperity, the 
 Wilmington and Weldon Rail Road, is as rich and produc¬ 
 tive as any portion of the State, and noted for its advance¬ 
 ment and prosperity in agriculture. In its adaptation to 
 agriculture and horticulture, New Hanover is scarcely ex- 
 called by any county in North Carolina. Good marl exists 
 in abundance on almost every man’s plantation, and conven¬ 
 ient to the surface, while the natural resources for compost¬ 
 ing and otherwise enriching the land universally exists in 
 the greatest abundance. Nor is there wanting evidence that 
 extensive beds of phosph&tic deposits, . similar to those 
 near Charleston, South Carolina, exist in our Countv. - " 
 Besides the almost universal distribution of marl beds and of 
 actual phosphatic deposits in certain localities, very exten- 
 
6 
 
 sive layers of lime rock exist in many parts, capable of 
 manufacturing immense amounts of excellent lime. The 
 eyes of science are now directed more earnestly than ever to 
 these formations and remains of the violent efforts and 
 upheavings of nature in olden times, in these near ap¬ 
 proaches to old ocean. The new impetus given within the 
 last few years to the cause of agriculture in the County, is 
 having the happy effect of changing the pursuits of many of 
 the inhabitants from the precarious business of naval stores, 
 lumber, shingles, <fcc., to the surer support and more sub¬ 
 stantial prosperity to be found in the cultivation of the 
 generous soil. Its beneficial results are seen, too, in the im¬ 
 provement of the health of the County, by these onslaughts 
 upon malaria, which the clearing of forests, drainage and 
 good farming always make. 
 
 The climate is temperate. The latitude is between 34 and 
 35 and the longitude between 77 and 78 degrees, the mean 
 temperature being about 50 degrees. That of winter is about 
 80, and that of summer about 50 degrees. The breezes from 
 the ocean in summer are greatly prized, especially by the 
 inhabitants in more immediate proximity to the coast ; com¬ 
 mencing about the middle of the forenoon, when the heat of 
 the day generally begins to be oppressive, they are not only 
 cordially welcomed, but are absolutely delicious. Snow is 
 seldom seen and rarely remains on the ground longer than a 
 few hours. So that while the climate is temperate and the 
 summers warm, the winters, sometimes variable, are gen¬ 
 erally mild. 
 
 Wilmington is situated on the East bank of the Cape 
 Eear river, at the confluence of the North East and North 
 West rivers, and about twenty-five (25) miles from the 
 ocean. Opposite the city is a large Island, composed of the 
 sedimentary deposits of the river, and formerly under suc¬ 
 cessful rice cultivation. The city is more elevated, ascending 
 from the margin of the river in sand hills of various heights, 
 the highest point being 36 feet above the level of the sea. 
 The North East and South sides of the city are encircled, to 
 a great degree, by creeks and rivulets with marshy borders, 
 many of them have been filled up in the progress of im¬ 
 provement, but too many yet remain for the good health of 
 the neighboring inhabitants. The opposite Island alluded 
 to, five miles long and two miles wide, is covered to a con¬ 
 siderable extent, with the original growth, cypress, ash, 
 black gum, bay and other trees, with an undergrowth of 
 flags, reed and aquatic plants. It is flooded by tide water, 
 except a small strip on the river margin opposite the city, 
 
7 
 
 artificially elevated by the construction of wharves. The 
 same description is applicable to the river margin on its 
 Western side below the city, the whole constituting what is 
 called “tide swamp.” The soil is sandy, underlaid by a 
 limestone formation. The city is supplied with water from 
 springs and wells, and much of it inferior in quality. This 
 is greatly improved, however, in summer, by the addition of 
 ice, large quantities of which are consumed in Wilmington. 
 The filling up of the low, swampy places, which heretofore 
 existed in some parts of the city, has largely contributed to 
 the public health and encouraging to further efforts in this 
 direction. What influence the turpentine distilleries here 
 have upon the general health is a matter of speculation, it is 
 true, but my observations here and elsewhere, inclines me to 
 the conviction that they are very desirable auxiliary conser¬ 
 vators of public health. During the late war, it is conten¬ 
 ded that it was more sickly in autumn in the vicinity of 
 turpentine distilleries, here and elsewhere in our lower Capo 
 Fear, where their operations were temporarily suspended, 
 than it was before and since, during such distillation of this 
 extensive commercial staple. 
 
 • In a city like Wilmington, so promising for the future, and 
 so justly noted for its enterprise and increase in population 
 and wealth, there is a lamentable want of parks and public 
 squares. These necessary appendages to every city, consti¬ 
 tuting in fact its very lungs, were sadly overlooked in the 
 earlier days of Wilmington. It is hoped and expected, how¬ 
 ever, that a substitute, to a great extent, for this obvkms 
 defect and continued want, will be found at an early day, in 
 these ornamental grounds and public squares that are 
 springing up contiguous to the city upon the soil of the 
 Cape h ear Agricultural Association. This institution, which 
 though an infant in age, is bounding forth in giant strides 
 an herculean power in its noble mission of improving the 
 commerce, mechanics and agriculture of Eastern North Caro¬ 
 lina, promises to supply, very materially, the comforts and 
 benefits that would flow from the existence of such conven¬ 
 iences more in the heart of the city. The population of 
 Wilmington, in 1850, was about seven thousand, now it is 
 believed to be about fifteen thousand inhabitants, and is 
 therefore the largest city in the State. 
 
 CAUSES—PREDISPOSING AND EXCITING. 
 
 At the very threshold of. our Etiology looms above all 
 -others for repetition, the old familiar tale of bad air as the 
 most potent agent of disease. It is the atmosphere of ter- 
 
8 
 
 estrial exhalations bearing the specific poison of malaria that 
 makes more work for the physicians of this section, either in 
 its more rapid and direct or in its slower and indirect 
 influences than most all other causes of disease combined. 
 Besides the list of periodical fevers that its absorption into the 
 system produces, it modifies nearly all the diseases of the 
 different seasons, gives the character of periodicity to many, 
 and introduces its great adversary, quinine, into a majority 
 of all our medical prescriptions. Malaria has been a more 
 fruitful theme of medical discussions—has been the occasion 
 of more theories, fanciful and reasonable, logical and illogi¬ 
 cal, and the publication of more and larger volumes, than 
 almost any subject in the whole range of medical literature, 
 and yet its analysis and true nature continues to elude inves¬ 
 tigation. Besides the great practical knowledge of its effects 
 and the fact that the constituents of the air of malarious 
 localities are found, Avitliout doubt to be different from those 
 where this poison does not exist, but little is really known 
 that can stand the test of our inductive system of medicine. 
 Nearer approaches, however, in my opinion, are being made 
 now than ever before, in the eager search after its 
 hidden nature. I beliove that the brilliant triumphs of med¬ 
 ical progress will not much longer permit its derisions and 
 reproaches at the science of chemistry and medicine. The 
 footprints of its haunts are seen on the whole habitable globe, 
 wherever there are condititions favorable to its production. 
 Nor is its universality, more marked than the uniform period¬ 
 icity of the fevers it engenders. It prefers such localities 
 and regions as would otherwise be the choicest of God’s 
 heritage. Prevailing in all ages, it is the same deleterious 
 agent and specific poison, except in degrees of virulence, 
 whether it appears upon the borders of Ganges or the Nile— 
 upon the Pontine marshes or in the Mississippi valley; upon 
 the island of Crete, the slopes of the Atlantic coast, or along 
 the border and tributaries of our own cherished Boanoke, Tar 
 Neuse and Cape Pear rivers. In these innumerable places 
 it comes forth every spring, summer and fall, in giant 
 strength but invisible form. With stealthy steps it lurks 
 around our homes and altars, producing more sickness and 
 mortality in its immediate or remote influences than any 
 other cause known. Not alone in the production of the 
 various forms of malarial fever, in the shape of intermittent, 
 remittent and congestive fevers, are its ravages recognized, 
 but in their sequaele as manifested in the multifarious 
 chronic diseases that in some way have a malarial origin and 
 character do we see the destructive influences of this agent 
 
9 
 
 upon human health, life and happiness. Sometimes they are 
 presented in the shape of jaundice, hepatitis, and other 
 chronic derangements of the biliary organs so generally 
 observed in malarious localities, and so often the forerunners 
 of dropsies, diseases of the stomach, bowels and other organs. 
 At other times the strength of the constitution of some 
 persons, and their capacity to resist for a longer or shorter 
 time malarious influences, enable them to reside in such locali¬ 
 ties without any special attack of malarial fever. Few there are, 
 however, who, living in these regions, do not present that sal¬ 
 low hue and malarious physiognomy which alwaj^s character¬ 
 izes the inhabitants of malarious regions. In other instances 
 these malarial manifestations are observed in that large list of 
 nervous diseases that are seen in those cases of spinal and 
 cerebral hemiplegia, sciatica, hysteria neuralgia and like 
 annoying affections which are more numerous in malarious 
 than in regions free from its influences. The literature of 
 malaria is destined to be still more enriched with the results 
 of the experience yet to be proven and the discoveries yet to 
 be made in its production of the family of nervous and 
 spinal diseases. But in whatever form this prolific cause of 
 disease may act, or however labaryntliian its'ways, it is the 
 conclusion of my long medical experience in the malarious 
 regions of Eastern North Carolina, that once introduced into 
 the system, it is very difficult to be eradicated. I repeat the 
 important fact, that residence in these malarious localities 
 engenders, sooner or later, either an acute attack of malarial 
 fever or those slow derangements of functional action and of 
 the nervous and vascular systoms which produce some 
 chronic lingering disease, or some gradual undermining of the 
 general health, most generally attended wdtli a lowering of 
 the vital forces and a depression of spirits. The inhabitants 
 of such localities are noted for more languor of body and 
 debility, and have less desire to enjoy the innocent pleasures 
 and amusements of life, than those residing in healthier 
 districts. 
 
 Hepatic derangement constitutes, in the main, the basis of 
 these troubles, however much the doctrine may be ridiculed 
 by those who have never resided in a malarious region or 
 treated a malarial fever. Sometimes they arc.manifested in 
 that failure of the appetite, furred tonge, constipated bowels, 
 feeble pulse and general debility, with that saffron hue of 
 countenance and dejected eye which meet us in our daily 
 professional ■walks. In other cases, we find conjoined to this 
 torpid condition of the liver such a relaxation of the.alimen ¬ 
 tary canal and general debility as produce or co-exist with 
 
10 
 
 chronic gastritis, gasto-enteritis, chronic diarrhoea, <fcc., that 
 only make up another feature of this common disease in 
 these lower counties. In all these hepatic and splenic affec¬ 
 tions so intimately related to those slow and exhausting com¬ 
 plications, that, without efficient treatment, gradually under¬ 
 mine physical health and destroy human life, I find united, 
 more or less, depression of spirits and perversion of feeling, 
 sometimes even closely approaching insanity. The residents 
 of the purer atmosphere and more elevated regions of the 
 hills and mountains of our State are in their more elastic 
 steps, more vigorous frames and more buoyant spirits, not 
 only more healthy, but more happy and contented than are 
 the same number of population in the swamps and flat coun¬ 
 ties of these Eastern shores, whose sallow countenances, 
 enervated movements and dejected spirits, correspond with 
 the enervating influences of the atmosphere and general 
 physical surrounding of the soil. One general remark as to 
 the treatment of these troublesome diseases. While the 
 claims of mercury are not to be ignored, I have been par¬ 
 ticularly gratified at the results of the use of nitro-muriatic 
 acid. Its action upon the liver is undoubted, and in doses 
 of from five to ten drops, repeated several times a day, I have 
 found marked benefit in the treatment of the various forms 
 of these chronic complaints. I find it useful, whenever di¬ 
 gestion is enfebled or nutrition is impaired, and whether the 
 bowels are constipated or too loose. It seems to operate, 
 not alone as a stimulant to the liver, causing generally an 
 increased flow of bile, nor yet alone is it a tonic, acting as an 
 auxiliary to the functions of nutrition and assimilation, but 
 it also exerts, in my opinion, an alterative action upon the 
 mucous surface of the stomach and bowels and upon the 
 blood. In jaundice, dropsical accumulations and general 
 cacliepia it acts well. Of course I need not speak of the well 
 known caution to be observed of not administering nitro- 
 muriatic acid with mercury, from the poison of corrosive 
 sublimate formed by their joint administration at the same 
 time. 
 
 In that form of chronic malarial diseases known as obsti¬ 
 nate and protracted intermittent fever, in which quinine has 
 failed, I know of no remedy so effective in breaking up and 
 permanently curing the disease, as a combination of iron, 
 quinine and strichnine. When the chill and fever continues 
 to recur in spite of all the quinine, arsenic and other means, 
 you will find a certain cure and preventative of the return in 
 a pill, administered three times a day, of two to five grains of 
 quinine, a like quantity of carbonate of iron, combined with 
 from one-fifteenth to one-twelfth of a grain of strichnine. 
 
11 
 
 But it is pleasing to know that the cause of these diseases 
 can be modified and removed. The industry and science of 
 man, which in all departments of life are more than ever 
 removing the difficulties to human progress, can circumscribe 
 this fell-destroyer, malaria, and not merely modify his 
 power, but rout him entirely from his strongholds. In this 
 very county, as before intimated, the advancement of agri¬ 
 culture, in the clearing of forests, drainage and other physical 
 improvements, have made and are still making, many of our 
 hitherto most sickly places the most healthy. Thus are the 
 profits and improvements in agriculture made to correspond 
 with the improvement of health and the prolongation of 
 human life. 
 
 But there are other than physical causes operating in 
 this section with more than ordinary force in the production 
 of disease. I refer to those emotions and to those liarrassing 
 cares and crushing anxieties connected with the existence 
 and results of the late war. Herein are causes which have 
 already placed beneath the sod many of our oldest citizens, 
 and which are preparing others for premature graves.— 
 Anterior to that period, we did not meet upon the streets of 
 our cities and on the byways and highways so many witli 
 haggard eyes, dark frowns, pale faces, and discontented 
 weariness of body and mind, as we now meet in increased 
 numbers at every turn. Nor did the physician have then, as 
 now, upon his list of patients, so many of those long suffering 
 victims of nervous, dyspeptic and organic diseases. I can 
 discover in my own practice the cause in the war and its 
 results; and the effects in a much larger number of these 
 cases, especially of heart disease. Never have I seen so 
 much comparatively of paralytic disease or nervous affections 
 generally, and of functional and organic derangements of the 
 heart, as I have witnessed since the war. These influences 
 upon health and longevity are as marked, in my observation, 
 as they are lamentable. These causes, however, are not to 
 be mistaken for or confounded with imperfect food, bad 
 clothing, violent exposures, &c., or with those other influ¬ 
 ences that arise from the atmosphere, soil and other physi¬ 
 cal characteristics of our low flat country, which either in 
 their direct influence upon the human organization, or in 
 their indirect operations, so act upon the mental and physical 
 powers as to lower the action of the vital forces and produce 
 disease. But these causes in relation to the war are sepa¬ 
 rately marked by those profound impressions of the mmu 
 and body that attend disappointments, blasted hopes, woun¬ 
 ded sensibilities, and the inroads of the canker-worms o 
 penury and want. Upon no class have these disastious 
 
12 
 
 results of the war been so marked as upon the medical pro¬ 
 fession. Not only have they made the true medical man 
 poorer, from his humane disposition to respond to every call 
 for his services, and to extend the credit system, when lie is 
 about the only man in the community who does it at all, but 
 the increased wear and tear legitimately upon his mental 
 and physical system, in every respect, since the war, more 
 than that upon other professional men, have produced and 
 continues to produce more haggard looks, more gray hairs, 
 a greater tendency to functional and organic disease, and a 
 more general and premature decay, physically in him, than in 
 the follower of any other occupation or profession among us. 
 
 The changed relations of our colored population have given 
 a new interest to our tables of health and mortality. While 
 the vexed question of their capacity for self-government 
 politically, is left as a problem to be solved by themselves 
 and the politicians and statesmen of the country, it has 
 already been demonstrated, that in this period of their 
 progress in freedom, they are, as a class, incapable of taking 
 ordinary care of their health. Prior to their emancipation, 
 under the kind attention and fostering care of their former 
 masters, which, in sickness as in health, they received, their 
 general health was as good and their mortality as small as 
 those of the whites. But sickness prevails more generally 
 now among them than the whites, and death is making sad 
 havoc in their ranks. Disease in its acute stage or chronic 
 form, often of scrofula and consumption, is sweeping them 
 off by thousands, almost every month, in these Eastern 
 Counties. While they can better stand the sunshine and 
 heat of our summers than the whites, they cannot so well 
 resist the rigors of winter, and the African succumbs more 
 readily than the Caucasian to severe congestions and high 
 inflammations. The latter bears depletion much better, and 
 requires less of stimulation. Naturally improvident and care¬ 
 less, obliged to assume the responsibility of providing for 
 themselves, they are dying in large numbers, from exposures 
 and from the want of cleanliness, clothing, food and medi¬ 
 cines. They are living upon good terms, generally, with the 
 whites, especially their former masters; and the whites are 
 doing all in their power to aid them. But in consideration 
 of their number and the amount of their suffering and sick¬ 
 ness, true philanthropy and genuine Christianity, so fond of 
 going beyond distant seas in search of the poor and idola¬ 
 trous heathen, would do well to look more closely to our 
 own shores as missionary fields worthy of the dissemination 
 of the blessings and means of the cause of missions. Since 
 
emancipation, this :, race (previously so prolific In num¬ 
 bers,) Lave but lew children, comparatively, and many of 
 them are given to the crime of abortion/ The mortality 
 among them is very great and alarmingly on the increase; 
 and I now suggest to this Society the importance of taking 
 special steps to secure more accurate statistics of their mor¬ 
 tality. If this progresses for the next fifty years, in the 
 same ratio as it has done within the last five, this unfortu¬ 
 nate race, destined to remain among us, endowed not only 
 with the claims of humanity but with equal rights of citi¬ 
 zenship, and so worthy of the sympathies and assistance of 
 every lover of humanity and friend of civilization, will, long 
 •before this period expires, have become not alone greatly 
 -degenerated in physical endurance and longevity, but, sad 
 -to say, vastly diminished in numbers. 
 
 I will allude to but one other prevailing cause of disease 
 -among us. It is not that of imperfect food and clothing, 
 which since the war has been so seriously felt among 
 white and black, operating as a constant source of disease 
 sand death. Nor do I refer to any every-day exciting cause, 
 originating from excess of passion, or fatigue, or food, or of 
 ^sudden reduction of temperature, suppression of perspira¬ 
 tion, violent exposure, &c., but I refer to that inlliction upon 
 the health of the community which is produced in the 
 alarming amount over all preceding years, of cheap , Imu, mean 
 •ardent spirits, dispensed by the multifarious grog shops and 
 drinking saloons which have sprung up and are springing 
 up among us. Nearly all the. abominable, adulterated, in¬ 
 flammatory, poisonous liquids in the shape of whiskey, gin, 
 brandy, rum, &c., that the ingenuity of man can manufacture, 
 and which, from their poisonous and fatal eftects, can no 
 longer be imposed upon the Western, Eastern and Northern 
 markets, are now from their cheapness, and the too generous 
 credulity of Southerners, flooded upon this poverty stricken 
 land. The opinions of mankind are too often based upon 
 their appetites and inclinations, as well as their supposed 
 interest. When there is a fondness for drinking ardent 
 spirits, the thousand excuses and arguments therefor are 
 always ready, even if reason and experience teach that sick¬ 
 ness and death are the legitimate results. And they are 
 now productive of a greater amount of injury, not onJy m 
 ‘causing disease, but in aggravating all forms of fevers and 
 epidemics, where the patient has been previously addicted 
 to an excess, than is generally acknowledged by those 
 ^unacquainted with the very largo amount of cheap vhiskev 
 
14 
 
 that our people consume in this day. It is time that our 
 law makers and conservators of the public health had risen 
 in their power and in defiance of the demands of the grov¬ 
 eling appetites and prejudices of these demoralizing times ; 
 and armed with the panoply of truth, humanity and science, 
 had enacted and enforced more strongly sanitary and 
 other laws that will stay this tide of corruption, sickness 
 and death which is filling so many new made graves, and 
 crowding our prisons, hospitals and insane asylums. I take 
 the liberty of appealing to the Board of Public Charity of 
 North Carolina, whose important services in the cause of 
 humanity in our State arc of so much interest to all classes 
 and occupations, to address them selves wutli renewed energy 
 to this important feature of their labors, and to give to the 
 subject its merited prominence in their next report to the Leg¬ 
 islature. And I also appeal to the proper authorities every¬ 
 where, to the municipal authorities of every town and city, 
 to the board of commissioners of each county, to the trus¬ 
 tees of the poor, to the guardians of public health all over 
 the State, to men in office and out of office in every com¬ 
 munity, who have bosoms that glow with the generous emo¬ 
 tions of State pride or warm with the love ol humanity, to 
 gome, one and all, to the rescue of our people and State from 
 this maelstrom of destruction to the health and lives of our 
 fellow citizens. The great decrease of population among the 
 colored people already referred to, their habits of indolence, 
 vice and crime, and the awful destruction of human health 
 and life of both the African and Caucasian races of our State, 
 by this alaiming increase of grog shops, liquor saloons, and 
 whiskey drinking, is enough to stir the hearts and nerve the 
 arms of every patriot, philanthropist and Christian. No man 
 who is able to estimate the blessings of health and virtue, 
 or to appreciate the relations of population to the welfare of 
 the community, or the prosperity of the State, can hesitate 
 to admit the magnitude of this question. Every man versed 
 in political economy, knows the importance of health and of a 
 good population and of good order to the industrial pursuits 
 and general welfare of every community. Every legislator., 
 who loves his race and State more than party, and who 
 allows reason, justice and conscience to guide him, rather 
 than prejudice, ignorance or passion, will not hesitate to 
 listen considerately to the voice of lamentation and sorrow 
 that now comes in pleading tones from every quarter of our 
 State for more effectual means and measures, moral and 
 legal, to stay this sweeping tide of misery and destruction. 
 
PREVAILING DISEASES. 
 
 It lias been unusually healthy in this locality, as I think it 
 lias been generally in the South Eastern pait of the State for 
 several years past. An epidemic of Yariola, in 186G, and 
 another of Diptheria, in 1869, appeared in this city. "With these 
 exceptions, no general epidemic of the whole country has 
 appeared since the war. Our endemic diseases of summer and 
 fall have been milder in form, and fewer in number than 
 common, while the ravages of war have decimated our 
 numbers, desolated our fields, and paralized our industrial ope¬ 
 rations, it would seem that Providence, in mercy at the woes 
 and sufferings of this afflicted land during the last decade 
 has, within the last few years, interposed His mighty arm of 
 deliverance in protecting our people, in their noble efforts at 
 recuperation, from the usual amount of sickness. Still there 
 lias not been an entire absence of the diseases more peculiar 
 to the different seasons and always of interest to the progress¬ 
 ive physician. In the winter we have the customary inflam¬ 
 mations of the respiratory apparatus. Cynance Trachsales, 
 Pneumonias, Bronchites, Pleurites, &c., together with 
 .Rheumatisms, Neuralgias, and other diseases, acute and 
 chronic, of these Eastern shores. In the Spring we have 
 a continuance of these inflammations and chronic derange- . 
 ments, together with influenzas and diseases of the stomach 
 and bowels, more particularly of children. It is in these 
 months and later in the Summer, that we have more preva¬ 
 lent, that terror of parents and fruitful source of mortality— 
 Cholera Infantum. The Spring, too, is often marked by an 
 aggravation of that numerous class of nervous diseases in the 
 shape of Neuralgias, Neuralgie Rheumatisms, Spinal affections. 
 Sciaticas, and other nervous affections, which in their tormen¬ 
 ting nature love to linger here a large portion of the whole 
 year. In their causes, however obscure,.I do not consider it 
 bad medical logic to attribute a large share to these anoma¬ 
 lous influences of malaria upon our nervous organization, 
 and other structures. True, the distressing maladies may, 
 in this moist climate, be owing in no small degree, to the influ¬ 
 ence upon the organization of those sidden vicissitudes o 
 temperature observed in this locality. The tliermometei 
 .often falls or rises forty degrees and upwards m less than 
 twenty-four hours, during the winter and spring, and Icannot 
 .admit with some, that these great changes are unattended 
 with injury to the health. Still I believe that pbsen a ions 
 which have been and will be made in the yet inviting cc o ^ 
 malaria will disclose valuable facts in their relations o CS( j 
 nervous and other diseases, which in their mini ci am 
 
1G 
 
 severity are, as already stated, more common to malarious 
 than other localities. 1 repeat my conviction that this taint of 
 malaria modifies most our diseases, not merely those of 
 acute inflammation, but is influential in the cause and modi¬ 
 fication of very many of that numerous family of chronic 
 diseases, splenic and hepatic derangements, subacute inflam¬ 
 mations of the stomach and bowels, dropsies, stomatitis 
 materna, and other lingering complaints, more numerous and 
 obstinate in malarious than in more favored sections as 
 regards health. Nor is this influence of rapid change of 
 temperature and of malarious taint, more to be considered in 
 tracing the came, than in adopting the corresponding treat¬ 
 ment, of this extensive class of diseases, acute and chronic, of 
 malarious portions of the country. Inflammation of the 
 bowels, I have already remarked, is prominent among our 
 ordinary diseases of spring and summer. I have known it to 
 prevail extensively and violently here in an endemic and 
 epidemic form also, and in despite of the best medical 
 tieatment, hurrying many adults, as well as .children, rapidly 
 to the grave. In the shape of an epidemic dysentery, a 
 malignant disease of the bowels prevailed over a limited 
 section of the county about one year ;ago. There were 
 numerous cases in and about the vicinity of the town of 
 * Lillington, in this county. It was one of the most difficult and 
 dangerous forms of bowel disease which I ever encountered. 
 It seemed to select from preference the borders and bottoms 
 .of adjacent streams. Some of the cases seemed periodical in 
 .character giving force to the opinion that the terrestrical 
 •exhalations from these bottoms were connected with the 
 eause. It occurred in that season when these bottoms and 
 .streams were dry, and when the cool nights and warm days 
 .denoted those vicissitudes of temperature, that so sensibly 
 impress the skin and produce a want of balance in the circula¬ 
 tion. The influence in contracting the capillaries and smaller 
 .arteries, and impelling an immense quantity of blood through 
 the internal and lesser resisting vessels, disturbing the 
 equilibrium and nervous and vascular power, was likewise 
 .attended with other abnormal changes and intestinal irrita¬ 
 tions so well known to produce diarrlicea and dysentery. It 
 .spared neither age nor sex. It was generally ushered in by a 
 chill, followed with fever, severe pains in the bowels, head 
 and other parts, with mucous and bloody discharges. To a 
 constant nauseu and irritability of the stomach, thirst, and 
 other ordinary symptoms of bowel complaints, there was 
 added early and rapid prostration, continued high fever, and 
 a persistent discharge of bloody and dark coloured matter. 
 
IT 
 
 winch resisted, with remarkable success, all attempts to change 
 its character or reduce its quantity. Its general character 
 was inflammatory and confined chiefly to the lower bowels. 
 As the type of the disease seemed to contra-indicate the use of 
 the lancet, I found a free administration of mercury, if the case 
 was seen early, the most potential remedy in subduing the 
 disease. This followed with such smaller doses combined 
 with opiate and astringents as circumstances indicated, using 
 sudorifics when they could be retained, poultices, Ac., consti ¬ 
 tuted the main treatment, modified according to the varying; 
 symptoms and changes of this truly formidable disease. * 
 
 But of all our Spring and Summer diseases, none is so 
 frequent and so fatal as “ Cholera Infautum,” or the “ Summer 
 Complaint,” as it is commonty called, from its chief preva¬ 
 lance during that season. Of all our prevailing diseases, 
 none so stings the hearts of anxious parents and friends— 
 none is more trying to the metal of-the physician, and none- 
 enters more largely into our mortality than this dreaded 
 enemy of infantile life. I may say, with an emphasis, 
 that is based upon a long observation of the sad and pro¬ 
 verbial want of proper attention to the diet and regimen of 
 children, that no disease demands more than this correct 
 dissemination and intelligent appreciation from the family as 
 well as the medical attendant, of the true principles of food, 
 clothing and general hygienic treatment necessary for them. 
 Insidious in character often this scourge of childhood is too 
 frequently allowed to approach a fatal termination, under 
 that temporizing domestic management based on the want 
 of correct views as to the cause, nature and pathology of the 
 disease. If the bowels can only be checked, the anxious? 
 mother too often rests satisfied that the child is improving 
 and the danger is over, while in fact the slumbering fires- 
 beneath are only aggravating the actual condition—while the- 
 main predisposing cause is so generally found in the 
 changing temperature and other conditions of the atmos¬ 
 phere, modified more or less by emanations from contiguous- 
 soils. It is to be regretted that there does not prevail a more 
 general appreciation of the laws of what I shall term infant 
 hygiene , as related to the attendant circumstances and condi¬ 
 tions found—indentition, improper clothing, unnecessary 
 confinement within door from the health-giving influence of 
 the sun and air, violent exposure at other times, bad iood, Ac. r 
 that not merely excite but aggravate this disease. It annu¬ 
 ally bears its thousands and tens of thousands of victims to 
 premature graves—New Hanover County and Wilmington 
 furnishing their sad quota. Let the suggestions ol common 
 
sense and of philosophic medicine be more generally heeded 
 by the community, and more, many more, of our children 
 will live to bo sources of joy to parents and friends and bless¬ 
 ings to the community. In the diet, clothing and general 
 hygiene of their children, will not our mothers consent to 
 heed less the allurements of fashion and false pride and 
 listen more to the demands of reason, experience and 
 humanity? Would they save their darling offspring from 
 diarrhoea, cliolara infantum, <fcc. ? If so, let them take more 
 warning from the solem truth, which needs to be more 
 profoundly impressed upon them all, that not alone do 
 sudden atmospheric changes and bad air contribute to the 
 production of these diseases and of otln r congestions and 
 inflammations of children, but that their ignorance and false 
 pride, in adhering to practices unreasonable and* customs 
 ruinous in the feeding and clothing of their children, are 
 not less potential in causing infantile disease and mortality. 
 Let children be taken in good weather, from the unwhole¬ 
 some air of pent up abodes into the more invigorating life of 
 the out-door air* and sunshine of Heaven. The accumula¬ 
 tion of a litl-e dirt and sun-burn will readily yield to soap,, 
 water and time. Let us teach these fashionable mothers* 
 how it is that their devotion to low neck dresses, bare arms 
 and legs causes such a loss of animal heat, such defective 
 circulation in the parts exposed, and such an excess of blood 
 to the internal organs as* often ends in their congestion and 
 inflammation, not unfrequently ending in death. Mothers 
 who so often wilfully disregard the- plainest laws of health in 
 these respects, of raising their children, would shiver and 
 suffer from suck exposures of their own persons and oxpect 
 to be sick therefrom, and yet they can stand such treatment 
 with far less danger than do their tender infants.. The symp¬ 
 toms of the formidable disease in question aire- much tho 
 same here as elsewhere : pulse small and quick; fever higher 
 at first, assumes the lower grade as it progresses; irritability 
 and frequent evacuations from the bowels often attended 
 with nausea and vomiting; thirst more or less ; urgent; 
 discharges, at first, more of undigested feculent matter,, 
 mixed with bile, become more of a combination of mucus 
 bile and serum, greenish in color and offensive. The serous 
 portion is more easily absorbed by the diaper of the child, 
 leaving the green mucus discharges more visible to the eye. 
 When these discharges change to those more putrid exhala¬ 
 tions from the mucus coat of the intestines, the danger is 
 of course increased and the symptoms more aggravated,— 
 sometimes, even in eases which seem to be extreme, the 
 
1 o 
 -I o 
 
 disease is checked and tends to revolution and ends ill 
 recovery. Too often, however, do encouraging symptoms 
 exist* but to delude and disappoint. The heart of the fond 
 parent is thrilled into joy to-day, only to be more deeply 
 plunged in anguish, as on the morrow more fatal symptoms 
 than ever supervene. The child, however, lives on. It be¬ 
 comes more and more reduced to a mere skeleton ; the skin 
 becomes more loose and flabby ; the face more shrunken and 
 j^ale, indicating still more suffering and distress ; the signifi¬ 
 cant turnings of the head takes its place with other bad 
 omens. The evacuations from the bowels in these fatal 
 cases* suspended though they may be for a time, break forth 
 with renewed power—other untoward symptoms complicate 
 the case. There is a general failure of the vital forces. 
 The disease, in defiance of all the powers of nature and the 
 best medical aid, lays the little sufferer in the grave. To 
 detail the treatment is but to repeat an old familiar tale, as 
 its recital by different persons give to it its changing hue and 
 various shades. Small doses of mercury, in the early stage 
 especially, with the various combinations of opiates, astrin¬ 
 gents and antacids, I have found most beneficial. As the 
 case progresses, subnitrate of bismuth, Dover’s powders, 
 acetate of lead, alternated as indicated, with the various 
 other adjuvants, external and internal, with a constant at¬ 
 tention to proper food and to the general support of the 
 system, enter into the established principles of treatment in 
 this section. 
 
 Our sickly season commences in July. It generally appears 
 with so much regularity, that the physician expects and 
 prepares for it with as much certainty, as does the farmer 
 arrange his ground for corn in the spring, or for wheat in tho 
 fall. It brings with it a crop of diseases more generate than 
 any other, in the shape of malarial fever. Here it is that 
 until a few heavy frosts in the fall come to our relief, 
 our medical men battle with and generally vanquish that 
 varied type of fever known as remittent, intermittent and 
 congestive. Commencing most generally with simple inter¬ 
 mittent, it increases in severity and obstinacy, with the ad¬ 
 vancing season, and is succeeded by remittent or congestive. 
 Under the disturbing influence of some exciting cause, the 
 intermittent form is ushered in by the usual cold or chilly 
 stage, followed by sick stomach, pain in head, back and 
 limbs, furred tongue, accession of fever, &c. This mild form 
 is followed later in the season with that higher grade, of 
 bilious fever, wherein there is an aggravation and exaltation 
 of all these symptoms. The system is more prostrated and 
 
 C 
 
20 
 
 restless, pulse quicker and stronger. There' is more or less 
 gastric or cerebral disturbance according as the gastric or 
 cerebral form of the fever predominates in different seasons. 
 Add to this grade, and you have sometimes, as the weather 
 becomes warmer, the season more advanced, and the amount 
 of sickness on the increase, cases of bilious congestive fever. 
 These are more striking still in violence and danger. It is 
 now that the faithful interpreter of nature and of the laws of 
 disease must come to the rescue. Not alone with the reme¬ 
 dies suggested by enlightened experience and science, but 
 with the caution, firmness and decision of the true physician. 
 With antiphlogistic remedies and antiperiodic medicines 
 must he, in this critical hour, battle with opposing forces, or 
 else this high congestion and raging paroxysm will maintain 
 the victory unto death. When promptly and properly treated 
 these autumnal fevers, however variant the type in different 
 seasons, are generally cured. When neglected, or impro¬ 
 perly treated, they are apt either to terminate fatally, or to 
 run into a slow and tedious, and sometimes fatal, form of 
 typhoid fever, more or less complicating with the original 
 bilious remittent. Indeed this blending of the types of fever 
 either at first, or from the cause just named, is a feature 
 sometimes of our autumnal fevers not to be forgotten, either 
 in diagnosis or treatment. There is more or less of it every 
 year, and whenever or wherever it appears, demands fine 
 discrimination and very careful treatment. Leaving out of 
 consideration the question of uncomplicated typhoid fever 
 which often appears sporadically, and otherwise, in this 
 locality, we have to repeat 3 that in whatever form or compli¬ 
 cation malarial fever presents itself—whether as a simple 
 intermittent, remittent, or blending of types, or in a bilious 
 congestive form, with that prostration, high fever, delirium 
 and yellow bilious tinge, peculiar to the skin, tongue and 
 eyes, and incident to the danger and critical condition of a 
 high grade of fall fever—the treatment must correspond with 
 the indications and severity of the'case. In the usual course 
 of uncomplicated malarial fever, I have not only found 
 quinine indispensable, but mercury in quantities and doses, 
 to suit the grade of fever, a most important auxiliary means. 
 Its action upon the liver, which is so greatly involved in this 
 disease, is very necessary in those cases, and I have seen 
 deplorable results follow the neglect of its use therein. If 
 those physicians of Great Britain and elsewhere, who, by 
 their experiments upon dogs, have concluded that calomel 
 has no specific infiuence upon the biliary secretions, and that 
 it is not entitled to be ranked among the cholagogucs, could 
 
21 
 
 make their observations upon the human subject in the 
 diseases of these high Southern latitudes, where the liver is 
 so evidently engorged, and calomel so strongly indicated, 
 they might be induced to bo less peremptory in their express¬ 
 ions, and a little more charitable to those who difler with 
 them as to the action of calomel and the treatment of 
 disease. I will discuss this question at more length, how¬ 
 ever, when I enter upon the more elaborate subject of the 
 treatment of internal inflammations, and of the high conges¬ 
 tive fevers of this southern latitude, as I shall do in my last 
 division of the General Treatment of Disease. 
 
 Quinine, in larger and repeated doses, I administer with 
 impunity, whenever its prompt influence upon the system is 
 necessary. An important disease of increasing interest in 
 our eastern section has presented me with a number of cases 
 during the past few years. I refer to it the more readily 
 because in proportion to its importance, the allusions to it 
 in our standard books and journals, are too brief and in¬ 
 definite as respects the relative value of its pathology and 
 treatment. I allude to the disease known as “ Puerperal 
 Anaemia,” or “ Stomatitis Materna,” or more popularly 
 known as the “ Nursing Sore Mouth.” It has been known to 
 prevail as an epidemic in the great Mississippi valley, where 
 it has mostly existed in this country. It seems to prefer 
 malarious regions. Here, the cases presented are sporadic 
 mainly, if not entirely. This disease of pregnancy and 
 childbed seems to be an inflammation per se, presenting a 
 depraved state of the blood, attended with such a preponder¬ 
 ance of white corpuscles and deficiency of red particles as 
 make up an anaermic condition, or Brunet’s “ Leucaemia of 
 Pregnancy,” as it is called. The fact that it occurs but 
 seldom ill the lower classes, being chiefly confined to women 
 of fine intellectual endowments, delicate organizations and 
 nervous temperaments, who remain close at home and avoid 
 exercise in the open air during pregnancy, point to these 
 defects in functional action and hygienic measures,, and this 
 condition of anaermia is favorable to its production. In¬ 
 sidious in its approaches and deceptive in its symptoms, it 
 is often so mild in its progress in early pregnancy as to fail 
 to attract marked attention, or is mistaken for some other 
 disease. Hence weeks and months of golden importance 
 have been too often allowed to pass before proper treatment 
 is commenced. Then it becomes so grave as sometimes to 
 render the approach of the full term of gestation truly 
 alarming. And, occasionally after childbirth, the case runs 
 its course to fatalitv. The importance then of proper treat- 
 
ment in the very incipiency of this increasing disease among 
 us cannot be over estimated.- Taken in time, suitable medi¬ 
 cation generally effects a cure. I have found the best treat¬ 
 ment to consist in an administration of those constitutional 
 remedies found in chalybeate tonics, alteratives, astringent 
 bitters, good food and generous support, which strike at the 
 root of the disease and effect the necessary change of the 
 fluids from their abnormal to their normal condition. The 
 alarm created by the appearance of those secondary symp¬ 
 toms of aphthous ulcerations appearing on the tongue and 
 travelling downwards through the whole alimentary canal, 
 and attacking the mucous surfaces of other structures, often 
 attract such attention and local treatment to these coexistent 
 lesions as to cause the general treatment to be neglected 
 until too late. 
 
 Among our most common diseases, and one that seems to 
 be alarmingly on the increase in this county, is “ Pulmonary 
 Consumption.” My observations do not corroborate the 
 opinion that either a moist or a malarious climate lessens its 
 liability. Nor have I observed any facts to justify the too 
 common opinion that this dreadful malady is nearly always 
 hereditary or intimately connected with certain climates. 
 This error, conjoined with a popular belief, too often fixing 
 itself upon the attending physician, that the disease is 
 always incurable, is exerting a deleterious influence upon the 
 course of medical science and the claims of humanity. I see 
 cases every year that could be traced to neither of these 
 causes, but were dependent upon excess in sedentary occu¬ 
 pations, too much confinement within doors, over anxiety of 
 mind, bad air of apartments, disregard of other hygienic 
 laws, and more especially for the want of clothing during 
 our winter months, and of sufficient food the year round, 
 which render their victims so susceptible to disease, and 
 which, in the present day, causes so much suffering in the 
 community, more than ever in this section in this want of 
 food and clothing, not alone a prolific source of acute affec¬ 
 tions, but of those gradually consuming diseases of Scrofula 
 and Consumption. And when the important fact is borne in 
 mind that this frequent disease of Pulmonary Consumption 
 is so generally fatal, although dependent so often upon 
 causes which may be modified and sometimes removed by an 
 application of the ordinary motives and principles of pru¬ 
 dence, philanthropy and science, it is high time that our 
 profession should more generally arouse, in conjunction with 
 other non-professional philanthropists of the day, and ad¬ 
 dress themselves with increasing vigor and faith to the 
 
23 
 
 blessed work of more correctly understanding and removing 
 the causes of this most fatal disease of the whole country. 
 I may remark that my medical observations and experience 
 as a Surgeon in the Confederate army during those late four 
 years of bloody war, justifies me in the opinion, that most 
 of those who left their homes for its active service with weak 
 lungs and tendencies to “ Phthisis Pulmonalis,” and even 
 sometimes incipient tubercles and who escaped other dangers 
 and diseases of that conflict, returned home either greatly 
 improved or entirely restored. I have nothing new to offer 
 as to treatment, excepting to express my concurrence with 
 the established opinion of the great superiority of the 
 modern building-up treatment of tonics, alteratives, stimu¬ 
 lants, good food, out door physical exercise, &c., over the 
 old plan of diet, depletents, &c. I have found more general 
 good to follow the use of arsenic when the condition of the 
 stomach and bowels will tolerate it, than from any other 
 single remedy. When the digestive organs are not impaired it 
 seems to act most favorably upon the functions of nutrition, 
 furnishing new life to the countenance, more animation to 
 the eye, a better appetite and more general strength and 
 flesh to the languishing patient. The recent observations of 
 some of the most illustrious physicians of Paris, that its use 
 in this disease also acts happily on the mucous membranes 
 of the lungs are sustained by my experience. The inhabi¬ 
 tants of lower Austria, Styria and the Tyrol, frequently make 
 use of arsenic even in health, because it enables them to 
 breathe more freely in climbing up their rugged mountains. 
 
 But whether arsenic is to be used when indicated, or the 
 different preparations of iodine, iron, vegetable tonics, good 
 diet, stimulants, cod liver oil, Ac., according to the stage of 
 the disease, tolerance of the stomach, or the general condi¬ 
 tion of the patient, and the attendant circumstances. I 
 choose not to be of those physicians who honestly prefer a 
 voluntary abandonment of consumptive patients, either to 
 the powers of unaided nature, or to those swarms of medical 
 sharks who, in their unprincipled course and with their 
 captivating paraphernalia of consumptive remedies, infest 
 every community. These medical imposters, whose flaming 
 advertisements are seen in every newspaper and public 
 place, rely upon meanness for a living, and fatten upon the 
 ill-gotten gains which they extract from the unfortunate and 
 sinking subject's of this chronic and wasting pulmonary 
 malady, and who, as is so natural, are so generally liable to 
 become the injured victims of the glittering hopes held out, 
 and the lying promises made. My conceptions of duty to 
 
myself and -of a common obligation to my profession and 
 humanity, do not encourage me, of my own accord, to abandon 
 these trying ;&nd touching cases to the various snares thus 
 set for them, nor even to rest satisfied with the ordinary 
 palliations of regular treatment, except in the last stage. 
 Bather do I elect to work on and to hope on in the faith of 
 curing the disease by legitimate means. While its relative 
 mortality is so fearful and discouraging to friends, and so 
 many in our own ranks get much, very much, of this vast 
 amount of disease, and death may be prevented by the exer¬ 
 cise of more persistent faith and more skilful management, 
 especially in its earlier development and inception. The 
 progress of medical science finds me a believer in the 
 prophylactic treatment of this formidable disease. Judi¬ 
 ciously applied, I regard it as not only capable of preventing 
 much suffering, but able to snatch from premature graves 
 many a darling son or daughter—the delight of parents and 
 the ornament of the social circle, and from the consumptive’s 
 -death, many a father and mother—the pride, hope, and 
 dependence of the family and the joy of admiring friends. 
 Let me proceed to explain : This thing of tubercle, and how 
 it is deposited in the lungs, &c., has long been unsettled. 
 The most popular theory has been that it is an abnormal 
 exudation from the blood. As we all know pathologists 
 recognize two forms of tubercle, the gray miliary and the 
 yellow, cheesy tubercle. Whatever the origin or nature of 
 this tubercular deposit, its tendency, unless removed, is of 
 course to suppurative abscess, and destruction of the tissues 
 involved, with a gradual waste of the entire physical system. 
 
 J. H. Bennett stands most prominent among those who 
 contend that tubercle is an exudation or abortive development 
 of the plasma of the blood. That great microscopist, 
 Yircliow leads those who make a distinction between the 
 grey and yellow tubucle, getting a clue therefrom, it is said, 
 for his well known doctrine of cell growth. He and his dis¬ 
 ciples contend that the gray tubercle is but a progressive 
 development of cells from a parent cell, and that the yellow 
 tubercle is only the result of a fatty degeneration and disinte¬ 
 gration of other tissues, perhaps of the gray deposit itself, or 
 of pus, or of carcinoma and the like. They hold that this 
 gray tubercle may cause what they denominate acute 
 phthisis, with constitutional symptoms, not unlike those of 
 typhus fever, for which it has been sometimes mistaken, but 
 that this form of pulmonary disease is unlike that old 
 fashioned form of chronic Phthisis Pulmonalis, which by its 
 slow and wasting ravages daily lays its thousands in tho 
 
grate, and that is' caused by the yellow or cheesy tubercular* 
 deposits. It is contended that this yellow material comes, 
 not as an exudation from an altered state of the blood, but 
 from the -worn out epithelial cells of the air vesicles. That 
 instead of being removed by the vital actions of the part, 
 they are allowed to remain as sources of irritation, and by 
 gradual accumulation render that portion of the lung unfit 
 for respiration. The advocates of the epithelial origin of the 
 common yellow tubercle, argue that tlieir theory explains 
 satisfactorily difficulties and problems that cannot be solved 
 by the admission of the doctrine of exudation from the 
 blood—that the advocates of the latter cannot show how it 
 is that these cheesy deposits are so uniformly found on the 
 apex of the lungs, and are so long restricted to one side of 
 the lungs, after being deposited. They contend that no 
 chemical or microscopic test has ever discovered any proof 
 of that peculiar morbid condition or alteration of the blood 
 claimed as necessary to the production of the deposit in 
 question. Virchow says that he “ found a series of tubercular 
 deposits in different organs, never at any time exhibited a 
 discernible exudation, but always, during the whole course 
 of their development, presented organized elements, without 
 its being possible to observe either in them, or before they 
 existed, any stage in which amorphous, shapeless matter 
 was- present.” He ^lso says that “ nuclei and cells are found, 
 in great abundance, though they afterwards break up, and 
 directly supply the material for the final accumulation of 
 cheesy substance.” Upon such and similar grounds are 
 founded their argument, that this material is not a morbid 
 product of exudation from the blood, but that it is more of a 
 normal constituent, which, failing to be excreted in time, 
 remains as a foreign body to be softened and excreted by 
 expectoration or otherwise removed from the system. They 
 reason that this deposit is not found in those lower and 
 more depending portions of the lungs where movement is so 
 free and easy, but in those upper parts where the bony 
 structures and harder parietes do not admit of that full 
 motion and play of the lungs necessary to the full ingress 
 and egress of air. It is in these portions of imperfect and 
 restricted respiratory action, except at great muscular effoit, 
 that these deposits are almost wholly found, and it is held 
 that these accumulations Would never occur if there was 
 sufficient force to prevent it. It is claimed that this loicc 01 
 agency exists in the pressure of the air vesicles, and in t re 
 power of respiration to press out tlieir contents, and t 1 a. 
 such power mainly depends upon the vigor of the icspnatoiy 
 
2 G 
 
 action. That while the peristaltic action and passing sub-* 
 stances of the alimentary canal are competent to throw off 
 from the mucous surface the worn out epithelium, the ciliary 
 currents of the bronchi are not always thus competent, and 
 that as an auxiliary therefore, a free and full action of the 
 respiratory apparatus is necessary. Adducing such reasons 
 in support of their conclusions, those men not only contend 
 that consumption is curable, but, that as a disease, it is not 
 hereditary. They admit that the tendency to pulmonary 
 consumption may be transmissible in the physical formation 
 or mental temperament of the offspring, but that the disease ' 
 itself is not handed down from parent to child* and does not 
 claim its victims at birth. The celebrated Dr. Walshe says, 
 after a careful investigation of the family history of four 
 hundred and forty-six (446) patients with this malady, that 
 “ phthisis in the adult hospital population of Great Britain 
 is to a slight amount only, a disease demonstrably derived 
 from parents.” 
 
 Not to pursue any further the reasoning of the advocates 
 of this plausible and more pleasing theory of the origin, 
 nature, and curability of this destructive disease, should we 
 not feel encouraged to have more faith, and to use more 
 perseverance, in the prophylatic measures so naturally sug¬ 
 gested by the theory presented? As is a man’s faith so will 
 lie be, as he thinks and resolves so will lie put forth his 
 efforts and continue in his hopes and energies. 
 
 There is encouragement, I repeat, in these cases of pulmo¬ 
 nary consumption. The great, golden rule is to sustain and 
 bring up the general strength. The entire 'physical system 
 shotdd be raised to the highest possible vigor. In the young 
 physical culture is the safeguard against consumption. Incipient 
 phthisis is always preceded by debility. This debility 
 engenders like feebleness of respiration, and this accom¬ 
 panies or rather produces insufficient pulmonary excretion 
 with its consequent accumulation of this epithelial debris. 
 The forerunner of debility may arise from inadequate nutri¬ 
 tion or deficient food, protracted sickness, overburdening 
 mental cares and anxieties. I have often thought that this 
 alarming increase of consumption here, especially since the 
 war, was in all jmobability owing mainly to the general 
 and well known prevalence, since then among us, of these 
 very causes. The deficient clothing and food and general 
 suffering, as I before said, of our colored population, doubt¬ 
 less bears an important part in the production of a greatly 
 increased mortality from consumption among that race in 
 the Southern States. 
 
27 
 
 Drive off this actual or threatened accumulation of tubercular 
 deposit by all those means which will add to the flesh and general 
 strength ., and by. all those measures which loill give the greatest 
 vigor to the respiratory act and add to the fullest expansion of 
 the entire lungs . Special and methodical attention to full 
 respiratory action and to a development of the respiratory 
 muscles—active muscular exercise in the open air—a free 
 use at all times of fresh air—a diet nutritious and digestible 
 —suitable protection to the skin—united to a habitual exer¬ 
 cise of hope and cheerfulness, will not alone insure general 
 health to the lungs and body, but will, in a large majority of 
 cases, prevent the formation and secure the removal of those 
 pulmonary deposits, upon which the ravages of consumption 
 are based. Why do children enjoy such a happy immunity 
 from its attacks ? Because the activity of their habits, the 
 energy of their respiratory movements, and their love, when 
 well, of the open air, which gives them a plenty of oxygen 
 and a full expansion of their lungs, are safeguards to the 
 accumulation of tubercular material. The waste and repair 
 of tissue in children is very rapid, and were it not for the 
 energy and efficiency of their habits and love of play and 
 exercise, they would not be blessed with this fortunate 
 exemption. But when they arrive at the age of puberty 
 their pleasures and habits change. The boy is confined at 
 home or at school, and hours which should be given to play 
 or the exercise of his lungs, finds him at his books or at some 
 other close occupation that denies exercise to his body and 
 expansion to his lungs. It is the same with the girl. She 
 no longer romps over the fields, or sings gladsome songs as 
 she glides rapidly along wherever she pleases. But she is 
 placed under the restrictions of fashion and under the dis¬ 
 cipline of home and school, which regards, too little the 
 claims of health and good lungs. She is imprisoned. in 
 tight dresses, her neck and arms perhaps bare, and is denied 
 the merry laugh, the running gait, and other exercises so 
 much needed to give form and grace to her body and expan¬ 
 sion to her lungs. Can we wonder soon to see that prom¬ 
 ising boy and that charming girl yielding to those seeds of 
 consumption engendered by the unnatural and cruel ch ango 
 to which unwise regulations of home and unphilosophical 
 rules of school subject so generally. the youth of our 
 country ? The wild beast, confined within liis iron bais, 
 often dies with consumption, while the parents continue to 
 roam their native forests to an extreme old age, and die nom 
 some other cause. 
 
 The remarkable benefit derived by our consumptive 
 T) 
 
soldiers during the late war, from the fresh air and rough 
 living of army life can never be forgotten while memory 
 reverts to those trying days, or history shall transmit their 
 unequalled heroism to future ages. They left home, hosts of 
 them with feeble lungs, often bearing incipient tubercles. 
 Others, actually were wasting away with night sweats and 
 profuse expectoration, and were, on this account, never 
 expected to return. A decided improvement seems to have 
 been the result in nearly every instance, and complete 
 recovery followed most of those unpromising cases. Those 
 who, with weak lungs and newly formed tubercular deposit 
 were able to escape other casualties of war, returned home, 
 as I before said, always greatly improved and generally 
 restored. If such examples and facts do not bear their 
 valuable lessons of wisdom and of warning to us all, then 
 may we turn a deaf ear to the teachings of experience or the 
 deductions of observation. It is good fresh air, then, and not 
 confinement in ceiled houses with closed doors that our 
 people should value, especially those who dread, or have, 
 consumption. Muscular exercise, free and persistent, with 
 that all-important attention to the functions of nutrition—to 
 digestion and assimilation, will save our patients from con¬ 
 sumptive graves, if, with living faith in the means suggested, 
 we can in time have the entire management. 
 
 To provide for the physical education of the children 
 around us, is as much a duty, sadly though it is neglected, 
 as is the education of their morals and minds. He whose 
 children and wards are liable to this fell-destroyer of so 
 many of the human race, should especially bear in his bosom 
 at all times an enduring consciousness of the duty which 
 this solemn truth suggests. As conservators of the public 
 health, let us on all appropriate occasions, impress upon 
 every parent, guardian, and instructor of youth, the vital 
 importance of protecting children with warm clothing—of 
 securing for them an abundance of frc sh air and sun-light; 
 that all their rooms and apartments be well ventilated ; that 
 bathing be made a family arrangement; that the diet be 
 plain and nutritious ; that proper habits of self-control in 
 eating be acquired, and that exercise sufficient to develop 
 all the muscles be regularly observed. Due attention to 
 these things is not alone necessary to the health, comfort 
 and usefulness of the child, but essential to the happiness of 
 parents and to the general good and prosperity hereafter of 
 the whole State and country. 
 
29 
 
 GENERAL TREATMENT OF FEVERS AND ACUTE INTERNAL INFLAMMA¬ 
 TIONS. 
 
 He 13 the wise physician who, bringing to his daily prac¬ 
 tice a. mind untrammelled by prejudice or preconceived 
 ideas of earlier training, follows the teachings of observa¬ 
 tions and. the legitimate deductions of science. Such a 
 practitioner, while informing himself of the views of others 
 and the doctrines of his profession at different epochs, will 
 at the same time carefully observe for himself. Thus armed 
 he will go forth to battle with disease in that spirit of inde¬ 
 pendence and self-reliance which forms a material attribute 
 of every truly successful physician. He treats Iris patients 
 upon general principles, modified not only by the sugges¬ 
 tions of each particular case, but by the surrounding 
 circumstances and prevailing tendencies and indications. 
 Profiting by the observations of every case, and the expe¬ 
 rience of the changing seasons and years, he heeds on the 
 one hand neither the extreme views of blind devotees of the 
 past, nor on the other the assumptions of the ultra advocates 
 of the innovations and reforms of the present. But 
 gathering as a philosopher from the past, as well as the 
 present, avoiding those Sc 3 dlas and Charybdes of his pro¬ 
 fession that have always existed, he becomes, in truth, the 
 genuine eclectic in its true sense, learned and unprejudiced 
 while conservative and successful. Pursuing such a course 
 of common sense and enlightened experience, he cannot 
 fail to consult as guides the great Books of Nature and the 
 Laws of Disease. This accustoms him to follow the methods 
 suggested by the changing forms and types of diseases of 
 the different seasons and years, modified by the locality, 
 climate and varying indications of each individual case. 
 From such stand points arises the general treatment of 
 every physician, who, leaving routine and pre-existent 
 partialities and prejudices to such inferior minds as will not 
 study and think, is governed by his own knowledge, and 
 observation as connected with the broad and established 
 principles of his profession. Such a course may not win for 
 him the admiration of shallow minds or the sensational 
 applause of the fickle multitude so prone to be captivated 
 by attractive novelties and the bold innovations of extremists. 
 But instead thereof he will avoid the injury which such nu n 
 do to science and humanity. Ho will, in addition, justg 
 secure the more enviable reputation of skill and success m 
 practice. He will gather around him the sincere friendsnip 
 and lasting esteem of the learned, the sensible, and me 
 
30 
 
 appreciative. When ultraists and extremists have gone 
 down in ridicule, or are forgotten in their graves, his memory 
 will be fondly cherished, and remain to illumine the pages of 
 Medical History. 
 
 In this section of the State, we treat disease according to 
 indications. In one or more seasons the asthenic type is so 
 prevalent, the tendency so strong to the typhoid form, that 
 in acute inflammations and fevers we apply the antiphlo¬ 
 gistic treatment with much caution. In such years we 
 seldom use the lancet, except in occasional instances of 
 violent inflammation and severe congestive fevers. At other 
 periods we find the disease more sthenic in character—the 
 inflammatory symptoms of a higher range—cases more 
 violent and hurry more rapidly either to resolution, if 
 properly aided, or to a fatal end if neglected or improperly 
 treated. Under such indications it becomes our duty to 
 apply with a bolder hand the antiphlogistic treatment— 
 sometimes using the lancet, more generally those mercurial 
 purgatives, blisters, local depletion, diaphoretics, and de¬ 
 pressants which in this locality cannot be dispensed with 
 when our ordinary congestions and acute inflammations 
 assume' an aggravated character. So that our treatment 
 depends upon the prevailing type and individual indications. 
 This is the result of my observation and experience, based 
 upon a laborious practice for the last twenty years in 
 Eastern North Carolina. Earlier in my medical life the 
 sthenic tide was up and my lancet was often used. For a 
 number of years past it has become somewhat rusty, because 
 the asthenic waves have prevailed, though it remains in my 
 pocket case as a necessary companion. Well do I remember, 
 as my note book shows, the high grade of many of my cases 
 treated in earlier life, and I used the lancet freely and often 
 and with marked benefit. It was indispensable that I should 
 open the batteries of my antiphlogistic treatment in order to 
 save human life. But in more recent years the indications 
 are changed—the type is lower, and I bleed more rarely 
 and deplete less freely. I am aware that Markham, Watson 
 and other distinguished medical men maintain the contrary 
 theory, but the great majority of the master minds of the 
 profession are united with the great masses of active prac¬ 
 titioners in support of the belief that diseases change in 
 their type. If we could discard the word type and regard 
 the discussion as betwmen sthenic and asthenic forms and 
 dispositions much embarrassment would be prevented and 
 extraneous matter avoided. But we must take the question 
 as it stands: that nature is powerful and often efficient to 
 

 31 
 
 throw off disease ‘no one will deny ; that the expectant 
 system will sometimes answer, cannot be disj3uted. No 1 
 judicious practitioner ever fails to call to his aid all the 
 conservative strength that is possible from this source. 
 Perhaps the truth more generally lies between the extreme 
 advocates of the phlogistic and antiphlogistic systems. 
 Each correct under certain circumstances, both in error' 
 under other conditions. Especially do they seem to be 
 wrong in the uncompromising tenacity with which they hold 
 to their peculiar views, unmodified by circumstances. How¬ 
 ever this may be, let us, I repeat, maintain ourselves free 
 from prejudice and passion in the contests of those rival 
 theories that have so long divided the medical world, and 
 with the single aim of medical truth follow observation and 
 the legitimate deductions of medical logic whithersoever 
 they may lead. 
 
 These sentiments do not create any sympathy in me for 
 that wholesale proscription and sweejung denunciation of 
 the antiphlogistic system so generally indulged in by the 
 followers of Todd, Bennett & Company. It has become 
 too fashionable to denounce as old fogies and as enemies to 
 true medical progress those who refuse to join the ranks of 
 these proscriptive men. Our medical students, who go. to 
 more northern medical colleges every year for instruction, 
 are taught by professors who never saw a case of malarial 
 fever or treated a case of our high grades of internal inflam¬ 
 mation, that it is suicidal to bleed and ignorance. to give 
 calomel, and they are taught to regard as behind this 
 enlightened age those Southern practitioners who presume 
 now to use in any case these antiphlogistics. I conceive it 
 a duty, therefore, to speak out on this subject noiv ,. as these 
 onslaughts upon truth and the practice and writings of a 
 very large majority of the great, leading medical minds of 
 all ages and countries, are not conducive to the interests, of 
 medical science or to humanity, so long as their heresies 
 remain unanswered and are not exposed. I am the more 
 disposed to discuss this question, because of the industrious 
 efforts being made, within a recent period, to spread in our 
 own State these dangerous doctrines of Todd, Bennet & Co. 
 Their followers are earnestly soliciting their acceptance, by 
 the profession of our good old State, so uniformly unwilling 
 of her own choice to accept heresies of any kind, whether 
 medical, -political or religious. One. of our own sons, a 
 gentleman of talent and promise in his profession, ^ a 
 prominent member of this Society, bearing an honore 
 name, which, by its high accomplishments and brig it pro- 
 
Sessional lustre, lias illumined the medical annals of the 
 State, has fallen from grace, and now stands forth among us 
 as the representative man in North Carolina of this mis- 
 cliievous doctrine. I need scarcely say that I allude to 
 William A. B. Norcom, M. D., of Edenton, whose Annual 
 Address before this Body at Warrenton, in May, 1868, has 
 atttracted much attention, and deserves to be noticed, in our 
 general allusions, to the sentiments of those whom he quotes 
 and endorses. However ungracious the task, it is clue to 
 science and the profession that such sophistry should be 
 exposed, and such false premises and illogical deductions 
 overthrown. Dr. Norcom’s address is ingenious and well 
 put together, but untenable and injurious upon medical 
 practice. It is the more surprising and to be regretted that 
 he has fallen into these errors, because his whole life has 
 been passed amid disease that has presented indications I 
 respectfully submit, calling for different treatment than that 
 he now advocates. Unlike those noted authors whom, he 
 quotes, scarcely one of whom knows anything practically of 
 of the nature, grade, and demands for treatment, of our 
 Southern acute diseases, he is one of our own physicians, 
 daily in contact, from his location, with malarious fevers anct 
 acute internal inflammations, demanding, as I insist, a more 
 rational treatment than he applies. 
 
 The opponents of blood-letting and mercury assume, as 
 their premises, that the progress of medical science and the 
 revelations of truth have subverted the antiphlogistic 
 system, and, in place thereof, have substituted alimentation, 
 stimulants and similar remedies. That blood-letting, mer¬ 
 curial purgatives and other depletants and lowering remedies 
 are injudicious and uncalled for, and that they prolong, 
 rather than shorten disease—increase, rather than decrease 
 mortality. Bespectable medical authorities, not novel to 
 the profession, are quoted in support of these statements. 
 Some of the very authorities, quoted in support of the posi¬ 
 tion taken, may be arrayed in opposition thereto in other 
 portions of their writings. When Dr. Norcom mentions one 
 prominent author, in vindication of his views, he might have 
 named dozens equally high in authority against himself. 
 He fails to acknowledge that the grade of fevers and inflam¬ 
 mations of this latitude generally produce such disturbances 
 and indications, as to demand a more vigorous treatment 
 than do the acute diseases of the regions embraced in the 
 fields of practice of his learned supporters in Europe and 
 elsewhere, who wage this war against the lancet. There tlie 
 observations of those authors are based in the main upon 
 
Hospital and Dispensary practice, when most of the cases 
 treated have passed from the acute to the chronic stage 
 before admission, and, of course, rendering blood-letting 
 inadmissible. Most of their cases are asthenic in character 
 and different from the acute diseases of our latitude that are 
 more phlogistic and demand a more active treatment. 
 <£ Distance,” too, “ lends enchantment to the view,” and names 
 arrayed here as distinguished lights in the profession and as 
 offered to all lowering treatment, w T ill be found by Dr. Nor- 
 com to be more transcendental extremists, patronized but 
 little at home and more respected abroad. They will suffer 
 in comparison with the scores of those successful and 
 illustrious men in all ages, who maintain adverse views, who 
 were sensible and practical, and who contribute to adorn the 
 brighest pages of Medical History. 
 
 Dr. Norcom sets out with the emphatic declaration that 
 “ great progress and improvement have taken place in our 
 profession,” and says that “ nowhere is this more apparent 
 than in the treatment of Acute Internal Inflammations.” 
 The improvement on this point is questionable. There is no 
 fact to prove that the treatment of acute internal inflamma¬ 
 tions has improved. For thousands of years the anti¬ 
 phlogistic treatment was employed successfully by the 
 greatest physicians—the founders of the science of medicine, 
 to whom it owes everything, commencing with Hippocrates 
 and running down its illumined pages to Watson, Aitkin, 
 Wood, and others of the present day. The efficacy of tlio 
 anti-phlogistic plan has been attested by the experience and 
 observations made upon millions and myriads of cases^ 
 Until the new lights can show better and more numerous 
 authorities for the superiority of their so-called novelties 
 (but really not) the improvement is not established. 
 
 He next says: ££ Foremost in importance stands the 
 
 enforcement of the study of their Natural History and a 
 revival of the Hippocratian doctrine of a greater reliance 
 upon nature rather than of a perturbatory and lowering 
 treatment and the substitution of a proper and sufficient 
 alimentation for low diet—yes we may say starvation. 
 
 The promulgation of this statement is founded upon a 
 total misconception or misapprehension of the doctrines 
 and practices of Hippocrates. So far from being offered to 
 lowering or anti-phlogistic treatment, he. was one of its 
 most constant and enthusiastic supporters, in fact one of its 
 very founders. It is true he employed it judiciously and 
 wisely, but on all proper occasions, especially in the treat¬ 
 ment of acute internal inflammations, he was one oi tiro 
 
34 
 
 boldest practitioners the world has ever known. This is 
 proven by the following quotations from his works, within 
 the reach of every physician. I quote from the translation 
 of Dr. Francis Adams, published by the Sydenham Society 
 of England, London 1849 : 
 
 “ 1st. Bleed in the acute affections, if the disease appears 
 strong and the patients be in the vigor of life, and if they 
 have strength. 
 
 “ 2. Again : Hypochondria not from retention of flatus, 
 tension of the diaphragm, checked perspiration, with dry 
 orthopnoea, when no pus is formed, but when these com¬ 
 plaints are connected with obstructed respiration, more 
 especially strong pains above the diaphragm—diseases con¬ 
 nected with a collection of humours—all these diseases do 
 not admit of resolution if treated first by medicine, but 
 venesection holds the first place in conducting the treatment. 
 
 “ 3. Again : When a person suddenly loses his speech, in 
 connection with obstruction of the veins, if this happen 
 without warning or any other strong cause, we ought to open 
 the internal vein of the right arm and abstract blood, more 
 or less, according to the habit and age of the patient. 
 
 “4. Again: Patients seized with Epilepsy or Apoplexy 
 are immediately to be bled at the commencement. 
 
 “ 5. Again: In peri-pneumona and pleuritic affections, 
 bleed largely and boldly, if the pain be acute, so as to bring 
 on delinqum animi. 
 
 “ 6. Again : When Pneumonia is at its height the case is 
 beyond remedy, if he is not purged. In Quinsy, bleed in the 
 arm and open the sublingual veins. 
 
 “ 7. Again: In Dropsy, if he labors under difficultly of 
 breathing, if it is in the summer season, and if he is in the 
 prime of life, blood should be abstracted from the arm. 
 
 “ 8. Again : The most important point of regimen to 
 observe and be guarded about in protracted diseases, is to 
 pay attention to the exacerbations and remissions of fever, 
 so as to avoid the times when food should not be given, and 
 to know when it may be administered without danger. This 
 last season is at the greatest possible distance from the 
 exacerbation. 
 
 “ 9. Again: If you think expedient to let blood, see that 
 the bowels be previously settled, and then bleed. Conjoin 
 abstinence, and forbid the use of wine, and complete the 
 cure by means of a suitable regimen and wet fomentations. 
 
 “ 10. Again: For extreme diseases, extreme methods of 
 cure as to restriction are most suitable. When the disease 
 is very acute, it is attended with extremely severe symptoms* 
 
35 
 
 in its first stage, and, therefore, an extremely attenuating 
 diet, must be used. When this is not the case, but it is 
 allowable to give them more generous diet, we may depart in 
 so far from the severity of regimen as the disease by its 
 mildness is removed from the extreme. When the disease 
 is at its height, it will then be necessary to use a more 
 slender diet. We must retrench during paroxysms, for to 
 exhibit food, would be injurious. And in all diseases having 
 periodical paroxysm w*e must restrict during the paroxysms/’ 
 
 How unjust then to the memory of this immortal Father 
 of Medicine, the very author of blood-letting and rigid diet, 
 that Dr. Norcom should refer to him in support of the theory 
 of a greater reliance on nature rather than upon a perturba- 
 tory, and lowering treatment. True, Hippocrates relied 
 much, as all sensible men do, upon the powers of nature in 
 the treatment of disease, but we see from the above and 
 similar quotations that might be given from him, that, when 
 treating severe inflammations and high fevers, he used 
 additional means as do judicious practitioners at this en¬ 
 lightened day. From these passages it will be clearly seen 
 that Hippocrates was one of the prime originators of the 
 lowering treatment, bleeding his patients freely and as largely 
 as they would bear, and following it by rigid diet. He even 
 forbade the use of barley water until the inflammation was 
 arrested. Flow little support do shell or any of the writings 
 of Hippocrates give to the plan pursued by Todd, who saysy 
 “ there is no necessity for having recourse to violent anti- 
 * phlogistic measures in cases of pneumonia [Clinical Lectures 
 Phil., Ed. page 271] and who in “ rapidly spreading 
 pneumonia” gave “half an ounce of brandy every hour,” 
 [page 266 ibid] and in another case of laryngitis, with 
 pneumonia and delirium, gave half an ounce of brandy every 
 half hour. It is true the patients recovered, but have they 
 not recovered after the worst treatment ever invented ? How 
 different the treatment of Hippocrates and that of Dr. Nor- 
 com, who, to a child eight years old, with a severe pneu¬ 
 monia, with pulse 140 and respiration 70 to the minute, gave 
 three pints of milk, one and a half pints of rich soup, with 
 little alcoholic stimulus every twenty-four hours! Dr. 
 Fioreom’s treatment is neither that of Hippocrates or Todd. 
 
 Leaving Hippocrates, we find that all the greater classics 
 of antiquity advocated judicious anti-phlogistic treatment in 
 acute internal inflammations. Celsus recommended both 
 venesection and cupping—[Edinburg Ed. 1814, pp. 60-64.] 
 in pestilential and ardent fevers, ho says, “ if the strength 
 will admit it is best to let blood.” [Page 103.] In the case 
 
 E 
 
of a semi-tertian ne says : •* unless mere is some important 
 reason against it, blood ought to be let in the beginnig.” In 
 pleurisy he says: “Now the cure of a violent and recent pain 
 is letting of blood.” [Page 161.]—of pneumonia and its 
 cure he says : “ It is fit if the strength will admit of it to let 
 blood.” Of the disease of the liver and its cure he says, 
 [page 1641] “ in the beginning the best thing is to let blood, 
 then the bowels must be opened—if this cannot be done 
 otherwise by means of black hellebore.” “In ileus the cure 
 is letting of blood.” 
 
 If we turn to the pages of Galen we find that he is a. 
 strenuous advocate of anti-phlogistics in all acute internal 
 inflammations. Thus in his books on Therapentics, ad¬ 
 dressed to Glaucus, he says: “ We will say then that it is 
 necessary to consider the age of the patient, the season, the 
 country, the actual condition of the air, the strength of the 
 patient, his complexion, his habits, and even the state of the 
 disease. In fact you will ascertain from these whether it is 
 necessary to evacuate or not, and when and how it ought to 
 be done, for example in the diathesis in question. Thus if 
 the determination is to the knee, the j'oint suddenly swelling 
 greatly, if the whole body is redundant with blood, the 
 patient vigorous, the disease occurring in the spring in a 
 very temperate climate, $nd the subject a youth or young 
 man, it will require an evacuation of blood from the upper 
 parts, and to select from the veins of the fore arm—the 
 internal or median vein. If one of the superior parts aro 
 affected the blood must be drawn from the inferior region.” 
 [Vol. 11, pp. 746-50.] Also in inflammation of the uterus, 
 ovaries, spleen, liver, angina, affections of the head, &c., 
 bleeding is enjoined and the mode in which it is to be em¬ 
 ployed and the locality of the operation minutely described— 
 [vol. 2, pp. 755-6.] 
 
 If we consult Aretaeus we find him endorsing the treatment 
 advocated by Hippocrates and Galen. He recommends 
 bleeding in apoplexy [page 259] and cupping [page 265] in 
 tetanus moderately, abundantly in Cynanche with light diet, 
 [page 270.] In pleurisy repeated bleedings [page 286] and 
 cupping [291] are recommended. Repeated bleedings in 
 pneumonia [page 296] in persons of plethoric habits, in ileus, 
 in acute affections of the liver [page 335] and in fact in all 
 acute diseases attended with fever and inflammation. 
 
 The observations of Paulus iEgineta, [Syd. Soc. Ed. 
 1844, London,] one of the most celebrated writers after 
 Galen, proves that blood-letting was the universal practice 
 among the leading authorities of his and previous times. 
 
37 
 
 At tlio same time lie employed it judiciously just like all 
 men of good sense use everything—cautiously when doubtful 
 and withholding it when injurious. Paul of Egina says that 
 “ if the peripneumonia was the original affection and the 
 strength admit we must open a vein, or if not we may cup, 
 proportioning the evacuation of blood to the powers of the 
 patient, but if the disease originate from the conversion of 
 other diseases into this (secondary pneumonia) we must not 
 have recourse to venesection, more especially if the disease 
 be of a chronic nature , and if blood had been previously 
 drawn.” What admirable rules! In all ages we see that 
 those who employed bleeding boldly, yet in many cases 
 withheld it altogether. Indeed many things now promul¬ 
 gated as new more properly belong to the men and ages of 
 the past. Among the Arabians who treated pneumonia like 
 the Greeks, and which Haley Abbas describes as a hot 
 inflammation of the lungs, for which he recommended 
 bleeding, cooling and diluent drinks, &c. We still find 
 Bhazes describing a species of pneumonia which was treated 
 with tonics, wine, &c. [Commentary Paulus Eginefa 
 vol. 1—482.] 
 
 If we come down to Sydenham we find that in acute 
 internal inflammations—pleurisy for example—“ the fever 
 and its most dangerous symptoms were best relieved by 
 bleeding in the arm, applying blisters to the neck and giving 
 injections every day.” Change in the character of disease 
 was even then sometimes observed. He says : “ Now though 
 I conceive that a true and essential pleurisy, which, as shall 
 hereafter be observed, happens indifferently in all constitu¬ 
 tions, does in all years equally indicate repeated bleeding; 
 yet it sometimes happens that the peculiar epidemic fever of 
 the year, from some sudden alteration of the manifest 
 qualities of the air, readily throws off the morbific matter 
 upon the lungs and pleurae, whilst the fever, notwithstanding, 
 continues exactly the same. Wherefore, in this case, though 
 bleeding may be used to abate the symptom when it is very 
 violent, yet, generally speaking, little more blood ought to 
 bo taken away than is required by the fever whenever this 
 symptom depends.”—[Sydenham’s Works, London, 1768, 
 vol. 1—339.] 
 
 The great Cullen, whose authority was for a long time 
 cognized throughout the whole medical world, was, a 
 
 reco 
 
 IS is 
 
 _throughout—- —----- 
 
 well known, an advocate of the antiphlogistic treatment, m 
 acute internal inflammations and fevers. He says : “ Nothing 
 is more evident than that blood-letting is one oi the mosu 
 powerful means of diminishing the activity of the whole oouy, 
 
;38 
 
 especially of tlie sanguineous system, and it must, therefore, 
 be the most effectual means of moderating the violence of 
 reaction in fevers. Taking this as a fact, I omit enquiring 
 into its mode of operation, and shall only consider in what 
 circumstances of fever it may be most properly employed. 
 When the violence of reaction and its constant attendant, a 
 phlogistic diathesis, are sufficiently manifest, when these 
 constitute the principal part of the disease and may be 
 expected to continue throughout the whole of it, as in the 
 case of synocha, then blood-letting is the principal remedy 
 and may be even played as far as the symptoms of the 
 disease may seem to require and the constitution of tho 
 patient will bear. It is, however, to be attended to, that a 
 greater evacuation than is necessary may occasion a slower 
 recovery ; may render the person more liable to a relapso 
 or may bring on other diseases.” He then states under 
 what circumstances blood-letting is to be used in fevers and 
 inflammations, and they are as follows : 
 
 “ 1st. The nature of the 'prevailing epidemic. 
 
 “ 2. The nature of the remote cause. 
 
 “ 3. The name and climate in which the disease occurs. 
 
 “ 4. The degree of phlogistic diathesis present. 
 
 “ 5. The age, vigor, and plethoric state of the patient. 
 
 “ 6. The former diseases and habits of blood-letting of the 
 patient. 
 
 “ 7. The appearance of the blood drawn out. 
 
 “ 8. The effects of the blood-letting that may have been 
 already practised.”—[Yol. 1, pp. 58-59.] 
 
 To these names may be added those of Booerhave, Andral, 
 Ohomel, Lronnec, Louis, Grisolle, McIntosh, Yalleit, 
 Gintral, Stokes, and the great .French medical philosopher, 
 Bouillaud, whose directions to bleed freely in acute diseases 
 I have heard from his own eloquent lips, as I followed him 
 through his wards in the celebrated de la charite hospital at 
 Paris. In fact there are but few physicians of note who 
 cannot be quoted as authority in support of the antiphlo¬ 
 gistic treatment in acute internal inflammation. And yet 
 these great men are charged with being guilty of a reckless 
 and profligate waste of human blood. They lay down the 
 rules by which this treatment is to be guided, and these rules 
 are as good now as they ever were. If our acute internal 
 inflammations of the present day were attended by a hard, 
 full pulse, headache, delirium, redness of face and ardent 
 fever, we would bleed as much as ever, but this is not 
 usually the case. The grade of reaction is lower ; the type 
 usually typhoid or asthenic, and we have, therefore, adopted 
 
a more moderate treatment, just precisely as they advised , 
 and even commanded. By no means would we underestimate 
 the importance of improvements in physiology and pathology 
 in the diagnosis and treatment of disease, but the employ¬ 
 ment of remedies is to be guided by results , and surely wo 
 arrogate to ourselves undue importance in assuming that 
 we of to-day are better judges of results than the long list of 
 illustrious names before us. The mass of the profession 
 indeed began to employ bleeding with more caution long 
 before the great lecturers said a word about it. Men of 
 practical common sense in the backwoods, remote from the 
 centres of learning, and who never read a medical book or 
 journal, recognized this change of disease and demand for a 
 change of treatment just as soon as this new party, so-called, 
 of Todd, Bennett & Co. Men of common sense, who are 
 not (led off by the power of prejudice or the charms of 
 novelty, will profit by the lessons which these facts teach. 
 Every physician, endowed with powers of common observa¬ 
 tion, who is conversant with the history of medicine, has a 
 good share of clinical experience, and refuses to allow his 
 mind to be confused by narrow circumscribed theories, is 
 aware of them and has always been and always will be guided 
 by them. Men may fulminate against mercury, tartar 
 emetic and blood-letting, still the judicious and discrimina¬ 
 ting practitioner will ply them with success and snatch his 
 patients from the jaws of death, at the same time that he 
 guards against their improper use and bad effects. He will 
 also seek constantly for such efficient aids and substitutes as 
 observation, accident or experiment are constantly offering 
 to his notice. He will learn something of the Natural 
 History of Disease from Hahneman, of the use of cold water 
 from Priestnitz, of the expectant method from the French, 
 and of the capacity to endure alimentation and stimulants 
 from Todd & Company. He will be ready to learn, but will 
 not discard good remedies until others are proved to be 
 better, numerous, repeated, prolonged trials are necessary 
 before he gives up Rules of Art established for centuries. 
 
 Again, says Dr. Norcom : “ Let us bear in mind that there 
 are no foreign forces to be attacked, nor is there an excess 
 of vitality but a deficiency of the powers which naturally 
 reside in the organism. Indeed it may be that the cause ot 
 the attack, which demands an aid, is an already deficient 
 vitality. I am every day more and more convinced that a 
 recognition and observance of these important facts must 
 form the basis of successful practice. Rather than being 
 too intent upon driving out the enemy, let us busy oui- 
 
40 
 
 selves, as Dr. Bennett says, to secure tlie safety of the 
 fortress—let us try to bring the individual up to his physi¬ 
 ological status. In a word, let us help him to restore his 
 natural powers. This support can only be given by food. 
 As Dr. Hewett says, nutrition is the basis of the treatment 
 -of disease and no other is possible for a rational system of 
 medicine.” 
 
 The plain English of this paragraph, and the gist 
 of the whole address, is, that disease arises from 
 inanition , is always asthenic *in type, and always requires 
 the same treatment—“ support” —which can only be given by 
 food. This is not only erroneous, but downright absurdity— 
 not only unsupported by facts, but in direct antagonism to 
 facts, and the daily observations of every correct medical 
 observer. Let U3 give an instance : A man in the vigor of 
 life, after having partaken of a full dinner and washed it 
 down with brandy and wine, falls from his chair in a fit of 
 apoplexy, shall we give him more food to cure him ? Shall 
 we attempt to induce him to eat another dinner and drink 
 more wine, or relieve the oppressed brain by bleeding and 
 purgatives, cold applications to the head, &c. ? 
 
 A young man of full habit, (if these toddyists will admit a 
 man can possess a habit too full) who has not missed a full 
 meal for years, is suddenly seized with acute asthenic 
 pneumonia, agonizing pain in the side, full bounding pulse, 
 intense headache, difficult breathing, with a sense of weight 
 and oppression in the chest, nausea and vomiting, what 
 must we do ? Give brandy and food ? Can he digest it 
 even if he can retain it upon his stomach ? Can any sane 
 man say that nutrition can be accomplished in the condition 
 of that man’s system ? On the other hand, is it not known 
 as positively as any thing in medicine can be, that a free 
 bleeding has relieved this condition of things, in some 
 instances, as if by magic, more slowly but surely in others ? 
 Are not cases of this kind cut short by antiphlogistic treat¬ 
 ment ? Is not human life saved by such means ? Let the 
 great lights of medicine answer. Says Andral. [Cours de 
 Pathologie Intern, Tome 11, p. 34—Paris, 1848.]—“ For 
 many centuries the treament of pneumonia has been nearly 
 the same, and it may be and has only varied in degree. 
 Blood-letting has constituted its basis. The advantages 
 which it here produces is much more direct than in other 
 inflammations, for in diminishing the quantity of blood 
 traversing the lung in a given time, it diminishes the activity 
 of its functions—a result which must assist in the most 
 efficacious manner in the cure of pneumonia, ” “ Venesec- 
 
41 
 
 tion is the method to which we ought principally to have 
 recourse. This especially at the commencement of pneumonia, 
 when the lung is only engorged that a copious bleeding often 
 suffices to remove the disease. It is then a heroic means 
 whose advantages can be rarely appreciated in hospitals, 
 where the patient only arrives some time after the invasion, 
 but which, in civil practice, cannot be too highly recom¬ 
 mended. Sometimes bleeding does not remove the disease, 
 still it is not less happy in its results. As the blood flows, 
 the patient feels his respiration less obstructed, expectora¬ 
 tion becomes easier, the sputa less viscid and less rusty. 
 Then the pneumonia resumes its course, and, if the bleeding 
 is repeated, a new amelioration results.” 
 
 Yalleit sums up the use of bleeding in a few words, and as 
 follows: “ If the pulse is strong, full and hard, bleeding 
 ought to be insisted upon ; if it, on the contrary, becomes 
 feeble, small and contracted venesection should be re¬ 
 nounced.” 
 
 Louis, who certainly cannot be accused of any undue bias 
 towards the antiphlogistic treatment, thus sums up his 
 observations : 1st. That blood-letting has a happy influence 
 in the march of pneumonia; that it shortens its duration, 
 but that this influence is much less than usually imagined ; 
 that the patients who are bled in the first few days recover, 
 all other things being equal, four or five days sooner than 
 those who are bled afterwards. 2nd. That pneumonia 
 cannot be jugulated by means of bleeding, unless it is in the 
 first days of the disease. 3rd. That tartar emetic given in 
 haute dose when bleeding, appears to have no influence, and, 
 therefore, the cases are grave—has a favorable action and 
 appears to diminish the mortality.” 
 
 Lsennec, whose nice ear followed the increase and sub¬ 
 sidence of pneumonia, says : “ I treated, in 1824, at the 
 clinic of the Faculty, with tartar emetic, twenty-eight cases of 
 pneumonia, either simple or complicated by slight pleuritic 
 effusion. All the patients were cured except a cachectic 
 septuagenary, who had already fallen into senile dementia, 
 and who took but little antimony because he supported it 
 badly, yet, nevertheless, the most of these cases were very 
 grave.” 
 
 No little of this antagonism of doctrine and practice seems 
 to arise from the fact that the opposing parties are speaking 
 of two different things—one seems to be writing of sthenic 
 and the other of asthenic pneumonia—diseases as far apart 
 as the antipodes. The reaction in the one case is vigorous— 
 in the other weak. They require, of course, opposite 
 
42 
 
 methods of treatment. The disagreement, moreover, gome-* 
 times arises from the fact, too often disregarded, that in 
 malarious districts a form of disease is recognized of which 
 malaria is an important element—a disease arising not so 
 much from deficiency or redundancy of blood as from 
 poisoned blood, which deranging the forces regulating the 
 circulation of the part, gives rise to hyperemia and inflam¬ 
 mation. In this disease, bleeding can only be moderately 
 employed with safety, and then in the exacerbation. Nor 
 does it, like all other malarial diseases, bear alcoholic 
 stimuli well, as is well known to practitioners in malarial 
 regions, but is mainly controlled by a remedy which, though 
 sedative in large doses, has an action sui generis in removing 
 the local determinations and arresting the course of the 
 febrile malady, of which they are the local expression. 
 
 But this new party, as they term themselves, though their 
 doctrines are as old as Arabian medicine, are not content 
 with advocating their treatment as applicable to the diseases 
 of the present. They desire to cast odium upon the past 
 history of therapeutics, thinking thereby to glorify them¬ 
 selves. According to their views, disease has never changed 
 in the character of its reaction, and never will; that inflam¬ 
 mation is always, and ever will be, the same,—a position 
 totally untenable as regards the past, and merely hypotheti¬ 
 cal in reference to the future. It need not excite surprise, if 
 in a few years, they are found advocating bleeding, tartar 
 emetic and calomel. They certainly must, if the pulse again 
 becomes full, hard, bounding and resistant as described by 
 the old authors quoted : Now it is soft , compressible , contracted 
 and frequent . 
 
 But in claiming that the recovery of their patients is due 
 to nutriment, they forget that in the first stage of acute 
 internal inflammation, nutrition is impossible. The patient 
 loathes food, and, if it is forced upon him, his stomach cannot 
 digest it, and it remains there a foreign body, or is rejected 
 by vomiting. The very fact that digestion returns after¬ 
 wards, is a proof of convalescence , not of cure induced by it. 
 When healthy appetite returns, disease is fleeing, and the 
 capacity for nutrition is a consequence , not a cause of the 
 recovery of the patient. In how many cases of acute internal 
 inflammation can you succeed, in inducing the patient te 
 take food or even stimulants, without marked aversion if not 
 rejection ? Nearly all fevers and inflammations commence 
 with nausea and vomiting, furred tongue, anorexia, more or 
 less epigastric tenderness, constipation or unhealthy stools ; 
 the secretions are arrested, diminished or prevented, the 
 
43 
 
 gastric fluids especially, thus rendering assimilation difficult 
 or impossible. Do not these facts annihilate the theory of 
 the stuffing and stimulating treatment? Does not the 
 physiology of digestion combine with the enlightened 
 experience in disease of every unprejudiced physician in 
 announcing the falsity of the doctrines of this so-called new 
 party ? Do not physiology and pathology unite with 
 therapeutics and medical experience everywhere in over¬ 
 whelming Dr. Norcom’s misapplied strength of alimentation 
 and stimulation in acute internal inflammation ? True, the 
 period arrives under all methods of treatment^ or under none 
 at all, when the patient requires nourishment. Then, also, 
 does he, as a general rule, desire it. But I repel the impu¬ 
 tation upon the great men of our profession in the past, that 
 they starved their patients, and did not have sense enough 
 to recognize the importance of “support,” when the proper 
 time came for it. That physician must indeed have read 
 the past records of medicine with but little profit who has 
 not found that all judicious men seized with avidity the first 
 opportunity for building up their patients, when the proper 
 period came. Although bleeding, <fcc., may have been the 
 main remedy, yet they prescribed it under certain wise rules, 
 diminishing it, suspending it, and even rejecting it altogether, 
 when circumstances of age, climate, country, locality, consti¬ 
 tution, complications and anterior conditions were opposed 
 to it. The change in the character of disease bearing the 
 same name , is recognized by the great masters at every 
 period in the history of medicine, and their treatment w^as 
 varied according to circumstances. In epidemics of acute 
 fever and inflammation of an asthenic character, bleeding 
 was renounced by physicians a thousand years ago, and a 
 corresponding medication adopted. History denies the 
 right of any one to pronounce it neiv, and repudiates those 
 who now claim credit for originality. 
 
 The fear of bleeding has become a 'phobia of the day. 
 As before intimated, swarms of young medical graduates 
 come forth every Spring, from Northern Medical Colleges, to 
 settle in this Southern land, their minds filled with prejudice 
 at their institutions against venesection, calomel, <fcc., and 
 boasting of the superior remedies of alimentation and 
 stimulation in the treatment of our Southern fevers and 
 inflammations. It is time for the South to ask whether duty 
 to science and to ourselves does not require a change in this 
 respect—whether we should not cease to patronize medical 
 heresies and to seek to turn the tide of medical pupilago to 
 our own languishing schools, whose professors, not less able 
 F 
 
nor skilful than the ablest of the North, teach doctrines 
 generally more in unison with the laws of Southern diseases 
 and the experience and practice of enlightened Southern 
 practitioners. Under the constant influence of these false 
 teachings, and such like causes, it has so much become the 
 fashion not to bleed, that cases imperatively demanding it 
 often suffer and die from its neglect. Men do not die so ! 
 easily from a small loss of blood as these terror-stricken 
 alarmists imagine. Look how many cases of protracted' 
 typhoid fever began: to improve after copious hemorrhages 
 from the nose find bowels! Every day we see spontaneous 
 hemorrhage improving the condition of patients, even those 
 suffering from tubercular consumption. Every fall, during 
 the prevalence' of those high congestive fevers of malarial 
 character that are every sickly season, more or less com¬ 
 mon in these eastern counties, do I meet with cerebral- 
 congestion relieving itself by hemorrhage from the nose, 
 when proper depletion has been neglected in the outset, and 
 without which depletion or spontaneous hemorrhage eleath- 
 would have resulted. 
 
 In regard to the expedient method of treating disease, or 
 what amounts to the same thing, Dr. Norcom’s plan of 
 treating acute internal inflammation, there is every reason 1 
 to believe that this was the first plan adopted in the infancy 
 of the art or even before art existed. Men of course ivere led 
 to seek for remedies because of the results of non-treatment. If 
 the 'poiuers of nature alone had been found efficient to control > 
 and cure disease , of course no one would have ivished for more. 
 But it must have been because this was not the case ; it musk 
 have been owing to the fearful and fatal results of disease 
 when left to the unaided powers of nature that men eagerly 
 sought for remedies. Therefore the animal, vegetable and 
 mineral kingdoms were diligently explored to find relief from 
 pain and protection from death. 
 
 It is fashionable to talk about a neglect of the study of the 
 Natural History of disease being prevalent, but from the 
 commencement of medicine this has been the object of the 
 greatest physicians, from Hippocrates down to Louis. 
 What better or more numerous examples could have been 
 wanting than in the thousands of patients placed upon the 
 gum water treatment of Brouissais and the wholly do-nothing 
 treatment of Hahnemann! And yet what rational, scientific 
 man of the present day is content with the results of their 
 treatment? What admirable pictures of the Natural History 
 of diseases were given by Hippocrates, is attested by every 
 author who lias perused his works. What masterly delinea- 
 
45 
 
 tions of the same were given by Celsus Aretaeus, and Galen, 
 and in our day wlio complains of the clinical histories of 
 disease as given by Louis, Andral and Trousseau ? In cases 
 of pneumonia we have seen that Hippocrates first used 
 simple fomentations before bleeding. Was not this great 
 man able to discover the relative value of expectation and 
 venesection ? Did it require a greater genius than his to 
 determine such a plain matter ? It was clearly because men 
 were appalled at the view of the Natural History of Disease, 
 and the fatal results of inaction that they w r ere induced to 
 look for remedies. Moderate bleedings were often tried and 
 failed, when subsequently copious bleedings were attended 
 with manifest good results. We have clear examples of this 
 fact in the case of Cleghorn, army Surgeon and lecturer of 
 anatomy in the Universy of Dublin, in his universally 
 admired and classic treatise on the Diseases of Minorca. He 
 says : “ When these Pleurisies first became epidemic their 
 quick Progress and uncommon mortality surprised me 
 greatly. I attempted to cure them by bleeding once or 
 twice a Day if the Complaint were violent, as I had always 
 used to do in Inflammatory Fevers. But the Remissions in 
 the mornings sometimes induced me to omit the operation, 
 and the Cessation of the symptoms, which generally hap¬ 
 pened about the third day, made me imagine the Danger was 
 over. So that before the Patients were blooded above Twice 
 or three Times, the Exacerbation came on upon the fourth or 
 fifth Days, and defeated all attempts by Bleeding, Blistering, 
 or otherwise to relieve them. 
 
 “ These unforeseen Events startled me greatly, and led me 
 again to review the whole Progress oi the Disease, its Symp¬ 
 toms and Issue. I had observed that some escaped by means 
 of Expectoration and purulent Urine without much assistance 
 from Phlebotomy ; and, considering the periodical Revolution 
 of the Fever, the quick Transition of the stitches, from one 
 Part to another, together with the prevailing Color of the 
 Blood as well as that of the Spitting and other Excretions, I 
 was apprehensive that these were what Authors call bilious 
 Pleurisies, which they alledge are exasperated by large 
 Evacuations, particularly Duretius who exclaims with gieat 
 vehemence against those Physicians who trust principally to 
 Bleeding in the cure of these Diseases without waiting toi 
 the natural Evacuations. These motives induced me to use 
 flie Lancet with more caution, and to. rely chiefly on the 
 speedy Application of Blisters for restraining tne mptoms. 
 But this management proved less successful than le 
 former, and I w r as convinced in a short time teat insteac 0 
 
46 
 
 too much, too little Blood had been taken away in the 
 beginning, having been sometimes’misled by the insidious 
 Intervals of the Disease, at others having trusted too much 
 to the faint Attempts which Nature made to relieve herself by 
 Expectoration and Urine, the latter, after becoming crude on 
 the fourth day as the Delirium advanced, though it had 
 promised favorably on the socond or third, the former 
 frequently being checked about that Period of the Disease by 
 the immoderate Heat of the Lungs, rendering the matter 
 viscid, globular and not to be discharged but with the utmost 
 difficulty. I then began to bleed more plentifully, and 
 repeated it so as to take away thirty or forty ounces within 
 the three first days of the Distemper; and endeavoured by 
 bathing the legs and blistering them on the third Day to 
 prevent the fatal symptoms from coming on about the fourth 
 or fifth, giving Nitre at the same Time liberally and Camphire 
 in small Doses to promote the thinner Secretions. This 
 method succeeded well in several cases—Expectoration and 
 Urine being thereby increased.” 
 
 This treatment, however, did not satisfy this eminent 
 practitioner, and he at last adopted the following, as given 
 in his own -words: “If I was called, for Example in the 
 morning, the patient was immediately laid in a horizontal 
 position and bled at the Arm until his pains abated or he 
 began to faint, neither of which commonly happened before 
 sixteen, twenty, or twenty-four ounces were taken away. 
 If the Symptoms continued, I ordered about the same 
 quantity to be taken from the other Arm in the Afternoon 
 without regarding the urine. Expectoration or Appearances 
 of the Blood, next Morning, though there might be a great 
 Alteration for the better, yet if there was the least room to 
 suspect that any Obstruction remained in the Head or Breast, 
 the Bleeding was repeated. And, by carefully weighing the 
 Blood, I found that between forty-eight and fifty-four 
 Ounces were frequently taken away the first four and twenty 
 Hours of my Attendance. This sudden, copious Evacuation 
 commonly produced a cessation of all violent Symptoms, 
 and afforded an Opportunity to give an antiphlogistic Purge 
 the next day. But if the Symptoms did not cease, or if the 
 Pains and difficulty of Breathing returned the day after the 
 Purge had been given, or if there was room to suspect from 
 the Head-ache, Giddiness, Tingling of the Ears and disturbed 
 Best that the Brain was in danger of being affected, I had 
 again immediate Recourse to Bleeding, taking away at 
 different Times to the amount of twelve, eighteen, or twenty- 
 four Ounces in the space of a day, cither by the Lancet or 
 
Cupping glasses or both, as occasion required; by which 
 means the impending Storm was happily averted, and as 
 soon as the Commotions were quelled tho Purgative repeated 
 every other Day for three times unless some of tho critical 
 Evacuations appeared with such visible good effects as 
 rendered it unnecessary. In this manner I found with 
 Sydenham that Pleurisies of the most fatal Tendency might 
 be happily cured in the space of a few days, and with as 
 much certainty as any Distemper whatever. And it w T as no 
 less remarkable to observe how quickly the Sick recovered 
 their usual Health and Strength notwithstanding the great 
 loss of Blood they had sustained, while many who had been 
 bled more sparingly, continued in a languid, infirm state for 
 month, without being able to get rid of the Cough and Pains 
 in the Breast.”—-(Third London Edition, 1768. The Extract 
 is verbatim, the initial letters of the names being printed in 
 Capitals in the old English Text, as it now continues to be 
 in the German.) 
 
 Dr. Norcom denies (page 25 of his address) that there has 
 been any change of type in disease. He cannot be a reliable 
 witness in the trial of this important cause as the change 
 occurred before he began to practice. What physician of 
 acute observation, and wdio lias grown gray in medical 
 service, does not know that Dr. Norcom is in error ? Who 
 that is conversant with the History of Medicine can deny 
 the fact of this change ? Is not an ordinary autumnal Fever 
 less severe in character and of shorter duration than 
 formerly? Where is the respectable sypliilographer who 
 w r ill deny that syphilis is a mild disease compared to that of 
 former days? The same may be said of Small-Pox. Is it 
 not well knowm that even Asiatic Cholera is much more fatal 
 at particular times than at others, as proven by statistics ? 
 Does not every respectable author on the subject know that 
 Yellow Fever is sometimes a very benignant, and at other 
 times a very malignant disease ? Of the latter, witness the 
 epidemic at Norfolk and Portsmouth, which defied all treat¬ 
 ment, which baffled the skill of the illustrious Warren Stone 
 as well as others of the most distinguished physicians of 
 New Orleans, Savannah, Mobile and Charleston, as com¬ 
 pletely as it did the efforts of the merest tyro of the profession. 
 Does not the habitual endemic of this and of Dr. Norcom s 
 own region assume various types and degrees of violence . 
 Most readily will the practitioners of twenty-five years 
 experience in all our malarial regions answer this question 
 in the affirmative. Do we not see it in some seasons 
 .attended with a short cold stage and prompt vigorous 
 
48 
 
 reaction, anti in others ushered in with a cold stage of days 
 duration and followed by imperfect reaction ? Does it not 
 .assume the intermittent, remittent and continued forms? 
 Do we not meet in some malarial seasons more than at 
 others with that high and alarming grade of cerebral conges¬ 
 tion, attended with that condition of pulse so apt to mislead 
 and deceive the unwary and inexperienced, and cause the 
 medical attendant perhaps to neglect the golden opportunity 
 for rescuing and saving his patient by bold and decided 
 treatment ? That physician who lives in these eastern 
 counties and does not admit this and such as this, will do 
 well to commence and learn over again the alphabet of his 
 Art, or begin it for the first time. Was not the pulse of the 
 pleurisies and pneumonias of former days as described by 
 the great masters of medicine hard, full and resisting ? 
 Would they have continued to bleed if the lowering treat¬ 
 ment tad been attended with such deplorable results as 
 described by Dr. Norcom. Authors who wrote on pneumonia 
 twenty-five or thirty years ago, describe the pulse as either 
 hard or full and resisting and bearing venesection well. Did 
 not Cullen, Sydenham, Boerliaave, Chomel and Andral, and 
 hosts of other observers and writers in ancient and modern 
 times, have as keen perception of the results of treatment as 
 Bennett, Todd and Company ? To ask these questions is to 
 answer them. Let Dr. Norcom observe as intelligently and 
 closely and laboriously as these men, and his reputation is 
 made. They were no idlers nor dreamers, but practical, 
 sagacious, acute observers, whose pictures of disease will 
 forever be esteemed as master pieces, for they were drawn 
 from Nature. 
 
 Diseases are not units. Tho same disease undergoes 
 radical changes. Change is written over the pages of* 
 creation. It is a part of the sublime system of our Heavenly 
 Father for governing the Universe and disposing of events. 
 The changing seasons, and all that pertains to the heavens 
 above and the earth below proclaim this wisely ordained 
 and universal law of Nature. The science and art of our own 
 profession, as attested by its records, makes no exemption to 
 the law. It teaches the true physician not alone to look at 
 the name of disease, or its anatomical seat, but also at tho 
 patient as influenced by age, sex, temperament, diathesis, 
 idiosyncrasy, climate, locality and seasons. He does not 
 bleed all his patients or starve them all, or stimulate them 
 all, but is guided by the actual condition of the patient at 
 the time of prescribing. He varies his treatment according 
 ,to circumstances, and is not overruled in his judgment by 
 
49 
 
 any exclusive theory or blind adherence to authority. God,- 
 as a general rule , has given every man the capacity to judge for 
 himself as well as to receive ideas from others, and he is an 
 unprofitable servant who does-not maize use of it. 
 
 The authorities in favor of the change of type theory of 
 disease are almost innumerable and their arguments are 
 unanswerable and overwhelming. It would be a work of 
 supererogation on an occasion like this, and an unprofitable 
 consumption of your valuable time to array before you the 
 hosts of medical philosophers and able and successful prac¬ 
 titioners, -who bear willing testimony to its truth. Among* 
 those who have presented the subject in its clearest and most 
 convincing light, and whose arguments are most conclusive' 
 may be named the distinguished Dr. Aitkin, the able author 
 of the Science and Practice of Medicine, in volume first, page 
 one hundred and thirty-nine and following. I will, in addi¬ 
 tion, cite the testimony of a former practitioner of our own 
 State, now a prominent physician of Baltimore and well 
 known to this Society as one of the able Professors of the 
 Faculty of Medicine in the University of Maryland. I allude' 
 to Professor William T. Howard. In a controversy with* 
 another eminent medical gentleman formerly of our State; 
 also, but now a leading physician of [Richmond and one of 
 the most distinguished Professors in the Richmond Medical- 
 College—Professor Otis F. Manson. Professor Howard, in 1 
 an article published several years ago in the North Carolina 
 Medical Journal, remarked as follows: “Since the time of 1 
 Hippocrates, blood-letting has been regarded by a multitude 
 of physicians as the remedium magnum in pneumonia—to be 
 used with proper discrimination and judgment; and during 
 all this lengthened period, observing and reflecting men have 
 practised it largely, moderately, or refrained from it entirely,- 
 according to the status of the vital forces in each individual- 
 case. Like everything else, however, blood-letting has been ! 
 used in every age to great excess; and it has often happened' 
 that a profuse and preposterous expenditure of the vital fluid 
 has driven some, who witnessed its destructive effects thus 
 practised into the opposite extreme, of abandoning it alto¬ 
 gether. Every one knows, that within a few r years past, a* 
 great change has taken place in the treatment of inflammatory 
 diseases, especially hi the practice of bleeding; and that, 
 although formerly it was the rule to bleed in such affections,- 
 it has now become the exception and is rarely resorted to. 
 This change in practice, admitted on all hands, has been 
 differently accounted for by different observers. Me have, 
 first, Professor J. Hughes Bennett and his party contending. 
 
50 
 
 that the great revolution in treatment has resulted naturally 
 from the great advances made in modern times in diagnosis 
 and pathology. Secondly, The late Professor Alison and 
 his party contending that the type of disease having changed 
 from a sthenic to an asthenic character, the practice has 
 very properly changed accordingly; and third, Doctor 
 Balfour and his party contending that the change has 
 originated from neither of these circumstances, but has been 
 forced on all alike by the results of a successful empiricism. 
 Although the controversy involves the treatment of inflamma* 
 tion in general, yet, practically, it has turned almost entirely 
 on the treatment of pneumonia by blood-letting.” 
 
 It is beside our purpose to discuss these questions here. 
 “ Suffice it to say that with Kennedy we believe that both 
 animal and vegetable life is subject at times to epidemic 
 influences, which at one period raise and at another depress 
 the standard of health; that pneumonia, like fever, alters its 
 type at certain times, and that no single plan of treatment 
 can, therefore, possibly meet the ever varying shades of 
 disease, pneumonia among the rest; or, as Watson has 
 expressed it, we are fully persuaded boih by our own obser¬ 
 vation and the records of medicine that there are waves of 
 time through which the sthenic and asthenic characters of 
 disease prevail in succession ; and that we are at present 
 living amid one of its adynamic phases.”—(N. C. Medical 
 Journal, March 1860. 
 
 Again : At the same time Professor Howard continues, as 
 follows, after comparing the results of twenty-four cases 
 of pneumonia treated by M. Grisolle, in eleven of w r hick 
 bleeding was not employed, and in thirteen of the number it 
 was used : “ It seems to me that no one can compare these 
 two series of cases together without admitting the efficacy of 
 blood-letting on those in which it was employed. Having so 
 often witnessed in suitable cases the influence of bleeding in 
 reducing the force and frequency of the pulse, in diminishing 
 the heat of the skin and rendering it moist, relieving 
 delirium, calming restlessness, relieving head ache, lessening 
 dyspnoea, and removing or greatly moderating the pain in 
 pneumonia, for us to doubt its utility w^ould be wholly to 
 discredit the evidence of our own senses.” 
 
 Dr. Norcom publishes his Reform doctrines after and not 
 before the Reformation. Why denounce with such noisy 
 clamor the antiphlogistic treatment, and especially blood¬ 
 letting, when it is so sparingly used, and I may say timidly 
 employed by the great mass of the profession now, and has 
 been almost abandoned by a great majority of physicians ? 
 
51 
 
 Aj 3 evidence of this change and of a correct appreciation of 
 this reactive stage of disease, I may refer to its general 
 recognition by those who commenced their career years 
 before Dr. Norcom commenced his. Well do I remember 
 my early recognition of this important medical truth and of 
 my corresponding shape of treatment. Let us refer to high 
 authority m the profession of this and of other States in 
 corroboration of this statement. 
 
 Professor Manson, already referred to, and recognized by 
 this Society as on© of the ablest and most accomplished 
 physicians of the whole country, makes the following state¬ 
 ments in a communication to the Stethoscope and Virginia 
 Medical Gazette of February, 1851 : “ Called to a patient in 
 the exacerbations of remittent fever, venesection is practised 
 in every case where the pulse wall justify it, but it is rarely 
 that this is called for. In fact the general experience of myself 
 and confreres is adverse to the use of the lancet in this affec¬ 
 tion. The pulse, though often full and apparently tense, is 
 generally compressible . Local bleeding by cups and leeches 
 will usually be sufficient, and if there is tenderness on 
 abdominal pressure or other symptoms of visceral complica¬ 
 tion these should be freely applied. Should symptoms of 
 cerebral irritation be present, a copious flow of blood wall bo 
 obtained by cups to the mastoidal regions.” 
 
 In an article on malarial pneumonia, published in our 
 Transactions for the year 1857, and written for the Society 
 by the same careful observer, he says : that “ the pulse which 
 had been very frequent and contracted in the chill becomes 
 expanded, acquires force, and sometimes, though rarely , 
 becomes full or tense. The term compressible applies to the 
 usual condition of pulse and the idea entertained on its 
 careful examination is that the heart is acting with only a 
 seeming force and not with real vigor.” When speaking of 
 the treatment, he remarks as follows : “If the pulse is hard, 
 full or tense, as it is in rare and exceptional cases, or if the 
 patient is robust or previously healthy and possessing 
 ordinary vigor, and the pain or dyspnoea is very intense and 
 the character of the pulse or other symptoms do not decid¬ 
 edly contraindicate its employment, then a moderate quantity 
 of blood may be taken from the arm. In this diseaso 
 goneral blood-letting should be employed with a view only to 
 moderate and not with an expectation to cut short the disease; 
 nor should it be employed except in the instances referred 
 to. In cases where this is not followed by marked relief, 
 and in those where venesection is inadmissible, the local 
 abstraction of blood by cups or leeches should be resorted to 
 
 Gr 
 
and may be used as freely as considerations of safety will 
 permit. Tlie time at which bleeding by any mode should be 
 practised, is that period when the exacerbation has reached 
 its acme, which is almost invariably in the afternoon or 
 evening.” 
 
 These and other extracts that might be given from other 
 authors show how careful blood-letting was used twenty 
 years ago, when but few, if any of us, who were then coming 
 upon the stage of action had ever heard of the doctrines of 
 Bennett, Todd & Co. 
 
 As to the employment of the expectant treatment, and the 
 use of stimulants in malarial fevers, and their complications 
 —the endemic affections of Dr. Norcom’s own immediate 
 region—I feel authorized to warn the practitioner against 
 the habitual application of such practice. Except as a tem¬ 
 porary means of support after these fevers have been broken 
 up, or as an auxiliary in sustaining the vital forces in some 
 cases of neglected treatment, while other efforts are being 
 made to induce the action upon the system of more curative 
 remedies, I do not believe there can be found a single expe¬ 
 rienced and judicious practitioner who will uphold the gene¬ 
 ral employment of stimulants, even in those cases in which, 
 from the very outset, there is prostration of the vital pow¬ 
 ers. If a physician gives brandy in the cold stage of -con¬ 
 gestive fever, it will end fatally in a large majority of 
 cases; and, as to alimentation in the cold or hot stage, 
 that is but little less than preposterous. Bather do I agree 
 with the lamented Dr. Drake, so justly regarded in his 
 day as the Nestor of the profession in the Northwestern States. 
 Guided not only by his own observation, but by that of near¬ 
 ly every physician of note from the Great Lakes to the Gulf 
 of Mexico, we have his high authority against the use of 
 stimulants in these instances. In his celebrated work on the 
 “Diseases of the Interior Yalley of North America, ’ second 
 series, he remarks, page 86,? in treating of “ internal stimu- 
 lents ” in “malignant Intermittent Eevers,” that “almost 
 every kind of excitant and norcotico-stimulant has been ad¬ 
 ministered internally in the cold stage. In this stage of the 
 paroxysm of malignant intermittent fever, wine, brandy, 
 whisky, and other alcoholic drinks have been liberally given; 
 but the results have not been such as to commend them. 
 They probably act upon the brain unfavorably.” 
 
 I have seen patients in the protracted cold stage of remit¬ 
 tent fever, with claj-cold skin and feeble pulse, become colder 
 and colder under the influence of stimulants. When reaction 
 followed their use I have seen them die in apopletic convul- 
 
moils. "Were we to bo guiclecl by any a priori theory, de¬ 
 duced from physiology, m our treatment of malarial "fever, 
 we should certainly expect stimulants to be useful in those 
 cases where the vital powers were prostrate and the pulse 
 flagging; but every sensible practitioner is perfectly aware 
 that they.are either generally inert or hazardous. If the young 
 men coming into practice in the malarious regions of North 
 Carolina, depend upon stimulants and alimentation in the 
 treatment of Periodical Fevers, they will soon be^ compelled, 
 like the followers of Jack o’ Lantern, to find themselves in a 
 bog, and their patients in premature graves. 
 
 Other vulnerable points in Dr. Norcom’s Address consist 
 in his omission to make any distinction in his views as to the 
 sthenic and asthenic states in inflammation. We look in 
 wain for an exposition of his sentiments as to the treatment 
 of many of our every-day acute diseases. How would he 
 treat cholera infantum, comatose remittent fever, or Asiatic 
 cholera ? Would he bring to bear his batteries of food and 
 brandy ? How long would his patients live under such 
 treatment ? Hoy/ would he treat acute gastritis, entiritis, 
 nephritis, or cystitis ? With food and brandy ? Would not 
 the grave soon claim and receive them under such manage¬ 
 ment ? How would he treat iritis or retinitis ? With food 
 and brandy ? How long would his patient be able to grope 
 his way out of perpetual darkness ? Why should Dr. Nor- 
 com, at this late day, declaim against wholesale blood-letting 
 and the abuse of calomel and antimony, as such treatment 
 had been abandoned before he graduated by every correct 
 medical thinker and accurate observer ? Let him take heed, 
 clever man as he is, that he does not allow himself to be 
 ranked among that too numerous class of the present day, 
 who set up men of straw for the glory of knocking them 
 down. Is he aware that his onslaughts upon anti-plogistic 
 remedies contain unmerited strictures upon the practice of 
 his own honored and lamented father. Dr. James Norcom? 
 He, too, resided in Edenton, in this State, was a gentleman 
 of profound erudition and high accomplishments, and one of 
 the most distinguished pfiiysicians in the whole country, as 
 lie certainly was one of the most successful practitioners. I 
 cherish a peculiar pride and gratification in the belief that 
 at, and for many years prior to, his death, ho was at the head 
 of the profession in North Carolina. What were his views of 
 disease before the rolling in upon us of the “ adynamic 
 waves of the change of type?” Listen to what ho says in 
 some “ Observations on the Influenza, as it appeared at 
 Edenton, N. C.,” in a letter to Dr. Kush, of Philadelphia, 
 
£4 
 
 published in the Philadelphia Medical Museum in 1808, vol¬ 
 ume five, page 118. “ Since I returned to North Carolina I 
 
 have been engaged in business with Dr. Sawyer, and have 
 had a respectable practice, and enjoyed a greater degree of 
 success than I ever before experienced. In the Influenza, 
 which prevailed here from the last of September until the 
 beginning of the year, I hardly lost a patient. The disease, 
 in its form and character, resembled very nearly that which 
 you have described in your Medical Inquiries. It was uni¬ 
 versally inflammatory and uniformly yielded to depletion. 
 
 “ There appeared to me to be in the course of the season a 
 greater proportion of cases with pulmonary determination 
 than is common, and some of the most inflammatory I ever 
 saw. One patient I bled seven times largely in forty-eight 
 hours, and another three times in eight hours. The event in 
 both cases was favorable. It was my happy lot to be instru¬ 
 mental in saving the life of an amiable woman through 
 a series of relapses by, I am sure, not less than fifty bleedings. 
 Bleeding, I found, in all cases of violence, an antidote to the 
 disease, and in milder cases less direct and less active evac- 
 uants never failed to cure. 
 
 “ The most fatal consequences of the fever, when it was 
 not properly treated or speedily cured, were dropsy and 
 consumption. Few of these have fallen to my share for a 
 reason I have assigned already. In the dropsies that have 
 occurred within my observation, my practice has been 
 happy. The lancet, purging, nitre and sage tea, cream 
 of tartar and mercury, have been my remedies. And in con¬ 
 sumption I have cured and relieved more patients than 
 I ever saw cured, according to the number I have attended. 
 My remedies have been the lancet, opium, camphor, hore- 
 hound and salivation.” Thus do we introduce against Dr. 
 Norcom, and in favor of the change of type theory, not alone 
 the conclusive and overpowering testimony of his own dear 
 father, but we could go on and pile authority upon authority, 
 equally strong and convincing, in support of the positions we 
 have taken in this paper. We have introduced our wit¬ 
 nesses, not to advocate the propriety of their practice at this 
 day—for, were they now in practice, they would make it cor¬ 
 respond to the indications of the prevailing character of the 
 disease—but our main object is to show how idle are 
 the fears of those who condemn moderate and judicious 
 venesection. 
 
 In relation to the general character of Inflammation, 
 Dr. Norcom seems to differ in his views with those of 
 standard authors and the ablest writers. Assuming that it is 
 
unnecessary to diminish the amount of blood in an inflamed 
 tissue, he asks : “ Can general blood-letting diminish the 
 amount of blood in an inflamed part ?” In inflammatory 
 action of the contents of the three great cavities of the head, 
 chest and abdomen, it is found, according to high authority, 
 that blood-letting not only diminishes the quantity of blood 
 circulating in the vessels, but at the same time calms 
 the turbulent action of the heart and arteries. It is admit¬ 
 ted that in external inflammation, so liable to be diffused, the 
 lancet should be used with great caution, lest by too free 
 a detraction of blood the constitutional symptoms already 
 existing may be converted into fever of a different type or 
 character. Blood-letting in internal inflammations not only 
 diminishes the mass of circulating fluids, but is advantageous 
 in the inflammation of external parts by drawing blood from 
 the larger vessels going ?more immediately to, or returning 
 from, these parts. It is here that the salutary influence 
 of venesection is sure, and does not act, as Dr. Norcom 
 insists, by materially weakening the force of the heart’s 
 action. A true interpreter of vital phenomena, a judicious 
 observer, a stranger to the exactions of mere party systems, 
 and unseduced by the subtleties of the schools, clearly 
 understands that, when the excitability of the sanguineous 
 system is carried to a very high degree, blood-letting not 
 only diminishes the amount of blood, but in other respects 
 proves highly beneficial. His assertion that during in¬ 
 flammation the vessels lose their contractile power, and 
 are distended with blood, and that stasis, owing to adhesive¬ 
 ness of the corpuscles, occurs, and is followed by exuda¬ 
 tion, will not be accepted. The vessels do not lose their con¬ 
 tractile power from this cause, but during inflammation, the 
 blood ceases to undergo its changes to the proper extent 
 from arterial into venous, and the functions of nutrition and 
 secretion are to a very great extent suspended. On the 
 inner surface of the walls of the dilated vessels colorless 
 corpuscles are said to collect sometimes; but there are no 
 new formations called forth by this change—they already 
 exist in the blood, and when the velocity of the current 
 is materially increased they mingle with the red corpus¬ 
 cles, and are carried along with them. It is not established 
 that stasis is followed by exudation, for the reason that 
 new canals are formed by globules of blood bursting through 
 the sides of a vessel, and forcing a passage for them¬ 
 selves through the cellular texture into another vessel. A 
 considerable number of new canals are sometimes formed by 
 this process of nature through which the blood continues to 
 
5G 
 
 circulate. It is surely not rational or philosophic to apply 
 to these varied phenomena any other hypothesis than the 
 one of increased or diminished action. It appears also in¬ 
 correct to describe vessels which performed their functions 
 efficiently during health, as affected with direct debility 
 because they are unable to perform double their usual labor 
 with equal efficiency in disease. It cannot be denied that, 
 unless under peculiar circumstances—forming exceptions to 
 the general rule—the action of the vessels is at first greatly 
 and powerfully increased; and it is only when they become 
 clogged and over-distended by an excess of blood, and that, 
 too, thinner and more fluid than that which they contain in 
 health, which being no longer able to contract, become 
 passive ; but it is not occasioned in consequence of injury to 
 the vaso motor nerves of the part as, he contends. Adhesive¬ 
 ness of the corpuscles cannot, therefore, be correctly admit¬ 
 ted as the cause of the distension of the vessels—thereby 
 causing debility-—since we only perceive this to occur as a 
 secondary effect. Weak and relaxed vessels are themselves 
 susceptible of increased action, and often in a much greater 
 degree than vessels in an opposite state; for it is well known 
 that constitutions in which the fibre is lax and delicate are 
 generally characterized by a much higher degree of mobility 
 and irritability, and are much more predisposed to inflamma¬ 
 tion than constitutions endowed with a more firm and rigid 
 texture of the solids. While delicate and sensitive vessels 
 are easily roused into excessive action, they are less able to 
 sustain it, and are, therefore, more readily overcome by the 
 increased flow of blood, and more quickly affected with 
 inflammation. 
 
 Nor will Dr. Norcom, in the assumption that there is no 
 direct anastomosis between the surface vessels and the 
 inflamed part, and therefore that cupping in inflammation 
 is not profitable, secure the concurrence of his professional 
 brethren. Let us see how this is. When a stimulus is 
 applied to a living part, the first effect produced is an excite¬ 
 ment of the sensibility of the part and a consequent degree 
 of pain. The necessary result of this morbid excitement of 
 the sensibility and contractility of the vessels is a more rapid 
 flow of blood to the part, which acting as a stimulant tends 
 still more to quicken the circulation. There is, consequently, 
 a considerable influx of blood in all the vessels, capillaries 
 and veins, to the amount of double the usual quantity. This 
 is precisely the action which takes place in inflammations— 
 the surface vessels in most cases anastomosing with those of 
 the inflamed part. His opposition, therefore, to cupping 
 
cannot bo sustained, and is founded upon an anatomical 
 error, in part, because, while it is in some parts of tbfc sur¬ 
 face true, that the vessels from which the blood is withdrawn 
 have no anatomical connexion with those inflamed beneath, 
 it is equally untrue as respects other parts. In all these 
 cases of cupping, however, let it not be forgotten, whether 
 there is or is not any direct anastomosis, that there is a 
 sympathy existing through the great organic nervous centres,, 
 between the outer and inner surface or organ, by which any 
 impression made upon the former is communicated to the 
 latter. Herein consists a conservative law of useful results- 
 that the experience of every enlightened practitioner must 
 have observed. It is recognized in the fact that, amid all the 
 fluctuations of general blood-letting, the local abstraction by 
 leeching and cupping has maintained its ground with more 
 consistent uniformity. Local bleeding is an invaluable 
 remedy under various circumstances of disease. When there 
 is not much general excitement, but troublesome local con¬ 
 gestion or inflammation; in other cases when general 
 depletion has reduced the fullness of the pulse and moving 
 forces of the blood with still a co-existent local inflammation 
 and again, where the reasons for and against the use of the 
 lancet are so equal that it is difficult to determine as to its 
 use, as in many cases of fever attended with inflammations; 
 in these and similar circumstances we can often use cupping 
 with the happiest results, even restoring health and saving 
 life thereby in certain cases. No one conversant with the 
 effects of both general and local bleeding will deny, that a 
 certain quantity of blood taken from an inflamed part or 
 near by, lias decidedly more effect on the disease than a like 
 quantity abstracted elsewhere. 
 
 CALOMEL. 
 
 Not more unsparing and persistent have been the attacks 
 of Todd, Bennett & Co., upon venesection than are their 
 denunciations of the various forms of Mercury. If calomel 
 deserves one-thousandth part of the anathemas which these 
 and other extremists have so long hurled against its use, 
 surely it should long since have been expelled from the 
 Materia Medica. After all its ups and downs in professional 
 appreciation, the “ much abused Mercury” still maintains its 
 stronghold upon the profession. True, it has been morn 
 sparingly used in the Southern States,, within the last twenty- 
 five or thirty years, and for the following reasons: Tte 
 prevailing endemic and epidemic diseases were, before and 
 since that time, of malarial origin, yet the powers oi quinine- 
 
58 
 
 were not so generally known as now. In the simple inter- 
 mittents with a stage of complete apyrexia ancl in the benign 
 forms of remittent fever, in which the remissions were 
 decidedly manifest, quinine in small doses was administered 
 by physicians generally ; but in the violent cases in which 
 the remissions were not evident, and in which symptoms of 
 cerebral or gastro-enteric irritation, congestion, and inflam¬ 
 mation, were either singly or unitedly present—in tho large 
 majority of cases quinine, except by a very few physicians, 
 was usually withheld. In these cases, mercury was almost 
 universally given. It is well known that the patient was 
 usually pronounced “ safe” as soon as ptyalism in the 
 slightest degree presented itself. It vms objected to the 
 mercurial treatment that it was too slow and uncertain in 
 the rapid and malignant cases, and was attended with the 
 injurious consequences often of ptyalism, nevertheless, the 
 mercurial treatment proved highly successful in the hands 
 of experienced and judicious practitioners. The malignant 
 cases which defied its powers were not so numerous as might 
 be supposed, while the evil consequences of mercurialization 
 were in many cases exaggerated, the majority of cases soon 
 recovering from its effects entirely. Even after the intro¬ 
 duction of the use of large doses of quinine, calomel continued 
 to be necessary in completing the cure, and is still regarded 
 as a most valuable adjuvant. 
 
 In pneumonia calomel is regarded as a most excellent 
 remedy in skilful hands. In all my practice I can, with 
 truth, say that I have seen but few cases of pneumonia die 
 where the patient was clearly and timely brought under its 
 influence. I have also seen its great beneficial influence in 
 Dysentery, Diarrhoea, Cholera Infantum, and many others 
 of our endemic diseases. Tho best, the ablest, the most 
 successful practitioners of tljis and ev-ery other portion of 
 the South have always regarded mercury as a useful and 
 most important remedy in our Southern diseases generally. 
 In Syphilis, though for a time it fell into some disrepute 
 under the opposition of prominent men, yet, it still holds 
 its place in the therapeutics of nearly every modern 
 Sypliylographer. 
 
 Even the French, who have the greatest prejudices against 
 it of any other people, have been compelled to return to its 
 use in true chancre. Jticord still recommends it as the 
 principal remedy. It is.true that tho use of mercury, even 
 m moderate quantities, is sometimes attended with unpleas¬ 
 ant and injurious consequences. It is true that the habit 
 which too many of our farmers and others still pursue of 
 
•59 
 
 \ 
 
 * 
 
 keeping calomel in their houses bj the pound, and of dealing 
 it out to their families and themselves profusely, even 
 sometimes by the teaspoonful, and for almost any and every 
 complaint, is highly injurious and amounts to a deplorablo 
 evil; for, by the disintegration and disorganization of the 
 blood frequently induced by such mal-practice, the constitu¬ 
 tions of their children are often undermined and ruined, and 
 other bad consequences entailed. But this is the abuse 
 and not the proper use of this potent remedy. The same 
 can be said of nearly every other active agent in the Materia 
 Medica. Opium, Arsenic, Strychnine, Iodine, Chloroform, 
 &c., are sometimes not only injurious but fatal in their effects 
 in the best of hands. But we are unable to discard them 
 until better agents are provided. Of one fact we may be 
 fully assured, and that is, neither food or whiskey can ever 
 supply the place of calomel or the other remedies in a larger 
 majority of cases of disease we are called upon to treat. 
 When the ^oi-distant Modern Revolutionists in Medicine 
 supply us with better remedies than those we have we will 
 discard them, and not until then . While I am ready with Dr. 
 Norcom to concede it as “ certain that improvements in 
 pathology must follow in the wake of an advancing physi¬ 
 ology,” yet, in the face of all the discoveries and improve¬ 
 ments that have been made in these departments, I utterly 
 deny that the treatment of Acute Internal Inflammations 
 can be based upon our present knowledge of them. Decry 
 empiricism as we may, yet, the knowledge of the great value 
 of thereapeutic agents is chiefly due to experience, and obser¬ 
 vation. Vaccination, quinine, opium, arsenic, iodine, 
 mercury and a host of other remedies— the best . we have 
 indeeal —were never, and could never have been, indicated or 
 dreamed of by physiologists or pathologists. And they will 
 continue to be employed by all endowed with common sense 
 until greater experience and larger observation have given 
 us better. With all our boasted knowledge of Inflammation, 
 yet, after all, how little do wo really know of its essential 
 nature ? Do the microscopic phenomena, as observed in the 
 web of the frog’s foot, tell you anything of the specific nature 
 of the varieties of inflammation, of the causes or cure, ? How 
 idle then to attempt to baso the art of medicine upon 
 Physiology or Pathological Anatomy! They aro simply 
 accessories—aids—but not tho corner stones of Therapeutics. 
 Dispute as we will about the modus operandi of medicines, 
 yet, quinine still as certainly annihilates malarial diseases, 
 opium relieves pain and produces sleep, and mercury cures 
 inflammation and syphilis . The art of medicine is bascc 
 
 II 
 
66 
 
 upon the accumulated facts and observations of ages. It* 
 rules and principles are simply derived from these sources. 
 Call it empiricism, or what you will, it is the nearest approach 
 to Truth bequeathed to us and can never be superseded by 
 the Cook and Distiller of the theory of Alimentation and 
 Stimulation. It is as irrational to declaim against the use of 
 bleeding, mercury and tartar emetic because they are some¬ 
 times injudiciously employed, as it is to denounce food and 
 wine and whiskey, because their abuse leads to gout, intem¬ 
 perance, delirium tremens, paralysis and death. 
 
 The high claims set up by the friends of mercury, as to its 
 beneficial effects in subduing inflammation and other 
 diseases, and its adaptation especially to malarial fevers and 
 affections of the liver, are disputed by its opponents. They 
 deny it has any cholagogue action, most of them, and will 
 not admit the theory of its absorption into the system. Todd, 
 Bennett & Co. are noted for their opposition to calomel in 
 these relations, and the boldness of their denial of its reputed 
 virtues in inflammatory diseases and In acting upon the 
 liver is very injurious to the cause of medical truth, especially 
 in the case of many young and inexperienced members of 
 the profession. Committees of prominent European medical 
 men have been appointed to make special investigations of 
 the action of these mercurial preparations upon the human 
 system, and to enquire into the important question of their 
 absorption. After elaborate enquiries and protracted labors 
 directed to a knowledge of the action of mercury upon dogs 
 and other inferior animals, and as far as possible upon man, 
 embracing the feature of absorption, these gentlemen report¬ 
 ed very unfavorably as to its action and value. It is even 
 denied that it is absorbed into the human system, and the 
 denial is willingly caught up by the opponents of calomel, 
 and they are seeking to get up a greater hue and cry than 
 ever before against it. Their experiments upon inferior 
 animals are very fine illustrations of their devotion to physi¬ 
 ology, and their fine spun theory as to the impossibility of 
 introducing into the system by absorption, or any other 
 possible way, globules or particles, however small or 
 minutely reduced, of any preparation of mercury, reads well 
 enough on paper, but unfortunately for their reasoning and 
 conclusions, are overthrown by innumerable and overwhelm¬ 
 ing facts to the contrary. Let us apply the test of medical 
 logic and of scientific induction to this question, and proceed 
 to examine it fairly and clearly. 
 
 I have often seen under the operation of calomel almost 
 apparently pure bile discharged by stool, and often have I 
 
•seen bile discharged by vomiting in largo quantities during 
 the purgative action of the same mercurial; and how any 
 one, conversant with this tendency, undisputed until recently, 
 of calomel to increase the secretion of bile, I am utterly at a 
 loss to conceive. How, if it is not absorbed, can you account 
 for its action on the gums, or the dissolution of plastic 
 deposits, its removal of serous effusions, its power of rapidly 
 healing chancre, its unquestioned ability to cure iritis? 
 How can we otherwise account for salivation produced by 
 mercury introduced into the system by inunction or hypo¬ 
 dermic injection ? Let us summon to the stand as a witness 
 of great reliability and experience the distinguished Head¬ 
 land, than whom there is no higher authority in our profes¬ 
 sion. In his admirable work “ On the Action of Medicines 
 on the System,” this great light states that “ Mercury is 
 absorbed into the blood, and 'particularly tends to the liver , bowels , 
 salivary glands and skin .” He classes it among the “ true 
 cholagogues.” He says that <c Mercurials increase more or 
 less all the secretions, and even if we had no direct proof of 
 their action on the liver we might almost have affirmed that 
 they especially increase the secretion of bile from the obvious 
 way in which bilious symptoms yield to their action. But 
 we have direct proof of this. M. Bucklein has made some 
 careful experiments on a dog. Having given it Mercury, he 
 cut down upon the hepatic duct and collected the secretion 
 and subsequently analyzed it. He found that the bile was 
 increased and that mercury was found in it.”—[Page 297.] 
 Again he says: “ Mercury, sulphur and iodine have been 
 ,chemically detected in the perspiration. It has happened 
 when a course of mercury has followed the administration of 
 sulphur that parts of the skin have turned black from tha 
 formation of sulphuret of mercury.”—[Page 301.] He also 
 says that “ mercury has been detected in the urine.”— 
 [Page 306.] 
 
 Let us now consult another learned and high authority, 
 Pereira. He states, in his great work on Materia Medica 
 and Therapeutics—[American Edition, 1852, volume 1, page 
 773]—that, “ By the external or internal use of Mercury 
 this metal becomes absorbed , and is subsequently either 
 deposited in some of the solids of the body , or thrown out of the 
 system by some of the excretories. The accuracy of the 
 statement is proven by the following facts: 1st. Mercury 
 has been detecto i in the blood by Zeller, Buckner, Schubartli, 
 Colson and Dicterich. It appears to be in such intimate 
 combination with the vital fluid that it cannot be recognized 
 by the ordinary tests. Destructive distillation is in most 
 
cases necessary for its detection. 2nd. Mercury lias been 
 found in tlie secretions, viz: in the perspiration, in 
 the saliva, in the gastro-intestinal secretion, the bile, 
 the urine, and in the fluid of ulcers. 3rd. Mercury has 
 been found in the organic solids, viz : in the bones, brain, 
 synovial capsules, pleura, humours of the eye, cellular tissue, 
 lungs, Ac. In what part of the system reduction is effected 
 has not been made out.”—[Volume 1, pp. 773-74.] 
 
 “ The secretion of bile (by mercury) is promoted.”— 
 [Page 774.] 
 
 Who has not seen in the old treatment of Remittent 
 Fevers, that just as soon as the gums were touched by mer¬ 
 cury the liver poured out large quantities of blackish, green, 
 viscid bile, which invariably denoted a favorable solution of 
 the disease ? Rut let us go on with the authorities. Our 
 own illustrious American Professor, Wood, remarks as 
 follows, in his able work on Therapeutics and Pharmacology 
 •—[2nd vol., page 243]—“ That mercury is absorbed is 
 proved by the following facts : When rubbed upon the skin 
 it in parts appears. After administration it has been de¬ 
 tected by chemica itests in the blood, saliva, perspiration, 
 bile and urine, and is said to have been found in a metallic 
 state in the brain, bones, cellular tissue, lungs, &c. Infants 
 affected with syphilis are asserted to be treated effectually 
 by the administration of mercurials to the nurse, &c. The 
 hepatic secretion is often energetically stimulated, especially 
 when the medicine is administered internally. There is no 
 cholagogue which approaches in efficiency some of the 
 preparations of mercury. A true cholera morbus, with 
 copious vomiting and purging of bile, is not unfrequontly 
 induced by a largo dose of calomel.” 
 
 State, in his Therapeutics and Materia Medica (Vol. 2, p. 
 731), cites numerous and convincing proofs of the absorption 
 of Mercury. After mentioning the experiments of Schobarth 
 and Zeller, before mentioned, he says: “ Oesterlen found 
 minute globules of Mercury in the pancreas, liver, spleen, lungs, 
 heart, mesenteric glands, kidneys, &c., and also in the urine, bile, 
 :milk and saliva ,” (p. 782). “ Among the proofs of mercurial 
 
 absorption by man, tlie following may bo selected : In 1810 
 Brickmann published an account of a lady who, a year after 
 being salivated, having become heated by violent dancing, 
 mercurial stains appeared on her breast, and metallic mercury 
 was found in her linen. In 1813 Jourda collected a quantity 
 of mercury from the urine of a syphilitic patient who was 
 taking this remedy.” b'title quotes other authorities to simi¬ 
 lar facts, and treats at length, fully and clearly, of the effects 
 
G3 
 
 of medicinal doses of mercurial remedies, their action—sim¬ 
 ilar to that given by others—producing liquid and billious 
 discharges, Ac.” I might go on and cite additional authori¬ 
 ties, numerous and high, in corroboration of the observa¬ 
 tions, experiments and statements of those I have given ; but 
 can any honest and unprejudiced man require further proof 
 of the position that mercury is absorbed into the blood, and 
 is a cholagogue ? 
 
 The following additional quotations from Headland are 
 well worthy of introduction here : “As hematic medicines 
 mercurials have a double action. They counteract in¬ 
 flammation in general, and the poison of syphilis in particu¬ 
 lar (p. 325). On account of the durable and effectual naturo 
 of its action, mercury is of great use in preventing the 
 process of effusion , and in causing the absorption of effused 
 'products. It is thus employed in pleurisy , and in other mem¬ 
 braneous inflammations. Next to these it is most useful in in¬ 
 flammations of the liver and brain. It is inferior to antimo¬ 
 ny in fevers and rapid inflammations, because slower in 
 operation, and without any direct action on the nervous sys¬ 
 tem. In cases of primary syphilis mercury is by far the 
 best medicine with which we are acquainted. It should 
 be used in all cases, except where there is deep-rooted scrof¬ 
 ula or marked debility, or a sloughing and irregular con¬ 
 dition of the primary sore. It should always be given in 
 Iritis ” 
 
 “ Mercury, being unnatural to the blood, passes at length 
 out of the system through the glands, and acts as an elimi¬ 
 native. Like antimony, it tends to increase all the secre- 
 ' tions in the body. But whereas, antimony acts especially 
 on the secretions of the skin and pulmonary membranes, 
 Mercury tends particularly to excite the functions of the 
 liver and bowels, being cathartic and cholagogue 
 
 On another occasion Headland writes as follows : “Another 
 remedy, of a different kind, has been used in all the diseasos 
 in which quinine is admissible, proving in some cases superi¬ 
 or, and in other instances second only to it in its beneficial 
 action. This is mercury ; and in remittent and yellow fever ; 
 of the first importance in dysentery ; employed by Hr. Bail- 
 lie in ague, and pronounced by him to be superior in some 
 cases even to quinia. In small doses it is frequently of use 
 in cases of debility and scrofula. And mercury is a chola¬ 
 gogue, i. e., an agent which is known to have the enect 
 of promoting the secretory function of the liver. lhus 
 we may conceive that mercury, not given in excess, or 
 to salivation, may operate in a different way to produce 
 the same effect as quinine. 
 
If the connection between tonics and the bile were actually 
 established, then we should be enabled to explain a mat¬ 
 ter which otherwise would seem difficult to understand—how 
 it is that small doses of mercury may sometimes act as tonics, 
 though we know that the ultimate action of the medicine, 
 like that of other catalytics, is to deterioate the blood. Even 
 in scrofulous and enfeebled cases small doses of blue pills or 
 calomel are often signally useful, and not prejudicial, as 
 is sometimes stated by those who confound their application 
 with that of mercury, given in salivating doses. Under such 
 a course, when judiciously enforced, we may see the dilated 
 pupil contract to its normal size, and the pale, enervated 
 countenance become rosy and lively, and feel the weak and 
 compressible pulse to become hard and firm. Perhaps mer¬ 
 cury in such a case may be indirectly tonic, by restoring to 
 the blood the natural tonic principle of the bile.” 
 
 The reactions in the history of this valuable but much 
 abused remedy of calomel, the fluctuations of professional 
 appreciation of its importance and value, have been greater 
 than attach to any other remedial agent of the whole p rofes- 
 sion. But when we remember that our best remedies are 
 those which have been most abused, shall w T e reject the good 
 which this powerful agent is capable of producing, because 
 its abuse has been so great ? To yield to the unfoun¬ 
 ded prejudices and noisy clamor against the use of calo¬ 
 mel, which are becoming' even traditional, that to use it 
 in efficient doses places a practitioner in the ranks of 
 old fogyism, and behind the rapid strides of medical science, 
 is neither manly, philosophical, nor scientific. That physi¬ 
 cian is wanting in the stamina of real manhood, and in the 
 sustaining power of true professional devotion, who allows 
 any storms of surrounding circumstances, or any prejudice 
 or tradition, however honored by time or authority, to stand 
 between himself and a judicious trial of legitimate means, 
 whether of ancient origin or modern growth, in combatting 
 disease and saving life. I admit that much prudence and 
 discrimination should be exercised in the administration 
 of mercurials. I confess that I have often seen them 
 used to such an excess in the bowel complaints of children, 
 and other diseases of infancy and adult age, as to produce 
 that deterioration-of the system, that disintegration and dis¬ 
 organization of the blood, that entailed dropsy, consump¬ 
 tion, and other protracted and wasting affections, which 
 •either greatly injured the constitution or ended in death. 
 •Such ignorance and mal-practice in the use of this effective 
 
65 
 
 weapon, while inexcusable, have contributed greatly to that 
 discrepancy in the results of its administration which has 
 made the calomel treatment objectionable to so many good 
 men. But when we learn, as learn we must, more of its 
 mode of action, as well as of its remarkable capabilities and 
 most valuable adaptations in subduing many of the most 
 fatal diseases of the human system, it is reasonable to 
 suppose that less ignorance will guide, and less prejudice 
 and danger attend, its use. The authentic accounts from 
 high authorities of the happy effects of large doses of a 
 scruple and upwards of calomel in cholera morbus, epi¬ 
 demic dysentery, cholera, <&c., are only equalled in striking 
 import by the well-attested records of the cure of that terri¬ 
 ble enemy of infantile life, membraneous croup, by similar 
 doses, during the last twenty years, in the practice of most 
 distinguished physicians of New York city and elsewhere. 
 The introduction of the calomel treatment m croup has been 
 credited to Dr. Bay, of Albany, New York ; but Dr. Hamil¬ 
 ton, in his work on mercury, published early in the present 
 century, regards it simply as the American treatment, and 
 says it spread from America to England. This celebrated 
 author, w r ho has written more strongly against the gen¬ 
 eral use of calomel than almost any writer prior to those 
 Modern Revolutionists, Todd, Bennett & Co., extolled its 
 action in large doses nevertheless in genuine croup. He 
 says that “ no relief whatever has been afforded by that 
 medicine (calomel), imles copious, dark-green colored stools, 
 like boiled spinach, have been discharged, and that it 
 , requires large and repeated doses of the medicine to 
 produce that effect. For example, to a child seven years 
 old, one hundred and thirty-three grains were given within 
 sixty hours.” He says, moreover, that “ in the only cases in 
 which this medicine has failed under the author’s direction 
 (being in the proportion of four out of fifty), no evacuation 
 through the bowels could be produced.” “ It is extremely 
 difficult,” remarks Professor Hamilton, “ to explain, in the 
 first place, the safety with which a hundred and thirty-three 
 grains of calomel could be given in this climate '(England) 
 within sixty hours to & child of seven years. Secondly, the 
 relief which has invariably followed the discharge of the 
 dark-green colored evacuations.” 
 
 Nowhere have I known or seen recorded such remarkable 
 success in the treatment of croup, nor the necessity so 
 strongly enforced of a pre-requisite to success of a con¬ 
 tinuance of the treatment until relief follows, or until there 
 appears those free evacuations of the stools just described. 
 
GG 
 
 I and told that scruple doses, and larger, are common in Kew 
 York among the best practitioners, who treat croup success¬ 
 fully, although no published allusions are made to such treat¬ 
 ment, owing to the prejudice against large doses of calomel, 
 both within and without the profession. 
 
 The administration of heroic doses of this mineral under 
 suitable cases and stages of disease reoeived a revival in the 
 example and endorsement of the illustrious James Johnson. 
 He contracted a violent attack of dysentery while hunting 
 on the banks of the Ganges. His medical attendants put 
 him upon the usual treatment of small doses of calomel, 
 combined with opium, together with mercurial inunction. 
 This was continued for two days, but he constantly grew 
 worse and worse. He says, in his own graphic account, that 
 at this stage : “ The Surgeon endeavored to cheer me, with 
 the hope of ptyalism, which, he assured me would alleviate 
 my sufferings. I then had no local experience in the com¬ 
 plaint myself. As the night advanced, all the symptoms 
 became aggravated, and I was convinced that a fatal termi¬ 
 nation must ensue unless a speedy relief could be procured. 
 I had no other hope but on ptyalism, for my medical friend 
 held out no other prospect. I sent for my assistant, and 
 desired him to give me a scruple of calomel, which I instantly 
 swallowed, and found that it produced no additional uneasi¬ 
 ness ; on the contrary, I fancied it rather lulled the tormina. 
 But my sufferings were great—my debility was increasing 
 rapidly, and I quite despaired of recovery ! Indeed I looked 
 forward with impatience to a final release! At four o’clock 
 in the morning I repeated the dose of calomel, and at eight 
 o’clock (or between sixty and seventy hours from the attack) 
 I fell, for the first time, into a sound and refreshing sleep, 
 which lasted till near midnight, when I awoke. It was some 
 minutes before I could bring myself to a perfect recollection 
 of my situation prior to this repose ; hut I feared it was still 
 a dream, for I felt no pain whatever ! My skin was covered 
 with a warm moisture, and I lay £or some considerable time 
 without moving a voluntary muscle, doubtful whether my 
 feelings and senses did not deceive me. I now felt an 
 uneasiness in my bowels and a call to stool. Alas, thought 
 I, my miseries are not yet over. I wrapped myself up to 
 prevent a chill, and was most agreeably surprised to find 7 
 that with little or no griping, 1 passed a copious, feculant 
 billious stool, succeeded by such agreeable sensations—acqui¬ 
 sition of strength, and elevation of spirits—that I ejaculated 
 aloud the most sincere and heartfelt tribute of gratitude to 
 Heaven for my deliverance.” 
 
67 
 
 I 
 
 In addition to the slower and alterative action of calomel 
 in minute doses, there seems to be a growing belief that 
 when given in larger and purgative doses it is attended with 
 very decided sedative powers. Dr. Learning and others claim 
 for it distinct sedative virtues, and the power to produce a 
 profound and favorable impression through the sympathetic 
 system of nerves upon those violent forms of disease common 
 to Southern localities. But whether it acts mostly through ab¬ 
 sorption into th^e blood, or in no small degree, according to the 
 theory of the reflex action enunciated by Marshall Hall, and 
 which, through the investigations of Brown Sequard and 
 others, have solved many intricate physiological and patho¬ 
 logical problems, as many are assured, it cannot be denied, 
 that, whether given in smaller or larger doses, as existing 
 indications and changing circumstances should always 
 decide, its use is indispensable in the treatment of a large 
 number of the prevailing congestions, inflammations and 
 other affections of this latitude. 
 
 Finally, in relation to the modern treatment of fever and 
 inflammation, I have yet to learn of a single advocate of the 
 depletory system who denies the influence of the conservative 
 powers of nature in disease, or rejects the judicious adminis¬ 
 tration of food and brandy. No considerate physician has 
 ever denied that, when high fevers have been removed and 
 inflammatory action subdued and other indications are 
 favorable to alimentation, or when the system is much re¬ 
 duced either by acute affections, or slow, lingering diseases, 
 suitable food and stimulation is not only proper but neces¬ 
 sary. But that food and stimulants, except in limited 
 quantities, are contra-indicated under opposite states and 
 conditions, is a fact sustained by the general voice of the 
 profession in this country and in Europe. The sensible 
 physician never opposes, but always seeks, the aid of nature; 
 the expectant system has its comparative value, and its 
 remedies are sometimes appropriate and sufficient; and ali¬ 
 mentation and stimulation have their subordinate and proper 
 positions in the catalogue of remedial agents ; but singly , or 
 in any combination , such influences and agents, when 
 brought to bear upon concentrated malaria, or directed 
 against the higher grade of our congestive fevers and 
 inflammations, are nothing more than mere “ medita¬ 
 tions upon death.” The disciples of a judicious antiphlo¬ 
 gistic treatment are among the foremost in recognition of 
 the influences named; they are ever ready and anxious 
 to consult with nature, and to admit its full power in 
 I 
 
68 
 
 the class of self-limited diseases, and that under this self- 
 limitation numerous cases will progress to recovery without 
 medication. But all this is no evidence that, even in self¬ 
 limited diseases, judicious treatment is not indicated—not 
 alone to cut short, modify, and control disease, but also to 
 prevent unnecessary complications, and sometimes to save life. 
 
 If the medical profession has no higher functions to per¬ 
 form than a mere skilful manipulation of the Liquor 
 Distillery, as some have doubtless concluded who have read 
 Dr. Norcoufs address, it is a mere mockery to the community, 
 and our science, instead of being humane and noble, as we 
 have claimed it to be, is worthy of no higher devotion than 
 such as the cook and distiller can bestow. If the views we 
 have honestly sought to combat are correct, better, much 
 better, would it be to disorganize all our medical organiza¬ 
 tions, break up our Medical Schools and Universities, and 
 burn up our Medical Journals and Books. And then, in 
 penitential sorrow for the offences of our past professional 
 devotion, to come forward, in a spirit of humiliation and 
 mortification, to admit, that the advancement of medicine 
 and the reputed glories of our profession are eclipsed by the 
 triumphs of the kitchen and the achievements of the distil¬ 
 leries and drinking saloons. 
 
 While, with good feelings towards Dr. Norcoin, I am 
 pleased to admire the ingenuity and ability of his Address, 
 yet, I am induced to offer these opposing views and ai- 
 guments from a sincere conviction that his doctrines are not 
 in accDrdance with the teachings of medical truth, and of 
 true medical progress; that they tend to throw discredit 
 upon this Society, and upon the experienced practitioners of 
 the State; that their tendencies are to bring the art and sci¬ 
 ence of medicine into contempt with the ignorant and vul¬ 
 gar; and are pernicious in their influences upon the minds 
 of the younger men of the profession. 
 
 He only is a true medical philosopher who alike interprets 
 wisely the instructions of Nature and the indications of dis¬ 
 ease, and then pursues with patience and firmness the path¬ 
 way illumined by their radiant beams. Let him shun equally 
 the dogmas of those extremists in medicine whose enthu¬ 
 siasm or prejudices are so liable to lead them from the true 
 paths of legitimate practice. Pursuing the even tenor of 
 his way, seeking only for truth, let him reject no doctrine be¬ 
 cause it is old, nor adopt any theory because it is arrayed in 
 the captivating charms of novelty. Such a course may be 
 slow to secure public attention and patronage, and may" not 
 
< 
 
 strike the admiration of the fickle multitude ; but in the 
 end it will secure that kind of permanent success which no 
 sneaking detraction or envenomed envy can shake, and which 
 the superficial and wily medical demagogue never attains. 
 His name will be enrolled high upon the list of noble and 
 faithful physicians, and will go down as a rich and proud in¬ 
 heritance to his children and family. Such a conservative 
 course, always to be united surely with personal integrity 
 and honor, may not satisfy the ambitious aims of those who 
 are not content with the gradual advancement of themselves, 
 and the sure progress of a well-settled science. It may not 
 serve to calm the restlessness of those who are ever on the 
 alert, either to weave new theories themselves, or to adopt 
 the new-fangled doctrines of others—sometimes for lack of 
 judgment, but too often from a love of gain and notoriety. 
 13ut, founded upon the rock of principle rather than expedi¬ 
 ency, he who takes this rough but alluring pathway, and 
 pursues it with honesty and persistent industry, will surely 
 reach that higher and more enduring basis of prosperity and 
 renown that are the rewards of a high course, and which 
 constitute the true ends of effort and the noble objects of 
 life. These transcendental extremists may not do as much 
 injury to society and medical science as those cunning, un¬ 
 dermining, despicable, medical demagogues in our own regu¬ 
 lar ranks, who, under the authority of an ill-gotten diploma, 
 smear their filthy slime on their daily ways of humbuggery 
 and evil. Their motives are superior to those of these pests 
 of the profession; but, whatever their purposes, they do more 
 - real harm to science and the profession than those irregulars 
 who come out openly against us, and boldly pitch their tents 
 outside the garrison of Legitimate Medicine.